Acute Torticollis, Synovitis and HVLA-SM

Written by: James Demetrious, DC, DABCO

Anecdotal Relief

Without equivocation, I can attest to the substantial relief afforded to patients through chiropractic High Velocity Low Amplitude Spinal Manipulation (HVLA-SM in the care of acute torticollis and synovitis. The ability to perform HVLA-SM on this patient cohort requires advanced training and skill. The benefits are at times astounding with regard to pain relief, restoration of function, and wellness.

Insight Gained from a Medical Orthopedic Friend

Early in practice, I had the opportunity to watch dozens of arthroscopic surgeries performed by a fellowship-trained medical orthopedist. In every surgical intervention that I attended, I observed intra-articular debris that was deftly vacuumed out by the surgeon.

While playing tennis with the same surgeon, his knee locked and he fell to the ground. He reported that he had intra-articular debris. He asked me to stabilize his ankle and he moved his upper leg, freeing the debris stuck between the joint surfaces. He subsequently underwent arthroscopic surgery to remove intra-articular floaters.

This experience provided me with a macro perspective of what may occur in the spine and other synovial joints.

Supportive Research

The paucity of high-quality evidence related to the benefit of HVLA-SM in this patient cohort is disappointing. Supportive evidence is anecdotal and theoretical. When faced with a deficit of high-quality research evidence, one must consider mechanisms based upon accepted anatomic and physiologic observations.

Some Plausible Explanations

We must consider observations gleaned from orthopedic experience, diagnostic imaging, and case reports:

  • World-renowned medical orthopedist Robert Salter, MD, reported many years ago that chronic synovitis produces synovial membrane hypertrophy that can intrude into the intra-articular space.
  • Plica syndromes and meniscoid entrapment have been carefully described in the medical literature as a source of synovial joint pain and dysfunction.
  • Research by Cramer at al. provides pre-post MRI evaluations following HVLA-SM in which we can observe synovial joint gapping post manipulation (see attached Open Access image from Cramer et al. [1]).
  • New research published by Anderst et al. provides insight to facet joint gapping and improved range of motion following manipulation.
  • Case studies by Dr. Cox reveal the improvement of patients with synovial cysts.

Future Research

Much of the patient satisfaction that is associated with chiropractic care stems from pain relief from HVLA-SM that is safe and effective in comparison to other modalities of care. In this regard, doctors of chiropractic shine, and further research is needed to explain the anecdotal relief experienced by our patients.

Image Reference:

  1. Free PMC Article: J Manipulative Physiol Ther. 2012 Oct; 35(8): 614–621.

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