T Spine and Rib HVLA

Question 1

First action to perform

Answer 1

TART Exam

Question 2

HVLA Supine T Spine (Kirksville Crunch)

Answer 2

• Doc stands opposite PTP
• Patient crosses arms over chest (arm on side of PTP on top)
• Caudad hand monitors ar PTP
• Pt elbows positioned in examiner’s upper abdomen
• Cephalad hand lifts and positions (flexion/extension, sidebending and rotation)
• TYPE 1: Sidebend away from you
• TYPE 2: Sidebend towards
• Instruct patient to inhale and exhale deeply
• While patient deeply exhales, exert A to P thrust thru abdomen towards PTP
• Reassess

Question 3

HVLA Prone (Texas Twist)

Answer 3

• Stand opposite PTP
• T1: hand faces caudad, place thenar eminence on PTP; hand facing cephalad, place hypothenar eminence on opposite transverse process
• T2 (Flexed): hand facing cephalad, place thenar eminence on PTP; hand facing caudad, place hypothenar eminence on opposite TP
• Instruct pt to inhale and exhale deeply
• @ end of exhalation, downward anterior HVLA thrust is applied with twist in direction the fingers are pointing (greater force on PTP side) -Reassess

Question 4

Supine Knee Fulcrum HVLA: Upper and Middle Thoracics

Answer 4

• Patient supine (hands behind neck) w/ doc @ head of table
• Ipsilateral knee on PTP of dysfunctional vertebrae
• Doc passes hands thru flexed UEs and encircles patient’s rib cage with fingers over rib angle posterolaterally
• Have patient inhale and exhale
• @ end of exhalation, doc gently and quickly pulss patient’s chest downward into thigh while adding cephalad traction
• Reassess

Question 5

Seated Lower T-Spine HVLA

Answer 5

• Can perform MET prior to HVLA
• Patient seated with ipsilateral hand to PTP clasped behind neck, holding that elbow with their other hand
• Doc stands opposite PTP
• Doc places thenar eminence to PTP of dysfunctional vertebrae
• Grasp patient’s biceps, with arm orientation dependent on type of SD (type 1: under one arm, type 2: under both)
• Engage restrictive barrier in all 3 planes
• The patient inhales
• On exhalation, doc quickly and minimally pulls pt through rotational barrier (while other hand is applying an anterior force to the PTP)
• Reassess

Question 6

HVLA Seated Knee Fulcrum Technique

Answer 6

• Patient seated with hands clasped behind neck
• Doc behind patient -Using stool for foot, place ipsilateral knee to PTP on dysfunctional vertebrae (can also use pillow between patient’s back and your knee)
• Pass hands beneath patient’s arms and then thru flexed arms fo grasp forearms proximal to wrist
• Patient deeply inhales and exhales
• @ end of exhalation, quickly and gently pull patient superiorly and posteriorly to roll PTP over knee
• Reassess

Question 7

Upper Ribs 1-4 (Chin Pivot)

Answer 7

• Patient prone w/ chin cupped on ipsilateral side of dysfunction
• Doc at head of table/ opposite dysfunctional side
• Doc places one hand thenar/hypothenar eminence @ rib dysfunction
• Other hand on patient’s head, rotating it towards side of dysfunction into restrictive barrier
• Patient inhales and doc loads further into the barrier
• @ end of exhalation, doc applies rapid anterolateral thrust onto dysfunctional rib
• Reassess

(this can also be done on upper thoracics, contacting PTP instead of the rib and applying a direct anterior thrust)

Question 8

Seated 1st rib inhalation dysfunction HVLA (J stroke)

Answer 8

• Patient seated w/ doc standing behind
• Doc places foot on table opposite dysfunction (patient drapes arm over this knee)
• Doc contacts dysfunctional rib w/ second MCP joint of one hand and top of patient’s head with the other
• Doc engages barrier by sidebending head toward dysfunctional rib (so opposite where knee is)
• Patient inhales
• With exhalation, doc applies inferior/medial thrust on superior rib
• Reasses

Question 9

Ribs 3-10 Bucket Handle Inhalation Dysfunction HVLA

Answer 9

• Patient supine (crosses arms over body with arm on side of dysfunctional rib on top)
• Doc opposite dysfunctional rib w/ thenar eminence of caudad hand posterior/superior to angle of dysfunctional rib
• Other hand on patient’s elbows or used to elevate patient’s head/neck
• Doc applies pressure thru patient’s elbows (localizing at dysfunctional rib angle)
• Patient inhales
• @ exhalation, doc loads further into barrier
• @ end of next exhalation, doc applies posterior thrust directed towards thenar eminence
• Reassess

Question 10

Ribs 3-10 Bucket Handle Exhalation Dysfunction HVLA

Answer 10

• Patient supine (crosses arms over body with arm on side of dysfunctional rib on top)
• Doc on opposite side w/ thenar eminence of caudad hand posterior/superior to angle of dysfunctional rib
• Other hand on patient’s elbows or used to elevate patient’s head/neck
• Doc applies pressure thru patient’s elbows, localizing @ dysfunctional rib angle
• Patient inhales
• @ exhalation doc loads further into the barrier
• @ end of next exhalation, doc applies posterior thrust directed slightly caudal to doc’s thenar eminence
• Reassess

Question 11

Same Side SD HVLA (Modified Kirksville Crunch)

Answer 11

• Patient supine w/ arms crossed over chest (side of PTP on top)
• Doc on same side, w/ thenar eminence of cephalad hand on PTP
• Doc grasps patient’s elbows and raises them until vector is felt on posterior hand
• Posterior hand induces sidebending
• Patient breathes deeply
• @ exhalation, examiner exerts A to P HVLA thrust thru patient’s body towards PTP
• Reassess