HVLA Flashcards
Normal Coupling - C0-1
Type 1
Normal Coupling - C1-2
Complex primary rotation, technique uses ligamentous myofascial q
Normal Coupling - C2-T7
Type 2
Normal Coupling - C7-T3 (prone)
Type 1 or Type 2
Normal Coupling - T3-L5
Flexion = type 2 Extension = type 1
Spine positioning - C1-2
Ligamentous myofascial
Spine positioning - C2-7 Upslope
Type 1 (facet apposition)
Spine positioning - C2-7 Downslope
Type 1 (facet apposition)
Spine positioning - C7-T3
Type 1 or Type 2
Prone: Facet apposition
Seated: Ligamentous myofascial
Spine positioning - T4-9 extension (seated)
Ligamentous myofascial
Spine positioning - T4-9 flexion (supine)
Ligamentous myofascial
Spine positioning - L1-5 neutral/extension
Type 2 (facet apposition)
Spine positioning - L1-5 flexion
Type 1 (facet apposition)
Normal Coupling L1-5 (Flexion)
Type 2
Normal Coupling - C7-T3 (seated)
Ligamentous myofascial
Normal Coupling L1-5 (Neutral/extension)
Type 1
Substantive reversible impairment - Lumbar
- Disc herniation or prolapse
- Minor vertebral body compression
- Posterior element fracture without lost of structural integrity
- Nerve root compression
- Lumbopelvic region strain
Substantive non-reversible Cervical
- Unresolved disc herniation
- Unresolved radioculopathy
Substantive non-reversible Thoracic
- Significant vertebral body compression fracture
- Posterior element fracture with disruption to the spinal cord
Substantive non-reversible Lumbar
- Significant vertebral body fracture
- Unresolved disc herniation/prolapse
- Unresolved radioculopathy
- Posterior element fracture with disruption to the spinal cord
Serious non-reversible Cervical
- Stroke
- Spinal cord compression
Serious non-reversible Thoracic
- Spinal cord compression
Serious non-reversible Lumbar
- Cauda equine syndrome
Vertebrobasilar insufficiency signs/symptoms
- Overt loss of balance in relation to head movements
- Facial lip paraesthesia, reproduced by active or passive neck movement
- Bilateral or quad-lateral limb paraesthesia either constant or reproduced by neck movement
- Nystagmus produced by active or passive neck movement
Cardinal cervical instability signs/symptoms
- Overt loss of balance in relation to head movements
- Facial lip paraesthesia, reproduced by active or passive neck movement
- Bilateral or quad-lateral limb paraesthesia either constant or reproduced by neck movement
- Nystagmus produced by active or passive neck movement
Vertebrobasilar insufficiency signs/symptoms
Signs:
- Nystagmus
- Gait disturbances
- Homer’s syndrome
Symptoms:
- Headache/neck pain
- Dizziness/vertigo
- Nausea/vomiting
- Facial paraesthesia
- Tingling upper limbs
- Blurred vision
- Light headed
Relative contraindications
- Previous adverse reactions to treatment
- pregnancy
- Hypermobile/ligamentous laxity
- Osteoporosis
Absolute contraindications
- Any bone pathology that has lead to significant bone weakening (tumour, severe rheumatoid arthritis)
- Cord compression
- lack of consent or diagnosis
Tests for upper cervical instability
- Transverse (translate occipital and atlas are moved posteriorly from the pressure on the forehead)
- positive symptoms with head and neck flexion - Alar (same hand hold and passive rotate the atlas to the right & left
Things to include
- cracking sound from movement
- symptoms may persist but should subside in 24-72hrs if not, please contact me
- this treatment approach has caused or aggravated a disc injury or a pinched nerve. If you feel any discomfort at any time please tell me
- thoracic, rib or vertebra fracture
- lumbar, damage to the nerves which can cause permanent bladder/bowel issue
- from my assessment today I believe the benefits outweighs the risk associated
- do you have any questions
- am I okay to proceed?
