Intro to HVLA Flashcards
When was the first documented HVLA treatment?
2700 bce (earliest Chinese recordings)
What physician, besides AT Still, promoted HVLA?
Dr. Palmer (opened Palmer School of Chiropractic Medicine in 1892)
Who furthered HVLA techniques?
Dr. Hulett
Dr. Hazzare
Dr. McConnell
What is the definition of HVLA?
thrusting technique
employs a rapid, therapeutic force of brief duration that travels a short distance w/ in anatomic range of a joint & engages the restrictive barrier to elicit release
What force do you use in HVLA?
minimum amount of force required for release of 1 localized segment
What is most important in HVLA?
more precise localization of positioning, less force is needed
When can tears during muscle stretching occur?
before anatomic barrier is met
Quantity in ROM
determined by amount of movement available from neutral position
What do you look for in HVLA?
end feel in ROM that is firm & distinct
What does rubbery end feel indicate?
typically from muscle, fascia, or reflex
What is HVLA?
a joint release technique
Indications for HVLA
dysfunction localized to a joint
distinctive barrier w/ firm or hard end feel
Mechanism of treatment w/ HVLA
thrust thru restrictive barrier
restoration of motion @ articulation
restoration of normal proprioceptive input
reflex relaxation of muscles
improve TART findings
What is the barrier positioning in HLVA?
localize firmly against restrictive barrier
moves thru restrictive barrier into elastic barrier to restore motion
Is noise in HVLA necessary for success?
NO!
What is the goal of OMT?
restore or augment tissue function
Steps for HVLA
diagnose SD
provide soft tissue prep
localize force to segment or joint
release enhancing maneuver
accumulation of forces
corrective thrust
return to neutral
reassess
What is the purpose of soft tissue preparation?
reduces risk of soft tissue injury
increases pt confidence in physician
Why should physician be relaxed during HVLA?
free up cortex to receive kinesthetic input from hands & fingers (can think about what you are feeling more)
relaxed muscles better for rapid contraction
Why should pt be relaxed during HVLA?
muscle relax prevents tensing that can interfere w/ correction
reduces risk of muscle or tendon injury
What is localization of HVLA?
engagement & stacking of barriers
Where can you treat in all 3 planes of motion?
the spine
Where is the HVLA force localized on vertebrae?
forces localized to facet joints between 2 vertebrae (L3 SD on L4)
What occurs during accumulation of forces?
move firmly against barrier on pt exhalation
When should you not continue to thrust?
if localization to barrier in 1 of the planes is lost
What is the direction of your thrust?
towards the culmination of all planes of motion
What are the general rules regarding OMT dosage?
more acute or sick, less the dose
older pts respond more slowly
usually do not thrust the same segment more than once a week
decrease treatment as pt improvement duration increases
Benefits of HVLA
time efficient
well tolerated
pt usually experiences immediate relief, decreased pain & increased ROM
Indications for HVLA
SD
articular SD
joint motion restriction
When is HVLA super helpful?
adhesive capsulitis
chronic dysfunction
modify reflexes
hypomobile joints
restore alignment
reduce meniscus entrapment
pain modulation
What is significant about OMT safety & efficacy?
OMT is one of safest procedures in medicine
How to minimize injury w/ HVLA?
take thorough history
careful PE
use minimal amt of force
What is a major precaution for cervical spine?
avoid hyperextension & excessive rotation
“Absolute” contraindications for HVLA
local cancer ligament disruption RA Down Syndrome Osteomyelitis Spinal cord Dx
What is the most important absolute contraindication for OMT/HVLA?
pt refusal
What are relative contraindications for HVLA?
acute herniated nucleus pulposus acute radiculopathy acute injury osteoporosis spondylolisthesis metabolic bone disease hypermobile syndromes
What are some precautions for HVLA?
apprehension by pt
mild to moderate strain or sprain in area being treated
When would you avoid compression?
mild osteopenia or osteoporosis
