The effect of one session of high velocity low amplitude thrust manipulation (HVLA) at the cervicothoracic junction (CTJ) and thoracolumbar junction (TLJ) in healthy female elite waterpolo players on maximal throwing speed performance, functional movement (SPADI and DASH questionnaire ), pain (NPRS questionnaire), range of motion (inclinometer (CTJ, TLJ and shoulder) and strength of the muscles in the shoulder region by hand-held dynamometer.

Manipulative therapy is nowadays common in elite sports although the working
mechanism isn*t totally clear. In the support staff of the Dutch national women
water polo two of the members are physiotherapist skilled in manual therapy.
During the last decade every team member had a high-velocity, low-amplitude
thrust manipulation during her career, most of them improved after treatment
and could perform well. The team was very successful during the last
tournaments and became vice World champion and vice European champion. Also the
coaches, former players, use frequently high velocity low amplitude thrust
manipulation at the cervical-thoracic junction for a better functional
movement. In the fields of manual therapy and water polo it*s believed by al
the national coaches and players that manual therapy contributes to an
improvement in the shoulder function. Although water polo requires high levels
of physical fitness the throwing velocity and capacity is considered to be one
of the most important aspects of the game. *
The shoulder function is a key factor in the throwing capacity of the athlete
and disorders in the shoulder region are a major concern for the medical staff
of the water polo teams.

In this study we are interested in the effect of high velocity low amplitude
thrust manipulation at the cervical-thoracic junction and thoracic-lumbar
junction in healthy elite female water polo players on :
maximum throwing speed
functional movement SPADI, DASH,
pain NRS
range of motion of the shoulder
strength of the shoulder muscles

explorative
cross over
double blind

Manuel manipulation

The study is integrated in the normal training of the national team in a
relative easy period
So no burdens or risk are expected