Lumbar spine high-velocity low-amplitude (HVLA) thrusting techniques are a form of manual medicine used by osteopathic providers. As the name implies, this technique involves high-velocity thrusting techniques under controlled pressure applied to correct a specific osteopathic diagnosis discovered previously on an osteopathic physical exam. HVLA techniques are frequently used in osteopathic manipulative medicine as an adjunct to other treatment modalities for low back pain, among other conditions.

This article reviews the background anatomy and physiology behind these techniques as well as discusses the technical aspects of their application. This discussion includes patient screening for contraindications and discussion of alternate techniques to attempt prior to HVLA application. The technical aspects addressed include obtaining a proper osteopathic diagnosis for the vertebral segment in question as well as outlining the set-up and application of the thrusting techniques themselves. Also, common pitfalls and a discussion on improving healthcare team implementation of these techniques are both addressed.