HVLA and positioning

[snowhite]

I would love to do more HVLA, but unfortunately, I'm not comfortable and am a little scared honestly to practice it outside of lab. In OMT lab, they tell and show us how to place our hands and where to thrust, but when my classmates and I try to figure it out outside of class, we're at a loss.

The only thing I know that I can do that will pop is the Texas twist. I've tried Kirksville, sacrum, lumbars and other techniques and have never cracked anyone. And about cervicals - forget about it. I don't think I'll ever be comfortable with cervicals. I feel like I'm doomed to only muscle energy, counterstrain and myofascial release.

I hear most of HVLA is based on positioning. So, how can you learn positioning? I can read it in books and I can learn about it in class, but without a doctor showing me what to do every step of the way, I can never get it to work. I know HVLA works and our OMT fellows have done WONDERS on me (seriously) that I really want to learn it. I know practice makes perfect, but I'd rather not be practicing the wrong technique.

How have you guys learned HVLA? I guess it's a good thing that we don't have to perform this on boards, but still - I want to learn it for more than just passing lab practicals. I feel like an HVLA ******.

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[DrB]

We are just learning it now snowhite, so I know where you are coming from. I have been successful outside of the lab, but only with Texas Twist and Kirksville. I think it is just a matter of practice. Make sure you are approaching all three barriers. Make sure you take out all the slack in the tissues. Make sure you don't back off just before applying the thrust (this is the thing I always seem to be doing) and make sure you recheck after applying the technique. Just because you don't hear a pop, doesn't mean you did not perform a powerful adjustment!

-Good Luck 👍

 

[Krazykritter]

Texas twist?? Can you explain this technique?

Anyway, HVLA is all about finding the barriers in the right positions. If you are having problems getting the barriers in a reasonable ROM, add flexion when possible (Fryette's 3rd Law). When you approximate the barrier you need to come right to it & then give your HVLA thrust. You should not come to the barrier, back off, & then thrust b/c your objective is to go just beyond that restrictive barrier to bring the motion back to physiologic state. In what I have seen in my classmates that struggle w/ HVLA, that is the most common problem.

Thoracolumbar & Lumbosacral HVLA is almost entirely on set up. You really have to localize movement to the segment you are treating before you can give the proper thrust.

Kirksville crunch (Double Arm Thrust) is also about setup & placing your thenar in the correct area while using the Type I/II principles to direct you in the movement of the upper body for setup. Also keep taking up the slack during exhalation so that your thrust is at the barrier to just beyond...if you let up you are not going to have any effect on the thoracics you are aiming to treat.

Hopefully I answered a few questions w/out opening myself up for flaming b/c of my description of what works for me.

 

[yanky5]

The only one I am able to do most of the time is lumbar HVLA. Cervical I only did correct once. Thoracic HVLA I look like I'm jumping on a cat. This HVLA stuff is brushed over, but it is REALLY HARD TO DO. Maybee if you practice it you'll get better. I am frustrated with this HVLA because it is so damn hard to do. The only advice I can give you is positioning is 99% of the tecnique. Once you have the right position, you are well off. The next mistake is that most people don't get in there and spring back on the guy but they just jump right in. You want to make as close contact as possible and spring the guy just until he is about to crack. Make him breath in and out 3 times and each time, spring harder and harder. You should not be affraid to go right on top of the guy even though it may be uncomfortable for you, but it is necessary. Once it is about to go, then tell him to breath in one more time and do HVLA. [advice for lumbar and thoracic HVLA]

 

[snowhite]

Make sure you don't back off just before applying the thrust (this is the thing I always seem to be doing) and make sure you recheck after applying the technique. Just because you don't hear a pop, doesn't mean you did not perform a powerful adjustment!

-Good Luck 👍

I think this is exactly what I do sometimes. I back off before applying the thrust - I'm not sure why I do it. I load in and am ready to go, but right before I'm about to thrust, I lift up and then jump back into it. Sometimes I literally jump onto the person - it always gives everyone a good laugh (at my expense 😡 ).

I think I'm afraid of loading in too hard. I've had people perform HVLA on me and in these instances I felt like all the life was getting sucked out of me as it was suffocating pain. I left feeling worse than before. I think about this when I practice and go the other extreme it seems. I am VERY conservative.

 

[snowhite]

Texas twist?? Can you explain this technique?

let's see - the Texas twist is used to treat dysfunction in the thoracic spine. the patient is prone. the physician's hands are on opposite sides of the spine (supposedly by the transverse processes - correct me if I'm wrong) with fingers of one hand facing the feet and the other facing superiorly. Same principles apply - deep breath, load in and instead of a unidirectional thrust, you rotate on the palm of your hands in a twisting fashion.

