Overview of Osteopathic Manipulative Treatment: HVLA Procedure – Cervical Vertebrae
Osteopathy, a type of alternative medicine that emphasizes physical manipulation of the body, was founded by Andrew Taylor Still in 1874. A key principle of this approach focuses on treating conditions related to the body’s structure aka, “somatic dysfunction”. These conditions can involve our muscles, nerves, blood vessels, lymphatic system (part of our immune system that helps fight off diseases), and more.
High-velocity low amplitude (HVLA) treatment, a specific type of manual therapy, is often used to restore health to the body. In HVLA treatment, a fast, short burst of therapeutic force is applied within a joint’s range of movement. This technique is used to overcome a restriction in a joint (a point where two or more bones meet), resulting in a release or ‘pop’ sound. This is believed to signify the release of the restricted joint.
The cervical region, or the neck, includes pathways for muscles, blood vessels, and nerves between the head and the chest. It’s a common area for injury and somatic dysfunction, which can result in pain and loss of mobility. Understanding how to diagnose and treat issues in the neck area is a critical part of manual medicine.
Somatic dysfunction can occur at various locations in the neck, including different joints and muscles. Various manual therapy techniques, including HVLA, are used to relieve such issues. HVLA aims to restore normal movement in a joint and alleviate pain.
Conditions related to the neck can cause significant health problems and disabilities, often due to work-related injuries and poor ergonomic practices. Symptoms can include neck pain, stiffness, reduced neck mobility, arm pain, tingling sensations in the upper extremities, weakness, dizziness, and headaches.
HVLA treatment of the cervical spine is a form of therapy where a therapeutic force is applied to treat loss of mobility. During this treatment, the patient remains still while the practitioner applies the force, which aims to stretch a tight musculoskeletal system. This sends signals from the muscles to the brain, triggering a response that helps to relax the muscle.
It’s important for this treatment to be carried out only by clinicians experienced with this technique. As with any medical procedure, getting the right education, checking for any potential contraindications, and understanding the risks and benefits are absolutely crucial before starting the treatment. It’s also important for patients to give informed consent, meaning they’re fully aware of what the treatment involves and agree to it. In this context, patients should be encouraged to ask questions about the treatment to make informed decisions.
Anatomy and Physiology of Osteopathic Manipulative Treatment: HVLA Procedure – Cervical Vertebrae
The neck, or cervical spine, includes seven bones stacked vertically. These bones are named C1 through C7. The first one, C1, attaches the neck to the skull, and C7, the last one, joins with the upper spine that lies around your shoulder level. These bones are a crucial part of your spinal column, which protects your spinal cord. The spinal cord is a collection of nerves that link your body with your brain.
The top two bones (C1 and C2) are unique due to how they function together. They allow your neck to rotate and move forward or backward. These movements majorly happen at C1 and C2. The remaining bones in the neck (C3 to C7) are smaller and contain a hollow center that holds your spinal cord. The cervical spine also includes discs that function as “shock-absorbing pads” positioned between each bone level. These ensure your spinal cord’s safety and help to absorb any pressure or shock.
These spinal discs maintain the stability of your vertebral column and create spaces, also known as foramen, between each bone. These spaces serve as an exit point for nerves that connect to different parts of your body. If there’s an injury or a disorder in your disc, like disc disease or hernia, it can cause irritation to the nerves near it. This could lead to pain in your neck, head, back, and arms.
If the hollow center within your spinal canal gets narrow, it’s called cervical spinal stenosis. This can cause nerve compression, leading to nerve irritation. Also, if there’s trauma to your neck, it may damage the muscles, tendons, ligaments, bones, and nerves, disrupting communication between your brain and body, causing weakness and loss of sensation.
In addition, continual poor posture can cause neck strain, which could lead to pain. This type of strain is often caused by sports injuries, falls, vehicle accidents, or simple activities like sitting in a bad position for long periods.
Each bone in your neck, excluding C1 and C2, has two parts. The body, which is in the front, and the vertebral arch at the back. This arch is composed of additional parts that help with movement between each vertebra. Each vertebra also has two small bony points on each side called the transverse processes, which are important for muscle attachment. There are also small openings called the transverse foramen, located in these processes, through which major blood vessels pass to supply the brain and spinal cord.
The back part of each vertebra also has another bony outgrowth called the spinous process. It’s an essential spot for muscle attachment and helps with movements like bending and provides stability to your spine.
Overall, a comprehensive grasp of the anatomy of your neck or cervical spine is crucial in diagnosing any potential problems and ensuring the best possible treatment. This knowledge is also important for your doctor to safely provide neck treatments.
Why do People Need Osteopathic Manipulative Treatment: HVLA Procedure – Cervical Vertebrae
High-Velocity, Low-Amplitude (HVLA) therapy is a technique often used by manual medicine practitioners, or those who treat conditions through physical touch and manipulation, like chiropractors. This method is most commonly used to treat what’s known as “joint fixation”. This happens when two bones in a joint, or the part of the body where two bones meet, get stuck or misaligned.
