Understanding "crack" during osteopathic sessions
One of the most debated and sometimes misunderstood aspects of osteopathy concerns the "crack" sound often heard during joint manipulation. Many people wonder about this phenomenon: where does it come from? Is it a sign of successful manipulation? And above all, is it safe?
What is this "crack"?
The characteristic noise heard during certain osteopathic manipulations is mainly due to a phenomenon known as "cavitation". Cavitation occurs when there is a rapid separation of the joint surfaces, leading to a change in pressure in the joint cavity. This change in pressure causes the formation of small gas bubbles (mainly carbon dioxide) dissolved in the synovial fluid - the liquid that lubricates the joints. When these gas bubbles collapse or implode, they emit a distinct "crack" or "pop" sound.
What do the scientific studies say?
Several studies have sought to understand and document this phenomenon. One key piece of research, published in the Journal of Manipulative and Physiological Therapeutics, used magnetic resonance imaging (MRI) to observe joint changes in real time. The results confirmed that cavitation occurs at the exact moment the sound is produced.
Joint cavitation study (Kawchuk et al., 2015)
- Publication: Journal of Manipulative and Physiological Therapeutics
- Methodology: Use of MRI to observe cavitation in real time during joint manipulation.
- Results: This study showed that the "crack" sound is associated with the rapid formation of a gas cavity in the synovial fluid, confirming the cavitation hypothesis.
Biomechanics and pathophysiology of joint noise (Protopapas and Cymet, 2002)
- Publication: Clinical Orthopaedics and Related Research
- Methodology: Review of existing literature and analysis of pathophysiological theories.
- Results: The authors discuss various theories on the origin of joint noise, including cavitation and ligament or tendon movement. They conclude that, although cavitation is widely accepted, the complexity of the phenomenon is not fully understood.
These studies provide important scientific insight into the phenomenon of "crack" in osteopathy. It is interesting to note that, despite a great deal of research, certain aspects of this phenomenon still remain mysterious and continue to attract the interest of the scientific community. The interpretation and clinical application of this information must always be carried out by a qualified professional.
Is the cracking sound an indicator of successful manipulation?
Contrary to popular belief, sound itself is not an indicator of the effectiveness of manipulation. Studies have shown that improved mobility or pain reduction can occur with or without the presence of sound. What's important is the quality of the manipulation and the body's response to it, rather than the production of a sound.
He said to himself:
"You can't measure the effectiveness of an osteopathic technique by the number of decibels it produces".
There is a whole range of osteopathic techniques, from fascial and visceral to articular and cranial. A good osteopath must master this range of techniques, just as a good craftsman knows how to use different tools. Osteopaths need to adapt their practice to each patient, according to their pathologies and antecedents, but also according to their wishes and apprehensions. Joint techniques that cause cracking are not painful, at most unpleasant for a second; if they are painful, it's often because the technique is not up to scratch.
Is crack dangerous?
With regard to safety, the scientific literature indicates that, when performed by a qualified professional, osteopathic manipulation is safe. Complications are rare, and are often linked to inappropriate manipulation or to underlying conditions that remain undetected in the patient.
Safety of spinal manipulation (Cassidy et al., 2008)
- Publication: Spine
- Methodology: Analysis of spinal manipulation injury cases in relation to GP consultations.
- Results: This study suggests that the risk of serious injury after spinal manipulation is rare and comparable to that seen in general consultations for similar symptoms.
Can crack cocaine cause osteoarthritis?
The potential association between the "crack" audible during osteopathic manipulation and the development of osteoarthritis is a subject that has been studied and debated in the medical literature. To date, scientific evidence does not support the idea that the cracking noises produced by osteopathic manipulation lead to osteoarthritis.
Longitudinal studies that follow patients over long periods after osteopathic manipulations have shown no increase in the risk of joint problems, including osteoarthritis. It's important to note that osteopathy, when practised correctly by a trained and qualified professional, is considered a safe and effective approach to treating a variety of musculoskeletal conditions without causing joint damage.
Here are a few points based on the available scientific literature
Study on the relationship between joint noise and osteoarthritis
- Study title: "Does Knuckle Cracking Lead to Arthritis of the Fingers?"
- Publication: Western Journal of Medicine in 1975
- Results: This longitudinal study by Castellanos and Axelrod compared the frequency of hand osteoarthritis in people who cracked their fingers and those who did not. They found no significant increase in the risk of osteoarthritis in those who crack their knuckles.
Conclusion on joint noise
In short, the "crack" heard during osteopathic manipulation is a natural phenomenon associated with cavitation. It is not a direct indicator of treatment efficacy and, when practised correctly, is generally harmless. It is always advisable to discuss any concerns or questions with your osteopath, who can provide more detailed information depending on your individual situation.
Marie Messager
Osteopath D.O
2 rue Alexis de Tocqueville
78000 Versailles
