The displaced vertebra, myth or reality?
by Antoine Pérot
"I locked my back. I must have a displaced vertebra. I'm going to ring my osteopath, so that he puts it back in place. »
It is not uncommon to hear this kind of statement before, after or during an osteopathic consultation. In a statistical study, 49% of participants associated the “crunch” with spinal repositioning. (1) Many are those (therapists and patients) who still convey this concept of displaced vertebra. But is it still on the agenda?
Historically, the first caregivers to use spinal manipulation techniques were called bone setters. They were known to heal and treat dislocations or even sometimes fractures!
The “bone setters” being the ancestors of osteopaths and/or chiropractors, this concept of “bone straightening” is still used today.
A LITTLE ANATOMICAL REMINDER:
The spinal column is made up of 24 vertebrae that stack on top of each other. The vertebrae are interconnected by very powerful ligaments as well as muscles preventing any form of displacement.
From a physiological point of view (normal functional state of man), it is therefore impossible for a vertebra to move. The only cases where we will observe a vertebral displacement strictly speaking are associated with pathologies of the spine (spondylolisthesis) or serious accidents (car accident, fall) which require, in both cases, surgical treatment.
BUT THEN, WHAT REALLY HAPPENS DURING JOINT MANIPULATION, WHEN IT CRACKS?
Joint noise heard during manipulation is associated with the production of small gas bubbles within the joint (tribonucleation phenomenon). (2)
During this same manipulation, we do find a vertebral displacement BUT of the order of a millimeter. It is therefore more appropriate to speak of minimal, relative movement rather than real vertebral displacement. (3-4)
WHY THIS FEELING OF DISPLACED VERTEBRA, LOCKED VERTEBRA?
The sensation of dorsal blockage comes from too much tension in the deep muscles of the spine, probably associated with too much muscle activity (a sudden movement, more important and/or inappropriate physical activity). This greater muscle tension will hinder the mobility of one or more vertebrae and give rise to a sensation of blockage.
Spinal manipulation will be indicated in this situation (but not for single use!). It will aim to restore mobility at the levels impacted by complex neurophysiological mechanisms. (5) Vertebral manipulation will notably make it possible to relax the surrounding muscles by reflex action.
This feeling of post-manipulation well-being is therefore in no way linked to the repositioning of a displaced vertebra
A vertebra does not move! Except in cases of violent trauma
The osteopath, or any other therapist, therefore does not put a vertebra back in place
Yet many therapists will defend this misconception in order to further mystify the benefit of their intervention! But from a medical, scientific and orthopedic point of view, this does not represent reality at all.
Want advice or more information? Contact our team of physiotherapists or osteopaths.
We care, u perform.
1. Demoulin C, Baeri D, Toussaint G, et al. Beliefs in the population about cracking sounds produced during spinal manipulation. Joint Bone Spine. 2018;85(2):239-242. doi:10.1016/j.jbspin.2017.04.006
2. Kawchuk GN, Fryer J, Jaremko JL, Zeng H, Rowe L, Thompson R. Real-Time Visualization of Joint Cavitation. Zhang Q, ed. PLoS ONE. 2015;10(4):e0119470. doi:10.1371/journal.pone.0119470
3. Cramer GD, Ross K, Pocius J, et al. Evaluating the Relationship Among Cavitation, Zygapophyseal Joint Gapping, and Spinal Manipulation: An Exploratory Case Series. Journal of Manipulative and Physiological Therapeutics. 2011;34(1):2-14. doi:10.1016/j.jmpt.2010.11.008
4. Cramer GD, Ross K, Raju PK, et al. Quantification of Cavitation and Gapping of Lumbar Zygapophyseal Joints During Spinal Manipulative Therapy. Journal of Manipulative and Physiological Therapeutics. 2012;35(8):614-621. doi:10.1016/j.jmpt.2012.06.007
5. Wirth B, Gassner A, de Bruin ED, Axén I, Swanenburg J, Humphreys BK, Schweinhardt P. Neurophysiological Effects of High Velocity and Low Amplitude Spinal Manipulation in Symptomatic and Asymptomatic Humans: A Systematic Literature Review. Spine (Phila Pa 1976). 2019 Aug 1;44(15):E914-E926. doi: 10.1097/BRS.0000000000003013. PMID: 31335790.