Alignment and Manipulation

“Alignment” is a term patient’s speak to us about regularly and it is one of the most frustrating terms that has been adopted by therapy industry. It leads to individual’s believing that something is wrong with them, they are broken and it creates reliance on a therapist to put them right.

Don’t get me wrong, sometimes alignment in terms of biomechanical positioning can have an influence on injury occurrence. Think of landing on a bent, knee rotating inwards. The biomechanical alignment is poor and could lead to ligament injuries of the knee as opposed to a nice straight line with the knee being aligned over the foot and the hip directly above. However, the majority of the time when referred to in a therapy context is in regards to joint position and relates to things being out of place!


The majority of this comes down to subluxation theory, the thought that joints can sublux or pop slightly out of place and needs to be put back to the original position. This does happen at joints within the body, shoulders and knee caps are great examples. However, rather than a dislocation, subluxations return to their original position relatively quickly without much intervention of someone pulling on your arm or driving your knee cap back across as they straighten your leg!

Here is the point where some healthcare practitioner will tell you this joint is out of alignment and we need to put it back. They will then perform some type of manipulation treatment; you’ll hear a click and they’ll tell you that was the joint/bone jumping back to exactly where it needs to be. But let’s go through what’s really happening.

Joint manipulation, whether spinal or peripheral joints can have a benefit by reducing pain but that is not because the magic popping/cracking sound was a bone realigning! This sound is a cavitation, meaning formation of an empty space. The popping sound results from gas bubble formation within the joint. When a force is applied altering the space within the joint, it can create a vacuum effect that leads to these bubbles imploding resulting in a sound. No bones jumping around here!

So how does that reduce pain?

There is not evidence that manipulative treatment “corrects biomechanical faults”, nor is there evidence of manipulation causing positional changes but we do feel more mobile and experience a reduction in stiffness in the area treated. There has been a change from the original physical, biomechanical proposed benefits of manipulation to psychological and neurophysiological benefits. Pain and the brain!

The benefits of manipulation are TEMPORARY! If they weren’t your back pain would be gone immediately following manipulation, staying that way until that pesky little vertebrae decides to leap out of its neatly stacked, perfectly ALIGNED spinal column again! But that’s not what happens. What we do get is an immediate reduction in pain, a greater tolerance to and threshold for pain signals and increased range of motion due to reduced neural tensioning and relaxation of tissues in the area. These effects however, only last around 5 minutes and the pain-relieving benefit can be long gone within 24 hours. Just like when you crack your knuckles and can repeat the same thing a few moments later.

If the benefit is so short lived then why bother?

If that temporary reduction in pain and improved range of motion is enough to allow you to move then it may be all we need to get you reducing your pain. CHECK OUT OUR PAIN AND THE BRAIN article. It allows the opportunity to get you moving again – motion is lotion and movement is medicine. Once you’re moving, we can then begin to expose the body to positions that were previously painful and convince your brain it doesn’t need to guard you from those positions. We can begin to work on increasing your resilience to positions that may have aggravated or brought on the condition and we can address why the issue presented in the first place, making you strong enough through rehabilitation to reduce the likelihood of the issue returning at all.
Rather than creating reliance on a therapist who will put you back in alignment when something goes wrong, you should be educated on what to do if such things happen again. It is not about needing to come back in for additional manipulation treatments for the rest of your life to ensure we keep things where they should be!

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