cccCCRRRACCKK! Ahhh that’s the spot. Am I the only one who loves the sound and feeling of a freshly cracked back in the morning? But wait– is cracking your back even good? Is it bad? Will it give me arthritis? What is actually going on back there? It even happens in my neck, shoulders, knees, and toes. There is plenty of research describing what is happening, but the information still usually omits whether or not it is beneficial and what the long term results are. This article will not tackle everything, but it will explain in the most simple terms what that Snap, Crackle, and Pop really is.
In this article, I am joined by a few of my colleagues from Smart Success PT to help me tackle this topic and give you the best information possible. Cindy Zhang (article here) answers the question, “What does it mean to crack your back?” She presents a great visual perspective on what is happening when a joint pops and informs on how physical therapists and chiropractors differ in their approach. Jeff Douglas (article here) answers the question, “Is cracking really all it’s cracked up to be?” He explains in depth what a joint manipulation is and explains the risks and benefits of this technique. Dr.Will Boyd from The Knowbodies podcast & Breaking Student Debt podcast, produced an episode featuring Dr. Jeff Moore, DPT and Founder of the Institute of Clinical Excellence. Great insight from an expert in the field of physical therapy was expressed there and this article was inspired by that very episode.
What: The proper medical term for the audible noise heard when popping a joint is called joint cavitation. The popular belief is that the “pop” is the release of an air bubble as joints are separated. However, this 2015 study, published in PLOS ONE, found that the noise actually occurred when fluid rushed into the joint cavity. Cavitation can be accidentally done by an individual, or purposefully performed by a licensed medical professional, like a physical therapist. A physical therapist uses a technique called manipulation to achieve cavitation or gapping of a joint. Spinal manipulation, as well as manipulations or mobilizations of other joints, can be used to relax muscles, increase movement, and relieve pain.
Joe Waller MPT, Cert. SMT, CMTPT gives a great example when saying, “[physical therapists] utilize spinal and extremity manipulation, along with other manual therapy techniques and exercise, in the treatment of neuro-musculo-skeletal pain and dysfunction in order to restore mobility within these systems.”
Is it Serious? With joint noises, certain sounds may be serious and some are not. Many people can pop their own knuckles by pushing or pulling on a joint. This study in the Journal of the American Board of Family Medicine found evidence of no correlation between knuckle popping and osteoarthritis. Popping or cracking sounds may be produced when ligaments and tendons slide over an adjacent structure in narrow joint spaces, like in the shoulder, when something is caught between joint surfaces, such as a torn cartilage in the knee, or when bone is grinding on bone where smooth cartilage is lost, such as in cases of osteoarthritis . Other factors could cause joint sounds, such as tendons catching on irregular bones in your neck or poor patellar tracking in the patellofemoral knee join, but these are only a few examples.
Does my joint become damaged the more I pop it? Dr. Pedro Beredjiklian, the Chief of Hand and Wrist Surgery at Philadelphia’s Rothman Institute, says in this TIME article, “The more you crack your joint, the more you stretch and loosen both its capsule and the surrounding ligaments. And the looser those components become, the more easily your joint will pop.” That being said, there are effects that happen from cracking a joint, whether that is perceive as damage or not is another debate.
Multiple studies like these two, PLOS ONE & JABFM , have affirmed no correlations to damaging effects of this practice. If no pain is experienced when the sound is produced, the soft tissue in the joint is most likely the cause. The sounds alone do not call for a certain treatment and there are no known long-term health issues associated with the sounds themselves. However, noises accompanied by pain may indicate joint surface damage and further inspection by a medical professional should be warranted.
What About My Back? Back pain is one of the most common health complaints in the healthcare industry. Back pain affects almost everyone at some point in their lives and is said to cost an annual total of $100 billion (including work productivity and wages lost). Back pain can be treated through a technique called spinal manipulation. Licensed practitioners, such as physical therapists, perform spinal manipulations by using their hands and body to produce a controlled end-range passive motion through a target joint in the spine. The goal of this treatment is to increase range of motion in the spine, improve function, and decrease pain.
A spinal manipulation is one of several options when treating back pain and is best used in conjunction with other conventional treatments, such as posture correction, weight loss, improved core strength, ice or heat, and other manual techniques, like soft tissue mobilization.
What Happens? The bones of the spine are called vertebrae with facet joints (zygapophyseal joints) on the posterior side. These joints slide past each other and allow for most of the motion produced in the spine. Therefore, when immobility is found, these facet joints are most likely causing the restrictions. The facet joints may become immobile from static posture, poor biomechanics, muscle spasm, or trauma. The specific cause of facet restrictions will be thoroughly evaluated and contraindications will be ruled out in order to make sure that spinal manipulations are safe for each case. During a spinal manipulation, the facet joints are taken to end range, then pushed into further range at a high speed over a very short distance. This creates the cavitation that produces the infamous snap, crackle, or pop. This technique creates space in the facet joint, restoring overall mobility in that section of the spine. With this technique, it is difficult to isolate to 1 joint, therefore multiple joints may be manipulated at one time.
