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

Downie, Aron; Vemulpad, Subramanyam; Bull, Peter W.

doi:10.1016/j.jmpt.2010.08.001

Cited by 75 publications

(80 citation statements)

References 41 publications

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“…136,138 The amount of force delivered during cervical spine manipulation with manual high-velocity, low-amplitude techniques on living human subjects is 100 to 150 N. 136,139,140 A higher peak force, between 200 and 273 N, has been reported on cadavers. 141 A study comparing peak force during cervical manipulation on living subjects and cadavers demonstrated considerably more force being used on cadavers.…”

Section: Cervical Spine Biomechanics and Cmtmentioning

confidence: 99%

“…Moreover, all studies have shown considerably less force used in cervical manipulation compared with thoracic and lumbar manipulation. 136,139,143 After studying external forces applied to the cervical spine during manipulation, researchers began attempts to quantify the force absorbed by and strain placed on the VAs during manipulation. 137 Using ultrasonographic crystals surgically placed in the VAs of human cadavers to measure strain, they measured 6% strain during manipulation (strain refers to the percent change in the length of the vessel from its length at neutral position).…”

Section: Cervical Spine Biomechanics and Cmtmentioning

confidence: 99%

See 1 more Smart Citation

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

175

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3155Purpose-Cervical artery dissections (CDs) are among the most common causes of stroke in young and middle-aged adults.The aim of this scientific statement is to review the current state of evidence on the diagnosis and management of CDs and their statistical association with cervical manipulative therapy (CMT). In some forms of CMT, a high or low amplitude thrust is applied to the cervical spine by a healthcare professional. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. Results-Patients with CD may present with unilateral headaches, posterior cervical pain, or cerebral or retinal ischemia (transient ischemic or strokes) attributable mainly to artery-artery embolism, CD cranial nerve palsies, oculosympathetic palsy, or pulsatile tinnitus. Diagnosis of CD depends on a thorough history, physical examination, and targeted ancillary investigations. Although the role of trivial trauma is debatable, mechanical forces can lead to intimal injuries of the vertebral arteries and internal carotid arteries and result in CD. Disability levels vary among CD patients with many having good outcomes, but serious neurological sequelae can occur. No evidence-based guidelines are currently available to endorse best management strategies for CDs. Antiplatelet and anticoagulant treatments are both used for prevention of local thrombus and secondary embolism. Case-control and other articles have suggested an epidemiologic association between CD, particularly vertebral artery dissection, and CMT. It is unclear whether this is due to lack of recognition of preexisting CD in these patients or due to trauma caused by CMT. Ultrasonography, computed tomographic angiography, and magnetic resonance imaging with magnetic resonance angiography are useful in the diagnosis of CD. Follow-up neuroimaging is preferentially done with noninvasive modalities, but we suggest that no single test should be seen as the gold standard.

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Section: Cervical Spine Biomechanics and Cmtmentioning

confidence: 99%

Section: Cervical Spine Biomechanics and Cmtmentioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

175

View full text Add to dashboard Cite

show abstract

“…The available evidence to guide colleges in the development of their technique curriculum is growing but uncertainties remain. 8 To study the effect of two separate technique curricula from independent training programs, Triano et al 9 compared groups of students exposed to different ratios of laboratory and didactic technique teaching. Laboratory sessions in the group with more hours devoted to practical training were characterized by systematic rehearsal of patient transfer and positioning as well as nonmanipulative soft tissue manual procedures.…”

Section: Introductionmentioning

confidence: 99%

Learning Spinal Manipulation

Harvey

Wynd

Richardson

et al. 2011

Journal of Chiropractic Education

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Purpose:The goal of the present study was to quantify the high-velocity, low-amplitude spinal manipulation biomechanical parameters in two cohorts of students from different teaching institutions. The first cohort of students was taught chiropractic techniques in a patient-doctor positioning practice setting, while the second cohort of students was taught in a "complete practice" manipulation setting, thus performing spinal manipulation skills on fellow student colleagues. It was hypothesized that the students exposed to complete practice would perform the standardized spinal manipulation with better biomechanical parameters. Methods: Participants (n = 88) were students enrolled in two distinct chiropractic programs. Thoracic spine manipulation skills were assessed using an instrumented manikin, which allowed the measurement of applied force. Dependent variables included peak force, time to peak force, rate of force production, peak force variability, and global coordination. Results: The results revealed that students exposed to complete practice demonstrated lower time to peak force values, higher peak force, and a steeper rate of force production compared with students in the patient-doctor positioning scenario. A significant group by gender interaction was also noted for the time to peak force and rate of force production variables. Conclusion: The results of the present study confirm the importance of chiropractic technique curriculum and perhaps gender in spinal manipulation skill learning. It also stresses the importance of integrating spinal manipulation skills practice early in training to maximize the number and the quality of significant learner-instructor interactions. (J Chiropr Educ 2011;25(2):125-131)

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“…In contrast, the SI manipulation, which is also performed with the patient in side-lying, does not permit effective reinforcement of the thrust with the clinician's body mass due to the need to apply the thrust in a horizontal plane. In practice, the SI thrusts rely to a great extent on the application of a lateral input from the upper extremity (Peterson & Bergmann, 2002;Downie et al, 2010). The inability to transfer this body mass component likely accounts for the lower accelerations seen in the SI manipulations relative to those at the lumbar level.…”

Section: Discussionmentioning

confidence: 99%

Acceleration of clinician hand movements during spinal manipulative therapy

Gelley¹,

Passmore

MacNeil

2015

Manual Therapy

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The primary objective of this study was to determine the acceleration characteristics of spinal manipulative therapy (SMT) and whether patient anthropometric parameters correlated with the SMT kinematic parameters. For this, a wireless tri-axial accelerometer was taped to the dorsum of a clinician's hand to record the accelerations generated during clinical treatment of 95 symptomatic patients. Peak acceleration magnitudes differed significantly between spinal levels (p<0.0001; lumbar > cervical > thoracic = sacroiliac). The latencies of these peaks were also significantly different (p<0.0001; lumbar < cervical = thoracic < sacroiliac). Within a given spinal level, acceleration amplitudes varied over a wide range with temporal parameters remaining relatively constant. Overall, anthropometric parameters were poorly correlated with SMT parameters. In summary, distinct acceleration amplitudes were observed across spinal levels with relatively constant temporal factors. Thus, clinicians appear to vary the magnitude rather than the duration of the SMT thrust.ii Acknowledgements

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

Cited by 75 publications

References 41 publications

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Learning Spinal Manipulation

Acceleration of clinician hand movements during spinal manipulative therapy

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