The Health Benefits of Joint Manipulation

How hands-on manual therapy provides all-over pain relief

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Joint manipulation is a manual therapy that involves applying force to your spinal or peripheral joints to help them move better. The goal of joint manipulation therapy is to lessen pain and improve range of motion.

Physical therapists (PTs) and chiropractors may use this technique to help you move and feel better after an injury or illness that causes loss of functional mobility.

This article will explain joint manipulation and how it's applied, as well as provide insight into whether the technique is safe for you.

Potential Benefits of Joint Manipulation - VWH illustration by Joules Garcia

Verywell / Joules Garcia

Why Do Joints Pop?

The joints in your body are places where two bones come together and articulate. On the ends of each bone in a joint is a smooth lining of hyaline cartilage. This cartilage allows the joint surfaces to glide and slide smoothly past one another. If the cartilage is impaired, pain and limited motion may occur.

Often when a joint isn't moving properly, the muscles surrounding that joint become inhibited. This means that those muscles don't contract properly. Suppose a joint in your body is dysfunctional for quite some time. In that case, significant muscle wasting and atrophy may occur around the joint, leading to difficulty with functional mobility like walking or reaching overhead.

Where Does the Pop Come From?

Your body is made up of cells. These cells "respirate" by converting energy and releasing waste materials. One such waste material from cellular respiration is carbon dioxide gas. Normally, this gas is transported to your blood and delivered out of the body while breathing.

Sometimes, small pockets of gas become trapped in your joints. These pockets of gas expand and contract as pressure around the joint changes with movement. This expansion and contraction is known as cavitation. When that gas is suddenly released from a joint through manual joint manipulation, the joint will pop.

When joints pop, you'll likely hear a loud snapping sound as you move the joint. Once the gas is released, you may feel decreased pressure in your joint and increased mobility around it.

Is Joint Popping Normal?

Popping joints is a normal physiological process and should be painless.

There are other times when a joint may pop, such as when joint dysfunction or derangement is present. This means joint surfaces are simply in a bad or non-anatomical position, leading to pain and loss of motion. The joint may pop when it's moved into its normal anatomical position.

Joint derangement may occur for a variety of reasons.

Non-Medical Causes

There are several non-medical causes of joint derangement and dysfunction that may lead to popping. These include:

In all of these situations, your joints may be temporarily placed in a dysfunctional position. When moving to the correct anatomical position, a popping sound may occur as built-up pressure in the joint is released. Popping may also occur as the joint surfaces slide past one another on their way to the optimal position.

Medical Causes

In some cases, joint popping may occur due to a medical condition. These include but aren't limited to:

In all of these cases, a medical problem is occurring that may be causing a limitation in your joint's position and movement. Often as an injured or contracted joint moves, it makes a popping sound when the bony joint surfaces move past one another.

Popping may also occur when gaseous pressure is released from the joint during joint manipulation therapy.

Benefits of Joint Manipulation

If your healthcare practitioner determines that a joint is dysfunctional and not moving properly, they may choose to perform joint manipulation on your body. There are several benefits to joint manipulation:

  • Decreased pain: When a dysfunctional joint starts moving properly after a manipulation, pain receptors in the area are "reset" and pain may be decreased.
  • Improved muscle activation near the joint: After a deranged joint is manipulated into its anatomical position, muscles surrounding the joint can contract properly.
  • Improved range of motion: After joint manipulation, the surfaces of that joint are in a better position for movement. This may lead to improved freedom of movement and range of motion with less stiffness.
  • Improved functional mobility: Once a joint is manipulated, the improved range of motion and muscle activation around the joint can lead to improved overall functional mobility.

If you're having pain, loss of movement, or decreased mobility after an injury or surgery, then a chiropractic adjustment with joint manipulation may be beneficial.

However, joint manipulations and manual therapy aren't for everyone.

Who It Helps

Joint manipulation can be a helpful and safe manual therapy technique for certain people. This includes:

  • People with acute neck pain, back pain, or peripheral joint pain
  • Adults from age 25 to 65 with no significant medical conditions
  • Athletes who have been injured during their sport
  • People who have been immobilized after injury or surgery

If you are generally healthy and are experiencing loss of movement after an injury or surgery, then you may benefit from some form of manual therapy, including joint manipulations, to help you regain movement.

