SPINAL HVT

Question 1

SPINAL HVT - WHAT TO SAY

Answer 1

Going to perform a HVT
Potetnial risks, including stroke for Csp (1/100,000)- examination + Hx= not in risk category

Position may feel tight but shouldnt be uncomfortable, if it is let me know and I will stop
I will apply a quick impulse which may result in a cavitation (click sound), this is just CO2 and N2 leaving the Jt space, not bone on bone

The aim is to restore normal functioning + ROM

Happy?

Question 2

SPINAL HVT - WHAT IS THE POINT OF A HVT?

Answer 2

Speed to overcome muscle contraction not produce a clicking sound

Question 3

SPINAL HVT - CAUTIONS

Answer 3

Hypermobility- cant feel bind
Hesistance

Question 4

SPINAL HVT - CONTRAINDICATIONS

Answer 4

Lack of consent
Undiagnosed/previous disc injury
High blood pressure
P on set up

Question 5

SPINAL HVT - HVT VS MOBILISATION

Answer 5

Quicker + same outcome
Lower amplitude- at end range for less time

Inc time- Pt may feel in more control

Question 6

SPINAL HVT - CHEMICAL RESPONSE TO HVT

Answer 6

May feel spaced out after
Release of Co2 and N2 from the joint space is what the clicking noise is
Inc ROM= Inc BF

Question 7

SPINAL HVT - NEUROLOGICAL RESPONSE

Answer 7

Balances proprioceptive reflex

Question 8

SPINAL HVT - PSYCHOLOGICAL RESPONSE

Answer 8

Audible sound may make Pt believe something has happened
Highlights importance of explaining what happens and getting informed consent

Question 9

SPINAL HVT - CSP CONTACT

Answer 9

Contact is 2nd MCP on articular pillar
Other hand is supporting (not moving)
You are moving the superior segment.
Flx/SB/Rot = accumulating bind

Question 10

SPINAL HVT - CSP CONSIDERATIONS

Answer 10

Consider age (60+), if normal blood pressure (exercise caution if medicated), cervical clearing test

Question 11

SPINAL HVT - CSP SET UP

Answer 11

Couch high- able to rest elbows on pillows
Pt supine, head close to you
Flx/SB/Rot with nose still in line with sternum

Question 12

SPINAL HVT - CSP IMPULSE

Answer 12

Impulse= rotation away
Lower segments- 2-3, thrust more towards axilla
Middle- thrust more in line with mouth
Upper- more in line with eyes

Question 13

SPINAL HVT - CSP CHIN HOLD

Answer 13

Pt supine
Forearm comes behind the ear/under the head with the hand gripping the chin
Other hand is under the occiput and the finger pads of the hand are in contact witht he forearm
Flex, sidebend and rotate as normal

Question 14

SPINAL HVT - CSP SEATED

Answer 14

Pt seated
Stand facing, on their side of the pt
Your front hand comes round and use the middle, ring and little fingers to palpate the articular pillar
First finger comes round under the occiput
Other hand rests/stabilises around the zygomatic arch
Flex, side bend and rotate so the pt is looking at you
Cavitation is on the opposite side to the one where you are stood

Question 15

SPINAL HVT - CT LIFT

Answer 15

Pt hands on their head
Place your hands linked over C5/6
Ask them to place their hands over yours
Squeeze your elbow into their lats
Ask them to squeeze their elbows together
Relax stomach, breathe in/out, look up
Pull back and up
Direction- thrusting C7 away from T1. C7 moves anteriorly

Question 16

SPINAL HVT - CT PRONE

Answer 16

Pt prone
Stand on the opposite side to the restriction facing the pt head
Side bend pt head away from the restriction (towards you) and rotate towards the side of the restriction (so they are looking at the restriction)
Place contact on T1 with the hand that is furthest away from the couch (support with the thumb)
Control the head and neck into the same side as your contact
Support around the base of the cranium
Pt breathe in and out
Thrust is you squeezing/crossing your hands (thrust is on T1)

Question 17

SPINAL HVT - TSP RISKS

Answer 17

Soreness 24-48 hours

Question 18

SPINAL HVT - TSP PRONE

Answer 18

Start with harmonic, whilst palpating to find area of Rx
Springing to identify further
Closest hand in line with TPs closest
Other hand perpendicular
Breathe in, breathe out, then thrust down towards floor
Contact on TP above, pisiform on TP below which will cavitate

