High-velocity Low-amplitude Manipulation Research Articles

Effects of Multimodal Physical Therapy on Pain, Disability, H-reflex, and Diffusion Tensor Imaging Parameters in Patients With Lumbosacral Radiculopathy Due to Lumbar Disc Herniation: A Preliminary Trial.

Background Lumbosacral radiculopathy (LSR) due to lumbar disc herniation (LDH) is a condition caused by mechanical compression of nerve roots. Various physical therapy interventions have been proposed for the conservative management of LSR due to LDH. However, the study of physical therapy interventions in a multimodal form is lacking. Additionally, the effect of physical therapy on diffusion tensor imaging (DTI) parameters of the compressed nerve root has not been studied. This study aimed to investigate the effects of multimodal physical therapy (MPT) on pain, disability, soleus H-reflex, and DTI parameters of the compressed nerve root in patients with chronic unilateral LSR due to LDH. Methods A prospective preliminary pre-postclinical trial with a convenience sample was conducted. A total of 14 patients with chronic unilateral LSR due to paracentral L4-L5 or L5-S1 LDH were recruited for the study. Participants received a total of 18 sessions of a six-weekMPT program that consisted of electrophysical agents, manual therapy interventions, and core stability exercises. Electrophysical agents involved interferential current and hot pack. Manual therapy interventions included myofascial release, side posture positional distraction, passive spinal rotation mobilization, and high-velocity low-amplitude manipulation. Visual analog scale (VAS), Roland-Morris Disability Questionnaire (RMDQ), soleus H-reflex amplitude, side-to-side amplitude (H/H) ratio, fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of the compressed nerve root were measured at baseline and post-intervention. Results There were significant improvements in VAS, RMDQ, H/H ratio, FA, and ADC of the compressed nerve root. Furthermore,significant improvement was found in the affected side compared with the contralateral side in H-reflex amplitude. Conclusions The observations of this preliminary trial suggest that MPT is a successful intervention in patients with chronic unilateral LSR due to LDH. Regarding DTI parameters of the compressed nerve root, FA increased and ADC decreased. Future studies with a control group, large sample sizes, and longer follow-up periods are needed.

THE EFFECT OF SINGLE HIGH-VELOCITY, LOW-AMPLITUDE SPINE MANIPULATION ON POSTURE, FUNCTIONAL STATE OF TORSO, THIGH MUSCLES, AND VERTICAL JUMP HEIGHT

The effects impact of single high-velocity, low-amplitude (HVLA) spinal manipulation on posture, torso, and thigh functional condition, and the height of the vertical jump have not been adequately studied. The research aims to investigate the immediate changes caused by a single spinal vertebral HVLA manipulation 3 weeks after posture, torso, and thigh muscle functional state, and vertical jump height. The study involved 46 men aged 18-25 years old who practiced indoor volleyball training at least twice a week, as well as a deviation of the vertebral vertebrae from the non-thymic position. Initially, posture was assessed using the photogrammetry method and muscle length was assessed using the goniometry method. A vertical jump height test was performed by the Sargent Jump test. A single HVLA spinal manipulation was performed by a certified chiropractor for segment correction. Then, a re-assessment of posture (photogrammetry), re-assessment of movement volume (goniometry) as well a re-assessment of vertical jump height test- the Sargent Jump test was performed. After 3 weeks post HVLA manipulation participants were retested. The main findings are: immediately after the HVLA spinal correction changes in posture were observed in all evaluated parameters, deviations from the norm decreased by 25.45% ± 1.27% (p < .005), while the vertical jump height test results immediately after HVLA increased by 4.34% ± 0.11% (p < .005). After 3 weeks post HVLA spine manipulation therapeutic effect was reduced by 5.48% ± 1.27% (p < .005), while the Sargent Jump test result 3 weeks after manipulation decreased by 0.05% ± 0.11% (p > .005). Conclusion: the persistence of the effect of a single HVLA spine manipulation was maintained for 3 weeks after the manipulation into the posture.

