{"id":3552,"date":"2022-05-18T13:55:00","date_gmt":"2022-05-18T13:55:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3552"},"modified":"2025-10-01T11:42:40","modified_gmt":"2025-10-01T19:42:40","slug":"omm-question-of-the-day-oa-hvla","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-oa-hvla","title":{"rendered":"OMM Question of the Day: OA HVLA"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-oa-hvla\/#The_correct_answer_to_todays_OMM_Question_is%E2%80%A6\" >The correct answer to today&#8217;s OMM Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-oa-hvla\/#C_Position_her_in_flexion_with_your_2nd_MCP_joint_against_her_right_posterior_occiput\" >C. Position her in flexion, with your 2nd&nbsp;MCP joint against her right posterior occiput<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-oa-hvla\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-oa-hvla\/#A_Position_her_in_neutral_with_your_2nd_MCP_joint_against_her_right_posterior_occiput\" >A. Position her in neutral, with your 2nd&nbsp;MCP joint against her right posterior occiput<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-oa-hvla\/#B_Position_her_in_flexion_with_your_2nd_MCP_joint_against_her_left_posterior_occiput\" >B. Position her in flexion, with your 2nd&nbsp;MCP joint against her left posterior occiput<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-oa-hvla\/#D_Position_her_in_extension_with_your_2nd_MCP_joint_against_her_right_posterior_occiput\" >D. Position her in extension, with your 2nd&nbsp;MCP joint against her right posterior occiput<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-oa-hvla\/#E_Position_her_in_extension_with_your_2nd_MCP_joint_against_her_left_posterior_occiput\" >E. Position her in extension, with your 2nd&nbsp;MCP joint against her left posterior occiput<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-oa-hvla\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-oa-hvla\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Today&#8217;s OMM question involves a 35-year-old woman with pain radiating down from the bottom of her skull toward her lower neck. How would you set up for HVLA to the occipitoatlantal joint in this patient?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 35-year-old woman presents to your clinic for one week of moderately severe pain radiating down from the bottom of her skull toward her lower neck. She has no numbness, tingling, photophobia or back pain. She has no family or personal history of osteoporosis or rheumatoid arthritis. Her temperature is 37 \u00baC (98.6 \u00baF), pulse is 66\/min, respirations are 12\/min, blood pressure is 118\/75 mmHg. Physical examination of the occipitoatlantal joint shows a deep right sulcus which evens out with the left sulcus upon extension. Her friend sees an osteopathic physician who recommended HVLA techniques to her. How would you set up for HVLA to the occipitoatlantal joint in this patient?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Position her in neutral, with your 2<sup>nd<\/sup>&nbsp;MCP joint against her right posterior occiput<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Position her in flexion, with your 2<sup>nd<\/sup>&nbsp;MCP joint against her left posterior occiput<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Position her in flexion, with your 2<sup>nd<\/sup>&nbsp;MCP joint against her right posterior occiput<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Position her in extension, with your 2<sup>nd<\/sup>&nbsp;MCP joint against her right posterior occiput<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Position her in extension, with your 2<sup>nd<\/sup>&nbsp;MCP joint against her left posterior occiput<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down for the correct answer!<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis Around the World: Morocco!\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/o0AWQK7QcWA?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_OMM_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s OMM Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Position_her_in_flexion_with_your_2nd_MCP_joint_against_her_right_posterior_occiput\"><\/span>C. Position her in flexion, with your 2<sup>nd<\/sup>&nbsp;MCP joint against her right posterior occiput<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s OMM Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Position_her_in_neutral_with_your_2nd_MCP_joint_against_her_right_posterior_occiput\"><\/span>A. Position her in neutral, with your 2<sup>nd<\/sup>&nbsp;MCP joint against her right posterior occiput<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Since her OA joint is E S<strong><sub>L<\/sub><\/strong>&nbsp;R<strong><sub>R<\/sub><\/strong>, you should place her joint in slight flexion with left rotation and slight right sidebending. This is the correct side for setup but does not include the slight flexion component.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Position_her_in_flexion_with_your_2nd_MCP_joint_against_her_left_posterior_occiput\"><\/span>B. Position her in flexion, with your 2<sup>nd<\/sup>&nbsp;MCP joint against her left posterior occiput<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Since her OA joint is E S<strong><sub>L<\/sub><\/strong>&nbsp;R<strong><sub>R<\/sub><\/strong>, you should place her joint in slight flexion with left rotation and slight right sidebending. This correctly includes flexion but is the wrong side for setup.