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Europa Medicophysica 1999 March;35(1):41-5


lingua: Inglese

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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