Journal of Manipulative and Physiological Therapeutics
Volume 29, Issue 1 , Pages 72-82 , January 2006

A Biomechanical Model for Mechanically Efficient Cavitation Production During Spinal Manipulation: Prethrust Position and the Neutral Zone

  • David W. Evans, BSc(Hons)Ost

      Affiliations

    • Researcher, School of Health and Rehabilitation, Keele University, Staffordshire, UK; Associate Researcher, Research Centre, British School of Osteopathy, London, UK
    • Corresponding Author InformationSubmit requests for reprints to: David W. Evans, School of Health and Rehabilitation, MacKay Building, Keele University, Staffordshire, ST5 5BG, UK.
    • ,
  • Alan C. Breen, DC, PhD

      Affiliations

    • Director, Institute for Musculoskeletal Research and Clinical Implementation, AECC, Bournemouth, UK

Received 3 August 2004 ,Revised 2 August 2005

References 

  1. Harvey E, Burton AK, Moffett JK, Breen A. Spinal manipulation for low-back pain: a treatment package agreed to by the UK chiropractic, osteopathy and physiotherapy professional associations. Man Ther. 2003;8:46–51
  2. Cramer GD, Gregerson DM, Knudsen JT, Hubbard BB, Ustas LM, Cantu JA. The effects of side-posture positioning and spinal adjusting on the lumbar Z joints: a randomized controlled trial with sixty-four subjects. Spine. 2002;27:2459–2466
  3. Herzog W, Symons B. The biomechanics of spinal manipulation. Crit Rev Phys Rehabil Med. 2001;13:191–216
  4. Evans DW. Mechanisms and effects of spinal high-velocity, low-amplitude thrust manipulation: previous theories. J Manipulative Physiol Ther. 2002;25:251–262
  5. Hearn A, Rivett DA. Cervical SNAGs: a biomechanical analysis. Man Ther. 2002;7:71–79
  6. Shekelle PG. Spinal manipulation. Spine. 1994;19:858–861
  7. Wright A. Hypoalgesia post-manipulative therapy: a review of a potential neurophysiological mechanism. Man Ther. 2000;1:11–16
  8. Zusman M. What does manipulation do? The need for basic research. In:  Boyling JD,  Pastalanga N editor. Grieve's modern manual therapy. Edinburgh: Churchill Livingstone; 1994;p. 651–659
  9. Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Ann Intern Med. 2003;138:871–881
  10. Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine. 1996;21:1746–1759
  11. Koes BW, Assendelft WJ, van der Heijden GJ, Bouter LM. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine. 1996;21:2860–2871
  12. Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Brook RH. Spinal manipulation for low-back pain. Ann Intern Med. 1992;117:590–598
  13. van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine. 1997;22:2128–2156
  14. Haas M, Groupp E, Panzer D, Partna L, Lumsden S, Aickin M. Efficacy of cervical endplay assessment as an indicator for spinal manipulation. Spine. 2003;28:1091–1096
  15. Lee M, Gál JM, Herzog W. Biomechanics of manual therapy. In:  Dvir Z editors. Clinical biomechanics. Philadelphia: Churchill Livingstone; 2000;p. 209–238
  16. Rebain R, Baxter GD, McDonough S. The passive straight leg raising test in the diagnosis and treatment of lumbar disc herniation: a survey of United Kingdom osteopathic opinion and clinical practice. Spine. 2003;28:1717–1724
  17. Solinger AB. Theory of small vertebral motions: an analytical model compared to data. Clin Biomech (Bristol, Avon). 2000;15:87–94
  18. Herzog W, Kawchuk GN, Conway PJW. Relationship between preload and peak forces during spinal manipulative treatments. J Neuromusculoskelet Syst. 1993;1:52–58
  19. Van Zoest GG, Gosselin G. Three-dimensionality of direct contact forces in chiropractic spinal manipulative therapy. J Manipulative Physiol Ther. 2003;26:549–556
  20. Klein P, Broers C, Feipel V, Salvia P, Van Geyt B, Dugailly PM, et al. Global 3D head-trunk kinematics during cervical spine manipulation at different levels. Clin Biomech (Bristol, Avon). 2003;18:827–831
