Popping or clicking a joint: what is a manipulation?

Now is very normal to get a little worried about sounds in your neck, and too right, it holds up the most important part of the body. In reality, it would be extremely hard to cause any damage to the bodyguard in this example. Below may give you some insight into what these noises are and what they mean.

Popping

Joints within the body are lubricated by a liquid called synovial fluid which helps prevent wear and tear of the articular surface. Like oil in a gear cog. When the space between the two bones increases this causes gasses (that are present in the synovial fluid, which is naturally found in all bodily fluids) to collect together to form a bubble, or cavity, which rapidly ‘pops or collapses’ upon itself, resulting in a “popping” sound. 

This gas bubble dissolves back into the synovial fluid after 15-20 minutes or so. Hence why you can’t perform a manipulation or adjustment of the joint to get another pop in this time. This is important when trying to diagnosis what nature of the audible ‘grinding’ ‘popping’ or ‘snapping’ sound.

As a practitioner who specializes in the treatment of spinal disorders, a question that commonly comes up with our patients is whether or not the audible noises noted with movements of the neck are normal.  While there may be many reasons why someone might experience noises in their neck or cervical spine, the three main causes are Pop (mentioned above), Snap, and Crackle.

Snapping

For example, if you googled the anatomy of the neck you will see 7 individual vertebrae, each with various bony prominences that serve as anchor points for a number of tendons and ligaments to attach on. Tendons connect muscles that move the neck, while ligaments connect bone to bone, which gives the neck its stability. 

As you move your neck, the tendons and ligaments may rub over these bony prominences, resulting in a snapping sound. This is a normal process, and should not result in any pain. This snapping sensation, while a result of a ligament or tendon rubbing, can still cause neck or shoulder pain. With repetition, the snapping will eventually get better as the neck tendons and ligaments loosen and settle into their ideal position if settled properly.

Grinding

Just like our ankle, knees, hips, and shoulders, the neck is subjected to the same type of degeneration or ‘wear and tear’ that happens in our body naturally as we age. In time our joints begin to lose the lubrication and cartilage which protects them from everyday use. In the neck, for example, we have a number of joints between each of the seven cervical vertebrae. The joints are often referred to as “facet joints”.

When we move our head and neck, the facet joints glide and slide over one another. As the lubrication begins to wear away and decrease over time, the surfaces of the facets can rub or grind over each other. The movement often is associated with a crackling or grinding sensation. While the noise or sensation can be unsettling, as long as there is no pain associated with the grinding, then it should be no cause for significant concern.

With reference to the above, if you can perform the same movement over and over with the spine or joint and create the same sensation and sound then it’s more likely the snapping or grinding examples. 

If you hear a pop then perform the same movement straight after and can’t reproduce the sound then it’s more likely the ‘popping’ example above. But this is just a ‘rule of thumb’ or rough diagnosis.

What is spinal manipulation, or an ‘adjustment’ from a health care practitioner?

Spinal manipulation, or an ‘adjustment’, is a form of treatment technique to bring about the release of pressure within the joint as explained above under ‘Popping’. Practitioners use techniques with a ‘high velocity & ‘low amplitude’ (HVLA) to achieve cavitation (release) within the joint. 

This angle of joint movement is performed in the most suitable direction specific to the joint in question, to achieve this goal, but also at the lowest risk of irritation to the joint surfaces. This is why practitioners have extensive knowledge of anatomy and years of training. 

The aim is to: 

• Increased range of motion
• Reduce pain
• Decentralized the nervous system around the joint (calm the surrounding nerves) 
• Increase vitality to the joint (lubrication, blood flow, and natural position)

Do I need to be worried?

Some people have reservations about spinal manipulation as they’re afraid that the noise is coming from their bones. This is far from the truth. While it is thought that the force needed to ‘crack or pop’’ a joint is typically great enough to damage a hard surface, such as bone, research has shown that manipulation has no long-term negative health effects.

The manipulations or adjustments may be uncomfortable, especially if you stretch yourself too far or if you’re not used to the feeling of the technique. But you shouldn’t feel intense, sharp, or unbearable pain.

Here are some possible risks of adjusting your own back incorrectly:

• Manipulating or ‘popping’ your own back too fast or forcefully can pinch nerves near your spinal column. A pinched nerve can be very painful. Some pinched nerves can stay pinched and reduce your mobility until you have them examined and treated by a professional.

• Manipulating or ‘popping’ your own back forcefully can also strain or tear muscles in and around your back and deep spine, including your neck muscles near the top of the spine and your hip muscles near the bottom. Strained muscles can be painful or difficult to move, and severe muscle injuries may require surgery or other interventions.

• Manipulating or ‘popping’ your own back too hard or too much can injure blood vessels. This may be dangerous because many important vessels run up and down your back, many of which connect to your brain. One possible complication is blood clotting, which can cause strokes, aneurysms, or other brain complications.

• Manipulating or ‘popping’ your own back frequently over time can stretch your deep back ligaments. This permanent stretching is called perpetual instability. This can increase your risk of getting osteoarthritis as you get older.  Reminder – if you are worried about anything, just reach out to us at Inline Osteo for a chat. 

What does this all mean?

Noises associated with snapping and crackling in the neck are normal. What I suggest to my patients is to monitor the noises as they happen and what position your body is in when you hear it.

Manipulation is an effective treatment tool when paired with other techniques such as articulation and muscle work, but the most important change is of the external aggravating factors to which will bring the joint or segments back into dysfunction. Without fixing the root cause, the joint will find itself in dysfunction (stuck) again. 

For examples of why the joint may get into dysfunction or keep going back to its ‘bad self’ then check out ‘Why manual treatment may not work’ (Blog) for more answers.

Practitioners are trained for years and have protocols and clinical tests to make manipulations safe for you, so you get the amazing benefit it holds. If you are unsure or worried then have an honest talk with your practitioner, and remember you can always say no. There are lots of different ways to treat the body, so you will not be missing out entirely.

If you have any further questions about the topics covered above or any other questions on how Osteopathy can help you, then please do not hesitate to reach out. 

Our Osteopathic clinic, Inline Osteo, is situated on the North Shore in Auckland. A list below are the areas we serve:

• Albany
• Rosedale
• Glenfield
• Browns Bay
• Takapuna
• Milford
• Wairau Valley
• Mairangi Bay