Lumbar spine HVLA

Page created: March 11, 2021

Notes

Lumbar spine

Lumbar spine HVLA

HVLA with the “lumbar roll” technique can be performed with the posterior transverse process (side of rotation) up or down, though down on the table is more common. It can also be performed seated with the “walk around” technique, which is less common and not described here.
STEPS OF SUCCESSFUL LUMBAR HVLA
Example Diagnosis: L2 E SRRR
  1. Diagnose somatic dysfunction and prepare the lumbar tissue with soft tissue treatment
  2. Stand in front of patient, who is lying in a right lateral recumbent position (rotation side down)
  3. Monitor the L2–L3 junction with your cephalad hand and flex the knees, hips and lumbar spine until motion is localized to L2
  4. Monitor the L2 transverse processes with your caudad hand and rotate the torso to the left (restrictive barrier) by having the patient grasp your cephalad elbow as you pull your arm toward you
  5. Place your cephalad forearm into the patient’s axilla to ensure that the torso does not rotate while asking the patient to extend their right leg and hook their left foot behind their right knee
  6. Place your caudad forearm between the patient’s iliac crest and greater trochanter, then rotate the patient’s pelvis toward you (anteriorly) until you feel motion at L2–L3
  7. Bring the patient’s entire body toward you to maximally engage the restrictive barrier
  8. Ask the patient to inhale and exhale deeply and fine tune to take up any extra slack of motion
  9. At the end of exhalation, apply a thrust to the patient’s pelvis with your caudad forearm as the cephalad forearm stabilizes the torso (see below for direction of thrust)
LUMBAR HVLA THRUST

EXAMPLEDIRECTIONALITY OF THRUST
TYPE 1 SOMATIC DYSFUNCTION
L2–4 N SRRL
Anterior (toward you) and caudad
TYPE 2 SOMATIC DYSFUNCTION
L2 F SRRR
Anterior (toward you) and cephalad
Author: Arman Israelyan, OMS-III
Editor: Matt Lipinski, DO
Editor: Robyn Hughes, MScBMC

Key Takeaways

High-velocity low-amplitude thrust manipulations (HVLA) are a common chiropractic treatment for back pain. They involve a short, fast thrust that is said to help release tension and restore mobility to the spinal joints.

There is some evidence that HVLA manipulations may be helpful for some people with back pain, but the research is far from conclusive. There are also risks associated with HVLA manipulation, such as joint damage and spinal cord injury.