| Question | Answer |
| What is a Direct manipulative Technique? Give 4 examples | Treatment where the restrictive barrier is engaged and a final activating force is applied to correct somatic dysfunction:
1.DMF.
2.ME.
3.Articulatory.
4.Thrust. |
| When would you want to use Lumbar HVLA/LVHA? | 1.Back pain.
2.Pelvic pain.
3.Scoliosis. |
| Relative contraindications for Lumbar HVLA/LVHA | 1.Acute Sprain or fracture.
2.Cancer/infection.
3.DVT.
4.Vascular instability (on BL thinners, or have a bleeding disorder). |
| When will you have radiculopathy/Neuropathy? What test would you use to test for it in the lumbar spine? | If the neurologic exam is ABNORMAL neurological exam (then get Xray or workup).
**Straight Leg Raise. |
| What is the somatic dysfunction: fullness only at L3 on the R, gets better in flexion. | L3 FRSR |
| Thrust (HVLA) | Technique using a rapid force of brief duration that travels a short distance within the anatomic ROM of joint.
**it engages the restrictive barrier in one or more planes of motion to elicit release of restriction. |
| What are some relative contraindications for HVLA/LVHA that you should treat with caution | 1.Joint inflammation.
2.Undiagnosed neuropathy.
3.Hypermobility.
4.Osteoarthritis.
5.Osteoporosis.
6.Elderly.
7.Patient guarding. |
| 4 Steps of THRUST | 1.Diagnose joint restriction.
2.Move the joint to the direct barrier of all planes (localization).
3.Apply a short quick thrust through the direct barrier.
4.Retest. |
| With thrusts, what will DECREASE muscle gaurding and prevent injury? | Faster thrusts prevent muscle gaurding. Applying them only to a short distance prevents injury. |
| Lumbar lateral Recumbent HVLA | 1.Rotated side down on the table.
2.Flex knee & turn trunk until motion at segment.
3.Hold shoulder and rotate pelvis until motion at segment.
4.Short quick rotational thrust at end of exhalation. |
| What type of back pain is manipulation effective on? | 1.Acute.
2.Subacute.
3.Chronic. |
| What creates the "Pop" sound in Thrust? | ARTICULATORY RELEASE: joint immobility creates a partial vacuum containing CO2 and gas within the joint fluid. When the joint is seperated the vapor cavity collapses.
**doesn't indicate effectiveness, rather its the return of ROM** |
| Is repeated joint popping degenerative? | NO, can get an overuse soarness from TOO much popping. |
| Articulatory Technique (LVHA) | Low velocity/moderate to high amplitude where the joint is carried through its full ROM.
**Activating force is a repetitive springing motion OR repetitive concentric movement of joint through restrictive barrier. |
| 5 steps of LVHA | 1.Diagnose restricted joint motion.
2.Slow movement of joint into position of laxity.
3.Slow movement of joint into its restriction for all planes.
4.3-5 repetitions as one smooth movement.
5.Retest motion.
**Dont forget to do more than 1 time. |
| Supine Lumbar Articulatory | **this is a combined thrust so you only do it once instead of 3-5 times.
1.Stand on side away from rotation.
2.Hold affected side ASIS.
3.Slowly lift patient into flexion & rotation.
4.Repeat for other side. |
| Describe the mechanisms of action for HVLA/LVHA | 1.Restoration of joint mobility.
2.Reduced muscle tension (immediate muscle relaxation in neurological myotome).
3.Reduced nocioception (local & distal reduction of pain). |
| What is the main difference b/w ME, HVLA, LVHA? | Method of ACTIVATION:
1.ME: Isometric contraction.
2.HVLA: short/quick thrust.
3.LVHA: Long/slow movement 3-5 times. |
