Joint Cracking – What was that!?

Have you ever wondered what the joint cracking technique used by osteopaths (and others) really is? Maybe you’ve experienced it for treatment of a musculoskeletal complaint. Or possibly you’ve heard of it and are curious to know more. In Osteopathy, we call this technique a High Velocity Low Amplitude Thrust, or HVLA for short. You may have heard of it as an ‘adjustment’ or ‘manipulation’. In this technique, the therapist sets up the joint at an optimal angle and applies a short and fast thrust, usually creating a cracking sound.

The cause of that ‘cracking’ sound is probably not what you expect. It’s not the sound of a bone moving into place, joints realigning or two bones contacting each other. In fact, there is very limited movement available at a spinal joint. If we were able to move bones around with our thrust, the average collision in a game of football would leave players in a crumpled heap! Although there’s a lot of nuance that we still don’t fully understand, the leading scientific theory suggests that the ‘pop’, or ‘cavitation’, is from a gas bubble within the joint. And the effects are a lot more intricate than “realigning” joints.

Each joint is fully enclosed by a capsule and filled with fluid, allowing for smooth movement of the two adjoining bones. During a manipulation the joint is safely and temporarily stretched, changing the pressure levels in the joint fluid and either forming or collapsing a gas bubble… and like a bottle of the Bellarine’s finest sparkling – pop!

This technique is often used in the treatment of neck and back pain, but can also be utilised to effect change in the limbs, hips and shoulders. HVLA is proposed to act on the nervous system and the musculoskeletal system. Research has shown it to be helpful in reducing pain, increasing motor control and strength, and improving range of movement.

The osteopaths at Peninsula Osteopathy + Allied Health may choose to offer you this technique if it is appropriate for your condition. There are a multitude of techniques at the osteopath’s disposal and they will work closely with you to design a treatment and management plan that best suits your personal circumstances. When questioning you about your condition and health history, your osteopath will be determining whether there are risks for any of our treatment options. So now you know a little more about HVLA, would you be willing to explore it with your osteopath?


  • Haavik, Heidi, et al. “The Potential Mechanisms of High-Velocity, Low-Amplitude, Controlled Vertebral Thrusts on Neuroimmune Function: A Narrative Review.” Medicina 57.6 (2021): 536.
  • Wirth, Brigitte, et al. “Neurophysiological effects of high velocity and low amplitude spinal manipulation in symptomatic and asymptomatic humans: a systematic literature review.” Spine 44.15 (2019): E914-E926.
  • Dunning, James, et al. “Cavitation sounds during cervicothoracic spinal manipulation.” International journal of sports physical therapy 12.4 (2017): 642.
  • Harwich, Andrew S. “Joint manipulation: toward a general theory of high-velocity, low-amplitude Thrust techniques.” Journal of chiropractic humanities 24.1 (2017): 15-23.

5 Things You Need To Know About Dry Needling

1. What Is Dry Needling?

Dry needling is a treatment technique whereby a sterile single use fine filament needle (acupuncture needle) is inserted into the skin and muscle tissue to create a response in the body. It is commonly used to help with muscle tightness or tension, chronic connective tissue soreness and pain. Combined with other hands on treatment methods that Osteopaths use, dry needling can help to decrease pain, promote tissue healing and restore normal tissue funtion.

2. How Does It Work?

The exact mechanisms are complex and somewhat unknown, but, there is a growing body of scientific evidence that supports these two ideas:

Locally –Inserting the tiny needle into the muscle induces injury signals the brain uses to initiate a sequence of events to replace or repair the damaged tissue. Needling in a painful ‘trigger point’ or tight muscles can provoke a twitch response from the muscle. Once the twitch response has been elicited, the muscle fibres in that area relax, inflammation is reduced and circulation improves. As a result of these physiologic processes, dry needling can address muscle, tendon and myofascial pain and dysfunction.
Centrally – the brain and spinal cord are influenced by inhibiting the transmission of pain signals in our spinal cord and increasing the release of our own pain relieveing chemincals within our brains.

3. What Can Dry Needling Help With?

Dry needling can be used to help treat both acute and chronic pain. It’s used as part of a larger treatment plant to effectively manage conditions such as:

– neck pain and headaches

– back pain

– golfers/tennis elbow

– shoulder pain

– hip pain

– Shin splints and plantar fasciitis

– A range of other conditions involving muscle tension

4. Will It Hurt?

Initially a small pinprick sensation may be felt on insertion into the tissue. When a muscle is very tight, a local twitching sensation can be felt and can be quite intense. This is a good sign of release! Most people describe the feeling as ‘unusual’ rather than painful. After the session you can feel an ache in the muscle that can last few hours and occasionally up to a day or two. As you move around more, the soreness will be less noticeable.

5. What Is The Difference Between Acupuncture And Dry Needling?

The obvious similarity between dry needling and acupuncture is the needles used in both are identical. Generally dry needling is based on Western anatomical and neurophysiological principles and focuses predominately on the assessment and treatment of the musculoskeletal system. Acupuncture is based on Traditional Chinese Medicine meridian theory -the flow of ‘Qi’ in the body and acupoints and treats both musculoskeletal conditions as well as a variety of internal conditions such as asthma, gastrointestinal, gynaecological and psychological complaints.