Raissa Caroline Brito Costa*

rccosta@uea.edu.br

Kaellen Almeida Scantbelruy**

kaellen.scantbelruy@gmail.com

Ioni Cardoso Correa**

ionicardoso7@gmail.com

Drielle Matos Silva Estrázulas+

driellemattos@hotmail.com

Jansen Atier Estrázulas++

jestrazulas@uea.edu.br

*PhD in Performing Arts (UNICAMP)

Graduated in Physiotherapy (UNINORTE) and Dance (UEA)

Specialist in Biomechanics (Literatus)

Adjunct Professor at the State University of Amazonas

and member of the Biomechanics

and Ergonomics Laboratory - Biomech Lab (UEA)

**Master's degree in Public Health (PPGSC/UEA)

Specializations in progress in Osteopathy (EBOM) and Biomechanics (UEA)

Degree in Physiotherapy (UFAM) and member of the Biomechanics

and Ergonomics Laboratory - Biomech Lab (UEA)

+Specialization in Osteopathy (EBOM)

Specialization in Orthopedics and Traumatology

with Emphasis on Manual Therapies (FASSERRA)

Bachelor's degree in Physiotherapy (UNINORTE)

Member of the Biomechanics

and Ergonomics Laboratory - Biomech Lab (UEA)

++PhD in Production Engineering (UFSC)

Adjunct Professor at the State University of Amazonas (UEA)

Coordinator of the Postgraduate Program in Biomechanics at UEA

Coordinator of the Biomechanics

and Ergonomics Laboratory - Biomech Lab (UEA)

(Brasil)

Reception: 08/08/2025 - Acceptance: 01/01/2026

1st Review: 09/01/2025 - 2nd Review: 12/23/2025

Accessible document. Law N° 26.653. WCAG 2.0

Suggested reference: Costa, R.C.B., Scantbelruy, K.A., Correa, I.C., Estrázulas, D.M.S., & Estrázulas, J.A. (2026). Effects of Upper Cervical Manipulation on Stabilometry in Asymptomatic Individuals with Cervical Dysfunction. Lecturas: Educación Física y Deportes, 30(333), 136-148. https://doi.org/10.46642/efd.v30i333.8498

 

Abstract

    The atlanto-occipital joint plays a fundamental role in integrating proprioceptive, vestibular, and visual inputs, which are essential for postural control. Functional alterations in this region may affect body stability, even in asymptomatic individuals. The present study aimed to investigate the immediate effects of a single session of high-velocity, low-amplitude osteopathic manipulation on the stabilometry in asymptomatic, physically active university students. This experimental, cross-sectional study included 24 university students (mean age: 23 ± 3.9 years). Participants were evaluated using a baropodometric platform at 3 time points: before, immediately after, and 2 minutes after the intervention, under 2 conditions: eyes open and eyes closed. The variables analyzed were: center of pressure displacement area, center of pressure path length, and mean square velocity. Results showed greater postural instability immediately after the manipulation, with increased center of pressure area and path length. After two minutes, a reduction in mean square velocity was observed, indicating the beginning of postural reorganization. The eyes-closed condition resulted in the highest sway values, highlighting the critical role of vision in balance. These findings suggest that upper cervical manipulation can trigger acute neurophysiological responses, which are detectable by sensitive instruments, even if not clinically evident. It is concluded that the beneficial effects of cervical manipulation are not immediate but emerge over time. Future studies with longer post-intervention follow-up periods it is recommended, to better understand the sensorimotor adaptation process of the postural control system following osteopathic manipulation.

    Keywords: Manipulation osteopathic. Cervical spine. Postural balance. Spine.

