Overview of Osteopathic Manipulative Treatment: HVLA Procedure – Thoracic Vertebrae
Osteopathic manipulative treatment or OMT is a method where doctors use their hands to identify and treat many health problems. This hands-on approach has helped lessen the quantity of pain medicine a patient may need for muscle or bone injury. A specific type of OMT is high velocity-low amplitude (HVLA), which involves the doctor applying a quick, short, and effective force within the natural movement space of a joint to release its restriction. This article explains how HVLA works on the thoracic (chest) area, and the crucial role of the healthcare team in assessing and treating this.
High velocity, low amplitude manipulation is often used when patients are feeling pain or have limited joint movement. A common way of using thoracic HVLA is the “Kirksville Crunch,” a technique known and effective within osteopathy, which is the study of treating health issues through the manipulation of the muscles and bones. This method is especially useful for most thoracic joint issues. It’s important for the doctor to know this technique, along with other alternatives, if a patient cannot be treated with one specific approach. Learning to effectively perform thoracic HVLA can greatly help doctors, as it gives immediate results and can increase patient satisfaction. Moreover, using thoracic HVLA to treat a patient’s muscle or bone problem can decrease the number of pain medications prescribed to them.
Anatomy and Physiology of Osteopathic Manipulative Treatment: HVLA Procedure – Thoracic Vertebrae
Osteopathic doctors, or doctors that specialize in treating the body as a whole, typically stick to four important principles during their treatments. These principles are (1) the body, mind, and spirit form a single unit, (2) the body can naturally heal and regulate itself, (3) the formation and function of body parts are linked, and (4) all treatments should be based on understanding these first three principles. It’s essential these doctors keep these principles in mind, especially when they are doing physical manipulations, or hands on treatment. These doctors undergo special training to understand the body’s structure and how it functions before treating patients.
High velocity, low amplitude (HVLA) is a special kind of treatment which many doctors use for treating a variety of body dysfunctions. This kind of treatment specifically targets the thoracic spine or the part of your backbone that’s connected to your ribs. It is designed to restore both the structure and the function to this part of the spine. This area is unique because each small bone or vertebra of the spine is connected to a pair of ribs. This portion of the spine is responsible for supporting the rib cage. There are certain laws, known as Fryette’s Laws, which help doctors understand the dysfunctions of the thoracic spine. By examining patient’s pain and their body’s response to certain movements, doctors can understand the dysfunction and treat it effectively with HVLA.
From a scientific point of view, there are a few theories as to why HVLA treatment can help your body. One theory suggests that an HVLA treatment might stretch a tight muscle, sending signals to your brain which then instructs the muscle to relax. Another theory suggests that the treatment might activate certain receptors, causing the muscle to relax.
Why do People Need Osteopathic Manipulative Treatment: HVLA Procedure – Thoracic Vertebrae
High velocity, low amplitude (HVLA) therapy, which is a kind of manual therapy applied to your spine, might be used by your healthcare provider in case of following occurrences:
- If they can detect a somatic dysfunction, which means there’s an issue with the ways your bones, muscles, or other structures in your body are working together, in a joint of your upper or middle back (known as the thoracic spine).
- If they detect a firm, clear barrier that blocks the normal movement or functions in that area.
- If you are experiencing pain in your upper or middle back.
- If you have lost the ability to move your upper or middle back as much as you usually can.
These could be signs of an issue in your thoracic spine that may be improved with this kind of therapy. If you are experiencing any of these symptoms, please consult with your healthcare provider about the best course of action.
When a Person Should Avoid Osteopathic Manipulative Treatment: HVLA Procedure – Thoracic Vertebrae
When a doctor decides to use a certain type of chiropractic treatment called HVLA (high-velocity, low-amplitude) on a patient’s chest area, there are some conditions that can make this treatment inappropriate or even dangerous. Some conditions mean that HVLA should absolutely never be used (absolute contraindications), while others mean it should be used with caution (relative contraindications).
Absolute contraindications include:
- Weak or damaged bones due to things like cancer, infection, injury, or inflammation
- Problems with the nervous system such as severe disease in the spinal cord, pressure on the spinal cord or nerve roots, and condition called cauda equina syndrome (when nerves at the end of spinal cord are compressed)
- Issues with blood vessels such as abnormalities in the arteries in the neck, an enlarged aorta (main heart artery), chest pain from heart disease, or sudden stomach pain with stomach muscles that are hard to the touch
- Any situation where the treatment could potentially harm the patient, like when the doctor doesn’t have a diagnosis yet, the doctor lacks enough skill or expertise, or the patient hasn’t given their consent
Relative contraindications include:
- Hypermobility (where joints move more than normal)
- Severe curvatures of the spine, known as kyphosis (forward rounding of the back) or scoliosis (sideways curve of the spine)
- A herniated disc or a disc protrusion, both conditions where the cushioning between spinal bones protrudes and might press on nerves
- A serious body-wide infection
- Severe deterioration of the joints (degenerative joint disease)
- Harmful response to previous HVLA manipulation treatment
No matter what treatment is chosen, the doctor should always thoroughly review the patient’s health history and do a physical exam beforehand.
