Chapter 16 - HVLA

Question 1

Neurophysiology behind HVLA

Answer 1

Quick thrust –> forceful stretch of muscle –> activation of muscle spindles and golgi tendon organs –> reflexive relaxation of the tight muscle

Question 2

***Absolute contraindications to HVLA (6)

Answer 2

Osteoporosis
Osteomyelitis/Pott’s disease
Fractures
Bone metastases
Severe RA (weakened transverse ligament of dens)
Down syndrome (laxity in transverse ligament of dens)

Question 3

***Relative contraindications to HLVA (6)

Answer 3

Acute whiplash
Pregnancy
Post-surgery
Herniated disc
Anticoagulation or hemophiliacs
Vertebral artery ischemia

Question 4

Most common major complication of cervical HVLA

Especially in what position?

Answer 4

Vertebral artery injury

Extended neck

Question 5

OA F SBR RL - HVLA position

Thrust?

Answer 5

Flex neck slightly, then extend OA joint slightly
Thrusting MCP is at base of occiput
SB and R INTO the barrier

Thrust = translation of occiput into the SB barrier (R), direction is toward opposite (R) eye

Question 6

AA RR - HVLA position

Thrust?

Answer 6

Grasp chin w/ (L) hand
Right index finger at the AA joint, Right thumb is on the zygomatic process (NOT the mandible)
Rotate head INTO the barrier

Rotational thrust into barrier on exhalation, using right index finger as fulcrum

Question 7

Typical cervical HVLA - where is the thrusting finger?

2 types?

Position? (for each)

Thrust? (for each)

Direction of thrust for each?

Answer 7

MCP joint on articular pillar of the dysfunctional segment

Rotational or Sidebending Thrust

Flex head and neck to segment, then extend slightly via slight F/E at that segment. ROTATE or SIDEBEND the head INTO the barrier. If it’s a sidebending thrust, rotate the head AWAY from the barrier.

Thrust via the MCP as fulcrum (rotational) or via translating the segment (sidebending)

Rotational - direct thrust at opposite eye
Sidebending - direct thrust at opposite shoulder

Question 8

Thoracics and Ribs HVLA - position

Answer 8

Supine, patient’s arms are crossed “opposite over adjacent”. The physician reaches across to put the thenar eminence on the PTP or rib angle. Use the other arm to flex and SB the torso towards doc (INTO barrier). Apply a thrust with your body during exhalation

Question 9

Flexion vs. extension dysfunctions for thoracic HVLA

Which way do you do it for a neutral? Change?

Answer 9

Flexion - thrust down on dysfunctional PTP
Extension - thrust cephalad at 45º angle on PTP BELOW

Like flexion, but sidebend the patient away from doc

Question 10

Rib 1 inhalation dysfunction - HVLA

Answer 10

SB the head and neck TOWARD, Rotate AWAY

Thrust CAUDAD via the 1st MCP on the TUBERCLE of rib

Question 11

Ribs 2-10 - HVLA (inhalation OR exhalation)

Answer 11

Same as thoracics - sidebend torso away (like neutral thoracics)

Question 12

Type 2 T10-L5 - HVLA

Answer 12

Lateral recumbent (either side)
Flex upper leg and place foot in opposite popliteal fossa
Sidebend torso INTO the barrier via the pulling the lower arm up or down (depends on if PTP is up or down)
Stabilize opposite axilla with cephalad arm, contact ipsilateral hip with caudad arm
Thrust (rotate) hip forward (into barrier)

Question 13

Type 1 T10-L5 - HVLA (how different than type 2?)

Answer 13

Rotate and sidebend torso in OPPOSITE directions into the barriers