Dr. Gregory Cramer, Dean of Research and Research & Basic Sciences Professor

The National University of Health Sciences (NUHS) Department of Research recently published, “Vibration and Acoustic Crepitus Sensing Using Piezoelectric Accelerometers,” in the November edition of the Journal of Engineering and Science in Medical Diagnostics and Therapy. The findings of the study address the chronic worldwide issue of lower back pain, its financial burden on health care systems, and faster diagnosis and treatment for patients.

 Lower back pain is a common musculoskeletal problem globally and comprises a significant source of health care use and cost, with low back and neck pain amounting to 2013 health care costs of $134.5 billion in the United States alone. According to a study published in the Annals of Translational Medicine: National Library of Medicine (NIH):

“Globally, lower back pain (LBP) is the leading global cause of years lived with disability (YLD). Greater attention is urgently needed to mitigate this increasing burden and the impact it is having on health and social systems.”

“Our preliminary evidence indicates that zygapophyseal joint (Z joints, facet joint) crepitus (sounds/vibrations originating from the joints) may be a biomarker for spinal joint function,” said Gregory Cramer, DC, PhD, and NUHS Dean of Research. “However, it takes a human observer approximately 24 working hours to assess the recordings of just one patient, which is too long to be practical in a large clinical study or in clinical practice.”

“Consequently, we have been working to automate the assessment of the recordings; this project evaluated the automated method. We found that the automated method was as accurate as humans in assessing crepitus and took dramatically less time (seconds vs. hours),” he said.

The ultimate goal of this line of investigation is to provide practitioners and their patients with an objective measure of facet joint dysfunction. Crepitus has been linked to decreased joint lubrication (related to increased joint stiffness). The team’s preliminary work indicated that spinal manipulation decreased joint crepitus, which is interpreted as an indication of increased joint lubrication, or enhanced joint function.

To make this identification method cost-effective and easy to use for practitioners, the NUHS team is currently conducting a study to test the automated method on human data. If the results are positive, the next step will be to move forward to conduct a clinical trial assessing crepitus before and after spinal manipulation.

“We have already conducted a pilot study that showed promising results, but we will need to validate these results in a larger study,” Dr. Cramer said. “We would also like to assess different low back pain and age populations. If these studies provide positive results, we would proceed to developing the methods for use in clinical practice.”

Although Dr. Cramer acknowledged that “there is a long road ahead,” development of a biomarker for Z joint dysfunction would help doctors – notably Doctors of Chiropractic and Naturopathic Physicians – when conducting spinal manipulation, to better identify patients who would benefit the most from their treatments, and also to help document the effectiveness of those treatments.

Members of the NUHS research team publishing this article include: Dr. Gregory Cramer, (senior author) Dean of Research, and Research & Basic Sciences Professor; Gregory Roytman, DC, ’2019 (first author), currently a Yale University post-doctoral student; Matthew Budavich, DC, ’2016, practicing in North Carolina; Judith D. Pocius, Research Coordinator;  Jocelyn Faydenko, Research Fellow and Dana Muligano, DC, ’2020, practicing in Illinois.