Principles of HLVA Thrust Technique Flashcards by Amanda Romeu

What does HVLA stand for?

High Velocity Low Amplitude

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How does HVLA work?

A direct method manipulative treatment that moves a restricted joint through its dysfunctional barrier

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How should the amplitude be performed?

Sufficient enough to move through the restrictive barrier but precise enough to stop short of or at the anatomic barrier

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After HVLA is performed , what motion should be observed?

There should be an immediate increase in both the range of motion and the freedom of motion

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What are some theories about what the “popping” noise?

Bone being put back into place
Snapping of adhesion
Breaking of joint seal at which time a small bubble of nitrogen is released at the joint
Thin layer adherence

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What defines Thin layer adherence?

A process where two congruent surfaces are “glued” together by a typically lubricating substance when said substance is spread thinly enough

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What defines congruent surfaces?

All joint surfaces are in complete contact with each other in anatomic position

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What is an example of a congruent surface?

Spinal facet joints

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What is an example on a non-congruent surface?

Femoral condyles on the tibial plateau

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Describe Synovial fluid:

Lubricant, slippery, high surface tension

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What should the goal of HVLA?

Restoring motion, NOT MAKING NOISE

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What is the popping noise?

Articular release is a repeatable phenomenon that can occur with or without a noise
An articular release is a change in joint space

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How fast does HVLA occur?

0.04 to 0.06 seconds

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What is phonoarthrography?

Method for recording a release
The joint sound is picked up by an electronic stethoscope and passed through an amplifier to an electrograph (ultraviolet) recorder

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What is the first step in articular release?

Preliminary tension mobilization

Pressure is applied to joint without a change in gap between articular cartilage

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What is the second step in articular release?

Articular release
A release occurs and a rapid change in gap range results
This step can be audible or inaudible

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What is the third step in articular release?

Overshoot of release without increase in gap area

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What is the fourth step in articular release?

Refractory tension

Reduction in tension with decrease in gap; not returning to baseline reading

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What does the articular clunk sound like?

A sound similar to a loud thud.
Present normally from sacroiliac joint, hip joint
May emanate from any osteoarthritic joint

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What does the articular crack sound like?

A “breaking” noise may exhibit on sound wave analysis a bimodal or multimodal peak

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What does the articular pop sound like?

“Popping” noise expressed as a single modal curve on a sound frequency scale

What is crepitus?

A sound that is emitted most frequently when the wrist is placed in lateral extension
A crackling sound akin to rubbing hair between ones’ fingers

What does the ligamentous strum sound like?

A sound that results from a tense ligament or fascial structure rolling over a bone or other solid prominence
Ex: The snapping ankle,
Snapping psoas tendon

What does the torn adhesion sound like?

A high-pitched, non-repeatable “tearing” sound. Similar to peeling Velcro apart
Ex: Frozen Shoulder

If the joint is large, is it more likely that the joint will pop?

What should the pressure on the facet joints prior to articular release be?

3.5 atmospheres

What happens if HVLA is used too often?

Articular mobilization may lead to hypermobility and ligamentous & capsular hypertrophy

Are lose articular joints after HVLA more common in men or women?

Women

What is the refractory period for a finger joint?

If left undisturbed for 20 minutes, it regains the ability to release and the articular pop can again be obtained

What is the refractory period for a spinal articular process joint?

Range from one to several hours

Do diseased or healthy joints pop?

Both pop

What are some contraindications to HVLA?

Unstable/hypermobile joints Rheumatoid arthritis and down syndrome Cervical manipulation has been associated with vertebral basilar thrombosis Local metastases and osseous or ligamentous disruption and infection If patient says no

Which region for HVLA scares people the most?

Neck

When doing the inspection what should you look for?

Posture, torticollis, nuchal rigidity

When doing the palpation what should you look for?

Bony changes, osteoarthritis, muscle tension, trigger points, tender points, TTA, somatic dysfunction

What is the Spurling's test?

Evaluation for cervical nerve root impingement in which the patient extends the neck and rotates and sidebends the head toward the side you are testing

What does a positive spurling's test mean?

Positive test is reproduction of radicular symptoms distant from the neck in the distribution of a cervical spinal nerve root

What does the spurling's test cause?

Causes the neural foramina on the ipsilateral side to narrow

What is the compression test?

Compression test is performed by pressing on the top of the patient's head with her neck in a neutral position

What does a positives compression test mean?

Positive test is reproduction of radicular symptoms distant from the neck in the distribution of a cervical spinal nerve root

How do you perform the distraction test?

Grasp head under occiput and chin Apply axial traction (10-15 kg) Only do for a positive compression test or spurlings

What does a positive sign in the distraction test mean?

Positive test is relief or reduction of cervical radicular symptoms Increases diameter of neural foramina

What are the symptoms of a C4-C5 herniated disc?

Can cause weakness in the deltoid muscle in the upper arm Does not usually cause numbness or tingling Can cause shoulder pain

What are the symptoms of a C5-C6 herniated disc?

Can cause weakness in the biceps (muscles in the front of the upper arms) and wrist extensor muscles Numbness and tingling along with pain can radiate to the thumb side of the hand This is one of the most common levels for a cervical disc herniation to occur

What are the symptoms of a C6-C7 herniated disc?

Can cause weakness in the triceps (muscles in the back of the upper arm and extending to the forearm) and the finger extensor muscles Numbness and tingling along with pain can radiate down the triceps and into the middle finger This is also one of the most common levels for a cervical disc herniation

What are the symtoms of a C7-T1 herninated disc?

Can cause weakness with handgrip | Numbness and tingling and pain can radiate down the arm to the little finger side of hand

What is the vertebral artery test?

Passive extension and cervical spine rotation | Causes significant decrease in contralateral vertebral artery

What is a positive sign for the vertebral artery test?

Positive test if this results in dizziness, nausea, syncope, dysarthria, dysphagia, and disturbances of the hearing or vision, paresis or paralysis of patients Suggestive of Positional Vertebral Basilar Insufficiency

Who provides the most C-spine treatment?

Chiropractors

What is the assessment of NSAIDs vs cervical manupulation?

Cervical manipulation for neck pain is much safer than the use of NSAIDs by as much as a factor of several hundred times There is no evidence that indicates NSAID use is any more effective than cervical manipulation for neck pain