Chiropractic popping, also known as spinal manipulation or adjustment, is a common technique used by chiropractors to treat misalignments in the spine called subluxations. During an adjustment, the chiropractor applies a controlled force to a spinal joint that goes slightly beyond the normal range of motion. This causes the joint to “pop” or crack. While many patients report feeling immediate relief after popping sounds, there is ongoing debate about whether this technique truly brings health benefits or poses risks.
What causes the popping sound during a chiropractic adjustment?
The signature pop or crack comes from a process called cavitation. Cavitation occurs when the pressure and speed applied to the joint exceeds a certain threshold, causing dissolved gasses in the synovial fluid to form tiny bubbles. These bubbles then rapidly collapse, resulting in the audible cracking sound.
It was previously theorized that the popping noise came from bones at the joint actually moving out of place, but extensive research has disproven this idea. Imaging studies show the bones stay in proper alignment and do not dislocate during cavitation. The only thing popping in and out is the formation and collapse of gas bubbles.
Does chiropractic adjustment align the spine?
Chiropractors perform adjustments with the goal of realigning joints in the spine or other areas of the body. They believe minor misalignments or subluxations interfere with proper nervous system functioning and cause a variety of health problems. By applying a directed force, they aim to move the joint back into its ideal position to restore proper motion and nerve communication.
However, according to scientific reviews, there is no reliable evidence that chiropractic manipulation can actually move bones into place. One reason is that the amount of force applied during the adjustment is very small compared to the total strength of the surrounding ligaments and muscles. So even if the joint is “out of position,” a chiropractor is unlikely to push it back by popping it.
Can chiropractic popping relieve back pain?
There is some evidence spinal manipulation may bring short term relief for lower back pain. Potential explanations include:
- The popping stretches joint structures, improving mobility.
- It loosens the facets joints to reduce stiffness.
- It stimulates receptors in the joint capsule, helping override pain signals.
A 2010 review found spinal manipulation moderately improved acute low back pain. The effects were similar to other therapies like heat, massage, or medications. But no evidence shows longer term benefits of ongoing chiropractic care.
Effectiveness for other types of pain
Studies suggest spinal manipulation does not relieve neck pain or headache symptoms any better than gentle massage. There’s also insufficient evidence it helps with middle back pain, pregnancy-related pain, or pain from osteoarthritis.
Are there risks associated with popping joints?
Potential risks of joint popping include:
- Increased soreness: Some patients experience muscle soreness or stiffness after an intense session of cracks and pops.
- Joint injury: Forceful thrusts could over-stretch ligaments or strain muscles surrounding the joint.
- Vertebrobasilar stroke: There are reported cases of stroke occurring after forceful neck manipulation, likely due to damage to arteries supplying the brain.
- Disc herniation: A small percentage of patients develop herniated discs, either when getting adjusted or soon after.
These serious complications seem to be very rare, estimated at 1 in 40,000 to 2 million neck adjustments. Mild soreness and stiffness are far more common.
Risk factors
The following factors likely increase risk:
- Underlying conditions like arthritis or bone weakening
- Genetic factors like Ehlers-Danlos syndrome
- Past neck or spine injury
- Recent trauma or accident
- Advanced age
- Forceful, sudden, or uncontrollable manipulations
When should you avoid chiropractic popping?
Spinal manipulation is not recommended for certain patients, including:
- People with bleeding disorders, taking blood thinners, or with low platelets – due to stroke risk
- Those with weakened bones from osteoporosis, cancer, or long-term steroid use
- Patients with arthritis or joint instability
- Individuals with heart conditions, as force could dislodge blood clots
- People with disc herniation or spinal cord compression
- Those with previous stroke or vertebrobasiliar insufficiency
- Patients with signs of nerve damage like numbness or weakness
Pregnant women should use caution with spinal adjustments and avoid abdominal thrusts.
What’s the takeaway on chiropractic popping and cracking?
Here are some key points to consider about the risks and benefits of chiropractic joint popping:
- It provides immediate relief for some back pain sufferers, but has not been proven effective for long term pain management.
- There is insufficient evidence it can realign the spine or has widespread health benefits.
- It appears relatively safe when performed by a licensed professional, but does carry some rare risks.
- Forces should not be overly forceful or uncontrolled.
- Patients with underlying conditions should use caution or avoid it altogether.
- More high quality research is still needed on its true efficacy and safety.
In general, chiropractic adjustment may be helpful for temporary back pain relief when used selectively in otherwise healthy individuals. Patients should share their full medical history to allow practitioners to properly evaluate if they are good candidates. Those considering manipulation should weigh potential benefits against rare but serious risks before consenting to popping techniques.
Conclusion
The characteristic popping sound of a chiropractic spinal adjustment comes from cavitation – the formation and collapse of gas bubbles in the joint. While this technique may provide some immediate relief from back pain, current evidence does not support claims it realigns the spine. Potential benefits must be carefully weighed against rare but serious vascular and neurological risks, especially in vulnerable patients. Patients with underlying conditions or who are concerned about risks may prefer to avoid chiropractic cracking altogether and opt for safer methods of pain relief.
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References
- Schneider, M., et al. “Spinal manipulation therapy: is it all about the brain?” The spine journal : official journal of the North American Spine Society 5.6 (2005): 608-13 .
- Herzog, W. “The biomechanics of spinal manipulation.” Journal of bodywork and movement therapies 14.3 (2010): 280-286.
- Paanalahti, Kristiina, et al. “Spinal manipulative therapy and fibromyalgia: a systematic review and meta-analysis.” BMC musculoskeletal disorders 15.1 (2014): 1-18.
- Church, Ellen W., et al. “Systematic review and meta-analysis of chiropractic care and cervical artery dissection: no evidence for causation.” Cureus 8.2 (2016).
- Vincent, Kathryn, et al. “The chiropractic profession.” Advances in Integrative Medicine. Elsevier, 2014. 129-145.