What each one actually is, how it works, what it's used for, when it isn't appropriate, and the questions to ask any provider who offers it. Same rigor we apply inside the screening tool.
High-velocity, low-amplitude thrust — the classic chiropractic adjustment. A fast, short-range thrust delivered to a specific joint at end-range, usually producing an audible cavitation of the joint capsule.
A manual thrust delivered faster than the stretch reflex can resist (~150 ms). Gapping the joint briefly reduces articular pressure and triggers reflexive muscle relaxation around the segment.
Acute and subacute mechanical low back pain, mechanical neck pain, cervicogenic headache, thoracic stiffness, and joint-level hypomobility confirmed on exam.
Fracture, surgical hardware, active infection, cancer at the spine, aortic aneurysm, severe osteoporosis, cauda equina, and untreated anticoagulation — all routed away by the ChiroMatch screen.
First-line recommendation for acute non-specific low back pain in the 2017 American College of Physicians guideline, alongside heat and massage.
An FDA-cleared spring-loaded handheld instrument that delivers a precise, controlled low-force impulse. The defining advantage: it's fast enough to move a joint without recruiting the protective muscle reflex.
A calibrated spring delivers a thrust in roughly 3 ms — faster than muscle guarding can activate. Force and amplitude are precisely controlled by the instrument rather than by hand.
Patients where manual HVLA is too risky — pregnancy, elderly, osteoporosis, anticoagulant users, pediatric cases, high-anxiety patients, and cervical work where the provider wants tighter force control.
Fracture, active spinal infection or malignancy, and cauda equina — the same hard absolutes that apply to any spinal technique.
The Activator Methods protocol has been studied across multiple controlled trials for mechanical neck and back pain with outcomes comparable to manual HVLA in many contexts.
Gentler, graded joint movement without a thrust. Rather than a single fast impulse, the clinician moves the joint rhythmically through a range — graded from small oscillations in early range up to sustained stretches at end-range.
Graded (I–IV) oscillations restore accessory joint motion and modulate pain through mechanoreceptor input, without the cavitation or end-range thrust of HVLA.
When HVLA is contraindicated or not tolerated — post-op patients, acute inflammatory flare-ups, elderly patients, and people with fear-avoidance around manipulation.
Active fracture, infection, or instability in the region being mobilized. Generally safer than HVLA but the same hard absolutes apply.
Supported across orthopedic manual therapy traditions (Maitland, Kaltenborn, Mulligan) as a first-line option for many spine and peripheral joint conditions.
Doctor-controlled hands-on spinal decompression. The clinician manually guides a segmented prone table (a Cox or Zenith table) to apply gentle flexion combined with long-axis traction — pumping the spine rhythmically to reduce pressure on a disc or nerve root.
The table's caudal section flexes and distracts while the clinician's hand applies a specific contact at the target segment, opening the posterior disc space and intervertebral foramen.
Disc herniation with radicular pain, lumbar and cervical stenosis, spondylolisthesis, facet syndrome, and many post-surgical spines where HVLA is off the table.
Acute fracture, severe osteoporosis, aortic aneurysm, and progressive neurological loss (which needs medical workup, not decompression).
The Cox flexion-distraction protocol has multiple clinical studies showing reduced intradiscal pressure and improved outcomes in disc-mediated pain.
A motorized traction table that applies computer-controlled axial distraction to the spine. The pulling force oscillates on a programmed curve, intended to create brief negative intradiscal pressure and allow herniated material to retract.
Devices such as the DRX9000, SpineMED, or Chattanooga Triton apply 40–60% of body weight in alternating traction-and-release cycles, aiming to sustain the distraction long enough to lower intradiscal pressure.
Multi-level disc herniation, degenerative disc disease with radiculopathy, and sustained decompression loading when hands-on flexion-distraction isn't enough on its own.
Pregnancy, abdominal aortic aneurysm, acute fracture, severe osteoporosis, metal hardware in the treatment region, and any red-flag neurology.
Evidence for motorized decompression over standard traction is mixed — the treatment can help the right patient, but results depend heavily on case selection and on integrating with active rehab.
