REVIEW Cervical Spine HVLA

Question 1

Steps of HVLA

Answer 1

1. Diagnosis - Correctly diagnose SD
2. Position - Pt and physician relaxed and comfortable
3. Isolation - Forces localized at facet joints b/w 2 vertebrae
4. Forces - Accumulate, engage restrictive barrier
5. Release - use pt’s breathing to perform release enhancing maneuver
6. Thrust - Barrier engaged => Short, rapid thrust w/ sudden acceleration and deceleration
7. Reassess - Confirm treatment resolved

Question 2

Restrictive barrier

Answer 2

Functional limit w/in anatomic ROM that abnormally diminishes normal physiologic range

Question 3

In cervical HVLA, what motion should you absolutely do not do?

Answer 3

Hyperextend the neck

Question 4

Contralateral Traction

Cervical ST or MFR

Answer 4

Question 5

Cradling with Traction

Cervical ST or MFR

Answer 5

Question 6

Suboccipital Release

Cervical ST or MFR

Answer 6

Question 7

Bilateral Forearm Fulcrum Forward Bending

Cervical ST or MFR

Answer 7

Question 8

OA SD Cervical HVLA

Answer 8

Question 9

AA SD Cervical HVLA

Answer 9

Question 10

C2-7 Rotational Emphasis Cervical HVLA

Answer 10

Doc uses index finger pads to form a “little bridge” contacting the articular pillars on either side spinous process of the affected vertebra (C4).

• Flex the patient’s head until motion is identified at the level of dysfunction (not below).
• Sidebend towards the freedom TO the interspace at level of dysfunction. (ex. Sidebend right to C4-5)
• Rotate towards the RB to the restrictive barrier
• Apply a thrust in the rotational plane of C4 with the contact on the posterior transverse process.

ALTERNATE HAND POSITION

• Doc uses 2nd MCP to contact the lateral aspect of the articular pillar on the side of sidebending RB. The other hand and forearm cradles the patient’s head and chin
• Be conscious of finger positioning on chin to neither pull on the jaw or compromise the patient’s airway.
• Flex the patient’s head until motion is identified at the level of dysfunction, then allow the head to move into slight extension
• This isolates motion from above and below the segment.
• Sidebend towards the freedom (R in this case) TO the interspace of the dysfunction. (C3/4).
• This locks out the vertebrae above the dysfunction
• Rotate towards the RB (L in this case) THROUGH the interspace of dysfunction (C3/4)
• Apply a thrust in the rotational plane of the dysfunctional vertebra (C3) with the hand contacting the posterior transverse process.

Rays of the sun approach to direction of thrust:

• Upper cervicals thrust is towards the eye
• Middle cervicals thrust is straight across the neck
• Lower cervicals the thrust is directed down toward the chest

Example:
o DX: C4 E RrSr
o TX Localization: C4 F RL

Question 11

C2-C7 Sidebending Emphasis Cervical HVLA

Answer 11