Effects of cervical high-velocity low-amplitude techniques on range of motion, strength performance, and cardiovascular outcomes: A review

Background: 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. Objective: This review aims to describe the effects of cervical HVLA manipulation techniques on range of motion, strength, and cardiovascular performance. Methods/Design: 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. Results: 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. © Copyright 2017, Mary Ann Liebert, Inc

Randomised controlled pilot trial of high-velocity, low-amplitude manipulation on cervical and upper thoracic spine levels in asymptomatic subjects

Background High-velocity, low-amplitude (HVLA) manipulation techniques are habitually used on the cervical spine but the effects are not completely clear. The aim of this prospective comparative trial was to evaluate effects of an indiscriminate manipulation on the C5 (AMC5) a manipulation treatment based on a previous evaluation (MT) and a sham intervention (ST) on cervical spine range of motion (ROM); cervical flexion isometric peak force; EMG activation of sternocleidomastoid muscle (SCM) during the cranio-cervical flexion test (CCFT); and EMG signals of right and left biceps at rest were analyzed. Methods/Design Randomised controlled pilot study and intention-to-treat analysis was performed. Setting The study was conducted at an osteopathic clinic. Methods The outcomes were measured pre and immediately post intervention. Participants A total of 36 asymptomatic subjects (18 male, mean age 30 years) were randomly enrolled into 3 groups: AMC5 (n = 12), MT (n = 12), and ST (n = 12). Results Significant changes (p less than 0.1) were found in the cervical flexion isometric peak force (?13.15%), however, the effect size was considered moderate (d = 0.52). The extension (10.44%) and left rotation ROM (12.25%) showed significant improvement in MT group. During CCFT significant changes were not reported. Conclusions The current pilot study suggested that a tendency toward a decrease in the isometric strength peak in the cervical flexion of the MT group may appear. In cervical ROM the MT group achieved significant effects in extension and left rotation movement. © 2016 Elsevier Lt

Immediate effects of osteopathic treatment versus therapeutic exercise on patients with chronic cervical pain

Context. Alternatives to medication for immediate pain relief are needed because long-term use of pain medication has been associated with adverse effects. High-velocity, low-amplitude (HVLA) manipulation techniques (MTs) and craniocervical flexion (CCF) exercises have been frequently used in the management of chronic cervical pain. Objective. The study intended to compare the immediate effects on pain of a treatment using HVLA manipulation versus one using a CCF exercise protocol. Design. The research team designed a single-blinded, randomized clinical trial. Setting. The study was conducted at osteopathic clinics. Participants. Participants were 25 volunteer patients with chronic neck pain. Intervention. Participants were randomly enrolled in one of 2 groups: the HVLA manipulation group (MT group), n = 12, or the CCF exercise protocol group (CCF group), n = 13. Participants in the CCF group performed the exercise for 10 repetitions of a 10-s duration, with a 10-s rest interval between each contraction, for a total contraction time of 100 s and a total time of the session of 190 s. Outcome Measures • The outcomes were measured at baseline and at 60 s postintervention. The measures included (1) a visual analogue scale (VAS) completed during range of motion (ROM) measurement, (2) an evaluation of the ROM of the cervical spine, (3) a test of pressure pain thresholds (PPTs), and (4) electromyographic (EMG) activation of sternocleidomastoid muscle during a craniocervical flexion test. Results • Following both interventions, significant changes were found between baseline and immediately postintervention in the VAS score during ROM measurement for both groups, with P =.004 and P =.015, respectively. In the MT group, the measures for flexion (P =.001), right-side bending (P =.002), and left rotation (P =.005) changed significantly between baseline and postintervention; however, only flexion (P =.026) and extension (P =.040) ROM changed significantly between baseline and postintervention in the CCF group. Significant changes were observed in upper trapezius PPT following both interventions—MT group, P =.043, and CCF group, P =.005. In addition, significant changes in C5 PPT had occurred in the CCR group (P =.020). Between-group differences were significant for extension and right-side-bending ROM, with P =.019 and P =.012, respectively, and the changes between baseline and postintervention were greater in the MT group. None of the interventions led to changes in EMG. Conclusions • Although both interventions were associated with immediately improved ROM and pain after treatment, HVLA manipulation was more effective than CCF exercise in improving ROM and VAS during ROM. None of the interventions led to changes in EMG. © 2018, InnoVision Communications. All rights reserved

