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Cervical spine HVLA

Notes

Notes

Cervical spine

Cervical spine HVLA

Please note that HVLA thrusts should not be performed with the cervical spine in extension. HVLA thrusts should be performed only with the cervical spine in neutral or flexion.

Contraindications to cervical HVLA

  1. Cervical involvement of rheumatoid arthritis
  2. Trisomy 21 (Down syndrome)
  3. Vertebrobasilar insufficiency
  4. Acute cervical spine disc herniation, fracture, dislocation, or infection

Atlanto-occipital (OA) joint

Diagnosis: OA E SLRR

Treatment

  1. Stand at the head of the table with patient lying supine
  2. Place first MCP joint of right hand on patient's right occiput
  3. Cup patient's chin with left hand so palm makes contact with zygomatic process
  4. Side bend head and neck to the right and rotate to the left to engage restrictive barrier
  5. Instruct patient to take a full breath
  6. Apply HVLA thrust toward left orbit (toward barrier) at end of exhalation

Atlanto-axial (AA) joint

Diagnosis: AA RR

Treatment

  1. Stand at the head of the table with patient lying supine
  2. Place right 2nd finger at posterolateral aspect of the atlas with thumb contacting the face
  3. Place left palm at left zygomatic process
  4. Keeping the spine neutral, rotate head and neck to the left to engage restrictive barrier
  5. Instruct patient to take a full breath
  6. Apply HVLA rotational thrust to the left (toward barrier) at end of exhalation

C2–C7

HVLA of these segments may be achieved with either a rotational or side bending emphasis.

Diagnosis: C3 E SRRR

Rotational treatment

  1. Stand at the head of the table with patient lying supine
  2. Place first MCP joint against right articular pillar (side of rotation)
  3. Use other hand to support the head by cupping the chin or placing the head into the palm at the area of the zygomatic process
  4. Rotate head and neck to the left, then side bend to the left (toward restriction) 
  5. Instruct patient to take a full breath
  6. Apply HVLA rotational thrust toward barrier at end of exhalation
Diagnosis: C3 E SRRR

Side bending treatment

  1. Stand at the head of the table with patient lying supine
  2. Place first MCP joint against left articular pillar (side of restriction)
  3. Use other hand to support the head by cupping the chin or placing the head into the palm at the area of the zygomatic process
  4. Side bend head and neck to the left (toward restriction)
  5. Instruct patient to take a full breath
  6. Apply HVLA side bending thrust toward side bending barrier at end of exhalation 
    • Thrust should be directed toward opposite shoulder in upper cervicals and toward opposite nipple for lower cervicals