High Velocity Low Amplitude Research Articles

Cervicothoracic Manipulation Techniques Reviewed Utilizing Three-Dimensional Spine Model.

Currently, there is a paucity of studies that describe prone cervicothoracic joint high-velocity low-amplitude (HVLA) thrust techniques using an anatomically accurate, biomimetic three-dimensional (3D) spine model for educational demonstration. The purpose of this technical report was to present a learning model for two prone cervicothoracic HVLA thrust techniques using a 3D model, review intersegmental mobility observed on a 3D spine model with application of the techniques, and lastly discuss potential applications of this learning model.

Toward a Theory of the Mechanism of High-Velocity, Low-Amplitude Technique: A Literature Review.

This review seeks to integrate the current literature to create a more unified and inclusive theory regarding the therapeutic mechanism of high-velocity, low-amplitude (HVLA) technique. The authors review the literature currently available regarding the physiologic effects of HVLA. The progression from an articulatory model to a neuromuscular one is discussed, and the body of work demonstrating that HVLA has a centralized mechanism of action, rather than just a local one, is described.

The effect of a single high velocity low amplitude hip mobilization on strength in subjects with knee injuries

BackgroundManual therapy have been used as a disinhibitory intervention to increase muscle activation before performing functional tasks that are limited by weakness. Knee injuries are commonly associated with weakness in quadriceps and gluteus. Currently, there is no evidence to support anecdotal experience that a hip distraction mobilization improves muscle performance in subjects with knee injuries and lower extremity weakness. ObjectivesTo determine if a hip distraction mobilization would result in an immediate change of maximal force output of the quadriceps and gluteus. DesignNon-controlled observational pre-post design. MethodsForty individuals with knee pathology were included. Subjects underwent quadriceps, gluteus maximus, and gluteus medius muscle strength assessment before a single hip distraction of the symptomatic side. An immediate re-assessment of muscle strength of both symptomatic and asymptomatic sides followed the mobilization. Results/findings: Comparing pre-to post-mobilization strength on the symptomatic side, a significant increase was found with the gluteus maximus (average change = 2.0 kg [95%CI 0.6–3.4]; p < 0.01) but not gluteus medius (0.2 kg [-0.7-1.0]; p = 0.71) or quadriceps (0.1 kg [-1.4-1.7]; p = 0.86). When comparing the strength on the symptomatic side in subjects with weakness greater than the MDD95 (0.7–2.9 kg), a significant increase was again found for gluteus maximus (4.7 kg [2.6–6.8]; p < 0.01) but not for gluteus medius (0.2 kg [-1.0-1.4]; p = 0.71) or quadriceps (1.6 kg [-0.7-3.9]; p = 0.15). ConclusionA single hip distraction resulted in a significant increase in gluteus maximus strength but did not produce a change in gluteus medius or quadriceps strength in subjects with knee injuries.

Neurophysiological Effects of High Velocity and Low Amplitude Spinal Manipulation in Symptomatic and Asymptomatic Humans: A Systematic Literature Review.

Systematic review. To summarize the evidence of neurophysiological effects of spinal manipulative therapy (SMT) with a high velocity low amplitude thrust (HVLA-SMT) in asymptomatic and symptomatic humans. HVLA-SMT is effective in reducing back pain, but its mode of action is not fully understood. A systematic literature search (until July 2018) was conducted by a professional librarian in seven databases (Medline (OvidSP), Premedline (PubMed), EMBASE, Cochrane, CINAHL, PEDro, and Scopus). Two authors selected the studies according to the a priori described criteria and scored study quality. Only controlled studies of at least moderate quality were included. Effects of HVLA-SMT on a particular outcome measure were defined as more than one study showing a significantly greater effect of HVLA-SMT compared with the control intervention. From the 18 studies included (932 participants in total), there was evidence only for an association between HVLA-SMT and changes in the autonomic nervous system, reflected in changes in heart rate variability and skin conductance. Most studies focused on healthy volunteers and none related neurophysiologic changes to pain reduction. This systematic review points to HVLA-SMT affecting the autonomic nervous system. The effects seem to depend on the spinal level of HVLA-SMT application and might differ between healthy volunteers and pain patients. There is a need for high-quality studies that include patients, well characterized for pain duration and outcome measure baseline values, and address the relation between changes in neurophysiology and pain. 2.