 

Resumo

    A articulação atlanto-occipital desempenha papel fundamental na integração entre os sistemas proprioceptivo, vestibular e visual, sendo essencial para o controle postural. Alterações funcionais nessa região podem impactar a estabilidade corporal, mesmo na ausência de sintomas. O objetivo foi investigar os efeitos imediatos de uma única manipulação osteopática de alta velocidade e baixa amplitude na estabilometria de universitários assintomáticos, fisicamente ativos. Estudo experimental, de caráter transversal, com 24 universitários, média de idade de 23 ± 3,9 anos. Os participantes foram avaliados por meio de plataforma baropodométrica em 3 momentos: antes (nas condições com olhos abertos e olhos fechados), imediatamente após e 2 minutos após a intervenção. As variáveis analisadas foram: área de deslocamento do centro de pressão, distância percorrida pelo centro de pressão e velocidade média quadrática. Os resultados demonstraram maior instabilidade postural imediatamente após a manipulação, com valores elevados do centro de pressão e distância percorrida do centro de pressão. Após 2 minutos, observou-se tendência de redução da velocidade média quadrática, indicando início de reorganização postural. A condição de olhos fechados apresentou os maiores índices de oscilação, reforçando a importância da visão para o equilíbrio. Os achados sugerem que a manipulação cervical superior pode desencadear respostas neurofisiológicas agudas, perceptíveis por instrumentos sensíveis, ainda que não clinicamente evidentes. Conclui-se que os efeitos benéficos da manipulação não são instantâneos, mas se desenvolvem ao longo do tempo. Recomenda-se que futuras pesquisas avaliem períodos mais longos após a intervenção, para melhor compreensão da adaptação sensório-motora do sistema postural à manipulação osteopática.

    Unitermos: Manipulação osteopática. Coluna cervical. Equilíbrio postural. Coluna.

 

Resumen

    La articulación atlantooccipital desempeña un papel fundamental en la integración de señales propioceptivas, vestibulares y visuales, esenciales para el control postural. Las alteraciones funcionales en esta región pueden afectar la estabilidad corporal, incluso en personas asintomáticas. El presente estudio tuvo como objetivo investigar los efectos inmediatos de una sola sesión de manipulación osteopática de alta velocidad y baja amplitud sobre la estabilometría en estudiantes universitarios asintomáticos y físicamente activos. Este estudio experimental transversal incluyó a 24 estudiantes universitarios (edad media: 23±3,9 años). Los participantes fueron evaluados mediante una plataforma baropodométrica en tres momentos: antes, inmediatamente después y 2 minutos después de la intervención, en dos condiciones: ojos abiertos y ojos cerrados. Las variables analizadas fueron: área de desplazamiento del centro de presión, longitud de la trayectoria del centro de presión y velocidad cuadrática media. Los resultados mostraron una mayor inestabilidad postural inmediatamente después de la manipulación, con un aumento del área del centro de presión y de la longitud de la trayectoria. Después de dos minutos, se observó una reducción de velocidad cuadrática media, lo que indica el inicio de la reorganización postural. La condición con ojos cerrados resultó en valores más altos de balanceo, lo que resalta el papel crucial de la visión en el equilibrio. Estos hallazgos sugieren que la manipulación cervical superior puede desencadenar respuestas neurofisiológicas agudas, detectables con instrumentos sensibles, incluso si no son clínicamente evidentes. Se concluye que los efectos beneficiosos de la manipulación cervical no son inmediatos, sino que se manifiestan con el tiempo.

    Palabras clave: Manipulación osteopática. Columna cervical. Equilibrio postural. Columna.

 

Lecturas: Educación Física y Deportes, Vol. 30, Núm. 333, Feb. (2026)

---

 

Introduction 

 

    The cervical spine, particularly its upper portion, plays a fundamental role in integrating the proprioceptive, visual, and vestibular systems and is directly responsible for positioning and moving the head in space. This integration occurs through the muscle spindles and joint receptors in the cervical region, where sensory input is processed by the central nervous system to maintain balance and postural control. (Duarte, & Freitas, 2010; King et al., 2022)

 

    Functional alterations in these structures, even in the absence of clinical symptoms, can compromise postural stability and predispose individuals to movement dysfunction. Osteopathic manipulation of the spine, especially the upper cervical joints, is a widely used therapeutic approach, aimed at restoring joint mobility and modulating the response of sensory receptors (Gómez et al., 2020; Stelle, Zeigelboim, Lange, & Marques, 2013). Evidence shows that this intervention can induce acute neurophysiological effects, such as increasing the pain threshold, modulating motor activity, and potentially improving postural control. (Díaz-Muñoz, Heredia-Rizo, & Rodríguez-Blanco, 2014; Smith, & Mehta, 2008)

 

    Studies suggest that manipulation of the atlanto-occipital joint can influence body sway in standing posture, indicating a possible impact on the sensory-motor organization of balance (Malich, & Kijak, 2024; Romero del Rey et al., 2020). In this context, it is important to investigate the immediate effects of upper cervical manipulation in asymptomatic individuals, considering that subtle changes can be detected using sensitive instruments such as stabilometry. Thus, the current study aimed to analyze whether a single session of high-velocity, low-amplitude (HVLA) manipulation of the atlanto-occipital joint produces measurable changes in stabilometric parameters, testing the hypothesis that these changes occur acutely, both immediately and after a short time interval.

