The time has come to stop using the audible pop caused by thrust manipulation as a criterion of success

Abstract

Rob Sillevis

High velocity, small amplitude thrust manipulation has been shown to beneficial and is indicated to reduce pain, improve joint mobility, and reduce disability. Thrust manipulation of the spine often results in a popping sensation. The exact mechanism responsible for the audible pop remains elusive. Current clinical guidelines indicate that clinicians should use research evidence to guide clinical decision making. The effects and/or benefit of the audible pop during spinal manipulation has been the subject(s) of several previous studies. Such studies evaluated and failed to demonstrate any direct effect of an audible pop’s presence on the subjective reported pain levels, improvement in joint mobility, a change in nervous system activity, and a change in patient perceived disability. Based on current evidence, it seems abundantly clear that the audible pop cannot be used as a criterion (by clinicians and researchers) to determine if the spinal thrust manipulation was successful. Despite the current evidence, the research community continues to ignore this and uses the audible pop as a standard for the success of a spinal thrust manipulation. Additionally, the thrust manipulation will be repeated a second time if no audible pop is obtained or switching to the opposite spinal segment and attempted twice to achieve the audible pop. This potentially results into multiple capsular stretch maneuvers and makes comparison post intervention unreliable. The audible pop is not correlated to therapeutical success; stop using it for that.

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