I'm sorry I can't give a better description.

Anyway, HVLA is all about finding the barriers in the right positions. If you are having problems getting the barriers in a reasonable ROM, add flexion when possible (Fryette's 3rd Law). When you approximate the barrier you need to come right to it & then give your HVLA thrust. You should not come to the barrier, back off, & then thrust b/c your objective is to go just beyond that restrictive barrier to bring the motion back to physiologic state. In what I have seen in my classmates that struggle w/ HVLA, that is the most common problem.

Thoracolumbar & Lumbosacral HVLA is almost entirely on set up. You really have to localize movement to the segment you are treating before you can give the proper thrust.

Kirksville crunch (Double Arm Thrust) is also about setup & placing your thenar in the correct area while using the Type I/II principles to direct you in the movement of the upper body for setup. Also keep taking up the slack during exhalation so that your thrust is at the barrier to just beyond...if you let up you are not going to have any effect on the thoracics you are aiming to treat.

Hopefully I answered a few questions w/out opening myself up for flaming b/c of my description of what works for me.

Thanks for the advice. That makes sense...I'll have to keep it in mind when I practice.

 

[snowhite]

The only one I am able to do most of the time is lumbar HVLA. Cervical I only did correct once. Thoracic HVLA I look like I'm jumping on a cat. This HVLA stuff is brushed over, but it is REALLY HARD TO DO. Maybee if you practice it you'll get better. I am frustrated with this HVLA because it is so damn hard to do. The only advice I can give you is positioning is 99% of the tecnique. Once you have the right position, you are well off. The next mistake is that most people don't get in there and spring back on the guy but they just jump right in. You want to make as close contact as possible and spring the guy just until he is about to crack. Make him breath in and out 3 times and each time, spring harder and harder. You should not be affraid to go right on top of the guy even though it may be uncomfortable for you, but it is necessary. Once it is about to go, then tell him to breath in one more time and do HVLA. [advice for lumbar and thoracic HVLA]

Some of my partners have been big guys and as I'm relatively smaller, I have a hard time with the positioning. You guys can be heavy!

I'm somewhat glad to hear I'm not alone in my HVLA frustrations. Also seems like the jumping/springing is common. It's almost become a reflex for me...I have to unlearn this.

 

[yanky5]

Some of my partners have been big guys and as I'm relatively smaller, I have a hard time with the positioning. You guys can be heavy!

It goes the other way around too. I am a big guy and sometimes I get a small petite girl parner. I am afraid to do HVLA on them because I might squash them! Imagine the headlines "DO student crushes girl to death at NYCOM doing HVLA"

 

[snowhite]

It goes the other way around too. I am a heavy guy and sometimes I get a small petite girl parner. I am afraid to do HVLA on them because I always think I would squash them!

I guess I didn't think of this from that point of view. I still think you guys have it easier though. 😉

 

[OSUdoc08]

I would love to do more HVLA, but unfortunately, I'm not comfortable and am a little scared honestly to practice it outside of lab. In OMT lab, they tell and show us how to place our hands and where to thrust, but when my classmates and I try to figure it out outside of class, we're at a loss.

The only thing I know that I can do that will pop is the Texas twist. I've tried Kirksville, sacrum, lumbars and other techniques and have never cracked anyone. And about cervicals - forget about it. I don't think I'll ever be comfortable with cervicals. I feel like I'm doomed to only muscle energy, counterstrain and myofascial release.

I hear most of HVLA is based on positioning. So, how can you learn positioning? I can read it in books and I can learn about it in class, but without a doctor showing me what to do every step of the way, I can never get it to work. I know HVLA works and our OMT fellows have done WONDERS on me (seriously) that I really want to learn it. I know practice makes perfect, but I'd rather not be practicing the wrong technique.

How have you guys learned HVLA? I guess it's a good thing that we don't have to perform this on boards, but still - I want to learn it for more than just passing lab practicals. I feel like an HVLA ******.

Try a Lumbar Stroll.

 

[durak]

how about the knee-in-back technique for thoracics? anyone else learn that one? i feel like i'm doing some type of mixed martial arts move

 

[Tadgie]

It goes the other way around too. I am a big guy and sometimes I get a small petite girl parner. I am afraid to do HVLA on them because I might squash them! Imagine the headlines "DO student crushes girl to death at NYCOM doing HVLA"

One of my partners when I was doing cervical had an owl neck. Not joking, she had a 110 degree ROM for rotation, needless to say we could only do tranverse thrusts on her... In cases like that, it's good to practice on lots of different people.

