Palpatory and Ultrasound Assessment of Cervical Dysfunctions and the Effect of Cervical High-Velocity, Low-Amplitude (HVLA) Technique

Abstract

Abstract Background Ultrasound is commonly used to assess musculoskeletal abnormalities. High-velocity, low-amplitude (HVLA) is an osteopathic manipulative treatment technique commonly used by osteopathic physicians. The Shaw et al study has shown the reliability of ultrasound in measuring the improvement of rotational symmetry of lumbar somatic dysfunction (SD) after the use of HVLA. Objectives The purpose of this study was to evaluate the use of ultrasonography as a reference tool to quantitatively assess the rotational symmetry of cervical SD after the use of HVLA. Design The study was separated into 2 phases: 1) cervical diagnosis and pretreatment imaging and 2) HVLA or cranial vault hold (CVH) and post-treatment imaging. Method Two physicians independently diagnosed each participant (N = 51) with an SD between levels C2–C7; the key SD (the segment with the most posteriorly rotated articular pillar (AP)) was chosen. Ultrasound imaging was performed immediately after diagnosis. Next, the participants were randomly distributed into a treatment group, in which the participants were treated with HVLA, and a control group, in which a CVH was performed on the participant. Members of the HVLA group were then reassessed to confirm the key SD had resolved. Ultrasound imaging was immediately performed at the level of the segment with the key SD after HVLA reassessment or CVH completion. Results Physician reassessment confirmed SD resolution in 25 of 25 HVLA participants and 0 of 26 control participants. There was no significant change in ultrasound-measured AP rotation for the HVLA group (M=.05680 cm, P=.179) or control group (M=.02384 cm, P=.160). Conclusions Despite a palpatory resolution of the cervical SD, ultrasound was not able to determine a statistically significant change in AP rotation in either the HVLA or the control group.