脊柱的高速低幅（HVLA）手法治療

腰椎HVLA 

Diagnosis:

Push TP either side to determine rotation which side won’t spring anterior

Patient positioning:

1. T10-L5: bottom leg straight; L5-S1: lower hip 20 degree flexion

2. palpate interspinous space, flex both legs so that pelvis recurt L4, straight bottom leg

3. switch hand, pull bottom arm up to extend until L3 move without help pass segment

4. first rotate down feel L3 moving, rotate up until feel L4 moving

Doctor positioning:

5. forearm contact back of glut muslce not on great trochanter, moniter hand on pect fossa 

6. ready to go, face slightly to upper body

7. feet spread one behind, feet position

8. ASIS on ASIS not on thigh or upper

9. bring tissue as tight as possible, thrust arm pull towards as far close

10. leg extend and up on toe

Thrust：

11. deep breath in and all the way out

12. tighten barrier, drop body final thrust, heel back on ground, down on heel, keep head up

13. upper arm stabilizer, thrusting arm as close to body

14. push a little more up and down, direction of force down and slight pelvic rotation

 tighten barrier

SI HVLA

Patient positioning:

1. lower leg and spine straight, upper heel just anterior to the lower knee

2. patient’s upper knee placed between legs

Doctor positioning:

3. contact on inferior of PSIS

4. resist against upper pectoral and rib cage, avoid pressure to GH

Thoracic T4-9 HVLA

Rule 3:

T1-3、T12：SP line straight with TP

T4-6、T11: SP go half segment up to TP

T7-9、T10: go up a whole segment

Spine of scapular: T3

Inferior angle of scapular: T7

Supine

1. hold elbows right to pop segment to build up most tension, higher segment pull even tighter

2. shoulder problem hold arms behind neck put force to elbow

3. start in over rotation twist to skin lock, SP right down fist

4. pull in with upper hand to get pressure when skin locking

5. roll over, underneath sternum

6. bring elbows under stomach, come over patient lift head a little, got full control

7. flex up to the segment, get all weight on top, take deep breath in all way out, drop

8. lower sternum or upper abdomen maintain downward leverage, introduce a force in line with patient’s upper arm, emphasis on primary leverage

9. the shoulder girdles and thorax are a sold mass

10. HVLA downwards and cephalad via lower sternum, hand against TP in upward and caudal

11. not breathing to surprise

Prone

1. Start here and there, 90 each other

2. Caudal with left hand, cephalal with right hand

3. a little more skin locking then push down towards end range of available joint gliding

4. breath in and down, thrust

Guiding rule: most comfortably for patient and us

頸胸椎C7-T3 HVLA

1. the chin point resting on couch, arms hanging over the edge, small amount of right sidebending

2. stand as erect, hypothenar eminence on left TP of T3, caudad and downward force

3. head of couch, right hand against left side of head and neck with fingers pointing towards right shoulder / right head of couch, fingers towards couch

4. until a sense of tension is palpated at left hypothenar

5. HVLA down towards couch and in direction of left axilla, while a slight rapid increase of head and neck rotation

   L shape won't rotate over