Joint Manipulation / Articulation

Where I feel that joint manipulation would be appropriate, I first discuss this with my patient and (with their consent) I apply a quick (high-velocity), short (low-amplitude) thrust (HVLA) over the restricted joint.

However, in some cases this technique may not be appropriate and therefore I use my specialised treatment table which has sections that drop a short distance during an HVLA thrust, where the dropping of the table piece facilitates the movement of the joint.

The techniques aim to achieve:

  • relief of musculoskeletal pain
  • local reduction in pressure
  • restoring normal range of motion in the joint

Joint manipulation is usually associated with the production of an audible 'clicking' or 'popping' sound (Evans 2006).

The audible release is caused by a cavitation process whereby a sudden decrease in intracapsular pressure causes dissolved gasses in the synovial fluid to be released into the joint cavity. Once a joint undergoes cavitation, the force-displacement curve changes and the range of motion of the joint increases.

The cavitation provides a simple means for initiating the reflex actions; without the cavitation process, it would be difficult to generate the forces in the appropriate tissue without causing muscular damage (Brodeur 1995).

HVLA may result in regional changes in the musculature. It reduces local proprioceptive and nociceptive impulses from the joint. The sudden restoration of normal movement may help interrupt the cycle of pain-inflamation-restriction of the motion-contraction-histochemical changes-dysfunction (DiGiovanna et al, 2005).

References:

Brodeur R (1995) "The audible release associated with joint manipulation". J Manipulative Physiol Ther. 18 (3): 155–64. PMID 7790795.

DiGiovanna E, Schiowitz S, Dowling D (2005) "An Osteopathic Approach to Diagnosis and Treatment"

Evans DW, Breen AC (2006). "A biomechanical model for mechanically efficient cavitation production during spinal manipulation: prethrust position and the neutral zone.". J Manipulative Physiol Ther. 29 (1): 72–82.