High-velocity, Low-amplitude Spinal Manipulation Training of Prescribed Forces and Thrust Duration: A Pilot Study

Overview

Journal J Chiropr Educ

Date 2019 Apr 6

PMID 30951380

Citations 4

Authors

Zacariah K Shannon

Robert D Vining

Maruti Ram Gudavalli

Ron J Boesch

Affiliations

Soon will be listed here.

Abstract

Objective: High-velocity, low-amplitude spinal manipulation (HVLA-SM) may generate different therapeutic effects depending on force and duration characteristics. Variability among clinicians suggests training to target specific thrust duration and force levels is necessary to standardize dosing. This pilot study assessed an HVLA-SM training program using prescribed force and thrust characteristics.

Methods: Over 4 weeks, chiropractors and students at a chiropractic college delivered thoracic region HVLA-SM to a prone mannequin in six training sessions, each 30 minutes in duration. Force plates embedded in a treatment table were used to measure force over time. Training goals were 350 and 550 Newtons (N) for peak force and ≤150 ms for thrust duration. Verbal and visual feedback was provided after each training thrust. Assessments included 10 consecutive thrusts for each force target without feedback. Mixed-model regression was used to analyze assessments measured before, immediately following, and 1, 4, and 8 weeks after training.

Results: Error from peak force target, expressed as adjusted mean constant error (standard deviation), went from 107 N (127) at baseline, to 0.2 N (41) immediately after training, and 32 N (53) 8 weeks after training for the 350 N target, and 63 N (148), -6 N (58), and 9 N (87) for the 550 N target. Student median values met thrust duration target, but doctors' were >150 ms immediately after training.

Conclusion: After participation in an HVLA-SM training program, participants more accurately delivered two prescribed peak forces, but accuracy decreased 1 week afterwards. Future HVLA-SM training research should include follow-up of 1 week or more to assess skill retention.

Citing Articles

Comparison of force-time characteristics of prone cervicothoracic spinal manipulative therapy between chiropractic interns and chiropractors: A cross-sectional study.

Perron F, Funabashi M, Gauthier J, Page I J Chiropr Educ. 2025; 39.

PMID: 39998915 PMC: 11866453. DOI: 10.7899/JCE-24-10.

The association between students' confidence and ability to modulate spinal manipulation force-time characteristics of specific target forces: a cross-sectional study.

Nim C, Smith N, Starmer D, Wang S, Choi G, Alayed A Chiropr Man Therap. 2024; 32(1):34.

PMID: 39529163 PMC: 11552172. DOI: 10.1186/s12998-024-00557-w.

Chiropractic care and research priorities for the pediatric population: a cross-sectional survey of Quebec chiropractors.

Hayes R, Imbeau C, Pohlman K, Blanchette M, Doucet C Chiropr Man Therap. 2023; 31(1):42.

PMID: 37752493 PMC: 10523689. DOI: 10.1186/s12998-023-00514-z.

Developing spinal manipulation psychomotor skills competency: A systematic review of teaching methods.

de Kock E, Yelverton C, Myburgh C J Chiropr Educ. 2023; 37(2):116-123.

PMID: 37721391 PMC: 11095646. DOI: 10.7899/JCE-22-10.

Association Between Chiropractic Students' Hand-Eye Coordination or General Self-efficacy and Their Performance on a Spinal Manipulative Therapy Examination: A Cross-sectional Study.

Hodgetts C, McLeish T, Thomas E, Walker B J Chiropr Med. 2022; 20(4):183-190.

PMID: 35496722 PMC: 9051160. DOI: 10.1016/j.jcm.2021.12.011.

References

Snodgrass S, Odelli R . Objective concurrent feedback on force parameters improves performance of lumbar mobilisation, but skill retention declines rapidly. Physiotherapy. 2012; 98(1):47-56. DOI: 10.1016/j.physio.2011.02.002. View

Marchand A, Mendoza L, Dugas C, Descarreaux M, Page I . Effects of practice variability on spinal manipulation learning. J Chiropr Educ. 2017; 31(2):90-95. PMC: 5656152. DOI: 10.7899/JCE-16-8. View

Wise C, Schenk R, Lattanzi J . A model for teaching and learning spinal thrust manipulation and its effect on participant confidence in technique performance. J Man Manip Ther. 2016; 24(3):141-50. PMC: 4984821. DOI: 10.1179/2042618614Y.0000000088. View

Downie A, Vemulpad S, Bull P . Quantifying the high-velocity, low-amplitude spinal manipulative thrust: a systematic review. J Manipulative Physiol Ther. 2010; 33(7):542-53. DOI: 10.1016/j.jmpt.2010.08.001. View

