Author ORCID Identifier
Murdi S. Alanazi: https://orcid.org/0009-0003-9583-6432
Gwin Kelley-Franklin: https://orcid.org/0000-0002-7734-4309
Laura Lipke: https://orcid.org/0000-0003-3653-5843
William R. Reed: https://orcid.org/0000-0002-4580-485X
Document Type
Article
Publication Date
1-22-2025
Keywords
manual therapy; neuromuscular; high-velocity, low-amplitude spinal manipulation; spinal manipulation; electromyography
Abstract
The clinical use of spinal manipulation to treat musculoskeletal conditions has nearly tripled in the United States since 1980, and it is currently recommended by most global clinical guidelines as a conservative treatment for musculoskeletal pain, despite a lack of knowledge concerning its mechanisms of action. This overview highlights evidence of direct neuromuscular responses to high-velocity, low-amplitude spinal manipulation (HVLA-SM) as delivered by chiropractic, osteopathic, and physical therapy clinicians, with an intent to foster greater interprofessional dialogue and collaborative research to better address current gaps in mechanistic knowledge of the neuromuscular response to HVLA-SM. Three databases (PubMed, CINAHL Ultimate (EBSCO), EMBASE (Elsevier)) were searched from 2000 to December 2024 with specific search terms related to thrust HVLA-SM and the neuromuscular response. To focus strictly on neuromuscular responses related to HVLA-SM, this literature overview excluded articles using non-HVLA-SM manual therapy techniques (i.e., massage, non-thrust joint mobilization, and/or combined HVLA-SM with other forms of treatment such as exercise or non-thrust joint mobilization) and studies in which patient-centered outcomes (i.e., pain scores) were the primary outcomes of the HVLA-SM interventions. Pediatric studies, animal studies, and studies in languages other than English were also excluded. One-hundred and thirty six articles were identified and included in this overview. Neuromuscular findings related to HVLA-SM in the areas of electromyography (EMG), muscle thickness, muscle strength, reflexes, electroencephalogram (EEG), and evoked potential were often mixed; however, evidence is beginning to accumulate either in favor of or opposed to particular neuromuscular responses to HVLA-SM as larger and more scientifically rigorous studies are being performed. Recurrent limitations of many HVLA-SM-related studies are small sample sizes, leading to a lack of generalizability, and the non-standardization of HVLA-SM delivery, which has prevented researchers from arriving at definitive conclusions regarding neuromuscular responses to HVLA-SM. Discussions of future neuromuscular research needs related to HVLA-SM are included for clinicians and researchers inside and outside of the field of manual therapy, to advance this field.
Publisher Attribution
Alanazi, M. S., Degenhardt, B., Kelley-Franklin, G., Cox, J. M., Lipke, L., & Reed, W. R. (2025). Neuromuscular Response to High-Velocity, Low-Amplitude Spinal Manipulation—An Overview. Medicina, 61(2), 187. https://doi.org/10.3390/medicina61020187
(This article belongs to the Section Orthopedics)
Recommended Citation
Alanazi, Murdi; Degenhardt, Brian DO; Kelley-Franklin, Gwyn; Cox, James DO; Lipke, Laura; and Reed, William DO, "Neuromuscular Response to High-Velocity, Low-Amplitude Spinal Manipulation—An Overview" (2025). Library Scholarship. 109.
https://orb.binghamton.edu/librarian_fac/109
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Comments
© 2025 by the authors. Published by MDPI on behalf of the Lithuanian University of Health Sciences. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).