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.

Unilateral and Multiple Cavitation Sounds During Lumbosacral Spinal Manipulation

ObjectiveThe purpose of this study was to determine from which side of the spine the popping sound (PS) emanates during side-lying, rotatory high-velocity low-amplitude (HVLA) thrust manipulation directed to the L5-S1 articulation using a time-frequency analysis. Secondary aims were to calculate the average number of PSs, the duration of lumbar thrust manipulation, and the duration of a single PS. MethodsThirty-four asymptomatic participants received 2 lumbar HVLA thrust manipulations targeting the right and left L5-S1 articulations. Two high sampling rate accelerometers were secured bilaterally 25 mm lateral to the midline of the L5-S1 interspace. For each manipulation, 2 audio signals were extracted and singularly processed via spectrogram calculation to obtain the release of energy over time on each side of the lumbosacral junction. ResultsDuring 60 HVLA thrust manipulations, it was measured a total of 320 PSs. Of those PSs, 176 occurred ipsilateral and 144 occurred contralateral to the targeted L5-S1 articulation; that is, the PS was no more likely to occur on the upside than the downside facet after right or left rotatory L5-S1 HVLA thrust manipulation. Moreover, PSs occurring on both sides at the same time were detected very rarely (ie, 2% of cases) with the lumbar HVLA thrust manipulations. The mean number of audible PSs per lumbosacral HVLA thrust manipulation was 5.27 (range 2-9). The mean duration of a single manipulation was 139.13 milliseconds (95% confidence interval: 5.61-493.79), and the mean duration of a single PS was 2.69 milliseconds (95% confidence interval: 0.95-4.59). ConclusionBased on our findings, spinal manipulative therapy practitioners should expect multiple PSs that most often occur on the upside or the downside facet articulations when performing HVLA thrust manipulation to the lumbosacral junction (ie, L5-S1). However, whether the multiple PSs found in this study emanated from the same joint or adjacent ipsilateral or contralateral facet joints remains unknown. A single model may not necessarily be able to explain all of the audible sounds during HVLA thrust manipulation.

Friday, September 28, 2018 9:00 AM–10:00 AM best papers Friday: 148. Biological and clinical outcomes of chiropractic spinal manipulative therapy in the treatment of patients with acute inflammatory radiculopathy secondary to lumbar disc herniation: a pilot study

