1. HVLA

Question 1

High Velocity Low Amplitude (HVLA) is an osteopathic technique employing a
\_\_\_\_\_\_, \_\_\_\_\_\_\_ force of \_\_\_\_\_
duration that travels a \_\_\_\_\_\_
distance within the anatomic range
of a joint and that engages the
restrictive barrier to elicit release of
restriction

Answer 1

rapid, therapeutic force of RAPID duration that travels a SHORT

Question 2

HVLA is an osteopathic technique employing a rapid, therapeutic force of brief
duration that travels a short
distance within the \_\_\_\_\_\_\_ range
of a joint and that engages the
\_\_\_\_\_\_ barrier to elicit release of
restriction

Answer 2

anatomic range

restrictive

Question 3

Without SD, the end ROM that you will achieve during active motion is the ________ barrier.

Answer 3

physiologic barrier

Question 4

Without SD, the end ROM that you will acheive during PASSIVE motion is the ______ barrier

Answer 4

anatomic barrier

Question 5

_________ is the functional limit that abnormally

diminishes the normal physiologic range

Answer 5

restrictive barrier

Question 6

Before HVLA, if a patient complains in their history of symptoms of problems that are related to the ______ artery, what should the doc do?

Answer 6

VERTEBRAL ARTERY

Vertebral artery tests should be done

Question 7

If there is clinical suspicion of vertebral artery compromise by the history and physical findings, should HVLA be performed?

Answer 7

NO.

Question 8

HVLA stands for

Answer 8

HIGH VELOCITY
LOW AMPLITUDE (short distance)

Question 9

What technique what the MAIN OS technique in medical schools before 1970s?

Answer 9

HVLA; after, it expanded to other modalities

Question 10

What did was AT Still referred to as ?

Answer 10

Lightening bone setter

Question 11

HVLA is done within what barrier?

Answer 11

anatomic

Question 12

HVLA is also referred to as the _______ technique?

Answer 12

thrust

Question 13

Before doing HVLA, we should always feel what kind of end-feel?

Answer 13

Hard end-feel (firm and distinct barrier)

Question 14

What determines quantity of ROM?
What about the quality?

In a non-dysfunctional joint it is usually _______.

Answer 14

Quantity: the amount of movement FROM neutral.
Quality: palpatory sense of how smoothly a joint can move through its ROM.

symmetric

Question 15

ROM is tested when?

Answer 15

physical

Question 16

What is an end-feel?

Answer 16

quality of motion of a joint when it is brought passively to

its final barrier of motion

Question 17

HVLA is a ____ technique

Answer 17

DIRECT

Question 18

What are 2 indications for HVLA?

Answer 18

1. Good from SD with ROM that has a distinct firm barrier.

2. Articular SD.

Question 19

When conducting HVLA, we thrust through the RB.

What findings should we see after we complete HVLA?

Answer 19

Restore motion at articulation, restore normal proprioceptive input which will cause a reflex relaxation of muscles and improve our TART findings

Question 20

What causes the sound in HVLA.

Answer 20

We dont know:

1. Could be the release of gase

Question 21

What causes the sound in HVLA.

Answer 21

We dont know:

1. Could be the release of gas into the synovial fluid when we break surface tension
2. Snap/release of ligament adhesions in the joint
3. Ballooning of joint capsule
4. Bone itself snapping back into neutral

Question 22

Which of the following is considered a dysfunctional joint?

A. Subluxed
B. “Out of place”
C. “Out of joint”
D. Dislocated

Answer 22

NONEEEEE

Question 23

Do DOs “adjust” or “put back into place”

Answer 23

no

Question 24

What is an OMT’s goal in HVLA?

Answer 24

OMT’s goal is to restore motion loss and restore neutral point back to normal

Question 25

What are the 6 steps of HVLA?

Answer 25

1. Diagnose SD 2. Localize SEGMENT 3. Stack: Engage the RB in all 3 planes of motion 4. REM: Release enhancing maneuver (patient breathing) 5. Mobilizing force- Corrective Thrust 6. Reassess

Question 26

What is important to note about the initial position of HVLA?

Answer 26

its imp for the pt and doc to be in a comfortable position! | to do so, consider applying techniques to relax overlying myofascial structures

Question 27

What is a vertebral unit?

Answer 27

Two adjacent vertebrae with their associated disc, arthrodial, ligamentous, muscular, vascular , lymphatic, and neural components

Question 28

What part of the vertebral unit are we treating in HVLA?

Answer 28

forces are located at the facet joint between 2 vertebra

Question 29

What are 2 ways to engage the RB of the vertebral unit in HVLA?

Answer 29

1. "Through the dysfunction" to the segment below: – Forces are applied from the top down through the superior vertebra 2. "To the dysfunction"-– Forces are applied from the bottom up through the inferior vertebra Other Vertebrae of the unit is used as an opposing counterforce

Question 30

``` Typical Vertebrae (C2-L5)- Assessed and treated in 3 Planes of motion. What about if you do not have a segment that has 3 planes? ```

Answer 30

Assess for appendicular restriction: Typically restricted in one Major and an associated minor motion. HVLA typically treats restriction of minor motion.

Question 31

Once Barriers are engaged, use a short, rapid thrust with sudden __________ and __________

Answer 31

acceleration | deceleration

Question 32

should force be released before or after thrust?

Answer 32

AFTER

Question 33

the amount of HVLA to give a patient depends on the patient. ``` – The sicker the patient, the _____ the dose – Older patients respond more ______ – Most cases discourage thrusting the same segment more than ____________ – If the same SD keeps recurring, evaluate and address for underlying inciting factor ```

Answer 33

less slowly once a week

Question 34

What are the 3 benefits of HVLA?

Answer 34

1. GREAT for a SD with a distinct firm RB. 2. Well-tolerated and time efficient 3. Patients will experience immediate relief, increase ROM and decreased pain.

Question 35

Should we perform HVLA? 1. When a somatic dysfunction is judged to be an actual joint motion restriction (such as facet locking), not an exclusive soft tissue restriction. In the face of joint fixation 2. To disrupt connective tissue adhesions 3. To treat chronic dysfunction resistant to other treatment modalities

Answer 35

YES YES YES

Question 36

T/F HVLA possibly remains as the safest procedure in medicine.

Answer 36

yes

Question 37

When performing HVLA, when treating the cervical spine, what should we avoid?

Answer 37

1. Hyperextension | 2. Excessive rotation

Question 38

What is ESSENTIAL for uncovering any contraindications of HVLA?

Answer 38

Before treating, do a thorough history and physical exam.

Question 39

If the risk outweighs the benefit, should HVLA be performed?

Answer 39

NO

Question 40

What is the most important safety consideration to consider when performing HVLA?

Answer 40

ACCURATE DIAGNOSIS IS IMPORTANT

Question 41

What are 4 other safety considerations to consider when performing HVLA?

Answer 41

1. Patient’s consent and comfort is important 2. Listen with your hands- Don't thrust if the barrier DOES NOT FEEL RIGHT 3. Too much force can damage tissue 4. Hypermobility can be made worse by HVLA

Question 42

What are the 2 most important ABSOLUTE contraindications for HVLA and why?

Answer 42

1. Rheumatoid Arthritis 2. Down syndrome 3. Spondylysis 4. Local metastais 5. SEVERE osteomyletisis or osteporosis these patients can have alar ligament instability

Question 43

Relative contraindications?

Answer 43

1. Acute problems 2. Mild osteopenia, mild osteoporosis 3. SpondoloTHESIS 4. Hypermobility syndromes (marfans or ED)