HVLA - Lumbar, Sacrum, & Innominate Flashcards
HVLA: Superior Innominate Shear
Position • Patient: supine, feet off end of table • Physician: at the foot of the table Hand Position • Grasps patient’s tibia and fibula superior to the ankle Technique • Internally rotate and abduct the patient’s leg • Lean back to induce axial traction • Instruct the patient to inhale and exhale slowly over 2-3 cycles and gently increase traction on exhalation • Exert an axial high velocity, low amplitude thrust • Recheck innominate findings
HVLA: Inferior Innominate Shear
Position • Patient: lateral recumbent, affected side UP • Physician: behind the patient Hand Position • Cephalad hand: PSIS • Caudad hand: ASIS Technique • Provide lateral distraction to gap the SI joint, then cephalad force • Instruct the patient to inhale and exhale slowly over 2-3 cycles and gently increase force on exhalation • Exert a cephalad HVLA force through the ASIS and PSIS contacts • Recheck innominate findings
HVLA: Inferior Innominate Shear
Position • Patient: lateral recumbent, dysfunctional side UP • Physician: stand facing the patient Hand Position • Monitor lumbosacral junction Technique • Patient straightens bottom leg, and places foot of top leg just distal to popliteal fossa of the bottom leg • Cephalad hand monitors the SI joint • Caudal forearm is placed inferior aspect of the ipsilateral ischial tuberosity • Roll pelvis anterior to induce axial rotation until movement of the SI joint is palpated
HVLA Anterior Innominate Rotation
Position
• Patient: lateral recumbent, PTP
side UP
• Physician: stand facing the patient
Hand Position
• Cephalad hand: between L5 & S1
spinous process
• Caudal hand: flex patient’s hips
and knees until L5 & S1 spinous
processes separate Technique
• Drop the patient’s top leg off of the table
• Cephalad hand moves to antecubital fossa, with forearm on shoulder
• Caudal forearm is placed along the pelvis between the PSIS and trochanter
• Roll pelvis anterior to induce axial rotation until movement of the SI joint is palpated
• High velocity, low amplitude force is delivered with caudal forearm, directed down the shaft of the femur
• Recheck innominate findings
HVLA Posterior Innominate Rotation
Position
• Patient: lateral recumbent, PTP
side UP
• Physician: stand facing the patient
Hand Position
• Cephalad hand: between L5 & S1
spinous process
• Caudal hand: flex patient’s hips
and knees until L5 & S1 spinous
processes separate Technique
• Patient straightens bottom leg, places foot of top leg just distal to popliteal fossa of the bottom leg
• Cephalad hand moves to antecubital fossa, forearm on shoulder
• Caudad forearm on the PSIS and iliac crest
• Roll pelvis anterior to induce axial rotation until movement of the SI joint is palpated
• High velocity, low amplitude force is delivered with caudad forearm, directed towards the umbilicus
• Recheck innominate findings
HVLA Pubic Restrictions
Position
• Patient: supine, hips and knees
flexed with feet flat on table
• Physician: standing on either side
of patient Technique
• MET, alternating between
• ABduction of the knees with
forearm between the knees, patient force towards ADduction
• ADduction of the knees with knees squeezed together, patient force towards ABduction
• With final ABduction cycle, induce a high velocity, low amplitude thrust towards further abduction, while patient is still adducting
• Recheck pubic tubercle findings
HVLA Bilateral Sacral Flexion
Position
• Patient: Prone
• Physician: Beside patient
Set Up
• Monitor each SI joint, abduct the leg until motion is palpated, and
internally rotate
Hand Position
• Heel of physician’s hand is on the apex of the sacrum. Technique
• Have patient breathe in and out several times, each time accentuating inhalation and resisting exhalation to reach the barrier
• As the patient inhales (on the final cycle), apply an anterior/superior HVLA thrust
• Recheck sacral findings
HVLA Bilateral Sacral Extension
Position
• Patient: Prone, sphinx position
• Physician: Beside patient
Set Up
• Monitor each SI joint, abduct the leg until motion is palpated, and
externally rotate
Hand Position
• Heel of physician’s hand is on the base of the sacrum.
