Review: Cervical HVLA

Question 1

OA E RR SL: HVLA

Answer 1

Contact right posterior occiput posterior to mastoid process

Cradle head w/ left hand, sideband OA joint right, rotate left and extend to engage RB and add localizing cephalad directed traction

instruct pt to inhale deeply; at the end of exhalation, perform HVLA thrust medially, anteriorly, and superiorly

Question 2

AA RL: HVLA

Answer 2

Cradle head in hands, contacting left lateral mass of atlas w/ lateral margin of left index finger

Flex the C spine towards a straighter alignment and allow minimal extension to localize to the monitoring index finger

Rotate head right to the RB

Instruct pt to inhale; at the end of exhalation apply HVLA rotational thrust through a combined motion of both hand contacts and movement of the head and atlas

Question 3

C4 E RR SR: HVLA rotational emphasis

Answer 3

Index finger pad (straight bridge) or 2nd MCP is placed behind the articular pillar on the side of the PTP to restrict motion at that segment

Flex pts head until motion is identified at C4, then allow the head to move into slight extension (isolates motion from above and below segment)

Sidebend towards the freedom of motion (right), to C4-C5 interspace (locks out vertebrae above dysfunction)

Rotate towards the RB (left) through the C4-5 interspace. With the pt relaxed, the doc uses rapid acceleration supinating the left hand and wrist, which directs a left rotational arc-like thrust in the plane of the oblique facet

Question 4

C4 E RR SR: HVLA sidebending emphasis

Answer 4

Physician’s 2nd MCP joint contacts tip of transverse process of C3 on the left

Flex the cervical spine through the C3-C4 interspace

Rotate C spine towards freedom (right) to C3-C4 interspace (locks out vertebrae above dysfunctional segment)

Sideband towards the RB (left) through, and including the C3-4 interspace

Thrust in the side bending plane toward the T1 spinous process (or sternal notch)

Question 5

“Rays of the sun” approach to direction of HVLA thrust in cervical region

Answer 5

Upper cervicals: thrust toward the eye

Middle cervicals: thrust straight across the neck

Lower cervicals: thrust down toward the chest