The side, duration, and number of cavitation sounds during upper cervical thrust manipulation

Dunning, James and Mourad, Firas and Leoni, Diego and Barbero, Marco and Cescon, Corrado and Cleland, Joshua (2012) The side, duration, and number of cavitation sounds during upper cervical thrust manipulation. In: X IFOMPT Congress “A Rendez-Vous of Hands and Monds” , 30 Oct - 05 Nov 2012, Quebec City, Canada.

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PURPOSE: The primary purpose was to determine which side of the spine cavitates during C1-2 thrust manipulation. Secondary purposes were to calculate the average number of pops, the duration of upper cervical thrust manipulation, and the duration of a single cavitation. RELEVANCE: The popping produced during joint manipulation is a common sound; however, to date, only 1 study has previously investigated the location of cavitation sounds during thrust manipulation of the cervical spine, and no study has investigated the side, duration, or number of popping sounds when targeting the C1-2 articulation. METHODS: Nineteen asymptomatic participants received 2 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. Sound-wave signals were recorded. Identificationof the side, duration, and number of popping sounds was determined by simultaneous analysis of spectrograms with audio feedback using customsoftware developed in MATLAB. RESULTS: Bilateral popping sounds were detected in 34 (91.9%) of 37 manipulations, whereas unilateral popping sounds were detected in just 3 (8.1%) manipulations. Of the 132 total cavitations, 72 occurred ipsilateral and 60 occurred contralateral to the targeted C1-2 articulation; that is, cavitation was no more likely to occur on the ipsilateral than the contralateral side (P = .294). The mean number of pops per manipulation was 3.57. The mean duration of a single manipulation was 96.95 milliseconds, and the mean duration of a single pop was 5.66 milliseconds. CONCLUSIONS: Most subjects produced 3 to 4 pops during a single C1-2 thrust manipulation. The cavitation sounds during upper cervical thrust manipulation are 11 times more likely to occur bilaterally than just unilaterally. IMPLICATIONS: Clinicians should expect multiple popping sounds when performing upper cervical thrust manipulation; hence, the traditional approach of targeting a single ipsilateral or contralateral facet joint may not be realistic.

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