OBJECTIVE: To evaluate the efficacy of high-velocity low-amplitude thrust (HVLAT) manipulations in patients with cervical, thoracic, and lumbar radiculopathy. DESIGN: Intervention systematic review. LITERATURE SEARCH: Five electronic databases were searched from inception to May 2024. STUDY SELECTION CRITERIA: Randomized controlled trials comparing HVLAT to different interventions in patients with cervical, thoracic, or lumbar radiculopathy were eligible, if they reported outcomes related to pain intensity, disability, range of motion, and/or health-related quality of life. DATA SYNTHESIS: Data were pooled using a random-effects model. Heterogeneity was assessed using the I2 statistic. The risk of bias (RoB) was assessed with the revised Cochrane RoB tool (RoB 2). The certainty of evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. RESULTS: Eleven trials (N = 991) were included. HVLAT was associated with significant pain reduction compared to sham HVLAT (mean difference [MD], -1.20; 95% confidence interval [CI]: -1.90, -0.50) and to nonrecommended interventions (MD, -1.16; 95% CI: -1.54, -0.77) in both cervical and lumbar radiculopathy. HVLAT was associated with reduced pain compared to conventional physical therapy alone (MD, -1.26; 95% CI: -2.20, -0.32) at short- and medium-term follow-up. There were no differences at long-term follow-up. The overall RoB was high; the certainty of evidence ranged from very low to moderate. CONCLUSION: HVLAT could reduce pain and disability in patients with cervical and lumbar radiculopathy in the short term and medium term compared with sham HVLAT interventions, conventional physical therapy alone, and spinal mobilization, but not if compared to spinal mobilization with leg movement. J Orthop Sports Phys Ther 2025;55(10):1-12. Epub 11 September 2025. doi:10.2519/jospt.2025.13103.
| Discipline Area | Score |
|---|---|
| Rehab Clinician (OT/PT) |  |
Rehab Clinician (OT/PT) rater
According to the results, despite the risk of bias identified in the review, spinal manipulation remains a valid therapeutic option when no contraindications are present and the patient is properly informed. Attention to contraindications and the flag system is essential in an intervention as specific as joint manipulation.
Rehab Clinician (OT/PT) rater
This was a good review with practical suggestions for clinicians to implement in patients with radiculopathy. There is some bias in the articles reviewed, so the results should be taken with caution.
Rehab Clinician (OT/PT) rater
As the authors note, most studies exhibit a high risk of bias. Moreover, only one study compared thrust manipulation with conventional physiotherapy. This limitation prevents a full understanding of the effects of manipulation when applied in addition to physiotherapy. Therefore, for clinicians prescribing treatment based solely on manipulation is currently not a valid approach for this patient population.
, McMaster University