BACKGROUND CONTEXT Acute sciatica secondary to lumbar disc herniation (AS/LDH) is thought to be caused by mechanical compression of the spinal nerve root and/or chemical inflammatory mechanisms involving pro-inflammatory cytokines (IC) such as interleukin (IL)-1α, IL-8and tumor necrosis factor (TNF)-α). Although chiropractic high velocity low amplitude (HVLA) spinal manipulative therapy (CSMT) is commonly used to treat AS/LDH patients, randomized controlled studies demonstrating efficacy have not been carried out to date. In addition, preliminary studies have reported decreases in serum ICs following CSMT. PURPOSE To evaluate the feasibility of conducting a randomized controlled trial (RCT) of the clinical and biological effects of chiropractic spinal manipulative therapy (CSMT) on in vivo IC expression and clinical outcomes in patients with acute sciatica and lumbosacral disc herniation (AS/LDH). STUDY DESIGN/SETTING Randomized controlled clinical trial. Enzyme linked immunosorbent assay (ELISA) of serum and disc tissue inflammatory cytokine content. PATIENT SAMPLE Inclusion: AS/LDH ofless than 6 months’ duration with a McCulloch criteria score of 5/5. Exclusion: red flag condition, cauda equina syndrome, progressive neurological deficit. OUTCOME MEASURES VAS and Roland Morris Disability scores and serum IC levels at baseline, 6, 12 and 24 weeks. Physical examination findings of nerve root tension signs, motor and sensory spinal nerve root deficit and Schober's test of lumbar flexion recorded at all data collection points. IC levels measured by ELISA in disc tissue, nerve root and disc lavagate collected in patients undergoing surgery. METHODS Patients with AS/LDH of less than 16 weeks duration were randomized to 6 weeks of CSMT or the approximately 6 weeks surgical wait list. Standardized neurological and lumbar spine examinations, VAS and Roland Morris Disability scores, and serum IC levels were assessed at baseline, 6, 12 and 24 weeks. ICs were also measured in disc tissue, nerve root and disc lavagate collected during surgery. Research ethics approval was obtained. RESULTS A total of 40 of 44 (91%) invited patients participated and were randomized. A total of 13 patients avoided surgery. Post-CSMT improvement was associated with longer duration of sciatica, absence of cross-over sign and motor deficit, reduced lumbar flexion increment and lower IC levels at baseline. CONCLUSIONS It appears feasibleto conduct a RCT with patients randomized to CSMT or a waitlist control group. There may be a sub-group of AS/LDH patients who will significantly benefit from HVLA CSMT. A large scale clinical trial is now required to test this preliminary finding.

Motor Neuron Excitability Attenuation as a Sequel to Lumbosacral Manipulation in Subacute Low Back Pain Patients and Asymptomatic Adults: A Cross-Sectional H-Reflex Study

ObjectiveThe purpose of the study was to compare a time series of tibial nerve H-reflex trials between patients with subacute low back pain (LBP) and asymptomatic adults using pre and post high-velocity, low-amplitude (HVLA) spinal manipulation (SM) and control procedures. MethodsAsymptomatic adults (n = 66) and patients with subacute LBP (n = 45) were randomized into 3 lumbosacral procedures: side-posture positioning, joint preloading with no thrust, and HVLA SM. A time series of 40 Hmax/Mmax ratios at a rate of 0.1 Hz were recorded in blocks of 10 trials at baseline and after the lumbosacral procedures at time points corresponding to immediately after, 5 minutes after, and 10 minutes after the procedure. Descriptive time series analysis techniques included time plots, outlier detection, and autocorrelation functions. A mixed analysis of variance model (group × procedure × time) was used to compare the effects of lumbosacral procedures on Hmax/Mmax ratios between the patients with subacute LBP and asymptomatic participants. ResultsThe time series analysis and the significant lumbosacral × time interaction term (P < .05) indicated that inhibition of the Hmax/Mmax ratios at the 10-second postlumbosacral procedure time point was greatest after the HVLA SM procedure. The effects of lumbosacral procedures on Hmax/Mmax ratios were similar between patients with subacute LBP and asymptomatic participants. ConclusionsAlthough nonspecific effects of movement or position artifacts on the Hmax/Mmax ratio were present, a reliable and valid attenuation of the Hmax/Mmax ratio occurred as a specific aspect of HVLA SM in both asymptomatic adults and patients with subacute LBP.

Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders

Evidence indicates that manual therapy alone or in combination with exercise can be beneficial for temporomandibular disorders (TMD). However, there is still insufficient information demonstrating the effectiveness of treatment directed to the cervical spine for the management of TMD. To investigate the effects of spinal high-velocity low-amplitude (HVLA) manipulation with exercise compared to patient education in patients with chronic TMD. Another objective was to assess the effects of adding spinal HVLA manipulation to exercise. Sixty female patients with TMD were randomized to three groups: cervical spinal manipulation plus neck exercise (CSM + NE), sham manipulation plus neck exercise (SM + NE), and patient education only (PE). Scores on a numeric rating scale (NRS), pressure pain thresholds (PPT), pain-free maximum mouth opening (MMO), and Short Form 36 (SF-36) were evaluated at baseline, posttreatment, and 1‑month follow-up after randomization. No further treatment of TMD (like dental correction) was applied during the study period. In terms of pain, significant differences were observed in the CSM + NE group vs. the SM + NE and PE groups posttreatment. Although PPT increased significantly in the CSM + NE group, no significant changes in any PPT were found in either the SM + NE or PE group. Regarding pain-free MMO and SF-36 scores, there were significant increases posttreatment in the CSM + NE and SM + NE groups compared to the PE group. Our study suggests that HVLA manipulation of the upper cervical spine with neck exercise can be effective for treatment of pain and dysfunction in patients with chronic TMD, it is not the TMD treatment itself. Therefore, it seems reasonable to add cervical manipulation to the rehabilitation program.

