HVLA Flashcards
Who was the first African-American to be elected President of the AOA and when?
William G. Anderson, DO; 1994
Did the AOA beat the AMA to having the first black president?
Yes by 1 year
What was William Anderson best know for?
Coalition of Desegregation for the Albany Movement in Albany, Georgia 1961
What do we have in normal barrier mechanics?
- Physiologic Barrier
- Anatomic Barrier
- Neutral Point
What SD occurs, what happens to motion?
It is restricted in one direction forming the restrictive barrier with a new neutral point
What 2 things do we do for this new SD?
Engage barrier and thrust or move the joint to the new neutral point to normalize the motion
What does direct mean?
Engaging the barrier
Who proposed the 3rd motion law?
CR Nelson, DO
What does Principle 3 say?
When one motion is introduced, it modifies the others; i.e. when flexion or extension is introduced, the amount of sidebending and/or rotation is changed
What do we apply Fryette and Nelson to ONLY?
T1-L5
What do C2-C7 classify as?
Type 2 like (some type 3)
What 3 bones do not follow Fryette?
- C1 (atlas)
- C2 (axis)
- Sacrum
What MUST we do for HVLA?
Thrust along the plane of the facets
Describe the Cervicals and their direction
“Shingle like” - superiorly anteriorly, inferiorly posteriorly
Describe the Thoracics and their direction
Facet plane - coronal posteriorly
Describe the Lumbars
Sagittal
Describe the Sacroiliac
L-shaped with a coronal component
Describe the OA
Occiput on atlas - “bowl-like” introduces sidebending and rotation to opposite sides
What is AA and how is its movements?
Atlas on axis - movement about the dens, rotational
Describe SI
Sacroiliac - coronal component, sidebending/rotation to opposite sides
What must we do for the barrier concept?
Define your problem before you can hope to fix it
What must we be able to do for a diagnosis?
Understand and describe what the tissues are doing based on what your hands feel
What does Qualitative mean?
“End Feel”
How do we diagnose SD?
TART
What part of TART is most important for HVLA?
Restriction of motion
What do we considered for the R in TART for HVLA?
Quantity and Quality; are they localized?
What is the necessary skill needed to define Barrier Mechanics?
Palpation of restriction of motion
What 4 questions do we ask for Q&Q?
- Is segmental motion symmetrical/normal?
- Which directions are freer?
- How firm is the end feel at the restriction?
- Is the restriction segmental?
Give the Quantity, Quality, and End Feel for motion loss by Barrier Mechanics?
- Notably decreased ROM
- No motion lost until barrier is engaged
- A palpably distinct endpoint to ROM
Give the Quantity, Quality, and End Feel for motion loss with only soft tissue findings
- Minor QUANTITATIVE motion loss
- Rubbery, sluggish throughout that segment’s ROM
- Nebulous at best - rubbery feel
Define HVLA
A rapid impulse of force (HV) traveling a VERY short distance (low amplitude), directed at a firmly held barrier/restriction which has been engaged in all 3 dimensions
What is another way to say, “It will go this way, it won’t go that way”?
A local restriction of the myofascial components around a specific arthrodial joint, hindering movement of that joint in a specifically definable summed directional vector
4 steps to the Basic Concept of HVLA?
- Identify the arthrodial joint with somatic dysfunction (vertebral unit)
- Immobilize one of the bones and hold it there. This may be the segment itself or segment below
- Accumulate your forces into the barrier at the dysfunctional joint by moving the second bone
- Rapid impulse of force through the second bone into the barrier
Describe Lumbar Side Lumbar or Lumbar Roll Technique
Hold the segment above (dysfunctional segment) then move the segment below
Describe the Thoracic Knee-Back Technique
Hold the segment below, then move the segment above (dysfunctional segment)
Describe Lumbar or Thoracic Walk-Around Technique?
Localize to segment and move segment
What do we do for HVLA setup?
- Engage the barriers (sidebending/rotation, flexion/extension)
- Accumulate forces (maintain each barrier as you engage next one)
What MUST the end feel be for HVLA?
Solid with a distinct barrier to LOCALIZE the forces
What do we thrust along?
Vector that sums the accumulated (stacked) vectors
Do we apply least amount of force to be effective?
Yes
Do we back off ever before the thrust?
No
Does the auditory feedback (pop) matter?
No
What is the famous saying for HVLA?
FORCE IS NOT A SUBSTITUTE FOR LOCALIZATION
What MUST we do for HVLA?
Localize the forces!!!!!
What can excessive dosage cause?
Hypermobility
Why do we do HVLA?
To restore normal motion
Can we use another technique to relax the patient first?
Yes
What should we focus on? Avoid?
“Key” SD’s; repetitive thrusting on same segment
What is the indication for HVLA? IMPORTANT!!!!
ARTICULAR SOMATIC DYSFUNCTION WITH IDENTIFIABLE BARRIER MECHANICS
What are 3 contraindications for HVLA?
- Tissue fragility
- Severe overlying spasm
- Your own intuition (red flag!)
What are the treatment choices for HVLA?
- Quick effective treatment
- Easily integrates with other modalities
- Patient preference
