(1) Intro to HVLA Flashcards
Define HVLA
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”
Barrier Mechanics
Define: Physiologic Barrier
End ROM acheived during active motion in the absence of somatic dysfunction
Barrier Mechanics
Define: Anatomic Barrier
End ROM achieved during passive motion in absence of somatic dysfuntion
Barrier Mechanics
Define: Restrictive Barrier
A functinoal limit that abnormally diminishes the normal physiologic range
What is a MAJOR contraindication for HVLA?
How would you check for it?
Vertebral artery occlusion
Extend neck, look at eyes for nystagmus. If (+) nystagmus, do NOT treat with HVLA
How is the quantity of HVLA determined?
By the amount of movement available from a neutral positon
Measured in three planes
What does quality of a barrier refer to?
The palpatory “sense” of how smoothly a joint can be moved through it’s ROM
What is end feel?
Qality of motion of a joint when it is brought passively to it’s final barrier of motion
Is HVLA…
Direct
Combination
Indirect?
DIRECT AF
What is the major indication for HVLA?
HVLA is particularly effective when there is a :
Distinctive barrier with a firm end feel
Mechanism of treatment:
What is the neurophysiology of HVLA?
Thrust through the restrictive barrier
Restoration of motion at articulation
Restoration of normal proprioceptive input
Reflex relaxation of muscles
Imrpovement of TART findings
T/F
Joint noise is necessary for successful treatment
FALSE
Mechanism of Treatment:
Name a few examples of what a dysfunctional segment IS NOT
Subluxed
“Out of place”
“Out of joint”
Dislocated
Mechanism of Treatment:
As OS physicians, we do NOT do the following…
Adjust
Put back into place
What is the overarching goal of OMT?
Restore motion loss and restore neutral point back to normal
Summarize the steps for HVLA
- Correctly diagnose SD
- Localize segment
- Engage the RB in all 3 planes of motion - stacking
- Release enhancing maneuver
- Patient breathing
- Mobilizing force-Corrective thrust
- Reassess
Anatomically, what are you treating with HVLA?
Facet joints b/w two vertebra
Engagement and stacking of barriers
How do you engage the barrier?
Forces are applied from top-down through the superior vertebra
“Through the dysfunction”
Engagement and stacking of barriers
How do you apply force?
Forces are applied from the bottom up through inferior vertebra
“To the dystunction”
What are the general rules to follow for dosage of HVLA?
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
If the same SD keeps recurring… what should you do?
Evaluate and address for underlying inciting factor
What are the benefits of HVLA?
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
___________ possibly remains as the safest procedure in medicine, but like all modalities, it must be used properly
Manipulation
When addressing the cervical spine…
What should you avoid doing when positioning the patient and performing HVLA?
Avoid
-Hyperextension
-Excessive rotation
Guidelines for saftey
What are the major safety considerations with HVLA?
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
What are TWO MOST IMPORTANT absolute contraindications for HVLA?
Rheumatoid Arthritis
Down syndrome
*Both due to alar ligament instability
What is the comprehensive list of absolute contraindications HVLA?
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
What are relative contraindications for HVLA?
Acute herniated nucleus pulposus
Acute radiculopathy
Acute whiplash/severe muscle spasm/strain/sprain
Osteopenia/osteoporosis
Spondylolisthesis
Metabolic bone disease
Hypermobility syndromes
What are relative contraindications for HVLA?
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
