The Difference Between Chiropractic Mobilization and Manipulation Techniques

I often here from patients when they're at my office "Hay doc I'm in pain can you please pop/crack my back" and I usually reply, "I give adjustments not pops" or "I manipulate not crack" or "I'm going to first mobilize then manipulate then pop and crack". Laughter. Honestly, with all kidding put aside I don't care what my patients say, because I know its their way of saying they want to get out of pain. It's easy to say and that's what people remember, the popping or cracking sound. The snap, crackle and pop have long been associated with doctors properly trained in the use of manual therapies and in particular the Doctor of Chiropractic. With that said, I thought I'd write this article for those individuals who might want to know a little more about the terms that are in use today. Here are (2) definitions along with some clarification and discussion.

(1) Mobilization: Slow/slower or low-velocity techniques to which the joint remains within its passive range of motion/movement. The patient has control.

(2) Manipulation: Fast/faster or high velocity techniques that take the joint beyond the passive range end barrier (what is known as the paraphysiological space) of motion/movement. Because of the speed at which the technique is applied the patient does not have control.

The difference between mobilization and manipulation is that manipulation is a controlled sudden thrust or impulse with speed applied at the end of the passive range of motion/movement, which cannot be achieved through mobilization.

The manipulation is very quick and is similar to popping or cracking your knuckles. The technical term for the popping/cracking sound is called "cavitation". The sound is not made from bone on bone contact but rather from the collapse of a bubble of gas that escapes from the joint fluid, which creates low pressure within the joint capsule when the two joint surfaces are separated during the manipulation. Cavitation can also occur with mobilization.

Although the thought of a speedy thrust combined with popping or cracking sounds and the joint separating from each other might sound creepy, one must consider the fact that the separation is a controlled thrust and is over an extremely small range of movement.

All professions involved in manual health care use the terms "mobilization and manipulation". Chiropractors use both mobilization (low velocity) and manipulation (high velocity) techniques and the chiropractic "adjustment" in particular are usually synonymous with both manipulation and mobilization.

Manual diagnosis and treatment protocol is a complex endeavor, which requires extensive education, long standing training and great skill. For the untrained, going to weekend seminars will never provide the skills necessary to perform a safe and correct treatment. The practice of spinal and/or extremity manipulation and mobilization requires a deep understanding of human structural anatomy, human biomechanics and human nervous system motor function.

Highly trained health care professionals who employ manual health care such as licensed chiropractors, osteopaths and others who have the proper formal training, must know how, where and when to use mobilization and manipulation techniques. DO NOT TRY THESE TECHNIQUES AT HOME.

I hope this article is helpful for those interested and should anybody ask you, "have you ever had your (spine, neck, hip, back or whatever) popped or cracked"? You'll know what they mean.