Document Detail

Quantification of cavitation and gapping of lumbar zygapophyseal joints during spinal manipulative therapy.
MedLine Citation:
PMID:  22902194     Owner:  NLM     Status:  MEDLINE    
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.
Gregory D Cramer; Kim Ross; P K Raju; Jerrilyn Cambron; Joe A Cantu; Preetam Bora; Jennifer M Dexheimer; Ray McKinnis; Adam R Habeck; Scott Selby; Judith D Pocius; Douglas Gregerson
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2012-08-14
Journal Detail:
Title:  Journal of manipulative and physiological therapeutics     Volume:  35     ISSN:  1532-6586     ISO Abbreviation:  J Manipulative Physiol Ther     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-11-19     Completed Date:  2013-04-29     Revised Date:  2013-10-17    
Medline Journal Info:
Nlm Unique ID:  7807107     Medline TA:  J Manipulative Physiol Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  614-21     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Department of Research, National University of Health Sciences, Lombard, IL 60148, USA.
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MeSH Terms
Confidence Intervals
Evaluation Studies as Topic
Low Back Pain / diagnosis,  therapy*
Lumbar Vertebrae*
Lumbosacral Region
Magnetic Resonance Imaging / methods
Manipulation, Spinal / methods*
Pain Management
Range of Motion, Articular / physiology*
Reference Values
Single-Blind Method
Treatment Outcome
Young Adult
Zygapophyseal Joint / pathology*
Grant Support
Comment In:
J Manipulative Physiol Ther. 2013 May;36(4):259-60   [PMID:  23769264 ]
J Manipulative Physiol Ther. 2013 May;36(4):259   [PMID:  23816258 ]

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