THE Y-AXIS MANIPULATION—THE CLINICAL EFFICACY AND ASSOCIATED PATIENT SAFETY EXPLORED—A CLINICAL COMMENTARY

INTRODUCTION

Manual therapy is a broad term that includes various techniques for treating spinal pain and disability, including soft tissue mobilization (STM), joint mobilization, and high-velocity, low-amplitude (HVLA) thrust manipulation. There are many variations of these hands-on techniques, which align with the same principles but use different tools.¹ A common example of this is instrument-assisted soft tissue mobilization (IASTM). This kind of STM examines and treats the injured soft tissue structures using a variety of rigid instruments. The drop-piece manipulation, a variation of the HVLA manipulation, is another example. It involves performing a controlled drop toward the floor against the therapist’s thrust by using a drop table. It is a less forceful approach that stops after reaching a preset distance without any further movement.² One thing that is common among these variants is the associated positive therapeutic outcomes and neurophysiological changes.^3–5 Recently, however, a new manual technique known as Y-strap manipulation has gained popularity on social media platforms. It is essentially a Y-shaped strap that stretches the spine along the body’s Y-axis (hence the name Y-Strap). This method is based on manual traction techniques and claims to reduce spinal stress. Some in the industry believe it is appropriate for use as an HVLA application. However, the Y-strap manufacturers state it is not suitable for HVLA manipulation.⁶ Concerns have been raised within the chiropractic and osteopathic communities regarding the safety and efficacy of Y-strap manipulation. This article reviews the safety and efficacy claims and evaluate if the clinical benefits outweigh the risks.

METHOD

This commentary was developed through a structured review of the literature to provide an informed perspective on the subject. Relevant sources were identified using comprehensive searches in scientific databases, grey literature platforms, and reputable online resources.

Search Strategy: Searches were conducted on databases including PubMed, ScienceDirect, and Google Scholar, using combinations of the following keywords and MeSH terms: “spinal manipulation,” “cervical traction,” “high-velocity low-amplitude,” “manual therapy,” “Y-Strap adjustment,” “spinal decompression,” and “biomechanical effects.” Grey literature sources, including the Y-Strap official website,^1,2,7 email correspondence with the Y-Strap team,³ and other non-peer-reviewed materials, were also included for supplementary perspectives.

Filters were applied to prioritize articles published between 1990 and 2024, written in English, and relevant to manual therapy, spinal adjustment techniques, and their biomechanical/clinical effects. Articles without accessible full texts or insufficient methodological details were excluded.

Inclusion and Exclusion Criteria

• Included: Peer-reviewed journal articles, systematic reviews, meta-analyses, case studies, and relevant grey literature. Key sources include studies on manual therapy mechanisms,⁴ biomechanical parameters of spinal manipulation,⁵ and cervical traction efficacy.^6,8

• Excluded: Non-English articles, duplicate studies, and unrelated topics.

Source Breakdown: Of the 45 resources cited, 30 were peer-reviewed journal articles, including systematic reviews and meta-analyses. The remaining 15 sources comprised grey literature, such as manufacturer data,^1,2,7 clinical guidelines,⁹ and professional correspondence.³

This structured approach ensured that diverse evidence was incorporated while maintaining transparency about limitations. The inclusion of grey literature provides context for evolving clinical tools and practices but is acknowledged as a less verifiable source of information.

DISCUSSION

Difference Between Y-Strap Manipulation and Conventional Spinal Manipulation

Most variations of conventional manipulation techniques are very close to their original equivalents. However, the Y-strap manipulation differs from typical HVLA procedures in both directional force and application methods. In traditional HVLA manipulation, practitioners direct their efforts in several planes, including axial (along the spine), rotational (twisting), lateral (sideways), flexion (forward bending), and extension (backward bending). To accurately administer multiplanar force, they must have extensive anatomical understanding as well as years of hands-on experience.⁸ The Y-strap manipulation, however, applies a single axial decompressive force on the Y-axis. It is thought to be a more straightforward approach, requiring only a linear stretch. In contrast to multidirectional HVLA procedures, the Y-strap manipulation requires only a straight pull; its design ensures a direct line of pull.⁶ According to the creators’ claims, the Y-strap manipulation is a considerably more convenient approach to manipulating the spine than traditional HVLA treatments.¹⁰ Practitioners may not require substantial training in applying multidirectional thrusts to reap the benefits normally associated with manipulative techniques. Using this equipment, they can potentially achieve similar outcomes by assuring a direct line of pull along the spine’s natural axis.

