• Retrain Health

What’s cracking? - a beginner’s guide to manipulation

Many of us have heard our joints crack, either by complete accident, DIY, your mate picking you up in a big (pre-covid) bear hug or by a professional. So, what's happening when your joints crack?

While it goes by a number of names - cracking, manipulation, adjusting, cavitation, poping and clicking - us professionals call this technique HVLA (high velocity low amplitude).

To many people’s disappointment, when we use HVLA, we don’t adjust the alignment of the bones or “put them back in place”.

The technique invloves skilfully "locking up" the joint, by placing it in a position which localises tension (via the joint, ligaments and/or tissue), to the segment or joint we wish to adjust. We then apply a quick, short thrust to create a cavitation, which can produce the popping sound.

Current evidence suggests that the 'pop' is caused when the fluid, that is naturally present within the majority of our joints, is placed under specific tension, causing the body to rapidly form a gas bubble within the joint, potentially resulting in an audible release.

It is important to highlight that this technique is ideally performed with finess, not force, and that the success of the technique does not rely on the 'click'. Although not as exciting, a cavitation can be as effective without the 'pop'.

Following HVLA, the joint may experience an increase in range of motion, reduction in pain and increase in mobility.

The relief that is associated with HVLA, is generally short lived and is best used in combination with other treatment techniques and rehabilitation exercises.

Why we use it.

So, you may be asking, why we use this technique if the results are only short lived? The short-term changes we see allow us to get a decrease in pain, and increase in movement, which helps to improve overall function. An increase in function permits more efficient movement, which in turn will lead long-term change and improvement in overall pain and movement.

Is it safe?

As with any manual therapy technique, there are risks associated with performing it. At Retrain Health, your practitioner will take an indepth past medical history and perform a thorough assessment, to see which techniques may be right for you. Additionally, they will go through any risks that are associated with the techniques beforehand.

The side-effects that can occur from HVLA are usually transient in nature and will generally resolve themselves within 48-72 hours after your treatment. This includes generalised fatigue or tenderness in the area.

Additionally, there are some more serious risks associated with HVLA, though they are rarely reported in the literature. These risks are usually associated with an underlying predisposing factor, which is why your practitioner takes such a thorough history to ensure that these factors are not missed. The more serious risks include joint sprain or strain, fractures, neurological complications (nerve compression) or vascular compromise (generally associated with neck HVLA). Whilst there have been documented cases of these events happening, they are extremely rare.

When it comes to using any technique, including HVLA, the final say is down to you. If you don’t feel comfortable with HVLA, that’s a-ok, just notify your practitioner! Your practitioner has a wide arsenal of techniques that can be used to provide the same results, another way!


Retrain Health is based in the Northern Rivers, NSW. From our Byron Bay and Ballina clinics, our team provides a range of quality healthcare services and products.

Retrain Health offers osteopathy, remedial massage, strength and conditioning, and PT sessions with qualified practitioners.

If you are interested in finding out more information or would like to book an appointment, please contact the clinic by phone (02) 6680 7447, send us an email or click here to book an appointment online.

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