Technique
• Have patient breathe in and out several times, each time accentuating exhalation and resisting inhalation to reach the barrier
• As the patient exhales (on the final cycle) apply an anterior/inferior HVLA thrust
• Recheck sacral findings
HVLA: Right on a Left Axis Sacral Torsion
Position
• Patient: supine with hands clasped together behind neck
• Physician: on side of involved axis
Set Up
• Sidebend patient’s lower extremity and torso away, creating a “C-shape”
Hand Position
• Thenar eminence of caudal hand on patient’s ASIS on side opposite the axis
• Cephalad hand grasping the patient’s lateral distal bicep
Technique
• Using cephalad hand, physician induces rotation of upper torso as far as possible into barrier by pulling opposite elbow towards self, while stabilizing and preventing motion at opposite ASIS with caudal hand.
• During exhalation, apply a rotational thrust of the patient’s upper body while simultaneously stabilizing the opposite ASIS.
• Recheck sacral findings.
L1–L5 “Extension/Neutral” Dysfunctions; Long- Lever, Rotational Emphasis; Ex: L4 NSLRR, “Walk-Around”
Position
• Patient: supine with hands clasped together behind neck
• Physician: standing opposite of
PTP Set Up
• Monitor at segment and sidebend the patient towards the restrictive barrier (Making a “C” away from the physician)
Hand Position
• Cephalad hand grasping the patient’s lateral distal bicep
• Caudal hand stabilizes the patient’s opposite ASIS Technique
• Rotates the patient’s trunk with cephalad hand into the rotational barrier towards self.
• On exhalation, exert a rotational thrust through barrier with cephalad hand, while stabilizing ASIS with caudal hand.
• Recheck lumbar findings.
HVLA: Type-1 Lumbar, Lateral Recumbent
Position
• Patient: lateral recumbent, PTP UP
• Physician: facing patient
Hand Position
• Monitor at apex of curve with caudal hand.
Technique
• Grasp patient’s bottom arm, and pull anterior to rotate to the dysfunction and cephalad to engage sidebending. Switch monitoring hands.
• Flex hips and knees until motion is felt under monitoring hand. Patient straightens bottom leg, and places top foot in bottom leg’s popliteal space.
• Cephalad arm against patient’s anterior shoulder
• Caudal forearm contacts along the line between the patient’s PSIS and greater trochanter.
• Simultaneously, push shoulder posterior and roll pelvis anterior to engage the restrictive barrier. Patient is instructed to inhale deeply.
• At end of exhalation, deliver a rotational thrust by rotating patient’s hip forward/anteriorly.
• Recheck lumbar findings.
HVLA: Type-2 Lumbar, Lateral Recumbent
Position
• Patient: lateral recumbent, PTP
side UP
• Physician: facing patient
Hand Position
• Monitor spinous process of dysfunction and below with caudal
hand.
Technique
• Grasp patient’s bottom arm, and pull anterior to rotate to the dysfunctional segment and caudally to engage sidebending. Switch monitoring hands.
• Flex hips and knees until motion is felt at monitoring hand.
• For Extended dysfunctions, leave bottom leg slightly bent, with superior leg crossed over the bottom.
• For Flexed dysfunctions, patient straightens bottom leg and places top foot into bottom leg’s popliteal space.
• Caudal forearm contacts posterior aspect of the patient’s pelvis spanning from the SI joint to the greater trochanter.
• Cephalad arm contacts patient’s anterior shoulder.
• With the caudal forearm, roll pelvis anteriorly to engage the restrictive barrier. Patient is instructed to inhale deeply.
• At the end of exhalation, exert a rotational thrust through the barrier by rotating the patient’s pelvis forward and towards the table.
• Recheck lumbar findings.
