Osteopathic Manipulative Treatment: HVLA Procedure - Cervical Vertebrae

Since the founding of osteopathy by Andrew Taylor Still, M.D., D.O. in 1874, a fundamental principle of osteopathic medicine has been the treatment of somatic dysfunction by using osteopathic manipulative treatment (OMT).Somatic dysfunction is an impaired function of integral components of the somatic system (the body framework). It can include the musculoskeletal, nervous, vascular, and lymphatic systems and combinations of these systems in affected areas of dysfunction.  High-velocity low amplitude (HVLA) OMT is one technique utilized by various practitioners to restore health to the somatic system.  Specifically, HVLA therapy is a technique used in manual medicine that employs a rapid, therapeutic force of brief duration that travels a short distance within a joint's anatomic range of motion. The force engages a restrictive barrier to elicit a release of the restriction. HVLA treatment is frequently associated with an audible and palpable "release" in the form of a "pop" accepted to represent cavitation of a spinal intervertebral joint and its subsequent release. The cervical (neck) region comprises vascular, musculoskeletal, and neural pathways between the cranium and the thorax. It is a common area of injury and somatic dysfunction, resulting in pain and loss of mobility. Understanding the diagnostic approach and the treatment of cervical spinal somatic dysfunction is a cornerstone of manual medicine. Dysfunction may occur at 1 or many anatomical locations: the atlantooccipital joint, the atlantoaxial joint, the paraspinal musculature, or other cervical vertebral joints. OMT may include various myofascial release techniques, muscle energy techniques, strain-counter strain techniques, and HVLA techniques. HVLA is used to relieve movement restrictions by applying a quick, therapeutic force of rapid duration that travels a short distance within the range of motion of a joint. HVLA therapy aims to restore a more "normal" range of motion within a joint and alleviate pain. Neck dysfunction is associated with significant health costs and disability, typically due to work-related injuries and improper ergonomic practices.  Cervical musculoskeletal joint dysfunction symptoms include neck pain, stiffness, loss of neck mobility, arm pain, tingling in the upper extremities, weakness, dizziness, and headache. HVLA OMT of the cervical spine is a passive, direct therapy that provides an HVLA manually applied force to treat motion loss in a somatic dysfunction.  Passive treatment implies that the patient stays inactive throughout this therapy and does not attempt to assist the physician in executing cervical HVLA treatment. This therapy provides direct engagement into the restrictive barrier of the cervical spine. The treatment goal is to forcefully stretch a contracted musculoskeletal system, producing an aggressive response of afferent nerve impulses from the muscle spindles to the central nervous system. The central nervous system sends a reflex of inhibitory responses to the muscle spindle, relaxing the muscle. HVLA therapy of the cervical spine should be performed only by practitioners who have been educated with this technique and have demonstrated practical and cognitive skills.  Like any other procedure, education, pre-procedural screening for contraindications, and a detailed review of the risks and benefits are imperative before HVLA treatment. Informed consent to medical treatment is fundamental in both ethics and law. Patients can receive advice and ask questions about HVLA treatments to make well-founded decisions.