I do not want to learn or have cervical HVLA performed on me.

[TraderZoe]

My school starts HVLA in January. I have a family friend who is a chiropractor. He caused a young boy to rupture a vertebral artery and has discontinued his practice.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564146/

http://www.ncbi.nlm.nih.gov/pubmed/25552813

How on earth is this still allowed in the DO curriculum? There isn't any refutable evidence of it's benefits, and the side effects (albeit rare) can literally kill you. I'm not a huge OMM fan, but at least the other stuff is harmless.

I contacted my professor about this, and she told me the only way I could get out of it is if I have vertebral artery insufficiency or cervical vertebrae pathology. This is a joke.

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[deleted564680]

All I will say is that you need to do research on this. It's extremely safe. You have an anecdotal story and even though it is true that's 1 example/1 treatment out of probably MILLIONS of cervical HVLA treatments that are done without any consequence. AND this wasn't even done by a D.O.

As far as it not being beneficial, that's a different argument.

You should still learn it because it's part of the curriculum but not having it done to your own neck should be okay and your denial allowed (in my opinion).

 

[Drrrrrr. Celty]

Personally I wouldn't want it done to me despite having plenty of neck tension. You're free to use soft tissue techniques on me, but HVLA? No headache or neck pain is worth risking a rupture.

 

[ortnakas]

Personally I wouldn't want it done to me despite having plenty of neck tension. You're free to use soft tissue techniques on me, but HVLA? No headache or neck pain is worth risking a rupture.

Is it optional at your school?

 

[AlteredScale]

Is it optional at your school?

You can opt out I believe especially if you have any injury. I've had it done to me prob 50 times and it's never caused pain. The reason it's supposed to be safeguarded is because the overall torque your provide is low based on the low amplitude component.

Ugh it my mouth is prob stained red from looking like I drank all the Kool Aid.

 

[GUH]

Participation in OMM sessions is required at my school in the absence of a specific medical waiver and they take this rule quite seriously, even for cervical HVLA. There are not many here who object to the rule or its enforcement when broken (which has happened). I, for one, wouldn't want DOs out there with a license to perform manipulation who haven't actually done it before.

Cervical HVLA is quite safe especially if you avoid extension with rotation. You knew that this would be required if you before enrolling at an osteopathic medical school. It can be scary the first few times but you will be fine and once you finish the unit you can move on with your career.

 

[TraderZoe]

I, for one, wouldn't want DOs out there with a license to perform manipulation who haven't actually done it before.
You knew that this would be required if you before enrolling at an osteopathic medical school.

You bring up some good points. I agree, I wouldn't want a DO doing manipulation if they hadn't perfected the maneuver before. In this situation, I would never perform cervical HVLA on a patient, so I don't see that as a problem.

In regards to knowing before hand, I'm glad you brought that up. I was interviewed at my school by the (then) department chair of OMM. He stated that they are a progressive group of osteopathic physicians, and only spend time on material that has beneficial data to back it up. He said that he teaches the theory behind cervical HVLA but does not perform it in lab, because in his practice he has seen that the benefit isn't worth the risk when indirect methods can be used to treat the same condition. He also said that he teaches the theory of cranial technique, but does not hold us responsible for it in lab. He said he does this because it is on COMLEX, but it is an outdate maneuver and it's not worth our time.

He left our school to enter a group practice, and the new lady teaches everything. So no, I didn't expect to do cervical HVLA (or cranial) when I agreed to go to this school. It may not seem like much, but the experience I noted above with a family friend has been traumatic for everyone involved.

 

[rzoo14]

My school starts HVLA in January. I have a family friend who is a chiropractor. He caused a young boy to rupture a vertebral artery and has discontinued his practice.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564146/

http://www.ncbi.nlm.nih.gov/pubmed/25552813

How on earth is this still allowed in the DO curriculum? There isn't any refutable evidence of it's benefits, and the side effects (albeit rare) can literally kill you. I'm not a huge OMM fan, but at least the other stuff is harmless.

I contacted my professor about this, and she told me the only way I could get out of it is if I have vertebral artery insufficiency or cervical vertebrae pathology. This is a joke.

Find a partner who shares your views on hvla. During lab, learn the hand positions and the set up. You'll need those for the practical. No one will force you to go through the thrust. I did something similar when we went through it. I can do it but I'm not comfortable with the technique.

