Recently this article came across the Gonstead Clinical Study Society database. The title was “Clicks and Clunks with Low Back Pain: What Do They Mean?” This article was a literature review by the International Musculoskeletal Medicine in April of 2009. Dr. Steve Tanaka D.C summarized this article review.
Summary of the article:
To review knowledge about noises arising from the joints of the back, which can be felt or heard by back pain patients or those undergoing treatment for back pain. Materials and methods: A literature search relating to the clicks and clunks that can be heard or felt by patients with back pain either with normal movement or during manipulation. The databases searched were Pubmed, Embase, TRIP, CINAHL, and Amed. The text terms click, clunk, and pop was used. In addition, experimental work was reviewed which aimed to elucidate the mechanism by which noises can be produced in synovial joints.
The Conclusion of the Review:
Most of the literature deals with the mechanisms of clicks in joints in general and in finger joints in particular. In the spine, there are many references to the ‘popping’ of facet joints in the spine as a result of manipulative therapy. Research has centered around an examination of cavitation and the formation of a gas bubble in the joint cavity when the joint surfaces are distracted. There was scant information about clicks and clunks in relationship to the presentation of back and neck pain. Studies have found no correlation between clicks and the typical electromyographic changes produced at manipulation, nor with therapeutic benefit. Conclusion: The significance of clicks and clunks in joints, whether occurring naturally or during treatment, remains uncertain.
Discussion of the Topic:
Unless something more finite comes along, most people accept the idea that a gas cavity or bubble of carbon dioxide forms. When it collapses or cavitates, a sound is produced. Some have brought up the concept of capsular ligament “snap-back.”
Many studies have been done on the metacarpophalangeal joints. Some studies have been done on the cervical spine, lumbar spine, and sacroiliac joints. Most agree that the sound comes from the zygapophyseal joints. In sacroiliac joint and lumbar manipulation studies, the sound has been found to come from the lumbar spine, and sometimes from multiple levels ( due to the use of “lumbar roll”?).
Comments from Gonstead Clinical Study Society:
“I wonder what actually accounts for the difference between a well-done Gonstead adjustment and the higher pitched sound of many manipulative treatments and less than effective Gonstead adjustment attempts? We say what we think it is—sound of adjusting through the disc, rather than the apophyseal joints.” Dr. Steve Tanaka D.C.
The last comment by Dr. Steve Tanaka mentions between adjusting through the disc rather than the apophyseal joints is a technical comment that most Gonstead chiropractors would understand.
The apophyseal joints location in the spine is mainly a synovial joint that has fluid that can produce gas cavity or bubble from organic gases from carbon dioxide. Most people will hear this popping noise when there is a slight movement or a quick movement in the joint. These rapid movements with a popping noise are thought to be chiropractic adjustment.
A well-done Gonstead adjustment has a specific force with control into the person’s spine. The goal of the Gonstead adjustment is setting the spinal segment with the health of the disc in mind instead of restriction and movement.