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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE
Rivista di Medicina Fisica e Riabilitativa dopo Eventi Patologici
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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Europa Medicophysica 1999 March;35(1):41-5
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.