Lab 2.1: L-spine and C-spine HVLA

Question 1

Lumbar HVLA supine: “OB Roll” or “Walk-Around?”

Answer 1

• Pt is supine w/ hands behind head
• Doc stands opposite the PTP, monitors at segment and side-bends the trunk to the RB until motion felt at dysf. segment
• Place cephalad hand thru pt’s contralateral arm and rest the dorsum of hand of pt’s sternum.
• Caudad hand blocks linkage at pt’s ASIS on opposite side
• Doc rotates trunk into the rotational barrier (toward doc) and on exhalation, exerts a rotational thrust through barrier

Question 2

Lumbar HVLA Type I: Neutral SD

Answer 2

• Pt lateral recumbent, PTP UP, doc faces patient and monitors apex of curve w/ caudad hand while grasping pt’s bottom arm and pulling anterior to rotat to the dysf and cephalad to engage side-bending
• Swithc monitoring hands and flex hips/knees until motion is felt.
• Pt instructed to straighten bottom leg while doc maintains position of top leg and then places top foot in popliteal space of bottom leg
• Doc positions cephalad arms against pt’s anterior shoulder and caudad forearm contacts between PSIS and greater trochanter
• Doc induces posterior rotation at pt’s shoulder, while bringing hip anteriorly to barrier
• Pt inhales deeply and then at end of exhalation doc exerts rapid rotational thrust by rotating pt’s hip forward and towards the table, while moving shoulder posteriorly

Question 3

Lumbar HVLA Type II: Flexion or Extension SD

Answer 3

• Pt lateral recumbent, PTP Up, doc facing patient, monitoring seg. w/ caudad hand. Cephalad hand pulls pt’s bottom arm anterior to rotate to dysf. seg. and caudad to engage side-bending
• Switch monitoring hands, flex hips/knees until motion is felt (~90°). Pt instructed to straighten bottom leg and doc drops top leg off the table or have pt hook their foot in bottom leg popliteal space
• For Flexion SDusetorso to engage ext. barrier
• For Extension SD use legs to engage the flexion barrier
• Doc’s caudad forearm contacts posterior aspect of pt’s hip and cephalad arm contacts pt’s anterior shoulder
• Induce posterior rotation at pt’s shoulder to dysf. segment, while hip is brought anteriorly to barrier. On exhalation, exert a rapid rotational thrust thru barrier by rotating pt’s pelvis forward and toward table

Question 4

Cervical HVLA: OA SD with a DX: OA E Rr Sl?

Answer 4

• Contact right posterior occiput posterior to, but not on, mastoid process
• Cradle head w/ left hand, sidebend OA joint right, rotate left and engage RB and add localizing cephalad directed traction
• At the end of exhalation, perform HVLA thrust medially (left), anteriorly, and superiorly

Question 5

Cervical HVLA: AA SD with a DX: AA RL?

Answer 5

• Cradle head in hands, contacting left lateral mass of atlast w/ lateral margin of left index finger
• Flex the c-spine towards a straighter alignment and allow minimal ext. to localize to the monitoring index finger
• Rotate head right to the RB
• Instruct pt to inhale deeply and at end of exhalation apply HVLA rotational thrust

Question 6

Cervical HVLA: C2-C7 rotational emphasis; DX: C4 E RrSr?

Answer 6

• Pt supine, doc seated at head of table. Doc’s index finger pad (straight bridge) or 2nd MCP is placed behind articular pillar on the side of the PTP to restrict motion at that segment. Other hand supports pt’s head
• Flex head until motion is idenitified at C4, then allow head to move into slight ext.
• Sidebends towards the freedom and Rotates to the RB
• Apply a thrust in the rotational plane of C4 with the contact on the posterior transverse process

Question 7

Cervical HVLA: C2-C7 sidebending emphasis; DX: C3 E RrSr?

Answer 7

• Pt is supine and doc stands or sits at head of table
• Doc’s 2nd MCP joint contacts tip of TP of C3 on left
• Flex the C-spine through the C3-C4 interspace
• Rotate towards freedom (R in this case) TO C3-C4 interspace (NOT THROUGH).
• Sidebend towards RB (L in this case) THROUGH and including C3-C4 interspace
• Thrust in the sidebending plane toward the T1 spinous process (or sternal notch)

Question 15

What is the rays of the sun approach to direction of thrust for the cervicals?

Answer 15

• Upper cervicals thrust toward the eye
• Middle cervicals thrust is straight across neck
• Lower cervicals thrust is directed down toward the chest

Question 16

When diagnosing the OA joint what mechanics does it follow?

Answer 16

• Type I like
• Has a flexion and extension component

Question 17

What is critical to do when diagnosis the AA joint?

Answer 17

FULLY FLEX!

Question 18

When testing sidebending if the segment is hard to push from right to left, which was is it sidebent?

Answer 18

Sidebent Right