The effect of HVLA manipulation on static and dynamic postural parameters – a case study of a patient with a blocked atlanto-occipital transition

Przemysław Malich, Aleksandra Bitenc-Jasieńko, Agata Pasternak, Adrian Westfal, Helena Gronwald, Karina Kijak, Krzysztof Gronwald, Krzysztof Konior, Danuta Lietz-Kijak

Przemysław Malich, Aleksandra Bitenc-Jasieńko, Agata Pasternak, Adrian Westfal, Helena Gronwald, Karina Kijak, Krzysztof Gronwald, Krzysztof Konior, Danuta Lietz-Kijak – The effect of HVLA manipulation on static and dynamic postural parameters – a case study of a patient with a blocked atlanto-occipital transition –  Fizjoterapia Polska 2024; 24(1); 215-225

DOI: https://doi.org/10.56984/8ZG2EF8t5I

Abstract
Objective. The study aimed to assess the effects of high velocity low amplitude (HVLA) manipulations on force distribution, pressures, and balance in individuals with atlanto-occipital blockage, focusing on post-treatment improvements.
Research methods. Diagnostic tests (cervical spine compression, Spurling, de Kleyn) and pedobarography (using an EPS/R2 mat and BIOMECH STUDIO software) assessed functionality and postural parameters pre and post HVLA therapy.
Results. Initial diagnosis showed significant disturbances in force distribution, balance, and gait. Post-HVLA therapy improvements included:
1. Balanced forefoot load during standing, with a decrease in heel load percentage.
2. Improved global body pressure distribution, with a notable decrease in left-side body pressure.
3. Enhanced anteroposterior and lateral body oscillation ranges, with a reduced ratio of extreme deflection distances to deflection surface and a decreased average speed of displacements.
4. Normalization of the right foot abduction angle, with no significant change in the left foot’s visitation angle.
5. Slight improvements in foot vault index (AI) and average foot pressure during gait, with minimal changes in maximum foot pressure during gait.
Conclusions. HVLA manipulation significantly improves static balance parameters but shows minimal improvement in gait parameters. This indicates a complex relationship between atlanto-occipital blockage and postural disorders, suggesting the need for further research to explore the association between postural defects and atlanto-occipital transition blockage, as well as the impact of these blockages on postural changes.
Keywords
atlanto-occipital blockage, HVLA manipulation, postural disorders, balance improvement, pedobarography
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Effects of upper cervical HVLA manipulation on static and dynamic balance parameters in healthy adults – a systematic literature review

Przemysław Malich, Agata Pasternak, Danuta Lietz-Kijak, Aleksandra Bitenc-Jasiejko, Piotr Skomro, Konrad Kijak, Małgorzata Kowacka, Zbigniew Śliwiński


Przemysław Malich, Agata Pasternak, Danuta Lietz-Kijak, Aleksandra Bitenc-Jasiejko, Piotr Skomro, Konrad Kijak, Małgorzata Kowacka, Zbigniew Śliwiński – Effects of upper cervical HVLA manipulation on static and dynamic balance parameters in healthy adults – a systematic literature review. Fizjoterapia Polska 2023; 23(3); 210-220

DOI: https://doi.org/10.56984/8ZG1436RB

Abstract
Background. Balance is a complex concept that applies not only to tasks with a reduced base of support, but also to everyday activities that require us to maintain a fixed position. Just as the concept itself is broad, the mechanisms for maintaining balance are complex and rely on information received from many regions of the body and organs.
Objective. The aim of this systematic literature review is to analyse whether HVLA manipulation of a blocked C0-C1 segment can affect static and dynamic balance parameters in healthy adults.
Methods. Based on the available literature, accessed via PubMed, Google Scholar, Scopus, EBSCO databases, a detailed search of the electronic literature was performed for 2010–2023. Eligible studies were chosen according to inclusion and exclusion criteria, using keywords: static balance, dynamic balance, manipulation, HVLA. Out of 114 manuscripts, 82 were short-listed for the preliminary review process. Twenty experimental studies were selected for final analysis.
Results. Out of the 20 publications analysed, 14 examined the effect of HVLA manipulation on balance parameters. In most cases, the study groups consisted of people with no dysfunction or complaints and/or people with neck pain. The most commonly studied parameter was static balance in standing: 17 of 20 publications. For the cervical spine, 50% of the studies found a significant improvement in the parameters studied in the immediate assessment, while in the delayed assessment there were as many significant positive results as there were results with no effect on balance. In the analysis of a subset of trials that examined only asymptomatic patients, partial or significant positive effects were observed in both immediate and delayed assessment.
Conclusions. We were not able to identify studies that would provide a clear answer to the research question. Based on the publications included in the review, it can be assumed that HVLA manipulation in the cervical region has the potential to affect balance in healthy adults, but the number of available studies is too small to draw firm conclusions. Further research in this area is therefore warranted.
Keywords
static balance, dynamic balance, manipulation, HVLA, podoscope
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