Overview of High-Velocity, Low-Amplitude (HVLA) Spinal Mobilization Techniques

High velocity, low-amplitude (HVLA) spinal mobilization is one of the most popular chiropractic methods for addressing both lower and middle back pain. An evidence report compiled in 2010 by Bronfot et al. noted that spinal mobilization was also effective in adults for migraine, cervicogenic dizziness, and neck pain.[1]There are three schools of technique of HVLA spinal mobilization, as described below:

  1. Diversified technique: The most common of the three HVLA methodologies, a diversified technique is generally used to restore full range of motion to restricted joints. One short, high-velocity thrust is applied to the joint of interest to create an unlocking effect. Multiple adjustments can be made in a single appointment if more than one joint is restricted. Manipulation of patient body positioning may be necessary to allow for the ideal angle and leverage for diversified HVLA. 
  2. Palmer-Gonstead adjustment: The Palmer-Gonstead adjustment is similar to the diversified technique in both duration and magnitude of force, but places greater emphasis on isolating an exact spinal location for ideal joint adjustment. Location can be determined through palpation (both with motion and static), visualization, instrumentation, and X-ray analysis. A wide variety of specially-designed tables, chairs, and other equipment are employed to alter body configuration and create optimal angles for spinal adjustment. 
  3. Drop technique: Also known as the Thompson Terminal Point technique, the drop technique focuses specifically on facilitating the movement of the restricted joint during HVLA mobilization. Patients are placed on specialized tables that have the ability to drop a short distance during the physician’s or chiropractor’s thrust. Occasionally, the drop of the table along is sufficient to free the restricted joint. The drop technique is often used as a complement to the diversified technique.

Little research has been done to compare the relative efficacy of these techniques to each other; however, preliminary findings suggest they may perform similarly.[2] Regardless, it has been found that overall, successful HVLA spinal mobilization results in significantly superior patient outcomes as compared to placebos,[3] and should be considered a useful method for treating a variety of back-related issues.


[1] Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010 Feb 25;18:3. doi:10.1186/1746-1340-18-3. PMID: 20184717; PMCID: PMC2841070.

[2] Cao DY, Reed WR, Long CR, Kawchuk GN, Pickar JG. Effects of thrust amplitude and duration of high-velocity, low-amplitude spinal manipulation on lumbar muscle spindle responses to vertebral position and movement. J Manipulative Physiol Ther. 2013;36(2):68-77. doi:10.1016/j.jmpt.2013.01.004.

[3] von Heymann WJ, Schloemer P, Timm J, Muehlbauer B. Spinal high-velocity low amplitude manipulation in acute nonspecific low back pain: a double-blinded randomized controlled trial in comparison with diclofenac and placebo. Spine (Phila Pa 1976). 2013 Apr 1;38(7):540-8. doi:10.1097/BRS.0b013e318275d09c. PMID: 23026869.