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Colin OSII Final > Intro HVLA > Flashcards

Intro HVLA Flashcards

1
Q

What does HVLA stand for?

A

High Velocity, Low Amplitude

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2
Q

How important has HVLA been historically?

A

HVLA was the major type of technique taught in osteopathic medical colleges prior to the1970’s

After 1970’s, school curriculum’s began expanding to include other modalities

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3
Q

What is HVLA?

A

An osteopathic technique employing a RAPID, therapeutic force of brief duration that travels a SHORT DISTANCE within the anatomic range of a joint and that engages the Restrictive Barrier to elicit release of restriction

Also known as the Thrust Technique

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4
Q

What is the Physiologic Barrier?

A

End Range of Motion achieved during ACTIVE MOTION (patient moving) in the absence of Somatic Dysfunction

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5
Q

What is the Anatomic Barrier?

A

End Range of Motion achieved during PASSIVE MOTION (doctor moving patient) in absence of Somatic DYsfunction

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6
Q

What is the Restrictive Barrier?

A

A functional limit that abnormally diminishes the normal physiologic range of motion

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7
Q

What is a shifted neutral?

A

Neutral is the middle point between the physiologic barriers

When a Restrictive barrier is present, it reduces the range of motion forcing a new middle point, known as the shifted neutral

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8
Q

What is a contraindication of HVLA?

A

Vertebral Artery thrombosis

If patient complains in history of symptoms referable to the vertebral artery, or if there are related physical signs, vertebral artery tests should be conducted

If there is clinical suspicion of vertebral artery compromise by the history and physical findings, then HVLA manipulation of the cervical spine should not be attempted

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9
Q

What is Range of Motion Quantity?

A

ROM Quantity is determined by the amount of movement available from a neutral position

It is evaluated during physical exam

Typically symmetric in a non-dysfunctional joint

Measured in 3 distinct planes of motion

  • Sagittal
  • Coronal
  • Transverse
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10
Q

What is Range of Motion Quality?

A

Refers to palpatory “sense” of how smoothly a joint can be moved through its ROM

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11
Q

What is End Feel?

A

Quality of motion of a joint when it is brought passively to its final barrier of motion

Function of focal tissue turgor and tethering of attached muscles and fascia

Firm and Distinct

Typically mechanical type of arthrodial dysfunction

Rubbery - reflex somatic dysfunction

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12
Q

What kind of technique is HVLA?

A

Direct technique

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13
Q

What are indications for HVLA?

A

Quantity and Quality allow examiner to determine and define Restriction of Motion

HVLA is particularly effective when there is a DISTINCTIVE BARRIER WITH A FIRM END FEEL

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14
Q

What is the mechanism of treatment for HVLA?

A

Perform Soft Tissue treatment prior to performing technique

Ask Permission form Pt is they’re okay with you potentially cracking joints

Thrust through the restrictive barrier

Restoration of motion at articulation

Restoration of normal Proprioceptive Input

Reflex Relaxation of Muscles

Improvement of TART findings

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15
Q

What is the source of the cracking noise heard during HVLA treatment?

A

Source of noise is under debate

  • Eventration of gas into the synovial fluid with the breaking of surface tension
  • Snapping/releasing of ligamentous adhesions in the joint
  • Ballooning of the joint capsule
  • Bone itself being pulled out of place and snapping back into the neutral position
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16
Q

Is the cracking noise necessary for a successful HVLA treatment?

A

NO

17
Q

What is the goal of performing HVLA?

A

OMT’s goal is to restore motion loss and restore neutral point back to normal

18
Q

What is not a dysfunctional segment?

A

When it is:

  • Subluxed
  • Out of place
  • Out of Joint
  • Dislocated
19
Q

As Osteopathic physicians, we DO NOT:

A

Adjust

Put back into place

20
Q

What are the Steps for HVLA?

A

Correctly Diagnose SD

Localize Segment

Engage the Restrictive Barrier in all 3 planes of motion-stacking

Release enhancing maneuver
- Patient Breathing

Mobilize force-corrective thrust

Reassess

21
Q

What is the Vertebral Unit?

