Spinal Manipulation: High-Velocity Low-Amplitude (HVLA)

The high-velocity, low-amplitude (HVLA) technique is among the oldest and most frequently used chiropractic techniques. Most chiropractic clinical research has focused on the evaluating efficacy of this form of spinal manipulation, particularly for low back, mid-back, and neck pain.

A 2010 review of clinical data concluded that spinal manipulation may be helpful for several conditions in addition to back pain, including migraine and cervicogenic (neck-related) headaches, neck pain, upper- and lower-extremity joint conditions, and whiplash-associated disorders.1

Spinal Manipulation (HVLA) Techniques

There are many types of HVLA manipulation approaches. This article describes just a few of the more common HVLA spinal manipulation techniques:

  • Diversified technique: This technique is the form of high-velocity, low-amplitude thrust that is traditionally associated with chiropractic manual adjustments. For this method,chiropractors apply a short (low-amplitude), quick (high-velocity) thrust over restricted joints (one at a time) with the goal of restoring normal range of motion in the joint. The patient’s body is positioned in specific ways to optimize the adjustment of the spine.
  • Gonstead adjustment: While the Gonstead adjustment itself is an HVLA adjustment, similar to the diversified technique, the difference is in the evaluation of (locating) the problematic joint and the specificity of body positioning. Specially designed chairs and tables may be used to position the patient, such as the cervical chair or the chest-knee table. This approach is sometimes also referred to as the "Palmer-Gonstead" technique.
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  • Thompson Terminal Point (or Drop) technique: This technique involves specialized treatment tables that have sections that drop a short distance during an HVLA thrust, with the premise that the dropping of the table piece facilitates the movement of the joint. This adjustment approach is sometimes used in addition to or, in place of, a more traditional diversified HVLA adjustment. Here, the traditional "cracking sound" may or may not occur and therefore this type of manipulation may also be considered a form of mobilization, or a gentle adjustment approach.

Is the Audible Pop Necessary?

The sound often heard during an HVLA manipulation is called cavitation. The pop is caused by a release of gas when the joint is pushed a short distance past its passive range of motion of the joint. The mechanism is similar to cracking ones knuckles.

Some clinicians and patients consider an audible pop necessary for the treatment to be successful, although there is no scientific physiological data from studies with large patient populations to confirm this belief.2-5

Research and locate chiropractors in your area that can help alleviate your back and neck pain.


  1. "Chiropractic: An Introduction." National Institutes of Health.
  2. "The Audible Pop Is Not Necessary for Successful Spinal High-Velocity Thrust Manipulation in Individuals with Low Back Pain." Archives of Physical Medicine and Rehabilitation

Complete Listing of References