Neurological Effects: A review article published in the Spine Journal 2002 Sep-Oct;2(5):357-71. examined the neurophysiological effects of spinal manipulation. The study found evidence that this technique has an influence on the nervous system. The review states, “An experimental body of evidence exists indicating that spinal manipulation impacts primary afferent neurons from paraspinal tissues, the motor control system and pain processing.”
What does this mean? To better understand this, imagine that you woke up in the middle of the night and stubbed your toe. You might feel a sudden onset of intense pain, and your toe may be sore until the following day. Now, imagine that after you stubbed your toe, you fell down the stairs and broke your arm. After this event, your stubbed toe will be no longer be a concern and may no longer be perceived as painful. This phenomenon is said to occur during a spinal manipulation. If you have a muscle spasm, a spinal manipulation sends new overwhelming information through the afferent neurons. Afferent neurons receive information from external stimuli then relate that information to the brain. Only so much information can run through neurons at a time, therefore the newly received information from a mechanism, such as a spinal manipulation, “over rides” the pain signals and influences the pain perceived. If less pain is perceived, less muscle guarding occurs and new mobility is achieved. leading to that “ahh” feeling after you crack your back. Not to be confused, breaking an arm is not the same as cracking your back. However the processes of receiving information from external stimuli follows the same principle. This process is termed the gate control theory, and could be a possible reason why spinal manipulations are so effective.
What Does the Research Say? There are mixed findings in the majority of published research. More research is needed and encouraged to better understand the mechanisms of spinal manipulation and the its effects on the body. A few research references are listed below describing a range of experimental findings on the benefits or lack thereof, when discussing spinal manipulations.
What Did We Learn? The sound heard when cracking your back is called cavitation. In most instances, popping a joint is not harmful, unless the sound is accompanied by pain. Spinal manipulations were discussed and we learned that the facet joints are purposefully slid past each other by a licensed practitioner to gain more range in joint and overall mobility in the spine. We discussed the gate control theory and why spinal manipulations are thought to decrease pain. Lastly, we discussed that more research is needed and encouraged to obtain more information about the benefits or lack there of when discussing spinal manipulations or the snap, crackle, and pop of any joint.
Thank You for Your Attention
The contributors & featured members of the Smart Success PT family:
Dr.Cindy Zhang is the owner of Movement Wellness & Rehab. She graduated from Clarkson University in upstate New York with a Doctor of Physical Therapy specializing in manual therapy, fitness, and nutrition. Dr. Zhang has a gift of connecting with patients, understanding their challenges, effectively communicating treatment plans, and most importantly, motivating them on their road to recovery. Dr. Zhang is trilingual, allowing her to also work with the Chinese community. In her spare time, she enjoys hiking, trying new foods, and traveling. Be sure to follow her on social media for more resources. Facebook Instagram
Jeff Douglas Graduated from Winona State University and currently resides in Tampa Florida. He is also member of Smart Success PT season 3 and is using the information he is learning there to change the path of physical therapy for the betterment of the profession and society. Jeff Douglas can be reached at his Facebook and Instagram
Will Boyd received his Doctor of Physical Therapy (DPT) – Chatham University, 2016 B.A. International Studies – University of Iowa, 2010 B.A. Spanish Language – University of Iowa, 2010. Will boyd is also the co-founder of The Knowbodies Podcast and founder of Breaking Student Debt Podcast, both can be found on his website. Dr. Boyd exudes a passion for physical therapy and exhibits an empathetic understanding of patients’ place in the journey of health and rehab. “While I believe in the practice of Physical Therapy, which has become the focal point of my energy, truly understanding ourselves is the best of course of rehabilitation and growth I have discovered. My passion is to help people become to best versions of themselves.” Facebook Website
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Bronfort G, Haas M, Evans R, et al. Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. Spine Journal. 2008;8(1):213–225.
Bronfort G, Haas M, Evans RL, et al. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine Journal. 2004;4(3):335–356.
Cagnie B, Vinck E, Beernaert A, et al. How common are side effects of spinal manipulation and can these side effects be predicted? Manual Therapy. 2004;9(3):151–156.
Cherkin DC, Sherman KJ, Deyo RA, et al. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Annals of Internal Medicine. 2003;138(11):898–906.
Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low-back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Annals of Internal Medicine. 2007;147(7):492–504.
Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low-back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine. 2007;147(7):478–491.