Lab 7: Thoracic and Rib HVLA

Question 1

What soft tissue prep techniques can you do for the thoracic spine?

Answer 1

Prone Kneading
Lateral Recumbent Technique
Prone Pressure with counterpressure

Question 2

Prone kneading

Answer 2

1. Stand opposite of side to be treated
2. Place thenar and hypothenar eminence on opposite paravertebral muscles.
3. Apply ventral and lateral force while keeping elbow straight

do not slide

Question 3

Lateral recumbent technique

Answer 3

1. Patient lateral recumbent facing you.
2. Place hands under the humerus and on the paravertebral muscles
3. Apply anterior and lateral force

do not slide

Question 4

Prone pressure with counterpressure

Answer 4

1. Place caudad thenar eminence on opposite PV muscles (facing cephalad) and cephalad hypothenar eminence on same side PV muscles (facing caudad)
2. Apply gentle anterior force (rhythmically for soft tissue or hold for MFR)
3. Reverse hands and repeat

Question 5

HVLA Supine T Spine (Kirksville crunch)

Answer 5

1. Supine patient, stand opposite of PTP
2. Patient hugs themselves with PTP side arm superior
3. Caudal thenar eminence on PTP w/ patient elbows against upper abdomen
4. Use cephalad hand to take opposite of R and F/E dx and sidebend accordingly (away for Type 1 and toward for Type 2)
5. Pt inhales and exhales, at the end of the exhale, put anterior to posterior thrust through abdomen toward the PTP
6. Slow return to neutral
7. Reassess

Question 6

HVLA Prone (Texas Twist)
Type 1 SD

Answer 6

1. Patient prone, sand on same side as PTP
2. PTP pisiform faces caudal, opposite thenar faces cephalad
3. Patient inhales and exhales, follow their motion on exhalation and downward thrust (greater force on PTP side)
4. Reassess

Question 7

HVLA Prone (Texas Twist)
Type 2 (Flexed) SD

Answer 7

1. Patient prone, stand on opposite side as PTP
2. PTP thenar faces cephalad, opposite pisiform faces caudad
3. Patient inhales and exhales, follow their motion on exhalation and downward thrust (greater force on PTP side)
4. Reassess

Question 8

Seated Lower T Spine HVLA

Answer 8

1. Step away from the PTP. Pt hand grasps PTP neck side while other hand grabs the other arm

Type 1: hand over 1 bicep
Type 2: hand over both biceps

Other thenar eminence on dysfunctional PTP

3. Pull patient in dx direction while putting anterior thrust on PTP
4. Reassess

Question 9

Seated 1st rib inhalation (J stroke)

Answer 9

1. Patient seated
2. Place foot on opposite side of rib and patient drapes arm over your knee.
3. Ipsilateral hand grabs 2nd MCP joint while other hand on top of head
4. Sidebend toward dysfunctional rib
5. Inhale, exhale > load the 1st rib and thrust inferior, medial and slightly anterior
6. Reassess

Question 10

Ribs 3-10 Bucket Handle Inhalation

Answer 10

1. Supine, stand opposite of rib to be treated
2. Cross arms, side of dysfunction superior
3. Caudal thenar on superior angle of rib
   Cephalad hand flexes/elevates patient’s head
4. Adjust elbows against yourself to localize tx on rib
5. Inhale/exhale 1 > load
   exhale 2 > posterior and superior thrust (brings it down)
6. Reassess

Question 11

Ribs 3-10 Bucket Handle Exhalation

Answer 11

1. Supine, stand opposite of rib to be treated
2. Cross arms, side of dysfunction superior
3. Caudal thenar on inferior angle of rib
   Cephalad hand flexes/elevates patient’s head
4. Adjust elbows against yourself to localize tx on rib
5. Inhale/exhale 1 > load
   exhale 2 > posterior and inferior thrust (brings it up)
6. Reassess