Intro to HVLA

Question 1

muscle energy defined

Answer 1

form of OMT where patients muscles are actively used on request

Question 2

what did AT still say about ME

Answer 2

need to restore muscle and ligaments before joint

Question 3

who held a 5 day tutorial in 1970 described as ME

Answer 3

Fred Mitchell Sr.

Question 4

muscle energy is what kind of technique

Answer 4

direct and active

Question 5

benefits of ME

Answer 5

mobilize restricted joints and tissues
stretch tight muscles and fascia
decrease hypertonicity
lengthen fibers
improve circulation
balance neuromuscular relationships
strengthen weaker side of asymmetry
make patient feel better

Question 6

advantage of ME over HVLA

Answer 6

gentle technique, safer, geriatric pt, osteoporosis or risks

Question 7

contradictions of ME

Answer 7

open wounds
broken bones
uncoop patients
unresponsive patients
severe pain in muscle group utilized

Question 8

indications of ME

Answer 8

somatic dysfunction
segmental or regional somatic dys
good for chronic pain, tight hamstrings etc
useful in torticollis

Question 9

where is patient providing force

Answer 9

away from restriction/barrier

Question 10

post isometric relaxation

Answer 10

neuromuscular bundle in refractory state immediately after contraction
aollows passive stretching to occur without reflex opposition

Question 11

reciprocal inhibition

Answer 11

to lengthen shortened muscle

gentle contraction in agonist muscle and relex relaxation of antagonist

Question 12

barrier is 3D, which planes

Answer 12

sagittal, transverse, and coronal
also translator motions: forward, and back
right and left, compression and distraction

Question 13

ME technique specifics order

Answer 13

1) make diagnosis
2) position body part in restrictive barrier
3) patient provides force away from barrier, dr. provides counterforce (isometric contraction)
4) hold 3-5 seconds
5) pt and doctor relax
6) dr. engages new barrier
7) repeat until no new barrier, full ROM, or 3-5 X
8) reassess

Question 14

when is Golgi tendon stretched

Answer 14

whenever muscles contract

Question 15

purpose of Golgi tendon reflex

Answer 15

to prevent tissue disruption

responds to rapid change in length/tension

Question 16

Osteopathic technique employing rapid, therapeutic force of brief duration that travels short distance within the anatomic ROM of a joint and engages restrictive barrier is

Answer 16

thrust technique

Question 17

HVLA technique

Answer 17

direct
passive
move joint in direction of restrictive barrier
immediate restoration in ROM

Question 18

historical perspective HVLA

Answer 18

1970s taught,

AT still: lightning bone setter

Question 19

indications for HVLA

Answer 19

somatic dysfunction

restoration of motion, removal of restrictions

Question 20

verterbral segment

Answer 20

vertebra above and below and disc in between the two

Question 21

accumulation of force at restriction

Answer 21

one force applied to one vertebra other has opposing conterforce to resist inertia of body mass

Question 22

thrust force

Answer 22

applied after the setup is locked against restrictive barrier
-if localization not accurately against restrictive barrier, thrust force will dissipate thrgouh other parts of body = increased risk for iatrogenic side effects

short quick thrust, not too forceful

Question 23

when do you thrust? inhalation or exhalation

Answer 23

end of exhalation

Question 24

neurophysiology of HVLA

Answer 24

sudden stretch activates Golgi to strongly inhibit muscle activity until they equalize
normalize imbalanced afferent input

Question 25

HVLA precaustions/contraindications

Answer 25

• risk-benefit ratio
• neurological complications: vertebral/basilar artery, dens fracture, or dislocation, RA or DS, disc disruption
• joints can be sprained: consider hypermobile joints
• osseous or ligamentous damage
• pathologic fractures: osteoporosis, metastatic disease, arthritic spurs
• psychological contraindications: patient apprehension, patient does not want HVLA

Question 26

JAOA article by Dr. Vick

Answer 26

evaluated injuries from manipulation was 1 and 1 million for all practitioners

Question 27

position paper on OMT of cervical spine, AOA house of delegates

Answer 27

2005, speaks on overwhelming safety of cervical manipulation