Thoracic III/Direct II Flashcards
HVLA final activating force
Physician
HVLA needs what kind of diagnosis?
. Highly specific
. Appropriate patient selection
. Accurate diagnosis
Absolute Contraindications of HVLA
. Osteoporosis in treatment region . Osteomyelitis . Fractures . Bone metastasis . Sever RA (weakens transverse ligament of dens) . Down’s syndrome (same as above)
Relative contraindications of HVLA
. Acute whiplash . Pregnancy . Post-surgical conditions . Patients on anticoagulants . Potential vascular compromise . Excessive joint inflammation . Mechanical instability/hyper mobility . Bony deformity/weakness . Ligamentous laxity . Local tissue fragility . Severe muscle spasm . Intuition says not to
Indications for HVLA
. Specific joint mobilization
. MUST be firm endpoint to barrier
Advantage of HVLA
. Efficient use of physician time, highly specific
. Greater precision so less force required (gentle when localization of forces is precise)
Principles of HVLA
. Engage barrier in all planes of motion
. Final activating force is quick, gentle inc/ in fore through small distance
. End feel must be solid not rubbery
. Localize force to area of restriction of motion
. Don’t substitute more force for poor localization
. Excess dosage may produce plastic deformation of collagen and hyper mobility
. Consider risk-benefit
. Avoid when potential risks are high
Joint play of Mennell
Dysfunction occurs in minor motion (joint play) of an articulation
. Impacts major motion of joint
Altering afferent input of joint mechanoreceptor (Wyke)
. Neural activity of joint mechanoreceptors inc. muscle tone to protect joint from excessive motion under dysfunctional circumstances
. Motion becomes dysfunctionally limited
What could be the “pop” or “click”?
. Articular surfaces rapidly separate causing gapping/cavitation
. Process assoc. w/ rapid reduction in pressure and formation of gas bubbles that create snapping sound
. Joint capsule balloons outward w/ manipulation causing sound
. NOT UNDERSTOOD
How does HVLA help?
. Stimulate neural structures in fascial tissues to initiate neurophysiologic responses (central and peripheral) from afferent mechanoreceptors causes reflexive relaxation improving processes assoc. w/ homeostasis
. “Breaks” adhesions go hypomobile joint and joint motion is improved
. Restoration of normal motion after HVLA results in better mechanorecepor activity for better posture ad performance
Possible etiologies of articular restriction
. Alteration of joint surfaces
. Changes in articular capsule
. Short-restrictor muscle tension
. Pain
Joint restriction may accompany ___
. Disease
. Injury
. Long term stress/strain
. Immobilization, disuse, or faulty use
Inflammatory and biological changes from dysfunction
. Trapped synovial folds and changes in properties of synovial fluid
. Alteration of structures
. Possible malalignment of joint surfaces
Ruffini corpuscles
Respond to mechanical stress
Pacinian corpuscles
Respond to acceleration of joint
Golgi tendon organ
Respond to tensile forces and provide feedback about joint position
Free nerve endings
Nociceptors
Benefits of joint manipulation
. Restores motion
. Re-educates nervous system dec. noise from mechanoreceptors breaking feedback loop
. Better organ function
. Therapeutic exercise used to enhance gains created by manipulation
Does the pop sound matter?
. Controversial
. Bottom line reassess
How do you accumulate forces for HVLA?
Maintain previously engaged barrier as you engage the next one to arrive at single, summed vector
Correct dosage of HVLA
. Older patients respond slower and tolerate less
. Don’t treat same segment more than once a week (allows for tissue remodeling)
. If same dysfunction happens assess why don’t jus keep treating Same thing
. Avoid repetitive thrusting on same segment
