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The Audible Release Associated with Joint Manipulation

March 17, 2015

MARCH 10, 1995

Reference: Raymond Brodeur, DC, PhD. Journal of Manipulative and Physiological Therapeutics 1995 Mar-Apr;18(3):155-64




Objective: The objective of this paper is to review the literature on the audible release associated with manipulation.


Data Sources: Bibliographic information in pertinent articles  and papers located in the MEDLINE database containing the keywords  joint, joints, cartilage, crack, cracking, cavitation, crepitus and  noise.


Study Selection: All articles relevant to the objectives were selected.


Data Extraction: All available data was used.


Data Synthesis: The audible release is caused by a cavitation  process whereby a sudden decrease in intracapsular pressure causes  dissolved gasses in the synovial fluid to be released into the joint  cavity. Once a joint undergoes cavitation, the force-displacement curve  changes and the range of motion of the joint increases. The gasses  released from the synovial fluid make up about 15% of the joint volume  and consist of approximately 80% carbon dioxide. Habitual joint cracking  does not correlate with arthritic changes, but does correlate with loss  of grip strength and soft-tissue swelling. During the “crack”  associated with a joint manipulation, there is a sudden joint  distraction that occurs in less time than that required to complete the  stretch reflexes of periarticular muscles. Theories on the cavitation  mechanism were reviewed and new information on the cavitation process is  introduced. In this paper, it is proposed that the cavitation process  is generated by an elastic recoil of the synovial capsule as it “snaps  back” from the capsule/synovial fluid interface.


Conclusion: Because the sudden joint distraction during a  manipulation occurs in a shorter time period than that required to  complete the stretch reflexes of the periarticular muscles, there is  likely to be a high impulse acting on the ligaments and muscles  associated with the joint. This is an important conclusion, because  others have proposed that reflex actions from high threshold  periarticular receptors are associated with the many beneficial results  of manipulation. This suggests that the cavitation process provides a  simple means for initiating the reflex actions and that without the  cavitation process, it would be difficult to generate the forces in the  appropriate tissue without causing muscular damage.

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