SPINAL HVT Flashcards
SPINAL HVT - WHAT TO SAY
Going to perform a HVT
Potetnial risks, including stroke for Csp (1/100,000)- examination + Hx= not in risk category
Position may feel tight but shouldnt be uncomfortable, if it is let me know and I will stop
I will apply a quick impulse which may result in a cavitation (click sound), this is just CO2 and N2 leaving the Jt space, not bone on bone
The aim is to restore normal functioning + ROM
Happy?
SPINAL HVT - WHAT IS THE POINT OF A HVT?
Speed to overcome muscle contraction not produce a clicking sound
SPINAL HVT - CAUTIONS
Hypermobility- cant feel bind
Hesistance
SPINAL HVT - CONTRAINDICATIONS
Lack of consent
Undiagnosed/previous disc injury
High blood pressure
P on set up
SPINAL HVT - HVT VS MOBILISATION
Quicker + same outcome
Lower amplitude- at end range for less time
Inc time- Pt may feel in more control
SPINAL HVT - CHEMICAL RESPONSE TO HVT
May feel spaced out after
Release of Co2 and N2 from the joint space is what the clicking noise is
Inc ROM= Inc BF
SPINAL HVT - NEUROLOGICAL RESPONSE
Balances proprioceptive reflex
SPINAL HVT - PSYCHOLOGICAL RESPONSE
Audible sound may make Pt believe something has happened
Highlights importance of explaining what happens and getting informed consent
SPINAL HVT - CSP CONTACT
Contact is 2nd MCP on articular pillar
Other hand is supporting (not moving)
You are moving the superior segment.
Flx/SB/Rot = accumulating bind
SPINAL HVT - CSP CONSIDERATIONS
Consider age (60+), if normal blood pressure (exercise caution if medicated), cervical clearing test
SPINAL HVT - CSP SET UP
Couch high- able to rest elbows on pillows
Pt supine, head close to you
Flx/SB/Rot with nose still in line with sternum
SPINAL HVT - CSP IMPULSE
Impulse= rotation away
Lower segments- 2-3, thrust more towards axilla
Middle- thrust more in line with mouth
Upper- more in line with eyes
SPINAL HVT - CSP CHIN HOLD
Pt supine
Forearm comes behind the ear/under the head with the hand gripping the chin
Other hand is under the occiput and the finger pads of the hand are in contact witht he forearm
Flex, sidebend and rotate as normal
SPINAL HVT - CSP SEATED
Pt seated
Stand facing, on their side of the pt
Your front hand comes round and use the middle, ring and little fingers to palpate the articular pillar
First finger comes round under the occiput
Other hand rests/stabilises around the zygomatic arch
Flex, side bend and rotate so the pt is looking at you
Cavitation is on the opposite side to the one where you are stood
SPINAL HVT - CT LIFT
Pt hands on their head
Place your hands linked over C5/6
Ask them to place their hands over yours
Squeeze your elbow into their lats
Ask them to squeeze their elbows together
Relax stomach, breathe in/out, look up
Pull back and up
Direction- thrusting C7 away from T1. C7 moves anteriorly
SPINAL HVT - CT PRONE
Pt prone
Stand on the opposite side to the restriction facing the pt head
Side bend pt head away from the restriction (towards you) and rotate towards the side of the restriction (so they are looking at the restriction)
Place contact on T1 with the hand that is furthest away from the couch (support with the thumb)
Control the head and neck into the same side as your contact
Support around the base of the cranium
Pt breathe in and out
Thrust is you squeezing/crossing your hands (thrust is on T1)
SPINAL HVT - TSP RISKS
Soreness 24-48 hours
SPINAL HVT - TSP PRONE
Start with harmonic, whilst palpating to find area of Rx
Springing to identify further
Closest hand in line with TPs closest
Other hand perpendicular
Breathe in, breathe out, then thrust down towards floor
