Lecture 6: Intro to HVLA

Question 1

What was the major OMT taught in DO schools prior to the ’70s?

Answer 1

HVLA

Question 2

HVLA is an osteopathic technique employing ____, therapeutic force of ____ duration that travels a ____ distance w/in the anatomic range of a joint and engages the _____ barrier to elicit release of restriction

Answer 2

HVLA is an osteopathic technique employing rapid, therapeutic force of brief duration that travels a short distance w/in the anatomic range of a joint and engages the restrictive barrier to elicit release of restriction

Question 3

Physiologic barrier is achieved during ___ motion in the absence of somatic dysfunction

Answer 3

Active

Question 4

_____ barrier achieved during passive motion in the absence of somatic dysfunction

Answer 4

Anatomic barrier

Question 5

Compromise of what artery is a contraindication for cervical HVLA?

Answer 5

Vertebral A.

Question 6

What term is used to describe the palpatory “sense” of how smoothly a joint can move through ROM?

Answer 6

Quality

Question 7

A firm and distinct end feel usually indicates what type of dysfunction?

Answer 7

Mechanical-type arthroidal dysfunction

Question 8

A rubbery end feel usually indicates what kind of dysfunction?

Answer 8

Reflex somatic dysfunction

Question 9

HVLA is particularly effective under what barrier conditions?

Answer 9

Distinctive barrier with a firm end feel

Question 10

What is the mechanism of HVLA treatment?

Answer 10

Thrust through restrictive barrier =>

Restoration of motion at articulation =>

Restoration of normal proprioceptive input =>

Reflex relaxation of muscles =>

Improvement of TART findings

Question 11

When performing HVLA, you hear a joint “pop”. Is this required for a successful treatment?

Answer 11

Not required or necessary

Question 12

What is the ultimate goal of OMT?

Answer 12

Restore motion loss and restore neutral point back to normal

Question 13

What are the 6 steps to HVLA treatment?

Answer 13

1. Correctly dx SD
2. Localize segment
3. Engage RB in all 3 planes of motion => stacking barriers
4. Release enhancing maneuver (i.e. pt breathing)
5. Mobilizing force (i.e. corrective thrust)
6. Reassess

Question 14

Using what techniques may help with relaxation prior to the initial position of HVLA?

Answer 14

Techniques to relax overlying myofascial structures

Question 15

What are the 2 ways you can engage/stack the barriers for HVLA?

Answer 15

Forces applied from top down through superior vertebrae - “through the dysfunction”

Forces applied from bottom up through inferior vertebrae - “to the dysfunction”

Question 16

What is appendicular restriction?

Answer 16

Restriction in one major and an associated minor fxn

(HVLA typically focuses on minor joint motion restriction)

Question 17

What is the importance of maintaining engaging force during HVLA?

Answer 17

Forces that do not accumulate at SD dissipate into adjacent strucures => unwanted iatrogenic effects

Question 18

Corrective thrust must be performed on what phase of pt’s breath? Why?

Answer 18

Exhalation, muscles are more relaxed

Question 19

How frequently can you perform HVLA on the same segment?

Answer 19

No more than once a week

Question 20

What are the main benefits of HVLA?

Answer 20

Well tolerated, time efficient

Choice for SD with distinct firm barrier

Immediate relief, decreased pain, increased ROM

Question 21

What are the main indications for HVLA?

Answer 21

Articular somatic dysfunctioni

Joint motion restriction with a firm articular barrier

Question 22

Examples of indicated HVLA situations (there’s a lot, just read through bc they might be in the question stem)

Answer 22

SD judged to be an actual joint motion restriction instead of ST restriction

Joint fixation

Connective tissue adhesions

Chronic dysfunction resistant to other treatment

Modify reflexes

Maintenance in irreversible situations

Hypomobile joints

Restoration of bony alignment

Meniscoid entrapment

Pain modulation

Reprogramming of CNS

Displaced disc fragment

Reflex relaxation of affected muscles

Question 23

What positions must be avoided when performing HVLA of the C-spine?

Answer 23

Hyperextension

Excessive rotation

Question 24

Why are rheumatoid arthritis and Down syndrome absolute contraindications to HVLA?

Answer 24

Alar ligament instability

Question 25

What are the absolute contraindications to HVLA? (There’s a lot)

Answer 25

Local metastasis, osseous/ligamentous disruption, severe osteoporosis, RA, Down syndrome, osteomyelitis/joint replacement in the treatment area, vertebrobasilar insufficiency, severe herniated disc w/ radiculopathy, achondroplastic dwarfism, chiari malformation, ankylosis/spondylosis w/ fusion, surgical fusion, Klippel Feil syndrome, patient refusal

(basically the embryologic disorders and severe bone disorders like fracture and infection)

Question 26

What are the relative contraindications to HVLA? (There’s quite a few of these too)

Answer 26

Acute herniated nucleus pulpopus, acute radiculopathy, acute whiplash/severe muscle spasm/strain/sprain, osteopenia/osteoporosis, spondylolisthesis, metabolic bone disease, hypermobility (i.e. ehlers danlos or marfan’s), RA outside of the spine

(all the bone slippage disorders, strain/sprain/spasms)