From the Guidelines
High-Velocity Low-Amplitude (HVLA) spinal manipulation should be used in patients with somatic dysfunction, particularly joint restrictions or hypomobility, who would benefit from immediate improvement in range of motion and pain reduction, as evidenced by low-quality evidence showing a small effect on function compared to sham manipulation 1.
Key Considerations
- HVLA is most appropriate for treating specific joint dysfunctions in the spine and extremities when there is a clear positional fault or movement restriction that can be addressed through a quick, controlled thrust.
- This technique is typically used after a thorough assessment confirms the presence of restricted joint play, tissue texture changes, and asymmetry.
- HVLA should only be performed by properly trained practitioners such as osteopathic physicians, chiropractors, or physical therapists with advanced manual therapy training.
Contraindications
- Patients with bone fragility conditions like osteoporosis
- Acute inflammation
- Joint instability
- Vascular compromise
- Patients who cannot relax sufficiently to allow proper technique application
Mechanism of Action
- HVLA works by stimulating mechanoreceptors, breaking adhesions, and resetting muscle spindle activity, which helps normalize proprioceptive input and restore proper joint mechanics.
Evidence Quality
- The evidence supporting the use of HVLA spinal manipulation is generally of low quality, with some studies showing a small effect on function compared to sham manipulation 1.
- However, the potential benefits of HVLA in improving range of motion and pain reduction make it a viable treatment option for patients with somatic dysfunction.
Clinical Decision-Making
- Clinicians should use their professional judgment to determine the appropriateness of HVLA spinal manipulation for each patient, taking into account the patient's individual needs and circumstances.
- A thorough assessment and proper training are essential to ensure the safe and effective application of HVLA spinal manipulation.
From the Research
Indications for High-Velocity Low-Amplitude (HVLA) Spinal Manipulation
- HVLA spinal manipulation can be used to improve spinal and hip mobility and reduce pain and incapacity in low back pain patients that fit the clinical prediction rule 2
- It is widely used by many manual therapists to treat low back pain, with increasing evidence that spinal manipulation produces positive patient outcomes for acute low back pain 3
- HVLA manipulation has been shown to be significantly better than nonsteroidal anti-inflammatory drug diclofenac and clinically superior to placebo in patients with acute nonspecific low back pain 4
Patient Selection
- A history of good response to previous spinal manipulation is a highly rated predictor of instantaneous relief from non-specific low back pain with HVLA spinal manipulation therapy 5
- Other predictors of instantaneous relief include patient factors, practitioner factors, signs and symptoms of NSLBP presentation, and the presence of cavitation following SMT 5
- Patient positioning and spinal locking are critical factors in applying lumbar spine manipulation with minimal force, and a knowledge of coupled movements of the lumbar spine aids in understanding the patient positioning required to achieve spinal locking consistent with maximal patient comfort and cooperation 3
Specific Conditions
- HVLA spinal manipulation has been shown to be effective in reducing pain and improving function in patients with acute nonspecific low back pain 4
- It has also been shown to improve standing postural control and increase the rotational range of motion in the upper cervical spine in patients with chronic nonspecific neck pain 6
- A single upper cervical HVLA manipulation can produce an improvement in standing postural control and increase the rotational range of motion in the upper cervical spine in patients with CNSNP, with effects lasting up to 15 days 6