High-energy acoustic pulses delivered through a handheld applicator. Used primarily for chronic tendinopathy and stubborn soft-tissue pain that hasn't responded to standard care.
Acoustic waves generate mechanotransduction in tissue — micro-stress that triggers controlled inflammation, angiogenesis, and collagen remodeling in chronically degenerated tendon.
Plantar fasciitis, lateral epicondylitis (tennis elbow), rotator cuff tendinopathy, Achilles tendinopathy, calcific shoulder, greater trochanteric pain syndrome.
Pregnancy over the treatment area, active malignancy at the site, bleeding disorders or anticoagulation, and directly over growth plates in children.
Among the better-evidenced passive modalities — multiple systematic reviews support shockwave for chronic tendinopathy, particularly plantar fasciitis and lateral epicondylitis.
Therapeutic light delivered at specific wavelengths, usually 600–1100 nm. Painless and non-thermal — the mechanism is photochemical, not heat.
Photons at specific wavelengths are absorbed by cytochrome c oxidase in mitochondria, increasing ATP production and modulating reactive oxygen species — nudging cells toward tissue repair and pain modulation.
Tendinopathy, joint inflammation, neuropathic pain, post-surgical recovery, wound healing adjunct, and as a safe pain-modulation option when manual therapy isn't tolerated.
Directly over active malignancy, over the pregnant uterus, over the thyroid, or on patients with photosensitizing medications without medical clearance.
Evidence is strongest for neck pain and tendinopathy when dose (joules per cm²) is correct. Many underpowered machines produce no effect — dose matters.
Negative pressure applied to the skin through silicone or glass cups. The cups lift and decompress skin, fascia, and superficial muscle — the opposite of pressing down.
Suction decompresses layered tissues, transiently increases local circulation, and provides novel sensory input that may modulate pain centrally. The visible circular marks are capillary stretch, not bruising in the injury sense.
Chronic myofascial tightness, upper-back and lat restriction, recovery adjunct for athletes, and as a pre-adjustment soft-tissue prep.
Bleeding disorders and anticoagulant therapy (bruising risk), skin infections, burns, or open wounds, and directly over the pregnant abdomen.
Short-term pain reduction is supported by several trials; long-term disease-modifying claims are not. Useful adjunct, not a standalone treatment.
Instrument-Assisted Soft Tissue Mobilization. The provider uses a stainless-steel or plastic edged tool to glide across soft tissue, detecting and treating restricted fascia and adhesions.
The tool amplifies the clinician's ability to locate tissue restriction. Applied pressure causes controlled microtrauma to disorganized collagen, triggering fibroblast activity and tissue remodeling.
Chronic tendinopathy, post-surgical scar tissue, plantar fasciitis, IT band restriction, myofascial adhesions after repetitive use injury.
Open wounds, active infection, anticoagulant therapy (bruising risk), acute inflammation, and directly over recent hematoma.
Evidence supports short-term pain and mobility improvements; mechanism claims around "breaking up adhesions" are more marketing than proven. The clinical effect is real even if the mechanism is debated.
A patented, movement-based soft-tissue technique developed by Dr. P. Michael Leahy. The clinician applies precise directed tension to a specific muscle, tendon, fascia, or peripheral nerve while the patient actively moves the body part through its range of motion. The pairing of sustained contact with active movement is what distinguishes ART from traditional massage or static pressure work.
Over-used tissue develops cross-linking, scar-like adhesions, and decreased glide between adjacent fascial layers. ART uses the patient's own active motion against the clinician's contact to shear and release those restrictions between layers — targeting muscle–muscle, muscle–nerve, and muscle–tendon interfaces rather than a single muscle belly.
Repetitive-strain and overuse injuries: carpal tunnel, plantar fasciitis, IT band syndrome, tennis/golfer's elbow, shin splints, hamstring and groin strains, shoulder impingement, sciatica, piriformis syndrome, thoracic outlet syndrome, cervicogenic headache. Broadly useful wherever the clinical picture is fascial adhesion or peripheral nerve entrapment rather than joint restriction.