 

    Spinal manipulation produces effects on both vertebral biomechanics and sensory receptors, including an increase in the pain threshold and excitatory or inhibitory responses (Neves et al., 2025; Zambrano-Martín et al., 2019). Previous research has reported improvements in postural control after the upper cervical spinal manipulation technique, as well as improvements in joint movement restriction (Anderst et al., 2018; Romero del Rey et al., 2020). It is therefore fundamentally important to better understand the effects of spinal manipulation on maintaining balance, especially immediately after this intervention.

 

    In view of the above, the current research was based on the hypothesis that a single session of high-velocity, low-amplitude (HVLA) osteopathic manipulation of the atlanto-occipital joint would promote significant changes in the stabilometric parameters of asymptomatic individuals, reflecting improvements in postural control. It was assumed that these changes would be noticeable both immediately and after a short interval (two minutes), suggesting acute effects of the manipulation on standing balance. The present study aimed to investigate the immediate effects of a single HVLA osteopathic manipulation session on stabilometry in asymptomatic, physically active university students.

 

Methods 

 

    This is an experimental, cross-sectional study, which aimed to assess the immediate effects of a single high-speed, low-amplitude osteopathic manipulation session of the upper cervical region on stabilometric parameters in young individuals.

 

    The study was carried out between March and July 2025 at the Biomech Lab - Biomechanics and Ergonomics laboratory of the Amazonas State University. The study population consisted of 24 university students, with a mean age of 23±3.90 years, with no contraindications to upper cervical manipulation. The study obtained ethical approval under CAAE No. 79970924.1.0000.5016.

 

    Twenty-four university students of both sexes were recruited, with a mean age of 23 ± 3.9 years. All participants were physically active, asymptomatic for neck pain and headaches, and had no contraindications to upper neck manipulation. Individuals were included if they did not have pain conditions in the head or neck. Students with alterations related to balance or postural control, such as: dizziness, vertebrobasilar insufficiency or a positive Klein test, as well as those who had a history of craniovertebral trauma, vascular, neurological, or rheumatic pathologies, or congenital malformations in the cranial or cervical regions were excluded.

 

Protocol 

1.     Pre-intervention assessments 

 

    Stabilometric assessment: carried out using the BaroScan® electronic baropodometer (HS Technology®), recording the following variables: area of displacement of the center of pressure (COP), total distance traveled by the COP, and mean square velocity. The participants were positioned in comfortable orthostatism, with bipodal support and a free support base. During collection, they were instructed to fix their gaze on an imaginary point 1 meter away (Machado et al., 2017). Each acquisition lasted 20 seconds and was carried out in two conditions: with eyes open (EO) and eyes closed (EC).

 

    Clinical assessment: included axial compression and Klein tests to rule out signs of cervical instability or vertebrobasilar involvement. This was followed by a detailed palpatory assessment of the upper cervical region, covering the occipital (C0), atlas (C1), and axis (C2) segments, with an emphasis on detecting osteopathic dysfunctions, mobility limitations, and points of referred pain.

 

2.     Osteopathic intervention 

 

    The manipulative technique used was high-velocity, low-amplitude "global" manipulation for the upper cervical region. The procedure was performed with the participant in the supine position. The positioning of the therapist's hands was as follows: the cranial hand supported the chin with the forearm resting laterally to the face, while the biceps stabilized the occipital region. The caudal hand was positioned with the pisiform bone over the mastoid process, applying the manipulation impulse. The maneuver involved the parameters of slight contralateral rotation, translation, and joint decoaptation, respecting the anatomical and safety limits as described by Hu et al. (2021). Manipulation was performed bilaterally in order to promote functional balance.