 

[cabinbuilder]

Some of my partners have been big guys and as I'm relatively smaller, I have a hard time with the positioning. You guys can be heavy!

I'm somewhat glad to hear I'm not alone in my HVLA frustrations. Also seems like the jumping/springing is common. It's almost become a reflex for me...I have to unlearn this.

Yikes, you guys are scaring me talking about your HVLA. Remember that HVLA is not about POWER, it's about POSITION. The reason I say this is that I am a 5'6'', 145lbs petite woman and the largest person I have adjusted was 650lbs (male). I used my body wt and had my feet up on the wall. You really don't have to thrust to make it work. You have to have body contact. Have your patient supine, place your hand under back on the posterior transverse process. Have the pts arms crossed correctly. At the bottom the the pt's exhale literally roll your body on top of theirs and use your weight to create the adjustment. If your thenar eminence in is the correct position it will work. I found when I am teaching in lab that most students try to thrust at the beginning of the exhale and are trying to keep a space between the dr and pt. LAY ON THE PT SOFTLY, DO NOT BODY SLAM AS I HAVE SEEN MANY GUYS DO. IT'S PAINFUL AND CAN CAUSE INJURY.

As far as cervical. If you set it up like you would for muscle energy, the HVLA move is short and quick. Never force the cervicals, either it goes or it doesn't.

Keep practicing and try to find someone in your class that "gets it". Have them show you.

I found, too, being smaller, if you practice your techniques with the patient laying on the floor. I use my OMM table but don't set up the legs. That way you are not fighting a too high table vs short legs/arms. Once you get the technique down that way, its easier to go back to the table.

For lumbar/sacrum I use the sacral C technique. I can't get lumbar from the standard lumbar HVLA position. Never works, I don't have the strength or stomach muscles to be effective.

 

[Munchkin6245]

I'm 5'2" 130 and it's all about your positioning when you're smaller than your partner, especially. I learned some hints from a second year who is also small. Working on the ground is great for me too but when you don't have that option during the practicals you should still try to get it on the tables.

1. Try to get you partner to slide all the way over to the edge of the table you are working on, right up next to you. You have to be confident and basically hold them as close as possible to get it to the barrier when you're this small. Get comfortable holding people close to you and you will gain better control.
2. When I double arm thrust I pull them up toward me and then rock them back and forth while they exhale. Then at the end I lift my entire body up off the ground and roll them back down flat with my thrust. It's no WWF since I'm small but my thrust is quick and sufficient. Remember too that you do not have to get an articulation in order to get correction.
3. With Lumbosacral and Thoracolumbar, I get them locked out into a barrier during position, once they breath in and exhale once, I put my full body weight on them. Then I have them inhale/exhale again, keeping that weight on and adjusting any "looseness" I feel in my barrier. Then usually I get an articulation without a thrust but we are still being graded on them so I still thrust.
4. Cervicals - a common problem is losing your sidebending. Make sure you keep that side bending and then rotate until you reach the barrier. When I perform this my partner has their eyes in a diagonal line with the corner of the table. Then it's just a quick, short thrust.

I still can't figure out what Texas Twist is with your description. The knee in the back thing sort of sounds like a Full Nelson, which those I have to have my partner sitting on the table. Also too, I used to spring back and launch ontop of my partner for my thrust. But I've learned that's defeating the barrier so it's pointless. Keep yourself up against them when thrusting and it should go if you have them in position. Otherwise, you should work on your positioning.

 

[DeLaughterDO]

The "Texas Twist" is more of a "shotgun" technique than an actual OMT technique - very rarely does anyone do any kind of diagnosis before this treatment. Just a quick technique that will fix a lot of things. Another is pulling on a leg for just about any sacral dysfunction (try it, it really works and takes all the guesswork out of sacral diagnosis - just be sure they don't have knee or hip problems first).

I agree with what has been said in all the above posts that positioning is by far the most important factor in setting up HVLA. That said, I'll add this: I very rarely use HVLA any longer - pretty much only family, clinic staff, and friends in school. I almost NEVER use it on patients - I pretty much only use muscle energy, indirect techniques, MFR, and functional positional release (FPR gets you all the benefit of HVLA without the risks) and I have very good results.

Best of luck, and don't worry about not being able to do HVLA - you'll get it as you go through school.

jd

 

[newyorkcougar]

HVLA is all about correctly diagnosing the dysfunction and then appropriately positioning the patient. When you do that you just BARELY have to make the tiniest little impluse and you get great results. If you ever think that what you are doing could be in ANY way dangerous you are probably doing it wrong. Diagnose first...don't just jack your friends in the back hoping something pops.