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Position_her_in_extension_with_your_2nd_MCP_joint_against_her_right_posterior_occiput\"><\/span>D. Position her in extension, with your 2<sup>nd<\/sup>&nbsp;MCP joint against her right posterior occiput<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Since her OA joint is E S<strong><sub>L<\/sub><\/strong>&nbsp;R<strong><sub>R<\/sub><\/strong>, you should place her joint in slight flexion with left rotation and slight right sidebending. This is the correct side for setup, but she should be flexed rather than extended.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Position_her_in_extension_with_your_2nd_MCP_joint_against_her_left_posterior_occiput\"><\/span>E. Position her in extension, with your 2<sup>nd<\/sup>&nbsp;MCP joint against her left posterior occiput<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Since her OA joint is E S<strong><sub>L<\/sub><\/strong>&nbsp;R<strong><sub>R<\/sub><\/strong>, you should place her joint in slight flexion with left rotation and slight right sidebending. This represents her somatic dysfunction and would be correct if she had the opposite findings.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Rotation and sidebending always go in opposite directions at the OA joint, so you can diagnose both of these motions by only testing one of them. Use the depth of the sulci to determine the rotation (the deeper sulcus is the side of rotation), and the translation of the joint to determine sidebending (e.g. easier leftward translation means sidebent right). Flexion\/extension (or neutral) is determined by which motion causes the sulci to even out.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/learn\/Cervical_spine_HVLA\" target=\"_blank\" rel=\"noreferrer noopener\">HVLA<\/a>&nbsp;is a direct technique in which you take a patient to their barrier and then provide a low amplitude thrust directly into the barrier. Like muscle energy, patients should be set up directly opposite of their somatic dysfunction (freedom of motion). Be very careful to only extend the occipitoatlantal joint and not involve the lower cervical spine. Remember contraindications to&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Cervical_spine_HVLA\" target=\"_blank\" rel=\"noreferrer noopener\">HVLA of the cervical spine<\/a>, such as&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Osteoporosis\" target=\"_blank\" rel=\"noreferrer noopener\">osteoporosis<\/a>, previous fracture to the area, severe or longstanding&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Rheumatoid_arthritis:_Clinical_practice\" target=\"_blank\" rel=\"noreferrer noopener\">rheumatoid arthritis<\/a>,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Down_syndrome_(Trisomy_21)\" target=\"_blank\" rel=\"noreferrer noopener\">Down syndrome<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span><strong>Major Takeaway<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Once you have established the diagnosis, take the patient to their barrier by positioning directly opposite of their somatic dysfunction, then perform a low amplitude thrust through the barrier. For patients with a flexed dysfunction, remember to only extend at the occipitoatlantal joint and not involve the lower cervical spine.<\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>_________________________<\/strong><\/em><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>Want more OMM Questions as well as practice questions for USMLE\u00ae Step 1 and Step 2 CK?\u00a0Try Osmosis today! Access your\u00a0<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\/do?source_cta=navbar\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_658f24.png?w=700\" alt=\"\" class=\"wp-image-3507\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_658f24.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_658f24.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><br><a href=\"https:\/\/www.osmosis.org\/plans\/do?source_cta=navbar\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Today&#8217;s OMM question involves a 35-year-old woman with pain radiating down from the bottom of her skull toward her lower neck. How would you set up for HVLA to the occipitoatlantal joint in this patient? A 35-year-old woman presents to your clinic for one week of moderately severe pain radiating down from the bottom of [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3553,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,34,16],"tags":[],"class_list":["post-3552","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-omm","category-do"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>OMM Question of the Day: OA HVLA - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-oa-hvla\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"OMM Question of the Day: OA HVLA - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Today&#8217;s OMM question involves a 35-year-old woman with pain radiating down from the bottom of her skull toward her lower neck. How would you set up for HVLA to the occipitoatlantal joint in this patient? A 35-year-old woman presents to your clinic for one week of moderately severe pain radiating down from the bottom of [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-oa-hvla\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2022-05-18T13:55:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:42:40+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/omm-oa-hvla.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1081\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Marina Horiates Kerekes, MD &amp; Team\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-oa-hvla#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-oa-hvla\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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