The effect of HVLA manipulation on static and dynamic postural parameters – a case study of a patient with a blocked atlanto-occipital transition

Objective. The study aimed to assess the effects of high velocity low amplitude (HVLA) manipulations on force distribution, pressures, and balance in individuals with atlanto-occipital blockage, focusing on post-treatment improvements. Research methods. Diagnostic tests (cervical spine compression, Spurling, de Kleyn) and pedobarography (using an EPS/R2 mat and BIOMECH STUDIO software) assessed functionality and postural parameters pre and post HVLA therapy. Results. Initial diagnosis showed significant disturbances in force distribution, balance, and gait. Post-HVLA therapy improvements included: 1. Balanced forefoot load during standing, with a decrease in heel load percentage. 2. Improved global body pressure distribution, with a notable decrease in left-side body pressure. 3. Enhanced anteroposterior and lateral body oscillation ranges, with a reduced ratio of extreme deflection distances to deflection surface and a decreased average speed of displacements. 4. Normalization of the right foot abduction angle, with no significant change in the left foot's visitation angle. 5. Slight improvements in foot vault index (AI) and average foot pressure during gait, with minimal changes in maximum foot pressure during gait. Conclusions. HVLA manipulation significantly improves static balance parameters but shows minimal improvement in gait parameters. This indicates a complex relationship between atlanto-occipital blockage and postural disorders, suggesting the need for further research to explore the association between postural defects and atlanto-occipital transition blockage, as well as the impact of these blockages on postural changes. Keywords atlanto-occipital blockage, HVLA manipulation, postural disorders, balance improvement, pedobarography

A Hole in One

This case report discusses the presentation, diagnosis, and treatment of trigger finger in a 62-year-old right-handed male with a history of two months of right index finger pain and locking sensation. The patient's occupation and activities, such as typing, golfing, running, and biking, potentially contributed to the development of trigger finger. Physical examination revealed tenderness near the A1 pulley, a palpable nodule, and limited extension and abduction of the affected finger. Imaging showed mild degenerative changes and a small sesamoid bone. The patient received a corticosteroid injection to the tendon sheath, along with high-velocity low-amplitude (HVLA) manipulation and myofascial release to correct associated somatic dysfunctions. The patient experienced reduced pain and improved range of motion after treatment, and follow-up at one month showed complete resolution of symptoms.

The Impact of HVLA Manipulations and Therapeutic Massage in Increasing the Mobility of the Lateral Flexion of the Neck

The purpose of this study was to establish if high-velocity, low-amplitude manipulation (HVLA) combined with therapeutic massage can improve cervical spine mobility, particularly neck lateral flexion, on the left and right sides, given that lateral neck flexion is 90 degrees. The sample of 75 participants was comprised of 35 men (46.6%) and 40 women (53.3%), all of whom were between the ages of 20 and 60 and were divided into four groups based on their average ages: 20 to 30 years, 31 to 40 years, 41 to 50 years, and 51 to 60 years. These groups were further subdivided into two groups by gender, male and female. Patients' lateral flexion was measured with a goniometer, which displays the angle of lateral flexion before and after treatment. C1-C7 vertebral level and shoulder joint level HVLA procedures were conducted. The therapeutic massage concentrated on the trapezius, sternocleidomastoid, platysma, splenius, and semispinalis muscles using relaxing techniques. Each patient's left and right elbow lateral flexion was measured with a goniometer following HVLA manipulations and therapeutic massage to see whether or not there was a significant increase. After combining the findings and measurements, we were able to determine that these combined methods increase the cervical spine joint mobility of the 75 participants by a mean of 12.36 degrees.

A Comparison of the Immediate Effects of Chiropractic Thoracic High-Velocity Low-Amplitude Manipulation Applied Supine and Prone on the Autonomic Nervous System

Thoracic manipulation is one of the spinal manipulative treatment methods frequently used by clinicians. However, when carrying out this task, several methods could be preferred. This study aimed to compare the immediate effects of supine and prone thoracic high-velocity-low-amplitude chiropractic manipulations on the autonomic nervous system. The study included 62 healthy and volunteer participants aged 18-45 years. Participants were randomly assigned to supine and prone manipulation groups. Both groups, heart rate variability data were obtained with the Elite HRV CorSense device for 1 minute before the application, systolic and diastolic blood pressures were measured, pulse and saturation values were recorded. After the measurement, supine chiropractic manipulation was applied to the mid-thoracic region and the same measurements were repeated. Heart rate variability data were analyzed with Elite HRV application, pulse rate, saturation, systolic and diastolic blood pressure values were recorded, and the results were statistically evaluated. In the intra-group comparison, LF/HF ratio increased in the prone group (p=0.025). When the difference between the groups was analyzed, the change in LF/HF ratio was found to be statistically significant between the two groups (p=0.008). The effect of prone application on the autonomic nervous system was found to be higher than supine application. This study revealed that prone and supine thoracic chiropractic HVLA application was effective on OSS in healthy individuals and that the efficiency of prone manipulation was significantly higher.

