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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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Europa Medicophysica 1999 March;35(1):41-5

language: English

The aud­ible crack­ing ­sound asso­ciat­ed ­with lum­bar spi­nal manip­u­la­tions. A preliminary report

Rucco V. 1, Lo Giudice P. 2

1 Rehabilitation Unit, Ospedale di Spilimbergo-Maniago, Maniago (Pordenone);
2 Department of Orthopaedic Surgery, II Università di Medicina, Napoli, Italy


BACKGROUND: An ­often ­employed tech­nique of ver­te­bral manip­u­la­tion is the ­high veloc­ity and low ampli­tude ­thrust tech­nique. The appli­ca­tion of ­this tech­nique is ­often accom­pa­nied by an aud­ible crack­ing ­sound (ACS).
Integral to the manip­u­la­tive pro­cess, the ACS dis­tin­guish­es manip­u­la­tion in gen­er­al ­from mobil­iza­tion and indi­cates ­that some­thing is occur­ring in the zyga­poph­y­seal ­joint. Some ­authors main­tain ­that the ­side of the ­joint ­crack is depen­dent on the ­patient’s posi­tion and the ­type of manip­u­la­tive ­thrust ­used, but the few stud­ies to ­have ­addressed ­this top­ic ­have pro­duced con­flict­ing ­results. The pur­pose of the ­present ­study was to deter­mine wheth­er ­there is a rela­tion­ship ­between the ­side of the aud­ible crack­ing ­sound and the rota­tion ­side dur­ing the lum­bar manip­u­la­tion.
METHOD: Twenty-­three vol­un­teers ­were sub­ject­ed to a sin­gle manip­u­la­tion (by the ­thrust tech­nique) in rota­tion ­with the tho­rac­o­lum­bar ­tract ­placed in kypho­sis. Before manip­u­la­tion, ­each sub­ject had a omni­di­rec­tion­al micro­phon­ic con­dens­er cap­sule ­affixed to ­both ­sides of the lum­bar ­spine (­about 5 cm lat­er­al­ly to the spi­nous pro­cess­es). Each micro­phone was ­tagged ­with a ­right or ­left mark­er cor­re­spond­ing to the ­left and ­right chan­nels of the record­er.
RESULTS: In 19 cas­es the ACS ­occurred in the zyga­poph­y­seal ­joint(s) con­tro­lat­er­al to the ­thrust direc­tion and in 4 cas­es in the zyga­poph­y­seal ­joint(s) on ­both ­sides. In no ­case did the ACS ­occur ­only in zyga­poph­y­seal ­joint(s) homo­lat­er­al to the ­thrust direc­tion.
CONCLUSIONS: In ­recent ­years, ­long-stand­ing ­terms ­such as “ver­te­bral sub­lux­a­tion”, “restric­tion of move­ment at a ver­te­bral seg­ment”, “­block” or “­lock of a ver­te­bral seg­ment”, “derange­ment ­intervertébraux ­mineurs”, ­have ­been grad­u­al­ly ­replaced by “fac­et syn­drome” (American English) or “zyga­poph­y­seal ­joint syn­drome” (British and Australian English). These new def­i­ni­tions ­call atten­tion to the ­role of ­these ver­te­bral ­joints in ­some pain­ful ver­te­bral syn­dromes. For ­this rea­son, to be ­able to iden­ti­fy the zyga­poph­y­seal ­joint in ­which an ACS ­occurs dur­ing manip­u­la­tion may fur­ther our under­stand­ing of the mech­a­nisms of ­action of ver­te­bral manip­u­la­tions.

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