Editing Osteopathy (section)

=== High-velocity, low-amplitude manipulation ===
High velocity, low amplitude (HVLA) manipulation is a technique which employs a rapid, targeted, therapeutic force of brief duration that travels a short distance within the anatomic range of motion of a joint and engages the restrictive barrier in one or more places of motion to elicit release of restriction.<ref name="aacom" /> The use of HVLA is contraindicated in patients with [[Down syndrome]] due to instability of the [[atlantoaxial joint]] which may stem from [[ligamentous laxity]], and in pathologic bone conditions such as [[bone fracture|fracture]], history of a [[pathologic fracture]], [[osteomyelitis]], osteoporosis, and severe cases of [[rheumatoid arthritis]].<ref name="Emergency">{{cite journal |first1=Raymond J. |last1=Roberge |first2=Marc R. |last2=Roberge |title=Overcoming Barriers to the Use of Osteopathic Manipulation Techniques in the Emergency Department |journal=[[Western Journal of Emergency Medicine]] |pmid=19718381 |pmc=2729220 |url=http://escholarship.org/uc/item/31547932 |volume=10 |issue=3 |year=2009 |pages=184–9}}</ref>{{sfn|Savarese|Copabianco|Cox|2009|p=146}} HVLA is also contraindicated in patients with [[vascular disease]] such as [[aneurysm]]s, or disease of the [[carotid artery|carotid arteries]] or vertebral arteries.<ref name="Emergency"/> People taking [[ciprofloxacin]] or [[anticoagulant]]s, or who have local [[Metastasis|metastases]] should not receive HVLA.<ref name="Emergency"/>