07/03/2026
HVLA vs LVLA — what’s the difference?
HVLA (High Velocity Low Amplitude) is a fast thrust technique that often produces a cavitation — the familiar “crack” heard during spinal manipulation.
LVLA (Low Velocity Low Amplitude) refers to slower joint articulation or mobilisation techniques that typically do not produce cavitation.
One of the biggest misconceptions in manual therapy is that the “crack” is the treatment, or that a successful adjustment must cavitate.
In reality, cavitation is simply the rapid separation of joint surfaces causing a redistribution of gas within synovial fluid. It’s an interesting physical phenomenon, but research suggests it is not what determines clinical outcomes.
Multiple studies have shown similar improvements in pain and function when comparing spinal manipulation and mobilisation. From an evidence-based perspective, both approaches can be effective depending on the patient, the clinical presentation, and the clinician’s reasoning.
The key factors that influence outcomes are good assessment, appropriate patient selection, skilled technique, and reassessment after treatment — not whether a cavitation occurs.
You can deliver a very effective manual therapy intervention with or without a cavitation.
As our understanding of manual therapy continues to evolve, modern research increasingly highlights neurophysiological mechanisms and patient-centred care rather than older biomechanical explanations such as “putting bones back into place”.
Infographic developed by Dr Brogan Williams and Giles Gyer.
Chiropractic Physiotherapy PhysicalTherapy SportsMedicine MSKMedicine EvidenceBasedPractice PainScience ManualTherapist ClinicalReasoning TherapistEducation OMTTraining