When applied to the upper spine area called the cervical region, HVLA can help reduce pain in the neck, shoulders, and head. It’s useful for treating motion loss linked to “somatic dysfunction” – a fancy term for when the body’s internal structures don’t work as they should. The belief is that during periods when a joint isn’t moving much, fibrous adhesions, or ‘sticky’ tissue, can develop in the small joints of the spine, restricting their movement. HVLA therapy is seen as a way to alleviate symptoms related to these joint restrictions.
This treatment is typically recommended for patients with local or radiating neck pain that isn’t new or severe. It’s also used to help those suffering from headaches that originate from issues in the neck, known as “cervicogenic” headaches. Research suggests that manipulating or mobilizing the cervical spine – moving it around carefully – can benefit individuals experiencing these types of headaches.
When a Person Should Avoid Osteopathic Manipulative Treatment: HVLA Procedure – Cervical Vertebrae
Some conditions or health stats can make it unsafe for a patient to receive certain types of treatments. In the case of a type of neck manipulation called cervical HVLA OMT, certain conditions make the treatment absolutely unsafe, and for others, it might be risky but still possible.
Some factors mean a patient absolutely cannot receive cervical HVLA OMT treatment, including if they have:
This treatment should also not be given to patients with Down Syndrome, as it increases the risk of tearing a ligament in the neck, which is already more common in this population due to their increased laxness of the ligament.
There are some other specific conditions that would also prevent a patient from getting cervical HVLA OMT treatment, like recent fractures or surgeries, blood thinning therapy, certain deformities, infections and tumors among others.
Other conditions might mean that this treatment could be a bit risky but still possible, like:
Caution should be taken when considering the treatment for patients who are at risk of artery diseases or abnormalities, as improper application of cervical HVLA OMT has been previously associated with significant issues like strokes. It is therefore usually safer to avoid the treatment for these individuals.
Who is needed to perform Osteopathic Manipulative Treatment: HVLA Procedure – Cervical Vertebrae?
This method needs the doctor to be well-trained in OMT (Osteopathic Manipulative Treatment) or procedures involving hands-on treatment of the spine. To make sure the HVLA (High-Velocity Low-Amplitude) therapy works well, you, as the patient, need to agree to it, cooperate, and be relaxed. Also, you need to be healthy enough to be positioned correctly for the treatment.
Preparing for Osteopathic Manipulative Treatment: HVLA Procedure – Cervical Vertebrae
If you’re a healthcare provider considering using neck adjustments or cervical manipulation in your practice, it’s advised that you undertake formal training to reduce potential risks. Like all treatments, it’s important to thoroughly understand its benefits, manage the risks involved, and be able to detect early signs of problems. Before starting, you should always make a detailed health assessment for your patients to lessen the chance of complications arising from the neck manipulation.
Every patient must be carefully checked for any reasons that might make cervical manipulation risky for them. This kind of checking should mainly aim to detect patients whose health could be jeopardised by high-velocity, low-amplitude (HVLA) therapy, the kind of technique used in neck manipulation.
Since HVLA therapy is a form of treatment or procedure, it is important to obtain proper consent from patients before starting. Providing clear information about what HVLA is and making sure that the patient understands it are vital for achieving positive results and for ensuring the patient’s comfort during the procedure.
As healthcare practitioners, you have a responsibility to perform HVLA safely and appropriately, and to give relevant information and advice to your patient. This allows them to make an informed decision about their treatment. Not telling the patient about the potential risks and benefits, and not getting their informed consent, is a failure in your duty of care.
In preparing for a neck adjustment, it is crucial that you find the exact region where the patient’s somatic dysfunction or body imbalance is. To find out specific problem parts of the patient’s cervical spine, look out for areas that cause severe pain when touched or where movement is restricted. Once you’ve identified these, the next step is to do a series of movements and tests to identify the restrictions in the patient’s movement. For example, if the C4 vertebra – a bone in the spine – is causing problems when it is bent forward, rotated to the left and tilted to the left, try rotating it to the right, tilting it to the right and extending it or bending it backward.
The positioning of the patient also matters for a successful procedure. The patient should lie on their back, and the healthcare provider should be positioned at the head of the table. The patient needs to be as relaxed as possible throughout the assessment and treatment to avoid potential adverse effects and achieve the best results. A positive relationship between patient and provider, and trust in the procedure, are critical to positive outcomes.
How is Osteopathic Manipulative Treatment: HVLA Procedure – Cervical Vertebrae performed
The success of this procedure greatly depends on a well-organized, step-by-step process. First, we have to figure out if your neck (cervical) area has a problem we call somatic dysfunction. This basically means that parts of your body connecting to your spine aren’t moving as they should. Secondly, we need to make sure you don’t have any conditions that would prevent us from doing this High-Velocity, Low-Amplitude (HVLA) therapy, a type of treatment that uses quick, hands-on thrusts.
