Lecture 4: Intro to HVLA Flashcards
What type of technique is HVLA?
Direct
What is HVLA?
rapid therapeutic force of brief duration and short distance that elicits release of restriction AKA thrust technique
Review:
What does Type 1 dysfunction mean?
What does Type 2 dysfunction mean?
- TONGO (grouped, neutral, opposite)
- single, F/E, same
Barriers review: What is a barrier? Physiologic barrier? Restrictive barrier? Anatomic barrier?
- regions where tension builds up parabolically
- end ROM of active ROM
- limit to active ROM (less than physiologic barrier)
- end ROM of passive ROM
What does quantity of ROM mean?
What does quality of ROM mean?
What does end feel mean?
- 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
Firm and distinct end feels are associated with what type of dysfunction?
Rubbery end feels are associated with what type of dysfunction?
- arthroidal
- muscle, fascia, reflex
When is HVLA most effective?
- dysfunction is localized to a joint
- distinctive barrier has a firm/hard end feel
- if other techniques failed
Review:
How does an SD develop?
Local irritation > local swelling > capsular/myofascial tightening > regional muscle hypertonicity (facilitation) > TART becomes palpable
How does HVLA physiologically work?
thrust through barrier > motion restoration > proprioception restoration > reflex relaxation of muscles > TART improvement
What are the steps to applying HVLA?
- Dx
- Soft tissue prep
- Stack forces
- Enhancing maneuver (usually via exhalation)
- Force accumulation (prepare to thrust)
- Thrust
- Slow return to neutral
- Reassess
Why is a soft tissue preparation important?
reduces risk of injury, tensing
increases patient confidence in doc
-relaxed muscles better prepared for rapid contraction
Very simply, what does HVLA focus on treating?
joints
What does accumulation of forces mean?
-moving the patient further into the barrier (prepare to thrust), usually done during exhalation
How do you decide how much OMT to give pt?
- 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
If SD does not resolve with HVLA, what should you think about fixing?
Posture leg length, strength or joint imbalance scoliosis scar tissue interdependence with some other SD
What are the benefits of HVLA?
time efficient
well tolerated
immediate relief
best choice for SDs with distinct firm barrier
Indications of HVLA:
-articular SD (joint dysfxn as opposed to soft tissue dysfunction)
What precautions should you take when using HVLA?
- thorough Hx and Pex
- avoid hyperextension & excessive rotation if treating C-spine
- risk benefit ratio
- pt consent/comfort
- make sure barrier feels right
Absolute contraindications of HVLA:
pt refusal/apprehension osteogenesis imperfecta carotid insufficiency joint infection bone malignancy fracture fusion rheumatoid arthritis and down syndrome (due to Alar ligament instability)
Relative contraindications of HVLA:
nucleus pulposus radiculopathy osteopenia/osteoporosis spondylolistesis hypermobility syndromes joint replacements
