Bilateral and multiple cavitation sounds during upper cervical thrust manipulation

BMC Musculoskeletal Disorders

Research Article

James Dunning¹  Marco Barbero²  Corrado Cescon²  Diego Leoni²  Firas Mourad³  Raymond Butts⁴ 

[1] Alabama Physical Therapy & Acupuncture, Montgomery, AL, USA;Nova Southeastern University, Fort Lauderdale, FL, USA;Department of Health Sciences, University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Manno, Switzerland;Sportlife Physiotherapy, Montichiari, Italy;University of South Carolina, Columbia, SC, USA;

关键词: Cavitation;    Popping sound;    High velocity thrust manipulation;    Upper cervical;   

DOI  :  10.1186/1471-2474-14-24

 received in 2012-06-22, accepted in 2013-01-12,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundThe popping produced during high-velocity, low-amplitude (HVLA) thrust manipulation is a common sound; however to our knowledge, no study has previously investigated the location of cavitation sounds during manipulation of the upper cervical spine. The primary purpose was to determine which side of the spine cavitates during C1-2 rotatory HVLA thrust manipulation. Secondary aims were to calculate the average number of pops, the duration of upper cervical thrust manipulation, and the duration of a single cavitation.MethodsNineteen asymptomatic participants received two upper cervical thrust manipulations targeting the right and left C1-2 articulation, respectively. Skin mounted microphones were secured bilaterally over the transverse process of C1, and sound wave signals were recorded. Identification of the side, duration, and number of popping sounds were determined by simultaneous analysis of spectrograms with audio feedback using custom software developed in Matlab.ResultsBilateral popping sounds were detected in 34 (91.9%) of 37 manipulations while unilateral popping sounds were detected in just 3 (8.1%) manipulations; that is, cavitation was significantly (P < 0.001) more likely to occur bilaterally than unilaterally. Of the 132 total cavitations, 72 occurred ipsilateral and 60 occurred contralateral to the targeted C1-2 articulation. In other words, cavitation was no more likely to occur on the ipsilateral than the contralateral side (P = 0.294). The mean number of pops per C1-2 rotatory HVLA thrust manipulation was 3.57 (95% CI: 3.19, 3.94) and the mean number of pops per subject following both right and left C1-2 thrust manipulations was 6.95 (95% CI: 6.11, 7.79). The mean duration of a single audible pop was 5.66 ms (95% CI: 5.36, 5.96) and the mean duration of a single manipulation was 96.95 ms (95% CI: 57.20, 136.71).ConclusionsCavitation was significantly more likely to occur bilaterally than unilaterally during upper cervical HVLA thrust manipulation. Most subjects produced 3–4 pops during a single rotatory HVLA thrust manipulation targeting the right or left C1-2 articulation; therefore, practitioners of spinal manipulative therapy should expect multiple popping sounds when performing upper cervical thrust manipulation to the atlanto-axial joint. Furthermore, the traditional manual therapy approach of targeting a single ipsilateral or contralateral facet joint in the upper cervical spine may not be realistic.

【 授权许可】

CC BY   
© Dunning et al.; licensee BioMed Central Ltd. 2013