HVLA

Question 1

Cervicothoracic spine C7 - T3 Rotation Gliding (push)

Answer 1

Myofascia ligamentus

same side head and thrust

Apply sidebend and tuck chin

Question 2

Thoracolumbar spine T10 - L2 - neutral positioning

Answer 2

Neutral

coupled motion type 1

Facet apposition type 2

Question 3

Thoracolumbar spine T10 - L2 - flexion positioning

Answer 3

Flexion

Coupled motion Type 2

facet apposition Type 1

Question 4

Lumbosacral Joint L5 to S1 - Neutral positioning

Answer 4

Question 5

Cervicothoracic Spine C7 to T3 - Rotation gliding

(scissor)

Answer 5

myofascia ligamentus

Question 6

Cervicothoracic C7 to T3 - Extension Gliding

Answer 6

myofascia ligamentus

Question 7

Atlanto Axial Joint C1 to C2 - chin hold

Answer 7

AA coupled motion primary rotation

Rotation thrust

Question 8

Atlanto occipital joint C0 to C1 - contact occiput

Answer 8

OC joint coupled motion Type 1

Facet apposition Type 2

thrust is C-scoop

Question 9

Thoracic Spine T4-T9 - extension gliding

(seated)

Answer 9

Ligamentous myofascial

Question 10

Thoracic Spine T4-T9 - Rotation gliding

(“Dog” - Supine)

Answer 10

Ligamentous myofascial

Question 11

Cervical C2-C7 - Upslope chin hold

Answer 11

coupled motion type 2

facet apposition type 1

Primary leaver rotation secondary side bending

Question 12

Cervical C2-C7 upslope cradle hold

Answer 12

coupled motion type 2

fascet apposition type 1

Question 13

Cervical spine C2-C7 Downslope chin hold

Answer 13

Type 2 normal

type 1 lock up

Question 14

Cervical spine C2 - C7 downslope cradle

Answer 14

Normal Type 2

Coupling Type 1 - opposite rotation and side bending

Question 15

Lumbar L1 - L5 - flexion

Answer 15

Coupled motion Type 2

facet apposition Type 1

Question 16

Lumbar L1 - L5 - neutral

Answer 16

Coupled motion Type 1

facet apposition Type 2

Question 17

What are red flags for HVLA?

Answer 17

Fracture
Tumour
infection
Neurological condition
Aneurism
Haemorrhage
Other serious condition

Question 18

What are the absolute contraindications for HVLA?

Answer 18

1. Bone: weakening, osteoporosis, tumour
2. Neurological: cord compression, myelopathy
3. Vascular: cervical dissection, aneurysm
4. Lack of diagnosis
5. Lack of patient consent
6. Patient positioning can’t be achieved due to pain or ROM

Question 19

What are the relative contraindications to HVLA?

Answer 19

1. Averse reactions to previous treatment
2. Disc herniation or prolapse
3. pregnancy
4. vertigo
5. Osteoporosis
6. Psychological dependance to HVLA
7. inflammation
8. Spondylolisthesis / spondylosis
9. Corticosteroid therapy
10. Degenerative joint disease
11. ligamentous instability
12. Arterial calcification

Question 20

What are the risks of HVLA to each spinal segment?

Answer 20

• *Cervical:** Low (when the practitioner is well trained and the patient is well screened)
• *Thoracic:** Not documented
• *Lumbar:** Rare (when the practitioner is well trained and the patient is well screened)

Question 21

What are the four classifications of HVLA complications?

Answer 21

• Transient effect < 48-72h
• Substantive reversible impairment (take longer to recover)
• Substantive non-reversible impairment (wont recover)
• Serious non reversible impairment (adverse events - permanent damage)

Question 22

What are transient effects?

Answer 22

Local pain or discomfort
Stiffness
A headache
Tiredness/fatigue
Radiating pain or discomfort

Question 23

What are some Substantive reversible impairment to each spinal segment?

Answer 23

Cervical: Disc herniation, spinal compresion, Cs strain

Thoracic: Rib fracture, VB compression fracture, Posterior fracture, shoulder and rib cage strain.

Lumbar: VB compression fracture, posterior fracture, Disc herniation, nerve root compresion, strain

Question 24

What are some non-Substantive reversible impairment to each spinal segment?

Answer 24

• *Cervical:** unresolved disc herniation and radiculopathy
• *Thoracic:** Significant VB fracture, Post fracture with spinal canal disruption.
• *Lumbar**: unresolved disc herniation and radiculopathy, Significant VB fracture, Post fracture with spinal canal disruption.

Question 25

What are some serious non-reversible impairment?

Answer 25

• *Cervical:** stroke, Spinal cord compression = cervical myelopathy.
• *Thoracic:** Spinal cord compression
• *Lumbar:** Spinal chord compresion = cauda equina

Question 26

What are the causes for complications on HVLA relating to a patient selection?

Answer 26

Incorrect diagnosis
Inadequate palpatory assessment
lack of awareness
lack of patient consent

Question 27

What are the causes for complications on HVLA relating to poor technique application?

Answer 27

Excessive Force, amplitude and leverage
an incorrect plane of thrust
Wrong leverage
Poor patient positioning
Poor operator
lack of patient feedback