Thoracic and Rib HVLA

Question 1

HVLA Supine T spine

Answer 1

Kirksville cronch

1. Physician stand opposite the PTP
2. Pt covers arms over chest with the PTP sided arm SUPERIOR
3. Place THENAR eminence on the PTP with patients elbows in your upper abdomen
4. Using the cephalad hand, flex the patients head and neck to localize the restrictive barriers (flexion/extension, sidebending)

Type 1: sidebend AWAY from the physician

Type 2: Sidebend toward

5. Instruct the patient to inhale and exhale
6. End of exhalation apply a thrust
7. Reassess

Question 2

What way do you induce sidebending for a Type 1 SD in the kirksville crunch

Answer 2

Away

Question 3

What way do you induce sidebending for a Type 2 SD?

Answer 3

Toward the physician

Question 4

Thoracic HVLA prone (type 1)

Answer 4

Texas Twist

1. Stand on the same side of the PTP
2. With the hands facing in opposite directions, place pisiform on the PTP with fingers CAUDAL and hypothenar eminence on the other PTP
3. Instruct the patient to inhale and exhale
4. End of exhalation apply a downward anterior HVLA thrust with a twist
5. Reassess

Question 5

HVLA Prone Type 2

Answer 5

Texas Twist

1. Stand on the opposite side of the PTP
2. Place thenar eminence on the PTP with fingers pointing CEPHALAD. Other hand caudal with pisiform on the opposite PTP
3. Instruct the patient to inhale and exhale
4. End of exhalation apply a downward anterior HVLA thrust with a twist
5. Reassess

Question 6

Seated Lower T spine HVLA

Answer 6

Patient seated with ipsilateral hand of the PTP on the neck and the contralateral hand on the other elbow; same set up as MET

1. Grab biceps and engage all 3 barriers
2. Place ipsilateral thenar eminence to the PTP of the dysfunctional vertebrae
3. At the end of exhalation physician pulls the patient through the rotational barrier while applying a thrust anteriorly on the PTP causing an HVLA effect
4. Reassess

Question 7

Seated 1st rib inhalation dysfunction HVLA

Answer 7

J stroke

Patient is seated with the physician standing behind

1. Physican places the foot on the table opposite on the side of the dysfunction and the patient drapes their arm over the physicians knee
2. Physician contacts the dysfunctional rib with second MCP joint and the other hand n the patients head
3. Sidebend the head towards the rib
4. During exhalation gently load the first rib
5. At the end of the exhalation; apply a thrust (inferiorlly, medially, and slightly anterior)
6. Reassess

6.

Question 8

Ribs 3-10 Bucket handle inhalation dysfunction HVLA

Answer 8

Patient is supine with the physician opposite the dysfunctional rib; patient crosses arms on chest with dysfunctional side on top

1. Doctor places the thenar eminence of the caudal hand on the superior edge of the dysfunctional ridge
2. Elevate the head into flexion
3. Localize pressure at the patients elbows and have the patient breathe gently loading the barrier
4. End of exhalation apply a thrust posteriorly directed above thenar eminence
5. Reassess

Question 9

Ribs 3-10 Bucket handle exhalation dysfunction HVLA

Answer 9

Patient is supine with the physician opposite to the dysfunctional rib; patient crosses arm with the side of the dysfunctional rib on the top

1. Physician places thenar eminence of the caudal hand on inferior aspect of dys rib
2. Other hand on neck and takes into flexion
3. Physician localizes pressure through the patients elbows at the dys rinb
4. end of exhalation, the doctor applies a posterior thrust that is slightly caudal to the thenar
5. Reassess