  21. Triano JJ, Schultz AB. Motions of the head and thorax during neck manipulations. J Manipulative Physiol Ther. 1994;17:573–583
  22. Denslow J. Pathophysiologic evidence for the osteopathic lesion: the known, unknown, and controversial. In:  Beal M editors. The principles of palpatory diagnosis and manipulative technique. Newark (Ohio): American Academy of Osteopathy; 1989;p. 134–138
  23. Gibbons P, Tehan P. Manipulation of the spine, thorax and pelvis. An osteopathic perspective. Edinburgh: Churchill Livingstone; 2000;
  24. Gibbons P, Tehan P. Patient positioning and spinal locking for lumbar spine rotation manipulation. Man Ther. 2001;6:130–138
  25. Herzog W. The mechanical, neuromuscular, and physiologic effects produced by spinal manipulation. In:  Herzog W editors. Clinical biomechanics of spinal manipulation. New York: Churchill Livingstone; 2000;p. 191–207
  26. Livingstone WK. Pain mechanisms. New York: Macmillan Co; 1947;
  27. Maigne JY, Vautravers P. Mechanism of action of spinal manipulative therapy. Joint Bone Spine. 2003;70:336–341
  28. Mierau D, Cassidy JD, Bowen V, Dupuis P, Noftall F. Manipulation and mobilization of the third metacarpophalangeal joint. A quantitative radiographic and range of motion study. Man Med. 1986;3:135–140
  29. Reggars JW. The therapeutic benefit of the audible release associated with spinal manipulative therapy. A critical review of the literature. Aust Chiropr Osteopath. 1998;7:80–85
  30. Sandoz R. The significance of the manipulative crack and of other articular noises. Ann Swiss Chiro Assoc. 1969;4:47–68
  31. Ross JK, Bereznick DE, McGill SM. Determining cavitation location during lumbar and thoracic spinal manipulation: is spinal manipulation accurate and specific?. Spine. 2004;29:1452–1457
  32. Vernon H. Qualitative review of studies of manipulation-induced hypoalgesia. J Manipulative Physiol Ther. 2000;23:134–138
  33. Flynn TW, Fritz JM, Wainner RS, Whitman JM. The audible pop is not necessary for successful spinal high-velocity thrust manipulation in individuals with low back pain. Arch Phys Med Rehabil. 2003;84:1057–1060
  34. Unsworth A, Dowson D, Wright V. “Cracking joints”. A bioengineering study of cavitation in the metacarpophalangeal joint. Ann Rheum Dis. 1971;30:348–358
  35. Young FR. Cavitation. London: Imperial College Press; 1999;
  36. Trevena DH. Cavitation and tension in liquids. Bristol: Adam Hilger; 1987;
  37. Watson P, Kernohan WG, Mollan RAB. A study of the cracking sounds from the metacarpophalangeal joint. Proc Inst Mech Eng (H). 1989;203:109–118
  38. Chen YL, Kuhl T, Israelachvili J. Mechanism of cavitation damage in thin liquid films: collapse damage vs. inception damage. Wear. 1992;153:51
  39. Meal GM, Scott RA. Analysis of the joint crack by simultaneous recording of sound and tension. J Manipulative Physiol Ther. 1986;9:189–195
  40. Suter E, Herzog W, Conway PJ, Zhang YT. Reflex response associated with manipulative treatment of the thoracic spine. J Neuromusculoskelet Syst. 1994;2:124–130
  41. McGregor AH, Wragg P, Gedroyc WM. Can interventional MRI provide an insight into the mechanics of a posterior-anterior mobilisation?. Clin Biomech (Bristol, Avon). 2001;16:926–929
  42. Powers CM, Kulig K, Harrison J, Bergman G. Segmental mobility of the lumbar spine during a posterior to anterior mobilization: assessment using dynamic MRI. Clin Biomech (Bristol, Avon). 2003;18:80–83
  43. Brennan PC, Kokjohn K, Kaltinger CJ, Lohr GE, Glendening C, Hondras MA, et al. Enhanced phagocytic cell respiratory burst induced by spinal manipulation: potential role of substance P. J Manipulative Physiol Ther. 1991;14:399–408
