Innominate, Sacrum, and lumbar spine HVLA Flashcards
HVLA inferior innominate shear (with forearm)
bend legs
straighten the bottom one and take the top leg and put it in the popliteal fossa
place caudal hand on their rotated shoulder, place inferior forearm on the PSIS
engage the barrier with your forearm, breathe in and out and on exhale give a superior thrust through your forearm
HVLA Bilateral Sacral Flexion
Abduct the leg and internally rotate it on BOTH LEGS –> opening up the posterior side
palpate to the apex of the sacrum
encourage inhalation (extension) and resist exhalation (flexion). inhale, and at the top of inhalation, push anteriorly and superiorly and pop the sacrum backwards.
L1-L5 extension/neutral dysfunction: long lever rotational emphasis –> “Walk around”
YOU’RE STANDING OPPOSITE THE PTP (so L4 NSLRR you’re on their left side)
clasp hands together, behind their head
Make a C shape away!!
caudal hand on the contralateral ASIS
cephalad hand on the underside of the contralateral bicep
rotate them around towards you with your cephalad hand
on exhalation, exert a rotational thrust down towards the floor while stabilizing the ASIS
return to neutral
Right on a left axis sacral torsion HVLA
be on the axis side (so on their left side)
have them put their hands behind their head
put them in a C shape away from you
take your caudal hand on the contralateral ASIS, and cephalad hand on the contralateral underneath bicep
inhale, exhale, and rotate them over towards you into the barrier
inhale, and on exhalation you do a posterior thrust through the ASIS hand and go back to neutral
HVLA Pubic Restriction
bend legs like you would for the pubic muscle energy
start with muscle energy at this location
have them put their knees about 6 inches away and then have them squeeze in and breathe in and out, and you thrust away (quick and small) (abduction motion from you)
HVLA Type 1 lumbar, lateral recumbent?
Lateral recumbent, PTP SIDE UP
you grab their lower arm (elbows grabbing, and you rotate them down to the dysfunctional segment that you’re monitoring with the caudal hand
flex both legs up until you have movement with your bottom hand at the segment
straighten the bottom leg, top leg foot goes in popliteal fossa
to engage the side bending barrier you pull that lower arm UP the head
stabilize the shoulder, caudal forearm on the greater trochanter
breathes out you are doing a rotational thrust
return to neutral slowly
HVLA Inferior Innominate Shear (lateral recumbent with both hands)
Lateral recumbent, affected side UP, have them grab your elbow and you grab their elbow and rotate them a big to get the torso out of the way.
cephalad hand on the PSIS, caudal hand on the ASIS
push in and lift up (technically lateral) to distract the SI Joint
take a deep breath in and out, and on exhalation thrust towards head
HVLA Bilateral Sacral Extension
You have them come up on their elbows in sphinx position (encouraging flexion)
ABDUCTthe legs and EXTERNALLY rotate, opening up the anterior side
on inhalation you RESIST the INHALATION , and follow exhalation you move into flexion.
on final exhale you are giving an anterior and inferior thrust at the BASE of the sacrum
HVLA Posterior Innominate Rotation
1) lateral recumbent, rotate the trunk away using the elbows (same thing)
2) flex the legs up to the SI joint, STRAIGHTEN the bottom leg and hook the top leg in the popliteal fossa
3) the caudal forearm is on the PSIS and iliac crest
4) you’re going to be thrusting towards the umbilicus!
HVLA Anterior Innominate Rotation
affected side up, lateral recumbent, same thing, rotate the torso away through having them grab your elbow
bend the legs to localize to lumbosacral junction. take the top leg and drop it off. (DO NOT STRAIGHTEN LOWER LEG)
cephalad hand is on the shoulder holding it in place
caudal forearm is placed BETWEEN THE PSIS AND TROCHANTER
simultaneously push shoulder posterior and roll pelvis anterior to induce the rotation until SI joint is palpated
HVLA directed with caudal forearm DOWN THE SHAFT of the femur, parallel to the leg that’s off the table.
HVLA Superior Innominate Shear
1) patient is supine, you’re at the foot of the table
2) abduct leg, internally rotate, dorsiflex foot
3) take deep breath in and out
4) exhales, give a short thrust
HVLA: Type 2 Lumbar, Lateral Recumbent
what about if they’re flexed or extended?
PTP up, grab elbow and rotate down to the segment
take their arm and pull it DOWN!!
take their knees and flex them both up till you feel motion
straighten bottom leg COMPLETELY with the top leg’s foot in the popliteal fossa for FLEXION
bend the bottom leg a little bit with the top leg crossed over the bottom and off the table for EXTENDED
deep breath in, as they exhale you apply a ROTATIONAL thrust
return to neutral
