Abstract
Abstract Background: The use of high velocity low amplitude (HVLA) manipulation has been advocated in the treatment of range of motion disorders. However, there remains speculation as to which direction of HVLA manipulative thrust is most effective in the amelioration of range of motion restriction. Objective: To investigate the effect of various directions of HVLA manipulation on the amelioration of goniometrically verified passive atlanto-axial (AA) rotation asymmetry. Methods: 40 asymptomatic subjects (mean age=28) who displayed a persistent unilateral passive atlanto-axial rotation asymmetry of 8° or more were randomly allocated to one of three treatment groups. The first group (n=14) received a single HVLA manipulation to the atlanto-axial joint with the thrust directed towards the most restricted range. The second group (n=14) received a single HVLA manipulation to the atlanto-axial joint with the thrust directed away from the most restricted range i.e. manipulated into the direction of greatest range. The third group (n=12) received bilateral manipulation to the atlanto-axial joint with the direction of initial thrust being determined randomly. For the purpose of this study a successful HVLA manipulation was defined as being accompanied by audible cavitation. HVLA manipulation was not accompanied by audible cavitation in 4 subjects. Measures of passive atlanto-axial end-range asymmetry were performed pre and post-manipulation. Results: HVLA manipulation of the atlanto-axial joint was found to produce a statistically significant immediate amelioration of atlanto-axial rotation asymmetry for all three-treatment groups. Conclusion: HVLA manipulation of the atlanto-axial articulation produces a significant immediate amelioration of passive atlanto-axial rotation asymmetry. The reduction in AA rotation asymmetry occurred regardless of whether the HVLA manipulation was applied unilaterally either towards or away from the restricted rotation ROM or bilaterally.
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