Influence of high-velocity low amplitude manipulation of the lumbar spine on the activity of motor units of the erector spinal muscles with functional assessment in healthy young people

Influence of high-velocity low amplitude manipulation of the lumbar spine on the activity of motor units of the erector spinal muscles with functional assessment in healthy young people

Comparison of high velocity low amplitude manipulation and dry needle treatment in patients with nonspecific back pain

article: Comparison of high velocity low amplitude manipulation and dry needle treatment in patients with nonspecific back pain - Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2021 December;180(12):815-21 - Minerva Medica - Journals

Electromyographic Responses of Neck, Back, and Limb Outlet Muscles Associated With High-Velocity, Low-Amplitude Manual Cervical and Upper Thoracic Spinal Manipulation of Individuals With Mild Neck Disability: A Descriptive Observational Investigation

ObjectivesThe purpose of this study was to investigate the extent of electromyographic responses associated with manual high-velocity, low-amplitude (HVLA) spinal manipulation systematically applied to the upper and lower cervical and upper thoracic spines in a cohort with mild neck disability. MethodsThe study was a descriptive observational investigation, with all participants receiving the same interventions. Nineteen participants with mild neck disability received 6 manual HVLA manipulations to the cervical and upper thoracic spine. Bipolar surface electromyography electrode pairs were used to measure responses of 16 neck, back, and limb outlet muscles bilaterally. The number of electromyographic responses was then calculated. ResultsElectromyographic responses associated with cervical and thoracic manipulation occurred in a median of 4 of the 16 (range: 1-14) recorded muscles. Cervical spinal manipulation was associated with the highest rates of electromyographic responses in neck muscles, whereas responses in back muscles were highest after upper thoracic manipulation. ConclusionCervical spinal manipulation was associated with the highest rate of electromyographic responses in muscles of the cervical spine (sternocleidomastoid and splenius cervicis), whereas responses in back muscles (upper and middle trapezius, latissimus dorsi, and longissimus thoracis) were highest after upper thoracic manipulations. This result suggests that electromyographic muscular responses associated with spinal manipulation primarily occur locally (close to the target segment) rather than distally.

Instant Effect of Chiropractic Upper and Middle Thoracic Zone Manipulations on Autonomic Nervous System

Objective: This study aims to compare the instantaneous effects of chiropractic upper and middle thoracic manipulations on the autonomic nervous system.Material-Method: The study included 30 healthy volunteers aged 18-45 years. Manipulation was applied to the upper thoracic (T1-4) area (n=15, 8 female, 7 male) and to the middle thoracic (T6-9) area (n=15, 7 female, 8 male). Before the application, heart rate, body temperature and skin conductivity (EDA) measurements were performed using the Empatica E4 wristband device. Thoracic HVLA (high velocity low amplitude) manipulation was performed in the supine position. After the application, the measurement made with the Empatica E4 device was repeated. The mean bodytemperature and skin conductivity values were calculated for the analysis of the data. Heart rate data were evaluated using Kubios heart rate variability (HRV) standard program. Detailed information about the effects of upper and middle thoracic area manipulation on the autonomic nervous system was obtained according to the analysis results of the data obtained before and after manipulation. Correlation analysis of pre- and post-manipulation data and difference analysis between the two groups were performed based on significance level p<0.05.Results: As a result of the research, no significant changes in parasympathetic nervous system values such as RMSSD, pNN50, PNS Index and sympathetic nervous system values such as Stress Index and SNS Index were observed after upper thoracic manipulation. After middle thoracic manipulation, significant decreases occurred in sympathetic nervous system values such as Stress Index, SNS Index, while significant increases occurred in parasympathetic nervous system values such as RMSSD, pNN50, PNS Index. It was observed that there was no significant change in temperature and EDA. Conclusion: As a result of our measurements and analyzes, it was seen that chiropractic upper and middle thoracic manipulations had different instantaneous effects on the autonomic nervous system.

