Effects of upper cervical HVLA manipulation on static and dynamic balance parameters in healthy adults – a systematic literature review

Abstract

Background. Balance is a complex concept that applies not only to tasks with a reduced base of support, but also to everyday activities that require us to maintain a fixed position. Just as the concept itself is broad, the mechanisms for maintaining balance are complex and rely on information received from many regions of the body and organs. Objective. The aim of this systematic literature review is to analyse whether HVLA manipulation of a blocked C0-C1 segment can affect static and dynamic balance parameters in healthy adults. Methods. Based on the available literature, accessed via PubMed, Google Scholar, Scopus, EBSCO databases, a detailed search of the electronic literature was performed for 2010–2023. Eligible studies were chosen according to inclusion and exclusion criteria, using keywords: static balance, dynamic balance, manipulation, HVLA. Out of 114 manuscripts, 82 were short-listed for the preliminary review process. Twenty experimental studies were selected for final analysis. Results. Out of the 20 publications analysed, 14 examined the effect of HVLA manipulation on balance parameters. In most cases, the study groups consisted of people with no dysfunction or complaints and/or people with neck pain. The most commonly studied parameter was static balance in standing: 17 of 20 publications. For the cervical spine, 50% of the studies found a significant improvement in the parameters studied in the immediate assessment, while in the delayed assessment there were as many significant positive results as there were results with no effect on balance. In the analysis of a subset of trials that examined only asymptomatic patients, partial or significant positive effects were observed in both immediate and delayed assessment. Conclusions. We were not able to identify studies that would provide a clear answer to the research question. Based on the publications included in the review, it can be assumed that HVLA manipulation in the cervical region has the potential to affect balance in healthy adults, but the number of available studies is too small to draw firm conclusions. Further research in this area is therefore warranted.