Question 19

SPINAL HVT - TSP DOG

Answer 19

Contact- SP above sits in gutter of hand
Direction- straight down
Accumulation of bind- rotation and flexion

Question 20

SPINAL HVT - RIBS

Answer 20

Pt prone
Set up the same as prone Tsp but with the contact moved laterall to be just medial to the angle of the rib, just off the TP witht he thumb almost touching the SP
Direction- ribs 3-6 pressure more up. 6-9 more straight down

Question 21

SPINAL HVT - LSP CAUTIONS

Answer 21

Hypermobility- cant feel bind
Hesitant- may be due to previous bad experience

Question 22

SPINAL HVT - LSP CONTRAINDICATIONS

Answer 22

Cauda equina
Fracture- would have been screened
Lack of consent
P on set up
Undiagnosed/previous disc injury (worsens symptoms- would need to consider CHx)
Anky spon
Osteoporosis/osteopenia

Question 23

SPINAL HVT - LUMBAR ROLL

Answer 23

Forearm over iliac fossa, other arm is gapping= rotate thorax using rib cage
Knee on couch + leg straight
Other knee into popliteal fossa
Looking towards the head
ASIS to ASIS, leg forward
Thrust= rotational- downwards
Ipsilateral facets are gapping (may cavitate both facets)
Accumulation- opposing rotational forces
Contact- between SPs

Question 24

SPINAL HVT - SIJ

Answer 24

Palpate sulcus
Increase the rotation (compared to Lsp) + add SB
Contact on PSIS
Thrust goes through ASIS
Gapping posterior aspect of SIJ

Question 25

SPINAL HVT - SIJ CHICAGO TECHNIQUE

Answer 25

Anteriorised innominate Push down on ASIS, find which side moves less Whichever side is Rx= crossed over other leg, initiates posterior rotation Move legs away from you, allows quadratus femoris to slack Side bend upper body Cross arms over, bring your contact over shoulder Hand contact on ASIS (thrusting hand) Accumulation- rotation Thrust- down towards couch in posterior direction

Question 26

CSP

Answer 26

**CONTACT** - 2nd MCP on articular pillar, other hand supporting the head **BIND** - flex, side bend and rotate the head **SEGMENTS** - moving the superior segment on the inferior segment **THRUST** - rotate away lower segments - thrust towards the axilla middle segments - thrust in line with the mouth lower segments - thrust in line with the eyes

Question 27

CT LIFT

Answer 27

**CONTACT** - hands linked over C5/C6 **BIND** - pulling back and up **SEGMENTS** - C7 moves anteriorly **THRUST** - Thrusting C7 away from T1, pulling back and up

Question 28

TSP PRONE

Answer 28

**CONTACT** - closest hand in line with TPs, other hand perpendicular - almost pisiform to pisiform **BIND** - accumulation of bind is the rotation and extension **SEGMENTS** - TP below will be the one to cavitate **THRUST** - straight down to the floor

Question 29

TSP DOG

Answer 29

**CONTACT** - SP above sits in the gutter of the hand **BIND** - rotation and flexion **SEGMENTS** - SP of the segment below to move under the one above **THRUST** - straight down to the couch

Question 30

AP RIBS

Answer 30

**CONTACT** - medial to the angle of the ribs, just off the TP, thumb almost touching the SPs **BIND** - downward pressure **SEGMENTS** - the rib your contact is on **THRUST** - ribs 3-6 pressure is more upwards to follow the curvature of the thorax, ribs 6-9 pressure is straight down

Question 31

LUMBAR ROLL

Answer 31

**CONTACT** - contact between SPs, one above where you are locking off and one below where you are trying to cavitate **BIND** - opposing rotation, locking off more by flexion and rotation, moving all the segments below to move at the fixed point **SEGMENTS** - ipsilateral side aiming to cavitate but both sides may go **THRUST** - rotational and downwards

Question 32

SIJ

Answer 32

**CONTACT** - palpate the sulcus, contact on PSIS **BIND** - opposing rotation, increase the rotation (compared to lumbar roll) and add side bending **SEGMENTS** - gapping the posterior aspect of the SIJ **THRUST** - thrust goes through the ASIS

Question 33

SIJ CHICAGO TECHNIQUE

Answer 33

**CONTACT** - contact on the contralateral ASIS **BIND** - rotation **SEGMENTS** - anteriorised innominate **THRUST** - down towards the couch in posterior direction