Equipment used for Osteopathic Manipulative Treatment: HVLA Procedure – Thoracic Vertebrae
To carry out this procedure, an OMT (Osteopathic Manipulative Treatment) or a massage table is needed. This is a comfortable table where the patient can either sit or lie down.
Who is needed to perform Osteopathic Manipulative Treatment: HVLA Procedure – Thoracic Vertebrae?
Before doing a special kind of treatment called Osteopathic Manipulative Treatment (OMT), the doctor, who is specially trained in this type of medicine, will ask the patient for their permission. This training usually happens in medical school or further study after that. It is important that the patient agrees to the procedure before it happens so they understand what’s going to happen.
Preparing for Osteopathic Manipulative Treatment: HVLA Procedure – Thoracic Vertebrae
Before starting any treatment, the doctor needs the patient’s permission. This is known as ‘informed consent’. The doctor will discuss with the patient what the treatment involves, the potential risks and benefits, as well as other possible treatment options. This conversation should be noted down for reference.
Moreover, the doctor will carry out a complete examination of the patient’s mid-back area, referred to as the ‘thoracic spine’. This step is crucial and it needs to occur before starting the procedure. It can help the doctor to understand the patient’s condition better, making sure the most suitable treatment is chosen, providing the best chance of a successful outcome.
How is Osteopathic Manipulative Treatment: HVLA Procedure – Thoracic Vertebrae performed
There are two main methods for performing HVLA (a kind of adjustment that stands for High-Velocity, Low-Amplitude) on a patient with a problem in the thoracic (middle) part of their spine. These two methods are called the seated method and the supine (lying down on the back) method, also known as the Kirksville Crunch.
After identifying the problem area in the spine, the doctor will move the affected part of your back in a way that engages all the areas that are difficult to move. This is done by moving the part of your back in the opposite way that it is currently stuck or painful. For instance, if the problem area was showing signs of being extended (arched), rotated, and bent to the right (a condition known as ‘ERSr’), the doctor would move it into a position where it’s flexed (bent forward), rotated and bent to the left until they feel resistance. This resistance is known as the restrictive barrier. A fast, gentle push is then applied to try and free up the movement in the problematic area of the spine. The area is then reassessed.
Here’s how the seated and supine (Kirksville Crunch) methods are performed:
Seated Position Technique:
1. The doctor stands behind you with their hands behind your head.
2. The doctor places their belly against the back of the problem area.
3. The doctor reaches under your arms and holds your forearms, asks you to take a deep breath, and during exhalation, they pull your elbows together and arches your back.
4. The doctor pushes their stomach into your back.
5. After you’ve breathed out all the way, the doctor applies a swift, gentle push with their abdomen into your back. Your back is then rechecked.
Supine Position Technique (Kirksville Crunch):
1. The doctor stands on the opposite side of the rotation in your spine.
2. You cross your arms with elbows together. The arm that is on the opposite side from the doctor should be on top. If you have an issue at T5 (the fifth bone in your spine) that is flexed and bent to the right, your right arm would be on top of the left arm.
3. The doctor reaches their lower hand across you and places their hand against the back of the problem area.
The doctor leans into your crossed elbows while their other hand lifts your head and back until they feel pressure. You are asked to take a deep breath while the doctor leans into your elbows during exhalation. As you breathe out all the way, the doctor applies a swift, gentle push onto your elbows with their abdomen. Your back is then rechecked.
Possible Complications of Osteopathic Manipulative Treatment: HVLA Procedure – Thoracic Vertebrae
Performing high-velocity, low-amplitude (HVLA) procedures — a type of quick, small movement used in some therapies — in the chest area typically results in minor side effects like muscle discomfort or a brief increase in symptoms. However, when this method is applied to the neck or lower back region, it may lead to more serious side effects. Keep in mind that the discussion of these significant side effects is beyond the details provided in this piece.
What Else Should I Know About Osteopathic Manipulative Treatment: HVLA Procedure – Thoracic Vertebrae?
Back pain is something many of us have experienced and is a common reason people visit doctors or emergency rooms. Usually, this pain is related to the muscles and bones in our backs, and can be caused by things like awkward bending, straining, heavy lifting, or twisting the wrong way.
Sometimes, instead of medications, hands-on treatment methods can be very effective. Osteopathic doctors are specially trained in these hands-on techniques, which can help alleviate back pain. These methods mostly involve manipulating your muscles and joints using techniques like gentle pressure, stretching and resistance, commonly known as osteopathic manipulative treatment (OMT).
The technique the doctor chooses to use can depend on several things, including what they’re most comfortable with and what the patient is happy and able to do. One notable technique is called Thoracic High-Velocity Low Amplitude (HVLA), which is a popular method for treating back pain. It’s particularly useful as it can also help to reduce the need for pain killers or anti-inflammatory medications, which some patients may already be taking.