Unilateral and Multiple Cavitation Sounds During Lumbosacral Spinal Manipulation

Area of Science:

• Biomedical Engineering
• Orthopedics
• Physiotherapy

Background:

• Spinal manipulative therapy (SMT) often produces audible popping sounds, commonly referred to as the "cavitation" or
• The precise origin of these sounds during lumbar high-velocity low-amplitude (HVLA) thrust manipulation, particularly at the L5-S1 articulation, remains incompletely understood.

Purpose of the Study:

• To determine the origin side of popping sounds (PS) during side-lying rotatory HVLA thrust manipulation at the L5-S1 articulation.
• To quantify the frequency, duration, and occurrence patterns of PS during lumbar HVLA thrust manipulation.

Main Methods:

• Thirty-four asymptomatic participants underwent HVLA thrust manipulations targeting the L5-S1 articulation.
• High sampling rate accelerometers were placed bilaterally at the L5-S1 interspace to record vibrations.
• Audio signals were processed using spectrogram analysis to identify the timing and location of energy release (PS).

Main Results:

• A total of 320 PSs were recorded during 60 HVLA thrust manipulations.
• PSs occurred with nearly equal frequency on the ipsilateral (176) and contralateral (144) sides of the targeted L5-S1 articulation.
• The mean number of PSs per manipulation was 5.27, with a mean duration of 2.69 milliseconds.

Conclusions:

• The popping sound during lumbar HVLA thrust manipulation to the L5-S1 segment can originate from either the ipsilateral or contralateral facet joints.
• Practitioners should anticipate multiple PSs during SMT of the lumbosacral junction.
• Further research is needed to elucidate the exact anatomical source of each individual PS.