Lab 3: Innominate/Sacrum/Lumbar HVLA

Question 1

How to perform Superior Innominate Shear HVLA?

Answer 1

• IR and ABduct affected leg
• Lean back for axial traction and have pt breath over 2-3 cycles
• On final cycle exert an axial thrust

Question 2

How to perform Inferior Innominate Shear HVLA?

Answer 2

• Pt is LR w/ affected side UP; doc stands behind pt
• Cephalad hand on PSIS and caudad hand on ASIS
• Provide lateral distraction to gap SI joint, then cephalad force
• Pt breaths for 2-3 cycles and on final cycle exert cephalad HVLA force through the ASIS and PSIS

Question 3

How to perform Anterior Innominate Rotation HVLA?

Answer 3

• Pt LR, affected side is UP
• Cephalad hand btw L5/S1 SP and caudal hand flexes pt’s hips and knees until L5/S1 SP’s separate
• Drop pt’s top leg off table and doc’s cephalad hand move to antecubital fossa with forearm on shoulder
• Caudal forearm placed along pelvis btw PSIS and trochanter; pt’s pelvis rolled anterior
• HVLA is delivered w/ caudal forearm down shaft of femur

Question 4

How to perform Posterior Innominate Rotation HVLA?

Answer 4

• Pt LR w/ dysf. side UP; doc is facing the pt
• Monitor btw L5/S1 while flexing pt’s hips and knees until you feel separation
• Pt straighten bottom leg, placing foot of top leg in popliteal fossa of bottom leg
• Doc’s cephalad hand moves to antecubital fossa and caudad forearm on PSIS and iliac crest
• Push shoulder posterior and roll pelvis anterior; HVLA force is directed towards the umbilicus

Question 5

How to perform HVLA for backward sacral torsion?

Answer 5

• Pt supine w/ hands behind head; doc on side of involved axis.
• SB pt’s torso and LE away creating “C-shape.”
• Thenar eminence of caudal hand stabilizes opposite ASIS; cephalad hand grasps pt’s lateral distal bicep
• Induce rotation of upper torso; HVLA thrust is done by further rotation torso + posterior thrust on ASIS

Question 6

How to perform HVLA for L1–L5 “Extension/Neutral” Dysfunctions; Long-Lever, Rotational Emphasis; “walk-around”

Answer 6

• Pt supine w/ hands behind head and doc is opposite the PTP
• Monitor segment and SB pt toward the RB = “C-shape” toward doc
• Stabilize ASIS and rotate pt toward doc; on exhalation exert rotational thrust thru barrier while stabiling ASIS

Question 7

How does the direction in which you pull the pt’s arm differ for a Type-1 lumbar vs. Type-2 lumbar HVLA tx?

Answer 7

• Type 1: pull pt’s bottom arm anteriorly to rotate to the dysf and cephalad to engage SB
• Type 2: pull pt’s bottom arm anteriorly to rotate to the dysf and caudally to engage SB

Question 8

How does pt’s leg/foot position change for extended vs. flexed dysfunctions when doing HVLA for type-2 lumbar dysf?

Answer 8

• Extended dysf, leave bottom leg slightly bent w/ top leg cross over the bottom
• Flexed dysf, pt straightens bottom leg and places top foot into bottom leg’s popliteal space

Question 9

Where is the point of contact on the pelvis when performing HVLA for a type-1 vs. type-2 lumbar dysf?

Answer 9

• Type 1: caudal forearm contacts along the line btw pt’s PSIS and greater tronchanter
• Type 2: caudal forearm contacts posterior aspect of the pt’s pelvis spanning from the SI joint to greater trochanter