Manual Therapy Treatment for Penile Pain- A Clinical Case Report with 6-Month Follow-up

ABSTRACT Background Male genital pain, which is neither related to genitourinary nor other obvious pathology, is an uncommon symptom in male patients and not frequently treated using manual therapy. The purpose of this case study is to describe a clinical reasoning process in combination with anatomy-based differential diagnosis and manual treatment for genital pain. Case Description A male patient with a 3-week acute onset of genital pain was hospitalized and referred for evaluation and treatment after unsuccessful treatment with medication and acupuncture. Clinical examination was performed indicating a possible nerve entrapment followed by interventions of ligamentous articular strain, high-velocity low-amplitude (HVLA) manipulation, and strain– and counterstain, coupled with soft tissue stretching to lumbar and inguinal areas to address a possible lumbar referral potentially from L1 and/or ilioinguinal nerve entrapment. Outcomes After 4 consecutive days of manipulative treatment, pain decreased from 9/10 to 0/10 and the Barthel Index improved from 50 to 95. A 6-month follow-up revealed complete resolution of symptoms with no recurrence. Discussion This case illustrates that a detailed history and examination along with a reasoned diagnostic process to determine an appropriate intervention strategy may improve patient care using manual therapy techniques. Conclusion: By utilizing a deductive reasoning process related to the penile area, clinicians may better apply manual therapy techniques for successful treatment.

Teaching and use of cervical high-velocity, low-amplitude manipulation at colleges of osteopathic medicine.

Despite the documented effectiveness of high-velocity, low-amplitude (HVLA) treatment of the cervical spine, concerns about patient safety potentially limit didactic instruction and use in clinical practice. Understanding how cervical HVLA is taught and employed is of interest to osteopathic educators and clinicians. To characterize the perspectives of osteopathic manipulative medicine/osteopathic principles and practices (OMM/OPP) departments within colleges of osteopathic medicine (COMs) in the US regarding patterns of teaching and practice of HVLA treatment of the cervical spine. A questionnaire was distributed on April 11, 2019 in paper format to OMM/OPP department chairs or designated faculty member attendees at the Educational Council on Osteopathic Principles biannual meeting. If the department chair was not available, the survey was provided to the faculty member designated to represent the Chair of the institution at ECOP. All respondents in this category returned the survey in paper before they left the meeting. The OMM/OPP department chairs who did not attend or send representatives to the ECOP meeting were sent the survey by email on April 11, 2019 and given three opportunities over 6weeksat 2-week intervals to reply to this voluntary online survey. The survey was given or sent to a total of 51 OMM/OPP department chairs or representatives. Six questions elicited demographic information pertaining to status, age, gender, ethnicity, board-certified specialty, and COM affiliation. Nine questions examined perspectives related to the instruction of cervical HVLA manipulation and treatment. Of the 51 OMM/OPP department chairs surveyed, 38 (74.5%) responded, 32 to the paper survey at the ECOP meeting and six to the digital survey. Respondents were primarily dual Board-certified in Family Medicine and Neuromuscular Medicine (55.3%). At over 90% (35) of the COMs for which department chairs responded to the survey, cervical HVLA instruction occurs in the curriculum primarily during program years 1 and 2. Instruction in cervical HVLA to the 2nd through 7th cervical vertebral levels occurred in 97% (37), while 11% (4) of the COMs excluded the occipital-atlanto (OA) and atlanto-axial (AA) joints. A high percentage (81.6%; 31) of the OMM/OPP department chairs or representatives reported employing cervical HVLA techniques within their practice. Among the respondents, 40.5% (15) reported that 0-25% of their school's medical school class could perform cervical HVLA competently upon graduation, whereas 27% (10) said that 51-75% of their class could perform cervical HVLA. A majority of COMs provide education in their curricula related to cervical HVLA primarily in the first 2 years of medical education. However, instruction often excludes cervical HVLA to the upper regions of the cervical spine. At COMs where HVLA to the cervical spine is not taught, that decision is because the techniques are thought to be too difficult and the attendant medicolegal risk perceived to be too high. OMM/OPP department chairs expressed confidence in only a small proportion of their graduates having the ability to competently apply HVLA to the cervical spine immediately after completing their predoctoral medical training.

