Cervical & Thoracic HVLA - BHW

Question 1

Name the 7 relative C/I’s to HVLA?

Answer 1

1. Acute herniated nucleus pulposus 

2. Acute radiculopathy 

3. Acute whiplash / severe muscle spasm / strain/ sprain 

4. Osteopenia / Osteoporosis 

5. Spondylolisthesis 

6. Metabolic bone disease 

7. Hypermobility syndromes 


Question 2

Name the 3 absolute C/I’s to HVLA?

Answer 2

1. RA
2. Absence of SD
3. Lack of Pt consent 


Question 3

How do you perform epigastric thrust?

Answer 3

• Pt’s arms on neck, you grab under
• Corner of head behind posterior transverse process
• Have them drop and relax forward
• Translate back to extend, translate shoulders side-to-side to sidebend
o NO posterior translocation needed in an extended lesion. The initial position alone will set them up in flexion.
• The final corrective force is anterior & superior, directed through your epigastrium and the pillow, combined w/ an increased amount of superior traction through the back of your hands and forearms.

Question 4

How do you perform Knee-in-back? What levels is it for?

Answer 4

• For T2-T12
• Similar set up, but use the knee opposite the side of the posterior transverse process
• Extended segments are easy to treat, but for flexed segments, your knee goes on the side opposite and 1 level below

Question 5

How do you perform Texas Twist? What levels is it for?

Answer 5

• For Flexed segments T5-T12
• Stand on opposite side of the posterior transverse process
• Thenar eminence on the posterior transverse process
• Other hand goes 1 segment below
• Use twist to localize, then deliver a quick anteriorly directed final corrective force

Question 6

How do you perform Spinous Process Thrust? What levels is it for?

Answer 6

• For T1-4
• Ipsilateral arm goes over the ipsilateral knee (in reference to the posterior transverse process)
• Translate head a little posteriorly with ipsi arm
• With the thumb of your other hand, push the spinous process into the barrier. Keep this elbow up!
• Thrust your thumb towards your knee that is under the pt’s arm.
• If no pop, can transition right into MET

Question 7

What is the Cervical quadrant (vertebral artery) test? What is it for?

Answer 7

• Pt is supine. Position the patient’s head and neck in extension (off end of table). Sidebend and rotate the neck to the same side and hold for 30 seconds. Repeat on the opposite side.
• Dizziness, nystagmus, abnormal sensations and/or altered mental status may develop if the vertebral arteries are being compressed. If this occurs, do not perform cervical HVLA and notify your faculty.

Question 8

Mechanics for C2-7

Answer 8

• Rotation & SB are to the same side (d/t the backward, upward and medial orientation of the superior facets (mneumonic = BUM). Either Flexed or extended.

Question 9

HVLA for C2-7

Answer 9

• MCP joint goes over the articular pilar
• Apply an anterior force w/ your MCP joins B/L to introduce extension (you will extend them whether the segment is flexed or extended!)
• Rotate the head and avoid lifting / flexing
• The final corrective force is a quick, anterior, superior thrust towards the Pt’s eye from your right 2nd MCP joint

Question 10

Dysfxn at what locations will affect the jugular foramen? Why is this important?

Answer 10

• occipitoatlantal (OA) and atlantoaxial (AA) areas
• 85% of the venous drainage from the head courses through the internal jugular veins, which pass through the jugular foramen, which is formed at the junction of the occiput and temporal bones along the occipitomastoid suture. The venous drainage through this low pressure system can be impaired by increased tension in the suboccipital region resulting from OA and AA dysfunction.

Question 11

Should we treat T-spine / ribs first, or C-spine / cranial dysfxn first, generally speaking?

Answer 11

• treating upper thoracic and upper rib dysfunction first will make the cervical spine and cranial mechanism easier to treat.