Effects of cervical high-velocity low-amplitude techniques on range of motion, strength performance, and cardiovascular outcomes: A review

Background: 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. Objective: This review aims to describe the effects of cervical HVLA manipulation techniques on range of motion, strength, and cardiovascular performance. Methods/Design: 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. Results: 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. © Copyright 2017, Mary Ann Liebert, Inc

Immediate effects of osteopathic treatment versus therapeutic exercise on patients with chronic cervical pain

Context. Alternatives to medication for immediate pain relief are needed because long-term use of pain medication has been associated with adverse effects. High-velocity, low-amplitude (HVLA) manipulation techniques (MTs) and craniocervical flexion (CCF) exercises have been frequently used in the management of chronic cervical pain. Objective. The study intended to compare the immediate effects on pain of a treatment using HVLA manipulation versus one using a CCF exercise protocol. Design. The research team designed a single-blinded, randomized clinical trial. Setting. The study was conducted at osteopathic clinics. Participants. Participants were 25 volunteer patients with chronic neck pain. Intervention. Participants were randomly enrolled in one of 2 groups: the HVLA manipulation group (MT group), n = 12, or the CCF exercise protocol group (CCF group), n = 13. Participants in the CCF group performed the exercise for 10 repetitions of a 10-s duration, with a 10-s rest interval between each contraction, for a total contraction time of 100 s and a total time of the session of 190 s. Outcome Measures • The outcomes were measured at baseline and at 60 s postintervention. The measures included (1) a visual analogue scale (VAS) completed during range of motion (ROM) measurement, (2) an evaluation of the ROM of the cervical spine, (3) a test of pressure pain thresholds (PPTs), and (4) electromyographic (EMG) activation of sternocleidomastoid muscle during a craniocervical flexion test. Results • Following both interventions, significant changes were found between baseline and immediately postintervention in the VAS score during ROM measurement for both groups, with P =.004 and P =.015, respectively. In the MT group, the measures for flexion (P =.001), right-side bending (P =.002), and left rotation (P =.005) changed significantly between baseline and postintervention; however, only flexion (P =.026) and extension (P =.040) ROM changed significantly between baseline and postintervention in the CCF group. Significant changes were observed in upper trapezius PPT following both interventions—MT group, P =.043, and CCF group, P =.005. In addition, significant changes in C5 PPT had occurred in the CCR group (P =.020). Between-group differences were significant for extension and right-side-bending ROM, with P =.019 and P =.012, respectively, and the changes between baseline and postintervention were greater in the MT group. None of the interventions led to changes in EMG. Conclusions • Although both interventions were associated with immediately improved ROM and pain after treatment, HVLA manipulation was more effective than CCF exercise in improving ROM and VAS during ROM. None of the interventions led to changes in EMG. © 2018, InnoVision Communications. All rights reserved

Randomised controlled pilot trial of high-velocity, low-amplitude manipulation on cervical and upper thoracic spine levels in asymptomatic subjects

Background High-velocity, low-amplitude (HVLA) manipulation techniques are habitually used on the cervical spine but the effects are not completely clear. The aim of this prospective comparative trial was to evaluate effects of an indiscriminate manipulation on the C5 (AMC5) a manipulation treatment based on a previous evaluation (MT) and a sham intervention (ST) on cervical spine range of motion (ROM); cervical flexion isometric peak force; EMG activation of sternocleidomastoid muscle (SCM) during the cranio-cervical flexion test (CCFT); and EMG signals of right and left biceps at rest were analyzed. Methods/Design Randomised controlled pilot study and intention-to-treat analysis was performed. Setting The study was conducted at an osteopathic clinic. Methods The outcomes were measured pre and immediately post intervention. Participants A total of 36 asymptomatic subjects (18 male, mean age 30 years) were randomly enrolled into 3 groups: AMC5 (n = 12), MT (n = 12), and ST (n = 12). Results Significant changes (p less than 0.1) were found in the cervical flexion isometric peak force (?13.15%), however, the effect size was considered moderate (d = 0.52). The extension (10.44%) and left rotation ROM (12.25%) showed significant improvement in MT group. During CCFT significant changes were not reported. Conclusions The current pilot study suggested that a tendency toward a decrease in the isometric strength peak in the cervical flexion of the MT group may appear. In cervical ROM the MT group achieved significant effects in extension and left rotation movement. © 2016 Elsevier Lt