What About the Research?

Over the preceding decades, there has been a steady increase in research on spinal mobilization and manipulation. In order to ensure safe treatment and clinical efficacy, there is a greater emphasis now on the clinical justification for treatment and post-assessment follow-ups. This clarifies how, when, and why we should apply LVLA and HVLA techniques.^3–5 The working theory behind these methods has become more apparent, and the field of manual therapy has advanced significantly toward more solid evidence-based practice. Research has established that bones don’t slip out of place, and manipulations do not push them back together.^3,4,11 Aside from sound, cavitation does not guarantee improved results or accomplish anything clinically significant.^5,9 Spinal manipulation is less specific than previously thought,^12,13 and tissue pulls are unlikely to be effective when the fascia and skin have a frictionless interface.¹⁴ The mechanism behind spinal manipulation (transient neurophysiological symptomatic and functional changes) has become more well-known and respected, allowing practitioners around the globe to practice more ethically.^3,4

In 2024 we stated:

“Although hearing that “crack” and the process of tribonucleation and the disruption of synovial fluid almost always “feels” good, research shows that the majority of changes elicited by spinal manipulation (HVLA) are mostly, if not all, mediated through neurological and physiological mechanisms and not by “clicking or pushing bones back in place” - a common and outdated misconception.”⁵

How then does this relate to the Y-strap or Y-axis manipulation? We still do not fully know how this technique compares to more established methods in the long term. Does that imply we should be overly concerned? No, but it does mean we should seek clarity. In fact, Y-strap manufacturers do not suggest nor claim that this product should be used in an HVLA fashion, but rather a slow, gentle stretch, which we are all likely familiar with as “traction” or “decompression.”

The official Y-strap manufacturers state:

“Regarding using high force and/or high velocity, we do not encourage or recommend this and how our clients use our tool is out of our control.”¹⁵

If clinicians are using this device as intended, is it still effective and safe? The closest available research relates to spinal traction or distraction methods. Cervical traction has been around since Hippocrates in the fourth century BC, according to a 2023 research article that defines it as “a non-invasive procedure used to provide symptomatic relief for a variety of cervical pathologies”.¹⁶ Abi-Aad and Derian (2019) went on to list an extensive list of contraindications, including aortic aneurysm, active peptic ulcer disease, diskitis, osteomyelitis, osteoporosis, ligamentous instability, primary or metastatic tumor, spinal cord tumor, and myelopathy.¹⁶ A 2021 observational pilot study of 36 patients saw a reduction in pain and disability stemming from cervical radiculopathy in almost 50% of participants after performing a 5-day consecutive traction treatment, which was 30 minutes twice per day.¹⁷ Furthermore, a 1999 retrospective study of 58 outpatients investigated the effects of home cervical traction therapy. The 58 participants were subcategorized into 3 grades via the Quebec Task Force of Whiplash-Associated Disorders. The study had quite positive outcomes, with 81% of the patients experiencing symptomatic relief - the only negative, was a small number (8.7%) of patients who found the treatment aggravating. Furthermore, in 2017, a cross-sectional survey was carried out among 1001 members of the American Physical Therapy Association’s orthopedic section. 76.6% reported using traction, with 93.1% using it on patients who present with nerve root compression. Manual methods were the most popular at 92.3%, and mechanical traction devices or tables were used 88.3% of the time.¹⁸ An older study from 1990 also investigated the clinical effectiveness of cervical traction.100 patients with neck/arm pain were allocated into two groups, one receiving weighted manual traction of 6-15lbs, and the other receiving a placebo. One key factor here is that both groups were given neck-care education. The intervention group improved in measures of pain, sleep, and range of motion (ROM), however, only slightly and little post-treatment differences were documented.¹⁹ In Part 2 of this study, they investigated how cervical traction impacts muscle tension. 52 of the 100 participants who were randomly allocated to the intervention group or placebo group, also received surface electromyography (sEMG). The upper trapezius muscle was recorded, and 44 sets of data were usable. Results showed that while patients were reclining, both weighted traction (intervention group) and placebo traction showed significant reductions in muscle tension. The reduction was lost when the patient returned to the upright position, with no long-term changes.²⁰ Additionally, a 2018 systematic review of 9 studies was conducted to assess the effectiveness of intermittent mechanical traction (IMT) in the treatment of cervical radiculopathy (CR). Thre was only very low, low, and moderate evidence indicating the efficacy of IMT in the treatment of CR.²¹