 

3.     Post-intervention assessments 

 

    Stabilometric assessment immediately after manipulation (MI): participants were positioned on the baropodometer platform, in orthostatism, with bipodal support and a free support base. During collection, they were instructed to fix their gaze on an imaginary point 1 meter away (Machado et al., 2017). Each acquisition lasted 20 seconds, with eyes open (EO).

 

    Stabilometric assessment 2 minutes after manipulation (MA): participants were positioned on the baropodometer platform, in orthostatism, with bipodal support and a free support base. During collection, they were instructed to fix their gaze on an imaginary point 1 meter away (Machado et al., 2017). Each acquisition lasted 20 seconds, with eyes open (EO).

 

    Clinical reassessment: The upper cervical region was reassessed to check for changes resulting from the manipulation of previously identified dysfunctions.

Statistical analysis 

 

    The data were initially tabulated in Microsoft Excel® spreadsheets and submitted to descriptive analysis (mean and standard deviation) of the stabilometric parameters: COP displacement area, total distance covered by the COP, and mean square velocity.

 

    For intra-individual comparisons, the values obtained in the post-intervention conditions were normalized in relation to the baseline condition (EO) and expressed as percentage variations. This approach made it possible to more accurately assess individual changes in postural behavior throughout the different experimental conditions.

 

Results 

 

    Table 1 presents the descriptive values for the stabilometric parameters analyzed: area of displacement of the center of pressure (COP), total distance traveled by the COP, and mean square velocity, considering the four experimental conditions of plantar support: eyes open (EO), eyes closed (EC), immediately after manipulation (IA), and two minutes after manipulation (MA), allowing the analysis of postural oscillation and body stability in each condition.

 

    In the analysis of the stabilometric parameters, the EC condition showed the highest mean values for the COP area (24.04 mm²), distance traveled (86.06 mm), and mean square velocity (4.39 mm/s), when compared to the other conditions. The smallest displacement area was observed in the EO condition, with a mean of 12.44 mm².

 

    The IA condition also showed high mean values for COP area (21.28 mm²) and distance traveled (71.08 mm), while the MA condition showed slightly higher values than EO, with an mean area of 14.41 mm² and distance of 66.56 mm. With regard to velocity, the lowest values were found in the MA condition (3.34 mm/s).

 

    The standard deviation (SD) was higher in the EC condition for all parameters. The coefficient of variation (CV) followed a similar pattern, indicating greater mean postural oscillation with eyes closed, especially in the COP area (83.59%) and in the mean square velocity (48.30%).

 

Stabilometry	Variables	EO	EC	IA	MA
COP displacement area (mm²)	X̄	12.44	24.04	21.28	14.41
	SD	7.68	20.10	18.31	8.87
	Min	1.57	3.94	3.33	3.64
	Max	27.69	81.44	68.47	32.44
Distance covered by the COP (mm)	X̄	69.07	86.06	71.08	66.56
	SD	20.86	40.86	40.78	32.07
	Min	15.82	17.81	19.34	21.57
	Max	188.29	173.63	138.77	130.42
Mean square velocity (mm/s)	X̄	3.47	4.39	3.57	3.34
	SD	2.34	2.12	2.05	1.61
	Min	0.80	0.89	0.97	1.08
	Max	9.46	8.72	6.97	6.55

Legend: EO: Eyes open; EC: Eyes closed; IA: Immediately after manipulation; MA: Two minutes after manipulation; COP: Center of pressure oscillation; CV: Coefficient of variation; SD: standard deviation; X̄: mean. Source: Research data

 

    The COP displacement area increased by 126.21% in the EC condition, 103.34% in the IA condition, and 82.23% in the MA condition compared to the eyes-open condition. The distance covered by the COP increased by 45.95%, in the EC condition, 15.01% in the IA condition, and 3.63% in the MA condition compared to the eyes-open condition. Finally, the mean square velocity variable increased by 43.93% in the EC condition, 14.86% in the IA condition, and 15.18% in the MA condition compared to the eyes-open condition.

