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Physiotherapy Associates Pte Ltd
290 Orchard Road
The Paragon Medical Suite
Singapore 238859

Tel : 6834 9755
Fax : 6736 4577


About Joint Manipulation 

Joint manipulation is a type of passive movement of a skeletal joint, using high velocity low amplitude (HVLA) thrusting maneuvers. Joint Manipulation is synonymous with Grade V mobilization; a term commonly used by physiotherapists.

It is usually aimed at one or more 'target' synovial joints with the aim of achieving a therapeutic effect.

‘Pop’ or ‘Click’ sound

Joint manipulation is characteristically associated with the production of ‘pop’ or 'click' sound. This sound is believed to be the result of a phenomenon known as cavitation. When a joint manipulation is performed, the applied force separates the articular surfaces of the joint. This deforms the joint capsule and intra-articular tissues, which in turn creates a reduction in pressure within the joint cavity. In the low pressure environment, some of the gases that are dissolved in the synovial fluid, create a bubble or cavity. It rapidly collapses upon itself, resulting in a 'clicking' sound.

Effects of joint manipulation

The clinical effects of joint manipulation have been shown to include:

  1. Relief of musculoskeletal pain
  2. Unlocks joints, e.g. stiff neck/acute back sprains
  3. Improves joint range of motion
Side effects and risks of spinal joint manipulation

Common side effects of spinal joint manipulation therapy are characterized as mild to moderate and may include: local discomfort, headache, tiredness, or radiating discomfort.

There are risks associated with joint manipulation, especially spinal joint manipulation. Potentially serious side effects include: vertebrobasilar accidents (VBA), strokes, spinal disc herniation, vertebral and rib fractures, and cauda equina syndrome.

Spinal Joint Manipulation should only be performed for suitable conditions, and not to be used as ‘routine’ techniques. Make sure consensus is taken, and ensure practitioners are trained to conduct the maneuvers. Pre-manipulation tests should also be carried out before the manipulation thrust.