Comparison between high-velocity low-amplitude manipulation and muscle energy technique on pain and trunk neuromuscular postural control in male workers with chronic low back pain: A randomised crossover trial.

BackgroundA therapeutic recommendation for restoring function in individuals with chronic low back pain (CLBP) is manual therapy through manipulative spinal or muscle energy techniques.ObjectivesTo compare the effectiveness of two osteopathic manipulative techniques on clinical low back symptoms and trunk neuromuscular postural control in male workers with CLBP.MethodTen male workers with CLBP were randomly allocated to two groups: high-velocity low-amplitude (HVLA) manipulation or muscle energy techniques (MET). Each group received one therapy per week for both techniques during 7 weeks of treatment. Pain and function were measured by using the Numeric Pain-Rating Scale, the McGill Pain Questionnaire and the Roland Morris Disability Questionnaire. The lumbar flexibility was assessed by Modified Schober Test. Electromyography (EMG) and force platform measurements were used for evaluation of trunk muscular activation and postural balance, respectively at three different times: baseline, post intervention, and 15 days later.ResultsBoth techniques were effective (p < 0.01) in reducing pain with large clinical differences (-1.8 to -2.8) across immediate and after 15 days. However, no significant effect between groups and times was found for other variables, namely neuromuscular activation and postural balance measures.ConclusionBoth techniques (HVLA thrust manipulation and MET) were effective in reducing back pain immediately and 15 days later. Neither technique changed the trunk neuromuscular activation patterns nor postural balance in male workers with LBP.Clinical implicationsThese results may facilitate clinical decision-making for CLBP management in physiotherapy programs.

Immediate and Short-Term Effects of Upper Cervical High-Velocity, Low-Amplitude Manipulation on Standing Postural Control and Cervical Mobility in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial.

This study aimed to determine the immediate and short-term effects of a single upper cervical high-velocity, low-amplitude (HVLA) manipulation on standing postural control and cervical mobility in chronic nonspecific neck pain (CNSNP). A double-blinded, randomized placebo-controlled trial was performed. Forty-four patients with CNSNP were allocated to the experimental group (n = 22) or control group (n = 22). All participants were assessed before and immediately after the intervention, with a follow-up on the 7th and 15th days. In each evaluation, we assessed global and specific stabilometric parameters to analyze standing postural balance and performed the cervical flexion-rotation test (CFRT) to analyze upper cervical mobility. We obtained statistically significant differences, with a large effect size, in the limited cervical rotation and global stabilometric parameters. Upper cervical HVLA manipulation produced an improvement in the global stabilometric parameters, significantly decreasing the mean values of velocity, surface, path length, and pressure in all assessments (p < 0.001; ƞ 2 p = 0.323–0.856), as well as significantly decreasing the surface length ratio (L/S) on the 7th (−0.219 1/mm; p = 0.008; 95% confidence interval (CI): 0.042–0.395) and 15th days (−0.447 1/mm; p < 0.001; 95% CI: 0.265–0.629). Limited cervical rotation values increased significantly immediately after manipulation (7.409°; p < 0.001; 95% CI: 6.131–8.687) and were maintained during follow-up (p < 0.001). These results show that a single upper cervical HVLA manipulation produces an improvement in standing postural control and increases the rotational range of motion (ROM) in the upper cervical spine in patients with CNSNP.

Manipulative Therapy Plus Ankle Therapeutic Exercises for Adolescent Baseball Players with Chronic Ankle Instability: A Single-Blinded Randomized Controlled Trial.

