Hvla?

[DOdot]

Who would you guys NOT use HVLA on? Specific age groups? And do you generally prefer ME over indirect? Thanks for any input!

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[jonb12997]

osteoporosis is the one huge contra-indication they're always telling us about, so I'd imagine the classic "little old granny" patient, you might want to think twice about using HVLA. However, I certainly don't clame to be an OMM genius, so if anyone else wants to correct me on this I won't be offended at all...

 

[Ifellinapothole]

Contraindicated for:

1) downs patients in cervical area

2) whereever there may be metal implants (e.g. fusions etc.)

3) cancer to bone in area

probably many others....

 

[Idiopathic]

Cancer, RA, osteoporosis, old-age syndrome, hx of back fusion.

In my mind, only the young and healthy get HVLA 😉

 

[DeLaughterDO]

Cancer, RA, osteoporosis, old-age syndrome, hx of back fusion.

In my mind, only the young and healthy get HVLA 😉

along with those, and Down's syndrome (because of ligamentous laxity) HVLA may be relatively contraindicated in many of the other collagen-vascular diseases (SLE, scleroderma) for similar reasons. I don't know that I've seen research or anecdotal evidence showing damage caused by HVLA used in these patients, but better safe than sorry...

Also, anyone in acute pain and spasm do not get HVLA when I treat them...

Personally, I use a lot of indirect, functional positional release (as effective as hvla, only gentler), myofascial release, and ME on anyone with acute pain or any of the diseases mentioned above. All this after I use soft tissue to "soften up" the area.

jd

 

[Diane L. Evans]

I typically will not do HVLA in the obvious high risk patients complete previa 3rd trimester, premature rupture of mebranes, preterm labor. I stop Texas twist at 16 weeks and use a sidelying position. I prefer muscle energy to HVLA in 3rd trimester.

Typically those over 65 I try to treat with muscle energy first

 

[Sweepea8137]

Hi All...

Prior to doing HVLA, try ME or FPR. If you find that you cannot fix the somatic dysfunction using any of these techniques, then HVLA can serve as your next step. You should always employ some soft tissue techniques (myofascial) prior to thrusting.

HVLA is an absolute contraindication in people with malignancy and in patients with Down Syndrome (cervical region). Hope this helps.

 

[BMW19]

VBAI- arterial insufficiency

Must do a VBAI test by having pt. extend the head and rotate. Dizziness, Vertigo, nausea or nystagmus are good indications you don't want to whip this patient's neck around. The test is not 100% but along with other risk factors such as women, Birth control, smoking etc. it is a good tool.

BMW-

Hi All...

Prior to doing HVLA, try ME or FPR. If you find that you cannot fix the somatic dysfunction using any of these techniques, then HVLA can serve as your next step. You should always employ some soft tissue techniques (myofascial) prior to thrusting.

HVLA is an absolute contraindication in people with malignancy and in patients with Down Syndrome (cervical region). Hope this helps.

 

[Dr Alo]

Sometimes, while on rotations with allopathic physicians and seeing healthy young patients in pain, I feel like saying, "Hey, I could probably fix this!"

We usually discuss OMT afterwards and the next time I get the go ahead. Of course, like everyone is saying, use common sense and use your gestalt. If the patient is not looking good, you probably want to hold off.

 

[DeLaughterDO]

I typically will not do HVLA in the obvious high risk patients complete previa 3rd trimester, premature rupture of mebranes, preterm labor. I stop Texas twist at 16 weeks and use a sidelying position. I prefer muscle energy to HVLA in 3rd trimester.

Typically those over 65 I try to treat with muscle energy first

What is the Texas Twist? I'm from Texas, and I've never heard of it... Darn regional name variations!

jd

Good points about the late trimester pregnancy and the vertebro-basilar artery insufficiency comments, btw...

 

[GregsAnatomy]

What is the Texas Twist? I'm from Texas, and I've never heard of it... Darn regional name variations!

jd

Good points about the late trimester pregnancy and the vertebro-basilar artery insufficiency comments, btw...

"Texas Twist" is a nickname for double transverse thoracic HVLA, since you are essentially making a twisting motion....and maybe it originated in Texas.

 

[DeLaughterDO]

"Texas Twist" is a nickname for double transverse thoracic HVLA, since you are essentially making a twisting motion....and maybe it originated in Texas.

Hmm.. doesn't ring a bell - however, I don't know everything. I'll need to work on that (see sig quote) 🙂

jd

PS - do people at KCOM call it the Kirksville crunch? or is it just other locales that call it that?

 

[medicine1]

Actually I would rather use Still technique or counterstrain first, especially with children and geriatric pts. HVLA is more a general technique that has no true diagnosis. It is better to find the dysfunction, diagnose, and then treat. Not just simply treat everything with force and have no clue as to what the underlying problem is. HVLA is simply a rough, generalized, articulatory technique.
I find muscle energy and Still technique to be very helpful. Of course it depends on the problem at hand, but I would say outcomes are better with muscle energy techniques, which are very sensitive and specific for a given somatic dysfunction.

