Short-term relaxation after cervical rotatory manipulation is more closely associated with somatosensory input than cracking sound: a randomized controlled EEG study

Background Cervical rotatory manipulation is commonly used for neck-related symptoms and is often accompanied by a cracking sound. This sound is frequently regarded as a sign of successful manipulation, but whether it contributes substantially to the immediate relaxation response remains unclear. Objective This study examined whether short-term relaxation after cervical rotatory manipulation is more closely related to manipulation-associated sensory input than to the cracking sound cue alone. Methods In this single-session, three-arm, parallel randomized controlled study, 54 healthy volunteers were allocated to cervical rotatory manipulation, sham manipulation, or sham manipulation plus simulated cracking sound. Subjective outcomes were assessed before and after intervention, including positive affect, negative affect, comfort, and satisfaction. Eyes-closed resting-state electroencephalography was recorded before and after intervention. Prespecified neural outcomes included frontal alpha power, frontal alpha/beta ratio, occipital individual alpha frequency, and alpha-band fronto-parietal and fronto-temporal functional connectivity. Results Cervical rotatory manipulation produced greater improvements in positive affect, comfort, and satisfaction than sham manipulation or sham manipulation plus simulated cracking sound, whereas negative affect remained generally stable across groups. These subjective responses were accompanied by short-term electroencephalography changes, particularly in frontal alpha/beta and alpha-band fronto-parietal and fronto-temporal functional connectivity. Changes in frontal alpha/beta ratio were positively associated with changes in positive affect. In contrast, simulated cracking sound alone did not reproduce the full subjective or electroencephalography response observed after real manipulation. Conclusions The immediate relaxation response after cervical rotatory manipulation appears to be more closely related to manipulation-associated sensory input than to the cracking sound cue alone. These findings provide preliminary neurophysiological evidence for distinguishing real manipulation effects from sound-related contextual cues.