OBJECTIVE: To identify what has been theorized and/or written about the manual techniques generically classified as direct, but using specific contacts on short levers while using forces that may vary in speed and amplitude.

DATA SOURCES: A search of the MEDLINE bibliographic database using MeSH key words (chiropractic/methods; osteopathic manipulation) was conducted. The Index to Chiropractic Literature and Chiropractic Research Abstracts Collection were searched through the past 10 yr using the key terms of chiropractic-methods; chiropractic techniques; manipulation, chiropractic; manipulation, osteopathic, manipulation, spinal; and manipulation, joint. A hand search of text-books was undertaken as well as review of the references included in books, monographs and collected papers.

STUDY SELECTION: Studies in English were included, but it must be noted that these include publications that are not peer reviewed or refereed in any way.

DATA EXTRACTION: Descriptions that discussed aspects of manipulative procedures with the appropriate characteristics were extracted by a single author.

DATA SYNTHESIS: Very little was found or accessible using traditional methods of literature retrieval. Lack of common terminology as well as multiple technique systems developed in isolation contributed to the problem. Descriptions of characteristics for the attributes of techniques which use specific contacts on short levers are provided. The high-velocity, low-amplitude thrust technique is presented as one of the oldest and most widely used forms of manual medicine and remains one of the most frequently used forms of manual medicine. Derivation of applied forces as well as speculation as to the roll of specificity are discussed.

CONCLUSIONS: This type of review is considered the first step in the evaluative process for a chiropractic technique procedure. It demonstrates that very little has been written in an accessible fashion relative to techniques which use specific contacts on short levers while applying forces that may vary in speed and amplitude. Statements made concerning the appropriateness or effectiveness consist of opinions only, with no reference to any form of injury or testing. The need for clinical trials and studies comparing different techniques is great.

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