Cracking the Myth: Read This Before The Next Time You Crack Your Neck
- Andrew Geil
- 3 days ago
- 4 min read
The Science, Safety, and Performance of Spinal Manipulations
At AVION Sports Rehab, we provide more than just "adjustments." We offer precision-based Spinal and Extremity Manipulations designed to reset your nervous system and unlock your performance.
There is a lot of "dogma" surrounding manipulations and what the "crack" of a joint actually is. much of it fueled by misinformation. As elite physical therapists, our mission is to provide you with the evidence based truth about how these techniques work, why they are safe, and how they help you stay out of the surgery room.
What is a Manipulation? (It’s Not Just a "Crack" or "Pop")
In clinical terms, a manipulation is a High Velocity, Low Amplitude (HVLA) thrust. It is a passive movement that occurs so quickly (roughly 0.135 seconds) that the muscles cannot subconsciously guard against it. This is important as there are major central nervous system benefits we get when we perform a manipulation of a joint.
We have a saying: Dry Needling reset your nervous system from a muscular prospective and manipulations reset your nervous system from a joint perspective. Combined, they are a powerful holistic cocktail to address pain and improve your function.
So, What is that "crack" sound you hear? It is simply a change in pressure within the joint space. When the joint surfaces are gapped, gas bubbles are released from the synovial fluid (cavitation), alleviating joint pressure and clearing out the space to allow your facets to glide better during flexion and extension.
Debunked: The Stroke Myth vs. Medical Reality
You’ve likely heard a doctor say, "If you crack your neck, you’re going to cause a stroke." It’s an intimidating claim, but let’s look at the actual biomechanical data and risk benefit ratios.
According to the IFOMPT (International Framework for Examination of the Cervical Region), we must distinguish between causation and association.
The 51% Rule: It takes 51% strain beyond the normal end range to cause a dissection of the vertebral artery.
The Manipulation Reality: A skilled cervical manipulation only places 1–3% strain on the artery.
The Daily Life Comparison: Simply turning your head to its max range (Active ROM) places 38% strain on those same vessels.
Statistically speaking:
Risk of Stroke from Manipulation: Approximately 0.005% (1 in 5.85 million to 8 million).
Risk of Heart Attack/Bleeding from NSAIDs (Advil/Tylenol): Approximately 5–6%.
You are significantly more likely to suffer a serious medical event from taking over the counter pain medication than from a cervical manipulation performed by a trained professional. Most "manipulation related" strokes occurred because the patient already had a dissection in progress and sought care for the resulting neck pain, this is an association, not a causation.
How Do Manipulations "Reset" Your Body?
We don't just manipulate for the sound; we do it for the neurophysiological effects. A targeted thrust at "the junctions" (CTJ, AA, or Lumbar spine) creates an immediate systemic reset:
Muscle Tone Reduction: It elicits an immediate reduction in paravertebral muscle tone (relaxing those "knots").
Increased Strength: Studies show immediate improvements in cervical flexor strength and core contraction (TrA and LM) following a manipulation.
The TCN Reset: Upper cervical manipulations (at the AA joint) can help "reset" the Trigeminal Cervical Nucleus, which is the primary switchboard for cervicogenic headaches.
Overcoming AMI: Arthrogenic Muscle Inhibition (AMI) is a reflex where your body shuts down muscles surrounding a joint to "protect" it after an injury. Manipulation increases fluid and blood flow, signaling the brain that the joint is safe, thereby "re-starting" the inhibited muscles.
The AVION Safety Standard: Our Screening Process
At AVION, we are the first line of defense. We don't just "crack and go." Every patient undergoes a rigorous screening for Red Flags and vascular pathologies before we ever set up a barrier.
We utilize the 5Ds and 3Ns screening to ensure your safety:
5Ds: Diplopia (double vision), Dizziness, Drop attacks, Dysarthria (speech issues), Dysphagia (swallowing issues).
3Ns: Nausea, Numbness, Nystagmus (involuntary eye movement).
We perform blood pressure checks, neurological exams (including Hoffman’s, Babinski, and Clonus), and cranial nerve testing every time it's indicated. If you have advanced osteoporosis, upper cervical instability, or vascular disease, we pivot to non-thrust mobilizations. There is no wrong intervention, only wrong timing.
Why Manipulate Before a Workout?
Many of our athletes seek out manipulations before they hit the gym. Why?
Increased Neuromuscular Drive: It "wakes up" the nervous system.
Improved ROM: Clearing the joint space allows for the 45 degrees of rotation needed for optimal movement.
Pain Control: By modulating pain signals, you can move through a full range of motion with more confidence and less guarding.
Conclusion: Precision Over Dogma
Whether it's lateral elbow pain, an ankle sprain, or chronic neck-related headaches, spinal and extremity manipulations are powerful tools in the Regenerative Rehab toolkit. We use momentum induced techniques and specific levers (rotation, side shift, side bend) to target the exact segment that is restricted. We do not manipulate at end range of motion for the cervical spine.
Click here to see a full list of treatments and our methods
Stop living in fear of the "crack" and start leveraging the science of the "reset."
Ready for a diagnosis that leads straight to results?
Book your appointment today and let's find out what's holding you back.
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