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I have heard many healthcare professionals indicate that high-velocity low-amplitude (HVLA) procedures applied to the low back region are inappropriate and unsafe for patients with symptomatic lumbar disc herniation. However, research evidence contradicts this sentiment. As an example, a recent study published in The Journal of Manipulative and Physiological Therapeutics describes a clinical trial of 148 acute and chronic patients with MRI confirmed lumbar disc herniation, concurrent low back and leg pain, and signs of radiculopathy [1]. All patients were treated with side-lying HVLA spinal manipulation and followed for 1 year. No serious adverse events were reported and patients as a group reported substantial improvement. This is a study without a control group and several other limitations. Nevertheless, the study represents more evidence that side-lying HVLA can be performed safely while contributing to positive clinical results.

To be clear, I am not suggesting that all patients who suffer radiculopathy and lumbar disc herniation should be treated with side-lying HVLA procedures, nor am I advocating for any technique. We still need to learn much about the biological mechanisms at work with HVLA and other procedures, such as lumbar flexion distraction, another technique that has shown similar results in clinical studies [2,3]. There are certainly cases where any given treatment procedure might not be a good option, especially when patients cannot tolerate them, express a preference for an alternate method, or treatment history indicates poor response is likely. As we learn more about mechanisms, we should be able to better help patients understand their conditions and make educated choices about treatments which are most likely to result in improvement. Until that time, however, it is nice to know that there is more than one tool in the toolbox.

Reference List

    1.    Leemann S, Peterson CK, Schmid C, Anklin B, Humphreys BK: Outcomes of Acute and Chronic Patients With Magnetic Resonance Imaging-Confirmed Symptomatic Lumbar Disc Herniations Receiving High-Velocity, Low-Amplitude, Spinal Manipulative Therapy: A Prospective Observational Cohort Study With One-Year Follow-Up. J Manipulative Physiol Ther 2014.

2.    Gudavalli MR, Cambron JA, McGregor M, Jedlicka J, Keenum M, Ghanayem AJ et al.: A randomized clinical trial and subgroup analysis to compare flexion-distraction with active exercise for chronic low back pain. Eur Spine J 2006, 15: 1070-1082.

3.    Murphy DR, Hurwitz EL, McGovern EE: A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: a prospective observational cohort study with follow-up. J Manipulative Physiol Ther 2009, 32: 723-733.


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