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Flashcards in Cervical Spine HVLA Deck (11)
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Steps of HVLA

  1. Diagnosis - Correctly diagnose SD
  2. Position - Pt and physician relaxed and comfortable
  3. Isolation - Forces localized at facet joints b/w 2 vertebrae
  4. Forces - Accumulate, engage restrictive barrier
  5. Release - use pt's breathing to perform release enhancing maneuver
  6. Thrust - Barrier engaged => Short, rapid thrust w/ sudden acceleration and deceleration
  7. Reassess - Confirm treatment resolved


Restrictive barrier

Functional limit w/in anatomic ROM that abnormally diminishes normal physiologic range


In cervical HVLA, what motion should you absolutely do not do?

Hyperextend the neck


Contralateral Traction

Cervical ST or MFR


Cradling with Traction

Cervical ST or MFR


Suboccipital Release

Cervical ST or MFR


Bilateral Forearm Fulcrum Forward Bending

Cervical ST or MFR


OA SD Cervical HVLA


AA SD Cervical HVLA


C2-7 Rotational Emphasis Cervical HVLA

Doc uses index finger pads to form a “little bridge” contacting the articular pillars on either side spinous process of the affected vertebra (C4).

  • Flex the patient’s head until motion is identified at the level of dysfunction (not below).
  • Sidebend towards the freedom TO the interspace at level of dysfunction. (ex. Sidebend right to C4-5)
  • Rotate towards the RB to the restrictive barrier
  • Apply a thrust in the rotational plane of C4 with the contact on the posterior transverse process.


  • Doc uses 2nd MCP to contact the lateral aspect of the articular pillar on the side of sidebending RB. The other hand and forearm cradles the patient’s head and chin
  • Be conscious of finger positioning on chin to neither pull on the jaw or compromise the patient’s airway.
  • Flex the patient’s head until motion is identified at the level of dysfunction, then allow the head to move into slight extension
  • This isolates motion from above and below the segment.
  • Sidebend towards the freedom (R in this case) TO the interspace of the dysfunction. (C3/4).
  • This locks out the vertebrae above the dysfunction
  • Rotate towards the RB (L in this case) THROUGH the interspace of dysfunction (C3/4)
  • Apply a thrust in the rotational plane of the dysfunctional vertebra (C3) with the hand contacting the posterior transverse process.

Rays of the sun approach to direction of thrust:

  • Upper cervicals thrust is towards the eye
  • Middle cervicals thrust is straight across the neck
  • Lower cervicals the thrust is directed down toward the chest

o DX: C4 E RrSr
o TX Localization: C4 F RL


C2-C7 Sidebending Emphasis Cervical HVLA