Intro to HVLA

Question 1

When was the first documented HVLA treatment?

Answer 1

2700 bce (earliest Chinese recordings)

Question 2

What physician, besides AT Still, promoted HVLA?

Answer 2

Dr. Palmer (opened Palmer School of Chiropractic Medicine in 1892)

Question 3

Who furthered HVLA techniques?

Answer 3

Dr. Hulett
Dr. Hazzare
Dr. McConnell

Question 4

What is the definition of HVLA?

Answer 4

thrusting technique

employs a rapid, therapeutic force of brief duration that travels a short distance w/ in anatomic range of a joint & engages the restrictive barrier to elicit release

Question 5

What force do you use in HVLA?

Answer 5

minimum amount of force required for release of 1 localized segment

Question 6

What is most important in HVLA?

Answer 6

more precise localization of positioning, less force is needed

Question 7

When can tears during muscle stretching occur?

Answer 7

before anatomic barrier is met

Question 8

Quantity in ROM

Answer 8

determined by amount of movement available from neutral position

Question 9

What do you look for in HVLA?

Answer 9

end feel in ROM that is firm & distinct

Question 10

What does rubbery end feel indicate?

Answer 10

typically from muscle, fascia, or reflex

Question 11

What is HVLA?

Answer 11

a joint release technique

Question 12

Indications for HVLA

Answer 12

dysfunction localized to a joint

distinctive barrier w/ firm or hard end feel

Question 13

Mechanism of treatment w/ HVLA

Answer 13

thrust thru restrictive barrier

restoration of motion @ articulation

restoration of normal proprioceptive input

reflex relaxation of muscles

improve TART findings

Question 14

What is the barrier positioning in HLVA?

Answer 14

localize firmly against restrictive barrier

moves thru restrictive barrier into elastic barrier to restore motion

Question 15

Is noise in HVLA necessary for success?

Answer 15

NO!

Question 16

What is the goal of OMT?

Answer 16

restore or augment tissue function

Question 17

Steps for HVLA

Answer 17

diagnose SD

provide soft tissue prep

localize force to segment or joint

release enhancing maneuver

accumulation of forces

corrective thrust

return to neutral

reassess

Question 18

What is the purpose of soft tissue preparation?

Answer 18

reduces risk of soft tissue injury

increases pt confidence in physician

Question 19

Why should physician be relaxed during HVLA?

Answer 19

free up cortex to receive kinesthetic input from hands & fingers (can think about what you are feeling more)

relaxed muscles better for rapid contraction

Question 20

Why should pt be relaxed during HVLA?

Answer 20

muscle relax prevents tensing that can interfere w/ correction

reduces risk of muscle or tendon injury

Question 21

What is localization of HVLA?

Answer 21

engagement & stacking of barriers

Question 22

Where can you treat in all 3 planes of motion?

Answer 22

the spine

Question 23

Where is the HVLA force localized on vertebrae?

Answer 23

forces localized to facet joints between 2 vertebrae (L3 SD on L4)

Question 24

What occurs during accumulation of forces?

Answer 24

move firmly against barrier on pt exhalation

Question 25

When should you not continue to thrust?

Answer 25

if localization to barrier in 1 of the planes is lost

Question 26

What is the direction of your thrust?

Answer 26

towards the culmination of all planes of motion

Question 27

What are the general rules regarding OMT dosage?

Answer 27

more acute or sick, less the dose older pts respond more slowly usually do not thrust the same segment more than once a week decrease treatment as pt improvement duration increases

Question 28

Benefits of HVLA

Answer 28

time efficient well tolerated pt usually experiences immediate relief, decreased pain & increased ROM

Question 29

Indications for HVLA

Answer 29

SD articular SD joint motion restriction

Question 30

When is HVLA super helpful?

Answer 30

adhesive capsulitis chronic dysfunction modify reflexes hypomobile joints restore alignment reduce meniscus entrapment pain modulation

Question 31

What is significant about OMT safety & efficacy?

Answer 31

OMT is one of safest procedures in medicine

Question 32

How to minimize injury w/ HVLA?

Answer 32

take thorough history careful PE use minimal amt of force

Question 33

What is a major precaution for cervical spine?

Answer 33

avoid hyperextension & excessive rotation

Question 34

"Absolute" contraindications for HVLA

Answer 34

``` local cancer ligament disruption RA Down Syndrome Osteomyelitis Spinal cord Dx ```

Question 35

What is the most important absolute contraindication for OMT/HVLA?

Answer 35

pt refusal

Question 36

What are relative contraindications for HVLA?

Answer 36

``` acute herniated nucleus pulposus acute radiculopathy acute injury osteoporosis spondylolisthesis metabolic bone disease hypermobile syndromes ```

Question 37

What are some precautions for HVLA?

Answer 37

apprehension by pt mild to moderate strain or sprain in area being treated

Question 38

When would you avoid compression?

Answer 38

mild osteopenia or osteoporosis