Thoracic spine HVLA

Thoracic spine HVLA

Chronic Week 1

Chronic Week 1

Down syndrome (Trisomy 21)

Tay-Sachs disease (NORD)

Mucopolysaccharide storage disease type 1 (Hurler syndrome) (NORD)

Phenylketonuria (NORD)

Phenylketonuria (NORD): Year of the Zebra

Classical homocystinuria (NORD)

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: Pathology review

Deep vein thrombosis and pulmonary embolism: Pathology review

Raynaud phenomenon

Diagnosing cervical somatic dysfunction

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

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

Coronary artery disease: Clinical sciences

Coronary artery disease: Pathology review

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

Potassium sparing diuretics

cGMP mediated smooth muscle vasodilators

Lipid-lowering medications: Statins

Cardiac conduction velocity

Cardiac conduction system

ECG normal sinus rhythm

ECG QRS transition

ECG rate and rhythm

ECG cardiac infarction and ischemia

ECG cardiac hypertrophy and enlargement

Notes

Thoracic spine

Thoracic spine HVLA

STEPS OF SUCCESSFUL THORACIC HVLA

Stand at opposite side of posterior transverse process
Instruct the patient to cross their arms over their chest with the arm opposite you on top
Rotate the opposite shoulder and thorax toward you and place your thenar eminence (fulcrum) on the posterior transverse process of the somatic dysfunction
Flex the patient’s torso and side bend toward the restriction (toward or away from you depending on whether it is a type I or II dysfunction)
Instruct the patient to inhale and move them further into their restriction as they exhale
On the next respiratory cycle, deliver a high velocity, low amplitude thrust toward the fulcrum at the end of exhalation

TREATMENT POSITIONS FOR THORACIC HVLA
DIAGNOSIS	FULCRUM PLACEMENT		SIDE BENDING
T5–T7 N S_RR_L	On posterior transverse process of T6		Side bend trunk away from you (left)
T6 F S_LR_L	On posterior transverse process below dysfunctional segment		Side bend trunk toward you (right)
T6 E S_LR_L	On posterior transverse process		Side bend trunk toward you (right)

Tips for success

When treating a group curve (type I somatic dysfunction) of the thoracic spine, treat the “apex” segment (e.g., T6 of T5–T7 N S_RR_L)
With upper thoracic somatic dysfunctions (T1–T4), instruct the patient to put both hands behind the neck to help better engage the upper thoracic region
Since you are always standing opposite the side of rotation, you will side bend the trunk away for a type 1 somatic dysfunction and toward for a type 2 somatic dysfunction
As with other HVLA treatments, prepare the tissue with soft tissue treatment

Author: Arman Israelyan, OMS-III

Editor: Matt Lipinski, DO

Editor: Robyn Hughes, MScBMC

Key Takeaways

Thoracic spine HVLA (High-Velocity Low-Amplitude) is a manual therapy technique used to manipulate and mobilize the thoracic spine. It involves a quick and forceful thrust applied to a specific joint in the thoracic spine to restore mobility and reduce pain and discomfort. Thoracic spine HVLA is often used to treat conditions such as thoracic spine pain, postural problems, and musculoskeletal disorders.