Manipulations are techniques that can be used in physiotherapy. Often associated with cracking, there is a lot of information circulating about them, causing confusion among the general public. We'll see here that manipulations are very specific techniques with their own advantages and disadvantages.
Luis Cyr has been a physiotherapist for 30 years and is a member of the Canadian Academy of Manipulative Physiotherapy (CAMPT). He has also served on the Manipulations Committee of the Ordre professionnel de la physiothérapie du Québec (OPPQ), whose mission is to issue attestations to physiotherapists wishing to practice manipulations.
In this article, Mr. Cyr sheds light on the role of manipulations in physiotherapy, and provides valuable tips for understanding the benefits and limitations of this technique.
What is manipulation?
Before talking about manipulations, it's important to differentiate between manipulation and mobilization. Mobilization refers to all manual movements performed by physiotherapy professionals. So, although we tend to say that physiotherapists manipulate us, it would be more accurate to say that they mobilize us. Manipulation, on the other hand, is a treatment technique used among others, such as muscle stretching, strengthening and softening. However, it requires very specific knowledge and must be practiced by duly qualified professionals to be safe and effective.
From a technical point of view, a manipulation consists of a small-amplitude but very rapid movement (high velocity). It takes place at the end of the mobilization of a joint (end of movement).
For the patient, manipulation will be perceived as an action over which he or she has no control. During a manipulation, the physiotherapist retains control of the technique and the patient's position until the end. This technique is therefore different from gentler mobilizations, where the patient may decide to express discomfort or pain during mobilization. The professional will then adapt the movement accordingly.
Handling and cracking
In some cases, you may hear a sound when the physiotherapist performs the manipulation. This sound (cracking) means that the surfaces of the joint have separated before returning to their original state. The causes of this sound are not yet fully explained by the scientific community. The most likely hypothesis is the presence of nitrogen (gas) in the liquid lubricating the joint. When the joint surfaces separate, this gas changes from a liquid to a gaseous state, producing a crackling sound.
This crackling sound is highly significant for patients, who often interpret it as proof of successful treatment. However, the crackling sound is not mandatory in a manipulation, since some will remain silent while others will produce a crackling sound. The sound is therefore not related to the success of the technique.
The usefulness of manipulations in physiotherapy
As part of physiotherapy treatment, manipulations are used when movement is restricted. The aim of manipulation is to restore optimal mobility to the joint. It is important to note, however, that not all mobility limitations can be manipulated.
There are two types of handling:
- Vertebral manipulations, which include all manipulations performed on the spinal column.
- Peripheral manipulations, which include all manipulations performed on limb joints (elbows, wrists, ankles, etc.).
It's important to remember that manipulation is never the only technique used in physiotherapy treatment. It is always part of the overall treatment and will be used following an assessment. It will often be followed by other mobilization or exercise techniques.
Who can perform manipulations?
In Quebec, only three categories of professionals are legally authorized to perform manipulations:
- physiotherapists who hold a certificate to this effect ;
- chiropractors ;
- doctors.
What are the risks?
Like all medical treatments, manipulations entail risks of varying degrees of severity. They can cause inflammatory reactions, meaning that they were not indicated or that the movement was too strong. This reaction, which may feel like a sprain, will have very few long-term consequences, and will disappear within a few days of treatment.
The most serious consequences are encountered when manipulating the cervical region, and can range from paralysis to death. These risks are due, among other things, to damage to the vertebral artery that passes through the neck vertebrae. Most cases of paralysis and death seem to be caused by the use of a certain type of manipulation, which physiotherapists have replaced with safer techniques.
So, despite their effectiveness, manipulations must be practiced safely to protect the public. For this reason, an attestation has been introduced for physiotherapists wishing to practice manipulations. The OPPQ Committee assesses each professional's application to ensure that his or her technique is safe and in compliance with regulations.
The physiotherapist must then prove that he or she is capable of performing manipulations and will do so safely.
Advice from a physiotherapist
In conclusion, Mr. Cyr offers some advice if you need to undergo manipulations as part of your physiotherapy treatment.
1. Be sure to keep your physiotherapist informed of any changes in your health.
2. Never hesitate to talk to your physiotherapist if you're not comfortable with the treatment, or if you're experiencing discomfort or pain.
3. You must first give your consent. Before performing a manipulation, the physiotherapist must talk to you about the treatment and its consequences. You must then give your oral or written consent, depending on the type of manipulation. In case of doubt or misunderstanding, don't hesitate to ask questions. You can also ask for a demonstration of the technique so that you feel comfortable with it and can give your consent with complete peace of mind.