HVLA

Question 1

When was HVLA first seen in history?

Answer 1

2700 bce in chinese recording

hippocrates books on joints included spinal pressure or thrust to treat vertebra

Question 2

AT still incorporated join\t repositioning practiced by who?

Answer 2

central american healers

Dr. Palmer (palmer school of chiropractic medicine) used HVLA too

Question 3

How would you define HVLA?

Answer 3

direct technique that uses a rapid force through a short distance. engaging the restrictive barrier

thrust technique

Question 4

What does force mean for HVLA?

Answer 4

the minimum required for release of one localized segment

you utilize localization of positioning more than force

Question 5

What is nelson’s III principle?

Answer 5

motion in one plane limits motion in other planes

Question 6

What barrier is achieved with active motion what barrier is achieved with passive motion?

Answer 6

active - physiologic barrier
passive - anatomic barrier

majority of the barriers is from tension buildup

Question 7

What are the barrier mechanics of HVLA?

Answer 7

you localize firmly to the restrictive barrier and then make a small movement through RB

its never enough to be close to AB

Question 8

what is the first thing you want to do before treating hvla?

Answer 8

TART

check the quantity of ROM
planes let you know the barriers before we treat

Question 9

What is the quality of barrier mechanics?

Answer 9

feeling how smooth and easy a joint can move

Question 10

What type of end feel should you get for hvla

Answer 10

firm and distinct

if rubbery then it is from muscle, fascia, or a reflex -> soft tissue restriction and hvla will be less sufficient

Question 11

indications for hvla

Answer 11

somatic or articular somatic dysfunction localizes to a joint
distinctive barrier with a firm, hard end feel

Question 12

what is the neurophysiology of sd and using hvla to treat it

Answer 12

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

Question 13

must you have noise to be successful?

Answer 13

NO it isnt necessary for success

Question 14

steps of hvla

Answer 14

1. diagnose sd
2. soft tissue treatment (MET, mdf, kneading)
3. localize forces to segment or joint
   - stacking, engaging 3 barriers
4. release enhancing maneuver
   - pt exhales
5. accum of forces
6. corrective thrust
7. return to neutral
8. reassess for effectiveness and sd persistance

Question 15

is relaxation critical for hvla?

Answer 15

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

Question 16

What does stacking mean?

Answer 16

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

Question 17

when treating a vertebral sd, where do the forces localize to?

Answer 17

facet joints between 2 vertebrate

ex: treat L3 SD as it articulates w L4

Question 18

what does “through the dysfunction” mean

Answer 18

forces move from top down

ex: t12 tx includes upper body movement including t12

Question 19

what does “to the dysfunction” mean

Answer 19

forces are applied from bottom up

ex: t12 tx includes movement only up to and at L1

Question 20

if localization is lost, is it okay to thrust?

Answer 20

no don’t thrust

you must engage all RB - stacked

if you don’t, then you get unwanted iatrogenic effects

Question 21

what is your direction of your force?

Answer 21

combo of all vectors

short, rapid thrust induced without losing engagement w barrier

no running starts

Question 22

Can you have noise before treatment? If so, what does that mean?

Answer 22

yes, when you engage dysfunction (articulatory release)

Question 23

how do you determine the dosage for a pt?

Answer 23

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)

Question 24

benefits of HVLA?

Answer 24

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)

Question 25

What precautions must you take in hvla?

Answer 25

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

Question 26

absolute contraindications

Answer 26

rheumatoid arthritis
down syndrome

alar ligament instability

along with spine injury, bone deterioration/fusions, nerve issues, pt refusal