 

[hallowmann]

You bring up some good points. I agree, I wouldn't want a DO doing manipulation if they hadn't perfected the maneuver before. In this situation, I would never perform cervical HVLA on a patient, so I don't see that as a problem.

In regards to knowing before hand, I'm glad you brought that up. I was interviewed at my school by the (then) department chair of OMM. He stated that they are a progressive group of osteopathic physicians, and only spend time on material that has beneficial data to back it up. He said that he teaches the theory behind cervical HVLA but does not perform it in lab, because in his practice he has seen that the benefit isn't worth the risk when indirect methods can be used to treat the same condition. He also said that he teaches the theory of cranial technique, but does not hold us responsible for it in lab. He said he does this because it is on COMLEX, but it is an outdate maneuver and it's not worth our time.

He left our school to enter a group practice, and the new lady teaches everything. So no, I didn't expect to do cervical HVLA (or cranial) when I agreed to go to this school. It may not seem like much, but the experience I noted above with a family friend has been traumatic for everyone involved.

You could just fake it, and worst case scenario, fail that portion of the practical if it came down to you doing it. Hopefully you'd still pass the course with it. Plenty of people felt uncomfortable doing it at my school and at first we were told we didn't have to do the thrust. Eventually the new professor expected us to do it. We did it. No one died.

I hate having it done to me. No matter what it just ends up hurting my neck (not permanently, just for a day or so). You could just advise the person you're with that you'd prefer not to have it done to you, and I can't imagine they would be able to force someone to do it to you. You could even explain that you had a traumatic experience involving a similar technique with a friend of yours and your ability to comply is compromised (you won't be able to relax and as such would guard), and as a result may prevent your partner from doing the technique on you safely.

 

[Mbeas]

you'll be fine. i hate having it done on me but that's just because i don't like my neck being cracked. thousands of students across the country do it on a daily basis.

when I went through this, my class was given the following info to help allay our fears:

risk of vertebral artery dissection with cervical HVLA: 1:400,000 to 1:3.8million
Incidence of anaphylaxis to penicillin: 1:1 million
Risk of death from NSAID use: 1:17098
risk of traffic accident fatality: 1 in 9416

obviously, it is your prerogative and if you can get out of it, more power to you. but the statistics are stacked in your favor.

 

[572776]

At our school we weren't required to do it/have it done on us if we weren't comfortable with it.

 

[UTsksk]

I hated doing cervical HVLA and receiving treatment the first few times since none of us had any neck problems. Just be careful not to put people in extension when doing the move and isolate the vertebrae as good as you can.

In 2nd year it gets easier. I rarely do it now and if I want it done, we know who in our class is good at it so we ask them if we have neck pain.

 

[petyr_baelish]

.

 

[ortnakas]

I've had a similar experience to posters above. We saw the same data as @Mbeas did. If you make sure that the patient is never in extension, you'll be fine.

Personally, I avoid having to do it, but could safely make an attempt for a practical exam if need be. As far as learning the technique, as others have said, make sure you know the set-up down cold; if you half-a$$ the thrust, I doubt anyone will give you a hard time or fail you. For being "the patient," @hallowmann made a good point-- you could definitely argue that your anxiety about it/inability to relax your neck is a valid contraindication (although your school might end up asking for some sort of documentation).

 

[jl lin]

Holy crap. Since you don't have a clear view of someone's specific anatomy for this, seriously, it is concerning to me.

 

[WalterDonnie]

Just say you have recurring neck issues due to an old car accident.

 

[dodobirddo]

My school starts HVLA in January. I have a family friend who is a chiropractor. He caused a young boy to rupture a vertebral artery and has discontinued his practice.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564146/

http://www.ncbi.nlm.nih.gov/pubmed/25552813

How on earth is this still allowed in the DO curriculum? There isn't any refutable evidence of it's benefits, and the side effects (albeit rare) can literally kill you. I'm not a huge OMM fan, but at least the other stuff is harmless.

I contacted my professor about this, and she told me the only way I could get out of it is if I have vertebral artery insufficiency or cervical vertebrae pathology. This is a joke.

