Principles of HVLA Thrust Technique

Question 1

Define HVLA

Answer 1

osteopathic technique employing a rapid therapeutic force of brief duration that travels a short distance within the anatomic range of motion of a joint; engages restrictive barrier in one or more planes that releases restriction Does not go beyond anatomic barrier

Question 2

What type of manipulative treatment is HVLA?

Answer 2

direct

Question 3

What type of motion should be restored to the dysfunctional joint after HVLA?

Answer 3

appropriate physiologic motion

Question 4

Which barrier is engaged and which barrier is moved through?

Answer 4

restrictive barrier is engaged and dysfunctional barrier is moved through

Question 5

How many planes are positioned before a final force is delivered?

Answer 5

all three planes

Question 6

What theories explain the popping noise?

Answer 6

Hutton (bone popping into place); Wharton Hood (snapping of adhesions); Hargrove-Wilson (breaking of joint seal and release of nitrogen bubble); Nicholas-Ehrenfeuchter (thin layer adherence

Question 7

Process where two congruent surfaces are “glued” together by a typically lubricating substance is thinly spread

Answer 7

This layer adherence theory

Question 8

Joint surfaces in complete contact with each other in the anatomic position.

Answer 8

Congruent surgaces (ex. spinal facet joints)

Question 9

List an example of a non congruent surface

Answer 9

Femoral condyles on tibial plateau

Question 10

Synovial fluid is __X slippier than ice on ice

Answer 10

10X

Question 11

Synovial fluid possesses (high/low) surface tension.

Answer 11

very high

Question 12

An articular release must always be audible. (T/F)

Answer 12

False

Question 13

An articular release can be present in a healthy state. (T/F)

Answer 13

True

Question 14

How fast is an articular release?

Answer 14

0.04 to 0.06 seconds

Question 15

What is phonoarthrography?

Answer 15

method for recording release; commonly studied in metacarpal phalangeal and cervical spine facet joints

Question 16

List the steps of articular release?

Answer 16

Step 1: preliminary tension mobilization
Step 2: articular release
Step 3: overshoot in release
Step 4: Refractory tension; release in tension

Question 17

What regions make an articular clunk?

Answer 17

sacroiliac joint, hip joint, any osteoarthritic joint

Question 18

An articular crack sounds like what?

Answer 18

a breaking noise; bimodal or multimodal peak

Question 19

An articular pop expresses what modality on a sound frequency scale?

Answer 19

single modal curve

Question 20

When is crepitus most frequently emitted?

Answer 20

wrist in lateral extension

Question 21

A ligamentous strum is a result of what?

Answer 21

a tense ligament or fascial structure rolling over a bone or solid prominence

Question 22

A torn adhesion sound is heard during a ?

Answer 22

frozen shoulder; high-pitched non-repreatable tearing

Question 23

What is the pressure in a facet joint just prior to release?

Answer 23

3.5 atmospheres

Question 24

In what state must muscles be for producing articular release?

Answer 24

relaxed muscles

Question 25

Too frequent articular mobilization may lead to what?

Answer 25

hypermobility and ligamentous & capsular hypertrophy

Question 26

What is the refractory period in the finger? spinal articulations?

Answer 26

finger - 20 minutes | spinal articulations - 1- several hours

Question 27

When external barometric pressure is lower it makes joints (easier or more difficult) to crack.

Answer 27

easier

Question 28

What are some contraindications for HVLA?

Answer 28

``` 1 - unstable or hypermobile joints 2 - Rheumatoid arthritis 3 - Down Syndrome 4 - Advanced carotid disease 5 - local metastases 6 - osseous or ligamentous disruption and infection ```

Question 29

Do you need to do a physical exam before manipulation?

Answer 29

yes

Question 30

List 9 screening exams

Answer 30

``` 1 - Spurling's test 2- compression test 3- distraction test 4- vertebral artery test 5 - menigeal irritation tests 6- DTR: UE & LE 7 - Muscle strength 8 - sensation 9 - specific somatic dysfunction ```

Question 31

How do you set up the Spurling's test?

