Answers to Questions about Chiropractic:
Does "Popping" Indicate That a
Spinal Manipulation Has Been Helpful?

Samuel Homola, D.C.

Question

Does "popping" in the spine during manipulation mean that a beneficial adjustment has occurred?

Answer

Occasionally, a joint that is locked or binding will pop during manipulation when it is released and mobility has been restored. But popping is usually meaningless because a normal joint will also pop during manipulation. Range of motion in a normal joint may be temporarily increased when manipulation forces movement into the paraphysiologic space (beyond the normal range of movement), but this effect has no real benefit and, when done excessively, may cause harm by producing loose or hypermobile joints.

The popping sound heard during spinal manipulation is caused by cavitation that releases gasses to fill the vacuum that occurs when joints are forcefully separated by manipulation, much like popping a cork from a bottle of champagne. Once a joint pops, it will not pop again until the gasses are absorbed and the joints settle back together, usually in about half an hour. Many patients believe that the popping sound is caused by misaligned vertebrae going back into place. Some chiropractors use the popping sound to encourage patients to continue with unnecessary treatment to "keep the spine in line."

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Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient's Guide provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.

This article was posted on January 22, 2004.