Chiropractic Lumbar HVLA — Evidence Overview

Chiropractic lumbar high-velocity low-amplitude (HVLA) manipulation is a manual therapy technique characterised by a controlled, rapid thrust delivered to a specific spinal segment within its physiological range of motion, often producing an audible cavitation.

Proposed mechanisms include modulation of segmental joint mechanics, transient reduction in muscle hypertonicity, neurophysiological inhibition of nociception via mechanoreceptor stimulation, and reflex changes in the autonomic nervous system.

Evidence from systematic reviews supports modest short-term improvements in pain and function in acute or subacute non-specific mechanical low back pain when manipulation is combined with exercise and education; benefits over other active therapies in chronic pain are smaller and less consistent.

Contraindications include cauda equina syndrome, progressive neurological deficit, fracture, severe osteoporosis, malignancy in the spine, infection, inflammatory spondyloarthropathy in flare, anticoagulant therapy with significant bleeding risk and lumbar instability requiring surgery.

In Turkey HVLA manipulation should be performed only by physicians or qualified clinicians trained in manual therapy within Traditional and Complementary Medicine (GETAT) or physical medicine practice, after appropriate history, examination and imaging when red flags are present.