Mourad Firas, Dunning James, Zingoni Andrea, Iorio Raffaele, Butts Raymond, Zacharko Noah, Fernández-de-Las-Peñas César
Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, Alabama; Poliambulatorio Physio Power, Brescia, Italy.
Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, Alabama.
J Manipulative Physiol Ther. 2019 Jan;42(1):12-22. doi: 10.1016/j.jmpt.2018.08.002.
The purpose of this study was to determine from which side of the spine the popping sound (PS) emanates during side-lying, rotatory high-velocity low-amplitude (HVLA) thrust manipulation directed to the L5-S1 articulation using a time-frequency analysis. Secondary aims were to calculate the average number of PSs, the duration of lumbar thrust manipulation, and the duration of a single PS.
Thirty-four asymptomatic participants received 2 lumbar HVLA thrust manipulations targeting the right and left L5-S1 articulations. Two high sampling rate accelerometers were secured bilaterally 25 mm lateral to the midline of the L5-S1 interspace. For each manipulation, 2 audio signals were extracted and singularly processed via spectrogram calculation to obtain the release of energy over time on each side of the lumbosacral junction.
During 60 HVLA thrust manipulations, it was measured a total of 320 PSs. Of those PSs, 176 occurred ipsilateral and 144 occurred contralateral to the targeted L5-S1 articulation; that is, the PS was no more likely to occur on the upside than the downside facet after right or left rotatory L5-S1 HVLA thrust manipulation. Moreover, PSs occurring on both sides at the same time were detected very rarely (ie, 2% of cases) with the lumbar HVLA thrust manipulations. The mean number of audible PSs per lumbosacral HVLA thrust manipulation was 5.27 (range 2-9). The mean duration of a single manipulation was 139.13 milliseconds (95% confidence interval: 5.61-493.79), and the mean duration of a single PS was 2.69 milliseconds (95% confidence interval: 0.95-4.59).
Based on our findings, spinal manipulative therapy practitioners should expect multiple PSs that most often occur on the upside or the downside facet articulations when performing HVLA thrust manipulation to the lumbosacral junction (ie, L5-S1). However, whether the multiple PSs found in this study emanated from the same joint or adjacent ipsilateral or contralateral facet joints remains unknown. A single model may not necessarily be able to explain all of the audible sounds during HVLA thrust manipulation.
本研究旨在通过时频分析确定在针对L5-S1关节进行侧卧旋转高速低幅（HVLA）推力整复手法时，爆裂声（PS）是从脊柱的哪一侧发出的。次要目的是计算PS的平均数量、腰椎推力整复手法的持续时间以及单个PS的持续时间。
34名无症状参与者接受了针对左右L5-S1关节的2次腰椎HVLA推力整复手法。两个高采样率加速度计分别固定在L5-S1椎间隙中线外侧25毫米处的两侧。对于每次手法，提取2个音频信号并通过频谱图计算单独处理，以获得腰骶关节两侧随时间的能量释放情况。
在60次HVLA推力整复手法中，共测量到320次PS。在这些PS中，176次发生在目标L5-S1关节的同侧，144次发生在对侧；也就是说，在左右旋转L5-S1 HVLA推力整复手法后，PS在上方小关节面出现的可能性并不比下方小关节面更高。此外，在腰椎HVLA推力整复手法中，很少检测到两侧同时出现PS的情况（即2%的病例）。每次腰骶部HVLA推力整复手法中可听到的PS的平均数量为5.27（范围为2 - 9）。单次手法的平均持续时间为139.13毫秒（95%置信区间：5.61 - 493.79），单个PS的平均持续时间为2.69毫秒（95%置信区间：0.95 - 4.59）。
基于我们的研究结果，脊柱手法治疗从业者在对腰骶关节（即L5-S1）进行HVLA推力整复手法时，应预期会出现多个PS，这些PS最常出现在上方或下方小关节面。然而，本研究中发现的多个PS是来自同一个关节还是同侧或对侧相邻的小关节仍不清楚。单一模型不一定能够解释HVLA推力整复手法期间所有可听到的声音。
