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The Cracking Code: Understanding the Mechanism Behind Back and Neck Pain Relief


For many seeking relief from back or neck pain, the familiar sound of a joint crack during manual therapy can bring a sense of immediate comfort. These techniques, often referred to as manipulations, adjustments, or high-velocity thrusts, are commonly employed by chiropractors, osteopaths, and physiotherapists. In this blog post, we'll unravel the mystery behind why cracking your back or neck can provide pain relief and explore the mechanisms at play.

The Terminology: Manipulations, Adjustments, and Mobilizations

Manual therapy techniques that produce a crack fall under various terms, depending on the profession and training of the clinician. Chiropractors commonly use the term "adjustments," while osteopaths and physiotherapists may refer to them as "manipulations" or "high-velocity thrusts." These techniques are categorized as grade 5 mobilizations, indicating their forceful nature.

The Crack: Understanding Cavitation

The audible crack that accompanies these manual therapy techniques is termed a "cavitation." This occurs when joint surfaces move apart within the synovial fluid of the joint. While this phenomenon is well-known, the precise mechanism behind its pain-relieving effects has been a subject of ongoing exploration.

Receptors in the joints and muscles recognize the cavitation, sending signals to the brain. In response, the brain initiates a series of physiological changes. One significant outcome is the reduction of muscle tone around the treated area. Additionally, other central and peripheral responses are triggered, collectively working to modulate pain perception.

Misconceptions about Realignment

Despite the efficacy of these techniques in pain relief, it's crucial to dispel a common misconception – they do not realign the spine or reposition joints and discs. Presenting these manipulations as corrective measures can lead to inaccurate beliefs among patients, potentially contributing to the chronicity of their condition.

The Importance of Accurate Explanations

Clinicians utilizing these techniques play a crucial role in providing accurate and clear explanations to patients. Understanding that the relief comes from the modulation of pain perception and decreased muscle tone, rather than a structural realignment, empowers patients to make informed decisions about their care. This knowledge can contribute to a more realistic understanding of their condition and facilitate a more effective treatment approach.


The sound of cracking joints during manual therapy has long been associated with pain relief, but the mechanisms behind this phenomenon are not always well-understood. Cavitation, caused by joint surfaces moving within synovial fluid, triggers responses that modulate pain perception. However, it's important for clinicians to communicate accurately with patients, dispelling the notion of structural realignment. By fostering a realistic understanding, clinicians can empower patients to actively engage in their treatment and contribute to better long-term outcomes for those seeking relief from back or neck pain.

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