Determining Cavitation Location During Lumbar and Thoracic Spinal Manipulation

Abstract

In the lumbar spine, SMT was accurate about half the time. However, because most procedures were associated with multiple cavitations, in most cases, at least one cavitation emanated from the target joints. In the thoracic spine, SMT appears to be more accurate.

Improved Activation of Lumbar Multifidus Following Spinal Manipulation: A Case Report Applying Rehabilitative Ultrasound Imaging

“…5,18,20 The parasagittal view used in this case has been described in the literature as being used for realtime biofeedback to augment learning of volitional contraction of the lumbar multifidus. 20,40 Kiesel et al 28 reported the reliability of the parasagittal measurement (ICC 3,1 = 0.85) and (ICC 3,1 = 0.80) in asymptomatic subjects, but the SEM was not reported. The reliability results reported earlier (ICC 3,3 = 0.98; SEM, 0.094 cm) are from an ongoing clinical trial on patients with acute LBP where the average of 3 measures is being utilized.…”

“…2, 40 Ross et al, 40 utilizing accelerometers secured to the skin, reported an accuracy rate of only 46% when attempting to target a specific lumbar segment with manipulation. He also reported an average error from target of 1 vertebral segment and concluded that manipulation in the lumbar spine is generally not accurate.…”

“…This task was chosen because it allows for an objective measurement of multifidus thickness change and is not dependent on an individual's ability to volitionally contract the deep muscle system, which is known to vary in asymptomatic subjects. 40 The patient was positioned in prone with a pillow under his abdomen to slightly flex the lumbar spine for better imaging, and his shoulders were abducted to approximately 120°. The transducer was placed just lateral to midline on the left side over the lower lumbar segments in the sagittal plane (parasagittal view of the lumbar multifidus 47 ) and adjusted until an adequate view of the lumbar facet joints was obtained.…”

Heuristic exploration of how leg checking procedures may lead to inappropriate sacroiliac clinical interventions

“…There are legitimate grounds to question this assumption, as I did when in 2001 I asked the following question: "If, as so many have said, a good treatment outcome depends on an accurate diagnosis, then how can we explain fairly uniformly good outcomes, given huge variation in diagnostic inputs?" 55 In addition to the problems we have seen in achieving diagnostic specificity, there are similar problems in staking claim to treatment specificity, as exemplified in the works of Ross et al 56,57 These investigators showed that cavitations during manipulation are often multiple and may occur at spinal locations other than where the segmental contact is applied. Perle and Kawchuck 58 and Perle 59 have also effectively weighed in on the issue and likelihood of adjustive specificity.…”

Acceleration of clinician hand movements during spinal manipulative therapy

“…During the manipulative procedure there is often a "cracking" sound signifying successful cavitation of the joint (Herzog et al, 1993a;Herzog et al, 1997;Ross et al, 2004;Pickar & Kang, 2006). Cavitation is theorized to be the result of the formation of vapor and gas bubbles within the synovial fluid upon quick separation of the joint.…”