What are manual adjustments and how do they work?

Chiropractic care is often associated with the classic ‘click’ or ‘pop,’ but the range of techniques available is far broader, offering personalised care for various patient needs. This fact sheet is designed to provide you with a comprehensive overview of the different methods a chiropractor uses to restore movement and function to your joints.

In this fact sheet, Dr. Simon Nash (Chiropractor) discusses manual adjustments, gentle mobilisations, and low-force techniques like the Activator method, explaining how they work to improve the biomechanical function of the body.

Please note: The information provided in this article is for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for a diagnosis and personalised treatment plan.

Table of Contents

• The Concept of Chiropractic Adjustments
• Manual Adjustments: The ‘Click’ and ‘Pop’
• Understanding the Cavitation Noise
• Gentle Mobilisation Techniques
• Low-Force Activator Method
• Restoring Biomechanical Function
• Frequently Asked Questions (FAQs)
• Book a Consult with Our Chiro Brisbane
• References
• Video Transcript

The Concept of Chiropractic Adjustments

The core principle of chiropractic care is to restore optimal biomechanical function to the joints of the body. When a joint is restricted or not moving correctly, it can lead to discomfort, stiffness, and potentially impact overall function. Chiropractic techniques are applied to improve this movement.

Dr. Nash highlights the popularity and recognition of the most well-known technique:

“Another treatment we do here… which chiropractic has in recent times become really famous for is adjustments or manual adjustments.”

These treatments are all about targeting a joint to encourage proper movement, which is essential for a healthy musculoskeletal system.

Manual Adjustments: The ‘Click’ and ‘Pop’

Manual adjustments, also known as High-Velocity, Low-Amplitude (HVLA) thrusts, involve the chiropractor using their hands to apply a quick, specific movement to a joint. This is the technique that often results in a characteristic audible sound.

“So that’s where you sometimes hear the clicking and popping or what we call a cavitation of a joint.” Dr. Nash states.

The primary goal of this technique is to quickly and effectively restore the range of motion in the joint, alleviate restrictions, and improve overall joint alignment. The success of the manual adjustment is judged not by the noise, but by the functional change it creates in the joint.

Understanding the Cavitation Noise

Many patients express concern about the sound that can accompany a manual adjustment. Dr. Nash clarifies the nature of this noise, reassuring patients that it is a normal and harmless physical phenomenon.

“That noise doesn’t hurt. It’s not bone breaking. It’s just movement in and around the joint capsule.” he says.

This sound, called a cavitation, is simply the release of gas bubbles (primarily nitrogen, carbon dioxide, and oxygen) from the synovial fluid—the lubricating fluid within the joint capsule—when the pressure changes rapidly.

Dr. Nash notes. “It’s a simple movement of gas within the joint capsule. And basically like when you do this with your hands and then move it quickly that creates a little pop and that’s all that is.”

Understanding that this is a benign gas release, and not a physical break or damage, is key to easing any patient apprehension about the technique.

Gentle Mobilisation Techniques

Not all joints require a rapid manual adjustment, and not all patients prefer it. For those who need a gentler approach, or who have specific health concerns, mobilisation is a highly effective alternative.

“Other ways to move and mobilise joints is using what they call mobilisation. So we’d be specifically contacting certain joints whether it be the wrist or whether it be the neck and doing slower movements with that.”

Mobilisation techniques involve the chiropractor applying slower, more sustained, and repetitive movements to the joint. This Low-Velocity, Low-Amplitude (LVLA) approach is designed to gradually increase the joint’s range of motion and flexibility without the rapid thrust.

“That’s for people that either have different medical conditions or just don’t prefer to have that cracking happening. We can do that. That’s more of a lower force technique.”

This ensures that effective care can be delivered to every patient, tailored to their comfort level and clinical need. You can explore our dedication to tailored care and treatments on our website. Take a look at our manual adjustment service or learn more about muscle release.

Low-Force Activator Method

For some patients, even the slow pressure of mobilisation is too much, or a highly specific, low-force adjustment is necessary. This is where the Activator Method comes into play.

“And then for people that require even lower force, for example, we would use a little machine or a little handheld device called an activator. And that creates a really small little force specifically through the joints.”

The Activator Adjusting Instrument is a spring-loaded tool that delivers a high-speed, low-force impulse. This technique is gentle because the impulse is delivered so quickly that the body’s muscles do not have time to tense up and resist the adjustment, allowing for a precise and comfortable treatment.

A systematic review determined that the Activator Adjusting Instrument provides comparable clinically meaningful benefits to patients with spinal pain and certain musculoskeletal disorders when compared with high-velocity, low-amplitude (HVLA) manual manipulation. Although these results suggest the instrument-assisted technique is an effective alternative to manual adjustments, the review cautioned that the underlying clinical trials suffered from methodological limitations (Huggins et al., 2012).

