Spinal Manipulation (HVLA) Techniques

Spinal manipulation is a technique performed by chiropractors and osteopaths (doctors of osteopathy - DO) for the treatment of back pain conditions caused by misalignments of the vertebral spine. These misalignments of the spine are described by chiropractors as vertebral subluxations and may not be recognized by back specialists such as medical doctors as the cause of back pain. Nevertheless, chiropractors have their own techniques that they use to identify the spinal joints that have a reduced range of motion in the spine that may respond to chiropractic adjustments. The adjustments that are most commonly used by chiropractors to treat vertebral subluxations are High-Velocity Low-Amplitude (HVLA) spinal manipulations. Let's take look at the most common HVLA techniques.



These spinal manipulations involve easing patients into a relaxed position (usually on their side) and performing a short powerful arm thrust. These movements are called high-velocity because they are extremely fast and forceful. These movements are called low-amplitude because the arm movements of the chiropractor are short. While the movement is being performed, an audible crack will be heard as co2, nitrogen, and oxygen gasses are released by the joints that have become stiff and pressurized. As the gas is released, the joint pressure will be decreased, allowing the patient to begin to feel comfort once again in that part of the body.

Spinal Manipulation (HVLA) Techniques include the Diversified technique, Gonstead adjustment, and the Thompson Terminal Point (or Drop) technique.

  • Diversified technique: This is the most common technique that a patient is likely to receive during a treatment session. For this movement, the therapist will apply a high-velocity, low-amplitude thrust over the restricted joints. More than one thrust may be performed during one treatment session, because one joint at a time is treated. Before the short, quick thrust is administered, the patient will be gently rotated or oriented into position to give the therapist the ability to use his body and leverage to make the powerful adjustment. The goal of the Diversified technique is to restore the joint back to its previous normal range of motion.

  • Gonstead adjustment: This adjustment is also called the "Palmer-Gonstead" technique. Though this technique also uses a high-velocity, low amplitude thrust, it differs in the way that the restricted joints are identified and in the way that the patient is oriented prior to the performance of the arm thrust. Tables and chairs that are specifically designed to help orient the patient in preparation for the manipulative thrust. The patient's body is oriented in specific ways to optimize the adjustment of the spine.

  • Thompson Terminal Point (or Drop) Technique: While the Gonstead technique involves specialized equipment that is used to orient the patient in preparation for the thrust, the Thompson technique involves an specialized tables that move to unlock the restricted spinal joints. Patients are laid over specialized treatment tables that drop a short distance during the chiropractor's HVLA thrust. The theory behind this additional piece of equipment is that it will facilitate the movement of the joint. The treatment benefits of this machine should act as a complementary treatment to the more traditional HVLA technique. In some cases, the drop of the table alone may be used to initiate the movement of the rigid joint. The familiar "crack" or "pop" that is heard with the traditional HVLA technique may or may not be heard if the drop of the table alone is used to try to free up the restricted joint.

    Thompson Terminal Point (or Drop) Technique is considered to be a less aggressive for or therapy compared to the traditional HVLA thrust movements. For this reason, it is sometimes described as a gentle adjustment approach or a form of mobilization.