What is the definition of HVLA?
rapid, therapeutic force of brief duration that travels a short distance within the anatomic range of a joint.
With barrier mechanics, explain HVLA?
Move through the RB to the EB, but not through the anatomic barrier.
Negative consequences of HVLA?
super low.
biggest risk is vertebral artery compromise.
Quality of the barrier is going to feel like what?
firm and distinct –> mechanical type arthrodial dysfunction
What did Dr. Nichols stress with regards to the neurophysiology of SD?
you have a segmental irritation that gives you edema and swelling, tighting of the components of the joint –> this leads to REFLEX HYPERTONICITY of the muscles crossing the joint –> tart changes –> SD
Treatment mechanism of HVLA?
thrust through RB –> restore movement at articulation –> restore normal proprioceptive input –> reflex relaxation of muscles –> improvement of TART findings.
what is a dysfunctional segment “not”?
“out of place”, or “subluxed”.
we do not adjust or put back in place.. it’s just restoring loss of motion
Steps of HVLA summary
Correctly diagnose SD
Localize segment
Engage the RB in all 3 planes of motion (stacking)
release enhancing maneuver
mobilizing force - corrective thrust
reassess
What do you do before applying HVLA principles?
consider applying techniques to relax overlying myofascial structures
What are you treating during HVLA?
Forces are localized at the FACET JOINTS between the two vertebrae.
the part that articulates with both vertebra.
How are you engaging the barriers?
forces are applied from the top down through the superior vertebrae (THROUGH THE DYSFUNCTION), and forced
forces applied from bottom up through the inferior vertebrae TO the dysfunction
typical vertebrae (C2-L5) are assessed and treated how?
in 3 planes and by stacking
Why is exhalation good for HVLA?
it helps for muscle relaxation
Indications of HVLA
Articular somatic dysfunction
joint motion restriction with a firm articular-barrier
HVLA is effective when there is a DISTINCTIVE BARRIER WITH A FIRM END FEEL
what should you avoid?
hyperextension and excessive rotation when positioning the patient.
When would you not do HVLA?
EDS
Fracture
Down syndrome (maybe?)
Absolute Contraindications of HVLA?
local metastases
severe osteoporosis
RA / Down syndrome (alar ligament instability)
Osteomyelitis
Joint replacement
Vertebrobasilar insufficiency
severe herniated disc with radiculopathy
fracture
spondylosis
surgical fusion
Relative contraindications
Acute herniated nucleus pulposis
mild to moderate strain/sprain in area being treated
acute radiculopathy
acute whiplash/severe muscle spasm/strain/sprain
spondylolisthesis
hypermobility syndromes