Immediate and short-term effects of mulligan concept positional sustained natural apophyseal glides on an athletic young-adult population classified with mechanical neck pain: an exploratory investigation

Objectives: Mechanical neck pain (MNP) is common in the athletic population. While symptoms may present at the cervical spine for patients complaining of MNP, thoracic spinal alignment or dysfunction may influence cervical positioning and overall cervical function. Clinicians often employ cervical high-velocity low-amplitude (HVLA) thrust manipulations to treat MNP, albeit with a small level of inherent risk. Mulligan Concept positional sustained natural apophyseal glides (SNAGs) directed at the cervicothoracic region are emerging to treat patients with cervical pain and dysfunction, as evidence supporting an interdependent relationship between the thoracic and cervical spine grows. The purpose of this a priori study was to evaluate outcome measures of patients classified with MNP treated with the Mulligan Concept Positional SNAGs. Methods: Ten consecutive young-adult patients, ages ranging from 15 to 18 years (mean = 16.5 ± 1.78), classified with MNP were treated utilizing Mulligan Concept Positional SNAGs. The Numeric Rating Scale (NRS), Patient-Specific Functional Scale (PSFS), Neck Disability Index (NDI), Disablement in the Physically Active (DPAS), and Fear-Avoidance Based Questionnaire-Physical Activity (FABQPA) were collected for inclusion criteria and to identify patient-reported pain and dysfunction. Results: Patients reported decreases in pain on the NRS [5.4 to .16, p = .001], increases in function on the PSFS [5.2 to 10, p = .001], and increases in cervical range of motion (CROM) [ext p = .003, flex p = .009, left rot p = .001, right rot p = .002] immediately post-treatment and between treatments. Discussion: Positional SNAGs directed at the cervicothoracic region may address a variety of patient reported symptoms for MNP, and the number of treatment sessions needed for symptom resolution may be closer to a single session rather than multiple treatments. Level of Evidence: 4.

The Effects of Hip Mobilizations on Patient Outcomes: A Critically Appraised Topic.

Clinical Scenario: Hip osteoarthritis currently affects up to 28% of the population, and the number of affected Americans is expected to rise as the American population increases and ages. Limited hip range of motion (ROM) has been identified as a predisposing factor to hip osteoarthritis and limited patient function. Clinicians often apply therapy techniques, such as stretching and strengthening exercises, to improve hip ROM. Although traditional therapy has been recommended to improve hip ROM, the efficiency of the treatments within the literature is questionable due to lack of high-quality studies. More recently, clinicians have begun to utilize joint mobilization and the Mulligan Concept mobilization with movement techniques to increase ROM at the hip; however, there is a paucity of research on the lasting effects of mobilizations. Given the difficulties in improving ROM immediately (within a single treatment) and with long-lasting results (over the course of months), it is imperative to examine the evidence for the effectiveness of traditional therapy techniques and more novel manual therapy techniques. Focused Clinical Question: Is there evidence to suggest manual mobilizations techniques at the hip are effective at treating hip ROM limitations? Summary of Clinical Findings: 5 Randomized Controlled Studies, improved patient function and ROM with the Mulligan concept, high velocity low amplitude improved. Clinical Bottom Line: We found moderate evidence to suggest favorable outcomes following the use of hip mobilizations aimed at improving hip ROM and patient function. Strength of Recommendation: Strength of the studies identified are 1B.

