Patient Concerns and Beliefs Related to Audible Popping Sound and the Effectiveness of Manipulation: Findings From an Online Survey

Bergamino, Matteo; Vongher, Andrea; Mourad, Firas; Dunning, James; Rossettini, Giacomo; Palladino, Michael; Fernández‐de‐las‐Peñas, César; Testa, Marco; Maselli, Filippo

doi:10.1016/j.jmpt.2022.03.021

Cited by 4 publications

(3 citation statements)

References 35 publications

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“…Our observed immediate changes after the HVLA manipulation for the Theta and Beta-L waves at P7 and P8 was hypothesized to be the direct effect of the HVLA manipulation. This observation conflicts with the findings of Bergamino et al (2022) , who reported on the belief that the audible pop was directly related to the effectiveness of an HVLA manipulation. Although we observed increased occipital lobe brainwave activity in both groups, this might not reflect any personal believes in the subjects regarding the success of an HVLA and audible sounds.…”

Section: Discussioncontrasting

confidence: 98%

The effect of a spinal thrust manipulation’s audible pop on brain wave activity: a quasi-experimental repeated measure design

Sillevis,

Unum,

Weiss

et al. 2024

PeerJ

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Introduction High velocity thrust manipulation is commonly used when managing joint dysfunctions. Often, these thrust maneuvers will elicit an audible pop. It has been unclear what conclusively causes this audible sound and its clinical meaningfulness. This study sought to identify the effect of the audible pop on brainwave activity directly following a prone T7 thrust manipulation in asymptomatic/healthy subjects. Methods This was a quasi-experimental repeated measure study design in which 57 subjects completed the study protocol. Brain wave activity was measured with the Emotiv EPOC+, which collects data with a frequency of 128 HZ and has 14 electrodes. Testing was performed in a controlled environment with minimal electrical interference (as measured with a Gauss meter), temperature variance, lighting variance, sound pollution, and other variable changes that could have influenced or interfered with pure EEG data acquisition. After accommodation each subject underwent a prone T7 posterior-anterior thrust manipulation. Immediately after the thrust manipulation the brainwave activity was measured for 10 seconds. Results The non-audible group (N = 20) consisted of 55% males, and the audible group (N = 37) consisted of 43% males. The non-audible group EEG data revealed a significant change in brain wave activity under some of the electrodes in the frontal, parietal, and the occipital lobes. In the audible group, there was a significant change in brain wave activity under all electrodes in the frontal lobes, the parietal lobe, and the occipital lobes but not the temporal lobes. Conclusion The audible sounds caused by a thoracic high velocity thrust manipulation did not affect the activity in the audible centers in the temporal brain region. The results support the hypothesis that thrust manipulation with or without audible sound results in a generalized relaxation immediately following the manipulation. The absence of a significant difference in brainwave activity in the frontal lobe in this study might indicate that the audible pop does not produce a “placebo” mechanism.

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Section: Discussioncontrasting

confidence: 98%

The effect of a spinal thrust manipulation’s audible pop on brain wave activity: a quasi-experimental repeated measure design

Sillevis,

Unum,

Weiss

et al. 2024

PeerJ

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“…In a qualitative study on chiropractic patient’s personal perception of the AP [ 43 ] participants generally supported the argument that they experienced a release associated with the AP but the majority of patients considered the AP rather unnecessary for successful treatment. However, a cross-sectional online survey on patients receiving thrust manipulation given by a larger spectrum of manual therapists (such as physiotherapists, osteopaths, manual medicine physicians and chiropractors) [ 44 ] reported a belief that the presence of the AP was related to the effectiveness of thrust manipulation. Additionally, a high percentage of the patients had beliefs about thrust manipulation and the underlying mechanisms producing an AP that were inconsistent with current literature.…”

Section: Discussionmentioning

confidence: 99%

Impact of audible pops associated with spinal manipulation on perceived pain: a systematic review

