Study Treatments
HVLA-SM
HVLA-SM is performed with the participant in the lateral
recumbent or side-lying position. Participants attain
a side-lying position with the free hip and knee slightly
flexed and adducted while the lumbar spine and pelvis
remain roughly perpendicular to the treatment surface.
The hip and knee on the weight bearing side are
extended or very slightly flexed. The doctor stands in
front of (facing) the participant while stabilizing the free
thigh and leg with their own thigh. The participant’s
shoulder is stabilized with the doctor’s hand (stabilizing
hand) while the participant’s forearms rest across the
chest or abdomen. A high-velocity low-amplitude
manipulative thrust is applied with the doctor’s other
hand (thrust or contact hand) on specific areas of the
participant’s lumbar vertebrae (mamillary process, spinous
process) or pelvis (posterior superior iliac spine,
ischial tuberosity, sacral ala, 1st sacral segment, 3-4th
sacral segment), depending on the condition, physical
findings and treatment objective. Short, controlled
movement of the doctor’s upper body, shoulder and
arm, often combined with a slight falling or “body-drop”
movement creates the motion, momentum and position
for a HVLA-SM thrust, which is delivered through the
contact hand [75]. The thrust vector varies with therapeutic
intent and point of contact [13,76]. The doctor
does not thrust with the stabilizing hand; however, to
maintain participant stability on the treatment table,
mild counter-pressure is frequently necessary.