THE UTILIZATION OF MULLIGAN CONCEPT THORACIC SUSTAINED NATURAL APOPHYSEAL GLIDES ON PATIENTS CLASSIFIED WITH SECONDARY IMPINGEMENT SYNDROME: A MULTI-SITE CASE SERIES

Secondary impingement syndrome (SIS) is a common complaint in the sporting population particularly among athletes engaging in overhead activities. While symptoms may be present at the shoulder with patients complaining of SIS, spinal alignment or dysfunction can influence scapular positioning and overall shoulder girdle function. As an adjunct therapy to traditional interventions for SIS, thoracic high-velocity low-amplitude (HVLA) thrusts have been utilized and correlated with patient reported decreases in pain. Mulligan Concept (MC) thoracic sustained natural apophyseal glides (SNAGs) are an emerging treatment intervention utilized to treat patients with shoulder pain and dysfunction as the evidence supporting an interdependent relationship between the thoracic spine and the shoulder is growing. The purpose of this case series was to investigate the effects of one MC thoracic SNAG treatment session on subjects classified with SIS, while utilizing a classification-based treatment protocol. Seven subjects classified with SIS were treated utilizing a MC thoracic SNAG. The Numeric Rating Scale (NRS) was administered at initial evaluation, immediately following intervention, and at the 48-h follow-up to identify patient-reported pain during range of motion, manual strength testing, and special tests of the shoulder. Investigators collected the Shoulder Pain and Disability Index (SPADI) at initial evaluation and the 48-h follow-up to identify patient-reported dysfunction. Following one MC thoracic SNAG treatment (3 sets of 10 repetitions), minimal clinically important differences (MCIDs) were reported utilizing the NRS. A decrease in pain during active shoulder abduction (ABD) was detected immediately post-treatment, and the NRS change scores for resisted external rotation (RER) and active ABD were statistically different and clinically important at the 48-h follow-up. Based on the results of this case series, thoracic SNAGs may influence short-term pain levels and shoulder mobility in the included subjects with SIS and support the concept of regional interdependence (RI) between the thoracic spine and glenohumeral joint. Continued exploration into the proposed benefits of the MC thoracic SNAG treatment as an adjunct therapy when treating patients complaining of SIS is warranted. 4 (Case Series).

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

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.

Poster 100: Intervertebral Kinematics in the Cervical Spine Before, During and After High Velocity Low Amplitude Manipulation

Poster 100: Intervertebral Kinematics in the Cervical Spine Before, During and After High Velocity Low Amplitude Manipulation

Effects of Cervical High-Velocity Low-Amplitude Techniques on Range of Motion, Strength Performance, and Cardiovascular Outcomes: A Review.

Cervical high-velocity low-amplitude (HVLA) manipulation technique is among the oldest and most frequently used chiropractic manual therapy, but the physiologic and biomechanics effects were not completely clear. This review aims to describe the effects of cervical HVLA manipulation techniques on range of motion, strength, and cardiovascular performance. A systematic search was conducted of the electronic databases from January 2000 to August 2016: PubMed (n = 131), ScienceDirect (n = 101), Scopus (n = 991), PEDro (n = 33), CINAHL (n = 884), and SciELO (n = 5). Two independent reviewers conducted the screening process to determine article eligibility. The intervention that included randomized controlled trials was thrust, or HVLA, manipulative therapy directed to the cervical spine. Methodological quality was assessed using the Cochrane risk-of-bias tool. The initial search rendered 2145 articles. After screening titles and abstracts, 11 articles remained for full-text review. The review shows that cervical HVLA manipulation treatment results in a large effect size (d > 0.80) on increasing cervical range of motion and mouth opening. In patients with lateral epicondylalgia, cervical HVLA manipulation resulted in increased pain-free handgrip strength, with large effect sizes (1.44 and 0.78, respectively). Finally, in subjects with hypertension the blood pressure seemed to decrease after cervical HVLA manipulation. Higher quality studies are needed to develop a stronger evidence-based foundation for HVLA manipulation techniques as a treatment for cervical conditions.

