Thoracic III/Direct II Flashcards
HVLA final activating force
Physician
HVLA needs what kind of diagnosis?
. Highly specific
. Appropriate patient selection
. Accurate diagnosis
Absolute Contraindications of HVLA
. Osteoporosis in treatment region . Osteomyelitis . Fractures . Bone metastasis . Sever RA (weakens transverse ligament of dens) . Down’s syndrome (same as above)
Relative contraindications of HVLA
. Acute whiplash . Pregnancy . Post-surgical conditions . Patients on anticoagulants . Potential vascular compromise . Excessive joint inflammation . Mechanical instability/hyper mobility . Bony deformity/weakness . Ligamentous laxity . Local tissue fragility . Severe muscle spasm . Intuition says not to
Indications for HVLA
. Specific joint mobilization
. MUST be firm endpoint to barrier
Advantage of HVLA
. Efficient use of physician time, highly specific
. Greater precision so less force required (gentle when localization of forces is precise)
Principles of HVLA
. Engage barrier in all planes of motion
. Final activating force is quick, gentle inc/ in fore through small distance
. End feel must be solid not rubbery
. Localize force to area of restriction of motion
. Don’t substitute more force for poor localization
. Excess dosage may produce plastic deformation of collagen and hyper mobility
. Consider risk-benefit
. Avoid when potential risks are high
Joint play of Mennell
Dysfunction occurs in minor motion (joint play) of an articulation
. Impacts major motion of joint
Altering afferent input of joint mechanoreceptor (Wyke)
. Neural activity of joint mechanoreceptors inc. muscle tone to protect joint from excessive motion under dysfunctional circumstances
. Motion becomes dysfunctionally limited
What could be the “pop” or “click”?
. Articular surfaces rapidly separate causing gapping/cavitation
. Process assoc. w/ rapid reduction in pressure and formation of gas bubbles that create snapping sound
. Joint capsule balloons outward w/ manipulation causing sound
. NOT UNDERSTOOD
How does HVLA help?
. Stimulate neural structures in fascial tissues to initiate neurophysiologic responses (central and peripheral) from afferent mechanoreceptors causes reflexive relaxation improving processes assoc. w/ homeostasis
. “Breaks” adhesions go hypomobile joint and joint motion is improved
. Restoration of normal motion after HVLA results in better mechanorecepor activity for better posture ad performance
Possible etiologies of articular restriction
. Alteration of joint surfaces
. Changes in articular capsule
. Short-restrictor muscle tension
. Pain
Joint restriction may accompany ___
. Disease
. Injury
. Long term stress/strain
. Immobilization, disuse, or faulty use
Inflammatory and biological changes from dysfunction
. Trapped synovial folds and changes in properties of synovial fluid
. Alteration of structures
. Possible malalignment of joint surfaces
Ruffini corpuscles
Respond to mechanical stress