Answer 31

extend neck and rotate & sidebend head toward side of testing. Then add axial force by physician

Question 32

Why would you use a Spurling test?

Answer 32

evaluate cervical nerve root impingement

Question 33

What is a positive compression test?

Answer 33

reproduction of radicular symptoms distant from the neck

Question 34

When would you do a distraction test?

Answer 34

only with a positive compression or spurling's test

Question 35

What symptoms would display with C4/C5 disc herniation?

Answer 35

weakness in deltoid muscle; some shoulder pain

Question 36

What symptoms would display with C5/C6 disc herniation?

Answer 36

weakness in the biceps and wrist extensor muscles; numbness, tingling ** most common level**

Question 37

What symptoms would display with C6/C7 disc herniation?

Answer 37

weakness in triceps and finger extensor muscles; numbness, tingling **also common level**

Question 38

What symptoms would display with C7/T1 disc herniation?

Answer 38

weakness in handgrip, numbness, tingling

Question 39

How do you place the patient's head during the vertebral artery test?

Answer 39

passive extension and cervical spine rotation

Question 40

In the vertebral artery test, which vertebral artery will be tested (ipsilateral/contralateral)

Answer 40

contralateral

Question 41

What does a positive vertebral artery test result in?

Answer 41

dizziness, nausea, syncope, dysarthria, dysphagia

Question 42

List 2 meningeal irritation tests

Answer 42

Kernig's sign; Brudzinski's sign

Question 43

What factors can influence deep tendon reflexes?

Answer 43

age, metabolic factors (thyroid dysfunction, electrolyte abnormalities) and anxiety level

Question 44

Key sensory level C2

Answer 44

occipital protuberance

Question 45

Key sensory level C3

Answer 45

supraclavicular fossa

Question 46

Key sensory level C4

Answer 46

superior AC joint

Question 47

Key sensory level C5

Answer 47

lateral side of antecubital fossa

Question 48

Key sensory level C6

Answer 48

thumb, dorsal

Question 49

Key sensory level C7

Answer 49

middle finger, dorsal

Question 50

Key sensory level C8

Answer 50

little finger, dorsal

Question 51

Key sensory level T1

Answer 51

medial side of antecubital epicondyle

Question 52

Key sensory level T2

Answer 52

apex of axilla

Question 53

Key sensory level T3

Answer 53

3rd intercostal space

Question 54

Key sensory level T4

Answer 54

nipple line

Question 55

Key sensory level T5

Answer 55

5th intercostal space

Question 56

Key sensory level T6

Answer 56

xiphoid process

Question 57

Key sensory level T7

Answer 57

7th intercostal space

Question 58

Key sensory level T8

Answer 58

8th intercostal space

Question 59

Key sensory level T9

Answer 59

9th intercostal space

Question 60

Key sensory level T10

Answer 60

10 intercostal space

Question 61

Key sensory level T11

Answer 61

11th intercostal space

Question 62

Key sensory level T12

Answer 62

inguinal ligament

Question 63

Key sensory level L1

Answer 63

top of thigh

Question 64

Key sensory level L2

Answer 64

mid-anterior thigh

Question 65

Key sensory level L3

Answer 65

medial femoral condyle

Question 66

Key sensory level L4

Answer 66

medial malleolus

Question 67

Key sensory level L5

Answer 67

dorsum of foot at 3rd MTP; lateral leg

Question 68

Key sensory level S1

Answer 68

lateral heel

Question 69

Key sensory level S2

Answer 69

popliteal fossa

Question 70

Key sensory level S3

Answer 70

ischial tuberosity; groin

Question 71

Key sensory level S4-S5

Answer 71

perianal area

Question 72

Cervical manipulation is much safer than the use of NSAIDs (T/F)?

Answer 72

True

Question 73

Does the physician emphasize force or localization?

Answer 73

localization

Question 74

What is the indication for HVLA?

Answer 74

somatic dysfunction with articular restriction