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Accelerometer Assessment of Spinal Joint Crepitus Before and After Spinal Manipulation
Author(s) -
Cramer Gregory D,
Budavich Matthew,
Bora Preetam,
Ross Kim
Publication year - 2017
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.31.1_supplement.902.16
Subject(s) - zygapophyseal joint , medicine , range of motion , lumbar , accelerometer , orthodontics , physical therapy , surgery , facet joint , computer science , operating system
The objective of this IRB‐approved project was to assess spinal joint [facet joint, zygapophyseal (Z) joint] vibrations/sounds (crepitus) during lumbar motion before and after side‐posture spinal manipulation (SM). Methods Using methods previously developed to assess joint cavitation, 9 accelerometers were applied to the lumbar region of 5 healthy and 5 low back pain (LBP) subjects, allowing assessment of crepitus. Subjects underwent full lumbar ranges of motion, SM, and repeated ranges of motion, while accelerometer recordings were made. Subjects were also divided into 3 age groups for comparisons (18–25, 26–45, and 46–65 years). Primary outcomes included: incidence of crepitus, crepitus prevalence (average number of crepitus events/subject), crepitus amplitude, and motion(s) producing the most crepitus. Results The accelerometry methods were successfully implemented on all subjects. Crepitus was identified as simultaneous deviations from baseline of multiple accelerometers. As in previous work, artifacts had a distinct appearance and were easily distinguished from crepitus. Overall, 23 instances of crepitus were recorded from 15 different Z joints. Crepitus prevalence decreased pre‐ to post‐SM (average pre= 1.4 crepitus/subject, range 0–7 crepitus/subject vs. post= 0.9, range 0–2). Crepitus prevalence progressively increased from the youngest to oldest age groups (pre‐SM= 0.0, 1.67, and 2.0, respectively, range 0–10; and post‐SM= 0.5, 0.83, and 1.5, range 1–5). Prevalence was higher in LBP subjects compared to healthy (pre‐SM‐LBP= 2.0, range 0–7, vs. pre‐SM‐healthy= 0.8, range 0–4; post‐SM‐LBP= 1.0, range 0–2 vs. post‐SM‐healthy= 0.8, range 0–2), even though healthy subjects were older than LBP (40.8 years vs. 27.8 years). Crepitus amplitude was <0.16 mV. Average pre‐SM crepitus amplitude was 0.08 mV, which was greater than post‐SM crepitus, which was 0.03 mV. The pre‐ vs. post‐SM crepitus difference was greater in LBP (pre‐SM 0.09 mV, post‐SM 0.04) than healthy subjects (pre‐SM 0.04 mV, post‐SM 0.03 mV). Flexion produced the most crepitus (pre‐SM eight, 57.1%, post‐SM six, 66.7%, and overall fourteen, 60.9%). For pre‐SM, flexion was followed by right lateral flexion (three, 21.4%) with extension, left lateral flexion and left rotation all producing the same amount of crepitus (one each, 7.1%). Post‐SM flexion was followed by extension (two, 22.2%) and right rotation (one, 11.1%), with no crepitus recorded in the other motions. Conclusions Crepitus was greatest in flexion; prevalence increased with age, was higher in LBP than healthy subjects, and overall decreased following SM; crepitus amplitude was lower post‐SM than pre‐SM. Support or Funding Information NIH/NCCIH Grant# – 3R01AT000123‐06S2