Cervical spine HVLA

Cervical spine HVLA

Chronic Week 1

Chronic Week 1

Down syndrome (Trisomy 21)
Galactosemia
Tay-Sachs disease (NORD)
Mucopolysaccharide storage disease type 1 (Hurler syndrome) (NORD)
Phenylketonuria (NORD)
Phenylketonuria (NORD): Year of the Zebra
Classical homocystinuria (NORD)
Homocystinuria
Glycogen storage disease type II (NORD)
Hypertrophic cardiomyopathy
Abnormal heart sounds
Normal heart sounds
Development of the cardiovascular system
Fetal circulation
Aortic valve disease
Mitral valve disease
Pulmonary valve disease
Tricuspid valve disease
Valvular heart disease: Pathology review
Cyanotic congenital heart defects: Pathology review
Acyanotic congenital heart defects: Pathology review
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Coarctation of the aorta
Cardiomyopathies: Pathology review
Approach to cyanosis (newborn): Clinical sciences
Aortic dissections and aneurysms: Pathology review
Peripheral artery disease
Peripheral artery disease: Pathology review
Vasculitis
Vasculitis: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Raynaud phenomenon
Fryette laws
Diagnosing cervical somatic dysfunction
Spurling test
Cervical spine counterstrain
Cervical spine facilitated positional release
Cervical spine HVLA
Cervical muscle energy treatment
Cervical spine myofascial release
Other cervical spine treatments
Diagnosing lower limb somatic dysfunction
Special tests for the lower limb
Lower limb counterstrain
Lower limb HVLA
Lower limb muscle energy treatment
Lower limb myofascial release
Other lower limb treatments
Diagnosing lumbar spine somatic dysfunction
Lumbar muscle energy treatment
Lumbar spine counterstrain
Lumbar spine facilitated positional release
Lumbar spine HVLA
Lumbar spine myofascial release
Other lumbar spine treatments
Cranial osteopathy: Cranial nerves
Primary respiratory mechanism
Diagnosing cranial somatic dysfunction
Cranial treatments
Diagnosing pelvis somatic dysfunction
Pelvis counterstrain
Pelvis muscle energy treatment
Other pelvis treatments
Diagnosing rib somatic dysfunction
Rib counterstrain
Rib HVLA
Muscle energy for rib somatic dysfunction
Other rib treatments
Diagnosing sacral somatic dysfunction
Sacrum counterstrain
Sacrum muscle energy treatment
Sacrum myofascial release
Diagnosing thoracic spine somatic dysfunction
Thoracic spine counterstrain
Thoracic spine facilitated positional release
Thoracic spine HVLA
Thoracic muscle energy treatment
Thoracic spine myofascial release
Other thoracic spine treatments
Diagnosing upper limb somatic dysfunction
Special tests for the upper limb
Upper limb counterstrain
Upper limb HVLA
Upper limb muscle energy treatment
Upper limb myofascial release
Other upper limb treatments
Angina pectoris
Stable angina
Coronary artery disease: Clinical sciences
Coronary artery disease: Pathology review
Heart failure
Heart failure: Pathology review
Congestive heart failure: Clinical sciences
Dilated cardiomyopathy
Restrictive cardiomyopathy
ACE inhibitors, ARBs and direct renin inhibitors
Adrenergic antagonists: Beta blockers
Calcium channel blockers
Thiazide and thiazide-like diuretics
Loop diuretics
Potassium sparing diuretics
cGMP mediated smooth muscle vasodilators
Lipid-lowering medications: Statins
Cardiac conduction velocity
Cardiac conduction system
ECG basics
ECG normal sinus rhythm
ECG intervals
ECG QRS transition
ECG axis
ECG rate and rhythm
ECG cardiac infarction and ischemia
ECG cardiac hypertrophy and enlargement

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
Author: Arman Israelyan, OMS-III
Editor: Matt Lipinski, DO
Editor: Robyn Hughes, MScBMC

Key Takeaways

Cervical spine HVLA (high-velocity low-amplitude) thrust is a manual therapy technique that is used to improve cervical joint mobility and reduce pain. The therapist applies a quick, short thrust to the joint, and then uses their hands to apply pressure to the surrounding tissues to increase the effect of the thrust.