Intro to HVLA Flashcards
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
High velocity low amplitude (aka thrust technique)
To perform HVLA, physician localizes to _____ barrier, then through the ____ barrier into the _____ barrier
Restrictive; restrictive; elastic
____ barrier = end ROM achieved during active motion in the absence of SD
Physiologic barrier
____ barrier = end ROM achieved during passive motion in absence of SD
Anatomic
_____ barrier = a functional limit that abnormally diminishes the normal physiologic range
Restrictive
What type of end feel is targeted for HVLA treatment?
Firm and distinct - typically mechanical type arthrodial dysfunction
[HVLA is particularly effective when there is a distinctive barrier with a firm end feel]
What type of end feel is felt with reflex somatic dysfunction?
Rubbery
T/F: HVLA is an indirect technique
False - direct
Physical exam of ____ and _____ of movement allow examiner to determine and define patient’s restriction of motion
Quality; quantity
Neurophysiology of somatic dysfunction:
Local segmental ______ —> focal ______ and swelling —> tightening of ______ and capsular components of arthrodial joint —> reflex ________ of muscles crossing joint —> _____ changes —> somatic dysfunction
Irritation; edema; myofascial; hypertonicity; TART
Neurophysiology of HVLA:
Thrust through _______ —> restoration of motion at articulation —> restoration of normal ______ input —> reflex ______ of muscles —> improvement of ____ findings
Restrictive barrier; proprioceptive; relaxation; TART
T/F: joint noise is NOT necessary for successful treatment with HVLA
True - must reasses to determine tx success
What are some hypotheses as to where joint noise comes from during HVLA tx?
Eventration of gas into synovial fluid with breaking of surface tension
Snapping/releasing of ligamentous adhesions in the joint
Ballooning of joint capsule
Bone itself being pulled out of place and snapping back into neutral position
Dysfunctional segments are NOT labeled subluxed, “out of place”, “out of joint”, or dislocated. As osteopaths, we do NOT adjust or “put back into place”
What is the goal of OMT?
Goal is to restore motion loss and restore neutral point back to normal
Why is initial positioning crucial for physician and patient prior to performing HVLA?
For physician - frees up cortex to diagnostic input from hands and fingers; physican may consider applying techniques for relaxation such as MFR, soft tissue, or MET prior to HVLA
Patient - allows for muscular relaxation prior to thrust
What makes up a vertebral unit?
2 adjacent vertebrae with their associated disc, arthrodial, ligamentous, muscular, vascular, lymphatic and neural components
Based on the concept of vertebral units, you would treat an L3 SD as it articulates with _____
Forces will be localized at _____ joints between the two vertebrae
L4
Facet (aka zygopophyseal)
[so always treat segment below]
To engage the barrier:
Forces are applied from the top down through the superior vertebra — “______ the dysfunction”
Forcs are applied from the bottom up through the inferior vertebra — “____ the dysfunction”
Other vertebrae of the unit is used as an opposing _____
Through
To
Counterforce
Typical vertebrae C2-L5 are assessed and treated in 3 planes of motion, thus HVLA is utilized by ______ restrictive barriers in all three planes
Stacking
______ restriction = typically restricted in one major and an associated minor motion
Appendicular
In utilizing HVLA for an appendicular restriction, HVLA typically focuses on _____ joint motion restriction
Minor
[so in a flexed SD at the knee, HVLA focuses on posterior tibiofemoral glide SD]
Engaging force must be maintained once all RBs are stacked. Forces that do not accumulate at SD dissipate into adjacent structures leading to unwanted _____ effects. If the force is lost thrust must not be performed
Iatrogenic
Once barriers are engaged, a short, rapid thrust with sudden acceleration and deceleration is used to correct the SD. Should force be released prior to thrust?
No
How are release enhancing mechanisms useful for HVLA?
Exhalation muscle relaxation makes the thrust more effective
In some cases, speed and force may be modified to fit patient’s need. Well engaged dysfunctions may have an audible click prior to thrust, indicating effective treatment
