Thoracic III/Direct II

Question 1

HVLA final activating force

Answer 1

Physician

Question 2

HVLA needs what kind of diagnosis?

Answer 2

. Highly specific
. Appropriate patient selection
. Accurate diagnosis

Question 3

Absolute Contraindications of HVLA

Answer 3

. Osteoporosis in treatment region
. Osteomyelitis 
. Fractures
. Bone metastasis
. Sever RA (weakens transverse ligament of dens)
. Down’s syndrome (same as above)

Question 4

Relative contraindications of HVLA

Answer 4

. 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

Question 5

Indications for HVLA

Answer 5

. Specific joint mobilization

. MUST be firm endpoint to barrier

Question 6

Advantage of HVLA

Answer 6

. Efficient use of physician time, highly specific

. Greater precision so less force required (gentle when localization of forces is precise)

Question 7

Principles of HVLA

Answer 7

. 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

Question 8

Joint play of Mennell

Answer 8

Dysfunction occurs in minor motion (joint play) of an articulation
. Impacts major motion of joint

Question 9

Altering afferent input of joint mechanoreceptor (Wyke)

Answer 9

. Neural activity of joint mechanoreceptors inc. muscle tone to protect joint from excessive motion under dysfunctional circumstances
. Motion becomes dysfunctionally limited

Question 10

What could be the “pop” or “click”?

Answer 10

. 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

Question 11

How does HVLA help?

Answer 11

. 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

Question 12

Possible etiologies of articular restriction

Answer 12

. Alteration of joint surfaces
. Changes in articular capsule
. Short-restrictor muscle tension
. Pain

Question 13

Joint restriction may accompany ___

Answer 13

. Disease
. Injury
. Long term stress/strain
. Immobilization, disuse, or faulty use

Question 14

Inflammatory and biological changes from dysfunction

Answer 14

. Trapped synovial folds and changes in properties of synovial fluid
. Alteration of structures
. Possible malalignment of joint surfaces

Question 15

Ruffini corpuscles

Answer 15

Respond to mechanical stress

Question 16

Pacinian corpuscles

Answer 16

Respond to acceleration of joint

Question 17

Golgi tendon organ

Answer 17

Respond to tensile forces and provide feedback about joint position

Question 18

Free nerve endings

Answer 18

Nociceptors

Question 19

Benefits of joint manipulation

Answer 19

. 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

Question 20

Does the pop sound matter?

Answer 20

. Controversial

. Bottom line reassess

Question 21

How do you accumulate forces for HVLA?

Answer 21

Maintain previously engaged barrier as you engage the next one to arrive at single, summed vector

Question 22

Correct dosage of HVLA

Answer 22

. 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