 

Discussion 

 

    The findings of the current study suggest that high-velocity, low-amplitude (HVLA) osteopathic manipulation of the atlanto-occipital joint promotes acute changes in the stabilometric parameters of asymptomatic individuals, showing greater postural instability immediately after the intervention. However, two minutes after the intervention, only the mean square velocity variable showed a reduction compared to the baseline condition. The lack of immediate beneficial effects on balance may be related to the time needed for proprioceptive reorganization and vestibular integration to occur, essential processes in postural modulation after manipulative stimuli. (Young et al., 2024)

 

    The effect observed two minutes after the manipulation suggests that, even in asymptomatic individuals, osteopathic manipulation can favor subtle postural adjustments, which are not perceived clinically, but that can be detected by highly sensitive instruments. These findings reinforce the hypothesis that the positive effects of manipulation on postural balance are not immediate, but evolve over time as the sensorimotor system adapts to the stimulus. (Malaya et al., 2020; 2021; Schueren et al., 2022)

 

    The lack of immediate improvement in balance parameters corroborates studies suggesting that a minimum interval is required for proprioceptive and vestibular reorganization to occur. Smith, & Mehta (2008) identified a significant improvement in balance only 15 minutes after manipulation, reinforcing the idea that the beneficial effects of osteopathic manipulation require some time to manifest. Haavik et al. (2021) suggest that post-manipulative stabilization involves a process of progressive neuromuscular reorganization, and that early assessments may not fully capture these benefits. Thus, the absence of assessments at later time points (such as 5 or 15 minutes after manipulation) in the present study may have limited the detection of potential subsequent beneficial effects, as reported in the literature.

 

    In contrast to the results obtained, Gómez et al. (2020) reported statistically significant improvements in global stabilometric parameters after manipulation of the upper cervical region, with reductions in the mean values of velocity, surface, path length, and pressure immediately after the intervention and maintained until the 15th day (p < 0.001; ƞ²p = 0.323-0.856). This divergence may be related to differences in the intervention protocols, parameters analyzed, or sample characteristics.

 

    The stabilometric response may show delayed behavior, with more evident effects after a short time interval. The improvement observed in asymptomatic individuals, although subtle, reinforces the hypothesis of neurophysiological modulation of the sensorimotor system through cervical proprioceptive stimulation. (Acet, Güzel, & Günendi, 2024; Niazi et al, 2024)

 

    The condition of bipodal support with eyes closed (EC) posed a greater challenge to postural control, reflected in the higher percentage increases in all the variables analyzed: COP displacement area, distance traveled, and mean square velocity. This result corroborates previous studies showing that deprivation of visual information significantly compromises postural stability, as the visual system is one of the main factors responsible for spatial orientation and perception of body movement in relation to the environment (King et al., 2022). The IA and MA conditions also posed challenges to balance, but to a lesser extent, suggesting that the postural system is better able to compensate for mechanical instability or surface alterations than the absence of visual information.

 

    From a neurophysiological point of view, manipulation of the upper cervical region can induce excitatory or inhibitory responses in muscle and joint afferents, modulating postural reflexes and the activity of deep cervical muscles (King et al., 2022). Studies show that even in asymptomatic individuals, spinal manipulation is able to alter range of motion and muscle recruitment, probably due to the stimulation of joint mechanoreceptors and the subsequent central reorganization of sensory information. (King et al., 2022)

 

    These interventions can induce physiological responses, including pain reduction, improved joint mobility, and changes in muscle activity, possibly through modulation of joint sensory receptors and integration with the central nervous system. Studies suggest that spinal manipulation acts not only on local biomechanics, but also on the modulation of proprioception and motor control, essential factors for maintaining balance. (King et al., 2022)

 

    The superiority of manipulating the upper cervical spine (C1-C2) compared to other regions was also highlighted by Romero del Rey et al. (2020), who attribute this effectiveness to the high density of mechanoreceptors in the suboccipital region. These receptors play a fundamental role in the integration of proprioceptive information and balance control, explaining the significant influence of manipulation in this area on postural sway.

 

    The results of the current study suggest that, as proposed by Romero del Rey et al. (2020), the effects of cervical manipulation on stabilometry stem from neurophysiological rather than biomechanical mechanisms. In addition, the absence of structural alterations in the C0-C3 vertebrae in the study reinforces the hypothesis that postural improvement occurs through modulation of proprioceptive information, rather than anatomical corrections.

