HVLA thrust techniques: What are the risks?

High velocity low amplitude (HVLA) thrust techniques are amongst the most commonly used manipulative treatment techniques used by osteopaths. HVLA thrust techniques are considered potentially more dangerous when compared to non-impulse mobilisation type techniques because of the application of a rapid thrust or impulse. This has led to concerns as to the appropriateness of using HVLA thrust techniques in certain regions of the spine and in certain spinal pain presentations. Considerable research has been undertaken on both the effectiveness and potential adverse reactions arising from HVLA thrust techniques. This paper reviews the literature regarding the nature and incidence of transient and the more serious non-reversible impairments associated with the use of HVLA thrust techniques. Consideration is given to the efficacy and appropriateness of pre-manipulative vertebrobasilar artery screening protocols and suggestions are given as to ways in which practitioners may reduce perceived risk.