Manipulations are key tools in an Osteopath’s repertoire. It’s a quick way to get a joint moving, and the technique can have a more widespread effect on the local area. Some patients find it particularly effective, whereas others really do not enjoy it. Your treatment is all dependent on your consent, so don’t worry that you’ll have to have treatments you don’t like at your appointment.
What Happens When You Manipulate a Joint?
The longer name for the technique is HVLAT. It stands for High Velocity, Low Amplitude Thrust. Put simply, it’s a quick movement over a short distance. Depending on the joint being manipulated, the technique will look different. See the above illustration for a typical lumbar roll- a common HVLAT for the lower back. The upper back can be done laying on your front or back, or some Osteopaths might prefer treating with you sitting. The neck can be done in all three positions too, but different joints within the neck might need a completely different position.
There are a few theories about what exactly goes on within the joint. If you take an MRI of a knuckle joint as it clicks, you see a quick flash. The suggestion is that the flash, and the click, happen as dissolved gases within the joint fluid suddenly make a bubble, then pop. The result is a more comfortable joint that moves slightly further. It’s the link between what we see and feel that’s unclear. Spinal joints can respond especially well, with clear increases in movement on examination before and after.
It is possible to manipulate joints beyond the spine. Foot, hand, and ankle joints often go without too much difficulty. Knee and shoulder complex manipulations can bring relief to joints that have struggled for a long time. Any of these joints can make a clicking sound, but it’s not necessary in order to get relief. If you’ve seen videos online of very noisy manipulations, consider that there might be some editing going on!
When Are Manipulations Inappropriate?
Although the movement is small, it is fast and therefore is not suitable for everyone.
- The upper back should not be manipulated if you have Ankylosing Spondylitis. This is a rheumatological condition that causes a layer of bone to grow over joints throughout the spine.
- Manipulations are not recommended when bone density is low (osteopenia or osteoporosis)
- Spondylolisthetic segments (where one vertebra slips against another) are not suitable for manipulating. Note that this is not the same as a “slipped” disc, which should really be called a “disc bulge” because the disc is firmly attached to the bones above and below!
- And of course, if you do not consent to the technique, we will not perform it. This applies even if you’re happy for us to manipulate one area, but not another.
As always, your Osteopath will look at your individual case. Combining discussion with the findings in the treatment room, we can determine whether manipulations are appropriate or not for you. If they’re not, we have a range of other techniques we can use. Repetitive, gentle mobilisations are suitable for nearly everyone. Broader results that address muscle as well as joints, like METs, can be a good alternative too.
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