Lecture 4: Intro to HVLA

Question 1

What type of technique is HVLA?

Answer 1

Direct

Question 2

What is HVLA?

Answer 2

rapid therapeutic force of brief duration and short distance that elicits release of restriction AKA thrust technique

Question 3

Review:
What does Type 1 dysfunction mean?
What does Type 2 dysfunction mean?

Answer 3

• TONGO (grouped, neutral, opposite)

- single, F/E, same

Question 4

Barriers review: 
What is a barrier? 
Physiologic barrier? 
Restrictive barrier? 
Anatomic barrier?

Answer 4

• regions where tension builds up parabolically
• end ROM of active ROM
• limit to active ROM (less than physiologic barrier)
• end ROM of passive ROM

Question 5

What does quantity of ROM mean?
What does quality of ROM mean?
What does end feel mean?

Answer 5

• amount of movement available from a neutral position
• how smoothly or easily a joint can be moved (not how far)
• quantity and quality of a joint when brought to a barrier

Question 6

Firm and distinct end feels are associated with what type of dysfunction?

Rubbery end feels are associated with what type of dysfunction?

Answer 6

• arthroidal

- muscle, fascia, reflex

Question 7

When is HVLA most effective?

Answer 7

• dysfunction is localized to a joint
• distinctive barrier has a firm/hard end feel
• if other techniques failed

Question 8

Review:

How does an SD develop?

Answer 8

Local irritation > local swelling > capsular/myofascial tightening > regional muscle hypertonicity (facilitation) > TART becomes palpable

Question 9

How does HVLA physiologically work?

Answer 9

thrust through barrier > motion restoration > proprioception restoration > reflex relaxation of muscles > TART improvement

Question 10

What are the steps to applying HVLA?

Answer 10

1. Dx
2. Soft tissue prep
3. Stack forces
4. Enhancing maneuver (usually via exhalation)
5. Force accumulation (prepare to thrust)
6. Thrust
7. Slow return to neutral
8. Reassess

Question 11

Why is a soft tissue preparation important?

Answer 11

reduces risk of injury, tensing
increases patient confidence in doc
-relaxed muscles better prepared for rapid contraction

Question 12

Very simply, what does HVLA focus on treating?

Answer 12

joints

Question 13

What does accumulation of forces mean?

Answer 13

-moving the patient further into the barrier (prepare to thrust), usually done during exhalation

Question 14

How do you decide how much OMT to give pt?

Answer 14

• less if patient is older or more sick
• do not thrust a segment more than once a week (risk of tissue not recovering or becoming hypermobile)
• decrease treatment as patient improves

Question 15

If SD does not resolve with HVLA, what should you think about fixing?

Answer 15

Posture
leg length, strength or joint imbalance
scoliosis
scar tissue
interdependence with some other SD

Question 16

What are the benefits of HVLA?

Answer 16

time efficient
well tolerated
immediate relief
best choice for SDs with distinct firm barrier

Question 17

Indications of HVLA:

Answer 17

-articular SD (joint dysfxn as opposed to soft tissue dysfunction)

Question 18

What precautions should you take when using HVLA?

Answer 18

• thorough Hx and Pex
• avoid hyperextension & excessive rotation if treating C-spine
• risk benefit ratio
• pt consent/comfort
• make sure barrier feels right

Question 19

Absolute contraindications of HVLA:

Answer 19

pt refusal/apprehension
osteogenesis imperfecta
carotid insufficiency
joint infection
bone malignancy
fracture
fusion
rheumatoid arthritis and down syndrome (due to Alar ligament instability)

Question 20

Relative contraindications of HVLA:

Answer 20

nucleus pulposus
radiculopathy
osteopenia/osteoporosis
spondylolistesis
hypermobility syndromes
joint replacements