Evaluating the mechanisms of therapeutic impact of joint manipulation based on the results of experimental studies

Abstract

Spine joint manipulation is a form of treatment for spinal pain with various etiologies. The most common form of these maneuvers is: HVLA – (High Velocity Low Amplitude); (ICD-9 No. 93.62) which is widely used in everyday clinical practice. HVLA utilizes a mechanical manipulative stimulus characterized by high speed, short duration and low amplitude of displacement of joint surfaces with respect to each other. Despite the long history of use, the mechanisms of their biological impact are still insufficiently explained. In the review, the hypotheses concerning the therapeutic mechanism of HVLA impact were verified based on the analysis of scientific reports available in PubMed database. Reports have been discussed presenting theoretical mechanisms of influence of HVLA techniques and experimental work taking up the issues of manipulation carried out on animal material. The following keywords were used for search: HVLA, spine manipulation, experimental studies, osteopathic treatment. Particular attention was focused on the research examining basic biological mechanisms being the basis for explaining the observed clinical effects. The analysis of scientific reports in recent years has shown that there is no direct evidence pointing to the need for obtaining the phenomenon of cavitation during HVLA procedures. Moreover, studies on an animal model prove that HVLA are safe and non-invasive procedures from the point of view of biomechanics. They inhibit the development of hyperalgesia and allodynia as confirmed by immunohistochemical studies. Previous experimental studies have shown clearly that more than one biological mechanism is responsible for the obtained effects of HVLA therapy, and the patients' reactions to therapy are complex and individually variable.