Overview of Osteopathic Manipulative Treatment: HVLA Procedure – Exhaled Ribs
High-velocity low-amplitude (HVLA) is a type of therapy technique that involves quick and short movements over a small area that’s causing problems in the body. This technique is used by a doctor to treat joints that aren’t moving properly or are uneven. The doctor does this by making the problematic area move and quickly applying small forces to it. This usually makes a sound that lets the doctor know that the joint can move again. This method is commonly used in medical treatments and has been found to help decrease neck and shoulder pain when it is used in the area where your neck and upper back meet.
Exhalation dysfunction, previously known as inhalation restriction, happens when a rib moves downwards when a person breathes out, but doesn’t move upwards when they breathe in. This may cause the doctor to notice one or, in some cases, a group of ribs that seem stuck in an exhaled position. Osteopathic Manipulative Therapy (OMT), a type of therapy used to treat joint issues, works to fix the issues within a joint’s normal range of movement. This is done by moving the joint through the problem area, without moving it beyond its regular movement range. This could be why there aren’t many harmful side effects from OMT procedures. This review encourages the use of OMT to treat ribs that are stuck in an exhaled position during inhalation restriction.
Anatomy and Physiology of Osteopathic Manipulative Treatment: HVLA Procedure – Exhaled Ribs
Your rib cage is made up of different types of ribs, some of which are typical and others which are not. Typical ribs have features such as an angle, a shaft, and a neck, as well as a head and a tubercle that connect to certain parts of your spine. However, ribs 1, 2, 11, and sometimes rib 10, don’t follow this typical structure. For example, rib 1 only connects to one part of the spine, while ribs 11 and 12 only connect to their corresponding part of your spine and don’t have tubercles.
Ribs are further categorized as true, false, and floating. True ribs, which are ribs 1 through 7, are connected to your breastbone or sternum directly. Then you have false ribs, which are ribs 8 to 12. These don’t directly connect to your sternum. Out of these, the last two, ribs 11 and 12, are known as floating ribs because they aren’t attached at the front of your body.
Ribs can move in different ways: pump-handle motion, bucket-handle motion, or caliper motion. Generally, upper ribs, middle, and lower ribs fall into these categories respectively. But, this might vary depending on the individual rib’s location.
There are muscles that cater to two types of movements – the ones that help lift the rib cage, called muscles of inspiration, and the ones that push the rib cage downward, called muscles of expiration. Examples of such muscles are the sternocleidomastoid muscles, anterior serrati, and scaleni for inspiration and the abdominal recti and internal intercostals for expiration.
Now, your lungs can expand and contract in two ways. One way is through the upward and downward motion of your diaphragm to increase or decrease the size of your chest cavity, and the other is by lifting and lowering the ribs to increase or decrease the front-to-back diameter of your chest. Normal, quiet breathing mostly involves the first method, with your diaphragm contracting and pulling down the lower part of your lungs when you breathe in. When you breathe out, your diaphragm relaxes while the chest wall pushes on the lungs and expels the air.
But, when you’re breathing rapidly, the contraction of abdominal muscles becomes necessary as the body needs to expel air quickly. And the second method, the lifting of the rib cage, helps in this. At rest, your ribs are pointed downward, allowing the sternum to fall backward towards the spine. But when your rib cage lifts, the ribs point directly forward, moving the sternum away from the spine and increasing the thickness of the chest by about 20% more during full inspiration than during expiration.
Why do People Need Osteopathic Manipulative Treatment: HVLA Procedure – Exhaled Ribs
If you’re not able to move as you normally do, this might suggest that there’s a problem with your body (known as a somatic dysfunction). Specifically, if you find it hard to breathe in fully, it could be due to a problem with your 11th or 12th rib and might be related to various kinds of pain such as sacral pain (base of the spine), chest wall pain, back pain, pelvic pain, or abdominal pain.
Sometimes, this is because your ribs don’t move downward when you breathe out, and don’t move well when you breathe in. A doctor may feel that your ribs aren’t moving properly and can see that the space between your ribs gets narrower when this happens. This can cause your lower rib edge to stick out at the back, and you might feel tender or sore in the following places: where your ribs meet the breastbone, where your ribs meet their cartilage, and the angles of your ribs at the back.
On the other hand, if you have a condition known as ‘bucket-handle’ exhalation dysfunction, your ribs will move down a little when you breathe out, and won’t move much when you breathe in. A doctor might notice the space on the side of your ribs getting smaller. You might feel tenderness or pain at the back of your ribs or in the muscles between your ribs along your side.
