Michael L. Kuchera, DO, FAAO March 2014 AAO Convocation Cervical Fingertip HVLA Workshop Colorado Springs, Colorado 1 “Cervical Spine – HVLA at Your Fingertips” Hands-On Workshop Michael L. Kuchera, DO, FAAO, FNAOME Professor & Chairperson, Marian University - College of Osteopathic Medicine “Precise Facet Activation at Your Fingertips: Cervical and OA HVLA” Osteopathic Manipulative Treatment (OMT): HVLA in the Cervical Region Lecture Prior to Hands-On Laboratory Sessions • I -- Indications & Contraindications : “Avoiding Trauma” • II -- Finger Cervical HVLA Preliminary: Key Anatomy Review (Typical Cervical & OA Somatic Dysfunction; DJD) • III -- Interest: Research Two Lab Sessions: OA (SB Activation) & Typical Cervicals (SB & Rotation Options) Background: Bad “Rap” for Cervical HVLA Manipulation? Indications & Contraindications: Rare but potentially severe sequelae associated with vertebral artery dissection World Literature • Vertebral artery “trauma” concern • Most vulnerable position for “trauma” is with rotational force (while extended?) • Predicting adverse events? AAO & FIMM Recommendation for Diagnosis: To “DeKleyn or not to DeKleyn
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Michael L. Kuchera, DO, FAAO
March 2014 AAO Convocation
Cervical Fingertip HVLA Workshop
Colorado Springs, Colorado
1
“Cervical Spine – HVLA at Your Fingertips”
Hands-On Workshop
Michael L. Kuchera, DO, FAAO, FNAOME
Professor & Chairperson,
Marian University - College of Osteopathic Medicine
“Precise Facet Activation at Your Fingertips:
Cervical and OA HVLA”
Osteopathic Manipulative Treatment (OMT): HVLA in the Cervical Region
Lecture Prior to Hands-On Laboratory Sessions • I -- Indications & Contraindications : “Avoiding Trauma”
• II -- Finger Cervical HVLA Preliminary: Key Anatomy Review
(Typical Cervical & OA Somatic Dysfunction; DJD)
• III -- Interest: Research
Two Lab Sessions: OA (SB Activation) & Typical Cervicals (SB & Rotation Options)
Background: Bad “Rap” for Cervical HVLA Manipulation?
Indications & Contraindications: Rare but
potentially severe sequelae associated
with vertebral artery dissection
World Literature
• Vertebral artery “trauma” concern
• Most vulnerable position for “trauma” is
with rotational force (while extended?)
• Predicting adverse events?
AAO & FIMM Recommendation for
Diagnosis: To “DeKleyn or not to DeKleyn
Michael L. Kuchera, DO, FAAO
March 2014 AAO Convocation
Cervical Fingertip HVLA Workshop
Colorado Springs, Colorado
2
Cervical HVLA: Contraindications (Some Relative)
Cervical Instability examples:
• Fracture
• Severe rheumatoid arthritis
• Down syndrome
• Significant cervical trauma without
definitive status knowledge
Many Other Pathologies (Cancer, vertebrobasilar insufficiency,
myelopathy, aneurysms, etc)
Neurological Symptoms with
Set-Up
Anti-Coagulation Rx;
Hypermobility; Inflammation
Spectrum of OMT Techniques
(Each with Optional Variations)
AOA Position Paper- Cervical Spine Treatment
Additional Risk Factors for VBA: – Migraine
– Hypertension
– Oral Contraceptives
– Smoking
Cervical Extension has not proven to be a “prominent”
risk factor, as previously hypothesized. It is still
important to minimize extension elements in treatment.
7 of 9
AOA Position Paper On Osteopathic Treatment of the Cervical Spine
Conclusion:
“… it is the position of the AOA that all modalities of
osteopathic manipulative treatment of the cervical
spine, including High Velocity / Low Amplitude,
should be taught at all levels of education, and that
osteopathic physicians should continue to offer this
form of treatment.”
Adopted / Reaffirmed by the AOA House of Delegates
Michael L. Kuchera, DO, FAAO
March 2014 AAO Convocation
Cervical Fingertip HVLA Workshop
Colorado Springs, Colorado
3
HVLA: Some Common Indications (Some Generalities & Considerations)
Treating Somatic
Dysfunction without
Contraindications to
HVLA … including with: • Cervicogenic headache
• Isolated cervical pain
• Thoracic pain referred from the
neck
Chronicity (especially if
failure to respond to
other activating forces) Spectrum of OMT Techniques
(Each with Optional Variations)
HVLA: Risk-To-Benefit Ratio (Generalities & Considerations)
Spectrum of OMT Techniques
(Each with Optional Variations)
OMT Risk-to-Benefit Ratio
– HVLA Risk > Other OMT in area but
still small …
– AAO-AOA & FIMM Topical Papers …
DeKleyn test unreliable predictor
– Benefit doing OMT vs Time
preventing doing OMT to Neck?
– Skilled clinician listening to tissues in
least vulnerable position
Background for “Fingertip” Cervical OMT
Early experiences with
cervical HVLA (… my neck)
Fingertip Variation:
• Reduce discomfort & risk
with greater localization
• Focus to the articular pillar
• Gain specificity in “opening”
or “closing” the cervical facet
• Minimize activation forces
Proximal Phalanx (Index) –or–
Use Fingerpad (Index / Middle)
Michael L. Kuchera, DO, FAAO
March 2014 AAO Convocation
Cervical Fingertip HVLA Workshop
Colorado Springs, Colorado
4
“H”
“V”
“L”
“A”
Cervical Diagnoses: Typical Cervicals (& Which Facet?)