Thoracic III/Direct II

Question 1

HVLA treats ______

Answer 1

Somatic dysfunction of arthrodial joints

Question 2

To use HVLA you must ____

Answer 2

. Have joint motion dysfunction
. Make proper diagnosis
. Localize forces in all 3 planes

Question 3

M99.02 HVLA Thoracic cross hand pisiform thrust patient prone (Texas twist) dysfunction and objective

Answer 3

Dysfunction: T5FRSr (only good for flexed dysfunctions!)
Objective: improve extension, left sidebending, and left rotation

Question 4

Texas twist patient and physician position

Answer 4

Patient prone

Physician standing at side of table opposite post. Component

Question 5

Texas twist procedure for SRr

Answer 5

. Place right thenar eminence over right post. Transverse process
. Place left hypothenar eminence on opposite side of spine contacting left transverse process of vertebra below
. W/ firm contact push down (ant.) and sup. Right side while simultaneously pushing down (ant.) and inf. On left (downward pressure introduces extension, translation localized sidebending and applies twist to soft tissue)
. W/ elbows locked apply quick, light HVLA trust ant. Predominantly on post. Transverse process of problem vertebra
. Reassess

Question 6

HVLA thoracic knee in back extended dysfunction, objective, and discussion

Answer 6

. Dysfunction: T4ERSr (good for T2-T6or7)
. Objective: improve flexion, rotation and sidebending left
. Discussion: only for extended dysfunctions, knee on post. Transverse process of sup.. segment of dysfunction

Question 7

Thoracic knee in back HVLA patient and physician procedure

Answer 7

. Patient seated

. Physician standing behind patient

Question 8

HVLA thoracic knee in back procedure for ERSr

Answer 8

. Place right thumb on post. Component
. Place right foot on table w/ knee in contact w post. Component w/ pillow in btw
. Bring hands under patient’s axillae and over forearms bilaterally to rest hands on back of their wrists
. Patient clasps hands behind neck
. Hold knee firmly again back, have patient drop elbow forward, pull against axillae w/ forearms to introduce flexion
. Engage barrier by translating problem vertebra to right by shifting segment right trough knee and forearm at axillae while maintaining flexion
. Minimally rotate upper torso to left down to problem vertebra
. Quick thrust directed upward and lat. w knee combined w inc/ traction through back of hands and forearms through axilla
. Forces from above and below meet at dysfunctional segment
. Reassess

Question 9

Considerations for thoracic HVLA knee in back extended

Answer 9

. Don’t grasp patient’s wrists firmly or apply too mushy foreword bending stress to neck/upper thoracic
. Always use pillow
. Keep pt. Balanced over pelvis
. Technique more effective for T2-T6 w patient sitting w/ legs extended on table
. Keep patient’s weight balanced over ischial tuberosities
. Engage barrier w lat. translation to introduce proper side bending from below

Question 10

HVLA knee in back flexed dysfunction and objective and discussion

Answer 10

Dysfunction: T4FRSr
Objective: improve extension, rotation and side bending left
. Discussion: only for flexed thoracic dysfunctions, knee positioned on lower segment of dysfunctional unit on side OPPOSITE post. Component

Question 11

HVLA knee in back FRSr procedure

Answer 11

. Place right thumb on post. Component of dysfunction, place left thumb on left transverse process of vertebra below it
. Place left foot on table w/ knee contacting left thumb then replace thumb w/ pillow
. Put hands under axillae and over forearms resting on backs of wrists w/ patient hands behind neck
. Hold knee against patient, have them drop elbows forward and sit up straight
. Translate petulant post. Against holding force of knee
. Engage barrier by translating problem vertebra to right through knee and forearms at axillae
. Minimally rotate upper torso to left down to problem vertebra
. Quick thrust upward and medially w/ your knee combined w inc. upward traction w hands and forearms through axilla
. Reassess