In the Orthopedic Massage for Spine Mobility and Breathing course at RSM International Academy,

HVLA (High-Velocity Low-Amplitude) and LVLA (Low-Velocity Low-Amplitude) joint manipulation are taught for pain reduction, postural improvement, functional recovery and sports performance with an emphasis on safety and neuromuscular re-education.

To optimise joint motion, the therapist first assesses misalignment caused by muscle tension, trigger points and fascial restriction, while palpating during massage and observing the kinetic chain through guided stretching to identify movement dysfunction.

HVLA is never performed abruptly. Treatment begins with superficial myofascial release and active soft-tissue release, followed by deep-layer soft-tissue release around the joint to reduce tension. Then, LVLA joint mobilisation restores physiological motion and promotes joint centralisation.

This sequence stimulates capsular mechanoreceptors (Types I & II), enhancing neural glide, joint position sense, and coordination. LVLA specifically facilitates postural control and sensory reintegration. RSM follows the principle “Release → LVLA → Minimal HVLA.”

References 

1) Bialosky JE et al. (2009). Manual Therapy, 14(5), 531–538. [PubMed ID 19539559]

2) Pickar JG. (2002). Spine Journal, 2(5), 357–371. [PubMed ID 14589477]

Reed WR et al. (2020). Clinical Biomechanics, 73, 86–92. [PubMed ID 31958668]

3) Sterling M, Jull G. (2001). Manual Therapy, 6(3), 139–148. [PubMed ID 11414774]

At RSM International Academy, safety and patient specificity take priority in choosing between HVLA and LVLA.

For elderly or high-BMI clients with bone spurs, HVLA may detach micro-fragments and irritate nerves, so RSM uses a protocol centred on myofascial release, deep-tissue massage, and LVLA-dominant mobilisation.

HVLA is never performed on the cervical spine. Instead, alignment is corrected via deep-tissue methods, myofascial release, and towel-assisted LVLA traction for safe motion re-education.

In joint-manipulation sessions co-hosted with the Faculty of Medicine, Chiang Mai University, professors shared clinical examples:

“When HVLA is applied to osteophytic segments, small bone fragments may migrate and compress nerves—hard to detect on MRI and very difficult to remove surgically.”

Based on these clinical findings, RSM strictly follows the stepwise protocol “Release → LVLA → Minimal HVLA.”

This approach naturally induces pain relief, range-of-motion recovery, and neuromuscular re-education,

enhancing post-surgical rehabilitation and athletic performance with minimal post-session soreness and sustained results.

References
1) Puentedura EJ, Louw A. (2012). Physical Therapy, 92(7): 1097–1110. [PubMed ID 22654195]

2) Gorrell LM, Beffa R, Christensen MG. (2019). J Manipulative Physiol Ther, 42(1): 25–33. [PubMed ID 30509569]

3) Bialosky JE et al. (2018). J Orthop Sports Phys Ther, 48(9): 656–664. [PubMed ID 30126184]