Contact on TP above, pisiform on TP below which will cavitate
SPINAL HVT - TSP DOG
Contact- SP above sits in gutter of hand
Direction- straight down
Accumulation of bind- rotation and flexion
SPINAL HVT - RIBS
Pt prone
Set up the same as prone Tsp but with the contact moved laterall to be just medial to the angle of the rib, just off the TP witht he thumb almost touching the SP
Direction- ribs 3-6 pressure more up. 6-9 more straight down
SPINAL HVT - LSP CAUTIONS
Hypermobility- cant feel bind
Hesitant- may be due to previous bad experience
SPINAL HVT - LSP CONTRAINDICATIONS
Cauda equina
Fracture- would have been screened
Lack of consent
P on set up
Undiagnosed/previous disc injury (worsens symptoms- would need to consider CHx)
Anky spon
Osteoporosis/osteopenia
SPINAL HVT - LUMBAR ROLL
Forearm over iliac fossa, other arm is gapping= rotate thorax using rib cage
Knee on couch + leg straight
Other knee into popliteal fossa
Looking towards the head
ASIS to ASIS, leg forward
Thrust= rotational- downwards
Ipsilateral facets are gapping (may cavitate both facets)
Accumulation- opposing rotational forces
Contact- between SPs
SPINAL HVT - SIJ
Palpate sulcus
Increase the rotation (compared to Lsp) + add SB
Contact on PSIS
Thrust goes through ASIS
Gapping posterior aspect of SIJ
SPINAL HVT - SIJ CHICAGO TECHNIQUE
Anteriorised innominate
Push down on ASIS, find which side moves less
Whichever side is Rx= crossed over other leg, initiates posterior rotation
Move legs away from you, allows quadratus femoris to slack
Side bend upper body
Cross arms over, bring your contact over shoulder
Hand contact on ASIS (thrusting hand)
Accumulation- rotation
Thrust- down towards couch in posterior direction
CSP
CONTACT - 2nd MCP on articular pillar, other hand supporting the head
BIND - flex, side bend and rotate the head
SEGMENTS - moving the superior segment on the inferior segment
THRUST - rotate away
lower segments - thrust towards the axilla
middle segments - thrust in line with the mouth
lower segments - thrust in line with the eyes
CT LIFT
CONTACT - hands linked over C5/C6
BIND - pulling back and up
SEGMENTS - C7 moves anteriorly
THRUST - Thrusting C7 away from T1, pulling back and up
TSP PRONE
CONTACT - closest hand in line with TPs, other hand perpendicular - almost pisiform to pisiform
BIND - accumulation of bind is the rotation and extension
SEGMENTS - TP below will be the one to cavitate
THRUST - straight down to the floor
TSP DOG
CONTACT - SP above sits in the gutter of the hand
BIND - rotation and flexion
SEGMENTS - SP of the segment below to move under the one above
THRUST - straight down to the couch
AP RIBS
CONTACT - medial to the angle of the ribs, just off the TP, thumb almost touching the SPs
BIND - downward pressure
SEGMENTS - the rib your contact is on
THRUST - ribs 3-6 pressure is more upwards to follow the curvature of the thorax, ribs 6-9 pressure is straight down
LUMBAR ROLL
CONTACT - contact between SPs, one above where you are locking off and one below where you are trying to cavitate
BIND - opposing rotation, locking off more by flexion and rotation, moving all the segments below to move at the fixed point
SEGMENTS - ipsilateral side aiming to cavitate but both sides may go
THRUST - rotational and downwards
SIJ
CONTACT - palpate the sulcus, contact on PSIS
BIND - opposing rotation, increase the rotation (compared to lumbar roll) and add side bending
SEGMENTS - gapping the posterior aspect of the SIJ
THRUST - thrust goes through the ASIS
SIJ CHICAGO TECHNIQUE
CONTACT - contact on the contralateral ASIS
BIND - rotation
SEGMENTS - anteriorised innominate
THRUST - down towards the couch in posterior direction
