Does the "pop" from spinal manipulation mean anything?

Go for some spinal manipulation and you’re likely to get a therapist that works hard to get an audible “pop” or “crack” in the back, with the implicit suggestion that this means you’re better.

Yet is this so? Does the “pop” actually relate to the outcome in a patient with back or neck pain? Not according to a study recently published in the Journal of Manipulative Therapy.

In the study, 78 patients referred to physical therapy with mechanical neck pain underwent a standardised examination and thoracic spine manipulation treatment. All patients were treated with a total of six thrust manipulation techniques directed to the thoracic spine, followed by a basic cervical range of motion exercise.

The treating therapist recorded the presence or absence of a pop during each manipulation. Two to four days later, patients had their pain rated on an 11 point scale and were also tested on their available range of motion. There was no relationship between improvement in pain or movement and the number of audible “pops” recorded by the therapist.

This suggests that there is no relationship between the number of audible pops during thoracic spine thrust manipulation and clinically meaningful improvements in pain, disability, or range of movement in patients with mechanical neck pain.