Manipulation of the Spine, Thorax and Pelvis, Fourth Edition

An Evidence-Informed Guide to HVLA Thrust Techniques

Now in its fourth edition, Manipulation of the Spine, Thorax and Pelvis is a structured clinical reference for high-velocity low-amplitude (HVLA) thrust techniques. Published by Elsevier in 2016 and written by Peter Gibbons and Philip Tehan, this edition reflects current research, updated safety considerations, and a patient-centred approach to manual medicine.

The book is organised in two clear parts. Part A establishes the osteopathic perspective, history, principles, spinal kinematics, minimal leverage positioning, safety, and evidence-informed practice. Part B focuses on technique, with step-by-step chapters covering the cervical, cervicothoracic, thoracic, lumbar, and pelvic regions, supported by accompanying video sequences that demonstrate the techniques described in the text.

What the Fourth Edition Updates

The fourth edition responds to developments in the evidence base. It examines the debated relationship between neck manipulation and stroke, the limited clinical utility of cervical pretreatment screening for arterial dysfunction, and the importance of early detection when a cervical artery dissection may already be in progress. It also reviews evidence for spinal manipulation in patients with disc lesions and radiculopathy, and considers its use in pregnant women and children.

Patient comfort and safety remain central throughout. The authors present an approach that uses minimal leverage rather than full leverage, end-range, or barrier techniques, aiming to achieve cavitation in a safe and effective manner.

Inside the Book

• Osteopathic history, principles, and practice
• Kinematics and coupled motion of the spine
• Minimal leverage positioning for HVLA thrust techniques
• Safety, informed consent, and relative risk
• Evidence-informed practice
• Detailed HVLA techniques for the cervical, cervicothoracic, thoracic, lumbar, and pelvic regions
• Companion video sequences for techniques presented in Part B

Who This Book Is For

This is a professional-level resource for osteopathy, physiotherapy, manual therapy, and musculoskeletal practitioners, as well as advanced students and educators. The structured, step-by-step format supports both initial skill development and ongoing refinement, while the emphasis on evidence and safety makes it useful for clinicians who want to align technique with current best practice.

If you are building a clinical library on spinal manipulation, this fourth edition offers a focused, evidence-aware guide to HVLA thrust techniques from two experienced educators in the field.