Overview of Osteopathic Manipulative Treatment: HVLA Procedure – Inhaled Ribs
“Somatic dysfunction” refers to issues affecting the body’s structural components – such as our bones, joints, muscles and related blood vessels, lymph systems, and nerves. This concept was introduced by Andrew Taylor Still, the founder of osteopathy, in 1874. Osteopathy is a type of alternative medicine that focuses on physical manipulation of the body’s tissue and bones to promote self-healing.
Doctor of Osteopathic Medicine (DO) is a professional degree for osteopathic doctors, signifying they are licensed to practice osteopathic medicine. Central to their approach is treating somatic dysfunction through hands-on techniques known as osteopathic manipulative treatments (OMT).
One of these techniques is high-velocity low amplitude (HVLA), a procedure where an osteopathic doctor performs swift, small motions to restore the body’s health. There are also other techniques, like muscle energy, counterstrain, balanced ligamentous tension, cranial and myofascial release.
In this discussion, we will focus on the HLVA technique, especially as it relates to the ribs and their connection to the thoracic vertebrae in the spine. We’ll cover when and why this technique is used, how it’s done, when it shouldn’t be used, possible side effects, and how its effectiveness is monitored.
Anatomy and Physiology of Osteopathic Manipulative Treatment: HVLA Procedure – Inhaled Ribs
Human beings usually have 12 ribs on each side of their body. Each rib lines up with one of the 12 spinal bones in our back called vertebrae. Each rib attaches to the back of each vertebra at its own level and the one above it, except for the first rib, which only attaches to the first thoracic vertebra (the one at the top of your back).
Here’s a fun fact: not all ribs are alike. Ribs 1 to 7 are called “true ribs” because they connect directly to the sternum (the bone in the center of the chest) through tissues called costal cartilages. Ribs 8 to 10 are known as “false ribs” because they indirectly connect to the sternum through the seventh costal cartilage. Lastly, ribs 11 and 12 don’t connect to the sternum at all. They’re either known as “floating ribs.”
The movement of your ribs works with several muscles. Name drop: the diaphragm, pectoralis major/minor, external abdominal oblique, rectus abdominis, subclavius, serratus anterior, external intercostal, and a few others work together allowing you to breathe normally, among other things. Breathing normally is important as it allows the lymph, which carries substances throughout the body, to clear out properly. Simply put, if you can’t breathe well, your lymphatic system can’t do its job well.
When it comes to the movement of your ribs, there are three types based on how they move in respect to the spinal bones: pump handle motion (ribs 1 to 5), bucket handle motion (ribs 6 to 10), and caliper motion (ribs 11 and 12). The diaphragm (a muscle that helps you breathe) connects to ribs 6-12. It’s shaped like a dome when you’re at rest. But, when you breathe in, this dome flattens out, this causes your rib cage to expand and your lungs to fill with air. But, if something is not quite right with the structures around these areas, it can affect your ability to breathe properly.
For instance, a dysfunction of a rib can occur from excessive physical activity, constant coughing, poor posture, or increased rounding of the upper back among other things. This can result in the rib moving freely in one direction but being restricted to moving the opposite way during either inhalation or exhalation.
By the way, quick note: the lower angle of your shoulder blade (scientifically known as the inferior scapular angle or ISA) shouldn’t be used to identify a specific spinal bone. Some may suggest that it can mark where the T7 vertebra is (seventh bone of the thoracic spine), but that’s not an accurate method according to research studies.
Why do People Need Osteopathic Manipulative Treatment: HVLA Procedure – Inhaled Ribs
High-Velocity, Low Amplitude (HVLA) is a treatment method used to remedy issues with the chest area, specifically, the thoracic cage (the part of the spine that’s attached to the ribs), the thoracic vertebrae (the 12 bones of the spine in the chest area), and the ribs’ posterior angles (backsides of the ribs). This method is used to treat what’s called somatic dysfunction – problems with the ways your body’s different systems communicate with each other.
Such issues with the ribs can arise due to improper breathing or when you overexert yourself. A common symptom of these issues is sharp chest pain. Although chest pain can be a sign of severe heart disorders, it’s most often due to problems with the muscles and bones in the chest area for people who don’t have heart disease.