 

[Kevbot]

"Texas Twist" is a nickname for double transverse thoracic HVLA, since you are essentially making a twisting motion....and maybe it originated in Texas.

Here in NJ we call it the texas crunch. You shouldn't just twist while doing the technique but instead straighten your arm and push down while you twist. Its much more effective in my opinion than the kirksville crunch.

 

[box29]

Actually I would rather use Still technique or counterstrain first, especially with children and geriatric pts. HVLA is more a general technique that has no true diagnosis. It is better to find the dysfunction, diagnose, and then treat. Not just simply treat everything with force and have no clue as to what the underlying problem is. HVLA is simply a rough, generalized, articulatory technique.
I find muscle energy and Still technique to be very helpful. Of course it depends on the problem at hand, but I would say outcomes are better with muscle energy techniques, which are very sensitive and specific for a given somatic dysfunction.

HVLA is not a last resort. Still and CS might not work on some patients...I don't think you have learned HVLA yet as first years. Dr. Jones would ream you into an a$$h@!!e if he ever saw your post. Diagnosis is important...HVLA can be localized...how else are you going to lock out the segment properly. I think you are grossly generalizing just because it's fast. What have you learned about global scanning and the "key" lesion?

How do you know that outcomes are better with ME than other techniques? HVLA has helped me tremendously with cervical and upper thoracic SD, moreso than ME, CS, and Still. As a med student, I personally like to use the indirect techniques, but don't completely discount others. HVLA isn't for everyone and people have preferences as to which Tx use, so please be careful what you say. There are obvious relative and absolute contraindications and we can all look them up.

 

[medicine1]

HVLA is not a last resort. Still and CS might not work on some patients...I don't think you have learned HVLA yet as first years. Dr. Jones would ream you into an a$$h@!!e if he ever saw your post. Diagnosis is important...HVLA can be localized...how else are you going to lock out the segment properly. I think you are grossly generalizing just because it's fast. What have you learned about global scanning and the "key" lesion?

How do you know that outcomes are better with ME than other techniques? HVLA has helped me tremendously with cervical and upper thoracic SD, moreso than ME, CS, and Still. As a med student, I personally like to use the indirect techniques, but don't completely discount others. HVLA isn't for everyone and people have preferences as to which Tx use, so please be careful what you say. There are obvious relative and absolute contraindications and we can all look them up.

Well, I really don't care what you say. You obviously didn't read my reply very well. And if you want to, you can tattle-tell on me. There is freedom of speech and freedom of thought. I am giving my opinion. I am glad that HVLA works for you. Use it than. HVLA is nice, I just think with children and geriatric pts that HVLA may not be the best technique. JUST AN OPINION. 😱
Good luck.

 

[box29]

Duplicate

 

[box29]

Medicine1, it appears as if I rattled some feathers...no need to get all defensive. You are entitled to your opinion just as I am, but you haven't even learned HVLA yet as a first year. Like I said, there are relative and absolute contraindications for HVLA...duh 🙄 .

Your post is relatively general regarding HVLA...with the exception of "especially children and geriatric patients." Additionally, your verbage is quite confusing. I'm trying understand your reasoning. FOM is a required text for us so maybe you might want to read chapter 56, pp. 852 - 880, of which Dr. Jones co-authored.

 

[HoodyHoo]

Here in NJ we call it the texas crunch. You shouldn't just twist while doing the technique but instead straighten your arm and push down while you twist. Its much more effective in my opinion than the kirksville crunch.

more effective than kirksville? really? i'd have to disagree. but that's also just my opinion.

 

[HoodyHoo]

Actually I would rather use Still technique or counterstrain first, especially with children and geriatric pts. HVLA is more a general technique that has no true diagnosis. It is better to find the dysfunction, diagnose, and then treat. Not just simply treat everything with force and have no clue as to what the underlying problem is. HVLA is simply a rough, generalized, articulatory technique.
I find muscle energy and Still technique to be very helpful. Of course it depends on the problem at hand, but I would say outcomes are better with muscle energy techniques, which are very sensitive and specific for a given somatic dysfunction.

It is evident you haven't really learned about the different types of HVLA. Yesterday I treated my partners T6 NRRSL and it fixed her backward sacral torsion. it was evidently the key lesion and i treated with a kirksville.

HVLA a general technique?? better to find dysfuction, diagnose, then treat???????? what are you talking about? with HVLA you always find the dysfunction first, diagnose it, and treat it. in fact you usually use soft tissue techniques first to relax the muscles.

you think you just go around cracking $hit all over without a dx??. i'm sorry but please do your research before trying to sound like you know what you're saying.

 

[DOdot]

thanks to everyone for the input... got to say, though, it'd be nice if we could be a little less nasty to each other. i appreciate EVERYONE'S responses, thanks again