The effects of high-velocity, low-amplitude manipulation and muscle energy technique on suboccipital tenderness

Background and objectivesHigh-velocity, low-amplitude (HVLA) manipulation and muscle energy technique (MET) are commonly advocated by manual therapists to resolve pain and dysfunction. The aim of this controlled, single blinded study was to investigate whether HVLA manipulation of the occipito–atlantal (OA) joint and/or an MET stretch had an effect on pressure pain thresholds (PPT) in the suboccipital musculature in an asymptomatic population.MethodsParticipants (N = 90; mean age = 23 ± 5; 29 males and 61 females) were screened for suitability and PPT measurements were made using a hand-held electronic algometer which was positioned centrally in the suboccipital region. Participants were randomly allocated into three intervention groups and then received an HVLA thrust to cavitate the right and left OA joints, an MET stretch applied to the suboccipital muscles bilaterally, or a sham ‘functional’ technique. Post-intervention PPT measurements were recorded at 5 and 30 min.AnalysisAnalysis of the PPT data using a SPANOVA revealed a significant difference over time (F2,174 = 8.80, P < 0.01), but no significant difference between the groups (F2,87 = 0.08, P = 0.93). Within-group changes were further analysed using paired t-tests and repeated measures ANOVA which revealed significant changes at 5 min post treatment in the HVLA (P < 0.01) and MET groups (P < 0.01), but not in the control (P = 0.35). At the 30 min interval a significant change was calculated for the MET group (P < 0.03), but not in the HVLA (P = 0.29) or control group (P = 0.21).ConclusionNeither HVLA manipulation nor MET significantly changed the PPT of the suboccipital muscles in asymptomatic participants. Both techniques produced greater mean increases in PPT and effect sizes compared to the control group, and investigation of the effect of these techniques in a symptomatic population is recommended.