I felt the exact same way. I had a lot of neck pain the first 2 years of school and I never got comfortable having cervical hvla done on me, especially with first year students who had never done it before. I used to tense up so much beforehand which probably only worsened my neck pain.
I don't think it's right to force students to have a treatment or intervention they don't want or need. A 1 in 400,000 chance of causing vertebral artery insufficiency is not a risk I would take for a treatment I don't need.
I don't agree with it but this is temporary. 18 months from now you'll probably never have to do or experience hvla again, outside questions on board exams.

 

[ninjaman22]

At my school, I basically told my OMM partner not to pop it. She was able to get in the position and everything but not just pop it. Even during our practical, the practical card said Demonstrate the position without popping.

You can't pay me to have HVLA done on my neck. Thoracic and lumber HVLA? Sure go ahead.

 

[AlbinoHawk DO]

You bring up some good points. I agree, I wouldn't want a DO doing manipulation if they hadn't perfected the maneuver before. In this situation, I would never perform cervical HVLA on a patient, so I don't see that as a problem.

Except the problem is that you are licensed to perform it. You can't have a license that says you know how to do something without knowing how to do something.

I'm not a fan of cervical HVLA in general, but there really no data indicating that the way DOs perform it possesses a risk. Chiropractors perform HVLA in extension, which increases the risk. The AOA's official position is that it should be taught at all levels of training, so you're really out of luck here.

 

[costales]

I don't use OMM and have forgotten much of it, but I've tried HVLA on several people who all said it helped them. Short distance is important - you have to know the restrictive barrier and maintain good control.

 

[NurWollen]

Except the problem is that you are licensed to perform it. You can't have a license that says you know how to do something without knowing how to do something.

I'm not a fan of cervical HVLA in general, but there really no data indicating that the way DOs perform it possesses a risk. Chiropractors perform HVLA in extension, which increases the risk. The AOA's official position is that it should be taught at all levels of training, so you're really out of luck here.

MD's are licensed to perform it, too.

Also, does anyone actually have a source saying that chiropractors perform cervical HVLA in extension, or is this just something that gets repeated around and around?

 

[Doctor Bob]

You can't have a license that says you know how to do something without knowing how to do something.

Actually you can.

When you get licensed in any state, it is for the practice of "medicine and surgery". The state does not say what procedures or what kind of medicine a doctor can practice. I'm an ER/ICU doc. Based on my state license I could perform neurosurgery if I wanted because I'm licensed for the practice of "medicine and surgery".
However... the hospital I work at credentials me for the specific procedures that I do. No hospital would give me privileges to do neurosurgery based on my training, so I can't do it.

Cervical HVLA would be much the same. Knowing or not knowing how to do it has zero impact on the licensing aspect of medicine. And as it is a procedure that does not require credentialling or specific privileges in the hospital setting, a hospital won't care if you know or don't know how to do it either.

 

[DoctorSynthesis]

My school starts HVLA in January. I have a family friend who is a chiropractor. He caused a young boy to rupture a vertebral artery and has discontinued his practice.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564146/

http://www.ncbi.nlm.nih.gov/pubmed/25552813

How on earth is this still allowed in the DO curriculum? There isn't any refutable evidence of it's benefits, and the side effects (albeit rare) can literally kill you. I'm not a huge OMM fan, but at least the other stuff is harmless.

I contacted my professor about this, and she told me the only way I could get out of it is if I have vertebral artery insufficiency or cervical vertebrae pathology. This is a joke.

When you decided to attend a DO school you agreed to having manipulations performed on you.


Also your concerns aren't warranted. Extensive research has been done and no correlation has been found between cervical HVLA and vertebral artery insuffiency.

This happens when rotation and sidebending of the cervical region is sidebent and rotated in the opposite direction. A DO knows not to do this and knows not to go into extension. An American trained DO has never caused vertebral artery insuffiency. This is most likely to occur if someone tries to crack their own neck or in a chiropractic adjustment.


So relax and stop complaining!

 

[dodobirddo]

When you decided to attend a DO school you agreed to having manipulations performed on you.

I don't remember anyone ever asking me, or signing a contract saying I agreed to receive any kind of manipulation. I had no idea what HVLA was when I started first year. I understand that we all need to learn certain osteopathic techniques and I don't doubt that most DO's perform HVLA safely, however I have a big problem with medical students being forced to receive an intervention they don't want or need. We shouldn't take consent for granted, whether it's concerning a student, a research subject, or a patient.

To the OP, as someone else mentioned above, most of your student partners will respect your wishes if you ask them not to do cervical HVLA on you.