Who It Doesn't Help

Joint manipulation isn't for everyone. For some people, it may be dangerous or lead to injury. People with certain conditions should avoid joint manipulations. For instance:

  • Osteoporosis: Weakened bones may fracture if a high-velocity force is applied to a joint via manipulation
  • Joint fractures: If you have a fracture through your joint, that specific joint shouldn't be manipulated.
  • After spinal fusion surgery: If you've had a spinal fusion in your neck or lower back, you should avoid spinal joint manipulations or adjustments for at least one year after surgery. During this time, your bones are healing from the surgery. Manipulation may cause a failure of the fusion.
  • People with impaired judgment: During joint manipulations, you may need to give feedback to your chiropractor or PT. If your judgment is impaired due to emotional or mental health issues, this feedback may be limited, and an injury or increased pain may occur.
  • Those with arterial insufficiency in their neck: One rare but dangerous side effect of neck adjustments is the risk of tearing an artery in your neck called the vertebrobasilar artery. If there is a deficiency here, neck manipulation may cause a disruption here and lead to a stroke or death.

Talk to Your Healthcare Professional

The decision to have a joint manipulation is one that occurs between you and your trusted healthcare professional. They should provide you with information about the risks and expected benefits of such a procedure.

Joint Manipulation Techniques

When your chiropractor or PT applies joint manipulation to your body, specific techniques should be used. Manipulations, also known as chiropractic adjustments, are performed in a clinical office of a PT or chiropractor.

During the procedure, you should be relaxed. Most spinal manipulations occur with you lying on a table on your back or stomach. Some may be done in a seated position.

During the Procedure

After the therapist explains the procedure to be done, they'll gently take hold of your body. Then, with one hand stabilizing one side of a joint, a high-velocity thrusting force will be applied in a specific direction to the other side of a joint.

Often during a manipulation, a pop or snap will be heard and felt. This should be painless. After the manipulation, range of motion or strength and mobility should be checked to assess the effectiveness of the treatment. Several manipulations may be performed in one session.

Some chiropractors and PTs don't perform thrust manipulations but rather use joint mobilizations to gain range of motion for their patients. A mobilization is a manual therapy technique that's a bit gentler than a manipulation. Hand placement is about the same for these techniques, but the motions are slower, and the stretch through the affected joint is gentler when compared to manipulation.

If you have a severely contracted joint after surgery or a period of immobilization, then you may benefit from a manipulation under anesthesia (MUA). During this procedure, anesthesia will be used to sedate you, and an orthopedic surgeon will forcefully manipulate your contracted joint. This can be used to stretch out scar tissue around the joint after surgery. It may help you rapidly gain range of motion in the joint.

Where to Go

The best place to go for a spinal manipulation is your local chiropractor's office. You can find one by checking the website for the American Chiropractic Association. Be sure to call the chiropractor's office and ask if they perform joint manipulations for your specific condition.

A PT may also be able to provide manual therapy and joint manipulations. Some PTs aren't able to perform manipulations depending on the state in which they practice. Each state has a physical therapy practice act defining treatments that the PT is allowed to perform.

You can find a PT via the American Physical Therapy Association website. Be sure to ask your PT if they perform manipulations and if they would be helpful for your specific condition.

Cost of Joint Manipulation

Most joint manipulation techniques are covered by insurance. Check that your healthcare provider is in-network for your specific insurance before going in for treatment.

Most single joint manipulation techniques are billed at a rate of $30 to $50 per procedure. Paying out-of-pocket is often an option if your insurance doesn't cover the treatment.

A Word From Verywell

If you have back pain, neck pain, or pain in your shoulders, knees, ankles, or hips, you may benefit from a chiropractic adjustment or manipulation. Manual techniques like manipulation can help improve joint mobility, decrease pain, and increase strength and stability around your joints.

Joint manipulation isn't for everyone, so contact your local healthcare professional to see if it's safe for your specific condition. Joint manipulation may be what's needed to help you return to your previous level of activity.

Frequently Asked Questions

  • Is joint manipulation dangerous?

    Joint manipulation isn't dangerous as long it's performed correctly on the right patient. Cracking your knuckles, back cracking, or neck cracking isn't usually dangerous. There is some risk of worsening your condition with manual therapy. Also, if you have a bone-weakening disease, you may be at risk of fracture with manipulation. A serious risk of neck manipulation is stroke.

  • Who should try joint manipulations?

    Any person with a sudden onset of acute joint or spinal pain may benefit from a manipulation. Those who are generally healthy with few co-morbidities seem to benefit from joint manipulation.

  • Are there any physical therapist techniques you can try at home?

    One of the most important things you can do is learn self-care techniques. Manipulations and manual techniques are specialized, but a few things may be done at home for self-stretching and manipulation.

    If you have back pain, one stretch is the flexion and rotation procedure which may crack your back and provide relief. Be sure to check in with your PT or chiropractor before starting any stretches on your own.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.