A

Two Adjacent vertebrae with their associated disc as well as their:

  • Arthrodial Component
  • Ligamentous Component
  • Muscular Component
  • Vascular Component
  • Lymphatic Component
  • Neural Component
22
Q

Where are forces localized in the vertebral unit?

A

Forces will be localized at Facet Joints between the two vertebrae

23
Q

What are the two approaches to applying forces to engage barrier?

A

Forces are either applied:

  • Top-down through the superior vertebra, “THROUGH the dysfunction”
  • Bottom-up through the inferior vertebra, “TO the dysfunction”
24
Q

How does stacking barriers work?

A

You put patient into 3 planes of restriction:

  • Rotation
  • Side-bending
  • Flexion/Extension
25
Q

Should you perform a thrust without feeling a Hard-End Feel?

A

NO

26
Q

How often should you perform HVLA on a patient?

A

Depends on the patient

Generally:

  • Less frequent on sick patients
  • Older patients responds more slowly
  • Most cases discourage thrusting the same segment more than once a week
  • If the same SD keeps recurring, evaluate and address for underlying inciting factor
27
Q

What are the benefits of HVLA?

A

Well tolerated and time efficient

Modality of choice for SDs with DISTINCT FIRM BARRIER mechanics

Patient typically experiences immediate relief, decreased pain, and increased ROM

28
Q

What are indications for HVLA?

A

Articular somatic dysfunction

Joint motion restriction with a firm articular barrier

When SD is judged to be an actual joint motion restriction, not exclusive soft tissue restriction

In the face of joint fixation

To disrupt connective tissue adhesions

To treat chronic dysfunction resistant to other treatment modalities

To modify reflexes

A maintenance treatment in irreversible situations

HYPOmobile joints

Restoration of bony alignments

Meniscoid Entrapment

Pain modulation

Reprogramming of the CNS

Displaced disc fragment

Reflex relaxation of affected muscles

29
Q

Is manipulation safe?

A

Yes (especially indirect treatments) more safe than most treatments

  • No adverse affects like drugs
  • No risk of infections
30
Q

What are precautions for using HVLA?

A

It is important to conduct a thorough history and physical exam, so you can uncover any contraindications for HVLA

Avoid hyperextension and excessive rotation of the cervical spine

31
Q

What is the Risk:Benefit Ratio?

A

If risk outweighs the benefit of the technique, it is NOT INDICATED

32
Q

When would you not want to perform HVLA?

A

Fracture

Ehlers-Danlos Syndrome (hyper-mobility; lots of connective tissue)

Recovering from surgery

33
Q

Would you perform HVLA on a pt with a herniated disc?

A

It is a relative contraindication

Depends on the patient

34
Q

What are some safety considerations for HVLA?

A

ACCURATE DIAGNOSIS is crucial

Pt’s consent and comfort

Listen with your hands
- If barrier doesn’t feel right, DO NOT THRUST

Excessive force can damage tissue

Hypermobility of the joints could be exacerbated by HVLA

35
Q

What are ABSOLUTE CONTRAINDICATIONS for HVLA?

A

Local Metastases

Osseous or Ligamentous Disruption

Severe osteoporosis

Rheumatoid Arthritis
- Alar ligament instability

Downs Syndrome
- Alar ligament instability

Achondroplastic Dwarfism

Chiari malformation

Osteomyelitis in the area being treated

Joint replacement in the area being treated

Vertebrobasilar insufficiency

Severe Herniated Disc with Radiculopathy

Fracture/dislocation/Spine or joint instability

Ankylosis/Spondylosis with fusion

Surgical Fusion

Klippel-Feil Syndrome

Joint infection

Bony Malignancy

Patient Refusal

36
Q

What are relative contraindications?

A

Acute herniated nucleus palposus

Acute Radiculopathy

Acute Whiplash/severe muscle spasm/strain/sprain

Osteopenia/Osteoporosis

Sponylolisthesis

Metabolic Bone DIsease

Hypermobility syndromes

Apprehension by the Pt
- Always ask permission and explain expectations

Rheumatoid Arthritis disease other than in the spine

Colin OSII Final (5 decks)

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