 

[Makati2008]

When you decided to attend a DO school you agreed to having manipulations performed on you.


Also your concerns aren't warranted. Extensive research has been done and no correlation has been found between cervical HVLA and vertebral artery insuffiency.

This happens when rotation and sidebending of the cervical region is sidebent and rotated in the opposite direction. A DO knows not to do this and knows not to go into extension. An American trained DO has never caused vertebral artery insuffiency. This is most likely to occur if someone tries to crack their own neck or in a chiropractic adjustment.


So relax and stop complaining!

Unfortunately you are incorrect. In my residency last year, one of the speakers admitted that DOs sometimes(very rarely) cause a vertebral artery dissection. This person is a big OMM guru and I was shocked to hear it.

 

[DoctorSynthesis]

Unfortunately you are incorrect. In my residency last year, one of the speakers admitted that DOs sometimes(very rarely) cause a vertebral artery dissection. This person is a big OMM guru and I was shocked to hear it.

I got my information from the head of omm at my school. My facts are indeed true.

I don't remember anyone ever asking me, or signing a contract saying I agreed to receive any kind of manipulation. I had no idea what HVLA was when I started first year. I understand that we all need to learn certain osteopathic techniques and I don't doubt that most DO's perform HVLA safely, however I have a big problem with medical students being forced to receive an intervention they don't want or need. We shouldn't take consent for granted, whether it's concerning a student, a research subject, or a patient.

To the OP, as someone else mentioned above, most of your student partners will respect your wishes if you ask them not to do cervical HVLA on you.

At my school I was asked and consented. However, in sure if you read your schools handbook guidelines its in there also

 

[NurWollen]

I probably won't use cervical HVLA in my practice. I have done it in lab and on practicals and I've had it done on myself in those settings. I can't say I love it, but I'm sure all of us do things ever day that are far more likely do give us a stroke. Hamburgers, for example.

 

[Dharma]

Learn to isolate the treated area for the set up (useful for understanding as well as ME approach), then don't pop. Odds are you wont be using OMM much in a couple years anyway so any talk of being licensed and using it in real world are essentially moot. Just don't go claiming you know OMM when you really don't or smack talk about how you think it's a crock when you really haven't dug deep (which btw, describes the vast majority whose experience is limited to lab time). That said, it's relatively benign. I say relax and learn. Your "friend" was unlucky and like others said, his approach and technique may not have been ideal.

 

[jl lin]

Sorry. No. Do no more harm. I will let people put IVs in me and such in order to learn; but not this. How do you know some yahoo isn't going to screw it up? You don't. Unless the professor, who is a known and reputable expert, is standing right next to the student and is simply showing him the positioning w/o any use of force or extension, I cannot allow this on me.

 

[JustPlainBill]

I refused to allow my partner at the time to perform HVLA on me. And this was an OMM TA (OMS2) with the prof standing right there. Too many people confuse brute force with proper technique and at my school, it was usually the TAs who were that way -- there's one I'm thinking of that mashed on the back of my neck demonstrating a direct inhibition technique that almost put me out then claimed I must have had a unilateral vertebral artery, need to get it checked, etc. -- no, jerkweed, you just need to learn that brute force is no substitute for good technique.

Now, lest you think I'm anti HVLA, I regularly go to a reputable chiropractor that has been in practice for years, got me walking without pain after an L4/L5 herniation and only treats as needed -- but I do NOT trust my OMM colleagues to know WTF they're doing -- too much BS out of the OMM department at my school when I was there. There's a new crowd there now so maybe it's gotten better though....

Bottom line -- it's your neck, your ambulation/breathing/quality of life on the line -- if you're not comfortable, don't do it. If they get nasty with you, get a lawyer and your local investigative reporter on the hook and intimate that fact to the school -- ok, that's a bit extreme but I guess I'm trying to say don't let them browbeat you into something you're not comfortable with....

 

[ortnakas]

At my school I was asked and consented. However, in sure if you read your schools handbook guidelines are in there also

I think "full participation in OMM lab" was in our matriculation agreement, as well.

 

[Eremba]

At my school you learn setup but never actually do the manipulation on a fellow student in lab or on sign offs. Just tell your partner to put you in the setup position but don't do the treatment.

