Title: Bone Wizardry / OMM Mastery / 16.HVLA
Tags: #BW_OMM::Technique::HVLA #BW_OMM::Type::Cloze BoneWizardry bonewizardry-free omm omt
On every note of this deck, unless a note says otherwise:
Review Links: - Bone Wizardry cervical OMM
- Practice: HVLA QBank
Show outside sources
- HVLA cervical vertebrae
- HVLA thoracic vertebrae
- HVLA inhaled ribs
- AAFP neck pain evaluation

Q: HVLA is considered a [...], [...] technique.
A: passive; direct
Q: HVLA techniques may also be called [...] techniques.
A: thrust
Comment: HVLA delivers a quick, small-range thrust to push a restricted joint past its barrier. The high velocity matters most; the amplitude stays deliberately small to avoid overshoot.
Topic: HVLA
Bone Wizardry Lock: HVLA is passive and direct. The physician does the positioning and the work. The patient just relaxes.

Q: HVLA General Procedure:
1. After correct diagnosis of a SD, the physician will move the dysfunctional segment in such a way that it is against its [...] barrier.
A: restrictive
Q: To treat using HVLA (general HVLA), if a segment was FRlSl, the physician would position the patient how?
[...]
A: ERrSr
Q: HVLA General Procedure:
2. The patient is asked to [...].
A: relax
Q: HVLA General Procedure:
The [...] phase of respiration is the relaxation phase, and the final force is often applied during [...].
A: exhalation; exhalation
Q: HVLA General Procedure:
3. The physician then uses a [...], [...] thrust to move the dysfunctional segment through the restrictive barrier.
A: short; quick
Comment 2: Note: due to the facet orientation and biomechanics in certain regions of the spine, it is not always possible to reverse all three planes of motion (i.e. the cervical spine).
Comment 3: If the patient is not relaxed, the treatment will fail and the corrective thrust may cause soft tissue damage. The exhalation phase of respiration is the relaxation phase, and the final force is often applied during exhalation.
Comment 5: Often a pop or click is heard along with an increase in the range of motion. Be sure to remain against the restrictive barrier before applying the thrust, do not back off before the thrust.
After this step, re-evaluate range of motion.
Topic: HVLA
Bone Wizardry Lock: The sequence is fixed: get to the barrier, wait for exhalation, apply the thrust. Do not back off the barrier between setup and execution.

Q: HVLA is indicated when motion [...] is found in SD.
A: loss
Comment: Joint restriction from contracture or advanced degenerative disease is structural, not a motion barrier somatic dysfunction. HVLA needs a barrier to work against, and pathologic stiffness does not provide one.
Topic: HVLA
Bone Wizardry Lock: HVLA is for motion loss in somatic dysfunction. Structural restrictions from arthritis or contracture are not motion barriers, so HVLA has no target.

Name some absolute contraindications of HVLA:
1. Osteoporosis
2. Osteomyelitis
3. Fracture
4. Bone metastases
5. Severe rheumatoid arthritis
6. Down syndrome
Comment: Rheumatoid arthritis and Down syndrome can weaken the transverse ligament of the dens, increasing the risk of atlantoaxial instability. Avoid cervical HVLA when instability or cervical arterial dysfunction findings are suspected; use caution with acute whiplash, pregnancy, recent surgery, herniated nucleus pulposus, and anticoagulation.
Topic: HVLA
Bone Wizardry Lock: Bone fragility and ligamentous instability are the hard stops. RA and Down syndrome both compromise the transverse ligament of the dens, which is why they both land on the absolute contraindication list for cervical HVLA.

Q: What is the most common minor complication that patients experience with HVLA?
[...]
A: Soreness
Q: What is the most common overall major complication that patients experience with HVLA?
[...]
A: Vertebral artery injury
Q: What is the most common low back major complication when treating a patient with HVLA?
[...]
A: Cauda equina syndrome
Comment 2: These problems usually arise with the use of cervical rotatory forces with the neck in the extended position.
Comment 3: Very rare. Probably won't be tested.
Topic: HVLA
Bone Wizardry Lock: Soreness is the minor and common one. Vertebral artery injury is the serious one, tied to cervical rotation with extension. Cauda equina is the lumbar worst-case.