In 2006, a randomized control trial published in the Journal of Musculoskeletal Pain looked into the effects of cervical traction on thoracic outlet syndrome. 40 participants were divided into two groups, group 1 received hot pack therapy and an exercise program, and group 2 received cervical traction. Although pain scores were not significant between groups, orthopedic test improvements and numbness score was improved in the cervical traction group. The authors concluded that hot packs and exercise together are suggested, with cervical traction adding additional benefits to this conservative treatment.²² A randomized control trial published in 2022 investigated the short and long-term outcomes of thoracic traction (via a traction block) in patients with nonspecific neck pain.²³ 80 participants were split into two groups, both of which received a multimodal rehabilitation protocol that involved TENS, heat therapy, soft tissue work, thoracic spine manipulation, and functional exercises. However, only the intervention group additionally received the thoracic traction device. The participants receiving the thoracic traction device were instructed to begin with 3 minutes per session and work their way up to 15-20 minutes over the 10 weeks. Following the 10 weeks of treatment, the intervention group displayed a reduction in pain intensity, disability, overall stability index, and thoracic hyperkyphosis - the control group did not. There was no difference, however, between groups regarding the torsion test and left-sided head repositioning accuracy. However, some key limitations should be pointed out. Neither the participants nor the researchers were blinded in this process, the sample was chosen based on a convenience sampling method, and the thoracic kyphosis was measured via an external posture assessment, which is open to further bias and not nearly as accurate as objective radiographs.^23,24

Traction, sometimes referred to as “decompression,” is also commonly used for lower back pain.^25–29 A 2022 meta-analysis involving 6 studies reported that mechanical traction is effective at relieving lumbar and leg pain while improving Oswestry Disability Index (ODI) scores in patients who have disc herniations. The author concluded that mechanical traction is significantly better than conventional physical therapy.²⁵ A 2016 randomized trial investigated the effectiveness of mechanical traction in patients with low back pain and leg pain. One-hundred patients with nerve root compression were randomized into 2 groups: Group One, which received extension-based exercises only, and Group Two, which received extension exercises and mechanical traction. Although there were changes over the course of 6 weeks, there were no significant differences between both groups.²⁶ A 2015 study looked at pain and disability outcomes and straight leg raise (SRL) changes in patients with intervertebral disc herniations. 30 patients were divided into 2 groups, where 1 group received spinal decompression and the other a general traction. Both groups received physical therapy 3x per week for 4 weeks in total. Both groups saw a statistically significant reduction in pain and disability, as well as an increase in the SLR. When they compared the differences between these two groups, there were no significant differences—both therapies were effective.²⁷ Cannon, Edmond, and McGill (2016) demonstrated that a decompression belt restores spinal height by 4.3 ± 3.0 mm following an acute bout of lifting; this was tested on healthy, young, asymptomatic participants.²⁸ Ozturk et al. (2005) investigated the effect of lumbar traction on herniated discs, looking at the size of the herniation via computed tomography (CT). 46 patients were randomized into two groups, with both receiving physical therapy but only one receiving lumbar traction. Clinical symptoms and signs were gathered in conjunction with the size of the herniated material via CT. The size of the herniated disc significantly decreased in the lumbar traction group only. The authors concluded:

“Lumbar traction is both effective in improving symptoms and clinical findings in patients with lumbar disc herniation and also in decreasing the size of the herniated disc material as measured by CT.”²⁹

The only real research that covers a Y-axis decompression adjustment in an HVLA manner is a case report published in the Journal of Asia-Pacific Chiropractic Journal by Gregory Johnson himself (creator of the “ring dinger”, a rapid y-axis adjustment on a purpose-built table that immobilizes the hips to maximize traction). A 32-year-old male engineer with non-specific low back pain and lumbosacral radiculopathy received the decompression treatment (the “ring dinger”). The patient was a regularly scheduled patient at the clinic. Prior to and after the treatment, the patient took a test using the SR-3053 to measure fine motor control and coordination. A control test was administered to a second subject who did not receive the treatment. Results showed an improvement following the treatment in the subject compared to scores taken prior as well as the control subject’s score (see table 1).³⁰

Safety Concerns… High-Velocity, High-Amplitude

With little research to show the true efficacy or safety of this procedure, using it outside of the scope as stipulated by the Y-strap manufacturers may raise safety concerns.

