Why do we sometimes make you „crack“?

The „cracking“ sound or „audible release“ refers to a specific manipulation technique commonly used by osteopaths. High-Velocity Low-Amplitude (HVLA) Mobilization involves a quick but very short movement, an impulse that might result in a cracking sound. The High-Velocity Low-Amplitude technique is particularly used for relieving acute pain in the back, neck, or joints of the upper and lower limbs.

Why might you need manipulation?

During an osteopathic consultation, we will often ask you to perform certain movements, like touching your toes or turning your head. These exercises help us assess how easily you move in everyday life, identify muscles that contract to compensate for a lack of mobility, and locate joints that seem „stuck.“

The patient’s feedback is crucial in this process: we ask about what feels tense, painful, or difficult to move. Then, we check the situation while you’re lying down and relaxed, which allows for a more precise evaluation of the tension’s origin.

There are many potential causes for these subjectiv „blockages“. A sudden movement might trigger an acute pain in your lower back, for example when lifting a heavy object. Long-term poor habits like Postural habits or also sleeping on an unsupportive mattress for several months can also trigger pain and sensation of blockage.

In both cases, your body reacts by sending signals, often in the form of pain or discomfort. This leads to muscle contraction and joint blockage to limit movement and protect you from further injury. Fortunately, this protective mechanism is usually not dangerous.

What does an Osteopath do when manipulating a patient?

When you visit an osteopath for pain relief, we often begin by relaxing the muscles around the affected joint to restore a minimum of movement. Then, we perform the „cracking“ manipulation, but it’s important to understand that this is not about „putting a vertebra back in place.“

Our role is much simpler: we help the joint regain its mobility.

When a joint is stuck, the synovial fluid that lubricates the joint can no longer be properly distributed. Through the manipulation, we create a small space in the joint, allowing the synovial fluid to spread and nourish the joint surface. It’s similar to unscrewing a bottle of sparkling water—the air escapes, and the liquid mixes. This process makes the joint move more smoothly and allows the movement to be restored.

Why don’t we „crack“ everyone?

Patient consent is crucial. Every osteopathic technique must be preceded by a clear explanation and your agreement. You are in control of your body, and the final decision is always yours. We suggest techniques suited to your situation, but we never perform a „crack“ without informing you beforehand.

It’s also important to note that this technique isn’t suitable for everyone. For example:

• Growing children: Their skeletons are not fully solidified yet, so we prefer to use other approaches to avoid disrupting bone development.
• Elderly individuals, especially postmenopausal women: Osteoporosis, which causes bone fragility, can make manipulations risky since bones are more susceptible to fractures under pressure.
• Certain specific pathologies: For example, with a herniated disc, research shows that this technique doesn’t always improve the condition. In such cases, we prefer to use more appropriate methods.

What are the risks of manipulation?

Osteopathic manipulation techniques are extremely low-risk. Before any intervention, we ask detailed questions to assess your health and determine what can be done safely. When in doubt, we always choose not to use a technique that could potentially worsen the situation.

The risks are indeed minimal. According to studies from the National Council for Osteopathic Research, the incidence of undesirable side effects from manipulations is about 1 in 100,000 to 1 in 1,000,000. In comparison, the prolonged use of anti-inflammatory drugs like ibuprofen poses risks for about 1 in 1,000 people.

Osteopathic manipulation, though feared by some, is a safe and effective technique when performed by a qualified professional. It helps restore joint mobility, relieve pain, and promote better functional health. As with any procedure, it’s essential to discuss your expectations and concerns with your osteopath, who will guide you toward the most suitable solution for your situation.

Charles Pradeau, 02.2025