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Cervical HVLA Used as Single Intervention Improves Motion and Strength

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Veröffentlicht/Copyright: 1. Mai 2018
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Journal of Osteopathic Medicine
Aus der Zeitschrift Journal of Osteopathic Medicine Band 118 Heft 5

Galindez-Ibarbengoetxea X, Setuain I, Andersen LL, et al. Effects of cervical high-velocity low-amplitude techniques on range of motion, strength performance, and cardiovascular outcomes: a review. J Altern Complement Med. 2017;23(9):667-675.

Osteopathic physicians have the ability to provide an individualized and unique approach to patients with a variety of chief complaints.1 Despite the efficacy of this approach recorded in the osteopathic literature, meta-analyses and systematic reviews continue to exclude osteopathic research based solely on the study design. The profession needs to be cognizant of this ongoing issue, which diminishes the impact of osteopathic manipulative medicine.

Cervical high-velocity, low-amplitude (HVLA) is one of the most common techniques used by foreign-trained osteopaths, osteopathic physicians, physiotherapists, and chiropractors. Most research related to HVLA has been in relationship to neck pain or adverse effects after cervical HVLA. This gap in the literature led an international group of researchers to perform a systematic review of randomized controlled trials (RCTs) looking at the isolated effect of cervical HVLA on various conditions, including strength, spine and temporomandibular joint mobility, and the cardiovascular system, with no restriction on the outcomes measured. The researchers excluded studies that used a multimodal approach because, they argued, these studies lacked specificity in the effect size outcomes. Yet, they did not evaluate the effect size of all the included studies for specific outcomes.

The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Cochrane Back Review Group criteria. The authors conducted an electronic database literature search for English-language RCTs published in peer-reviewed scholarly journals from January 2000 to August 2016. Of 2145 articles initially assessed, 11 met the inclusion criteria, in which symptomatic and asymptomatic patients of any age or sex received cervical HVLA as the only intervention. The comparisons included inactive controls, sham, manual contact, quiet rest, or other placebo. The researchers excluded studies that used instrumentation, co-interventions, or comparisons with exercise, medication, patient education, or manipulation outside of the cervical spine. Studies that used a preparatory soft tissue massage were also excluded.

These exclusion criteria eliminated all US-based RCTs of osteopathic manipulative treatment (OMT), including the sole osteopathic RCT that demonstrated how a single cervical HVLA OMT procedure could be a reasonable and effective alternative to an injectable nonsteroidal anti-inflammatory drug in the emergency department for patients with acute neck pain.2 There is no explanation for the decision to exclude studies that used medication as a comparison group. Included articles had a low risk of bias, and effect sizes were calculated. However, the authors did not critique the quality of the methods in these articles.

This systematic review found that symptomatic patients had a large effect size after cervical HVLA for increased range of motion (d>0.80) and pain-free handgrip strength (d=0.78). This finding is consistent with Licciardone's landmark study that found that patients with higher baseline low back pain and dysfunction had more significant improvement after OMT.3

Although the authors concluded that stronger evidence-based studies are needed regarding cervical HVLA, it is unlikely that the osteopathic medical profession will participate in this endeavor because OMT research is conscientiously designed using instrumentation, co-interventions, and comparisons (eg, exercise, medication, patient education, manipulation). Although maintaining this approach is pragmatic, as it lends itself to better external validity, it provides researchers outside the profession with a reason to exclude OMT studies from consideration, as with the American College of Physicians’ clinical practice guidelines regarding nonpharmacologic treatments for patients with low back pain.4-6 There is therefore a need for OMT RCTs with specific outcome measures related to each technique modality to better discern which techniques have the greatest effect and what the combined effect is compared with individual procedures.

Western University of Health Sciences-College of Osteopathic Medicine, Pomona, California

References

1. Franke H , FrankeJD, FryerG. Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2014;15:286.10.1186/1471-2474-15-286Suche in Google Scholar PubMed PubMed Central

2. McReynolds TM , SheridanBJ. Intramuscular ketorolac versus osteopathic manipulative treatment in the management of acute neck pain in the emergency department: a randomized clinical trial. J Am Osteopath Assoc. 2005;105(2):57-68.Suche in Google Scholar

3. Licciardone JC , GatchelRJ, AryalS. Targeting patient subgroups with chronic low back pain for osteopathic manipulative treatment: responder analyses from a randomized controlled trial. J Am Osteopath Assoc. 2016;116(3):156-168.10.7556/jaoa.2016.032Suche in Google Scholar PubMed

4. Chou R , DeyoR, FriedlyJ , et al. Noninvasive Treatments for Low Back Pain . Comparative Effectiveness Review No. 169. AHRQ publication No. 16-EHC004-EF. Rockville, MD: Agency for Healthcare Research and Quality; February 2016.Suche in Google Scholar