Y-axis decompression or traction has been shown to be effective; however, applying an HVLA rapid and forceful Y-axis manipulation is not promoted nor suggested in any medical guidelines. The technique is not “low-amplitude” at all; rather, it should be classified as “high-velocity, high-amplitude”. Such a rapid and forceful migration of tensile force through the vertebral bodies, joints, and all associated structures could be deemed reckless. Every tissue or structure in the body has a physiological threshold and innate capacity prior to structural damage or tissue failure. When load, velocity, force, or power overcomes this tissue capacity, it will strain and/or adapt until it can’t; then, an injury occurs. How can one be sure this procedure is safe when the technique is gapping every joint with no predetermined specificity or finesse? As the Y-strap is performed, extreme amounts of tensile force are sent through various and numerous soft tissue and bony structures.

How can one control this?
How can we measure this?
How can we be sure that more harm than good won’t occur?

The history of chiropractic and osteopathy is fundamentally built upon the uniqueness of "spinal manipulation.. The application of force is fast enough yet light enough to create a gapping moment and help restore function with little overall force (note the “low amplitude”). This does not carry over to the Y-strap and raises many questions regarding the safety and clinical efficacy of this product.

Further Issues

MRI studies frequently reveal multiple spinal pathologies and abnormalities in asymptomatic individuals throughout the spine.^32,33 This suggests that such conditions might be overlooked, and high-velocity non-specific traction could potentially exacerbate or cause damage to these findings. For example, spinal cord compression in the cervical region is present in approximately 24% of asymptomatic individuals.³³ This statistic implies that procedures involving significant traction could lead to complications, especially in the context of widespread disc degeneration and height loss across all age groups. Such degeneration could result in segmental instability, and the substantial force required for rapid traction through the entire spinal column might impose excessive oscillatory loads on these unstable areas compared to more stable segments.^32–34

The force required to pull a 200-pound person horizontally 2 feet up a table from a stationary position in half a second would be approximately 45 kg (assuming negligible friction), with the majority of the force concentrated proximally at the cervical spine. Variables such as the patient’s body weight, along with the speed, distance, angle of the thrust, and friction of the table surface may significantly increase the force. Furthermore, some practitioners may thrust twice while administering the manipulation, potentially doubling the risk.

Considering these variables, paired with the fact that there is no measurable force prescription, risk assessment of the Y-strap manipulation is difficult to gauge. A study in 2010 examined subjects who suffered cervical facet dislocation due to road traffic accidents and found that 38 out of 40 patients were successfully treated with as little as 7-14 kg of traction to relocate the facet joint.³⁴

Some Y-strap manipulation videos on YouTube show patients reporting a tingling sensation down their spine post-manipulation. This sensation can be elicited when flexing the head forward in patients with an upper motor neuron lesion and is referred to as Lhermitte’s phenomenon. Lhermitte’s phenomenon is believed to occur due to the stretching of hyperexcitable, myelin-damaged nerve fibres of the dorsal columns, producing a painful electric shock sensation down the spine and sometimes the extremities.³⁵ This sensation experienced by the patient post-manipulation may possibly be a mild form of paroxysmal Lhermitte’s sign due to excessive traction resulting in overstretching of the spinal cord. Brachial plexus injuries are a more likely risk of nerve damage from this type of manipulation, as they are commonly caused by excessive violent traction with the head and neck being pulled caudally.³⁶

The likelihood of the Y-strap manipulation eliciting any lasting negative neurological effects in a healthy individual is likely low, but the long-term effects of repeated Y-strap manipulations are not documented. As with the variables of the manipulation itself affecting safety, the same can be said for the practitioner’s medical knowledge and competency when deciding on patient suitability for the application of excessive traction. Furthermore, the use of the Y-strap manipulation would also need to be justified as ethical and appropriate treatment in the event of any harm to the patient. For example, The General Chiropractic Council Code of Practice and Standard of Proficiency (2010) in the UK states that the practitioner must apply appropriate care that meets the patient’s health needs.³⁷ The Y-strap manipulation is non-specific to any particular level of the spine; for this reason, its application is also non-specific. For other low-risk manual therapy techniques, non-specific application raises very little concern. However, higher-risk techniques such as the Y-strap manipulation may prove more challenging to justify to the practitioner’s governing body in the event of injury to the patient.