 

[chizledfrmstone]

At my school you learn setup but never actually do the manipulation on a fellow student in lab or on sign offs. Just tell your partner to put you in the setup position but don't do the treatment.

+1

They have told us not to apply the thrust unless the person actually has a somatic dysfunction.

 

[jl lin]

Participation is one thing; taking needless risks with each other is totally another. I tend to think that most places are like the other responders stated--'set up position, no thrust.' What school would want the liability?

 

[Makati2008]

I got my information from the head of omm at my school. My facts are indeed true.




At my school I was asked and consented. However, in sure if you read your schools handbook guidelines its in there also

http://files.academyofosteopathy.org/CME/2012OMEDconvention/King_Presentation.pdf

Slide 15ish. I might be interpreting incorrectly but there are a few adverse outcomes from us.

 

[AlbinoHawk DO]

Actually you can.

When you get licensed in any state, it is for the practice of "medicine and surgery". The state does not say what procedures or what kind of medicine a doctor can practice. I'm an ER/ICU doc. Based on my state license I could perform neurosurgery if I wanted because I'm licensed for the practice of "medicine and surgery".
However... the hospital I work at credentials me for the specific procedures that I do. No hospital would give me privileges to do neurosurgery based on my training, so I can't do it.

Cervical HVLA would be much the same. Knowing or not knowing how to do it has zero impact on the licensing aspect of medicine. And as it is a procedure that does not require credentialling or specific privileges in the hospital setting, a hospital won't care if you know or don't know how to do it either.

I stand corrected then.

 

[Mjolner]

Actually you can.

When you get licensed in any state, it is for the practice of "medicine and surgery". The state does not say what procedures or what kind of medicine a doctor can practice. I'm an ER/ICU doc. Based on my state license I could perform neurosurgery if I wanted because I'm licensed for the practice of "medicine and surgery".
However... the hospital I work at credentials me for the specific procedures that I do. No hospital would give me privileges to do neurosurgery based on my training, so I can't do it.

Cervical HVLA would be much the same. Knowing or not knowing how to do it has zero impact on the licensing aspect of medicine. And as it is a procedure that does not require credentialling or specific privileges in the hospital setting, a hospital won't care if you know or don't know how to do it either.

All this is fine until you injure someone and they sue and the court discovers that you learned HVLA on YouTube.

 

[JustPlainBill]

All this is fine until you injure someone and they sue and the court discovers that you learned HVLA on YouTube.

Somebody better d*&n well tell faculty at a certain FM residency in the Southwest that it is unacceptable to learn a procedure on YouTube then --- when I was an intern we literally watched the NEJM paracentesis video, walked down the hall and then proceeded to make a big show out of using everything in the Safe-T-Centesis kit and spent 30 minutes just getting the probe into the patient's abdomen on the right side near the liver/appendix -- it was rather embarassing to have the GI team from the world class IM residency co-located there walk in right after the tap had started and inform the attending and senior resident that they tended to do taps on the left side if at all possible to avoid the liver....

I've also been told by a senior physician for a UC company I worked for to Youtube FB removal from the eye, joint injections/drainage, etc. ---

And lest you think I approve of this -- I emphatically do not and regularly refuse to do procedures that I have not been trained in. And No, I do not consider NPI training sufficient -- I would prefer to have another physician who's done more than a few precept me the first time I stick a needle into a shoulder -- yes, my residency sucked, we got few, if any procedures and now I have to make up for it. Can I do it by reading the book? Sure -- do I want to take that chance with patient safety -- not unless it's a real emergency and they're dying and I'm the only game in town....

Sorry but the post hit a nerve ---

 

[NontradCA]

If you rupture the VA, just use LAR to fix it. Tensegrity.

 

[Derivations]

Interesting that some people here are saying only chiropractors use extension for cervical HVLA. I just read the notes for our OMM class and it states to induce an "extension barrier" to localize the segment prior to rotation and side bending. It does say to be careful not to "hyper extend" the neck, but the thrust is still done in extension.

Regardless, I will not be performing cervical HVLA on my patients.

 

[hallowmann]

Interesting that some people here are saying only chiropractors use extension for cervical HVLA. I just read the notes for our OMM class and it states to induce an "extension barrier" to localize the segment prior to rotation and side bending. It does say to be careful not to "hyper extend" the neck, but the thrust is still done in extension.

Regardless, I will not be performing cervical HVLA on my patients.

