There are many different types of chiropractic adjustment styles. Examples include manual hands-on, flexion-distraction, drop tables, and instrument-assisted. While some adjustments produce an audible “pop” or “crack,” others do not.
Have you ever wondered about the significance of the “popping” sound that often accompanies chiropractic adjustments? Several research studies have explored the distinction between adjustments that produce a cracking sound and those that don’t. The findings reveal that the popping sound itself holds no bearing on the outcomes of the adjustment. Whether an adjustment produces a pop or not, there is no difference in terms of immediate, short-term, or long-term pain relief. Furthermore, improvements in disability and range of motion were found to be consistent across different types of adjustments. The table below summarizes the research studies.
Research Shows No Significant Difference Between Adjustments That Produce a Pop and Those That Don’t.
| Different forms of adjusting did not lead to different outcomes in older low back pain patients. 1 |
| No differences in pain or disability between groups were found for thrust manipulation versus non-thrust.2 |
| There is no relationship between the number of audible pops during thoracic spine thrust manipulation and improvements in pain, disability, or range of motion. Additionally, a greater number of audible pops experienced was not associated with a dramatic improvement. 3 |
| A perceived audible pop may not relate to improved outcomes for patients with low back pain at either an immediate or longer-term follow-up. 4 |
| There is no relationship between an audible pop and improvement in range of motion, pain, or disability in individuals with low back pain. Additionally, the occurrence of a pop did not improve the odds of a dramatic improvement. 5 |
| Currently there is little scientific evidence to support any therapeutic benefit derived from the audible pop and in fact, it appears the available evidence tends to refute many of the alleged beneficial effects. 6 |
It’s worth noting that the characteristic “popping” sound isn’t the result of joints snapping back into place. Rather, the sound originates from the rapid release of healthy gases within the joint during certain types of manual hands-on adjustments. However, there are chiropractic techniques designed to restore joint motion without generating a popping sound. Examples include flexion-distraction, drop tables, and instrument-assisted approaches. I have always used low-force adjustments because they are easy on me and the patient.
Exploring the Benefits of Low-Force Adjustments
1. Gentleness and Reduced Pain: One of the key advantages of low-force adjustments is their gentle nature, often resulting in less discomfort compared to more forceful techniques. The reduced intensity makes them a viable option for individuals who might be hesitant to undergo traditional manual adjustments.
2. Tolerated Well By All Ages: Some people can not tolerate the force used in manual adjustments. As we age the spine becomes arthritic which can make cracking style adjustments uncomfortable.
3. Precision and Consistency: Instruments used in low-force adjustments offer a consistent thrust and speed with each application. In contrast, chiropractors performing manual adjustments may experience fatigue throughout the day, affecting the precision of their adjustments. Low-force methods help maintain uniformity and accuracy.
4. Enhanced Patient Relaxation: Some individuals find it challenging to relax during the cracking style neck adjustments that involve twisting of their head. Low-force techniques, such as flexion-distraction, drop tables, and instruments, eliminate this concern. Most of these methods do not require neck twisting, promoting a more relaxed and comfortable experience for patients.
The world of chiropractic adjustments encompasses diverse styles, yet all aim to restore proper joint function and reduce pain and disability. The audible popping sound during adjustments is not an indicator of success, as studies show that both popping and non-popping adjustments yield similar outcomes. Low-force techniques, on the other hand, present a range of benefits including reduced pain, suitability for various patients, and enhanced precision.
- 1. A randomized controlled trial comparing 2 types of spinal manipulation and minimal conservative medical care for adults 55 years and older with subacute or chronic low back pain. J Manipulative Physiol Ther. 2009 Jun;32(5):330-43. doi: 10.1016/j.jmpt.2009.04.012.
- 2. No Differences in Outcomes in People with Low Back Pain Who Met the Clinical Prediction Rule for Lumbar Spine Manipulation When a Pragmatic Non-thrust Manipulation Was Used as the Comparator. Physiother Can. 2014 Fall;66(4):359-66. doi: 10.3138/ptc.2013-49.
- 3. The audible pop from thoracic spine thrust manipulation and its relation to short-term outcomes in patients with neck pain. J Man Manip Ther. 2007;15(3):143-54.
- 4. The audible pop from high-velocity thrust manipulation and outcome in individuals with low back pain. J Manipulative Physiol Ther. 2006 Jan;29(1):40-5
- 5. The audible pop is not necessary for successful spinal high-velocity thrust manipulation in individuals with low back pain. Arch Phys Med Rehabil. 2003 Jul;84(7):1057-60.
- 6. THE THERAPEUTIC BENEFIT OF THE AUDIBLE RELEASE ASSOCIATED WITH SPINAL MANIPULATIVE THERAPY. A Critical Review of the Literature. Australas Chiropr Osteopathy.1998 Jul; 7(2): 80–85.
- 7. Chiroup