Reed W, Cao D, Long C, Kawchuk G, Pickar J . Relationship between Biomechanical Characteristics of Spinal Manipulation and Neural Responses in an Animal Model: Effect of Linear Control of Thrust Displacement versus Force, Thrust Amplitude, Thrust Duration, and Thrust Rate. Evid Based Complement Alternat Med. 2013; 2013:492039. PMC: 3563165. DOI: 10.1155/2013/492039. View

Bereznick D, Ross J, McGill S . The frictional properties at the thoracic skin-fascia interface: implications in spine manipulation. Clin Biomech (Bristol). 2002; 17(4):297-303. DOI: 10.1016/s0021-9290(02)00014-3. View

Gudavalli M . Instantaneous rate of loading during manual high-velocity, low-amplitude spinal manipulations. J Manipulative Physiol Ther. 2014; 37(5):294-9. DOI: 10.1016/j.jmpt.2014.01.006. View

Lardon A, Cheron C, Page I, Dugas C, Descarreaux M . Systematic Augmented Feedback and Dependency in Spinal Manipulation Learning: a Randomized Comparative Study. J Manipulative Physiol Ther. 2016; 39(3):185-91. DOI: 10.1016/j.jmpt.2016.02.002. View

Descarreaux M, Dugas C . Learning spinal manipulation skills: assessment of biomechanical parameters in a 5-year longitudinal study. J Manipulative Physiol Ther. 2010; 33(3):226-30. DOI: 10.1016/j.jmpt.2010.01.011. View

10.

Reed W, Long C, Kawchuk G, Sozio R, Pickar J . Neural Responses to Physical Characteristics of a High-velocity, Low-amplitude Spinal Manipulation: Effect of Thrust Direction. Spine (Phila Pa 1976). 2016; 43(1):1-9. PMC: 4894003. DOI: 10.1097/BRS.0000000000001344. View

11.

Gudavalli M, Vining R, Salsbury S, Corber L, Long C, Patwardhan A . Clinician proficiency in delivering manual treatment for neck pain within specified force ranges. Spine J. 2014; 15(4):570-6. PMC: 4375060. DOI: 10.1016/j.spinee.2014.10.016. View

12.

Pasquier M, Cheron C, Dugas C, Lardon A, Descarreaux M . The Effect of Augmented Feedback and Expertise on Spinal Manipulation Skills: An Experimental Study. J Manipulative Physiol Ther. 2017; 40(6):404-410. DOI: 10.1016/j.jmpt.2017.03.010. View

13.

Descarreaux M, Dugas C, Raymond J, Normand M . Kinetic analysis of expertise in spinal manipulative therapy using an instrumented manikin. J Chiropr Med. 2009; 4(2):53-60. PMC: 2647034. DOI: 10.1016/S0899-3467(07)60114-1. View

14.

Triano J, Bougie J, Rogers C, Scaringe J, Sorrels K, Skogsbergh D . Procedural skills in spinal manipulation: do prerequisites matter?. Spine J. 2004; 4(5):557-63. DOI: 10.1016/j.spinee.2004.01.017. View

15.

Owens Jr E, Hosek R, Sullivan S, Russell B, Mullin L, Dever L . Establishing force and speed training targets for lumbar spine high-velocity, low-amplitude chiropractic adjustments. J Chiropr Educ. 2015; 30(1):7-13. PMC: 4771001. DOI: 10.7899/JCE-15-5. View

16.

Nougarou F, Page I, Loranger M, Dugas C, Descarreaux M . Neuromechanical response to spinal manipulation therapy: effects of a constant rate of force application. BMC Complement Altern Med. 2016; 16:161. PMC: 4890324. DOI: 10.1186/s12906-016-1153-6. View

17.

Triano J, McGregor M, Dinulos M, Tran S . Staging the use of teaching aids in the development of manipulation skill. Man Ther. 2014; 19(3):184-9. DOI: 10.1016/j.math.2014.01.003. View

18.

Gudavalli M, Cox J . Real-time force feedback during flexion-distraction procedure for low back pain: A pilot study. J Can Chiropr Assoc. 2014; 58(2):193-200. PMC: 4025089. View

19.

Kawchuk G, Perle S . The relation between the application angle of spinal manipulative therapy (SMT) and resultant vertebral accelerations in an in situ porcine model. Man Ther. 2009; 14(5):480-3. DOI: 10.1016/j.math.2008.11.001. View

20.

Flynn T, Wainner R, Fritz J . Spinal manipulation in physical therapist professional degree education: A model for teaching and integration into clinical practice. J Orthop Sports Phys Ther. 2006; 36(8):577-87. DOI: 10.2519/jospt.2006.2159. View