DOs use extension as well. DOs and DO students have also caused vertebrobasilar insufficiency with cervical HVLA, but probably at a much less frequent rate than other groups. It absolutely has happened before, and I believe it happened at WVSOM or CCOM (or an affiliate) in the past (I believe WVSOM doesn't have students practice it anymore).

That said, it is riskier to do it in extension as the risk of hyperextension is present and quite frankly dangerous extension could mean different things depending on the individuals blood supply. Its for that reason that most students are recommended not to preform it in extension nowadays, as its unnecessary and more risky.

 

[NurWollen]

DOs use extension as well. DOs and DO students have also caused vertebrobasilar insufficiency with cervical HVLA, but probably at a much less frequent rate than other groups. It absolutely has happened before, and I believe it happened at WVSOM or CCOM (or an affiliate) in the past (I believe WVSOM doesn't have students practice it anymore).

That said, it is riskier to do it in extension as the risk of hyperextension is present and quite frankly dangerous extension could mean different things depending on the individuals blood supply. Its for that reason that most students are recommended not to preform it in extension nowadays, as its unnecessary and more risky.

I'm not doubting you or calling you out, but I'm curious, do you have a source? I think it would be interesting to read, to say the least.

I'd also be interested to know if anyone has a source showing that Chiopractors do indeed perform the technique differently.

 

[hallowmann]

I'm not doubting you or calling you out, but I'm curious, do you have a source? I think it would be interesting to read, to say the least.

I'd also be interested to know if anyone has a source showing that Chiopractors do indeed perform the technique differently.

A classmate found a news article discussing a lawsuit against a DO school due to complications associated with cervical HVLA. If I can find it easily I'll post it, but honestly I don't it'll be today.

 

[Makati2008]

A classmate found a news article discussing a lawsuit against a DO school due to complications associated with cervical HVLA. If I can find it easily I'll post it, but honestly I don't it'll be today.

http://www.rapoportlaw.com/Verdicts...Chicago-College-of-Osteopathic-Medicine.shtml

 

[benzyne]

I'm not doubting you or calling you out, but I'm curious, do you have a source? I think it would be interesting to read, to say the least.

I'd also be interested to know if anyone has a source showing that Chiopractors do indeed perform the technique differently.

My professor mentioned an issue with cervical WVSOM at WVSOM the other day. I went looking for it but couldn't find it...google brought me here.

If anyone else reads this in the future, I was super nervous about HVLA at first but it's really not bad. Supine thoracic HVLA is the only one that produces cracking anyway and you can always set it up and explain that you would thrust during a practical.

 

[benzyne]

My professor mentioned an issue with cervical WVSOM at WVSOM the other day. I went looking for it but couldn't find it...google brought me here.

If anyone else reads this in the future, I was super nervous about HVLA at first but it's really not bad. Supine thoracic HVLA is the only one that produces cracking anyway and you can always set it up and explain that you would thrust during a practical.

*cervical HVLA

 

[EmergDoc2B]

I felt the same way as the OP. I took a grade hit of a zero during my practicals. I would not touch or allow my neck to be touched. Just ace the clinical test on the section and move on.

 

[IIIIIII]

I felt the same way as the OP. I took a grade hit of a zero during my practicals. I would not touch or allow my neck to be touched. Just ace the clinical test on the section and move on.

Your school actually made you perform and receive HVLA on practicals?
Mine just requires to go through the steps and talk about it during practicals.
And in lab, if you don't want it done on you, you say you don't want it done.

 

[Drrrrrr. Celty]

i'd like to come back after a year and say that I'm actually alright with getting some cervical hvla done if the person is trained or I trust them. And for the most part it actually does a lot of good for my neck and tight traps. Thankfully at my school they don't do practicals where they actually do it because for obvious reasons a patient may not have a somatic dysfunction.

 

[samac]

I love having it done by people I know can do it correctly and I feel absolutely comfortable doing it. When you're staring at a screen all day you give yourself somatic dysfunction in the cervical spine.
But on practicals we weren't forced to do the thrust, just to set them in position.

If anyone else reads this in the future, I was super nervous about HVLA at first but it's really not bad. Supine thoracic HVLA is the only one that produces cracking anyway and you can always set it up and explain that you would thrust during a practical.

That's just incorrect information. You can get cracking with cervical, thoracic, and lumbar.