HVLA Flashcards
What family moved from Europe to America to begin thrust techniques
Sweet family in New England
Theories of joint dysfunction
Alteration/disruption of normal tracking of the opposing joint surfaces
Articular capsule problems occur when the synovial fluid changes and causes synovium to be trapped between opposing surfaces
HVLA theory of action
Sudden stretch or change in the joint alters the afferent activity of the mechanoreceptors resulting in neural change related to that spinal cord segment
- releases hypertonic muscles that surround the joint that HVLA treatment is focused on
The body automatically rests the articular surface apposition
- due to “overload” of the CNS with too much information causes
Joint play
Small movements at synovial joints
- approximately 1/8th of movement
- NOT CONTROLLED by voluntary muscle contraction
- without joint play , the motions in the joint become restricted and possibly painful
Coined by John mennell
Secondary effects of HVLA
Alter length and tone of connective tissue and facia
Increases blood/lymph flow
Remove compression on nerves
- normalized autonomic balance
- allow improved neurotrophic flow of proteins
- decreases nociceptor activation (pain)
Primary effects of HVLA
Decrease pain and increase ROM of a joint
HVLA principles
1) Accurate intersegmental triplanes diagnosis for vertebrae
2) use ST/ MFR techniques to “warm up” area
3) position patient into ALL direct barriers
- be very specific with barriers
- could feel like “its going to click” which means you are engaged towards the barrier the best as possible
4) thrust directly into the barrier
- sometimes isnt even needed if stacked properly
“Locking”
Positioning a joint into direction of restriction, just short of being fixed in place, but there is a small amount of “joint play” allowed
It is required to lock a joint and have a hard end feel before applying HVLA
Steps in performing HVLA
1) accurate diagnosis by palpatory examination and motion testing
2) make sure the patient understands the procedure
3) decide whether to do tissue prep (ST/MFR/CS/Still technique)
4) gross level positioning in the direction of the restrictive barrier
- NOTE: if barrier is soft/rubbery and not a hard end-feel, DONT do HVLA, pick something else.
5) fine-tuning with accumulation of forces centered at the dysfunctional joint
- “lock” into place all 3 barriers
6) have patient breath in and on exhalation, you apply the HVLA thrust towards the appropriate barrier
Superior facets direction in the thoracic vertebrae
Backwards, upwards, lateral (BUL)
What two hand positions can you use as a fulcrum in throacic HVLA?
Open hand or closed fist
- can be perpendicular to spinal segment or 30 degree tilt to spinal segment
Where does the physician stand in thoracic supine HVLA?
Always on the opposite side of the posterior transverse process (which ever way the vertebral segment is rotated)
How is the patients arms supposed to be crossed during thoracic HVLA?
Contralateral side (same side as somatic dysfunction rotation) is to be on top
“Opposite over adjacent” as it pertains to the physician side
Where is the HVLA force applied in thoracic HVLA?
Straight down towards the fulcrum hand (usually down to the floor and through the epigastric region)
Why is the fulcrum placement different on flexion somatic dysfunctions in thoracic HVLA?
The fulcrum is placed below the posterior transverse process in order to induce extension of the dysfunctional vertebrae
Which vertebrae do you treat in a neutral somatic dysfunctional for a group of thoracic vertebrae in thoracic HVLA?
The “APEX” vertebrae (one that induces the most curvature of the spine)
- is almost always the middle one (i.e T6-8 = T7)
How do you change arm placements for upper thoracic vs lower thoracic in throacic HVLA?
Upper = have patient place hands behind neck or
- this is to better localize movement to those vertebrae
- upper include (T1-4)
Review: which ribs are atypical and why?
Rib 1 = articulates on with T1 and has no angle
Rib 2= large tuberosity on shaft for serratus anterior
Rib 10 = articulates only with T10
Ribs 11-12 = articulates with corresponding vertebra and lack tubercles
How do ribs 11 and 12 move with inhalation and exhalation?
Inhalation = ribs move posteriorly and inferiorly
Exhalation = ribs move anteriorly and superiorly
moves in a transverse plane with cephalad-pedad (vertical line) axis of motion
Tissue texture abnormalities for rib somatic dysfunctions
Skin lesions
Red reflex
Pseudo motor findings
Temperature changes
Biggie s and edema
Rosiness
Hypertonic muscles
What are the common sites of thoracic outlet syndrome to occur at?
Anterior and middle scalenes
- brachial plexus and subclavian artery gets impinged here
Clavicle and anterior Rib 1
- brachial plexus, subclavian artery and vein gets impinged here
Costo-pectoral-coracoid region
- brachial plexus, subclavian artery and vein gets impinged here
Absolute contraindications for RIB HVLA
Interferes with patients breathing in anyway
Open wound
Flail chest/fractured or cracked ribs
Osteopenia or osteoporosis
Bone cancer or Mets
Potts disease
Non compliant or patient who can relax
Superior 1st rib superior shear findings inTART
Tissue texture abnormalities
- scalene hypertonicity and upper cervical/thoracic muscle imbalances
Asymmetry
- posterior shaft at tubercle is elevated 5mm compared to normal side
- T1 is usually sidebent away from the side of the superior shear
ROM
- respiratory motion is poor at R1 and is associated with inhalation or exhalation SD (usually inhalation; rarely exhalation)
- greater resistance is felt when pressing inferiorly on dysfunctional R1
Tenderness
- marked tenderness at R1s superior aspect
TART with ribs 2-10 HVLA
Tissue texture
- hypertonic illiocostalis muscles at rib angle
Asymmetry
- anterior aspect of ribs are less prominent
- posterior rib angle is more prominent
- should confirm moth to be sure*
ROM:
- marked restriction in both exhalation or inhalation (usually inhalation)
Tenderness:
- marked tenderness at rib angle and “intercostal neuralgia complaints”
