High Velocity Thrust Techniques (HVTT) are known as “Manipulation” and are to be contrasted with “mobilisation” in which small bouncing type movements are utilised by the therapist to gradually increase joint range of movement. In HVTT a joint “cavitation” is often the result, which causes the cracking noise. In an earlier tip of the week we’ve discussed the physiological basis of this normal joint phenomenon.

Benefits can be dramatic and instant, with vast improvement in pain and range of movement, however when this technique is studied in larger populations, it is not really seen to be superior to other, safer, techniques in managing neck pain.

In the Thoracic spine and Lumbar spine this is quite safe, with the only real risk being further aggravation of the original injury if performed too forcefully, or in the wrong direction. In the neck, however, we have an artery running up through holes in the transverse processes, which then has to kink back and around to get up into the skull, to supply blood to the back of the brain. For this reason, cervical manipulation carries some nasty risks if the treatment causes damage to the artery – including stroke and death.

Rates of complications from neck manipulation are estimated to be between 5 and 10 per 10 million manipulations, but the catastrophic nature of these few complications causes reason to be cautious.

Physiotherapists trained in manipulation should always explain these potential risks before performing HVTT, and get explicit patient consent before continuing. We will then put the patient through a series of testing positions to determine the likelihood of vertebral artery compromise during the treatment. If this all seems safe, then WITH THE PATIENT’S WRITTEN CONSENT we might choose to proceed.