Q: To perform HVLA on the OA, the physician grasps the patient's head and flexes the neck. The [...] joint of the thrusting hand is placed at the base of the [...].
A: MCP; occiput
Q: What position would a patient's head be in in order to do HVLA on an OA FSrRl?
[...]
A: OA FSlRr
Comment 2: HVLA is a direct technique so the patient must be placed in a position that meets the restrictive barrier.
Topic: HVLA
Bone Wizardry Lock: OA has coupled motion: sidebending and rotation go opposite directions. To treat FSrRl, position into FSlRr. MCP contact goes at the base of the occiput, not the transverse process.

Q: To treat an AA somatic dysfunction with HVLA, what finger is used as a fulcrum?
[...]
A: Index
Q: What position would you place a patient to treat AA Rr with HVLA?
[...]
A: AA Rl
Topic: HVLA
Bone Wizardry Lock: C1 to C2 only rotates, no sidebending coupling. Index finger contacts the posterior arch. To treat Rr, position into Rl.

Q: To treat C3 FSlRl with a rotational thrust (HVLA), where is the MCP joint of the thrusting hand placed?
[...]
A: The articular pillar of C3
Q: How would you position a patient who has a C3 FSlRl SD using a rotational thrust (HVLA)?
[...]
A: C3 FRrSr
Topic: HVLA
Bone Wizardry Lock: Rotational thrust: MCP contacts the articular pillar of the dysfunctional vertebra. Position reverses all three planes of motion, then the thrust rotates through the barrier.

Q: To treat a patient with a C6 ESrRr SD, how would you position them to use a sidebending thrust (HVLA)?
[...]
A: C6 FSlRr
Comment: Grasp the patient's head and flex the neck to the C6-C7 joint. Induce a small amount of extension by applying anterior translation at C6
Sidebend the neck to the left until localized at the C6-C7 joint.
Rotate the neck to the right to limit motion of (lock) the above facet.
Apply a sidebending HVLA thrust by translating C6 to the right. The direction of the thrust should be directed toward the patient's opposite shoulder.
Topic: HVLA
Bone Wizardry Lock: Sidebending thrust at C6: flex down to the joint, add a touch of extension to open the segment, sidebend to the barrier, then translate the vertebra toward the opposite shoulder.

Q: The [...] (HVLA technique) can treat most thoracic and rib dysfunctions.
A: Kirksville Krunch
Q: When treating a [...] lesion (HVLA on thoracic/ribs), the corrective force will be directed at the dysfunctional segment and the thrust is aimed toward the [...].
A: flexed; floor
Q: When treating an [...] lesion (HVLA on thoracic/ribs), the corrective thrust is directed at the vertebrae [...] the dysfunctional segment and the thrust is aimed [...] cephalad.
A: extended; below; 45°
Topic: HVLA
Bone Wizardry Lock: Kirksville Krunch covers most thoracic and rib dysfunctions. Flexed lesion: force goes to the dysfunctional segment, aimed at the floor. Extended lesion: force goes to the level below, aimed 45 degrees cephalad.

Q: To treat thoracic SD with HVLA, the patient is in the [...] position.
A: supine
Q: What side of the patient is the physician when treating a patient with HVLA that has a T7 FSrRr SD?
[...]
A: Opposite side; so left side of patient
Q: When treating a flexed thoracic SD, the patient will cross their [...] arm over the [...] one to the physician.
A: opposite; adjacent
Steps to treat T7FSrRr with HVLA:
1. Physician is on left side
2. Patient crosses their arms
3. Place thenar eminence under the posterior TP of dysfunctional segment
4. With the other hand flex the patient's torso to the T7-8 joint space
5. Side bend the patient to the left engaging the restrictive barrier
6. Have the patient take a deep breath in and exhale
7. At end exhalation, apply an HVLA thrust straight down toward your fulcrum
Comment 4: Sorry for the word vomit. JK know these steps.
Topic: HVLA
Bone Wizardry Lock: Physician position and patient arm-crossing are the two setup decisions that change per SD. The thrust direction stays the same: straight down at end exhalation.

