HVLA Flashcards
Cervicothoracic spine C7 - T3 Rotation Gliding (push)
Myofascia ligamentus
same side head and thrust
Apply sidebend and tuck chin
Thoracolumbar spine T10 - L2 - neutral positioning
Neutral
coupled motion type 1
Facet apposition type 2
Thoracolumbar spine T10 - L2 - flexion positioning
Flexion
Coupled motion Type 2
facet apposition Type 1
Lumbosacral Joint L5 to S1 - Neutral positioning
Cervicothoracic Spine C7 to T3 - Rotation gliding
(scissor)
myofascia ligamentus
Cervicothoracic C7 to T3 - Extension Gliding
myofascia ligamentus
Atlanto Axial Joint C1 to C2 - chin hold
AA coupled motion primary rotation
Rotation thrust
Atlanto occipital joint C0 to C1 - contact occiput
OC joint coupled motion Type 1
Facet apposition Type 2
thrust is C-scoop
Thoracic Spine T4-T9 - extension gliding
(seated)
Ligamentous myofascial
Thoracic Spine T4-T9 - Rotation gliding
(“Dog” - Supine)
Ligamentous myofascial
Cervical C2-C7 - Upslope chin hold
coupled motion type 2
facet apposition type 1
Primary leaver rotation secondary side bending
Cervical C2-C7 upslope cradle hold
coupled motion type 2
fascet apposition type 1
Cervical spine C2-C7 Downslope chin hold
Type 2 normal
type 1 lock up
Cervical spine C2 - C7 downslope cradle
Normal Type 2
Coupling Type 1 - opposite rotation and side bending
Lumbar L1 - L5 - flexion
Coupled motion Type 2
facet apposition Type 1
Lumbar L1 - L5 - neutral
Coupled motion Type 1
facet apposition Type 2
What are red flags for HVLA?
Fracture
Tumour
infection
Neurological condition
Aneurism
Haemorrhage
Other serious condition
What are the absolute contraindications for HVLA?
- Bone: weakening, osteoporosis, tumour
- Neurological: cord compression, myelopathy
- Vascular: cervical dissection, aneurysm
- Lack of diagnosis
- Lack of patient consent
- Patient positioning can’t be achieved due to pain or ROM
What are the relative contraindications to HVLA?
- Averse reactions to previous treatment
- Disc herniation or prolapse
- pregnancy
- vertigo
- Osteoporosis
- Psychological dependance to HVLA
- inflammation
- Spondylolisthesis / spondylosis
- Corticosteroid therapy
- Degenerative joint disease
- ligamentous instability
- Arterial calcification
What are the risks of HVLA to each spinal segment?
- *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)
What are the four classifications of HVLA complications?
- 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)
What are transient effects?
Local pain or discomfort
Stiffness
A headache
Tiredness/fatigue
Radiating pain or discomfort
What are some Substantive reversible impairment to each spinal segment?
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
What are some non-Substantive reversible impairment to each spinal segment?
- *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.
What are some serious non-reversible impairment?
- *Cervical:** stroke, Spinal cord compression = cervical myelopathy.
- *Thoracic:** Spinal cord compression
- *Lumbar:** Spinal chord compresion = cauda equina
What are the causes for complications on HVLA relating to a patient selection?
Incorrect diagnosis
Inadequate palpatory assessment
lack of awareness
lack of patient consent
What are the causes for complications on HVLA relating to poor technique application?
Excessive Force, amplitude and leverage
an incorrect plane of thrust
Wrong leverage
Poor patient positioning
Poor operator
lack of patient feedback
