The “High Velocity Low Amplitude Techniques” in musculoskeletal chronic spinal pain treatment

Introduction. Chronic pain means any pain that lasts more than 12 weeks or, in any case, persists beyond normal time required by tissue warranty. Chronic spinal pain represents an important social issue, weighing heavily on health costs of each Country. For these reasons, it is important to understand which techniques can be clinically useful in order to reduce patients’ suffer of chronic spinal pain. Spinal manipulation (SMT) is one of the most used techniques by healthcare providers. Its effectiveness has been widely demonstrated in acute pain, while its use in chronic problems is still controversial. Aims. The purpose of this professional issues is to investigate the possible use of SMT in chronic spinal pain. Materials and methods. A review was performed from May to June 2018 in Medline database. Recent RCTs have been selected to investigate on effectiveness of SMT in chronic spinal pain. Results. Of the initial 203 records, 11 articles were included on the base of inclusion and exclusion criteria. The results of the studies were divided in 3 groups according to the comparison treatment: SMT vs SMT, SMT vs Sham, SMT vs Active treatment. There were no substantial differences, in terms of pain reduction and functionality improvement. Conclusions. Despite difficulties due to heterogeneity of studies, SMT seems to be equally effective in treatment of chronic spinal pain patients, like other manual therapy techniques. In short term, SMT can have more influence on pain, compared to joint mobilization. The role of SMT within a treatment associated with active exercise is still to be explained, since results in literature are conflicting.