HVLA Flashcards
What is the definition of HVLA?
rapid therapeutic force that travels a short distance within anatomic range, elicit release of restriction
How much force is used in HVLA?
minimum required for release of localized segment
What is a physiologic barrier?
end ROM achieved during active motion in absence of SD
What is a restrictive barrier?
functional limit that diminishes normal physiologic range
What is the anatomic barrier?
end ROM achieved during passive motion
What is quality vs quantity movement?
palpatory appreciation of how smoothly a joint can be moved vs. amt of movement available from a neutral position
What are some indications for HVLA?
dysfunction localizes to a joint, distinctive barrier with hard end feel
What is the mechanism of treatment of HVLA?
thrust through barrier, restore motion at articulation, restore normal proprioceptive input, reflex relaxation of muscles, improve TART findings
What is the source of the “pop” in HVLA?
conversion of nitrogen to gas, eventration of gas into synovial fluid, snapping of ligamentous adhesions, ballooning of joint capsule
What are the steps of HVLA?
diagnose SD, soft tissue preparation, localize forces to segment, release enhancing maneuver, accumulation of forces, corrective thrust, return to neutral, reassess for effectiveness and SD persistence
Why is soft tissue preparation done in HVLA?
reduces risk of soft tissue injury, prevents tensing that can interfere with correction
Where is the direction of force applied in HVLA?
culmination of all vectors used for localization
What are some general rules for OMT dosage?
more acute or sick, less dowse; older patients respond more slowly, discourage thrusting same segment more than once a week, decrease treatment as patient improvement duration increases
What are some underlying inciting factors for SD?
posture, leg length imbalances, scoliosis, strength imbalances, scar tissue, joint instability
What are some of the benefits of HVLA?
time efficient, well tolerated, immediate relief
What are some indications for HVLA?
SD, articular SD, joint motion restriction with firm articular barrier
What are some specific benefits of HVLA?
reduce joint fixation, release chronic dysfunction, CNS reprogramming, restore bony alignment, reduce meniscus entrapment
What are some precautions that should be taken in use of HVLA?
uncover possible diseases or conditions, avoid hyperextension and excessive rotation in C-spine
What are some safety considerations for HVLA?
pt consent and comfort, accurate diagnosis, minimum force necessary, hypermobile joint, excessive treatment
What are some absolute contraindications for HVLA?
local cancer, local osseous ligamentous disruption, osteoporosis, RA, down’s syndrome, osteomyelitis, spinal cord dx, pt refusal, fracture, joint infection, chiari malformation, etc.
What are some relative contraindications for HVLA?
acute herniated nucleus pulposis, acute radiculopathy, acute injury, osteopenia, spondylolisthesis, metabolic bone disease, hypermobility syndromes, joint replacement or other implant
Describe HVLA supine T-spine
stand on opposite side of PTP, have pt cross arms with PTP arm superior, place thenar eminence on PTP, localize to restrictive barriers (side bend away doc type 1, side bend towards doc type 2), at the end of exhalation exert anterior to posterior thrust
Describe HVLA prone for type 1
Stand on same side of PTP, place pisiform on PTP fingers pointing caudal, place other hand cephalad with hypothenar eminence on opp TP, thrust anterior
Describe HVLA prone for type 2
Stand on opp side of PTP, place thenar eminence on PTP fingers pointing cephalad, place other hand caudad with pisiform eminence on opp TP, thrust anterior
Describe seated lower t-spine HVLA
Pt seated with ipsi hand to PTP clasped behind neck and holding elbow with other hand, doc stand opp PTP, grasp pts biceps with arm orientation dependent on T1 or T2 dysfundction, engage barrier, pull pt thru rotational barrier while thenar eminence imparts anterior impulse on PTP
Describe seated 1st rib inhalation dysfunction HVLA
Physician places foot on table opp of dysfunction and pt drapers arm over physicians knee, contact rib with MCP jpint of IPSI hand, engage sidebending head toward SD rib localizing to T1, apply thrust inferiorly/medially and slightly anterior through the superior rib
Describe ribs 3-10 bucket handle inhalation dysfunction HVLA
Pt supine with physician opp dysfunctional rib, cross arms over body with dysfunctional rib on top, place thenar eminence of caudad hand on superior edge of angle to dysfunctional rib, elevate pts head and neck, localize pressure at dysfunctional rib, apply posterior thrust directed superior to thenar eminence
Describe ribs 3-10 bucket handle exhalation dysfunction HVLA
Pt supine with physician opp dysfunctional rib, cross arms over body with dysfunctional rib on top, place thenar eminence of caudad hand on inferior edge of angle to dysfunctional rib, elevate pts head and neck, localize pressure at dysfunctional rib, apply posterior thrust directed superior to thenar eminence