5. Licciardone JC , GatchelRJ. Nonpharmacologic therapies for low back pain [letter]. Ann Intern Med. 2017;167(8):606.10.7326/L17-0395Suche in Google Scholar PubMed

6. Chou R . Nonpharmacologic therapies for low back pain [letter]. Ann Intern Med. 2017;167(8):66-67.10.7326/L17-0395Suche in Google Scholar
Published Online: 2018-05-01
Published in Print: 2018-05-01

© 2018 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Artikel in diesem Heft

  1. SURF
  2. Psychogenic Dizziness: An Important but Overlooked Differential Diagnosis in the Workup of the Dizzy Patient
  3. THE SOMATIC CONNECTION
  4. Osteopathic Manipulation Shown to Improve Upper Airway Stabilization
  5. HEALTH POLICY
  6. Implications of a National Health Insurance Marketplace
  7. IN MY VIEW
  8. Toward a Renewal of Patient Care: Insights From Viktor Frankl, MD, PhD
  9. AOA COMMUNICATION
  10. Official Call: 2018 Annual Business Meeting of the American Osteopathic Association
  11. Proposed Amendments to the AOA Constitution, Bylaws, and Code of Ethics
  12. ORIGINAL CONTRIBUTION
  13. Laboratory Tests and X-ray Imaging in a Surgical Intensive Care Unit: Checking the Checklist
  14. REVIEW
  15. Iatrogenic Hepatitis C Virus Transmission and Safe Injection Practices
  16. JAOA/AACOM MEDICAL EDUCATION
  17. Faculty Vitality in Osteopathic Medical Schools: A Pilot Study
  18. SPECIAL COMMUNICATION
  19. Women in Osteopathic and Allopathic Medical Schools: An Analysis of Applicants, Matriculants, Enrollment, and Chief Academic Officers
  20. CASE REPORT
  21. Atrial Flutter With Exercise-Induced 1:1 Atrioventricular Conduction
  22. Restoration of Full Shoulder Range of Motion After Application of the Fascial Distortion Model
  23. THE SOMATIC CONNECTION
  24. Biopsychosocial Effects of Osteopathic Interventions in Patients With Chronic Pain
  25. Cervical HVLA Used as Single Intervention Improves Motion and Strength
  26. Cervical Osteopathic Manipulation Shown to Affect Median Nerve Function
  27. Fibromyalgia Symptoms Reduced by Osteopathic Manipulative Medicine and Gabapentin
  28. Myofascial Release Therapy Beneficial for Patients With Chronic Low Back Pain
  29. CLINICAL IMAGES
  30. Posterior Leukoencephalopathy Syndrome
https://doi.org/10.7556/jaoa.2018.068
Creative Commons
BY-NC-ND 4.0

Artikel in diesem Heft

  1. SURF
  2. Psychogenic Dizziness: An Important but Overlooked Differential Diagnosis in the Workup of the Dizzy Patient
  3. THE SOMATIC CONNECTION
  4. Osteopathic Manipulation Shown to Improve Upper Airway Stabilization
  5. HEALTH POLICY
  6. Implications of a National Health Insurance Marketplace
  7. IN MY VIEW
  8. Toward a Renewal of Patient Care: Insights From Viktor Frankl, MD, PhD
  9. AOA COMMUNICATION
  10. Official Call: 2018 Annual Business Meeting of the American Osteopathic Association
  11. Proposed Amendments to the AOA Constitution, Bylaws, and Code of Ethics
  12. ORIGINAL CONTRIBUTION
  13. Laboratory Tests and X-ray Imaging in a Surgical Intensive Care Unit: Checking the Checklist
  14. REVIEW
  15. Iatrogenic Hepatitis C Virus Transmission and Safe Injection Practices
  16. JAOA/AACOM MEDICAL EDUCATION
  17. Faculty Vitality in Osteopathic Medical Schools: A Pilot Study
  18. SPECIAL COMMUNICATION
  19. Women in Osteopathic and Allopathic Medical Schools: An Analysis of Applicants, Matriculants, Enrollment, and Chief Academic Officers
  20. CASE REPORT
  21. Atrial Flutter With Exercise-Induced 1:1 Atrioventricular Conduction
  22. Restoration of Full Shoulder Range of Motion After Application of the Fascial Distortion Model
  23. THE SOMATIC CONNECTION
  24. Biopsychosocial Effects of Osteopathic Interventions in Patients With Chronic Pain
  25. Cervical HVLA Used as Single Intervention Improves Motion and Strength
  26. Cervical Osteopathic Manipulation Shown to Affect Median Nerve Function
  27. Fibromyalgia Symptoms Reduced by Osteopathic Manipulative Medicine and Gabapentin
  28. Myofascial Release Therapy Beneficial for Patients With Chronic Low Back Pain
  29. CLINICAL IMAGES
  30. Posterior Leukoencephalopathy Syndrome
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