Lumbar, Sacrum, Innominate HVLA Flashcards
Requirements for HVLA?
distinctive barrier w a firm end feel
pt consent and comfort
What must you always do first before hvla?
soft tissue prep
ie hamstrin hypertonicty Me/MFR, ITB prone, ITB lateral recumbent, Lumbosacral MFR
superior innominate shear hvla
supine, foot off table, grasp superior to ankle, IR AND ABDUCT, lean back, breath 2-3x and increase traction on exhalation
inferior innominate shear hvla 1
lateral recumbent, affected side up, physician behind pt
cephalad hand PSIS
caudal hand ASIS
lateral distraction to gap SI joint***, exert cephalad force
breath 2-3x and increase force on exhalation
cephalad hvla force through ASIS AND PSIS contacts***
inferior innominate shear hvla 2
lateral recumbent, affected side up, physician in front
monitor lumbosacral junction
straight bottom leg, foot of top behind popliteal fossa***
cephalad hand monitors si joint
caudal forearm in inferior aspect of ipsi ischial tuberosity ***
push should posterior, pelvis anterior until move at si joint
high velocity, low amp force w caudal forearm, parallel to table in cephalad direction***
anterior innominate rotation hvla
pt lateral recumbent, sd up
physician facing pt
cephalad hand - bw L5 and S1 SP
caudal hand - flex pt hips and knees until separate L5-S1
drop pt top leg off table
cephalad hand moves to antecubital fossa (Elbow area)
caudal forearm along femur bw PSIS and trochanter
push shoulder posterior/pelvis anterior
high velocity, low amp force w caudal forearm directed down the shaft of the femur***
pubic restrictions Hvla
pt supine, hips and knees flexed w feet on table
dr on either side
MET bw AD and ABduction (squeeze knees together, keep them apart etc)
in final ABduction, thrust towards further ABduction w pt still adducting
Soft tissue for
MFR of lumbosacral region:
one hand in lumbar, other over superior lumbar
move in L/R, inferior/superior, CC/CCW motion - indirect/direct barriers
sacral rocking: pt prone heal of cephalad hand on sacral base, fingers point to coccyx caudal hand on top pointing cephalad inhalation = apex anterior - extend exhalation = base anterior - flexion
bilateral sacral flexion hvla
pt prone
monitor si joint, ABduct leg and IR
heel of hand on apex
accentuating inhalation and resisting exhalation
final inhale apply anterior/superior hvla thrust
bilateral sacral extension hvla
pt prone, sphinx position
monitor si joint, ADduct leg and ER
heel of hand on base
accentuating exhalation and resisting inhalation
final exhale apply anterior/inferior hvla thrust
R/L sacral torsion hvla
pt supine w hands clasped behind back
dr on side of involved axis
pt LE/torso SB away (makes C shape)
thenar eminence of caudal hand on ASIS on oppo of the axis
cephalad hand holding pt lateral distal bicep (oppo side)
dr rotates upper torso into barrier by pulling the oppo elbow towards self, while stabilizing the opposite ASIS
during exhalation, posterior thrust of pt asis while rotating torso
soft tissue for lumbar
prone pressure, prone pressure w counterleverage, paraspinal perpendicular stretch (lat recumbent)
L1-5 E or N SD, long-lever, rotational emphasis, ex: L4 NSLRR, Walk around
pt supine w hands clasped behind back
dr oppo of ptp
monitor segment and SB pt toward RB in NEUTRAL (C away from physican)
monitor segment and SB pt away? RB in Extension (C toward physical)
caudal hand on ASIS on oppo side
cephalad hand holding pt lateral distal bicep (oppo side)
rotate pt trunk w cephalad hand into rotational barrier toward self
exhalation, exert rotational thrust through barrier w cephalad hand, stabilizing asis w caudal hand
Type 1 lumbar, lateral recumbent HVLA
pt lateral recumbent PTP up
physical facing pt
monitor apex of curve w caudal hand
hold pt bottom arm and pull anterior to rotate the SD and cephalad to engage SB (switch hands)
flex hips and knees until motion felt
straightens bottom leg/top foo ti popliteral space
caudal forearm along line bw pt PSIS and greater trochanter, cephalad arm against anterior shoulder
shoulders posterior, pelvis anterior, inhale deep and in exhalation give a rotational thrust by rotating pt hip forward/anteriorly
Type 2 lumbar, lateral recumbent HVLA
pt lateral recumbent PTP up
physical facing pt
monitor apex of curve w caudal hand
hold pt bottom arm and pull anterior to rotate the SD and caudally to engage SB (switch hands)
flex hips and knees until motion felt
extended SD - bottom leg slightly flexed at hip/knee, w superior leg crossed over the bottom
flexed SD - pt straightens bottom leg, places top foot into bottom leg popliteal space
caudal forearm contacts posterior aspect of pt pelvis from si joint to great trochanter
cephalad on anterior shoulder
shoulders posterior, pelvis anterior, inhale deep and in exhalation give a rotational thrust by rotating pt hip forward/toward table