Decreased spontaneous activity and altered evoked nociceptive response of rat thalamic submedius neurons to lumbar vertebra thrust.

The thalamus is a central structure important to modulating and processing all mechanoreceptor input destined for the cortex. A large number of diverse mechanoreceptor endings are stimulated when a high velocity low amplitude thrust is delivered to the lumbar spine during spinal manipulation. The objective of this study was to determine if a lumbar thrust alters spontaneous and/or evoked nociceptive activity in medial thalamic submedius (Sm) neurons. Extracellular recordings were obtained from 94 thalamic Sm neurons in 54 urethane-anesthetized adult Wistar rats. Spontaneous activity was recorded 5min before and after an L5 control (no thrust) and thrust (85% rat body weight; 100ms) procedure. In a subset of responsive nociceptive-specific neurons, mean changes in noxious-evoked response (10-s pinch with clip; 795g) at three sites (tail, contra- and ipsilateral hindpaw) were determined following an L5 thrust. Mean changes in Sm spontaneous activity (60s bins) and evoked noxious response were compared using a mixed model repeated measures ANOVA with Bonferroni post hoc t tests and paired t tests, respectively. Compared to control, spontaneous Sm activity decreased 180-240s following the lumbar thrust (p<0.005). Inhibitory evoked responses were attenuated in the contralateral hindpaw following an L5 thrust compared to control (p<0.05). No other changes in spontaneous or noxious-evoked Sm activity were found. A delayed, but prolonged suppression of spontaneous Sm activity along with changes in noxious-evoked inhibitory responses in the contralateral hindpaw following lumbar vertebra thrust suggest that thalamic submedius neurons may play a role in central pain modulation related to manual therapy intervention.

Beliefs in the population about cracking sounds produced during spinal manipulation

ObjectivesTo examine beliefs about cracking sounds heard during high-velocity low-amplitude (HVLA) thrust spinal manipulation in individuals with and without personal experience of this technique. MethodsWe included 100 individuals. Among them, 60 had no history of spinal manipulation, including 40 who were asymptomatic with or without a past history of spinal pain and 20 who had nonspecific spinal pain. The remaining 40 patients had a history of spinal manipulation; among them, 20 were asymptomatic and 20 had spinal pain. Participants attended a one-on-one interview during which they completed a questionnaire about their history of spinal manipulation and their beliefs regarding sounds heard during spinal manipulation. ResultsMean age was 43.5±15.4years. The sounds were ascribed to vertebral repositioning by 49% of participants and to friction between two vertebras by 23% of participants; only 9% of participants correctly ascribed the sound to the formation of a gas bubble in the joint. The sound was mistakenly considered to indicate successful spinal manipulation by 40% of participants. No differences in beliefs were found between the groups with and without a history of spinal manipulation. ConclusionsCertain beliefs have documented adverse effects. This study showed a high prevalence of unfounded beliefs regarding spinal manipulation. These beliefs deserve greater attention from healthcare providers, particularly those who practice spinal manipulation.

Procedure Selection and Patient Positioning Influence Spine Kinematics During High-Velocity, Low-Amplitude Spinal Manipulation Applied to the Low Back

