HVT, or “clicking” is a technique a lot of patients would put down as a core part of their osteopathic treatment. But what really happens when we click a joint?
The Aims of HVT
This is a tool we have to get quick results in increasing movement and potentially relaxing the local musculature if there’s any guarding going on. If the muscles are really tight, they’ll need relaxing first so we can get the movement without them blocking the technique. But often, once the joint has “clicked”, the muscles relax themselves. The reasoning here is that the locking and tension created a vicious cycle, where signals the brain picked up were interpreted as “danger”, and the action was to tense up the muscles to hold that joint still and safe. But it’s that locking that causes further discomfort, and breaking the cycle can be difficult to achieve alone. A movement like HVT can be quick enough to make a change before the muscles have a chance to react and block it. There are other ways to convince the muscle to relax, but they typically take longer.
The Details
HVT is a shorter abbreviation of HVLAT. The latter stands for High Velocity, Low Amplitude Thrust. Put simply, it’s a short but quick movement. There are a few theories to explain how HVT might improve movement and decrease pain. One paper suggests that the click has an impact on the nervous system, causing local muscles to relax. This would explain some of it, but what about the actual “click”? We know from MRI imaging of someone clicking their knuckles that something happens within the joint. The flash seen on video could be interpreted as gases within the joint fluid forming a bubble. Either the formation or the pop of the bubble could be causing the sound. Ultimately, we don’t know exactly why clicking joints has the effect it does, but we do know that it helps.
Who is HVT for?
HVT is not suitable for everyone, and not everyone wants it anyway. If there are questions about low bone density or conditions that alter the way bone is laid down in certain areas, clicking is contraindicated. Clicking the thoracic (upper back) spine generally has the low rates of side effects in comparison to the neck and lower back. But osteoporosis can predispose this area to crush fractures, so may be best avoided if there are any hints of low density. There are still plenty of other ways to work around osteoporosis, so don’t let a diagnosis stop you from coming in. In fact, we may be able to help support your bone health by working to help you return to load bearing exercise. This is well recognised as the best thing you can do to improve your bone density, so pain need not limit your improvement there.
Another big reason to avoid HVT is if you simply don’t want it! Without your consent we can’t treat. Consent is ongoing, so if you’re happy to have one area clicked but not another, that’s fine too. We have other techniques we can use to reach the same goals.
