Quantifying the high-velocity, low-amplitude spinal manipulative thrust: a systematic review.

Area of Science:

• Biomechanics
• Spinal Manipulative Therapy
• Motor Learning

Background:

• High-velocity, low-amplitude (HVLA) spinal thrusts are a common manual therapy technique.
• Quantifying the biomechanical parameters of HVLA thrusts is crucial for understanding their effects.
• The role of quantified thrust data in enhancing psychomotor learning requires systematic investigation.

Purpose of the Study:

• To systematically review studies quantifying HVLA spinal thrusts.
• To qualitatively compare apparatus and force-time profiles in HVLA thrust research.
• To critically appraise the use of thrust quantification as an augmented feedback tool for psychomotor learning.

Main Methods:

• A comprehensive literature search was conducted across MEDLINE-OVID, MANTIS-OVID, and CINAHL-EBSCO host.
• Eligibility criteria included hand-delivered HVLA spinal thrusts in human, animal, or manikin subjects, published after 1980.
• Data extracted included force, force-time, or displacement-time histories; meta-analysis was precluded by study diversity.

Main Results:

• Twenty-seven studies met the inclusion criteria, with 17 measuring thrust as a primary outcome.
• Thrust measurements were predominantly from human subjects (13), with additional data from cadavers (2) and porcine models (2).
• Ten studies reported enhanced psychomotor learning in humans, manikins, or other devices when using quantified thrust data.

Conclusions:

• Quantifiable parameters of HVLA spinal thrusts have been identified and described.
• Variability in data recording methods currently hinders a standardized kinematic description of HVLA spinal manipulative therapy.
• Despite inter-study differences, a relationship between preload, peak force, and thrust duration was observed, and augmented feedback using thrust data improved psychomotor learning outcomes.