Why do some therapists deal in crack? This is going to be somewhat controversial to the joint-cracking devotees! (3 minute read)
Does cracking a joint put it ‘back in’?
One of the most pervasive lies about treatment of spinal pain is that joints go ‘out and in’.
According to the literature they don’t. The idea of ‘vertebral subluxation’ is not supported by any scientific evidence.
However, this idea underpins explanation that are given by a whole raft of health practitioners.
Now, that’s not to say that giving a joint a little stretch and pop can’t help, because clearly it can, depending on the problem. After all, there is a whole industry built on it!
If it doesn’t put something ‘back in’, what does joint-cracking actually do?
When you remove the concept of subluxation as an explanation, it really makes you wonder what is going on when you have a joint cracked or popped, doesn’t it?
This is an excerpt from an article by Paul Ingraham who has a cool website called painscience.com, where he stays quite impartial (mostly) and provides evidence-based info on different therapies.
‘Scratching the itch you can’t reach: why joint popping feels good and possibly relieves pain’
Whatever a joint pop really is, it probably provides a novel sensory experience: a little blast of proprioceptive stimulation. Since all living systems seem to thrive on sensory input, and generally suffer without it, I speculate that a joint crack essentially feels like getting “unstuck,” and is analogous to finally getting to stretch your legs after getting off a long flight — which is not intended to trivialize it.
The strength of this idea is that it just isn’t claiming much: it both accounts for the extremely satisfying feeling that many people report, but without promising the moon. Indeed, it also seems consistent with another widely reported feature of SMT (spinal manipulative therapy – a term to describe manipulation/adjustment/joint popping) : the benefits often don’t last long!
Soon the “itch” needs to be “scratched” again. It also could explain why the benefits of SMT are so variable and uncertain: it is highly dependent on many factors. For instance, whether a joint crack feels “refreshing” to you depends on how you feel about the whole idea of joint cracking.
I quite like this explanation – it helps explain why it feels good to so many people and how people crave their ‘hit’ of crack.
Taking that idea a bit further, I have often wondered if there is something about the pop that is truly addictive.
Could it be that there is something about joint cracking that is harnessing the endogenous opioid system or the pleasure/reward system that makes it physiologically addictive?
Could it also explain the euphoric feeling that some people report, especially on their first session of adjustment/manipulation?
I don’t know the answer to that, but the ‘itch that needs to be scratched’ certainly helps feed the problem of therapist-reliance that this kind of therapy cultivates.
And one thing that the literature shows us is that therapist-reliance is not in the best interests of our patients.
