Lecture 4: Introduction to HVLA

Question 1

Who started the first chiropractic school using HVLA in his practice?

Answer 1

Dr. D.D Palmer

Question 2

What type of technique is HVLA?

Answer 2

Direct

Question 3

What does HVLA stand for?

Answer 3

High Velocity Low Amplitude

Question 4

How does HVLA work?

Answer 4

Employing a 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
-thrust technique

Question 5

With HVLA, you move through the _____ barrier into the _____ barrier to restore motion.

Answer 5

With HVLA, you move through the RESTRICTIVE barrier into the ELASTIC barrier to restore motion.

Question 6

Regarding HVLA, how is quantity determined?

Answer 6

Amount of movement available from a neutral position

Question 7

Regarding HVLA, how is quality determined?

Answer 7

Palpatory appreciation of how smoothly and easily a joint

can be moved – not how far

Question 8

Regarding HVLA, what is end feel?

Answer 8

Quantity and quality of motion of a joint when it is brought

passively near and up to physiologic or restrictive barrier of motion

Question 9

What are indications of HVLA?

Answer 9

Somatic dysfunction localizing to a joint

-more effective w/ distinctive barrier with a firm or hard end feel

Question 10

What is the mechanism of a HVLA treatment?

Answer 10

1. Thrust through the restrictive barrier
2. Restoration of motion at articulation
3. Restoration of normal proprioceptive input
4. Reflex relaxation of muscles
5. Improvement of TART findings

Question 11

With HVLA treatments, where is the positioning localized?

Answer 11

Localized firmly against the restrictive barrier unlike feather edge in most other treatments

Question 12

True or false?

Noise is necessary for a successful HVLA treatment.

Answer 12

False

Question 13

What are the steps to a proper HVLA treatment?

Answer 13

1. Correctly Diagnose SD
2. Provide some soft tissue preparation
3. Localize forces to a segment or joint: engage the RB in all 3 planes of motion
4. Release enhancing maneuver (patient exhalation is typical)
5. Accumulation of forces
6. Corrective thrust
7. Return to neutral
8. Reassess for effectiveness and SD persistence

Question 14

How do you prepare a patient for a HVLA technique?

Answer 14

Apply techniques to relax regional muscle and
fascial structures 
-MET
-MFR
-Kneading

Question 15

How is a corrective thrust administered?

Answer 15

Make sure all forces are stacked in right direction to deliver a short, rapid thrust

• no running starts
• best to do in exhalation

Question 16

What are benefits of HVLA?

Answer 16

• Time efficient
• Well tolerated
• Patient typically experiences immediate relief, decreased pain, and increased ROM.

Question 17

When utilizing HVLA to treat the cervical spine, what are some precautions to take?

Answer 17

Avoid hyperextension and excessive

rotation

Question 18

What are absolute contraindications of HVLA?

Answer 18

• Local cancer or metastases
• Local osseous or complete ligamentous disruption
• Severe osteoporosis
• Rheumatoid Arthritis
• Down Syndrome
• Osteomyelitis
• Spinal cord injuries: severe acute herniated disc with radiculopathy, cauda equina syndrome, etc
• Patient refusal
• Osteogenesis imperfecta
• Carotid insufficiency
• Acute local inflammatory joint disease or infection
• Bone malignancy
• Fracture/dislocation
• Fusion
• Upper cervical issues

Question 19

What are relative contraindications of HVLA?

Answer 19

• Acute herniated nucleus pulposus
• Acute radiculopathy
• Acute injury: severe muscle spasm, sprain, strain
• Osteopenia/osteoporosis
• Spondylolisthesis
• Metabolic bone disease
• Hypermobility syndromes
• Joint replacement or other implant in the area being treated