(1) Intro to HVLA

Question 1

Define HVLA

Answer 1

High Velocity Low Amplitude

“An Osteopathic technique employing a rapid, therapeutic force of brief duration that travels a short distance within the anatomic range of a joint and that engages the restrictive barrier to elicit release of restriction”

Question 2

Barrier Mechanics

Define: Physiologic Barrier

Answer 2

End ROM acheived during active motion in the absence of somatic dysfunction

Question 3

Barrier Mechanics

Define: Anatomic Barrier

Answer 3

End ROM achieved during passive motion in absence of somatic dysfuntion

Question 4

Barrier Mechanics

Define: Restrictive Barrier

Answer 4

A functinoal limit that abnormally diminishes the normal physiologic range

Question 5

What is a MAJOR contraindication for HVLA?

How would you check for it?

Answer 5

Vertebral artery occlusion

Extend neck, look at eyes for nystagmus. If (+) nystagmus, do NOT treat with HVLA

Question 6

How is the quantity of HVLA determined?

Answer 6

By the amount of movement available from a neutral positon

Measured in three planes

Question 7

What does quality of a barrier refer to?

Answer 7

The palpatory “sense” of how smoothly a joint can be moved through it’s ROM

Question 8

What is end feel?

Answer 8

Qality of motion of a joint when it is brought passively to it’s final barrier of motion

Question 9

Is HVLA…

Direct

Combination

Indirect?

Answer 9

DIRECT AF

Question 10

What is the major indication for HVLA?

Answer 10

HVLA is particularly effective when there is a :

Distinctive barrier with a firm end feel

Question 11

Mechanism of treatment:

What is the neurophysiology of HVLA?

Answer 11

Thrust through the restrictive barrier

Restoration of motion at articulation

Restoration of normal proprioceptive input

Reflex relaxation of muscles

Imrpovement of TART findings

Question 12

T/F

Joint noise is necessary for successful treatment

Answer 12

FALSE

Question 13

Mechanism of Treatment:

Name a few examples of what a dysfunctional segment IS NOT

Answer 13

Subluxed

“Out of place”

“Out of joint”

Dislocated

Question 14

Mechanism of Treatment:

As OS physicians, we do NOT do the following…

Answer 14

Adjust

Put back into place

Question 15

What is the overarching goal of OMT?

Answer 15

Restore motion loss and restore neutral point back to normal

Question 16

Summarize the steps for HVLA

Answer 16

1. Correctly diagnose SD
2. Localize segment
3. Engage the RB in all 3 planes of motion - stacking
4. Release enhancing maneuver
5. Patient breathing
6. Mobilizing force-Corrective thrust
7. Reassess

Question 17

Anatomically, what are you treating with HVLA?

Answer 17

Facet joints b/w two vertebra

Question 18

Engagement and stacking of barriers

How do you engage the barrier?

Answer 18

Forces are applied from top-down through the superior vertebra

“Through the dysfunction”

Question 19

Engagement and stacking of barriers

How do you apply force?

Answer 19

Forces are applied from the bottom up through inferior vertebra

“To the dystunction”

Question 20

What are the general rules to follow for dosage of HVLA?

Answer 20

The sicker the pt., the less the dose

Older patients response more slowly

Most cases discourage thrusting the same segment more than once a week

Question 21

If the same SD keeps recurring… what should you do?

Answer 21

Evaluate and address for underlying inciting factor

Question 22

What are the benefits of HVLA?

Answer 22

Well tolerated and time efficient

Modality of choice for SDs with distinct firm barrier mechanics

Patient typically experiences immediate relief, decreased pain and increased ROM

Question 23

___________ possibly remains as the safest procedure in medicine, but like all modalities, it must be used properly

Answer 23

Manipulation

Question 24

When addressing the cervical spine…

What should you avoid doing when positioning the patient and performing HVLA?

Answer 24

Avoid

-Hyperextension

-Excessive rotation

Question 25

Guidelines for saftey

What are the major safety considerations with HVLA?

Answer 25

Accurate diagnosis is crucial

Patient’s consent and comfort

Listen with your hands (If barrier doesn’t feel right, DON’T THRUST)

Excessive force can damage tissue

Hypermobility of joints can be exacerbated by HVLA

Question 26

What are TWO MOST IMPORTANT absolute contraindications for HVLA?

Answer 26

Rheumatoid Arthritis

Down syndrome

*Both due to alar ligament instability

Question 27

What is the comprehensive list of absolute contraindications HVLA?

Answer 27

Local Metastases

Osseous or ligamentous disruption

Severe Osteoporosis

Osteomyelitis in area being treated

Joint replacement in area being treated

Vertebrobasilar insufficiency

Severe herniated disc with radiculopathy

Rheumatoid Arthritis

Down Syndrome

Patient refusal
Fracture/Dislocation

Question 28

What are relative contraindications for HVLA?

Answer 28

Acute herniated nucleus pulposus

Acute radiculopathy

Acute whiplash/severe muscle spasm/strain/sprain

Osteopenia/osteoporosis

Spondylolisthesis

Metabolic bone disease

Hypermobility syndromes

Question 29

What are relative contraindications for HVLA?

Answer 29

Apprehension by the patient

Mild to moderate strain or sprain in area being treated

Mild osteopenia or osteoporosis

RA disease other than in the spine

Some hypermobile states