High-Velocity Thrust Manipulation: Don’t Get Addicted to the Crack

Your patient walks into the clinic complaining of low back pain, and they fit the clinical prediction rule for a lumbar manipulation. You deliver a high-velocity, low amplitude thrust manipulation…but there was no cavitation (pop). Everything about the set up felt right, but in the patient’s mind “nothing happened” because their back didn’t crack. Thankfully there is some research indicating that a cavitation is not required for success with an HVLA manipulation.

In 2006, Flynn et al examined the relationship between hearing an audible “pop” during an HVLA manipulation and symptom improvement. Over 80% of the participants cavitated during the manipulation technique, but there were no significant differences in improvement between those who popped and those who did not.

So what does this mean? Educate your patients prior to performing any manual technique, especially a thrust manipulation. I tell patients right from the beginning that you may or may not hear a “pop” during the technique, but our goal is to get a quick stretch to the joints and that the sound does not matter. Long story short, don’t get addicted to the crack.

Resources:

Flynn TW, Childs JD, Fritz JM. The audible pop from high-velocity thrust
manipulation and outcome in individuals with low back pain. J Manipulative
Physiol Ther. 2006 Jan;29(1):40-5.
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