Lumbar spine HVLA
Lumbar 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
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
- Diagnose somatic dysfunction and prepare the lumbar tissue with soft tissue treatment
- Stand in front of patient, who is lying in a right lateral recumbent position (rotation side down)
- Monitor the L2–L3 junction with your cephalad hand and flex the knees, hips and lumbar spine until motion is localized to L2
- 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
- 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
- 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
- Bring the patient’s entire body toward you to maximally engage the restrictive barrier
- Ask the patient to inhale and exhale deeply and fine tune to take up any extra slack of motion
- 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 | ||
| EXAMPLE | DIRECTIONALITY 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.