Table 3b.

Recommendations to enhance patient safety of older patients judged to be at greater risk of injury during delivery of HVLA adjustments/manipulations²²⁵,²²⁸

Increase surface area [thus decreasing net pressure (not force)] through the use of a more broad contact by doctor (flat hand rather than pisiform/hypothenar or thenar) on patient (contact more than one vertebral segment and avoid contacting spinous pressure or transverse processes) Preferentially position patient side-posture or seated to provide thoracic adjustments (thus avoiding compression of thoracic cage) Use drop pieces to reduce amount of force during delivery of prone HLVA spinal adjustments/manipulations