"What IS that clicking noise my back just made?"
So many times, we have customers who come into clinic who say "X, Y or Z just needs clicking back into place" or "It's out of alignment", but what exactly is that sound you hear? Its technical term is a High Velocity, Low Amplitude Thrust (HVLAT, or sometimes HVT) but is commonly referred to as a manipulation or "click".
As a technique, it can be a useful tool that sets Chiropractors and Osteopaths apart from some other manual therapists, but it's really not the ONLY technique available to us. The technique is designed to take a joint past the range of movement it's stuck at in a short, sharp way to get the joint working to its full capacity and helping to redistribute movement through the whole spine. The clicking sound you hear is a release of a gas bubble formed in the joint fluid, like your knuckles going click, but is by no means vital to the technique being successful. One of its big benefits is a change to the nerve signals being fed back from the body to the brain from that bit of spine, which helps to "reset" the surrounding tissues and reduce the pain we feel.
These manipulations sound pretty scary but are often quick and simple with minimum discomfort. As an osteopath, there are several considerations as to why we would choose to use this technique, and rest assured if we decide to do so, we've often already assessed whether this technique is suitable for your individual circumstances. We rarely rely solely on these techniques in clinic, and if you'd prefer not to have them done, you only have to tell us, and we'll respect your wishes wholeheartedly. There are many other techniques that can be used to achieve the same results.
A word on "Alignment"…
We commonly hear people saying "My… [back] needs clicking back into place" or X, Y, Z is "Out of alignment". Let's clear things up here: Nothing (bone and joint wise) in the body goes "Out of alignment" unless it's dislocated, in which case please do seek emergency help such as A&E and not us! There are a couple of small caveats about disease causing alignment issues, but this isn't what this post is about.
The phrase was used by some therapists to describe a situation whereby one bone (lets use vertebrae in the spine as an example) sits slightly twisted compared to the next. We're talking fractions here - tiny, tiny movements - when maybe one is maybe slightly rotated or tilted to one side compared to those above and below it, and often if you had xrays or other scans there would be nothing visible at all. The bone is still where it should be in the body, it's not moved, it's just moved around an axis of movement as it would normally if we bent forwards or twisted round to look behind us.
Nothing "slips", nothing "misaligns", but bones DO get pulled by tight muscles and can be influenced by changes to the joint surfaces, to make it appear that we are "wonky".
"But you can click it back right?" Well, no, because nothing has gone "out of place". What is more beneficial in this instance, is a good deal of soft tissue work to the muscles surrounding the joint to get them to soften and stop holding the joint in an abnormal way. As mentioned above, clicking joints is just one tool in a very large bag of techniques, and by releasing the muscle using the appropriate techniques for you, more often than not the joint will then function perfectly well again, and your pain will reduce, all without needing to "click" anything!