Neurophysiological Effects of High Velocity and Low Amplitude Spinal Manipulation in Symptomatic and Asymptomatic Humans: A Systematic Literature Review

Spine (Phila Pa 1976). 2019 Aug 1;44(15):E914-E926. doi: 10.1097/BRS.0000000000003013.


Study design: Systematic review.

Objective: To summarize the evidence of neurophysiological effects of spinal manipulative therapy (SMT) with a high velocity low amplitude thrust (HVLA-SMT) in asymptomatic and symptomatic humans.

Summary of background data: HVLA-SMT is effective in reducing back pain, but its mode of action is not fully understood.

Methods: A systematic literature search (until July 2018) was conducted by a professional librarian in seven databases (Medline (OvidSP), Premedline (PubMed), EMBASE, Cochrane, CINAHL, PEDro, and Scopus). Two authors selected the studies according to the a priori described criteria and scored study quality. Only controlled studies of at least moderate quality were included. Effects of HVLA-SMT on a particular outcome measure were defined as more than one study showing a significantly greater effect of HVLA-SMT compared with the control intervention.

Results: From the 18 studies included (932 participants in total), there was evidence only for an association between HVLA-SMT and changes in the autonomic nervous system, reflected in changes in heart rate variability and skin conductance. Most studies focused on healthy volunteers and none related neurophysiologic changes to pain reduction.

Conclusion: This systematic review points to HVLA-SMT affecting the autonomic nervous system. The effects seem to depend on the spinal level of HVLA-SMT application and might differ between healthy volunteers and pain patients. There is a need for high-quality studies that include patients, well characterized for pain duration and outcome measure baseline values, and address the relation between changes in neurophysiology and pain.

Level of evidence: 2.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Back Pain
  • Databases, Factual
  • Female
  • Humans
  • Low Back Pain / physiopathology*
  • Low Back Pain / therapy*
  • Male
  • Manipulation, Spinal*
  • Neurophysiology
  • Outcome Assessment, Health Care