What is Manipulation Therapy?

Manipulation therapy is a type of manual therapy that is practiced worldwide by health care professionals in various specialities, such as osteopathy, chiropractic, to treat musculoskeletal pain and disability (Rubinstein et al., 2011). The therapy uses drug-free, non-surgical techniques to reduce joint pressure, improve joint range of motion, restore muscle and tissue balance, promote body fluid mobilisation, decrease inflammation and enhance nerve function (Di Fabio, 1992; Cyriax, 1973).

Historically, manipulation is one of the oldest forms of manual therapy. It has been widely practiced in many cultures for thousands of years, to effectively treat a variety of musculoskeletal ailments. The earliest record to the practice of spinal manipulation is found in China, which dates back to 2700 BC (Waddell, 1996).

How does Manipulation Therapy work?

Manipulation can be performed on almost any joint in the body. It consists of a low-velocity, high-amplitude (LVHA) or high-velocity low-amplitude (HVLA) thrust, applied to a joint at a specific angle (usually perpendicular). This force creates motion at the joint, resulting in articular surface separation.

This passive movement of the joint can improve range of motion, reduce inflammation and provide recovery stimulus to the surrounding soft tissues which affect the joint (muscles/ligaments/tendons/fascia).

At Prentice Sports Therapy we adopt a dual approach to alleviating musculoskeletal dysfunction, employing Osteopathic joint manipulation techniques alongside specialist soft tissue therapy.
In most cases the manipulation will be relatively pain-free and the patient may even feel an almost instant release of pressure and reduction of pain in the affected area. However, it is normal to take a few days for the patient to notice the full benefits of the procedure.

What is the ‘Cracking’ / ‘Popping’ noise?

During manipulation, a strong thrust is applied to the joint. This action causes separation of the joint beyond a certain magnitude, producing an audible cracking sound, or pop. This feature is known as ‘Cavitation’ of the joint.

The ‘cavitation’ causes the gaseous bubbles in the synovial fluid to be compressed and the ‘crack’ often signifies a successful manipulation (Sandoz, 1969), though it is not essential.

Is Manipulation dangerous?

Like most manual therapy modalities there are associated risks and benefits to manipulation. Although, high-velocity thrust techniques (HVT) are considered to be potentially more dangerous than non-thrust procedures, the risks are greatly reduced with a thorough clinical assessment – which is why it is essential to seek out a qualified and experienced therapist like those here at Prentice Sports Therapy.


“I have been practicing and receiving manipulation therapies for many years and I have yet to experience a negative outcome.” – (Paul Prentice – Principal Therapist).

“Repetitive manipulation has never been proven to be linked with any increased incidence of degeneration within the joints.” – (OMT, 2014)

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