Quantifying the High-Velocity, Low-Amplitude Spinal Manipulative Thrust: A Systematic Review

Department of Chiropractic, Macquarie University NSW 2109, Australia.
Journal of manipulative and physiological therapeutics (Impact Factor: 1.48). 09/2010; 33(7):542-53. DOI: 10.1016/j.jmpt.2010.08.001
Source: PubMed


The purpose of this study was to systematically review studies that quantify the high-velocity, low-amplitude (HVLA) spinal thrust, to qualitatively compare the apparatus used and the force-time profiles generated, and to critically appraise studies involving the quantification of thrust as an augmented feedback tool in psychomotor learning.
A search of the literature was conducted to identify the sources that reported quantification of the HVLA spinal thrust. MEDLINE-OVID (1966-present), MANTIS-OVID (1950-present), and CINAHL-EBSCO host (1981-present) were searched. Eligibility criteria included that thrust subjects were human, animal, or manikin and that the thrust type was a hand-delivered HVLA spinal thrust. Data recorded were single force, force-time, or displacement-time histories. Publications were in English language and after 1980. The relatively small number of studies, combined with the diversity of method and data interpretation, did not enable meta-analysis.
Twenty-seven studies met eligibility criteria: 17 studies measured thrust as a primary outcome (13 human, 2 cadaver, and 2 porcine). Ten studies demonstrated changes in psychomotor learning related to quantified thrust data on human, manikin, or other device.
Quantifiable parameters of the HVLA spinal thrust exist and have been described. There remain a number of variables in recording that prevent a standardized kinematic description of HVLA spinal manipulative therapy. Despite differences in data between studies, a relationship between preload, peak force, and thrust duration was evident. Psychomotor learning outcomes were enhanced by the application of thrust data as an augmented feedback tool.

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Available from: Aron Downie, Sep 08, 2014
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    • "Physical therapy was the most costly service overall [7]. Spinal manipulation is used by doctors of chiropractic (DC), osteopathic physicians, and physical therapists to treat musculoskeletal disorders [8] [9] [10] [11] [12]. While spinal manipulation has been shown to be effective in some studies [13], "
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    ABSTRACT: The objective of this study was to measure intradiscal pressure (IDP) changes in the lower cervical spine during a manual cervical distraction (MCD) procedure. Incisions were made anteriorly, and pressure transducers were inserted into each nucleus at lower cervical discs. Four skilled doctors of chiropractic (DCs) performed MCD procedure on nine specimens in prone position with contacts at C5 or at C6 vertebrae with the headpiece in different positions. IDP changes, traction forces, and manually applied posterior-to-anterior forces were analyzed using descriptive statistics. IDP decreases were observed during MCD procedure at all lower cervical levels C4-C5, C5-C6, and C6-C7. The mean IDP decreases were as high as 168.7 KPa. Mean traction forces were as high as 119.2 N. Posterior-to-anterior forces applied during manual traction were as high as 82.6 N. Intraclinician reliability for IDP decrease was high for all four DCs. While two DCs had high intraclinician reliability for applied traction force, the other two DCs demonstrated only moderate reliability. IDP decreases were greatest during moving flexion and traction. They were progressevely less pronouced with neutral traction, fixed flexion and traction, and generalized traction.
    Evidence-based Complementary and Alternative Medicine 08/2013; 2013(11):954134. DOI:10.1155/2013/954134 · 1.88 Impact Factor
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    • "The OMT was targeted to the patient's clinical picture. The techniques used were high-velocity, low-amplitude thrust in thoracic spine (Downie et al., 2010); cranial techniques (Sutherland, 1939; Magoun, 1966; Kostopoulos et al., 1992); and myofascial release (Fryer et al., 2009). The application of such techniques was based on the methodological and conceptual theory of osteopathic dysfunction, i.e., " damaged or altered function of the somatic components: skeletal structure, joint, myofascial in relation to the vascular system, lymphatic and nervous " (ICD-9-CM International Classification of Diseases, 2009). "

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    • "In terms of treatment procedures, most of the chiropractors indicated employing the Diversified technique, previously reported by 86% of surveyed Canadian chiropractors, [8,9] employing high-velocity, low-amplitude spinal manipulation maneuvers [10], as well as soft tissue therapy and exercise prescription. One particular chiropractor, among the most experienced of those interviewed, said that her treatment plan depended on the patient: "
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    ABSTRACT: Background Chiropractors regularly treat pregnant patients for low back pain during their pregnancy. An increasing amount of literature on this topic supports this form of treatment; however the experience of the pregnant patient with low back pain and their chiropractor has not yet been explored. The objective of this study is to explore the experience of chiropractic treatment for pregnant women with low back pain, and their chiropractors. Methods This qualitative study employed semi-structured interviews of pregnant patients in their second or third trimester, with low back pain during their pregnancy, and their treating chiropractors in separate interviews. Participants consisted of 11 patients and 12 chiropractors. The interviews consisted of 10 open-ended questions for patients, and eight open-ended questions for chiropractors, asking about their treatment experience or impressions of treating pregnant patients with LBP, respectively. All interviews were audio-recorded, transcribed verbatim, and reviewed independently by the investigators to develop codes, super-codes and themes. Thematic saturation was reached after the eleventh chiropractor and ninth patient interviews. All interviews were analyzed using the qualitative analysis software N-Vivo 9. Results Five themes emerged out of the chiropractor and patient interviews. The themes consisted of Treatment and Effectiveness; Chiropractor-Patient Communication; Pregnant Patient Presentation and the Chiropractic Approach to Pregnancy Care; Safety Considerations; and Self-Care. Conclusions Chiropractors approach pregnant patients with low back pain from a patient-centered standpoint, and the pregnant patients interviewed in this study who sought chiropractic care appeared to find this approach helpful for managing their back pain symptoms.
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