SynthesisPloS one2025
Systematic review on biomechanical effects of high-velocity, low amplitude spinal manipulation.
Synthesis in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
3 citing papers in PubMed.
- Efficacy of Mulligan Mobilization, Maitland Mobilization, High-Velocity Thrust, and Muscle Energy Technique for Pain, Disability, and Center-of-Gravity Displacement in Patients With Sacroiliac Joint Dysfunction: Protocol for a Randomized Controlled Trial.JMIR research protocols · 2026Article
- Effectiveness of Thoracic Spine Manipulation for the Management of Neck Pain: A Systematic Umbrella Review with Risk of Bias and Methodological and Reporting Quality.Healthcare (Basel, Switzerland) · 2026Review
- From mechanotransduction to manual therapy: advances in piezo/TRP channels and lumbar degeneration.Frontiers in physiology · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSpinal manipulative therapy uses high-velocity low-amplitude (HVLA) thrusts which are clinically effective, but underlying mechanisms are still unknown.
objectiveTo summarize the evidence for biomechanical effects of HVLA thrusts in asymptomatic and symptomatic humans as well as for a possible link between biomechanical effects and clinical effectiveness. STUDY
designSystematic review of randomized controlled trials.
methodsAn information specialist conducted systematic literature searches in six databases [Medline (OvidSP), Premedline (PubMed), CINAHL, EMBASE, Cochrane, and Biosis]. Studies were selected by two authors and classified using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Results were qualitatively summarized per biomechanical output [range of motion (ROM) according to the spinal region where HVLA thrusts were applied, facet joint gapping, and spinal stiffness].
resultsThe thirty-three included studies were heterogeneous regarding participant characteristics, intervention frequency and outcomes. Twenty-seven studies reported on the effects of HVLA thrusts on spinal ROM. There is evidence increased cervical ROM following cervical HVLA thrusts on cervical ROM [9/15 studies with a positive treatment effect (5 low risk of bias/4 some concern) and increased cervical ROM following thoracic HVLA thrusts [8/8 studies (4 low risk of bias/4 some concern)]. The effects of a thoracic and lumbar HVLA thrusts on the respective ROM were less clear. Three (2 low risk/1 some concern) studies on facet joint gapping showed increased gapping following HVLA thrusts compared to side-posture positioning, and a single study (some concern) on spinal stiffness showed no effect of HVLA thrusts. Only one study (some concern) linked the biomechanical to clinical outcomes.
conclusionHVLA thrusts, either applied to the cervical or the thoracic spine, appear to increase cervical ROM, based on studies with low risk and studies with some concern regarding risk of bias. For all other outcomes, the included studies were too heterogeneous and too few to draw any sound conclusion. Future studies on the biomechanical effects of HVLA thrusts should link the biomechanical to clinical outcomes such as pain and disability. PROSPERO REGISTRATION: CRD42018096963.
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