  44. Brennan PC, Triano JJ, McGregor M, Kokjohn K, Hondras MA, Brennan DC. Enhanced neutrophil respiratory burst as a biological marker for manipulation forces: duration of the effect and association with substance P and tumor necrosis factor. J Manipulative Physiol Ther. 1992;15:83–89
  45. Triano JJ. The mechanics of spinal manipulation. In:  Herzog W editors. Clinical biomechanics of spinal manipulation. New York: Churchill Livingstone; 2000;p. 191–207
  46. Triano JJ. Biomechanics of spinal manipulative therapy. Spine J. 2001;1:121–130
  47. Cramer GD, Skogsbergh D, Tuck NR, Floyd J, Allen S, Fonda S, et al. In: The effects of spinal manipulative therapy on the L5 intervertebral foramina as evaluated by magnetic resonance imaging. Des Moines: Foundation for Chiropractic Education and Research; 1996;p. 158–160
  48. Cramer GD, Tuck NR, Knudsen JT, Fonda SD, Schliesser JS, Fournier JT, et al. Effects of side-posture positioning and side-posture adjusting on the lumbar zygapophysial joints as evaluated by magnetic resonance imaging: a before and after study with randomization. J Manipulative Physiol Ther. 2000;23:380–394
  49. Gál JM, Herzog W, Kawchuk GN, Conway PJ, Zhang YT. Biomechanical studies of spinal manipulative therapy (SMT): quantifying the movements of vertebral bodies during SMT. J Can Chiropr Assoc. 1994;38:11–24
  50. Gal JM, Herzog W, Kawchuk GN, Conway PJ, Zhang YT. Forces and relative vertebral movements during SMT to unembalmed post-rigor human cadavers: peculiarities associated with joint cavitation. J Manipulative Physiol Ther. 1995;18:4–9
  51. Gal J, Herzog W, Kawchuk G, Conway PJ, Zhang YT. Movements of vertebrae during manipulative thrusts to unembalmed human cadavers. J Manipulative Physiol Ther. 1997;20:30–40
  52. Kawchuk GN, Herzog W. Biomechanical characterization (fingerprinting) of five novel methods of cervical spine manipulation. J Manipulative Physiol Ther. 1993;16:573–577
  53. Maigne JY, Guillon F. Highlighting of intervertebral movements and variations of intradiskal pressure during lumbar spine manipulation: a feasibility study. J Manipulative Physiol Ther. 2000;23:531–535
  54. White AA, Panjabi MM. Clinical biomechanics of the spine. Philadelphia: JB Lippincott; 1990;
  55. Lindh M. Biomechanics of the lumbar spine. In:  Nordin M,  Frankel VH editor. Basic biomechanics of the musculoskeletal system. London: Lea & Febiger; 1989;p. 183–207
  56. Bogduk N, Yoganandan N. Biomechanics of the cervical spine part 3: minor injuries. Clin Biomech (Bristol, Avon). 2001;16:267–275
  57. McClure P, Siegler S, Nobilini R. Three-dimensional flexibility characteristics of the human cervical spine in vivo. Spine. 1998;23:216–223
  58. Herzog W, Kats M, Symons B. The effective forces transmitted by high-speed, low-amplitude thoracic manipulation. Spine. 2001;26:2105–2110
  59. Panjabi MM. The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord. 1992;5:390–396
  60. Thompson RE, Barker TM, Pearcy MJ. Defining the neutral zone of sheep intervertebral joints during dynamic motions: an in vitro study. Clin Biomech (Bristol, Avon). 2003;18:89–98
  61. Edmondston SJ, Allison GT, Gregg CD, Purden SM, Svansson GR, Watson AE. Effect of position on the posteroanterior stiffness of the lumbar spine. Man Ther. 1998;3:21–26
  62. Panjabi M, Yamamoto I, Oxland T, Crisco J. How does posture affect coupling in the lumbar spine?. Spine. 1989;14:1002–1011
  63. Vicenzino G, Twomey L. Side flexion induced lumbar spine conjuct rotation and its influencing factors. Aust J Physiother. 1993;9:115–123
  64. Panjabi MM, Oda T, Crisco JJ, Dvorak J, Grob D. Posture affects motion coupling patterns of the upper cervical spine. J Orthop Res. 1993;11:525–536
  65. Conway PJW, Herzog W, Zhang Y, Hasler EM, Ladly K. Forces required to cause cavitation during spinal manipulation of the thoracic spine. Clin Biomech. 1993;8:210–214
