Intro HVLA Flashcards
What does HVLA stand for?
High Velocity, Low Amplitude
How important has HVLA been historically?
HVLA was the major type of technique taught in osteopathic medical colleges prior to the1970’s
After 1970’s, school curriculum’s began expanding to include other modalities
What is HVLA?
An osteopathic technique employing a RAPID, therapeutic force of brief duration that travels a SHORT DISTANCE within the anatomic range of a joint and that engages the Restrictive Barrier to elicit release of restriction
Also known as the Thrust Technique
What is the Physiologic Barrier?
End Range of Motion achieved during ACTIVE MOTION (patient moving) in the absence of Somatic Dysfunction
What is the Anatomic Barrier?
End Range of Motion achieved during PASSIVE MOTION (doctor moving patient) in absence of Somatic DYsfunction
What is the Restrictive Barrier?
A functional limit that abnormally diminishes the normal physiologic range of motion
What is a shifted neutral?
Neutral is the middle point between the physiologic barriers
When a Restrictive barrier is present, it reduces the range of motion forcing a new middle point, known as the shifted neutral
What is a contraindication of HVLA?
Vertebral Artery thrombosis
If patient complains in history of symptoms referable to the vertebral artery, or if there are related physical signs, vertebral artery tests should be conducted
If there is clinical suspicion of vertebral artery compromise by the history and physical findings, then HVLA manipulation of the cervical spine should not be attempted
What is Range of Motion Quantity?
ROM Quantity is determined by the amount of movement available from a neutral position
It is evaluated during physical exam
Typically symmetric in a non-dysfunctional joint
Measured in 3 distinct planes of motion
- Sagittal
- Coronal
- Transverse
What is Range of Motion Quality?
Refers to palpatory “sense” of how smoothly a joint can be moved through its ROM
What is End Feel?
Quality of motion of a joint when it is brought passively to its final barrier of motion
Function of focal tissue turgor and tethering of attached muscles and fascia
Firm and Distinct
Typically mechanical type of arthrodial dysfunction
Rubbery - reflex somatic dysfunction
What kind of technique is HVLA?
Direct technique
What are indications for HVLA?
Quantity and Quality allow examiner to determine and define Restriction of Motion
HVLA is particularly effective when there is a DISTINCTIVE BARRIER WITH A FIRM END FEEL
What is the mechanism of treatment for HVLA?
Perform Soft Tissue treatment prior to performing technique
Ask Permission form Pt is they’re okay with you potentially cracking joints
Thrust through the restrictive barrier
Restoration of motion at articulation
Restoration of normal Proprioceptive Input
Reflex Relaxation of Muscles
Improvement of TART findings
What is the source of the cracking noise heard during HVLA treatment?
Source of noise is under debate
- Eventration of gas into the synovial fluid with the breaking of surface tension
- Snapping/releasing of ligamentous adhesions in the joint
- Ballooning of the joint capsule
- Bone itself being pulled out of place and snapping back into the neutral position
Is the cracking noise necessary for a successful HVLA treatment?
NO
What is the goal of performing HVLA?
OMT’s goal is to restore motion loss and restore neutral point back to normal
What is not a dysfunctional segment?
When it is:
- Subluxed
- Out of place
- Out of Joint
- Dislocated
As Osteopathic physicians, we DO NOT:
Adjust
Put back into place
What are the Steps for HVLA?
Correctly Diagnose SD
Localize Segment
Engage the Restrictive Barrier in all 3 planes of motion-stacking
Release enhancing maneuver
- Patient Breathing
Mobilize force-corrective thrust
Reassess
What is the Vertebral Unit?
Two Adjacent vertebrae with their associated disc as well as their:
- Arthrodial Component
- Ligamentous Component
- Muscular Component
- Vascular Component
- Lymphatic Component
- Neural Component
Where are forces localized in the vertebral unit?
Forces will be localized at Facet Joints between the two vertebrae
What are the two approaches to applying forces to engage barrier?
Forces are either applied:
- Top-down through the superior vertebra, “THROUGH the dysfunction”
- Bottom-up through the inferior vertebra, “TO the dysfunction”
How does stacking barriers work?
You put patient into 3 planes of restriction:
- Rotation
- Side-bending
- Flexion/Extension