Clinical Efficacy…Specificity

A thorough history and detailed assessment are the cornerstones of effective treatment for any medical practitioner. For manual therapists and clinicians performing spinal manipulation, it is critical to base interventions on a clear clinical rationale and sound diagnostic reasoning. Such testing provides a justification of treatment, and this becomes specific to the patient—note: this is different from the segmental specificity of manipulation discussion.^12–14 Ultimately, treating every joint from head to toe risks unpredictable outcomes that are non-specific to the patient.

While it is widely accepted that bones cannot be directly repositioned or “put back into place,” the way manipulations are applied must follow a systematic and informed protocol.^{3–6,8,10,11} Structural failure or instability along the spinal column requires an entirely different approach than a soft tissue injury or muscular strain. Hypermobile or unstable structures don’t benefit from repeated thrusts or adjustments. In fact, unnecessary manipulation can exacerbate instability. These cases call for targeted stabilization strategies, often involving rehabilitative exercises and supportive therapies designed to improve function and mitigate further risk.

Manipulation should always be based on comprehensive assessment and individualized treatment plans that consider the patient’s unique presentation. A generalized, nonspecific approach, such as the Y-strap, raises concerns. Without the ability to tailor treatment to specific findings, clinicians risk applying excessive or misplaced forces, potentially causing harm or failing to address the underlying problem.

If we believe our treatments should prioritize patient safety, detailed assessments, and precise diagnostic protocols, then relying on a one-size-fits-all, “shotgun” manipulation technique contradicts these principles. As clinicians, we must ask ourselves: are we committed to evidence-based, patient-centered care, or are we compromising our standards for the sake of convenience or novelty?

Fact-checking: Claim vs. Our Concerns

• Claim: The Y-Strap is used for stretching the spine with gentle, smooth motion. The therapist may also use it to apply an HVLA movement. This HVLA procedure works by producing a swift decompression within the vertebral discs.¹⁰

• Our Concern: To apply the HVLA using the Y-strap, therapists fit it at the patient’s chin and then pull the head in the Y-Axis of the body. They pull the patient’s head upward or do side-to-side motions to create audible pop sounds. However, the shear force applied to pull the head away from the patient’s body may be higher than what is required for a conventional HVLA manipulation. Hence, given the force applied to the neck, it is likely that the Y-strap manipulation involves high-velocity, high-amplitude (HVHA) movements rather than HVLA.

• Claim: The Y-Axis manipulation carries no risk of harm to the vertebral artery, as it manipulates the spine without any torque—a twisting motion with force that is often a common feature of rotational manipulation.³⁸

• Our Concern: While the Y-Axis manipulation avoids rotational forces, it carries some level of risk due to the application of force to the neck. Cervical spine units are naturally more prone to trauma than the stiffer thoracic and lumbar segments.³⁹ The anatomic design of this spinal segment is such that it is difficult to withstand aggressive pulling or stretching. Therefore, manual techniques targeting the cervical spine must apply less force than those used on other spinal segments.³

  However, during the Y-Axis manipulation, the patient is pulled across the table to manipulate and decompress the upper cervical spine. This stretching exerts stress on the chin, carotid artery, vertebrae, facet joints, discs, ligaments, and nerves.

• Claim: The vertebral artery supplies the brain and spinal cord with blood from the heart. While running along the vertebrae to the brain, this artery curves at the atlas (C1) to allow neck rotation. Because the Y-strap manipulation applies vertical force along the Y-axis without rotation, it does not put any extra stress on the artery. Thus, it is safer than conventional HVLA techniques.³⁸

• Our Concern: This claim that the vertebral artery curves at C1 to allow neck rotation may oversimplify the complex anatomy and function of the neck. The artery does travel through the cervical vertebrae and winds around the atlas, but stating that its curvature at C1 enables neck movements is inaccurate. What is more accurate is that the artery’s anatomical pathway is designed to withstand a range of neck movements, including rotation.^40,41

  Although the Y-Strap tool utilizes vertical force without rotation, aggressive pulling of the chin could still put excessive stress on the vertebral artery. In fact, the vertebral artery is not the only structure at risk of vascular injury from the Y-strap manipulation. Given that the base of the skull is essentially a region of complex anatomical structures, aggressive neck stretching could also affect the carotid sheath and its contents, including the common and internal carotid arteries, the internal jugular vein, the ansa cervicalis, and the lower cranial nerves. Any undue harm to these structures might lead to vascular and nerve injuries, including dissections, compromised blood flow, and nerve entrapment. Hence, even without the rotational force, there is a risk of serious injury from the Y-strap manipulation.

