Review: HVLA Thoracic and Cervical Spine, Innominates Flashcards
doc/pt positioning for HVLA supine T-spine
Doc stands opposite side of PTP
Type 1: side bend away from doc
Type 2: sidebend toward doc
Upon exhalation, doc exerts posterior to anterior HVLA thrust through their abdomen toward PTP
[this is Kirksville Crunch]
Doc/pt positioning for HVLA prone (note type 1 vs. type 2 hand placement)
Stand opposite side of PTP
Type 1: hand facing caudad, place hypothenar eminence on PTP. Hand facing cephalad, place thenar eminence on opposite TP
Type 2 (flexed): hand facing cephalad, place thenar eminence on PTP; hand facing caudad, place hypothenar eminence on opposite TP
At end of exhalation, a downward anterior HVLA thrust with a counterbalance (twist) in direction the fingers are pointing with greater force on PTP side
OA E RR SL: HVLA
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
AA RL: HVLA
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
C4 E RR SR: HVLA rotational emphasis
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
C4 E RR SR: HVLA sidebending emphasis
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)
“Rays of the sun” approach to direction of HVLA thrust in cervical region
Upper cervicals: thrust toward the eye
Middle cervicals: thrust straight across the neck
Lower cervicals: thrust down toward the chest
Innominate HVLA: Superior shear
Pt supine with feet off end of table
Doc grasps pt’s tibia and fibula superior to the ankle.
Internally rotate and abduct the pt’s leg; lean back and induce axial traction. Instruct pt to inhale and exhale slowly over 2-3 cycles and gently increase traction on exhalation
Exert axial HVLA thrust
Innominate HVLA: inferior shear
Pt lateral recumbent, affected side up, with doc behind pt
Cephalad hand on PSIS, caudad hand on ASIS
Provide lateral distraction to gap SI joint, then cephalad force. Instruct pt to inhale and exhale slowly over 2-3 cycles and gently increase force on exhalation
Exert cephalad HVLA force through ASIS and PSIS contacts
[Alternative technique: same position but monitor lumbosacral junction, pt straightens bottom leg and places top leg just distal to popliteal fossa of bottom leg. cephalad hand monitors SI joint while caudad hand placed inferior aspect of ipsilateral ischial tuberosity; simultaneously push shoulder posterior and roll pelvis anterior to induce axial rotation until movement of SI joint is palpated. HVLA force delivered with caudad forearm, parallel to table]
Innominate HVLA: Anterior rotation
Pt lateral recumbent, dysfunctional side up w/ doc facing pt
Cephalad hand between L5 and S1 SP, caudad hand flexes pts hips and knees until L5 and S1 SP’s separate
Drop pts top leg off table (foot should not touch floor), cephalad hand moves to antecubital fossa, with forearm on shoulder; caudad forearm is placed along femur between PSIS and trochanter. Simultaneously push shoulder posterior and roll pelvis anterior to induce axial rotation until movement of SI joint is palpated. HVLA force delivered with caudad forearm, directed down the shaft of the femur
Innominate HVLA: Posterior rotation
Pt lateral recumbent with doc facing pt
Cephalad hand between L5 and S1 spinous process; caudad hand flexes pts hips and knees until L5 and S1 SP’s separate
Pt straightens bottom leg and places foot of top leg just distal to popliteal fossa of bottom leg. Cephalad hand moves to antecubital fossa with forearm on shoulder; caudad forearm is placed on PSIS and iliac crest. Simultaneously push shoulder posterior and roll pelvis anterior to induce axial rotation until movement of SI joint is palpated. HVLA force delivered with caudad forearm, directed towards umbilicus