Lecture 6: Intro to HVLA Flashcards
What was the major OMT taught in DO schools prior to the ’70s?
HVLA
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
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
Physiologic barrier is achieved during ___ motion in the absence of somatic dysfunction
Active
_____ barrier achieved during passive motion in the absence of somatic dysfunction
Anatomic barrier
Compromise of what artery is a contraindication for cervical HVLA?
Vertebral A.
What term is used to describe the palpatory “sense” of how smoothly a joint can move through ROM?
Quality
A firm and distinct end feel usually indicates what type of dysfunction?
Mechanical-type arthroidal dysfunction
A rubbery end feel usually indicates what kind of dysfunction?
Reflex somatic dysfunction
HVLA is particularly effective under what barrier conditions?
Distinctive barrier with a firm end feel
What is the mechanism of HVLA treatment?
Thrust through restrictive barrier =>
Restoration of motion at articulation =>
Restoration of normal proprioceptive input =>
Reflex relaxation of muscles =>
Improvement of TART findings
When performing HVLA, you hear a joint “pop”. Is this required for a successful treatment?
Not required or necessary
What is the ultimate goal of OMT?
Restore motion loss and restore neutral point back to normal
What are the 6 steps to HVLA treatment?
- Correctly dx SD
- Localize segment
- Engage RB in all 3 planes of motion => stacking barriers
- Release enhancing maneuver (i.e. pt breathing)
- Mobilizing force (i.e. corrective thrust)
- Reassess
Using what techniques may help with relaxation prior to the initial position of HVLA?
Techniques to relax overlying myofascial structures
What are the 2 ways you can engage/stack the barriers for HVLA?
Forces applied from top down through superior vertebrae - “through the dysfunction”
Forces applied from bottom up through inferior vertebrae - “to the dysfunction”
What is appendicular restriction?
Restriction in one major and an associated minor fxn
(HVLA typically focuses on minor joint motion restriction)
What is the importance of maintaining engaging force during HVLA?
Forces that do not accumulate at SD dissipate into adjacent strucures => unwanted iatrogenic effects
Corrective thrust must be performed on what phase of pt’s breath? Why?
Exhalation, muscles are more relaxed
How frequently can you perform HVLA on the same segment?
No more than once a week
What are the main benefits of HVLA?
Well tolerated, time efficient
Choice for SD with distinct firm barrier
Immediate relief, decreased pain, increased ROM
What are the main indications for HVLA?
Articular somatic dysfunctioni
Joint motion restriction with a firm articular barrier
Examples of indicated HVLA situations (there’s a lot, just read through bc they might be in the question stem)
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
What positions must be avoided when performing HVLA of the C-spine?
Hyperextension
Excessive rotation
Why are rheumatoid arthritis and Down syndrome absolute contraindications to HVLA?
Alar ligament instability
