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J Altern Complement Med. 2017 Sep;23(9):667-675. doi: 10.1089/acm.2017.0002. Epub 2017 Jul 21.

Effects of Cervical High-Velocity Low-Amplitude Techniques on Range of Motion, Strength Performance, and Cardiovascular Outcomes: A Review.

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1 International School of Osteopathy , Bilbao, Spain .
2 Department of Health Sciences, Public University of Navarra , Navarra, Spain .
3 Clinical Research Department , TDN, Orthopaedic Surgery and Advanced Rehabilitation Centre, Pamplona, Spain .
4 National Research Centre for the Working Environment , Copenhagen, Denmark .
5 Physical Activity and Human Performance Group, SMI, Department of Health Science and Technology, Aalborg University , Aalborg, Denmark .
6 Centre for Studies on Measurement of Physical Activity, School of Medicine and Health Sciences , Universidad del Rosario, Bogotá, Colombia .
7 University of Deusto , Bilbao, Spain .



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.


This review aims to describe the effects of cervical HVLA manipulation techniques on range of motion, strength, and cardiovascular performance.


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.


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.


cervical spine; chiropractic; manipulation; neck; osteopathic

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