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Whether the multiple popping sounds found in this study emanated from the same joint, adjacent ipsilateral or contralateral facet or uncovertebral joints, or even extra-articular soft-tissues remains to be elucidated.
However, the question of whether these multiple popping sounds emanate from the same joint, adjacent ipsilateral or contralateral joints, or even extra-articular soft-tissues has yet to be answered [ 1, 2, 4, 9, 11].
Although, Herzog et al. [ 7] reported triphasic "cavitation signals" with a mean duration of 20 ms, it is unclear whether this value represents a single popping sound or multiple popping sounds.
Most subjects produced 3 4 pops during a single rotatory HVLA thrust manipulation targeting the right or left C1-2 arthereforen; therefore, practitioners of spinal manipulative therapy should expect multiple popping sounds when performing upper cervical thrust manipulation to the atlanto-axial joint.
Although Herzog et al. [ 7] used a mechanical accelerometer during T4 posterior to anterior thrust manipulations in 28 patients with thoracic spine pain and reported triphasic "cavitation signals" with a mean duration of 20 ms; whether this value represents a single popping sound or multiple popping sounds remains unclear.
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Two distinct popping sounds were produced in 7 (18.9%) of the manipulations, whereas 11 (29.7%), 12 (32.4%), 5 (13.5%), and 2 (5.4%) manipulations produced 3, 4, 5, and 6 distinct popping sounds, respectively.
All 37 upper cervical HVLA thrust manipulations resulted in two or more audible joint popping sounds.
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