High-Velocity Low-Amplitude Techniques for the Management of Discogenic Lumbosacral Radicular Syndrome: A Systematic Review

Serio, Riccardo; Bertoni, Gianluca; Andreoletti, Federico; Maselli, Filippo; Testa, Marco; Battista, Simone

Abstract

Objective
The purpose of this study was to investigate the effect of high-velocity low-amplitude techniques (HVLATs) on discogenic lumbosacral radicular syndrome (LSRS).
Methods
This was a systematic review of randomized controlled trials (RCTs). Cochrane Central Register of Controlled Trials (CENTRAL), Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Physiotherapy Evidence Database (PEDro) and Web of Science (WoS) were searched from inception until 19 November 2023. Eligible RCTs involved adults with LSRS and compared HVLATs with other nonsurgical treatments, sham HVLATs or no intervention. Data related to pain, disability, health-related quality of life (HRQoL) and adverse events were extracted. The methodological quality was assessed with the ‘Cochrane Risk of Bias (RoB) Tool 2.0’ and the certainty of the evidence with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).
Results
Three of the 415 retrieved records met the inclusion criteria. One study investigated acute LSRS, comparing HVLAT versus sham HVLAT. The second study investigated subacute and chronic LSRS, comparing the same intervention with the intervention group receiving 3 adjunctive sessions of HVLAT. The third study investigated chronic LSRS, comparing HVLATs to another manual therapy technique. Totally, 186 people were involved (n = 95 intervention group; n = 91 control group). The first study reported greater improvement in pain and disability in favor of HVLATs. The second study found no differences in pain in favor of HVLATs. The third study found greater improvement for pain, disability and HRQoL in the control group. No adverse events were reported. Two studies were at high RoB and highly heterogeneous; 1 was considered of some concern. The certainty of the evidence was “very low.”
Conclusions
There is insufficient evidence to conclude whether HVLATs can be helpful in LSRS. Future high-quality RCTs are necessary.

• Journal Article Type: Article
• Acceptance Date: Aug 25, 2024
• Publication Date: Sep 30, 2024
• Deposit Date: Feb 4, 2025
• Publicly Available Date: Feb 4, 2025
• Journal: Journal of Manipulative and Physiological Therapeutics
• Print ISSN: 0161-4754
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 46
• Issue: 5
• Pages: 346-356
• DOI: https://doi.org/10.1016/j.jmpt.2024.08.008