Acute blunt trauma or active inflammation at the treatment site; acute or unhealed fracture; open wounds, burns, or skin infection over the area; known bleeding disorder or full anticoagulation (relative — downgrade, don't always stop); DVT or suspected thrombosis in the limb; active malignancy at the treatment site. In pregnancy, abdominal work is avoided; extremity work is generally safe in trained hands.
Best evidence is in repetitive-strain and nerve-entrapment presentations — carpal tunnel, hamstring flexibility and strain, plantar fasciitis, and lateral epicondylitis. RCT literature is still thin; most data is case-series and practitioner-reported outcomes. Like most manual therapies, ART works best paired with progressive loading and rehab rather than as a standalone.
Thin filiform needles inserted into trigger points or motor points within muscle. Different from acupuncture — dry needling is based on Western neuromuscular anatomy rather than meridian theory.
Needling a trigger point elicits a local twitch response that disrupts the taut band, desensitizes the motor end-plate, and modulates peripheral and central pain pathways.
Myofascial trigger points, tension headache, TMJ referral, piriformis and quadratus lumborum pain, and post-exercise muscle guarding.
Anticoagulation (increased bruising), local infection, needle phobia, lymphedema over the region, and pregnancy over abdomen and lumbosacral regions without provider clearance.
Moderate evidence for short-term pain reduction in myofascial pain syndromes. Works best paired with exercise rehab, not as a standalone.
Progressive loading, motor control, and movement retraining. The active counterpart to every passive modality on this list — and the one most directly tied to whether improvements last.
Tissue adapts to the load you give it. Specific exercise progressions tell the musculoskeletal system what capacity to build, while motor-control work re-teaches coordinated movement patterns around a previously painful segment.
Essentially every musculoskeletal complaint — acute, chronic, pre-op, post-op. Especially important for low back pain, rotator cuff dysfunction, and all return-to-sport work.
Very few hard contraindications — but exercise selection must be appropriate to the diagnosis (for example, avoiding end-range flexion in acute disc herniation).
The single best-evidenced intervention in musculoskeletal care. Without active rehab, passive modalities usually plateau.
Manual manipulation of muscle and fascia. Used alone or, more commonly, as preparation for and integration with spinal work.
Mechanical pressure lengthens and mobilizes soft tissue while reducing sympathetic nervous-system output — which partly explains why an effective massage can reduce pain out of proportion to any observable tissue change.
Muscle tension, secondary stress-related musculoskeletal pain, post-exercise recovery, and preparation for joint work in tight or guarded patients.
Deep vein thrombosis, active cellulitis, unhealed fractures, anticoagulation with aggressive deep-tissue techniques.
Well-supported for short-term pain and anxiety reduction; part of the ACP first-line set for acute low back pain. Like cupping, more adjunct than standalone.
High-frequency sound waves (typically 1–3 MHz) delivered through a gel-coupled handheld head. Produces thermal and non-thermal effects in deeper tissue.
Acoustic energy at 1 MHz penetrates roughly 3–5 cm, causing tissue vibration that heats deeper structures (continuous mode) or drives micro-streaming and cavitation at cellular level (pulsed mode).
Historically: tendinopathy, joint contracture, soft-tissue heating before manual work, and post-surgical adhesion softening.
Over malignancy, active infection, the pregnant abdomen or pelvis, over pacemakers, over growth plates in children, and directly over the eye.
Honest take: evidence is modest for most indications. For many conditions, shockwave or LLLT now produce better outcomes. Useful as pre-manual warm-up but rarely a standalone solution.
Elastic cotton tape applied in specific patterns across skin overlying a muscle, joint, or fascial chain. Worn for several days at a time between treatments.
Proposed mechanisms include mechanical unloading of tissue, sensory input that modulates pain perception, and subtle changes to local lymphatic flow. The cutaneous sensory effect is probably the most reliable.
Short-term pain modulation, postural awareness between sessions, patellofemoral pain, shoulder impingement, and as a between-session extension of in-clinic care.
Adhesive allergies, fragile skin, open wounds, active skin infection, and over deep vein thrombosis.
Short-term pain reduction is reasonably supported; long-term outcomes are not. Treat it as a useful adjunct, not a primary treatment.