Q: To treat T7 E SlRl with HVLA, the patient is lying [...].
A: supine
Q: To treat T7 E SlRl with HVLA, the physician stands on the patient's [...] side.
A: right
Q: To treat T7 E SlRl with HVLA, place the thenar eminence under the posterior TP of the vertebrae [...] the dysfunctional segment.
A: below
Q: To treat T7 E SlRl with HVLA, at the end of exhalation apply an HVLA thrust directed [...] cephalad toward your fulcrum (thenar eminence).
A: 45°
Comment 2: This is the side opposite of the posterior TP that is being treated.
Comment 3: Next you would flex the patient's torso to the T7-T8 joint space. Sidebend the patient to the right engaging the restrictive barrier.
Topic: HVLA
Bone Wizardry Lock: Extended thoracic SD: thenar eminence goes under the vertebra below the dysfunction, not at the level itself. The 45-degree cephalad angle distinguishes this from the flexed SD thrust direction.

Q: If you are treating a patient with HVLA and they have a T7 N SlRr SD, where does the physician stand?
[...]
A: Left side
Q: When treating a patient with HVLA that presents with T7 N SlRr, where do you push the thrust?
[...]
A: Toward your fulcrum (thenar eminence)
Comment: When treating a patient with HVLA in the thoracic region, the doctor always stands on the side opposite the rotated transverse process.
Comment 2: You treat this patient just like you would for a flexed thoracic SD.
Topic: HVLA
Bone Wizardry Lock: Neutral thoracic dysfunction follows the flexed treatment blueprint. Physician stands opposite the posterior TP regardless of whether the SD is Type I or Type II.

Q: [...] dysfunctions of rib one cannot be treated using the Kirksville Krunch.
A: Inhalation
To treat a rib 1 inhalation dysfunction:
1. The patient is in the supine position.
2. Sidebend the head and neck to the same side as the dysfunctional rib.
3. Rotate the head and neck away.
4. Place the 1st MCP on the tubercle of rib 1.
5. At end exhalation, apply an HVLA thrust through the thenar eminence. The direction of the thrust should be posteroanterior and caudad.
Topic: HVLA
Bone Wizardry Lock: The anatomical constraint at rib 1 forces a dedicated technique. Cervical sidebending and rotation position the neck, and the thrust goes posteroanterior and caudad, not the Kirksville vector.

Q: Ribs [...] can be treated using the Kirksville Krunch.
A: 2-10
Topic: HVLA
Bone Wizardry Lock: Knowing the rib range for the Kirksville Krunch means knowing what is excluded. Rib 1 inhalation and ribs 11-12 are handled by separate methods.

Q: [...] may be treated with HVLA using the "lumbar roll."
A: T10-L5
Q: What position is the patient placed in when using the "lumbar roll?"
[...]
A: Lateral recumbent
Q: When you are treating a patient with the lumbar roll, and you have the dysfunctional posterior TP up, you induce sidebending by rotating the torso [...] to the dysfunctional segment.
A: caudad
Comment 2: The physician may treat the patient with the posterior TP up or down. For example, if L3 was FRSr, the physician can treat the patient in the left lateral recumbent position (posterior TP up) or in the right lateral recumbent position (TP down). There is only one modification with the patient's position between the two treatments.
Topic: HVLA
Bone Wizardry Lock: Lumbar roll is lateral recumbent HVLA. Rotating the torso creates sidebending at the target level. The TP-up vs. TP-down choice changes one setup detail, but the barrier engagement logic is the same either way.

Q: When treating a patient with the lumbar roll, if you are treating the dysfunctional posterior TP down, you induce sidebending by rotating the torso [...] to the dysfunctional segment.
A: cephalad
Q: Type II dysfunction (lumbar roll):
If treating the patient with the TP up, pull the patient's inferior arm [...]
A: down
Q: Type II dysfunction (lumbar roll):
If treating the patient with the TP down, pull the patient's inferior arm [...]
A: up
Q: Type I dysfunction (lumbar roll):
If treating the patient with the TP up, pull the patient's inferior arm [...]
A: up
Q: Type I dysfunction (lumbar roll):
If treating the patient with the TP down, pull the patient's inferior arm [...].
A: down
Topic: HVLA
Bone Wizardry Lock: The arm direction rule flips between Type I and Type II, and flips again between TP up and down. Four combinations, two outcomes: always pulling toward the barrier to engage it.