Joint manipulations involve stretching a joint to a comfortable yet therapeutic range, followed by a quick controlled impulse. This causes a stretching or opening of the joint capsule, which is sometimes followed by a “pop” and a feeling of pressure release. The pop is a bubble being evaporated from the fluid on the surface of the joint, and not related to bones moving “into place”. After an adjustment, a sensation of pain relief, improved mobility, and general lightness of the body region is common.

Joint manipulation techniques are the second most studied treatment modality (exercise being the first) for common spinal conditions like neck and low back pain. They have been shown to be particularly effective for managing acute episodes, and as part of a care plan to help with chronic issues.

Adjustments are what most people think of when they think of Chiropractors, since the profession originated using adjustments as a main treatment tool. Because of their popularity and effectiveness, multiple professions and clinical practice guidelines now recommended using joint manipulation as a first line treatment for certain conditions.

Joint mobilizations involve a gentle “gliding” of joint spaces in order to reduce pain, improve mobility, and restore normal function. They are a lighter option than manipulations, and are often preferred if manipulation cannot be done due to history or condition-specific factors, or patient preference.

Joint mobilizations have been shown to reduce pain and improve function at similar levels as joint manipulations in some studies, and are therefore a very helpful alternative to manipulations. They can also be done with movement and this lets the patient guide the intensity of the treatment, while improving a limited or painful range of motion at the same time.

It is increasingly common that Chiropractors use joint mobilizations as well as adjustments to treat joint pain, depending on the patient, the Chiropractor, and the condition.

Traction techniques involve either manual (hands-on) or belt-assisted traction to a joint. Depending on the condition, traction can be very helpful in reducing pressure to a joint segment, and in some cases relieving nerve compression.

Traction is often effective for the neck pain, low back pain, hip pain, and certain nerve compression conditions like spinal stenosis. Although traction can be helpful and often feels relieving in the moment, it is more condition-specific than joint glides or adjustments, and is not effective for every joint problem. In other words, the use of traction is best guided by a proper examination.

Instrument-Assisted joint therapy involves the use of manual adjusting instruments (known as the “activator”). They are thought to be the lightest form of joint treatment, and as a result are sometimes used in infants, children, and older adults.

While they are preferred for some people and offered as an option, instrument-assisted therapies can be too light a treatment for most people. They do not have the same volume of research to back them up as adjustments, joint glides, or traction techniques.