HVLA of the Innominate, Sacrum, and Lumbar Spine Flashcards
HVLA Superior Innominate Shear
Position:
Patient supine, with feet off end of table
Doc at foot of table
Hand position: -Grasp patient’s tibia and fibula superior to the ankle
Technique: -Internally rotate and abduct patient’s leg (lean back to induce axial traction) - Instruct 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
HVLA Inferior Innominate Shear
Position: -Patient lateral recumbent (AFFECTED SIDE UP)
-Physician behind patient
Hand position: -Cephalad hand: PSIS -Caudad hand: ASIS
Technique:
- Provide lateral distraction to gap the SI joint, then cephalad force
- Instruct patient to inhale and exhale slowly over 2-3 cycles and gently increase force on exhalation
- Exert a cephalad HVLA force through ASIS and PSIS
- Reassess
HVLA Inferior Innominate Shear
Position:
- Patient lateral recumbent with affected side up
- Doc stands facing patient
Hand position: -Monitor lumbosacral junction
Technique:
- Patient straightens bottom leg and places foot on top of leg just distal to popliteal fossa of bottom leg
- Cephalad hand monitors SI joint
- Caudal forearm is placed inferior aspect of ipsilateral ischial tuberosity
- Roll pelvis anterior to induce axial rotation until movement of SI joint is palpated
- HVLA force delivered with caudal forearm parallel to table (in cephalad direction)
- Reassess
HVLA Anterior Innominate Rotation
Position:
- Patient lateral recumbent, PTP side up
- Doc stands facing pt
Hand position:
- Cephalad hand: between L5 and S1 spinous process
- Caudad hand: flex patient’s hips and knees until L5 and S1 spinous processes separate
Technique:
- Drop patient’s top leg off table
- Cephalad hand moves to antecubital fossa with forearm on shoulder
- Caudal forearm placed along the pelvis between PSIS and trochanter
- Roll pelvis anterior to induce axial rotation until movement of SI joint is palpated
- HVLA force applied with caudal forearm directed down the shaft of the femur
- Reassess
HVLA Posterior Innominate Rotation
Position:
- Patient lateral recumbent, PTP side up
- Doc stands facing patient
Hand position:
- Cephalad hand: between L5 and S1 spinous process
- Caudad hand: flex patient’s hips and knees until L5 and S1 spinous processes separate
Technique:
- Patient straightens bottom leg
- Places foot of top leg just distal to popliteal fossa of bottom leg
- Cephalad hang moves to antecubital fossa, forearm on shoulder
- Caudad forearm on PSIS and iliac crest
- Roll pelvis anterior to induce axial rotation until movement of SI joint is palpated
- HVLA force delivered with caudad forearm, directed towards umbilicus
- Reassess
HVLA Pubic Restrictions
Position:
- Patient supine, hips and knees flexed with feet flat on table
- Doc stands on either side of patient
Technique:
- MET, alternating between ABduction of knees with forearm between knees, patient force towards ADduction or ADduction of knees with knees squeezed together, patient force towards ABduction
- With final ABduction cycle, induce HVLA thrust towards further ABduction while patient is still ADducting
- Reassess
HVLA Bilateral Sacral Flexion
Position:
- Patient prone
- Physician beside patient
Set up:
- Monitor each SI joint
- ABduct the leg until motion is palpated, then internally rotate Hand position
- Heel of doc’s hand is on apex of sacrum
Technique:
- Have patient breathe in and out several times, each time accentuating inhalation and resisting exhalation to reach the barrier
- As patient inhales (on final cycle), apple anterior/superior HVLA thrust
- Reassess
HVLA Bilateral Sacral Extension
Position:
- Patient prone, sphinx position
- Doc beside patient
Set up:
- Monitor each SI joint
- ABduct leg until motion is palpated, then externally rotate
Hand position:
-Heel of doc’s hand is on base of sacrum
Technique:
- Have patient breathe in and out several times, each time accentuating exhalation and resisting inhalation to reach barrier
- As patient exhales (on final cycle) apply anterior/inferior HVLA thrust
- Reassess
HVLA Right on Left Axis Sacral Torsion
Position:
- Patient supine with hands clasped behind neck
- Doc on side of involved axis
Set up:
-Sidebend patient’s lower extremity and torso away, creating C shape
Hand position:
-Thenar eminence of caudal hand on patient’s ASIS on side opposite axis -Cephalad hand grasping patient’s lateral distal bicep
Technique:
- Using cephalad hand, doc 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 w/ caudal hand
- During exhalation, apply rotational thrust of patient’s upper body while simultaneously stabilizing opposite ASIS
- Reassess
HVLA: Type 1 Lumbar, Lateral Recumbent
Position:
- Patient lateral recumbent with PTP up
- Doc facing patient
Hand Position:
- Monitor at apex of curve w/ caudal hand
Technique:
- Grasp patient’s bottom arm and pull anterior to rotate to 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 patient’s PSIS and greater trochanter
- Simultaneously, push shoulder posterior and roll pelvis anterior to engage restrictive barrier. Patient is instructed to inhale deeply
- @ end of exhalation, deliver rotational thrust by rotating patient’s hip forward/anteriorly
- Reassess
HVLA Type 2 Lumbar, Lateral Recumbent
Position:
- Patient is lateral recumbent, PTP side UP
- Doc facing patient
Hand position:
-Monitor spinous process of dysfunction with caudal hand
Technique:
- Grasp patient’s bottom arm and pull anterior to rotate the dysfunctional segment and CAUDALLY to engage sidebending. Switch monitoring hands
- Flex hips and knees until motion is felt @ monitoring hand
- For EXTENDED dysfunctions, leave bottom leg slightly bent with superior leg crossed over bottom
- For FLEXED dysfunctions, patient straightens bottom leg and places top foot into bottom leg’s popliteal space
- Caudal forearm contacts posterior pelvis (spanning from SI joint to greater trochanter)
- Cephalad arm contacts anterior shoulder
- With caudal forearm, roll pelvis anteriorly to engage restrictive barrier. Pt inhales deeply
- @ end of exhalation, exert a rotational thrust thru barrier by rotating patient’s pelvis forward and towards the table
- Reassess
- L1-L5 Extension Neutral SD Long Lever Rotational Emphasis (walk around)
