HVLA, MFR, BLT, FPR, Still

Other major OMT techniques + indications/contraindications.

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◆HVLA (High-Velocity Low-Amplitude / Thrust)

•DIRECT technique: thrust through restrictive barrier in a quick, controlled motion
•Often produces audible 'pop' (cavitation)
•Localize at the segment, take up all slack (engage barrier in all 3 planes), then deliver thrust
•ABSOLUTE CONTRAINDICATIONS: fracture, dislocation, joint instability, malignancy at site, infection at site, severe osteoporosis with vertebral compression fractures, Down syndrome (atlantoaxial instability), rheumatoid arthritis (transverse ligament weakness), Chiari malformation, vertebrobasilar insufficiency, recent surgery at site, anticoagulation (relative)

•Direct: load fascia toward restriction, hold until release
•Indirect: load fascia AWAY from restriction (point of ease), hold until release
•Stacked, then unwound by the body's inherent forces
•Indications: chronic fascial restrictions, post-surgical adhesions, edema
•Gentle — well-tolerated in elderly, hospitalized, post-op

•INDIRECT technique — engage point of balance where ligaments are equally tensioned
•Hold position; inherent forces correct the dysfunction
•Gentle and safe — used in elderly, infants, post-op

•INDIRECT — quick technique
•Place region in neutral, then apply facilitating force (compression or torsion)
•Move to point of ease (or 'feather' the diagnosis position)
•Hold 3–5 seconds, return to neutral
•Quick, useful for acute dysfunctions

•COMBINED indirect/direct
•Start at point of ease (indirect), apply compression or distraction, then move through neutral and into the restrictive barrier (direct)
•Reassess

•Soft tissue: kneading, stretching, perpendicular traction of muscles — usually preparatory
•Inhibition: sustained pressure on a hypertonic muscle to reduce tone
•Articulatory: low-velocity, moderate-amplitude — gentle rhythmic motion through restricted range

•Pedal pump (Dalrymple): rhythmic dorsiflexion of feet (pumps lower extremity lymph)
•Thoracic pump: rhythmic compression on chest in supine position
•Indications: edema, lymphatic congestion, pneumonia (improve lymphatic drainage), CHF (cautiously), URI
•Contraindications: acute deep vein thrombosis, ABSCESS (could spread), fracture, recent abdominal surgery
•Rib raising: stretches paraspinal muscles, normalizes sympathetic tone (T1–T4 for upper, T5–T9 for GI)

Scenario	Preferred technique
Acute somatic dysfunction (too painful for direct)	Counterstrain, BLT, FPR, indirect MFR
Elderly, frail, osteoporotic	Counterstrain, ME, BLT, indirect MFR — AVOID HVLA
Hospitalized, post-op	Lymphatic, counterstrain, ME, indirect MFR
Acute rib pain / spasm	Counterstrain, ME with respiration
Pneumonia, URI	Rib raising + lymphatic pump
Pregnancy (LBP)	ME, counterstrain, MFR; AVOID HVLA in 3rd trimester pelvis
Chronic recurrent low back pain	ME, HVLA (if no contraindications), articulatory, MFR

◆HVLA contraindications: think DOWN (Down syndrome → AA instability), RA (transverse ligament), severe osteoporosis, malignancy, infection, instability, anticoagulation
◆Indirect techniques (counterstrain, BLT, FPR, indirect MFR): safest for acute, frail, hospitalized
◆Pedal pump: AVOID with DVT (could embolize)
◆Rib raising: T1–T4 normalizes upper extremity/head sympathetics; T5–T9 normalizes GI sympathetics

Quick check

Test yourself before moving on. ~1 min.

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