9. Intro to HVLA

Question 1

What is HVLA?

Answer 1

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
• Also known as a thrust technique

Question 2

What is the quantity of ROM?

Answer 2

• determined by amount of movement available form an neutral position
• refers to palpatory “sense” of how smoothly a joint can be moved through its ROM

Question 3

When should we not do HVLA?

Answer 3

vertebral a. problems

Question 4

When should we do HVLA?

Answer 4

when there is a distinctive barrier with a firm end feel

Question 5

What is the neurophysiology of SD?

Answer 5

local segment irritation –> focal edema and steeling –> tightening of myofascial and capsular components of the joint –> reflex hypertoncitiy of muscles crossing joint –> TART changes –> SD

Question 6

What is the neurophysiology of HVLA?

Answer 6

thrust through RB –> restoration of motion at articulation –> restoration of normal proprioceptive input –> reflex relaxation of muscles –> improvement of TART findings

Question 7

Where does the crack come from?

Answer 7

– eventration of gas into the synovial fluid with the breaking of surface tension
– Snapping/releasing of ligamentous adhesions in the joint
– Ballooning of joint capsule
– Bone itself being pulled out of place and snapping
back into neutral position

Question 8

What are the steps for HVLA?

Answer 8

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 9

What is the initial position of HVLA?

Answer 9

• Crucial for Physician AND patient to be in comfortable position
• Consider applying techniques to relax overlying myofascial structures

Question 10

What is the vertebral unit?

Answer 10

• Two adjacent vertebrae with their associated disc, arthrodial, ligamentous, muscular, vascular , lymphatic, and neural components
• in HVLA forces are localized at the facet joints b/t 2 vertebra

Question 11

Appendicular restriction- Typically restricted in__ ___ and an associated ___ ___.

Answer 11

Appendicular restriction- Typically restricted in one Major and an associated minor motion

*HVLA focuses on minor joint motion restriction

Question 12

How do we determine dosage for HVLA?

Answer 12

– The sicker the patient, the less the dose
– Older patients respond more slowly
– Most cases discourage thrusting the same segment more than once a week
– If the same SD keeps recurring, evaluate and address for underlying inciting factor

Question 13

What are the benefits of HVLA?

Answer 13

• 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 14

What are indications of HVLA?

Answer 14

• Articular somatic dysfunction

* Joint motion restriction with a firm articular barrier

Question 15

Is HVLA safe?

Answer 15

• Manipulation possibly remains as the safest procedure in medicine, but like all modalities, it must be used properly.
• Compared to the incidence of adverse effects (including death) associated with pharmaceuticals, manipulative treatment is an extremely safe and therapeutic modality when performed by a knowledgeable and skilled practitioner.

Question 16

What are the precautions of HVLA?

Answer 16

• In general, adverse effects of HVLA technique can be avoided by following certain principles.
• In particular, a thorough history and physical examination are essential for uncovering possible diseases or conditions, which would contraindicate the use of HVLA.
– In addition, when addressing the cervical spine, avoid hyperextension and excessive rotation

Question 17

What are absolute contraindications of HVLA?

Answer 17

– Local Metastases
– Osseous or ligamentous disruption
– Severe Osteoporosis
– Osteomyelitis in the area being treated
– Joint replacement in the area being treated
– Vertebrobasilar insufficiency
– Severe herniated disc with radiculopathy
• Upper cervical
– Rheumatoid arthritis (alar l. instability)
– Down syndrome (alar l. instability)
– Achondroplastic dwarfism
– Chiari malformation
• Fracture/dislocation/spinal or joint instability
• Ankylosis/spondylosis with fusion
• Surgical fusion
• Klippel-Feil syndrome
• Vertebrobasilar insufficiency
• Inflammatory joint disease
• Joint infection
• Bony malignancy
• Patient refusal

Question 18

What are relative contraindications of HVLA?

Answer 18

• Acute herniated nucleus pulposus
• Acute radiculopathy
• Acute whiplash/severe muscle spasm/strain/sprain
• Osteopenia/osteoporosis
• Spondylolisthesis
• Metabolic bone disease
• Hypermobility syndromes
– 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

Question 19

What is the difference b/t quantity and quality of ROM?

Answer 19

• quantity is how much it can move

- quality is how well it moves (placatory sense of how smoothly it moves)

Question 20

What does a firm and distinct end feel represent? rubbery?

Answer 20

1. typically mechanical type arthrodial dysfunction

2. reflex SD