When a Person Should Avoid Osteopathic Manipulative Treatment: HVLA Procedure – Exhaled Ribs
In simpler terms, High-Velocity, Low-Amplitude (HVLA) techniques are a type of adjustment used in physical therapy, specifically on ribs. However, these techniques require strong forces and might not be suitable for everyone. If a patient has any of the following issues, the doctor may need to rethink the treatment strategy:
— An acute rib fracture, which is a fresh break in a rib
— A pelvic fracture, a break in the pelvic bone
— Rib or vertebral cancer, which is cancer affecting the ribs or the bones in the spinal column
— Severe low back pain
In some conditions, the therapist might need to consider other treatment options instead of HVLA. These conditions include:
— Osteomyelitis, which is an infection in the bone
— Osteoporosis, a condition that weakens bones and makes them brittle
— Fractures in the area where HVLA is usually applied
— Bone metastasis, which means cancer has spread to the bones
— Down syndrome, a genetic disorder
— Severe cases of rheumatoid arthritis, an inflammatory disorder affecting the joints
— Pregnancy
— Acute whiplash, a neck injury usually caused by a sudden movement of the neck
— Herniated nucleus pulposus, a condition where the jelly-like center of a spinal disk can rupture through the tough outer layer
— Postoperative conditions, which means a person has recently had surgery
— Vertebral artery ischemia, a condition where there is inadequate blood flow through the arteries in the neck that travel up into the brain
— History of hemophilia or ongoing anticoagulation therapy, both of these conditions affect the blood’s ability to clot, making bleeding more likely.
Equipment used for Osteopathic Manipulative Treatment: HVLA Procedure – Exhaled Ribs
To perform osteopathic manipulative treatment (OMT), a special kind of physical treatment done by a physician, a few different types of tables might be used. These could include an OMT table, which is specifically designed for this purpose, or even a regular examination table found in most doctors’ offices. Sometimes, even a massage table might be used.
The key is to make sure that the patient is comfortable, whether they’re laying down or sitting up. It’s also important that the doctor can easily perform the treatment.
While a pillow isn’t always necessary, sometimes a doctor might use one to help make the patient feel more comfortable. However, they’ll avoid using it if it makes doing the technique more difficult.
Who is needed to perform Osteopathic Manipulative Treatment: HVLA Procedure – Exhaled Ribs?
Every medical treatment needs the patient’s permission. This means that the patient has been told about the treatment and its risks and has agreed to it. This also applies to being treated by a specially trained doctor who is experienced in OMT (Osteopathic Manipulative Treatment).
OMT is a type of treatment that doctors learn at medical schools or during their further training after they’ve graduated from medical school. These doctors have specific skills to use their hands to diagnose, treat, or prevent illness or injury. They can use a variety of techniques for things like relieving pain, promoting healing, and increasing overall mobility.
Preparing for Osteopathic Manipulative Treatment: HVLA Procedure – Exhaled Ribs
It’s important that patients fully understand their medical procedures. Doctors need to explain to them what the operation involves, what the potential benefits and risks are, and let them know if there are any other treatments available. This gives the patient the chance to make a well-informed decision about their care.
This also means that before any procedure is carried out, doctors must obtain the patient’s consent. They must be certain the patient has all the information they need and agrees to proceed with the treatment.
Lastly, before starting the procedure, doctors often warm their hands. They do this by rubbing them together to create friction. This creates a more comfortable experience for the patient.
How is Osteopathic Manipulative Treatment: HVLA Procedure – Exhaled Ribs performed
This procedure uses the rib that’s highest up as the main focus. Doctors use the patient’s attempts to breathe as well as additional breathing muscles to assist with the treatment. Here’s how this procedure is performed when the patient is lying down flat on their back:
1. The doctor stands on the side opposite to the affected rib and places the base of their hand (the fleshy part at the base of the thumb) on the innermost part of that rib, aiming for the joint where the rib and spine meet.
2. With their other hand, the doctor holds onto the front of the hip bone (also known as the ASIS) on the same side as the affected rib.
3. The doctor pushes the joint where the rib and spine meet in a forward and sideways direction by leaning onto it, while pulling the front of the hip bone backwards.
4. The doctor then asks the patient to take a deep breath and exhale afterward. At the point of maximum exhalation, they apply a short and quick push on the rib in a forward and sideways direction.
5. Finally, the doctor checks the rib’s movement again.
This method helps to improve the rib’s movement and can relieve any discomfort or pain.
Possible Complications of Osteopathic Manipulative Treatment: HVLA Procedure – Exhaled Ribs
According to a study from 1925 to 1993, there were only around 185 recorded instances where osteopathic manipulative treatment (OMT) – a type of hands-on care used by doctors to diagnose, treat, or prevent illness – resulted in injury. One form of OMT, the high-velocity, low-amplitude (HVLA) technique which involves quick, small movements, was generally found to not cause significant harm to patients. After OMT, some patients may experience temporary soreness for a day or two, but this usually depends on how the doctor performs the procedure.
The HVLA method is considered to have the most risks, since it involves fast impulses. In the study, there was only one recorded harmful case for every 50,000 times this method was used. However, this doesn’t mean that these techniques need to be abandoned. The hands-on treatments are generally safe when performed by a well-trained physician.
An important part of making sure these treatments are safe is for the physician to understand the patient’s medical history and perform a thorough examination before doing any procedure. This helps to identify any possible risks and to choose the best and safest method of treatment.
What Else Should I Know About Osteopathic Manipulative Treatment: HVLA Procedure – Exhaled Ribs?
High-Velocity Low-Amplitude (HVLA) manipulation techniques are therapies used to improve movement in a joint that isn’t moving as it should. These methods are mainly used to help with lower back and neck pain. Research indicates that using HVLA therapies to adjust the spine can be as beneficial for these types of pain as other treatments.
