high-velocity, low-amplitude (HVLA) technique

The high-velocity, low-amplitude (HVLA) technique is among the oldest and most frequently used chiropractic techniques. Most chiropractic clinical research has focused on the evaluating efficacy of this form of spinal manipulation.

A 2010 review of clinical data concluded that spinal manipulation is helpful for several conditions in addition to back pain, including migraine and cervicogenic (neck-related) headaches, neck pain, upper- and lower-extremity joint conditions, and whiplash-associated disorders. *1

There are many types of HVLA manipulation approaches. This article describes just the most HVLA spinal manipulation techniques:

Diversified technique: This technique is the form of high-velocity, low-amplitude thrust that is traditionally associated with chiropractic manual adjustments. For this method, chiropractors apply a short (low-amplitude), quick (high-velocity) thrust over restricted joints (one at a time) with the goal of restoring normal range of motion in the joint. The patient’s body is positioned in specific ways to optimize the adjustment of the spine.

Thompson Terminal Point (or Drop) technique: This technique is the one that I use the most in my office due to the least amount of pain and the most effective adjustment.

Doctor Clay Thompson patented the Thompson Drop Table in 1957, and today it is used by chiropractors around the world to help patients improve posture, gain strength and flexibility and prevent injuries.The Thompson Drop provides a full-spine technique through use of an adjusting table equipped with a pneumatically driven drop system. This system quickly lowers the section of your body that corresponds with the area of the spine that’s being adjusted. This includes the dorsal, lumber and pelvic areas.

Doctor David Thomson offers patients high-speed thrusts, while using minimal force. While the thrust begins needed movement, the quick drop brings your joint through the rest of its range of motion.

This involves specialized treatment tables that have sections that drop a short distance during an HVLA thrust, with the premise that the dropping of the table piece facilitates the movement of the joint. This adjustment approach is sometimes used in addition to or, in place of, a more traditional diversified HVLA adjustment. Here, the traditional "cracking sound" may or may not occur and therefore this type of manipulation may also be considered a form of mobilization, or a gentle adjustment approach.

The sound often heard during an HVLA manipulation is called cavitation. The pop is caused by a release of gas when the joint is pushed a short distance past its passive range of motion of the joint. The mechanism is similar to cracking ones knuckles.

Some clinicians and patients consider an audible pop necessary for the treatment to be successful, although there is no scientific physiological data from studies with large patient populations to confirm this belief. This poping sound is truly just a side effect not true. The objective is to first align the pelvis, then the mid back with the pelvis and then finally to align the neck or cervical spine with the rest of the body.