Brodeur R
Department of Biomechanics, Michigan State University, East Lansing 48824, USA.
J Manipulative Physiol Ther. 1995 Mar-Apr;18(3):155-64.
The objective of this paper is to review the literature on the audible release associated with manipulation.
Bibliographic information in pertinent articles and papers located in the MEDLINE database containing the keywords joint, joints, cartilage, crack, cracking, cavitation, crepitus and noise.
All articles relevant to the objectives were selected.
All available data was used.
The audible release is caused by a cavitation process whereby a sudden decrease in intracapsular pressure causes dissolved gasses in the synovial fluid to be released into the joint cavity. Once a joint undergoes cavitation, the force-displacement curve changes and the range of motion of the joint increases. The gasses released from the synovial fluid make up about 15% of the joint volume and consist of approximately 80% carbon dioxide. Habitual joint cracking does not correlate with arthritic changes, but does correlate with loss of grip strength and soft-tissue swelling. During the "crack" associated with a joint manipulation, there is a sudden joint distraction that occurs in less time than that required to complete the stretch reflexes of periarticular muscles. Theories on the cavitation mechanism were reviewed and new information on the cavitation process is introduced. In this paper, it is proposed that the cavitation process is generated by an elastic recoil of the synovial capsule as it "snaps back" from the capsule/synovial fluid interface.
Because the sudden joint distraction during a manipulation occurs in a shorter time period than that required to complete the stretch reflexes of the periarticular muscles, there is likely to be a high impulse acting on the ligaments and muscles associated with the joint. This is an important conclusion, because others have proposed that reflex actions from high threshold periarticular receptors are associated with the many beneficial results of manipulation. This suggests that the cavitation process provides a simple means for initiating the reflex actions and that without the cavitation process, it would be difficult to generate the forces in the appropriate tissue without causing muscular damage.
本文旨在综述与手法治疗相关的可闻性关节松动的文献。
MEDLINE数据库中相关文章和论文的书目信息，关键词包括关节、关节、软骨、爆裂声、发出爆裂声、气穴现象、摩擦音和噪音。
选取所有与研究目的相关的文章。
使用所有可得数据。
可闻性关节松动是由气穴现象过程引起的，即关节囊内压力突然降低导致滑液中溶解的气体释放到关节腔中。一旦关节发生气穴现象，力-位移曲线会发生变化，关节的活动范围会增加。从滑液中释放出的气体约占关节容积的15%，其中约80%为二氧化碳。习惯性关节弹响与关节炎变化无关，但与握力丧失和软组织肿胀相关。在与关节手法治疗相关的“爆裂声”过程中，会出现突然的关节牵张，其发生时间比完成关节周围肌肉的牵张反射所需时间短。对气穴现象机制的理论进行了综述，并介绍了气穴现象过程的新信息。本文提出，气穴现象过程是由滑膜囊从囊/滑液界面“回弹”时的弹性回缩产生的。
由于手法治疗过程中突然的关节牵张发生时间比完成关节周围肌肉的牵张反射所需时间短，因此很可能有一个高冲击力作用于与该关节相关的韧带和肌肉。这是一个重要结论，因为其他人提出，来自高阈值关节周围感受器的反射作用与手法治疗的许多有益效果相关。这表明气穴现象过程为引发反射作用提供了一种简单方式，并且如果没有气穴现象过程，在不造成肌肉损伤的情况下，很难在适当组织中产生所需力量。
