Manipulation is a passive technique in which the therapist applies a targeted manual impulse or thrust to a particular joint and the associated soft tissues. The aim is to restore lost movement and to relieve pain. It is usually done when the patient is fully relaxed.
This technique usually takes the joint further than its physiological range, but only momentarily. Accurately locating the joint’s position before the procedure, followed by a skilfully executed thrust, results in a very fast movement that is over even before the patient knows it has started.
The procedure is used when a joint fails to become fully mobile after mobilization. While it is mainly used in the treatment of spinal conditions, manipulation may also be recommended for shoulder or sacroiliac joints, as well as the small joints of the hands and feet.
A common feature of manipulation is the audible “click”, “crack” or “pop” sound. The cause is not fully known, but is widely accepted to be as a result of cavitations in the synovial fluid of that joint. Whilst it may sound alarming, there is no cause for concern!
During manipulation, the applied force causes the separation of the articular surfaces of the joint, creating a reduction in pressure within the cavity. As a result of the lower pressure some of the gases in the synovial fluid escape, resulting in a bubble. When the pressure rises again the bubble collapses on itself, making a “cracking” sound. Carbon dioxide is thought to be the main component of this gas bubble.
The effects of this process persist for a period of time, ranging from a few minutes to an hour or more as the carbon dioxide is slowly reabsorbed back into the joint fluid.
Good assessment is key in joint manipulation
When do we use manipulation/manipulative therapy?
Manipulation is indicated for pain and dysfunctions of musculoskeletal origin, be it longstanding or pain that started in the recent past, occurring in vertebral and peripheral joints.
While manipulation is not the solution for every problem of a mechanical origin, it has many benefits. The therapist knows that fast assessment and accurately identifying the location will speed up the healing that would eventually happen naturally.
At Lewis Morgan Physio, our physiotherapists are always updating themselves with new techniques in manipulation, as well as mentoring other physios in joint manipulation. Talk to us today and let us help you.
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