 

    Considering these aspects, it is recommended that future studies include evaluations at multiple times post-intervention, with medium and long-term follow-up. This would allow for better understanding of the time curve of the postural system's response to manipulative stimuli, contributing to the construction of more effective and well-founded clinical protocols.

 

Conclusions 

 

    The findings of the current study showed that high velocity, low amplitude (HVLA) osteopathic manipulation of the atlanto-occipital joint is able to cause acute stabilometric changes in young, asymptomatic individuals, with a temporary increase in postural instability immediately after the intervention. The trend towards reorganization observed two minutes after manipulation suggests the activation of neurophysiological mechanisms related to sensorimotor modulation, reinforcing the idea that the beneficial effects of these techniques are not immediate, but evolve over time. The use of stabilometry proved effective in detecting these subtle changes, even in the absence of obvious clinical signs.

 

    Despite the small sample size and the limited short-term follow-up of the evaluation, the results provide relevant information on the effects of cervical manipulations for future research. It is recommended that subsequent studies include multiple post-intervention assessment time points and control for potential confounding variables, such as postural dominance and level of physical activity. It was concluded that upper cervical manipulation may have the potential to influence postural control, even in individuals without symptoms, justifying its application as a therapeutic or preventive resource, provided that it is supported by careful clinical evaluation and objective monitoring of its effects.

 

References 

 

Acet, N., Güzel, N. A., & Günendi, Z. (2024). Effects of cervical mobilization on balance and proprioception in patients with nonspecific neck pain. Journal of Manipulative and Physiological Therapeutics, 47(5-9), 175-186. https://doi.org/10.1016/j.jmpt.2024.09.011

 

Anderst, W.J., Gale, T., Levasseur, C., & Schneider, M. (2018). Intervertebral kinematics of the cervical spine before, during and after high velocity low amplitude manipulation. The Spine Journal, 18(8), 1493-1501. https://doi.org/10.1016/j.spinee.2018.07.026

 

Díaz-Muñoz, C.L., Heredia-Rizo, A.M., & Rodríguez-Blanco, C. (2014). Técnicas de manipulación con impulso aplicadas en la columna cervical. European Journal Osteopathy & Related Clinical Research, 9(1), 2-7. https://www.europeanjournalosteopathy.com/index.php?journal=osteopatia_cientifica&page=article&op=view&path%5B%5D=142

 

Duarte, M., & Freitas, S.M.S.F. (2010). Revisão sobre posturografia baseada em plataforma de força para avaliação do equilíbrio. Revista Brasileira de Fisioterapia, 14(3), 183-192. https://doi.org/10.1590/S1413-35552010000300003

 

Gómez, F., Escribá, P., Oliva-Pascual-Vaca, J., Méndez-Sánchez, R., & Puente-González, A. S. (2020). Immediate and short-term effects of upper cervical high-velocity, low-amplitude manipulation on standing postural control and cervical mobility in chronic nonspecific neck pain: A randomized controlled trial. Journal of Clinical Medicine, 9(8), 2580. https://doi.org/10.3390/jcm9082580

 

Haavik, H., Niazi, I.K., Kumari, N., Amjad, I., Duehr, J., Holt, K., & Türker, K.S. (2021). The potential mechanisms of high-velocity, low-amplitude, controlled vertebral thrusts on neuroimmune function: A narrative review. Medicina, 57(6), 536. https://doi.org/10.3390/medicina57060536

 

Hu, A., Motyka, T., Gish, E. & Dogbey, G. (2021). Teaching and use of cervical high-velocity, low-amplitude manipulation at colleges of osteopathic medicine. Journal of Osteopathic Medicine, 121(3), 265-270. https://doi.org/10.1515/jom-2020-0120

 

King, S.L., Docrat, A., & Abdul-Rasheed, A. (2022). Immediate effects of cervical spine manipulation compared with muscle energy technique on neck muscle activity and range of motion in asymptomatic participants: A randomized study. Journal of Chiropractic Medicine, 21(4), 241-248. https://doi.org/10.1016/j.jcm.2022.04.001

 

Machado, Á.S., Silva, C.B.P., Rocha, E.S., & Carpes, F.P. (2017). Effects of plantar foot sensitivity manipulation on postural control of young adult and elderly. Revista Brasileira de Reumatologia, 57(1), 30-36. https://doi.org/10.1016/j.rbre.2016.03.007