• Claim: The Y-Strap manipulation can decompress the spine, relax back muscles, and relieve tension or pressure from the vertebrae. This stretching-by-traction technique restores natural joint and muscle tone. It also offers swift vertebral disc decompression, which creates a vacuum to allow nutrient flow into the discs.³⁸

• Our Concern: Currently, there is limited evidence to support these claims, which raises questions about their validity. Without robust, evidence-based backing, these assertions have minimal clinical relevance and should be approached cautiously. In summary, high-quality, peer-reviewed studies are necessary to rigorously evaluate the safety, efficacy, and overall clinical applicability of the Y-Strap tool.

• Claim: The Y-strap tool is an FDA-registered, Class 1 medical device, meaning it is recognized by the FDA as a product with the lowest risk to patients and users.

• Our Concern: The Y-Strap is indeed an FDA-registered, Class 1 medical device. However, this does not mean that the FDA endorses the device’s efficacy or guarantees that no harm will come to a patient under any circumstances. Being registered with the FDA simply means the device meets its basic manufacturing and safety standards, such as proper labeling, registration, and listing, and adherence to good manufacturing practices.

Is There a Need for Y-Strap Manipulation?

When a new therapy or intervention is introduced into clinical practice without prior scientific evaluation, it first undergoes those same phases it just skipped. As a consequence, it raises many questions and undergoes clinical scrutiny regarding its necessity, safety, and efficacy. Similarly, since the Y-Strap manipulation has little scientific evidence supporting its therapeutic effectiveness, its necessity and place in manual therapy is uncertain. For example, consider the process of drug approval. It involves 4 phases of studies, spanning 10-15 years. The first 2 phases evaluate the safety and efficacy of the drug on a small scale. Phase 3 involves larger-scale testing and comparison of the drug with current treatments. Once the drug successfully completes these phases, it can only then apply for regulatory approval. Finally, phase 4 conducts post-market surveillance to ensure the long-term safety and efficacy of the drug.⁴²

Likewise, the conventional osteopathic and chiropractic manipulation techniques have also passed the test of time, scrutiny, and refinement. These methods weren’t just accepted overnight. From being considered pure pseudoscience to becoming musculoskeletal-specific therapies, they have undergone a century-long journey of research and development. Over time, as more and more clinical evidence emerged supporting their safety and efficacy, they gradually gained wider acceptance.^43,44 The popularity of Y-axis manipulation on social media doesn’t mean it has earned its clinical endorsement. Given the potential risks associated with neck manipulation, any new therapy claiming to treat the cervical spine needs to undergo a rigorous process of scientific evaluation to avoid undue harm to the patients. Hence, until there is solid evidence to support the use of Y-axis manipulative tools, their relevance within manual therapy remains questionable.

Conclusion

In conclusion, the use of the Y-strap manipulation technique raises significant concerns regarding safety, efficacy, and ethical practice. Despite its popularity on social media and claims of therapeutic benefits, there is little robust scientific evidence to substantiate these claims. The rapid, high-velocity, high-amplitude forces applied during Y-strap manipulation deviate from established manual therapy principles, which emphasize specificity, controlled force, and patient-centered care.

The potential risks associated with the technique, including overstretching of spinal structures, nerve damage, and exacerbation of pre-existing spinal pathologies, cannot be ignored. The absence of measurable force parameters and patient-specific application further compounds the uncertainty surrounding its safety. While the Y-strap may have a place in controlled environments or specific clinical scenarios, its current widespread, nonspecific application lacks the rigorous assessment and evidence required for integration into standard medical practice.

Until more research provides a clearer understanding of its long-term effects and safety profile, practitioners must exercise caution. Upholding professional standards means prioritizing patient safety, adhering to evidence-based practices, and avoiding procedures that pose unnecessary risks. Ultimately, the burden of proof lies with proponents of the Y-strap technique to demonstrate its clinical validity and ensure it meets the ethical and scientific standards of modern healthcare.