HVLA Flashcards
When was HVLA first seen in history?
2700 bce in chinese recording
hippocrates books on joints included spinal pressure or thrust to treat vertebra
AT still incorporated join\t repositioning practiced by who?
central american healers
Dr. Palmer (palmer school of chiropractic medicine) used HVLA too
How would you define HVLA?
direct technique that uses a rapid force through a short distance. engaging the restrictive barrier
thrust technique
What does force mean for HVLA?
the minimum required for release of one localized segment
you utilize localization of positioning more than force
What is nelson’s III principle?
motion in one plane limits motion in other planes
What barrier is achieved with active motion what barrier is achieved with passive motion?
active - physiologic barrier
passive - anatomic barrier
majority of the barriers is from tension buildup
What are the barrier mechanics of HVLA?
you localize firmly to the restrictive barrier and then make a small movement through RB
its never enough to be close to AB
what is the first thing you want to do before treating hvla?
TART
check the quantity of ROM
planes let you know the barriers before we treat
What is the quality of barrier mechanics?
feeling how smooth and easy a joint can move
What type of end feel should you get for hvla
firm and distinct
if rubbery then it is from muscle, fascia, or a reflex -> soft tissue restriction and hvla will be less sufficient
indications for hvla
somatic or articular somatic dysfunction localizes to a joint
distinctive barrier with a firm, hard end feel
what is the neurophysiology of sd and using hvla to treat it
sd is caused from tightening of myofascial and capsular comp of a joint
thrusting through RB restores motion at articulation and normal input, relaxation and improved TART
must you have noise to be successful?
NO it isnt necessary for success
steps of hvla
- diagnose sd
- soft tissue treatment (MET, mdf, kneading)
- localize forces to segment or joint
- stacking, engaging 3 barriers - release enhancing maneuver
- pt exhales - accum of forces
- corrective thrust
- return to neutral
- reassess for effectiveness and sd persistance
is relaxation critical for hvla?
YES
if the pt tenses, it is hard to move quickly and get a good feel
reduces risk of m or tendon injury
it can interfere with rapid contraction and correction
What does stacking mean?
assessing all 3 planes of motion (C2-L5)
–some joints are restricted by muscles, so only have two motions
ie post tibiofemoral glide
if you don’t then it is absorbed by near by tissues, you lose the localization
when treating a vertebral sd, where do the forces localize to?
facet joints between 2 vertebrate
ex: treat L3 SD as it articulates w L4
what does “through the dysfunction” mean
forces move from top down
ex: t12 tx includes upper body movement including t12
what does “to the dysfunction” mean
forces are applied from bottom up
ex: t12 tx includes movement only up to and at L1
if localization is lost, is it okay to thrust?
no don’t thrust
you must engage all RB - stacked
if you don’t, then you get unwanted iatrogenic effects
what is your direction of your force?
combo of all vectors
short, rapid thrust induced without losing engagement w barrier
no running starts
Can you have noise before treatment? If so, what does that mean?
yes, when you engage dysfunction (articulatory release)
how do you determine the dosage for a pt?
pt dependent
acute/sick - less dose
old - less dose, need more time for recovery
optimal - 1x a week so they can recover and decrease chance of hypermobility (worse)
benefits of HVLA?
time efficient well tolerated immediate relief decreased pain increase ROM considered one of the safest procedures in medicine
treats chronic dysfunction better
effective with hypomobile joints
greater reflex relaxation of associated m (pain modulator)
What precautions must you take in hvla?
cervical spine - avoid hyperextension and lots of rotation
cautious of certain disease/cond
–take a good history and physical exam
risk > benefits then don’t do it
barrier must feel RIGHT
absolute contraindications
rheumatoid arthritis
down syndrome
alar ligament instability
along with spine injury, bone deterioration/fusions, nerve issues, pt refusal
