Lab 5: Innominate Dx & Tx HVLA & Review Flashcards
1
Q
What is the HVLA for a Superior Inominate Shear?
A
- Pt is supine w/ feet off end of table and doc at foot of the table
- Grasp pt’s tibia and fibula superior to ankle, IR and ABduct pt’s leg, while leaning back to induce axial traction
- Instruct pt to inhale and exhale slowly over 2-3 cycles and gently increase traction on exhalation
- Exert an axial HVLA thrust
2
Q
What is the HVLA for a Inferior Inominate Shear?
A
- Pt is lateral recumbent w/ affected side up and doc is behind the pt
- Place cephaland hand on PSIS and caudad hand on ASIS. Provide a lateral distraction to gap the SI joint, then cephalad force.
- Instruct the pt to inhale and exhale slowly over 2-3 cycles and gently increase force on exhalation
- Exert a cephalad force through the ASIS and PSIS contacts
3
Q
What is the alternative HVLA technique for a Inferior Inominate Shear?
A
- Pt is lateral recumbent w/ dysfunctional side UP, doc is standing facing the pt.
- Monitor the lumbosacral junction and have pt straighten bottom leg, placing foot of top leg just distal to popliteal fossa of bottom leg.
- Cephalad hand monitors the SI joint and caudad forearm is placed o inferior aspect of the ipsilateral ischial tuberosity. Simultaneously, push shoulder posterior and roll pelvis anterior to induce axial rotation until movement of the SI joint is palpated
- HVLA is delivered w/ caudad forearm, parallel to the table
4
Q
What is the HVLA for a Anterior Inominate Rotation?
A
- Pt is lateral recumbent w/ dysf. side UP and doc standing facing pt.
- Cephalad hand between L5 and S1 SP’s and caudad hand flexes pt’s hips and knees until L5 and S1 SP’s separate.
- Drop the pt’s top leg off the table (foot should NOT touch floor). Cephalad hand moves to antecubital fossa, w/ forearm on shoulder.
- Caudad hand is placed along the femur between the PSIS and trochanter
- Simultaneously, push shoulder posterior and roll pelvis anterior to induce axial rotation until movement of the SI joint is palpated.
- HVLA force is delivered w/ caudad forearm, directed down shaft of femur
5
Q
What is the HVLA for a Posterior Inominate Rotation?
A
- Pt is lateral recumbent w/ dysf. side UP and doc standing facing pt.
- Cephalad hand between L5 and S1 SP’s and caudad hand flexes pt’s hips and knees until L5 and S1 SP’s separate.
- Pt straightens leg, and placs foot of top leg just distal to the popliteal fossa of bottom leg.
- Cephalad hand moves to antecubital fossa, w/ forearm on shoulder and caudad forearm is placed on the PSIS and iliac crest
- Simultaneously, push shoulder posterior and roll pelvis anterior to induce axial rotation until movement of the SI joint is palpated.
- HVLA force is delivered w/ caudad forearm, directed towards the umbilicus
6
Q
What is the HVLA for Pubic Restrictions?
A
- Pt is supine, hips and knees flexed w/ feet flat on table. Doc standing on either side of pt.
- MET, alternating between
- ABduction of the knees w/ forearm between the knees, pt force towards ADduction
- ADduction of the knees w/ knees squeezed together, pt force towards ABduction*
- With final ABduction cycle, induce a HVLA thurst towards further abduction
7
Q
What is the BLT for a Posterior Inominate Rotation?
A
- Pt is seated and doc is seated in front of the pt
- Hold distal tibia or talotibial articulation bilaterally
- Slowly push up (cephald - ease of direction) on affected leg and simultaneously pull down on the contralateral leg. Attain the balance point
- Instruct pt to rotate trunk towards the ipsilateral side until the ipsilateral leg begins to draw upward w/ the motion, attaining the new balance point
- Instruct pt to inhale deeply and hold for 5-10 secs
- Release position and reassess
8
Q
What is the BLT for a Anterior Inominate Rotation?
A
- Pt is seated and doc is seated in front of the pt
- Hold distal tibia or talotibial articulation bilaterally
- Slowly pull down (cephald - ease of direction) on affected leg and simultaneously push up on the contralateral leg. Attain the balance point
- Instruct pt to rotate trunk towards the contralateral side until the contralateral leg begins to draw upward w/ the motion, attaining the new balance point
- Instruct pt to inhale deeply and hold for 5-10 secs
- Release position and reassess
