ArticleChiropractic & manual therapies2026
The use of high-velocity, low-amplitude techniques in paediatric osteopathic care: two multinational cross-sectional surveys on clinical practice and educational curricula.
Article in Chiropractic & manual therapies, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundUp to one osteopathic consultation out of four involve infants and children. Although the clinical effectiveness of osteopathic care in paediatric populations remains inconclusive, available evidence suggests that it is generally safe. In contrast, high velocity, low amplitude technique (HVLA) has been associated with potential adverse effects. To inform a professional position on the use of HVLA techniques in paediatric care, this study investigated (1) the use of HVLA techniques by osteopathic practitioners in the treatment of infants, children, and adolescents, and (2) the extent to which HVLA techniques are included in osteopathic training programmes for these paediatric age groups.
methodsTwo online cross-sectional surveys were conducted. The first targeted osteopathic practitioners and consisted of seven close-ended questions. The second survey was directed at osteopathic education institutes (OEIs) in Europe, Australia, Brazil, Israel, and New Zealand and consisted of three close-ended questions. Surveys were implemented via REDCap and made available in 11 languages. Participants were recruited between October 2025 and January 2026.
resultsAmong responding practitioners (n = 2607, response rate: 10.7%), 6.5% reported using HVLA in newborns or infants, 43.5% in children, and 78.3% in adolescents. Most respondents (54%) who apply HVLA to newborns and infants reported doing so "rarely". Of the 62 responding OEIs (response rate: 30.7%), 91.4% offered osteopathic paediatric education; however, only 4.8% reported teaching HVLA for newborns and infants, 11.3% for children, and 56.4% for adolescents. Most respondents (70.2%) held an HVLA-opposed stance. Among the distinct practitioner profiles identified in the prioritisation of conditions for HVLA use in newborns and infants, the precaution-informed stance (11.2%) was the most strongly associated with paediatric practice and with the highest reported HVLA use in this age group.
conclusionsMost respondents did not use HVLA in newborns and infants, with utilisation increasing in older paediatric age groups, and the majority expressed opposition to paediatric HVLA. More permissive stances were associated with greater HVLA use and more training. The generalisability of the findings is limited by potential coverage and self-selection bias, possible duplicate responses, and the low and variable response rate to the survey of osteopathic practitioners. Given its continued application, an evidence-based position statement and robust research on the safety and effectiveness of HVLA in paediatrics are urgently needed.
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