Professional Documents
Culture Documents
Grace Blankenhagen
therapy, the preferred term to refer to manipulation is a high velocity low amplitude
level PTs, and can be perfected with post-graduate education and certification in
manual therapy. There are many common musculoskeletal ailments treated by PTs
that can benefit from HVLA mobilizations, including adhesive capsulitis, ulnar
abduction (What is ulnar abduction? Not a common term), and lateral ankle sprains.
High velocity low amplitude mobilizations are a common practice in some outpatient
orthopaedic physical therapy clinics and is a necessary skill to be taught to all entry-
level practitioners.
One of the impairments physical therapists treat often with manual therapy is
study performed by Johnson et al3, it was determined that HVLA mobilizations were
more effective in restoring internal and external rotation of the affected shoulder than
companies pushing for fewer visits allowed for patients, it is important for the PT to
perform the most effective techniques available to decrease patient pain efficiently
and effectively.
tennis players in the United States are at some time affected by lateral epicondyle
pain. In the same study, it is stated that modalities and non-thrust techniques do not
work well to restore range of motion in an elbow with an abducted ulna 4. There is
one thrust technique that when performed correctly, works to restore near full range
of motion in the elbow of the sufferer4. This also falls under the importance of
efficiency when treating patients. It can save them time, for the patient as well as the
physical therapist. Performing HVLA to treat this condition would prevent the patient
from having to be referred back to the doctor and possibly referred out for an ailment
that could be treated by an entry level physical therapist with basic knowledge in
manual therapy.
Although the most effective technique for treating certain conditions is HVLA
a study focusing on lateral ankle sprains, which is a very common diagnosis, it was
combined with myofascial release were successful treatments 1 month after 4 weeks
of therapy5. The manual therapy itself was able to improve weight bearing and
mobility of the ankle/foot complex, both with and without HVLA mobilizations5. In
another study relating to shoulder adhesive capsulitis comparing high- and low-
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grade mobilization techniques, similar results were achieved, in that both improved
external rotation and abduction range of motion in a similar time frame6. From this
information, it can be assumed that practicing PTs are capable of treating lateral
ankle sprains without HVLA mobilizations, and the same with adhesive capsulitis if
necessary. However, it may take longer, which unfortunately is not a luxury most
Lateral ankle sprains also can come with another condition, called cuboid
up to 17% of ballet dancers7. Cuboid syndrome is hard to diagnose, but easy to treat
with HVLA. In a study performed by Jennings and Davies7, 7 patient athletes were
diagnosed and treated for cuboid syndrome with the cuboid thrust manipulation
technique. Of those 7, all of them experienced near full relief following one
manipulation, and only 2 patients returned for a second manipulation to resolve all
symptoms7. If the treating therapist is able to recognize the cluster of signs that point
to cuboid syndrome, the ailment can be treated quite easily with a manipulation.
Having training for the entry level therapists on this condition and learning how to
perform the manipulation in an entry level program could save a large amount of the
athletic population from dealing with pain and prevent a further loss of playing time
from a condition that can be treated quickly with one or two manipulations.
In conclusion, it is found that high velocity low amplitude mobilizations are the
most successful treatments a physical therapist can use when dealing with limited
range of motion in various joints. Although a practicing PT can achieve the same
benefits with less aggressive techniques, it takes more time and is not always as
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effective at restoring range of motion as HVLA techniques. In the current fast- paced
world, efficiency is everything. Insurance companies are covering fewer and fewer
treatments, and it is imperative PTs perform successful treatments in the short time
they are allotted. Therefore, it is in the patients and physical therapists best
interests to include high velocity low amplitude mobilization techniques in the entry-
level PT programs.
Works Cited
1. Hsu JE, Okechukwu AA, Warrender WJ, Abboud JA. Current review of adhesive
capsulitis. J Shou Elbo Surg. April 2011;20(3):502-514. doi:
http://dx.doi.org/10.1016/j.jse.2010.08.023
2. Theresa C, Hannafin JA. Adhesive capsulitis. Tech Shld & Elbo Surg. March
2014;15(1):2-7. doi: 10.1097/BTE.0000000000000015
3. Johnson AJ, Godges JJ, Zimmerman GJ, Ounanian LL. The effect of anterior
versus posterior glide joint mobilization on external rotation range of motion in
patients with shoulder adhesive capsulitis. J Orth & Spor Phys Ther. March
2007;37(3):88-99. doi: 10.2519/jospt.2007.2307
4. Windsor B. High-velocity thrust technique for traumatic onset lateral elbow pain. J
Man & Manip Ther. 2006;14(1):37-47. doi: 10.1179/106698106790820845
Scoring Criteria
1. Clearly describes the clinical question or purpose 1/1
2. Provides brief description of materials reviewed 1/1
3. Provides synopsis of conclusions/discussion 2/2
4. Assessed the quality of the evidence provided 1/1
5. Identifies why article(s) is/are appealing/interesting 1/1
6. Clinical implications (relevance to practice?) 2/2
7. Grammar/spelling/punctuation 1/1
8. Clarity, organization, conciseness 1/1
Total Score 10 /10
Additional Feedback: Grace, you did a great job with scouring the literature and
finding strong evidence for mobilizations and manipulations. You will need this
type of evidence in clinical practice when questioned by other healthcare
providers or if outcomes dont turn out positively. Stay current in the literature
and I feel you will be an outstanding PT one day! Dr. Zipple