HVLA

Question 1

What is the definition of HVLA?

Answer 1

rapid therapeutic force that travels a short distance within anatomic range, elicit release of restriction

Question 2

How much force is used in HVLA?

Answer 2

minimum required for release of localized segment

Question 3

What is a physiologic barrier?

Answer 3

end ROM achieved during active motion in absence of SD

Question 4

What is a restrictive barrier?

Answer 4

functional limit that diminishes normal physiologic range

Question 5

What is the anatomic barrier?

Answer 5

end ROM achieved during passive motion

Question 6

What is quality vs quantity movement?

Answer 6

palpatory appreciation of how smoothly a joint can be moved vs. amt of movement available from a neutral position

Question 7

What are some indications for HVLA?

Answer 7

dysfunction localizes to a joint, distinctive barrier with hard end feel

Question 8

What is the mechanism of treatment of HVLA?

Answer 8

thrust through barrier, restore motion at articulation, restore normal proprioceptive input, reflex relaxation of muscles, improve TART findings

Question 9

What is the source of the “pop” in HVLA?

Answer 9

conversion of nitrogen to gas, eventration of gas into synovial fluid, snapping of ligamentous adhesions, ballooning of joint capsule

Question 10

What are the steps of HVLA?

Answer 10

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

Question 11

Why is soft tissue preparation done in HVLA?

Answer 11

reduces risk of soft tissue injury, prevents tensing that can interfere with correction

Question 12

Where is the direction of force applied in HVLA?

Answer 12

culmination of all vectors used for localization

Question 13

What are some general rules for OMT dosage?

Answer 13

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

Question 14

What are some underlying inciting factors for SD?

Answer 14

posture, leg length imbalances, scoliosis, strength imbalances, scar tissue, joint instability

Question 15

What are some of the benefits of HVLA?

Answer 15

time efficient, well tolerated, immediate relief

Question 16

What are some indications for HVLA?

Answer 16

SD, articular SD, joint motion restriction with firm articular barrier

Question 17

What are some specific benefits of HVLA?

Answer 17

reduce joint fixation, release chronic dysfunction, CNS reprogramming, restore bony alignment, reduce meniscus entrapment

Question 18

What are some precautions that should be taken in use of HVLA?

Answer 18

uncover possible diseases or conditions, avoid hyperextension and excessive rotation in C-spine

Question 19

What are some safety considerations for HVLA?

Answer 19

pt consent and comfort, accurate diagnosis, minimum force necessary, hypermobile joint, excessive treatment

Question 20

What are some absolute contraindications for HVLA?

Answer 20

local cancer, local osseous ligamentous disruption, osteoporosis, RA, down’s syndrome, osteomyelitis, spinal cord dx, pt refusal, fracture, joint infection, chiari malformation, etc.

Question 21

What are some relative contraindications for HVLA?

Answer 21

acute herniated nucleus pulposis, acute radiculopathy, acute injury, osteopenia, spondylolisthesis, metabolic bone disease, hypermobility syndromes, joint replacement or other implant

Question 22

Describe HVLA supine T-spine

Answer 22

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

Question 23

Describe HVLA prone for type 1

Answer 23

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

Question 24

Describe HVLA prone for type 2

Answer 24

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

Question 25

Describe seated lower t-spine HVLA

Answer 25

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

Question 26

Describe seated 1st rib inhalation dysfunction HVLA

Answer 26

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

Question 27

Describe ribs 3-10 bucket handle inhalation dysfunction HVLA

Answer 27

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

Question 28

Describe ribs 3-10 bucket handle exhalation dysfunction HVLA

Answer 28

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