Other
The use of high velocity low amplitude manipulation as an osteopathic treatment technique for paediatric care: Analysis from two cross- sectional surveys
Dun PLv, Bohlen L, Ellwood J, Ferreira APA, Steel A et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study surveyed osteopathic practitioners and educational institutes across multiple countries to understand how often high velocity low amplitude (HVLA) manipulation is used to treat infants, children, and adolescents, and whether it is taught in osteopathic training programmes. The findings show that most practitioners rarely use HVLA on very young children, but usage increases with age. Most osteopathic educators and practitioners expressed concerns about using HVLA on infants and young children.
Key points
- Only 6.5% of osteopathic practitioners reported using HVLA in newborns or infants, compared to 43.5% in children and 78.3% in adolescents
- Among those using HVLA on infants, 54% reported doing so 'rarely'
- 91.4% of osteopathic education institutes offered paediatric education, but only 4.8% taught HVLA for newborns and infants
- 70.2% of respondents held an HVLA-opposed stance
- The study surveyed 2,607 practitioners and 62 educational institutes across Europe, Australia, Brazil, Israel, and New Zealand
Limitations
This study describes current practice patterns among osteopathic practitioners and educators but does not evaluate the safety or effectiveness of HVLA techniques themselves. The survey relies on self-reported data and may not capture the full range of practices or representative samples from all surveyed countries.
Abstract
Abstract Background Up to one-quarter of osteopathic consultations involve infants and children. Although the clinical effectiveness of osteopathic care in paediatric populations remains inconclusive, available evidence suggests that it is generally safe. In contrast, high velocity, low amplitude (HVLA) manipulation has been associated with potential adverse effects. To inform a professional position on the use of HVLA techniques in paediatric care, this study investigated (1) the use of HVLA techniques by osteopathic practitioners in the treatment of infants, children, and adolescents, and (2) the extent to which HVLA techniques are included in osteopathic training programmes for these paediatric age groups. Methods Two online cross-sectional surveys were conducted. The first targeted osteopathic practitioners and consisted of seven close-ended questions. The second survey was directed at osteopathic education institutes (OEIs) in Europe, Australia, Brazil, Israel, and New Zealand and consisted of three close-ended questions. Surveys were implemented via REDCap and made available in 11 languages. Participants were recruited between October 2025 and January 2026. Results Among responding practitioners (n = 2,607), 6.5% reported using HVLA in newborns or infants, 43.5% in children, and 78.3% in adolescents. Most respondents (54%) who apply HVLA to newborns and infants reported doing so “rarely”. Of the 62 responding OEIs, 91.4% offered osteopathic paediatric education; however, only 4.8% reported teaching HVLA for newborns and infants, 11.3% for children, and 56.4% for adolescents. Most respondents (70.2%) held an HVLA-opposed stance. Among the distinct practitioner profiles identified in the prioritisation of conditions for HVLA use in newborns and infants, the precaution-informed stance (11.2%) was the most strongly associated with paediatric practice and with the highest reported HVLA use in this age group. Conclusions Most respondents did not use HVLA in newborns and infants, with utilisation increasing in older paediatric age groups, and the majority expressed opposition to paediatric HVLA. More permissive stances were associated with greater HVLA use and more training. Given its continued application, an evidence-based position statement and robust research on the safety and effectiveness of HVLA in paediatrics are urgently needed.