Moorman

Newell

2022

Chiropr Man Therap

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Objectives An audible pop is the sound that can derive from an adjustment in spinal manipulative therapy and is often seen as an indicator of a successful treatment. A review conducted in 1998 concluded that there was little scientific evidence to support any therapeutic benefit derived from the audible pop. Since then, research methods have evolved considerably creating opportunities for new evidence to emerge. It was therefore timely to review the evidence. Methods The following electronic databases were searched for relevant studies pertaining to the impact of audible pops in spinal manipulative therapy: PubMed, Index to Chiropractic Literature (ICL), Cumulative Index to Nursing & Allied Health Literature (CINAHL) and Web-of-Science. The main outcome was pain. Two reviewers independently selected studies, extracted data, and assessed risk of bias and quality of the evidence using the Downs and Black checklist. Results of the included literature were synthesized into a systematic review. Results Five original research articles were included in the review, of which four were prospective cohort studies and one a randomized controlled trial. All studies reported similar results: regardless of the area of the spine manipulated or follow-up time, there was no evidence of improved pain outcomes associated with an audible pop. One study even reported a hypoalgesic effect to external pain stimuli after spinal manipulation, regardless of an audible pop. Conclusions Whilst there is still no consensus among chiropractors on the association of an audible pop and pain outcomes in spinal manipulative therapy, knowledge about the audible pop has advanced. This review suggests that the presence or absence of an audible pop may not be important regarding pain outcomes with spinal manipulation.

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“…Although no firm conclusions can be drawn about the clinical relevance, when the popping sound was a requirement in the methods, SM was found more effective in reducing short-term pain and disability than non-thrust mobilization (i.e., no audible popping sound) [74,82]. Interestingly, patients themselves appear to expect popping sounds to accompany SM [85,86]. Therefore, the assertion that the popping sound is not required for a successful SM is not supported by the three-pillars of evidence-based practice [87].…”

Section: Beliefs About Safety and The Influence Of Educational Programsmentioning

confidence: 99%

Knowledge, beliefs, and attitudes of spinal manipulation: a cross-sectional survey of Italian physiotherapists

et al. 2022

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Background and Objective High-velocity low-amplitude thrust spinal manipulation (SM) is a recommended and commonly used manual therapy intervention in physiotherapy. Beliefs surrounding the safety and effectiveness of SM have challenged its use, and even advocated for its abandonment. Our study aimed to investigate the knowledge and beliefs surrounding SM by Italian physiotherapists compared with similar practitioners in other countries. Methods An online survey with 41 questions was adapted from previous surveys and was distributed via a mailing list of the Italian Physiotherapists Association (March 22–26, 2020). The questionnaire was divided into 4 sections to capture information on participant demographics, utilization, potential barriers, and knowledge about SM. Questions were differentiated between spinal regions. Attitudes towards different spinal regions, attributes associated with beliefs, and the influence of previous educational background were each evaluated. Results Of the 7398 registered physiotherapists, 575 (7.8%) completed the survey and were included for analysis. The majority of respondents perceived SM as safe and effective when applied to the thoracic (74.1%) and lumbar (72.2%) spines; whereas, a smaller proportion viewed SM to the upper cervical spine (56.8%) as safe and effective. Respondents reported they were less likely to provide and feel comfortable with upper cervical SM (respectively, 27.5% and 48.5%) compared to the thoracic (respectively, 52.2% and 74.8%) and lumbar spines (respectively, 46.3% and 74.3%). Most physiotherapists (70.4%) agreed they would perform additional screening prior to upper cervical SM compared to other spinal regions. Respondents who were aware of clinical prediction rules were more likely to report being comfortable with SM (OR 2.38–3.69) and to perceive it as safe (OR 1.75–3.12). Finally, physiotherapists without musculoskeletal specialization, especially those with a traditional manual therapy background, were more likely to perform additional screening prior to SM, use SM less frequently, report being less comfortable performing SM, and report upper cervical SM as less safe (p < 0.001). Discussion The beliefs and attitudes of physiotherapists surrounding the use of SM are significantly different when comparing the upper cervical spine to other spinal regions. An educational background in traditional manual therapy significantly influences beliefs and attitudes. We propose an updated framework on evidence-based SM.

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Patient Concerns and Beliefs Related to Audible Popping Sound and the Effectiveness of Manipulation: Findings From an Online Survey

Cited by 4 publications

References 35 publications

The effect of a spinal thrust manipulation’s audible pop on brain wave activity: a quasi-experimental repeated measure design

The effect of a spinal thrust manipulation’s audible pop on brain wave activity: a quasi-experimental repeated measure design

Impact of audible pops associated with spinal manipulation on perceived pain: a systematic review

Knowledge, beliefs, and attitudes of spinal manipulation: a cross-sectional survey of Italian physiotherapists

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