  66. Herzog W, Conway PJ, Kawchuk GN, Zhang Y, Hasler EM. Forces exerted during spinal manipulative therapy. Spine. 1993;18:1206–1212
  67. Kawchuk GN, Herzog W, Hasler EM. Forces generated during spinal manipulative therapy of the cervical spine: a pilot study. J Manipulative Physiol Ther. 1992;15:275–278
  68. Kimberley PE. Formulating a prescription for osteopathic manipulative treatment. J Am Osteopath Assoc. 1980;79:506–513
  69. Sandoz R. Some physical mechanisms and effects of spinal adjustments. Ann Swiss Chiropr Assoc. 1976;6:91–141
  70. Sandoz R. Some reflex phenomena associated with spinal derangements and adjustments. Ann Swiss Chiropr Assoc. 1981;7:45–65
  71. Roston JB, Wheeler-Haines R. Cracking in the metacarpo-phalangeal joint. J Anat. 1947;81:165–173
  72. American Chiropractic Association . Spinal manipulation policy statement (updated version). Arlington: American Chiropractic Association; 2003;[Available from: http://www.amerchiro.org/pdf/spinal_manipulation_policy.pdf]
  73. Haldeman S, Hooper PD. Mobilization, manipulation, massage and exercise for the relief of musculoskeletal pain. In:  Wall PD,  Melzack R editor. Textbook of pain. Edinburgh: Churchill Livingstone; 1999;p. 1399–1418
  74. Herzog W, Zhang YT, Conway PJ, Kawchuk GN. Cavitation sounds during spinal manipulative treatments. J Manipulative Physiol Ther. 1993;16:523–526
  75. Myklebust JB, Pintar F, Yoganandan N, Cusick JF, Maiman D, Myers TJ, et al. Tensile strength of spinal ligaments. Spine. 1988;13:526–531
  76. Winkelstein BA, Nightingale RW, Richardson WJ, Myers BS. The cervical facet capsule and its role in whiplash injury: a biomechanical investigation. Spine. 2000;25:1238–1246
  77. Yoganandan N, Kumaresan S, Pintar FA. Geometric and mechanical properties of human cervical spine ligaments. J Biomech Eng. 2000;122:623–629
  78. Semlak K, Ferguson AB. Joint stability maintained by atmospheric pressure. An experimental study. Clin Orthop Relat Res. 1970;68:294–300
  79. Ianuzzi A, Khalsa PS. Comparison of human lumbar facet joint capsule strains during simulated high-velocity, low-amplitude spinal manipulation versus physiological motions. Spine J. 2005;5:277–290
  80. Symons BP, Leonard T, Herzog W. Internal forces sustained by the vertebral artery during spinal manipulative therapy. J Manipulative Physiol Ther. 2002;25:504–510
  81. McCarthy CJ. Spinal manipulative thrust technique using combined movement theory. Man Ther. 2001;6:197–204
  82. Vernon H, Mrozek J. A revised definition of manipulation. J Manipulative Physiol Ther. 2005;28:68–72
  83. Klein GN, Mannion AF, Panjabi MM, Dvorak J. Trapped in the neutral zone: another symptom of whiplash-associated disorder?. Eur Spine J. 2001;10:141–148
  84. Kumar S, Panjabi MM. In vivo axial rotations and neutral zones of the thoracolumbar spine. J Spinal Disord. 1995;8:253–263
  85. Adams MA, Hutton WC. The relevance of torsion to the mechanical derangement of the lumbar spine. Spine. 1981;6:241–248
  86. Onan OA, Heggeness MH, Hipp JA. A motion analysis of the cervical facet joint. Spine. 1998;23:430–439
  87. Cascioli V, Corr P, Till A, Ag G. An investigation into the production of intra-articular gas bubbles and increase in joint space in the zygapophyseal joints of the cervical spine in asymptomatic subjects after spinal manipulation. J Manipulative Physiol Ther. 2003;26:356–364
  88. Hukins DW, Kirby MC, Sikoryn TA, Aspden RM, Cox AJ. Comparison of structure, mechanical properties, and functions of lumbar spinal ligaments. Spine. 1990;15:787–795
  89. Nyberg RE. Manipulation: definition, types, application. In:  Basmajian JV,  Nyberg RE editor. Rational manual therapies. Baltimore: Williams & Wilkins; 1993;p. 21–47
  90. Reggars JW, Pollard HP. Analysis of zygapophyseal joint cracking during chiropractic manipulation. J Manipulative Physiol Ther. 1995;18:65–71
