Cervical HVLA Lab

Question 1

What is the Wallenberg Test?

Answer 1

• -pt. supine w/ doc at head of table
• -pt.’s head extends off table (support their head)
• -extend, rotate, sidebend in same direction for 5-10s

—> ask pt. to report dizziness, vision changes, and watch for nystagmus

Question 2

What do you do before starting an HVLA treatment?

Answer 2

-soft tissue preparation (MFR, kneading, stretch, etc.)

Question 3

How do you choose between a rotation treatment and a sidebending treatment for cervical HVLA?

Answer 3

pick the treatment for the dysfunction that has the firmer endpoint or has the greatest distance from the ideal/normal

Question 4

What do you need to do to the neck to be able to accurately assess the AA joint?

Answer 4

–fully flex the C-spine to lock C2-C7 which isolates the rotation to only the atlas

Question 5

What are examples of preparatory techniques that can be used prior to cervical HVLA?

Answer 5

• -C-spine contralateral traction (supine)
• -suboccipital release
• -unilateral/bilateral forearm fulcrum forward bending

Question 6

How do you stretch the trapezius using unilateral forearm fulcrum forward bending?

Answer 6

-rotate and sidebend the patient’s head and neck toward your elbow

(stretches the trapezius opposite the side of your hand placement on the patient’s shoulder)

Question 7

How do you stretch the posterior scalene using unilateral forearm fulcrum forward bending?

Answer 7

-rotate and sidebend the patient’s head and neck toward your hand placed on the patient’s shoulder

(stretches the posterior scalene opposite of your hand placement on the patient’s shoulder)

Question 8

What muscles does the bilateral forearm fulcrum forward bending stretch?

Answer 8

-longitudinally stretches the paravertebral muscles

Question 9

Why should you check for soft tissue restrictions after performing HVLA?

Answer 9

• they are another source of discomfort

- they could recreate the joint dysfunctions that we just corrected!

Question 10

When using rotational thrust to treat cervical HVLA, which way do you rotate the head and which way do you sidebend the head?

Answer 10

• rotate toward the restrictive barrier
• sidebend toward the direction of ease

–vice versa for using a sidebending thrust

Question 11

True or False: you should use minimal flexion/extension when performing cervical HVLA

Answer 11

True; use MINIMAL flexion/extension; the dysfunctional segment should only be tipped forward or backward a few degrees

Question 12

What is the major muscle in AA rotation?

Answer 12

-obliquus capitis inferior

• origin: spinous process of the axis
• insertion: lateral mass of the atlas

Question 13

Describe the process of AA HVLA.

Answer 13

• cradle head, contact atlas lateral mass w/ index finger
• fully flex Cspine (30 to 45 degrees) to lock C2 to C7
• rotate head to the feather edge of the barrier
• provide minimal rotational thrust through both hands

Question 14

Describe the process of OA HVLA.

Answer 14

• contact occiput posteromedial to mastoid process
• stack all 3 planes to the restriction
• add minimal localized traction

-perform rotational thrust medially, anteriorly, superiorly
(up and over)

Question 15

What is the set-up for performing T-spine HVLA (Kirksville Crunch)?

Answer 15

• doc stands on opposite side of the PTP
• pt. crosses arms w/ PTP arm on top, elbows aligned
• doc places thenar eminence on PTP, cradling SP
• flex occiput/neck to just past the lesion
• utilized head/neck to induce sidebending

Question 16

When using HVLA to treat a T-spine somatic dysfunction, which way to you sidebend the patient in a Type I versus a Type 2?

Answer 16

Type 1 - away from the doctor

Type 2 - toward the doctor

Question 17

Where is the caudad hand placed in treatment of an extension T-spine somatic dysfunction when using HVLA to treat?

Answer 17

at the vertebral segment below

Question 18

In what direction do you thrust for a Type II Flexed or a Type 1 T-spine somatic dysfunction when using HVLA?

Answer 18

A to P

Question 19

In what direction do you thrust for a Type II Extended somatic dysfunction when using HVLA?

Answer 19

anterior to posterosuperiorly

Question 20

In treating a somatic dysfunction of Rib 1-2 with HVLA, where do you localize the thrust for an inhalation dysfunction versus an exhalation dysfunction?

Answer 20

• inhalation: superior to the vertebral segment where the rib attaches to help drive the rib inferior
• exhalation: inferior to the vertebral segment where the rib attaches to hep drove the rib superior

Question 21

Describe HVLA to treat an inhalation dysfunction of Rib 11-12?

Answer 21

• doc stand opposite dysfxn, bend legs away from doc
• hypothenar eminence medial/inferior to rib angle
• inferior hand grasps pt.’s ASIS to stabilize pelvis

-at end of exhalation, apply cephalad/lateral thrust on rib

Question 22

Describe HVLA to treat an exhalation dysfunction of Rib 11-12?

Answer 22

• doc stand opposite dysfxn, bend legs toward doc
• thenar eminence superolateral to rib angle (w/ downward force to stabilize rib)

-inferior hand grasps ASIS and at end of exhalation, quickly lifts up to the ceiling