Before a thrust, what should you do?
soft tissue or MET
Rib 3-10 Inhalation SD bucket handle dysfunction HVLA, Exhalation emphasis
what about for inhalation?
JUST LIKE KIRKSVILLE CRUNCH… only difference is you’re placing your hand on the medial aspect of the angle of the rib, not the PTP.
1) for exhalation, your hand is going to be inferior to the angle of the rib and doing a thrust, for INHALATION you’re SUPERIOR to the angle of the rib and applying a thrust
T Spine Supine HVLA (Kirksville Crunch)
1) stand opposite the side of the PTP
2) arm of the involved segment to be on top, bear hug, arms are lined up
3) take cephalad hand to grab the shoulder and pull them up, and thenar eminence of caudal hand on that segment PTP.. forming a wedge
4) load your upper abdomen into their elbows
5) use cephalad hand to lift and position the pt’s head and neck to localize to the RESTRICTIVE barrier (F/E, side bending, rotation).. TYPE 1 SB AWAY, TYPE 2 SB TOWARDS doc
6) inhale and exhale
7) thrust down into table on exhalation
Same side SD HVLA?
ipsilateral to dysfunction
find the posterior segment and put cephalad hand thenar eminence on it.
PULL THE ELBOWS up until it feels tight on your hand
take your hand that’s on the back and give a twisting to induce a side bending component.
inhale and exale –> HVLA thrust
What are you supposed to say for how an HVLA is performed?
Rapid thrust traveling a short distance
Steps for HVLA?
localize the segment
Engage the RB
Release enhancing maneuver (breathe)
mobilizing force-corrective thrust
Seated Lower T-Spine HVLA?
1) put arm behind head that’s on the PTP side, have other arm grab the elbow.
2) type one you go under one, and over one.. type 2 is over both
3) Monitor at that segment with your other hand
4) side bend and rotate to that barrier till you’re at the segment
5) primer with muscle energy to get to neutral, do it 3 wish times.. (NOT NECESSARY BUT HELPS)
6) at the end of that thrust them into the barrier after exhalation and inhalation
Supine Knee Fulcrum HVLA – Upper and Middle thoracic
1) PT supine, fingers clasped behind neck
2) put ipsilateral knee to the PTP to the dysfunctional vertebrae to act as a fulcrum for the HVLA treatment
3) reach through the arms and contact the mid axillary line on the ribs
4) inhale and exhale, physician quickly and gently pulls pt chest downward into the thigh while adding cephalad traction
Upper Ribs 1-4 HVLA (chin pivot)
say a left rib
1) bring the right arm off the table toward the side.
2) you put your caudal hand on the medial angle of the rib
3) have them cup their dysfunctional side hand under their chin
4) rotate the head toward the dysfunctional side
5) take that elbow that’s cupping the chin and sidebend it up to the segment.
6) load into caudal hand, but monitor with the other hand on the head.
7) big breath in, breathe out, apply an anterolateral thrust into that rib.
Texas Twist (Prone HVLA)
1) stand opposite the PTP
2) Type 1 –> cephalad H and facing caudal, place thenar eminence on PTP… Opposite hand (caudad hand facing cephalad)
***TYPE 2 FLEXED ONLY –> opposite way. thenar eminence on PTP faces CEPHALAD, opposite faces caudal on non-PTP side
3) follow fingers until you follow your fingers and some twisting involved.
4) have them breathe in and out, following exhalation small thrust
Seated Knee Fulcrum HVLA?
very similar to the other one
1) patient is sitting, you’re behind them, put a stool up behind them and put your leg up. Ipsilateral leg on their ipsilateral side
2) their hands are behind their head.. you come from UNDERNEATH and go through like you’re full nelson them
3) apply extension over that knee,
4) have them breathe in, and out, and apply a thrust at the end
Rib 1-2 Inhalation SD, exhalation emphasis HVLA
1) dysfunctional rib say is on the left, you bring the opposite leg on the right side and drape their right arm over top of it
2) side bend them to the opposite side using your leg, so bringing that leg more to the right.
3) monitor with one hand at the dysfunctional ribs (MCP)
4) other hand goes on top of the head, apply compression, sidebend toward and rotate away
5) have them breathe in and out, on the out you apply and inferomedial thrust.