The Science of HVLA: Neurophysiology and Biomechanics

A Deep Understanding of the Mechanisms Behind HVLA Manipulations and Their Impact on the Musculoskeletal and Nervous Systems

 

HVLA (High Velocity Low Amplitude) technique is considered one of the most common and effective methods in manual therapy. It integrates biomechanical principles with profound neurophysiological effects, generating an immediate response in both the treated joint and the patient's nervous system. Clinical studies indicate that the technique does not only function at a local level, but also triggers complex mechanisms of pain regulation and movement control throughout the body.

The Biomechanical Aspect

HVLA is performed using a rapid, short thrust on a restricted joint. On a biomechanical level, this action releases joint fixations, reduces local stress, and restores the joint to its normal range of motion. The "cavitation" phenomenon—the familiar sound sometimes heard during the technique—is caused by the release of gases from within the synovial fluid, but it is not the primary objective.

 

Key Point: The goal is functional improvement, not the "sound." Studies show that the success of the treatment is measured by improved range of motion and pain reduction—not by the cavitation itself.

The Neurophysiological Aspect

One of the most fascinating findings regarding HVLA is its impact on the nervous system. The manipulation triggers the release of neurotransmitters that influence pain processing in the brain and activates descending inhibitory pathways. Furthermore, it affects the proprioceptive system—the system responsible for perceiving position and movement—thereby assisting in the improvement of motor control.

 

The Key Clinical Effects:

• Reduction of neural sensitivity in the treated area.
• Enhanced activity of central descending inhibitory pain pathways.
• Improved coordination between muscle groups.
• Positive impact on localized muscle tension.

Integrating Biomechanics and Neurology

The primary advantage of HVLA lies in the synergy between mechanical release and neurological impact. The result is an immediate improvement in the patient’s experience, characterized by reduced pain and enhanced function. Over a series of treatments, long-term changes can be observed, such as improved posture, more efficient movement patterns, and a reduction in repetitive strain on the tissues.

Clinical Aspects

In daily clinical practice, HVLA is primarily applied to the cervical, thoracic, and lumbar spine, though it can also be utilized for extremity joints. Patients report an immediate sense of relief, reduced pain, and a significant improvement in mobility. It is particularly effective for conditions such as:

• Low Back and Neck Pain.
• Cervicogenic Headaches.
• Range of Motion Restrictions in spinal and extremity joints.
• Rehabilitation following sports injuries.

Conclusion

HVLA is an advanced, integrated technique that functions on both biomechanical and neurological levels. It enables manual therapists to achieve rapid, safe, and evidence-based results—ultimately providing patients with an improved quality of life. Understanding the science behind the technique is essential for any practitioner seeking to work professionally and safely.

Written by: Eyal Feigin

Manual Therapy Specialist, Medical Massage, and Dry Needling Expert.

Want to learn how to integrate HVLA manipulations in a professional, safe, and precise manner?