Reproducibility of the Kinematics in Rotational High-Velocity, Low-Amplitude Thrust of the Upper Cervical Spine: A Cadaveric Study

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This study aimed to investigate the reproducibility of the kinematics in rotational high-velocity, low-amplitude (HVLA) thrust of the upper cervical spine.


Twenty fresh human cervical specimens were studied in a test-retest situation with 2 manual therapists. Kinematics of C1-C2 and C0-C1 were examined during segmental rotational HVLA manipulation through an ultrasound-based tracking system. The thrust moment was analyzed by 3-dimensional aspects: the range of motion of axial rotation, flexion-extension, lateral banding, and the cross-correlation between the axial rotation and the coupled lateral banding components.


During rotational HVLA thrust on C1-C2, the main axial rotation demonstrates an intraexaminer relationship varying from almost perfect to fair (intraclass correlation coefficient = 0.71; intraclass correlation coefficient = 0.35) and a substantial interexaminer correlation of 0.73.


This study showed substantial levels of reliability for the main axial rotation component of segmental manual rotational HVLA thrust on C1-C2. Intra- and interrater reliability for flexion-extension, lateral bending, and cross-correlation was low.

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