Thrust Joint Manipulation – Is it Safe?
Thrust joint manipulation, specifically a quick thrust to a joint that causes a single or multiple “pops,” has been used to treat neuromusculoskeletal disorders for more than two thousand years. Several research studies have demonstrated immediate, short-term, and long-term benefits of manipulation on pain, disability, and range-of-motion of mechanical spine issues.
Despite these benefits, some in the general public and in the health-care community question the safety of joint manipulation, believing it to be a dangerous, or at best “last-resort,” procedure.
Statistically, joint manipulation has an excellent safety record. To put this into perspective, if one compares spinal manipulation to the use of NSAIDS (such as Ibuprofen) for the treatment of a lumbar disc herniation, spinal manipulation is estimated as being 37,000 to 148,000 times safer (Oliphant 2004, Bjorkman 1999). In addition, a recent systematic review of adverse events (from 1998 to 2009) following neck manipulation or mobilization yielded favorable results. There were no major adverse events, including death, stroke, or permanent neurological damage. Minor events were estimated at an average of 16.3%, with transient increase in neck pain and headaches being the most common (Carlesso et al 2010).
What should you expect to feel?
A joint manipulation can be a little alarming, particularly if this is your first experience with the procedure. You should expect to feel some mild discomfort develop before the thrust occurs as the therapist finds the appropriate position to perform the manipulation. When the therapist feels it is appropriate, he will perform a quick thrust that will likely cause audible “pops” to occur. This is a normal and desired effect, as it indicates the joint has been released. The origin of the noise appears to be the separation of fluids between joint surfaces that results in the formation of a gas bubble. At the moment of thrust delivery, you will likely feel some apprehension and/or pain, but as mentioned previously, the chance of actual damage is rare. These feelings almost always resolve instantly or within a few minutes.
Often patients feel instantly better after a successful. Occasionally, there can be some increased soreness or headache later in the evening or the next day, but this usually resolves within a few days and the overall result is still positive. It should be emphasized that some mild worsening of symptoms is not cause for alarm, as the manipulation will naturally disrupt the painful adhesions, muscle stiffness, and joint dysfunction that are causing your problem. Of course, if different and/or more serious symptoms develop, contact your therapist to address concerns.