 

Malaya, C.A., Haworth, J., Pohlman, K.A., & Smith, D.L. (2021). Immediate impact of extremity manipulation on dual task performance: A randomized, crossover clinical trial. Chiropractic & Manual Therapies, 29, 6. https://doi.org/10.1186/s12998-021-00366-5

 

Malaya, C.A., Haworth, J., Pohlman, K.A., Powell, C., & Smith, D.L. (2020). Impact of extremity manipulation on postural sway characteristics: A preliminary, randomized crossover study. Journal of Manipulative and Physiological Therapeutics, 43(6), 457-468. https://doi.org/10.1016/j.jmpt.2019.02.014

 

Malich, P., & Kijak, K. (2024). The effect of HVLA manipulation on static and dynamic postural parameters - A case study of a patient with a blocked atlanto-occipital transition. Fizjoterapia Polska, 24(1), 215-225. https://doi.org/10.56984/8zg2ef8t5i

 

Neves, EA, Sousa, AMA, Evangelista, LS, Cavalcante, MKC, Campos, MBM, Lopes Junior, JEG, Vanderley, ESO, & Ferreira, TS (2025). Manipulação vertebral: efeito local ou neurofisiológico? Uma revisão integrativa. Revista Observatorio de la Economía Latinoamericana, 23(6), 1-14. https://doi.org/10.55905/oelv23n6-152

 

Niazi, IK, Navid, MS, Merkle, C., Amjad, I., Kumari, N., Trager, RJ, Holt, K., & Haavik, H. (2024). A randomized controlled trial comparing different sites of high-velocity low amplitude thrust on sensorimotor integration parameters. Scientific Reports, 14, 1159. https://doi.org/10.1038/s41598-024-51201-9

 

Romero del Rey, R., Saavedra Hernández, M., Rodríguez Blanco, C., Palomeque del Cerro, L., & Alarcón Rodríguez, R. (2020). Short-term effects of spinal thrust joint manipulation on postural sway in patients with chronic mechanical neck pain: A randomized controlled trial. Disability and Rehabilitation, 44(8), 1227-1233. https://doi.org/10.1080/09638288.2020.1717661

 

Schueren, S., Hunger, H., Pham, H., Smith, D. L., Layne, C., & Malaya, C.A. (2022). Immediate effect of lower extremity joint manipulation on a lower extremity somatosensory illusion: A randomized, controlled crossover clinical pilot study. Frontiers in Human Neuroscience, 16, 1011997. https://doi.org/10.3389/fnhum.2022.1011997

 

Smith, L., & Mehta, M. (2008). The effects of upper cervical complex high velocity low amplitude thrust technique and sub-occipital muscle group inhibition techniques on standing balance. International Journal of Osteopathic Medicine, 11(4), 149-168. https://www.journalofosteopathicmedicine.com/article/S1746-0689(08)00111-9/

 

Stelle, R., Zeigelboim, B.S., Lange, M.C., & Marques, J.M. (2013). Influence of manipulation at range of rotation of the cervical spine in chronic mechanical neck pain. Revista Dor, 14(4). https://doi.org/10.1590/S1806-00132013000400010

 

Young, KJ, Leboeuf-Yde, C., Gorrell, L., Bergström, C., Evans, DW, Axén, I., Chance-Larsen, K., Gagey, O., Georgopoulos, V., Goncalves, G., Harris, C., Harsted, S., Kerry, R., Lee, E., McCarthy, C., Nim, C., Nyirö, L., Schweinhardt, P., & Vogel, S. (2024). Mechanisms of manipulation: A systematic review of the literature on immediate anatomical structural or positional changes in response to manually delivered high-velocity, low-amplitude spinal manipulation. Chiropractic & Manual Therapies, 32(1), 28. https://doi.org/10.1186/s12998-024-00549-w

 

Zambrano-Martín, J., Feliz-Huerga, A., Brenlla, C., & Mendoza-Puente, M. (2019). Efectos de las manipulaciones vertebrales cervicales sobre el dolor: Revisión sistemática. Cuestiones de Fisioterapia, 48(3), 37-54. https://www.researchgate.net/publication/394069748

Lecturas: Educación Física y Deportes, Vol. 30, Núm. 333, Feb. (2026)