HVLA in the STB Method: Advanced Diagnostics and Clinical Results

How Deep Biomechanical Diagnosis Combined with HVLA Leads to Optimal Clinical Outcomes

 

HVLA (High Velocity Low Amplitude) is considered one of the most effective manual therapy techniques for releasing joint restrictions and reducing pain. However, its success depends not only on precise execution but primarily on the clinical diagnosis preceding it. This is where the STB Method comes into play—a therapeutic approach that integrates thorough biomechanical assessment, identification of movement patterns and compensations, and the personalization of manual techniques. When HVLA is incorporated into the STB framework, it becomes a more precise tool, delivering a profound and lasting impact.

What is the STB Method?

STB (Structural Tissue Balance) is a modern therapeutic approach designed to create harmony between soft tissues, joints, and the nervous system.

The method is built upon three primary pillars:

1. Biomechanical Diagnosis

Analyzing movement patterns, identifying joint restrictions, and understanding the specific loads applied to various tissues.

2. Compensation Mapping

Identifying the kinetic links between different regions of the body to distinguish between the "source of the problem" and the "site of the pain."

3. Tailored Intervention

Selecting the most effective technique for the specific clinical presentation—whether it be HVLA, mobilizations, myofascial release, or a targeted combination of these modalities.

The Advantage of Integrating HVLA within the STB Framework

When HVLA is performed as part of the STB (Structural Tissue Balance) process, the therapist does not simply "release a stuck joint." Instead, the intervention is guided by a holistic view of the body's global patterns. The advantages are:

• Targeted Precision: The technique focuses on the truly restricted segment rather than just the symptomatic area.

• Synergistic Integration: Combining HVLA with other STB modalities ensures a stable, lasting change rather than a temporary fix.

• Comprehensive Balance: Simultaneous improvement of muscle balance and movement patterns alongside joint release.

• Enhanced Pain Modulation: Achieving a more significant reduction in pain by activating neurological and mechanical mechanisms simultaneously.

Clinical Example

Patient Presentation: A patient suffering from recurrent lower back pain presented after several months of functional limitation.

Assessment & Diagnosis: Clinical examination revealed that the primary source of the dysfunction was a segmental restriction at the L4-L5 level. Simultaneously, significant compensations were identified in the pelvis and hip regions.

STB Method Intervention:

Soft Tissue & Fascial Release: The treatment began with soft tissue balancing and myofascial release to reduce protective guarding and prepare the area.

Targeted HVLA: Once the tissue tension was addressed, a precise HVLA manipulation was performed on the restricted L4-L5 segment.

The Result: The combination of these modalities led to an immediate reduction in pain and a significant improvement in mobility—an outcome that would not have been achieved through HVLA alone. This demonstrates the power of addressing the global tissue environment before performing a specific joint manipulation.

Clinical Outcomes and Implications

Integrating HVLA within the STB framework allows for therapeutic results that are more stable over time. Instead of a momentary improvement, the patient experiences a systemic change: a reduction in pain, improved respiratory patterns, balanced movement templates, and a decrease in repetitive mechanical loads.

For the practitioner, this represents a more efficient, science-based approach that ensures clinical precision. It distinguishes the therapist from those using "crude" or uncontrolled manipulation techniques, positioning them as a professional focused on controlled, evidence-based intervention.

Summary

HVLA is a powerful technique, but it only reaches its full potential when integrated within the STB method. The diagnostic precision, the analysis of compensations, and the synergy with additional modalities—all of these allow for a personalized treatment plan that yields excellent, evidence-based, and safe results for the patient.

Written by: Eyal Feigin

Manual Therapy, Medical Massage, and Dry Needling Specialist.

Interested in learning how to correctly integrate HVLA into the STB protocol and elevate your level of care?

Selected Research

Bialosky JE, et al. Spinal manipulative therapy and mechanisms of pain modulation. Journal of Pain, 2009.

Paige NM, et al. Effectiveness of spinal manipulation for acute low back pain. JAMA, 2017.

Schneider M, et al. Comparative effectiveness of manual therapy approaches. Spine, 2015.

Rubenstein SM, et al. Spinal manipulation for chronic low back pain. Cochrane Review, 2019.

Maiers M, et al. Multimodal care including manipulation in older adults with back pain. Spine Journal, 2014.