What the Pop?!
Have you ever heard the words: manipulation, adjustment, realignment, “pop or crack your back?”
These are terms associated with a hands-on technique called a “manipulation,” where a provider performs a quick stretch to a body part (often the neck or back); and that quick stretch may result in a “pop” or “crack” that you can hear or feel. There can be a lot of confusion surrounding these techniques, who provides them, and what is happening when they’re performed. Keep reading to learn more about how physical therapists utilize this tool to help fight neck pain, back pain, and more!
Why the Confusion?
When discussing the term manipulation or “getting your back cracked,” different things come to mind for different people. Some people love the sensation of getting their back popped or cracking their knuckles or neck. Some people fear the pop and think of bad things happening on the inside. Some people believe an adjustment is needed to realign parts of their spine or body that are “out of place.” Some people believe that you should avoid manipulations all together.
So, what the heck is happening during a manipulation, who should you believe, and why should you believe them?
What is Really Happening?
I want you to know that a manipulation is an awesome technique that produces a neurophysiological effect (aka: it changes the output of the nerves in your body – which often results in reduced pain)…regardless of whether you hear a “pop” or “crack.” This description is one of the most accurate explanations we currently have to explain what is happening during manipulations and other manual therapy (hands-on) techniques. But you still may be confused about what a “neurophysiological effect” is and how it can be a good thing…so I’ll give you an example:
Let’s pretend you have nagging low back pain. The pain doesn’t go down your leg, but your back hurts when you bend forward, lift, and twist. In this situation, your nerves are firing a lot more than normal to alert you that you need to take care of something in your back! We can compare this situation in your body to a frozen computer – or a computer that isn’t firing like normal. When your computer is frozen or not working right, it is helpful to press the CTRL+ALT+DELETE buttons and just start fresh. A spinal manipulation of the lower back in this example works similarly and can reset the nerves in your body like pressing the CTRL+ALT+DELETE buttons on that computer. The result of this “reset” to the nerves is bending, lifting, and twisting with less pain! That is why you may feel A TON better almost immediately after receiving this treatment.
A manipulation does not realign the body: The human body is resilient. Unless we are in a traumatic accident, our bones and joints stay where they should be and people do not get “out of alignment.” Most often, the pop that people feel and hear during a manipulation is pressure releasing inside the joint, not things shifting back into place.
Who Can You Trust and Believe?
Traditionally, people don’t think of physical therapists when they hear the word manipulation, but did you know that physical therapists have the expertise to perform manipulations on all areas of the body? The explanation of what is happening during a manipulation is equally important to the expertise that accompanies being able to provide this technique. It is important that someone provides you with the explanation of “resetting the nerves in the body,” not something about realigning parts of your body. Being provided with an honest explanation for a manipulation is the first clue into who you can trust. The second way to help you know who you can trust with providing this treatment is someone who follows it up with exercise and things to work on at home that provide continued benefit.
These are the key things to look for in a provider who you can trust to deliver a manipulation or other hands-on techniques…someone who:
Takes a thorough history of your pain and past medical history prior to starting a physical exam.
Looks at how you move, checks baseline range of motion and strength, and investigates to get to the root-cause of your pain prior to determining what would be the best treatment.
Asks you for your opinion on manipulation prior to performing that treatment…because if you don’t want to receive that treatment in the first place, they should not be performing it!
Provides a clear explanation of why manipulations are helpful in reducing pain (helps reset the nervous system), but also explains that it is a short-term fix.
Does not make you feel like you will need consistent manipulations to “stay aligned” for the rest of your life.
Combines hands-on treatment with exercise and strengthening to help you prevent the same pain from returning in the future!
Manipulations are helpful to reduce pain, but taking control of your pain does not stop here. Hands-on techniques should always be followed up with exercise and strengthening. This is the BEST way to get rid of pain and stay out of pain.