We start by diagnosing your neck’s somatic dysfunction. To do this, we carefully examine a particular joint in your neck (the atlantooccipital joint) while you lay on your back. We compare two areas called occipital sulci for any differences. We then examine another joint (the atlantoaxial joint) by bending your neck and locking certain joints. After, we slowly move your neck from side to side to see if you have any restricted movement. We continue the examination with you still lying on your back, paying close attention to how freely each segment of your spine moves when we lightly press on your neck.
Trained health professionals can notice if a segment of your spine moves easier to one side than the other, when positioned on different ways. This unequal movement indicates a restriction. The HVLA therapy tends to have better results when you’re relaxed, so we might use other techniques beforehand to help you relax your muscles. The technique involves applying a slow, gentle force to help loosen up any tight muscles. By applying force and stretching your muscles in a specific manner, your muscles and soft tissue can be effectively “released.”
Once we identify a restricted area (for example, a part of your neck), we try to move it in the opposite direction to help free up movement. If, for example, a specific part of your neck is flexed, rotated left and side-bent to the left, the doctor would try to engage it in the extended, rotated right, and side-bent right position.
We emphasize the need for you to stay relaxed during this procedure. If you’re stiff or tense, the treatment might not work. The doctor will instruct you to take deep breaths and focus on relaxation. After this, the doctor will then apply a swift, effective thrust to deliver movement to the troubled area.
Sometimes, you might hear a “popping” sound, which indicates your body is responding to the treatment. Releasing restrictions needs to be done thoroughly for us to apply the thrust properly. After performing the HVLA technique, we check again to see if there’s any change in your range of movement, and treatment results. A successful result would mean an around 70% or more improvement in your previously limited range of movement and/or relief of pain. After the procedure, you can go after half an hour of observation. But don’t forget to drink lots of water. We’ll see you again after a week to check your progress.
Possible Complications of Osteopathic Manipulative Treatment: HVLA Procedure – Cervical Vertebrae
Though uncommon, manual therapy of the neck, such as massage or manipulation, can sometimes cause serious side effects. In particular, it can pose risks to the arteries in the neck, potentially leading to serious conditions like stroke. Before starting any neck manipulation, it’s recommended for healthcare providers to carry out a test called the Vertebral Artery Test or Wallenberg Test. This test involves moving the neck in various positions and identifying symptoms such as lightheadedness or visual disturbance, which could indicate issues with the arteries in the neck. If these symptoms show up during the test, it’s suggested to avoid neck manipulation.
However, the reliability of this test is somewhat contested in the medical community, as some studies suggest that it might not be a precise tool to detect artery problems. Yet, it’s important to consider the potential risk of artery damage before performing neck manipulation.
Possible complications of neck manipulation can include overstretching the artery during the procedure, leading to damage within the artery walls. This could cause blood to leak into the artery walls, form a false aneurysm (a bulge in the blood vessel wall), develop a blood clot, or an embolism (blocked blood vessel).
Neck manipulations need to be performed by trained professionals because, although complications are rare, they can cause minor symptoms like soreness or muscle pain. Severe complications could include fractures in the bones of the neck, injury to the spinal cord, and other soft tissue injuries. In rare cases, it can worsen existing pain, cause tears in the outermost layer of the spinal cord, blockages in the retina’s central artery (especially in people with plaque buildup in the neck arteries), or result in spinal cord bruising.
What Else Should I Know About Osteopathic Manipulative Treatment: HVLA Procedure – Cervical Vertebrae?
HVLA, or “High-Velocity, Low-Amplitude” therapy, is a technique often used by doctors, chiropractors, physical therapists, and other health professionals. HVLA is sometimes called the “thrust” technique because it involves a quick, brief push through a joint, often in the spine. The goal of using HVLA on the neck (cervical spine) is to solve symptoms like reducing pain and increasing mobility.
Many think that HVLA works by restoring the normal movement of a joint or fixing the incorrect alignment of a joint. The belief is that this treatment can reduce pain caused by a malfunction related to the body’s mechanics—that is, how the parts of the body move and work together.
However, there’s some disagreement about the exact effect of HVLA. Some latest evidence suggests that treating the uneven movement of individual or multiple spine segments might not lead to treatment benefits and that the treatment only causes minor movement in the targeted spine segments. In trying to understand how HVLA works, researchers suggest that HVLA might offer relief through a complicated pathway involving sensory and motor neurons and their impact on the areas around the spine. It’s suggested that HVLA may also help reduce pain by stimulating the release of serotonin and noradrenaline, which are chemicals in the body known to help manage pain.
Studies have compared osteopathic manipulative treatment, which includes HVLA, to pain relief medication ketorolac injected into the muscle. These studies suggest that both the treatment methods are equally effective for pain relief. In this regard, it is concluded that this type of treatment is a reasonable alternative to injectable anti-inflammatory medication for patients with sudden neck pain.
Still, there’s a call for more studies to better understand how HVLA works and identify how this therapy can be best combined with other treatments for the benefit of the patient.
