Quantification of Cavitation and Gapping of Lumbar Zygapophyseal Joints During Spinal Manipulative Therapy

• Published in: Journal of manipulative and physiological therapeutics 2012-10, Vol.35 (8), p.614-621
• Main Authors: Cramer, Gregory D., DC, PhD, Ross, Kim, DC, PhD, Raju, P.K., PhD, Cambron, Jerrilyn, DC, MPH, PhD, Cantu, Joe A., DC, Bora, Preetam, MSME, Dexheimer, Jennifer M., BS, LMT, McKinnis, Ray, PhD, Habeck, Adam R., DC, Selby, Scott, DC, Pocius, Judith D., MS, Gregerson, Douglas, DC
• Format: Article
• Language: English
• Subjects: Acceleration; Adolescent; Adult; Cavitation; Chiropractic; Confidence Intervals; Evaluation Studies as Topic; Facet Joints; Female; Humans; Low Back Pain - diagnosis; Low Back Pain - therapy; Lumbar Vertebrae; Lumbosacral Region; Magnetic Resonance Imaging - methods; Male; Manipulation, Spinal - methods; Pain Management; Physical Medicine and Rehabilitation; Range of Motion, Articular - physiology; Reference Values; Single-Blind Method; Spinal Manipulation; Treatment Outcome; Young Adult; Zygapophyseal Joint - pathology; Zygapophyseal Joints
• ISSN: 0161-4754; 1532-6586
• DOI: 10.1016/j.jmpt.2012.06.007

Abstract Objectives The purpose of this study was to use previously validated methods to quantify and relate 2 phenomena associated with chiropractic spinal manipulative therapy (SMT): (1) cavitation and (2) the simultaneous gapping (separation) of the lumbar zygapophyseal (Z) joint spaces. Methods This was a randomized, controlled, mechanistic clinical trial with blinding. Forty healthy participants (18-30 years old) without a history of low-back pain participated. Seven accelerometers were affixed to the skin overlying the spinous processes of L1 to L5 and the S1 and S2 sacral tubercles. Two additional accelerometers were positioned 3 cm left and right lateral to the L4/L5 interspinous space. Participants were randomized into group 1, side-posture SMT (n = 30), or group 2, side-posture positioning (SPP, n = 10). Cavitations were determined by accelerometer recordings during SMT and SPP (left side = upside for both groups); gapping (gapping difference) was determined by the difference between pre- and postintervention magnetic resonance imaging scan joint space measurements. Results of mean gapping differences were compared. Results Upside SMT and SPP joints gapped more than downside joints (0.69 vs − 0.17 mm, P < .0001). Spinal manipulative therapy upside joints gapped more than SPP upside joints (0.75 vs 0.52 mm, P = .03). Spinal manipulative therapy upside joints gapped more in men than in women (1.01 vs 0.49 mm, P < .002). Overall, joints that cavitated gapped more than those that did not (0.56 vs 0.22 mm, P = .01). No relationship was found between the occurrence of cavitation and gapping with upside joints alone ( P = .43). Conclusions Zygapophyseal joints receiving chiropractic SMT gapped more than those receiving SPP alone; Z joints of men gapped more than those of women, and cavitation indicated that a joint had gapped but not how much a joint had gapped.