HVLA

Question 1

Normal Coupling - C0-1

Answer 1

Type 1

Question 2

Normal Coupling - C1-2

Answer 2

Complex primary rotation, technique uses ligamentous myofascial q

Question 3

Normal Coupling - C2-T7

Answer 3

Type 2

Question 4

Normal Coupling - C7-T3 (prone)

Answer 4

Type 1 or Type 2

Question 5

Normal Coupling - T3-L5

Answer 5

Flexion = type 2
Extension = type 1

Question 6

Spine positioning - C1-2

Answer 6

Ligamentous myofascial

Question 7

Spine positioning - C2-7 Upslope

Answer 7

Type 1 (facet apposition)

Question 8

Spine positioning - C2-7 Downslope

Answer 8

Type 1 (facet apposition)

Question 9

Spine positioning - C7-T3

Answer 9

Type 1 or Type 2

Prone: Facet apposition
Seated: Ligamentous myofascial

Question 10

Spine positioning - T4-9 extension (seated)

Answer 10

Ligamentous myofascial

Question 11

Spine positioning - T4-9 flexion (supine)

Answer 11

Ligamentous myofascial

Question 12

Spine positioning - L1-5 neutral/extension

Answer 12

Type 2 (facet apposition)

Question 13

Spine positioning - L1-5 flexion

Answer 13

Type 1 (facet apposition)

Question 14

Normal Coupling L1-5 (Flexion)

Answer 14

Type 2

Question 15

Normal Coupling - C7-T3 (seated)

Answer 15

Ligamentous myofascial

Question 16

Normal Coupling L1-5 (Neutral/extension)

Answer 16

Type 1

Question 17

Substantive reversible impairment - Lumbar

Answer 17

• Disc herniation or prolapse
• Minor vertebral body compression
• Posterior element fracture without lost of structural integrity
• Nerve root compression
• Lumbopelvic region strain

Question 18

Substantive non-reversible Cervical

Answer 18

• Unresolved disc herniation

- Unresolved radioculopathy

Question 19

Substantive non-reversible Thoracic

Answer 19

• Significant vertebral body compression fracture

- Posterior element fracture with disruption to the spinal cord

Question 20

Substantive non-reversible Lumbar

Answer 20

• Significant vertebral body fracture
• Unresolved disc herniation/prolapse
• Unresolved radioculopathy
• Posterior element fracture with disruption to the spinal cord

Question 21

Serious non-reversible Cervical

Answer 21

• Stroke

- Spinal cord compression

Question 22

Serious non-reversible Thoracic

Answer 22

• Spinal cord compression

Question 23

Serious non-reversible Lumbar

Answer 23

• Cauda equine syndrome

Question 24

Vertebrobasilar insufficiency signs/symptoms

Answer 24

• Overt loss of balance in relation to head movements
• Facial lip paraesthesia, reproduced by active or passive neck movement
• Bilateral or quad-lateral limb paraesthesia either constant or reproduced by neck movement
• Nystagmus produced by active or passive neck movement

Question 25

Cardinal cervical instability signs/symptoms

Answer 25

- Overt loss of balance in relation to head movements - Facial lip paraesthesia, reproduced by active or passive neck movement - Bilateral or quad-lateral limb paraesthesia either constant or reproduced by neck movement - Nystagmus produced by active or passive neck movement

Question 26

Vertebrobasilar insufficiency signs/symptoms

Answer 26

Signs: - Nystagmus - Gait disturbances - Homer's syndrome Symptoms: - Headache/neck pain - Dizziness/vertigo - Nausea/vomiting - Facial paraesthesia - Tingling upper limbs - Blurred vision - Light headed

Question 27

Relative contraindications

Answer 27

- Previous adverse reactions to treatment - pregnancy - Hypermobile/ligamentous laxity - Osteoporosis

Question 28

Absolute contraindications

Answer 28

- Any bone pathology that has lead to significant bone weakening (tumour, severe rheumatoid arthritis) - Cord compression - lack of consent or diagnosis

Question 29

Tests for upper cervical instability

Answer 29

1. Transverse (translate occipital and atlas are moved posteriorly from the pressure on the forehead) - positive symptoms with head and neck flexion 2. Alar (same hand hold and passive rotate the atlas to the right & left

Question 30

Things to include

Answer 30

- cracking sound from movement - symptoms may persist but should subside in 24-72hrs if not, please contact me - this treatment approach has caused or aggravated a disc injury or a pinched nerve. If you feel any discomfort at any time please tell me - thoracic, rib or vertebra fracture - lumbar, damage to the nerves which can cause permanent bladder/bowel issue - from my assessment today I believe the benefits outweighs the risk associated - do you have any questions - am I okay to proceed?