Lecture 3: Intro to HVLA Flashcards
What is the definition of HVLA?
Rapid, therapeutic force of brief duration that travels a short distance within the anatomic range of a joint and that engages the restrictive barrier to elicit release of restriction
You will localize to which barrier and then move through which barrier?
Localize to the RB and then move through RB into the PB
The ROM Quantity is measured in?
- Three distinct planes of motion
What does quality refer to in regards to barrier mechanics?
- Palpatory “sense” of how smoothly a joint can be moved through its ROM
What is End feel; when would you feel firm and distinct?
- Quality of a joint when it is brough passively to its final barrier of motion
- Firm and distinct = typically mechanical type arthroidal dysfunction
HVLA is what type of technique?
Direct
What are indications for HVLA; what type of end feel is best?
- Quantity + Quality allow examiner to determine and define restriction of motion
- HVLA is particularly effective when there is a distinctive barrier w/ a firm end feel
What is the neurophysiology of SD?
What is the mechanism for treatment: neurophysiology of HVLA?
What is OMT’s goal?
Restore motion loss and restorre neutral point back to normal
What is the first step of HVLA, the intial positon?
- Crucial for Physician AND patient to be in comfortable position
- Consider applying techniques to relax overlying myofascial structures (ST, BLT, MFR).
What constitutes a vertebral unit?
Two adjacent vertebrae w/ their associated disc, arthroidal, ligamentous, muscular, vascular, lymphatic, and neural components
Engagement and stacking of barriers for HVLA; you will treat an L3 SD as it articulates with ____?
L4; forces will be localized at the facet joints between the two vertebra
Forces of HVLA will be localized where?
At the facet joints between the two vertebra
When engaging and stacking barriers the forces are applied from the top down _______ the dysfunction; or from the bottom up ________ the dysfunction?
- Top down through the superior vertebra
- Bottom up through the inferior vertebra to the dysfunction
When stacking barriers and using HVLA the other vertebra of the unit (not the dysfunctional one) is used as?
An opposing counterforce
Typical vertebra (C2-L5) assessed and treated in how many planes of motion?
- 3 planes of motion
- HVLA is utilized by stacking RBs in all 3 planes
Appendicular restriction - typically restricted in one Major and an associated minor motion, which is the focus of HVLA?
Typically focuses on the minor joint motion restriction
What is absolutely critical of the engaging force once all RBs are stacked?
Must be maintained; if force is lost DON’T THRUST!
What will give the most effective thrust?
- Don’t release force prior to thrust
- Exhalation –> muscle relaxation –> more effective thrust
What are the 6 correct steps for HVLA?
- Correctly diagnose SD
- Localize segment
- Engafe the RB in all 3 planes of motion - stacking
- Release enhancing maneuever (patient breathing)
- Mobilizing force - Corrective thrust
- Reassess
What are the general rules for dosage of HVLA?
- Sicker the patient, less the dose
- Older patients respond more slowly
- Most cases discourage thrusting the same segment more than once a week
- If the same SD keeps recurring, evaluate and address for underlying inciting factors
Benefits of HVLA?
- Well tolerated and time efficient
- Modality of choice for SDs w/ distinct firm barrier mechanics (arthroidal types)
- Patient typically experiences immediate relief, decreased pain, and increased ROM
Absolute contraindications for HVLA?
- Local Metastases
- Osseous or ligamentous disruption
- Severe osteoporosis
- Rheumatoid Arthritis
- Down syndrome
- Osteomyelitis in the area being treated
- Joint replacement in the area being treated
- Vertebrobasilar insufficiency
- Severe herniated disc w/ radiculopathy
Why are Rheumatoid Arthritis and Down Syndrome absolute contraindications for HVLA?
Both associated w/ Alar ligament instability
What are the relative contraindications for HVLA?
- Apprehension by the patient
- Mild to moderate strain or sprain in area being treated
- Mild osteopenia or osteoporosis
- RA disease other than in the spine (arthritis)
- Some hypermobile states