  91. Keller TS, Colloca CJ, Fuhr AW. In vivo transient vibration assessment of the normal human thoracolumbar spine. J Manipulative Physiol Ther. 2000;23:521–530
  92. Solinger AB. The physics of spinal manipulation: a critical review of four articles by Haas. J Manipulative Physiol Ther. 1996;19:141–145
  93. Solinger AB. Oscillations of the vertebrae in spinal manipulative therapy. J Manipulative Physiol Ther. 1996;19:238–243
  94. Bereznick DE, Ross JK, McGill SM. The frictional properties at the thoracic skin-fascia interface: implications in spine manipulation. Clin Biomech (Bristol, Avon). 2002;17:297–303
  95. Pearcy M, Portek I, Shepherd J. The effect of low-back pain on lumbar spinal movements measured by three-dimensional x-ray analysis. Spine. 1985;10:150–153
  96. Amevo B, Aprill C, Bogduk N. Abnormal instantaneous axes of rotation in patients with neck pain. Spine. 1992;17:748–756
  97. Lund T, Nydegger T, Schlenzka D, Oxland TR. Three-dimensional motion patterns during active bending in patients with chronic low back pain. Spine. 2002;27:1865–1874
  98. Abumi K, Panjabi MM, Kramer KM, Duranceau J, Oxland T, Crisco JJ. Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine. 1990;15:1142–1147
  99. Tochigi Y, Amendola A, Rudert MJ, Baer TE, Brown TD, Hillis SL, et al. The role of the interosseous talocalcaneal ligament in subtalar joint stability. Foot Ankle Int. 2004;25:588–596
  100. Fryer GA, Mudge JM, McLaughlin PA. The effect of talocrural joint manipulation on range of motion at the ankle. J Manipulative Physiol Ther. 2002;25:384–390
  101. Brodeur R. The audible release associated with joint manipulation. J Manipulative Physiol Ther. 1995;18:155–164
  102. Buerger AA. Experimental neuromuscular models of spinal manual techniques. Man Med. 1983;1:17
  103. Gillette RG. Potential antinociceptive effects of high-level somatic stimulation—chiropractic manipulation therapy may coactivate both tonic and phasic analgesic systems. Some recent neurophysiological evidence. In:  Coyle BA,  Konsler GR,  Adams AH editor. Proceedings of the Pacific Consortium for Chiropractic Research: a series of communications. First Annual Conference on Research and Education. 1986 Jun 28-29. Belmont (Ca): Pacific Consortium for Chiropractic Research; 1986;p. 1–9
  104. Gillette RG. A speculative argument for the coactivation of diverse somatic receptor populations by forceful chiropractic adjustments. A review of the neurophysiological literature. Man Med. 1987;3:1–14
  105. Katavich L. Differential effects of spinal manipulative therapy on acute and chronic muscle spasm: a proposal for mechanisms and efficacy. Man Ther. 1998;3:132–139
  106. Korr IM. Proprioceptors and somatic dysfunction. J Am Osteopath Assoc. 1975;74:638–650
  107. Pickar JG. Neurophysiological effects of spinal manipulation. Spine J. 2002;2:357–371
  108. Wyke BD. The neurology of the cervical spinal joints. Physiotherapy. 1979;65:72–76
  109. Wyke BD. Receptor systems in lumbosacral tissues in relation to the production of low back pain. In:  White AA,  Gordon SL editor. Idiopathic low back pain. London: Mosby Co; 1982;p. 97–107
  110. Wyke BD. Articular neurology and manipulative therapy. In:  Glasgow EF,  Twomey LT,  Scull ER,  Kleynhans AM,  Idczak RM editor. Aspects of manipulative therapy. Edinburgh: Churchill Livingstone; 1985;p. 72–77
  111. Zusman M. Spinal manipulative therapy; review of some proposed mechanisms and a new hypothesis. Aus J Physiother. 1986;32:89–99

 Sources of support: No external funds were provided for this research.

PII: S0161-4754(05)00353-2

doi: 10.1016/j.jmpt.2005.11.011

Journal of Manipulative and Physiological Therapeutics
Volume 29, Issue 1 , Pages 72-82 , January 2006

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