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The Somatic Connection  |   July 2018
Effect of HVLA on Chronic Neck Pain and Dysfunction
Author Notes
  • Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, California 
Article Information
The Somatic Connection   |   July 2018
Effect of HVLA on Chronic Neck Pain and Dysfunction
The Journal of the American Osteopathic Association, July 2018, Vol. 118, 483-484. doi:10.7556/jaoa.2018.104
The Journal of the American Osteopathic Association, July 2018, Vol. 118, 483-484. doi:10.7556/jaoa.2018.104
Galindez-Ibarbengoetxea X, Setuain I, Ramírez-Vélez R, et al. Immediate effects of osteopathic treatment versus therapeutic exercise on patients with chronic cervical pain. Altern Ther Health Med. 2017;23(7):238-246. 
Neck pain is the third-most common chronic pain condition in the United States associated with long-term pain medication use.1 A 2005 American Osteopathic Association Position Paper supported cervical manipulation as a safe and efficacious alternative treatment.2 Despite this position paper, there is insufficient evidence to determine the effectiveness of high-velocity, low-amplitude (HVLA) manipulation vs craniocervical flexion (CCF) exercises in improving chronic neck pain. 
Physiotherapists in Spain evaluated HVLA in relation to CCF exercises through measuring pain using a visual analog scale (VAS), cervical range of motion (ROM), and electromyographic activation of the sternocleidomastoid at baseline and 60 seconds after intervention. Twenty-five patients were randomly assigned to the manual therapy (MT) group (n=12) or CCF group (n=13). They were aged between 18 to 50 years, with a mean (SD) age of 31.3 [1.8] years in the MT group and 34.0 (1.8) years in the CCF group. Patients had a history of neck pain for at least 3 months, pain intensity of at least 25/100 on VAS during ROM, and somatic dysfunction in the temporomandibular joint, cervical, and thoracic regions. Exclusion criteria were craniocervical trauma; neurologic alterations in limbs or the central nervous system; injury to a vertebral disk; degenerative, rheumatologic, or inflammatory pathologic processes; pregnant; operation on or fracture of cervical spine; or “a positive test” on vertebral artery evaluation. 
A therapist performed HVLA on the cervical and thoracic spine and articular techniques for the temporomandibular joint in the MT group. A physiotherapist performed the CCF protocol, which consisted of 10 repetitions of 10-second contractions with 10-second rest intervals. After treatment, both groups showed no changes in electromyographic activation with significant improvements in pain (MT: P=.004; CCF: P=.015) and ROM; however, HVLA was more effective. 
Despite limitations of a small sample size and absence of a control group, this randomized clinical trial found significant improvements in pain and cervical ROM immediately after treatment with manipulation over exercise. These findings support the osteopathic tenet of the body's ability to self-regulate and self-heal. For future studies, long-term effects and a conjunction of both treatments may further augment the role of osteopathic manipulation in neck pain. 
References
Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an internet-based survey. J Pain. 2010;11(11):1230-1239. doi: 10.1016/j.jpain.2010.07.002 [CrossRef] [PubMed]
American Osteopathy Association. Position paper on osteopathic manipulation treatment of the cervical spine. http://az480170.vo.msecnd.net/79a5b77a-ce83-4690-a2f8-3726afb41984/docs/b8b3b772-6c1d-40c3-ab15-74811bafdbd4/aoapositionpaperomtcervicalspine.pdf. Adopted July 14, 2005. Accessed May 16, 2018.