April 15, 2020; Vol. 12; No. 4; pp. E7682

Andrea Giacalone, Massimiliano Febbi, Fabrizio Magnifica, Enzo Ruberti: from the University of Rome Tor Vergata; Sapienza University, Rome; Aerospace Medicine, Diagnostic Therapeutic and Rehabilitative Aeromedical Center, Italian Air Force


Musculoskeletal disorders, particularly those affecting the cervical spine, pose a significant health concern with a rising global prevalence. In response to the escalating challenges posed by neck pain and associated symptoms, researchers have undertaken a systematic investigation into the effects of cervical manipulation as a potential therapeutic intervention. This article delves into the key findings of the study, shedding light on the role of high velocity low amplitude (HVLA) cervical manipulation in addressing musculoskeletal issues.

Key Findings:

  • Prevalence of Skeletal Muscle Problems:
  • The study begins by highlighting the increasing prevalence of skeletal muscle problems, often attributed to prolonged periods of poor posture during work activities. Neck pain, a leading cause of disability, affects a substantial portion of the global population.
  • Global Impact of Neck Pain:
  • Neck pain, classified among the top reasons for disability by the Global Burden of Disease studies, affects 70% of the general population at some point in their lives. The study underscores the urgent need for effective interventions to alleviate the burden of musculoskeletal conditions.
  • Symptoms Associated with Neck Pain:
  • Neck pain is commonly accompanied by symptoms such as stiffness, tingling in the upper limbs, loss of upper limb strength, brachialgia, headaches, and dizziness, emphasizing the multifaceted nature of musculoskeletal disorders.
  • Role of Spinal Manipulation:
  • Spinal manipulation, a manual therapy technique employed by various healthcare professionals, emerges as a potential treatment for skeletal muscle problems. High velocity low amplitude (HVLA) cervical manipulation techniques are frequently utilized, primarily targeting biomechanical joint dysfunction.
  • Positive Impact on Pain Reduction and Mobility:
  • The study reveals that cervical manipulation has reported positive outcomes, including pain reduction, improved cervical mobility, and enhanced general function in individuals with non-specific mechanical cervical pain.
  • Diverse Effects of Vertebral Manipulations:
  • Vertebral manipulations induce various effects on the body, including increased strength, changes in reflexes, alterations in central cortical neuron processing, and modifications in sensory-motor integration. Notably, these effects extend beyond the manipulated area, indicating the interconnected nature of musculoskeletal responses.
  • Hypoalgesic Effects of HVLA Techniques:
  • High velocity low amplitude (HVLA) techniques demonstrate a capacity to produce local hypoalgesia, surpassing the efficacy of other manual therapy techniques. The phenomenon of regional interdependence suggests that primary disorders may be linked to dysfunctions in different body regions or systems.
  • Cervical Manipulation vs. Passive Mobilization:
  • Comparative analyses indicate that HVLA vertebral manipulation tends to be more effective than passive mobilization, manual therapy, and kinesio-taping in addressing musculoskeletal disorders.
  • Neurophysiological Mechanisms:
  • The mechanism of action underlying manipulation is attributed to neurophysiological influences, potentially reducing inflammatory cytokines and increasing beta-endorphins. This suggests a multifaceted impact on pain modulation, mobility, and strength.
  • Comprehensive Approach for Mechanical Neck Pain:
  • The combination of HVLA thrust manipulation procedures targeting both the upper cervical and upper thoracic joints is identified as a strategy to enhance overall outcomes in patients with mechanical neck pain.
  • Safety Considerations:
  • While cervical manipulations pose a risk of complications, the study emphasizes that the frequency of adverse events is very low. The causal relationship between cervical spinal manipulative treatment and cervical artery dissection remains inconclusive, with most reviews suggesting no convincing data to prove or disprove any causality.


In conclusion, the comprehensive review of cervical manipulation’s impact on musculoskeletal disorders offers valuable insights into its therapeutic potential. The positive outcomes observed in pain reduction, improved mobility, and neurophysiological effects highlight the relevance of this manual therapy technique in managing cervicalgia and related conditions. As research continues to unravel the intricacies of musculoskeletal responses to cervical manipulation, healthcare professionals can explore its integration into holistic treatment approaches, considering both the benefits and potential risks associated with this intervention.