Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2013, Article ID 954134, 10 pages http://dx.doi.org/10.1155/2013/954134 Research Article Intradiscal Pressure Changes during Manual Cervical Distraction: A Cadaveric Study M. R. Gudavalli, 1 T. Potluri, 2 G. Carandang, 2 R. M. Havey, 2 L. I. Voronov, 2 J. M. Cox, 3 R. M. Rowell, 1 R. A. Kruse, 4 G. C. Joachim, 5 A. G. Patwardhan, 2,6 C. N. R. Henderson, 7 and C. Goertz 1 1 Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803, USA 2 Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA 3 Cox Chiropractic Medicine, Inc., 3125 Hobson Road, Fort Wayne, IN 46805, USA 4 Chiropractic Care, Ltd., 2417 183rd Street, Homewood, IL 60430, USA 5 Aaron Chiropractic Clinic, 3476 Stellhorn Road, Fort Wayne, IN 46815, USA 6 Loyola University Stritch School of Medicine, 2160 S. First Avenue, Maywood, IL 60153, USA 7 Henderson Technical Consulting, 5961 Broken Bow Lane, Port Orange, FL 32127, USA Correspondence should be addressed to M. R. Gudavalli; gudavalli r@palmer.edu Received 25 April 2013; Revised 2 July 2013; Accepted 6 July 2013 Academic Editor: Byung-Cheul Shin Copyright © 2013 M. R. Gudavalli et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Te objective of this study was to measure intradiscal pressure (IDP) changes in the lower cervical spine during a manual cervical distraction (MCD) procedure. Incisions were made anteriorly, and pressure transducers were inserted into each nucleus at lower cervical discs. Four skilled doctors of chiropractic (DCs) performed MCD procedure on nine specimens in prone position with contacts at C5 or at C6 vertebrae with the headpiece in diferent positions. IDP changes, traction forces, and manually applied posterior-to-anterior forces were analyzed using descriptive statistics. IDP decreases were observed during MCD procedure at all lower cervical levels C4-C5, C5-C6, and C6-C7. Te mean IDP decreases were as high as 168.7 KPa. Mean traction forces were as high as 119.2 N. Posterior-to-anterior forces applied during manual traction were as high as 82.6 N. Intraclinician reliability for IDP decrease was high for all four DCs. While two DCs had high intraclinician reliability for applied traction force, the other two DCs demonstrated only moderate reliability. IDP decreases were greatest during moving fexion and traction. Tey were progressevely less pronouced with neutral traction, fxed fexion and traction, and generalized traction. 1. Introduction Neck pain and neck-related shoulder and arm pain are a major health problem in Western societies [1–5]. Symptoms may include pain, tingling, numbness, stifness, loss of coordination or physical strength, skin discoloration, and temperature diferences located in the neck, shoulder, arm, elbow, wrist, hand, and/or fngers. Tese complaints cause discomfort and may lead to severe long-term pain and physical disability creating an economic burden due to work absences and healthcare costs [1]. In 2003 the 12-month prevalence of neck and shoulder pain in Te Netherlands was estimated at 31.4% and 30.3%, respectively [6]. In 2008, approximately 6% of US adults reported an ambulatory visit for a primary diagnosis of a back or neck condition (13.6 million). Between 1999 and 2008, the mean infation-adjusted annual expenditures on medical care for these patients increased by 95% (from $487 to $950); most of the increase was accounted for by increased costs for medical specialists, as opposed to primary care physicians. During the study period, the mean infation-adjusted annual expenditures on chiropractic care were relatively stable. Physical therapy was the most costly service overall [7]. Spinal manipulation is used by doctors of chiropractic (DC), osteopathic physicians, and physical therapists to treat musculoskeletal disorders [8–12]. While spinal manipula- tion has been shown to be efective in some studies [13],