High-Velocity Low-Amplitude Manipulation Techniques

Excerpt

Dr. Kirkaldy-Willis first conceptualized and published theories regarding the Biomechanics and Biology of the Spinal Degenerative Cascade. He defined the HVLA technique as "a skilled, passive manual therapeutic maneuver during which a synovial joint is beyond the normal physiological range of movement (in the direction of the restriction) without exceeding the boundaries of anatomical integrity."

High-velocity low amplitude techniques employ a rapid use of force over a short duration, distance, and/or rotational area within the anatomical range of motion of a joint to engage the restrictive barrier in one or more planes of motion to elicit the release of restriction. This manipulation technique uses high velocity and low amplitude thrusts to manipulate joints. Osteopathic physicians, chiropractors, and physical therapists are trained in HVLA and commonly perform these techniques.

Both therapies are used in cases of acute musculoskeletal back pain. The physician positions the person at the barrier of limited movement and then gives a rapid thrust in the isolated barrier's direction to resolve the restriction and improve motion. This method is among the oldest and most frequently used, and it is among the most common types of complementary medicine for children. Most clinical research has focused on evaluating the efficacy of this form of manipulation, particularly for low back, mid-back, and neck pain.

Purpose — restore motion to a restricted joint and improve function.

Terminology

High-velocity low amplitude is interchangeable with manipulation and thrust because of the different biomechanics. Nevertheless, these all unify in describing the process of increasing the range of motion.

1. Abbreviations — (AOA) American Osteopathic Association; (DO) Doctor of Osteopathic Medicine; (HLVA) High-velocity low amplitude; (HVLA-SM) High-velocity low amplitude spinal manipulation; (L) Lumbar; (ms) milliseconds; (N) newtons; (OMT) Osteopathic Manipulative Treatment; (RCT) randomized controlled trials

2. Adverse Event — Stroke, headache, joint pain, and vertebral artery dissection are possible adverse events associated with an HVLA OMT technique.

3. Amplitude — The thrust's distance attempts to create a movement of about 1/8th inch at the joint treated.

4. Cavitation — The process of using a mechanical force to precipitate a gas bubble in a joint space.

5. Fulcrum — This describes when a hand or body localizes a thrust's force into the segment or joint that is restricted.

6. Long Lever — The extremities or multiple segments of the vertebral column.

7. Manipulation — Synonym for a high-velocity low amplitude technique. Manipulation occurs at the end of and often beyond the available motion of the joint to break adhesions that disrupt or prevent joint movement.

8. Short Lever — Any portion of the vertebra held while force is applied to the adjacent vertebra's bony prominence.

9. Thrust — Synonym for a high-velocity low amplitude technique. Thrust may refer to cracking or popping sounds.

Statistics

1. Prevalence Of Use Amongst The Pediatric Population: 2 to 3%

2. Approximately Incidence Adverse Event Per OMT Procedure: 1/50,000

3. Approximate Number of Adverse Events Which Are Operator-Induced: 1/5

4. Approximate Number of Adverse Events In Cervical Manipulation: 1/400,000 to 1,000,000, 1 every 177.5 weeks