Manipulative therapies and exercises are commonly used for the management of chronic ankle instability (CAI), but there is no evidence regarding the efficacy of high-velocity low-amplitude manipulation (HVLA) in addition to ankle therapeutic exercise to improve CAI in adolescent baseball players (ABP). To compare the effects of HVLA plus ankle therapeutic exercise and ankle therapeutic exercise alone on ankle status, pain intensity, pain pressure threshold (PPT), range of motion (ROM) of the ankle joint, and balance ability in ABP with CAI, a single-blinded randomized controlled trial was conducted. A total of 31 ABP with CAI were randomly allocated to the intervention (n = 16) or control (n = 15) groups. The intervention group received HVLA plus resistance exercise twice a week for 4 weeks, while the control group received resistance exercise alone. Ankle status, pain intensity, PPT, ROM, and balance ability were assessed before and after the intervention. The American Orthopedic Foot and Ankle Society scores showed significant group and time interactions (total, p = 0.002; pain, p < 0.001; alignment, p = 0.001). There were significant group and time interactions in pain intensity (resting pain, p = 0.008; movement pain, p < 0.001). For ROM, there were significant group and time interactions on dorsiflexion (p = 0.006) and eversion (p = 0.026). The unipedal stance of the balance ability showed significant group and time interactions in path length (p = 0.006) and velocity (p = 0.006). Adding HVLA to resistance exercises may be synergistically effective in improving the ankle status, pain intensity, ROM, and balance ability in ABP with CAI.

Immediate effects of a lumbar spine manipulation on pain sensitivity and postural control in individuals with nonspecific low back pain: a randomized controlled trial

BackgroundAccording to the American Physical Therapy Association, there is strong evidence to show that vertebral mobilization and manipulation procedures 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. Objectives: To evaluate the immediate effects of high-velocity low-amplitude (HVLA) manipulation on pain and postural control parameters in individuals with nonspecific low back pain.MethodsThis study used a participant-blinded and assessor-blinded randomized controlled clinical trial involving a single session, in which 24 participants were randomly distributed into control (simulated manipulation) and intervention (HVLA lumbar manipulation) groups. The primary (pain: subjective pain intensity and pressure pain threshold) and secondary outcomes (postural control: ellipse area, center of pressure [COP] excursion, COP RMS velocity, and differences between the COP and center of projected gravity) were evaluated before and after the session using a numerical pain scale, algometer, and a force platform. For all outcomes, multiple mixed 2 (group) × 2 (time) ANOVAs were performed.ResultsFor the subjective pain intensity, only time was significant as a main effect, where pre-intervention presented a greater value then post-intervention (F [1.44] = 4.377; p = 0.042; r = 0.30). For the pressure pain threshold no significant effect was found. For the postural control parameters, as a main effect, only the ellipse area was significantly greater in the control group (F [1.44] = 6.760; p = 0.013; effect size = 0.36).ConclusionsThere was a reduction in subjective pain intensity, evaluated using a numerical scale, in both the intervention and control groups immediately after the intervention, suggesting that the spinal manipulation had a similar effect to the placebo procedure. No effect of HVLA lumbar manipulation was identified for postural control variables in either the intervention or control groups.Trial registrationThe study was registered at ClinicalTrials.gov under the number NCT02312778, registered at 14 September 2014.

Does manual therapy affect functional and biomechanical outcomes of a sit-to-stand task in a population with low back pain? A preliminary analysis

IntroductionManual therapy (MT) hypothetically affects discrepant neuromuscular control and movement observed in populations with low back pain (LBP). Previous studies have demonstrated the limited influence of MT on movement, predominately during range of motion (ROM) testing. It remains unclear if MT affects neuromuscular control in mobility-based activities of daily living (ADLs). The sit-to-stand (STS) task represents a commonly-performed ADL that is used in a variety of clinical settings to assess functional and biomechanical performance.ObjectiveTo determine whether MT affects functional performance and biomechanical performance during a STS task in a population with LBP.MethodsKinematic data were recorded from the pelvis and thorax of participants with LBP, using an optoelectronic motion capture system as they performed a STS task before and after MT from November 2011 to August 2014. MT for each participant consisted of two high-velocity low-amplitude spinal manipulations, as well as two grade IV mobilizations of the lumbar spine and pelvis targeted toward the third lumbar vertebra and sacroiliac joint in a side-lying position; the order of these treatments was randomized. Pelvis and thorax kinematic data were used to derive the time-varying lumbar angle in the sagittal plane for each STS trial. The difference between the maximum and minimum lumbar angles during the STS trial determined the sagittal ROM that was used as the biomechanical outcome. Time to complete each STS trial was used as a functional measure of performance. Pre-MT and post-MT values for the lumbar sagittal ROM and time to completion were statistically analysed using paired samples t-tests.ResultsData were obtained from 40 participants with 35 useful datasets (NRS = 3.3 ± 1.2; 32.4 ± 9.8 years; 16 females, 19 males). After MT, lumbar sagittal ROM increased by 2.7 ± 5.5 degrees (p = 0.007). Time to complete the STS test decreased by 0.4 ± 0.4 s (p < 0.001).DiscussionThese findings provide preliminary evidence that MT might influence the biomechanical and functional performance of an STS task in populations with LBP. The MT intervention in this study involved a combination of spinal manipulations and mobilizations. Future work will expand upon these data as a basis for targeted investigations on the effects of either spinal manipulation and mobilization on neuromuscular control and movement in populations with LBP.

