E4: HVLA

Question 1

What is another name for HVLA?

Answer 1

Mobilization with impulse

Question 2

How fast is the impulse in HVLA?

Answer 2

0.04 to 0.06 seconds

Question 3

High velocity makes the technique ______; low amplitude makes the technique ______.

Answer 3

Efficient; safe

Question 4

What are the absolute contraindications for HVLA?

Answer 4

There are none

Question 5

When is HVLA contraindicated?

Answer 5

If the risk of harming the patient exceeds the potential benefit.

Question 6

For what type of somatic dysfunction is HVLA most effective?

Answer 6

Articular dysfunctions

Question 7

What is thin layer adherence?

Answer 7

A process where two congruent surfaces are “glued” together by a typically lubricating substance when said substance is spread thinly enough

Question 8

What is the most likely articular popping theory?

Answer 8

Breaking of joint seal or thin layer adherence

Question 9

What can excessively frequent articular mobilization lead to?

Answer 9

Hypermobility and ligamentous / capsular hypertrophy.

This is much more common in women than men.

Question 10

What is the most effective way to mobilize a small joint?

Answer 10

A combination of gapping force and gliding force

Question 11

What are the relative contraindications for HVLA?

Answer 11

Same as for soft tissue

Question 12

What are contraindications dependent upon?

Answer 12

Physician skill and experience

Question 13

T/F: Pain is an indication for HVLA.

Answer 13

False. Pain is not an indication for any technique.

Question 14

When is HVLA indicated?

Answer 14

Somatic dysfunction with articular restriction

Question 15

What can cause articular restriction?

Answer 15

Acute trauma
Sustained muscle hypertonicity
Repetitive microtrauma
Fascial/ligamentous contracture
Poor postural alignment

Question 16

What is an example of congruent joints?

Answer 16

Spinal facet joints

Question 17

What is an example of non-congruent joints?

Answer 17

Femoral condyles on tibial plateau

Question 18

In a normal joint, the surfaces become _____ slipperier than ice on ice.

Answer 18

10x

Question 19

Where does the synovial fluid go in an acute condition?

Answer 19

It is squeezed out into the joint capsule with subsequent capsular distention and pain

Question 20

Where does the synovial fluid go in a chronic condition?

Answer 20

It is absorbed into the surface of the cartilage and joint capsule, then removed from the surrounding tissues via the lymphatics.

Question 21

What is an articular clunk?

Answer 21

Similar to a loud thud.

Present normally from SI joint, hip joint.

May emanate from any osteoarthritic joint.

Question 22

What is an articular pop?

Answer 22

“Popping” noise expressed as a single modal curve on a sound frequency scale.

Usually occurs with small, spinal joints.

Question 23

What is an articular crack?

Answer 23

A “breaking” noise. Bimodal or multimodal peak on sound scale.

Occurs with tearing adhesions. Sounds similar to ripping velcro.

Question 24

Where does crepitus usually occur?

Answer 24

When the wrist is placed in lateral extension.

Crackling sound akin to rubbing hair between one’s fingers.

Question 25

What is a ligamentous or tendinous strum?

Answer 25

A sound that results from a tense ligament or fascial structure rolling over a bone or other solid prominence.

Snapping ankle, snapping psoas tendon

Question 26

Torn adhesion sound usually occurs with what condition?

Answer 26

Frozen shoulder. Sounds like Velcro.

Question 27

What is the refractory period for spinal articulations?

Answer 27

One to several hours