Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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Residency/Fellowship SIG-Sponsored CSM 2018 Pre-conference Course

Trust in Your Thrust! Implementing High Velocity Techniques into Your Practice

Wednesday, February 21, 2018


Common barriers to the use of High Velocity Low Amplitude (HVLA) techniques often cited by students and clinical instructors include lack of confidence and insufficient instruction. These lead to underutilization of spinal and peripheral HVLA techniques in the clinic. These barriers remain despite the 2006 CAPTE mandate to include HVLA instruction in entry level PT education programs. Wide variation remains in methods and quantity of instruction across PT programs in the U.S. This course will address specific barriers to implementation of HVLA techniques in the clinic, including: safety, therapist confidence, and patient selection. Both spinal and peripheral HVLA techniques are included with a priority placed on patient comfort and minimal leverage and force used. A framework for implementing HVLA techniques into clinical practice will be presented based on current best evidence. There will be an emphasis on clinical reasoning and examination findings that assist with technique and patient selection. Reassessment of examination findings after technique application will be used to assess treatment outcome. The course will primarily consist of lab sessions with interspersed instructional components. We will discuss indications/contraindications of HVLA, screening for cervical artery dissection (CAD), and concepts related to this model of spinal positioning and locking for HVLA. Specific techniques and strategies from osteopathic and Australian traditions will be presented. The focus of this course will include primary 1:1 skills instruction so that participants can confidently implement these techniques into their practice.

  • Marwan Kublawi, PT, ScD, FAAOMPT
  • Aaron Hartstein, PT, MPT, OCS, FAAOMPT
  • Ed Schiavone, PT, COMT, OCS, FAAOMPT
  • Abe Shamma, PT, DPT, OCS, Cert. MDT, FAAOMPT
  • Matt Haberl, DPT, OCS, ATC, CSCS, FAAOMPT

Morning Topic/Time

  • Introduction 15 minutes
  • Overview of the day 5 minutes
  • Theoretical Models for HVLA, Biomechanics and principles of successful thrust technique;  Lecture 60 minutes
  • CAD Discussion and differential diagnosis; Lecture 30 minutes
  • Mid-Cervical Upslope - Cradle Hold;  Lecture/Vignette/Demo/Lab 60 minutes

Break 15 minutes

  • Lumbar Rotation in Neutral/Extension; Lecture/Vignette/Demo/Lab 60 minutes
  • Assessment and treatment demo integrating HVLA with audience volunteer as patient, 30 minutes
  • Seated CT Extension Glide, Lecture/Demo/Lab 30 minutes

Lunch 60 minutes

(Optional: Open forum discussion regarding Resident/Fellowship Education with course faculty and guests.)

Afternoon Topic/Time

  • C1/2 Rotation Cradle hold/Chin hold; Lecture/ Demo/Lab 30 minutes
  • Thoracic Supine PA (variation), Lecture/Demo/Lab 30 minutes
  • Talocrural Distraction; Lecture/Vignette/Demo/Lab 45 minutes
  • Radio-humeral Lateral Gapping; Lecture/Vignette/Demo/Lab 45 minutes

Break – 15 minutes 

  • Mid Cervical Upslope - Chin Hold; Lecture/Demo/Lab 30 minutes
  • Discussion and Technique Review, Case presentation 30 minutes
  • Wrap-up 15 minutes


Academy of Orthopaedic Physical Therapy
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