Alternative Effective Management of the Musculoskeletal Pain

There is a considerable amount of evidence regarding the effectiveness of high-velocity low amplitude (HVLA) manipulation on virtually all joints of the human body, both in the spine and extremities.

Immediate effects and associations between interoceptive accuracy and range of motion after a HVLA thrust on the thoracolumbar junction: A randomised controlled trial

BackgroundThere is paucity in the literature regarding the role of interoceptive accuracy (IAc) at predicting the effectiveness of osteopathic techniques which increase spinal mobility when directed specifically at the thoracolumbar junction (TLJ). AimsThe study aimed to explore whether a high velocity, low amplitude (HVLA) thrust of the TLJ would increase spinal mobility (measured through Range of Motion; ROM) and change IAc. Also, whether baseline IAc correlated with the post-ROM measures and change in ROM. Method21 asymptomatic participants were allocated into three conditions in a randomised order. These were; (1) a high velocity low amplitude manipulation of the TLJ; (2) sham (basic touch); and (3) a control (laying supine on a plinth). Before and following each intervention, the participants’ spinal ROM was measured using an Acumar digital inclinometer. In addition to this an ECG was used to measure their pre and post condition IAc. ResultsThere were significant increases in ROM for all condition, however, the HVLA thrust led to a significantly greater increase in ROM (p < 0.001) when compared to the control and sham. Baseline IAc was inversely associated with post-ROM but there was no association with change in ROM. The HVLA thrust did not significantly change IAc scores from pre to post intervention. Conclusions. HVLA thrust over the TLJ is a useful intervention for increasing spinal ROM. IAc maybe a useful predictor for intervention effectiveness of this technique and spinal area which could in the future be utilised by osteopaths as part of their diagnostics.

High-velocity, low-amplitude manipulation (HVLA) does not alter three-dimensional position of sacroiliac joint in healthy men: A quasi-experimental study

The impact of high-velocity, low-amplitude (HVLA) manipulations on the behavior of sacroiliac joint (SIJ) mobility in individuals submitted to an osteopathic intervention has not been sufficiently investigated. Furthermore, there is no standard agreement on the description of the acute effects of HLVA with regards to the mobility of the SIJ through three-dimensional motion analysis. The purpose of this study was to analyse possible alterations in the mobility of the SIJ pre- and post-manipulation of the ilium bone in healthy men. Thirty healthy male patients aged between 18 and 35 years were examined and divided into two groups: manipulation (MN) and placebo (PL) groups. SIJ movement was assessed through a three-dimensional motion analysis system before and after osteopathic manipulation of the anterior ilium bone, during hip flexion. Statistical analysis was performed using the Kolmogorov-Smirnov normality test, and Fisher's exact test was used to observe associations of interest in the mobility of the SIJ. Finally, the t-test was used to analyse values of mobility of the SIJ pre- and post-manipulation (p < 0.05). Non-significant differences were observed in SIJ mobility. In MN the means were pre-manipulation right SIJ 39.98 mm ± 10.82 [CI - 29.16–50.8] and post- 42.85 mm ± 27.17 [CI – 15.68–70.02] with p = 0.61. Pre-manipulation left SIJ 41.73 mm ± 15.34 [CI 10.89–82.99] and post- 39.97 mm ± 14.70 [CI - 24.67-54.07] with p = 0.39. HVLA does not alter the mobility of SIJ under these conditions. Further studies under different conditions, with patients that report pain, are required to fully understand the behavior of the SIJ after HVLA manipulation.