Restoring Biomechanical Function

Regardless of the technique used—manual adjustment, gentle mobilisation, or the low-force Activator—the ultimate goal remains the same: to restore the optimal movement and health of the joint.

“And none of them should hurt and they’re all very very effective in mobilising and restoring biomechanical function to your joints.”

Chiropractic care is about selecting the right tool for the right patient, ensuring the experience is both comfortable and effective. Restoring this biomechanical function is crucial for alleviating discomfort, improving posture, and promoting long-term spinal health. In fact, active spinal manipulation has been shown to be effective in providing pain relief and improving function in patients with mechanical issues (Santilli et al., 2006).

For those with mobility issues or specific joint restrictions, we offer targeted chiropractic adjustments to address these issues.

Frequently Asked Questions (FAQs)

Q1: What exactly causes the ‘popping’ sound during a manual adjustment? A: The sound, called a ‘cavitation,’ is simply the release of gas (nitrogen, oxygen, and carbon dioxide) from the joint capsule fluid when the pressure is quickly changed, similar to cracking your knuckles. It does not indicate that bones are breaking.

Q2: Will a chiropractic adjustment hurt? A: A proper chiropractic adjustment, whether manual or low-force, should not be painful. You may feel a sensation of pressure or movement, but Dr. Nash assures that “none of them should hurt.” Your chiropractor will select a technique that is appropriate and comfortable for you.

Q3: What is the main difference between an adjustment and mobilisation? A: An adjustment (manual) is a quick, controlled thrust (high-velocity, low-amplitude) aimed at restoring motion, often resulting in a ‘pop.’ Mobilisation is a slower, gentler, and repetitive movement (low-velocity) used to gradually increase joint flexibility without a thrust.

Q4: Is the low-force Activator Method as effective as a manual adjustment? A: Yes, clinical studies suggest the Activator Method provides comparable clinical benefits to manual adjustments, making it an excellent and safe option, especially for those who prefer a non-thrust or non-audible technique.

Q5: Can I have chiropractic care if I don’t want the ‘cracking’ to happen? A: Absolutely. Techniques like gentle mobilisation and the low-force Activator Method are specifically used for patients who prefer to avoid the cracking or popping sound associated with manual adjustments.

Q6: What is ‘biomechanical function’ and why is it important? A: Biomechanical function refers to how your joints, muscles, and bones move and work together. Restoring this function means ensuring your joints move properly and efficiently, which is key to reducing pain and improving posture and mobility.

Q7: Is the Activator device safe? A: Yes. The Activator Adjusting Instrument delivers a very light, specific force, and is considered a safe and gentle technique. It is often recommended for patients who may have conditions like osteoporosis or acute pain that preclude a more forceful manual adjustment.

Book a Consult with Our Chiro Brisbane

We understand that seeking care can sometimes feel overwhelming, especially if you are unsure about the different treatment methods. Whether you prefer a traditional manual adjustment, a gentle mobilisation, or the ultra-low-force Activator technique, we are here to listen to your needs and customise a treatment plan that is right for you.

At Our Chiro Brisbane, our goal is to restore the movement and function of your joints safely and effectively, getting you back to living your life with comfort and mobility.

Take the first step towards better joint health. Book an appointment with Our Chiro Brisbane today.

References

Huggins, T., Luburic Boras, A., Gleberzon, B. J., Popescu, M., & Bahry, L. A. (2012). Clinical effectiveness of the activator adjusting instrument in the management of musculoskeletal disorders: A systematic review of the literature. Journal of the Canadian Chiropractic Association, 56(1), 49–57. https://pubmed.ncbi.nlm.nih.gov/22457541/

Santilli, V., Beghi, E., & Finucci, S. (2006). Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. The Journal of Manipulative and Physiological Therapeutics, 29(4), 266–273. https://pubmed.ncbi.nlm.nih.gov/16517383/

Video Transcript

Another treatment we do here um which chiropractic has in recent times become really famous for is adjustments or manual adjustments. So that’s where you hear sometimes the clicking and popping or what we call a cavitation um of a joint. So that noise doesn’t hurt. It’s not bones breaking. It’s just movement in and around the joint capsule. Um it’s a simple movement of gas uh within the joint capsule. And basically like when you do this with your hands and then move it quickly that creates a little pop and that’s all that is. Um other ways to move and mobilize joints is using what they call mobilisation. So we’d be specifically contacting certain joints whether it be the wrist or whether it be the neck and doing slower movements with that. That’s for people that either for different medical conditions um or just don’t prefer to have that cracking happening. Um we can do that. That’s more of a lower force technique. And then for people that require even um lower force, for example, um we would use a little machine or a little handheld device called an activator. Um and that creates a really small little force specifically through uh the joints. Um, and none of them should hurt and uh they’re all very very effective in mobilising and restoring biomechanical function to your joints.