ObjectivesThis investigation compared indirect 3-dimensional angular kinematics (position, velocity, and acceleration) of the lumbar spine for 2 different high-velocity, low-amplitude (HVLA) spinal manipulation procedures (lumbar spinous pull or push), and altered initial patient lower limb posture. MethodsTwenty-four participants underwent 6 HVLA procedures directed toward the presumed L4 vertebra, reflecting each combination of 2 variants of a spinal manipulation application technique (spinous pull and push) and 3 initial hip flexion angles (0°, 45°, and 90°) applied using a right lateral recumbent patient position. All contact forces and moments between the patient and the external environment, as well as 3-dimensional kinematics of the patient’s pelvis and thorax, were recorded. Lumbar spine angular positions, velocities, and accelerations were analyzed within the preload and impulse stages of each HVLA trial. ResultsLumbar spine left axial rotation was greater for the pull HVLA. The pull HVLA also generated a greater maximum (leftward) and lower minimum (rightward) axial rotation velocity and deceleration and greater leftward and rightward lateral bend velocities, acceleration, and deceleration components. Not flexing the hip produced the greatest amount of extension, as well as the lowest axial rotation and maximum axial rotation acceleration during the impulse. ConclusionsThis investigation provides basic kinematic information for clinicians to understand the similarities and differences between 2 HVLA side-lying manipulations in the lumbar spine. Use of these findings and novel technology can drive future research initiatives that can both affect clinical decision making and influence teaching environments surrounding spinal manipulative therapy skill acquisition.

Assessment of in vivo 3D kinematics of cervical spine manipulation: Influence of practitioner experience and occurrence of cavitation noise

Investigations on 3D kinematics during spinal manipulation are widely reported for assessing motion data, task reliability and clinical effects. However the link between cavitation occurrence and specific kinematics remains questionable. This paper investigates the 3D head-trunk kinematics during high velocity low amplitude (HVLA) manipulation for different practitioners with respect to the occurrence of cavitation. Head-trunk 3D motions were sampled during HVLA manipulation in twenty asymptomatic volunteers manipulated by four practitioners with different seniority (years of experience). Four target levels were selected, C3 and C5 on each side, and were randomly allocated to the different practitioners. The data was recorded before, during and after each set of trial in each anatomical plane. The number of trials with cavitation occurrence was collected for each practitioner. The manipulation task was performed using extension, ipsilateral side bending and contra-lateral axial rotation independent of side or target level. The displayed angular motion magnitudes did not exceed normal active ROM. Regardless cavitation occurrence, wide variations were observed between practitioners, especially in terms of velocity and acceleration. Cavitation occurrence was related to several kinematics features (i.e. frontal ROM and velocity, sagittal acceleration) and practitioner experience. In addition, multilevel cavitation was observed regularly. Kinematics of cervical manipulation is dependent on practitioner and years of experience. Cavitation occurrence could be related to particular kinematics features. These aspects should be further investigated in order to improve teaching and learning of cervical manipulation technique.

Hypoalgesic effects of three different manual therapy techniques on cervical spine and psychological interaction: A randomized clinical trial

ObjectiveThe purpose of this study was to evaluate the extent to which psychological factors interact with a particular manual therapy (MT) technique to induce hypoalgesia in healthy subjects. MethodsSeventy-five healthy volunteers (36 female, 39 males), were recruited in this double-blind, controlled and parallel study. Subjects were randomly assigned to receive: High velocity low amplitude technique (HVLA), joint mobilization, or Cervical Lateral glide mobilization (CLGM). Pressure pain threshold (PPT) over C7 unilaterally, trapezius muscle and lateral epicondyle bilaterally, were measured prior to single technique MT was applied and immediately after to applied MT. Pain catastrophizing, depression, anxiety and kinesiophobia were evaluated before treatment. ResultsThe results indicate that hypoalgesia was observed in all groups after treatment in the neck and elbow region (P < 0.05), but mobilization induces more hypoalgesic effects. Catastrophizing interacted with change over time in PPT, for changes in C7 and in manipulation group. ConclusionsAll the MT techniques studied produced local and segmental hypoalgesic effects, supporting the results of previous studies studying the individual interventions. Interaction between catastrophizing and HVLA technique suggest that whether catastrophizing level is low or medium, the chance of success is high, but high levels of catastrophizing may result in poor outcome after HVLA intervention. Trial registrationClinicalTrials.gov Registration Number: NCT02782585.