Lab 3: T-spine and Rib HVLA

Question 1

HVLA supine T-spine (aka Kirksville Crunch)

Answer 1

• Doc opposite PTP, pt crosses arms over chest, with arm on side of PTP on top
• Place thenar eminence of caudal hand on PTP. Pt’s elbows are positioned in doc upper abdomen
• Use cephalad hand/forearm to lift and position pt’s head and neck to localize to the RB (F/E, sidebending, rotation)

Type 1: side bend away from doc

Type 2: side bend towards doc

• Upon exhalation, doc exerts anterior to posterior thrust thru their abdomen toward the PTP

Question 2

HVLA prone T- spine (aka Texas Twist)

Answer 2

• Pt prone, doc opposite the PTP
• Place hands facing opposing directions on either side of SP’s to induce SB into RB

Type 1: Place thenar eminence of cephalad hand on PTP (fingers facing caudad), other hand is opposite

Type 2: Place thenar eminence of caudad hand on PTP (fingers facing cephalad), other hand is opposite

• Have pt inhale and exhale fully, and as pt exhales follow the motion to futher engage barrier
• Apply downward anterior thrust at end of exhalation w/ a counter balance pressure (twist) in the direction fingers are pointing with greater force on PTP side

Question 3

Supine knee fulcrum HVLA: Upper and Middle Thoracics

Answer 3

• Pt supine w/ fingers clasped behind neck. Doc at head of table
• Position ipsilateral knee to the PTP of dysf. vertebrae
• Pass hands thru the pt’s flexed UEs on both sides and encircles the pts rib cage w/ the fingers over the rib angles posterolaterally
• Deep inhale and exhale, at end of exhalation, doc quickly but gently pulls the pt’s chest downward into the thigh, while adding cephalad traction

Question 4

Seated HVLA: Lower Thoracics

Answer 4

• Pt seated w/ ipsilateral hand to the PTP clasped behind their neck and holding that elbow w/ other hand. Doc standing opposite to PTP
• Place your ipsilateral thenar eminence to the PTP of the dysf. vertebrae
• Grasp pt’s biceps, w/ arm orientation dependent on type of SD (Type 1 vs 2) and engage RB in all 3 planes
• Pt inhales and on exhalation the doc quickly and minimally pulls the pt thru the rotational barrier while the thenar eminence imparts an anterior impulse on the PTP

Question 5

HVLA seated knee fulcrum technique?

Answer 5

• Pt seated w/ hands clasped behind their neck. Doc behind pt using a stool for your foot, position ipsilateral knee to the PTP on dysf. vertebrae acting as a fulcrum. Can place pillow between knee and back if necessary
• Pass your hands beneath pt’s arms and then thru their flexed arms to grasp their forearms just proximal to their wrists
• Pt deeply inhales and exhales, at end of exhalation quickly and gently pull the pt superiorly and posteriorly to roll th PTP over your knee

Question 6

Rib HVLA: Upper Ribs 1-4 (Chin Pivot)

Answer 6

• Pt prone w/ doc standing at the head of table - opposite the dysf
• Pt cups chin w// the hand ipsilateral to SD, doc places thenar/hypothenar eminence at the rib dysf. w/ one hand
• Doc moves pt’ elbow cephalad (SB head and neck away) until motion is palpated at dysf.
• Doc places other hand on pt’s head, rotating it toward the side of dysf into the barrier
• Pt inhales and w/ exhalation the doc loads further into barrier. At end of exhalation apply rapid anterolateral thrust on dysf rib

*DO NOT thrust onto the pt’s head - you are only stabilizing the head

Question 7

Seated 1st rib Inhalation Dysfunction HVLA (J stroke)

Answer 7

• Pt seated w/ physician standing behind
• Doc places foot on the table opposite the dysf and pt drapes their arm over doc’s knee
• Doc contacts the dysf. rib w/ the second MCP joint of one han and the top of the pt’s head w/ the other
• Doc engages the barrier by sidebending the head towards the dysf. rib
• At the end of exhalation, doc applies a thrust inferiorly/medially on the superior rib

Question 8

Ribs 3-10 Bucket Handle Inhalation Dysf. HVLA

Answer 8

• Pt supine w/ doc opposite the dysf. rib. Pt crosses arms over body w/ the arm on side of dysf. on top
• Doc places thenar eminence of caudad hand posterior/superior to the dysf. rib angle
• Other hand may be placed on the pt’s elbows or may be used to elevate pts head/neck
• Doc applies a pressure thru the pt’s elbows localizing at the dysf. rib angle
• At end of exhalation apply a posterior thrust directed toward the thenar eminence

Question 9

Ribs 3-10 Bucket Handle Exhalation Dysf. HVLA

Answer 9

• Pt supine w/ doc opposite the dysf. rib. Pt crosses arms over body w/ the arm on side of dysf. on top
• Doc places thenar eminence of caudad hand posterior/inferior to the dysf. rib angle
• Other hand may be placed on the pt’s elbows or may be used to elevate pts head/neck
• Doc applies a pressure thru the pt’s elbows localizing at the dysf. rib angle
• At end of exhalation apply a posterior thrust directed slightly caudal to the doc’s thenar eminence

Question 10

Posterior Rib Head (Modified Kirksville Crunch)

Answer 10

• Pt supine w/ doc opposite side of dysf
• Pt crosses arms over body - arm on side of dysf. grasps opposite ASIS while contralateral arm grasps opposite shoulder
• Doc places thenar eminence of the caudad hand on the angle of the dysf. rib. Other hand may be placed on the pt’s elbows, or may be used to elevate the patient head/neck
• Doc applies a pressure through the pt’s elbows localizing at the dysf. rib
• At end of exhalation, doc applies a posterior thrust directed toward the thenar eminence