Chapter 16 HVLA Basics

Question 1

What type of technique is HVLA?

Answer 1

Passive direct

Question 2

Theories of the neurophysiology of HVLA?

Answer 2

1) Forcefully stretching a contracted muscle sends a barrage of afferents to CNS, causes reflex inhibitory signals to the spindles
2) Forcefully stretching contracted muscle activates the golgi tendon and reflexively relaxes muscle

Question 3

When is the final force applied?

Answer 3

Relaxation/exhalation phase

Question 4

What is the main indication of HVLA?

Answer 4

Motion loss in somatic dysfunction

Question 5

What are the absolute contraindications?

Answer 5

1) Osteoporosis
2) Osteomyelitis (including Pott’s)
3) Fractures in area of thrust
4) Bone mets
5) Severe RA
6) Down’s

Question 6

Why are RA pts at risk?

Answer 6

RA weakens the transverse ligament of the dens, so cervical manipulation may cause AA subluxation

Question 7

Why are Down’s pts at risk?

Answer 7

Laxity in transverse ligament of dens may results in AA subluxation with cervical manipulation

Question 8

What are the relative contraindications?

Answer 8

1) Acute whiplash
2) Pregnancy
3) Post-op conditions
4) Herniated nucleus pulposus
5) Pt’s on anticoagulaion or hemophiliacs
6) Vertebral artery ischemia (positive Wallenberg’s test)

Question 9

What is the most common MINOR complication?

Answer 9

Soreness or symptom exacerbation

Question 10

What is the most common MAJOR complication overall?

Answer 10

Vertebral artery injury–usually due to cervical rotatory forces with neck in extended position

Question 11

What is the most common MAJOR complication in the low back?

Answer 11

Cauda equina syndrome (very rare)