HVLA, on its own or combined with other OMT (Osteopathic Manipulative Therapy) techniques, can be an alternative treatment for those who cannot take standard pain relievers or do not respond well to them. This method can be a handy option for people who cannot or do not wish to use pharmaceutical drugs to deal with pain.
When a Person Should Avoid Osteopathic Manipulative Treatment: HVLA Procedure – Inhaled Ribs
High-Velocity, Low-Amplitude (HVLA) is a type of manual therapy used by professionals to treat a range of conditions. However, not everyone can undergo HVLA treatments safely. The following are reasons someone might not be able to receive this treatment:
- If they’re taking anticoagulant therapy, which is a type of medication that stops blood clots.
- If they have a connective tissue disease, which is an illness that affects the parts of the body that connect, like joints and skin.
- If they have a fracture or broken bone.
- If they have cancer that has spread locally.
- If they have osteoporosis, a condition that weakens bones and makes them brittle.
- If they’re unable or unwilling to cooperate during treatment.
- If they have severe rheumatoid arthritis, a serious condition that causes pain and swelling in the joints.
- If they have had surgery in the local area recently.
When it’s not safe or possible to use HVLA, there are several other therapies to consider. These alternative therapies include muscle energy, myofascial release, rib raising, and soft tissue techniques. In a recent study, the rib raising technique was used on 87 patients with breathing issues who weren’t in intensive care. This treatment was well received and didn’t cause any problems for the patients.
Who is needed to perform Osteopathic Manipulative Treatment: HVLA Procedure – Inhaled Ribs?
The procedure of OMT (Osteopathic manipulative treatment, a type of therapy) needs a specialist like an osteopathic doctor, a chiropractor, or a medical doctor who has been given the ok to do this type of treatment. For this therapy to work, understandably, the patient must be able to cooperate and be comfortable enough to be put in the right position for the treatment to begin and take place.
Plus, the doctor should be aware of the patient’s position and how the treatment is set up to make sure they don’t hurt themselves. It’s basically a team effort between the patient and doctor to make the therapy safe and successful.
Preparing for Osteopathic Manipulative Treatment: HVLA Procedure – Inhaled Ribs
OMT, or Osteopathic Manipulative Treatment, is a type of hands-on care used in the treatment of illness or injury. However, before a doctor can perform OMT, they must have the patient’s permission. This means that the doctor should discuss the procedure with the patient and answer any questions they might have before getting the patient’s agreement to go ahead with it.
How is Osteopathic Manipulative Treatment: HVLA Procedure – Inhaled Ribs performed
High Velocity Low Amplitude (HVLA) is a technique that medical professionals use to help treat issues related to your rib cage. Here’s a general idea of how doctors use this technique:
– First, you will be asked to lie flat on your back. The doctor will be standing next to the side of your body opposite to the side where you are experiencing discomfort. This is because the rib causing pain or discomfort is not correctly aligned with the ribs above and below it.
– Next, you will need to cross your arms over your chest, with the arm on the side of the discomfort being on top.
– The doctor will then gently roll you towards them and place the fleshy part of their thumb(a part known as the thenar eminence) on the troublesome rib, directly between the transverse process (a bony part on your spine) and the angle of the rib.
After this setup, they will roll you back onto their thumb. The doctor will then bend your body towards the spot just below the rib causing the problem with their free hand. They will ask you to take a deep breath, and as you breathe out, the doctor will apply force through your elbow to the affected rib. Just as you finish exhaling and are about to take another breath, the doctor will apply a quick and firm thrust onto the problematic rib. You may feel the rib move back into place and hear a “popping” or “cracking” sound.
After performing this technique, the doctor will check the previously painful area again to make sure everything is in order. If needed, they may repeat the procedure until any remaining discomfort is completely addressed.
Possible Complications of Osteopathic Manipulative Treatment: HVLA Procedure – Inhaled Ribs
Most people generally respond well to osteopathic manipulative treatment (OMT) – a type of hands-on care helping to diagnose, treat and prevent illness or injury – as long as they’ve been properly checked for any reasons they shouldn’t have it.
Some common after-effects can include feeling sore or tender in the part of the body where the treatment was done. To help with this, it’s usually best for patients to have a warm shower and drink lots of water after their treatment session.
Two previous studies have suggested that this type of treatment is very safe when performed by trained professionals.
