Part C Technique failure and analysis

Techniques in this manual have been described in a structured format. This format allows flexibility so that each technique can be modified to suit both the patient and practitioner.

Competence and expertise in the use of high-velocity low-amplitude (HVLA) thrust techniques increase with practice and experience. Development of a high level of skill in the use of HVLA thrust techniques is predicated upon critical reflection of performance. When a HVLA thrust technique does not produce cavitation with minimal force, the practitioner should reflect upon how the technique might have been modified and improved. Even the experienced practitioner should review each HVLA thrust technique to identify factors that might improve technique delivery.

Inability to achieve cavitation with minimal force may arise for a number of reasons and can be reviewed under three broad headings:

• General technique analysis

— Incorrect selection of technique

— Inadequate localization of forces

— Ineffective thrust

• Practitioner and patient variables

— Patient comfort and cooperation

— Patient positioning

— Practitioner comfort and confidence

— Practitioner posture

• Physical and biomechanical modifying factors

— Primary leverage

— Secondary leverages

— Contact point pressure

— Identification of appropriate pre-thrust tension

— ×Direction of thrust

— Velocity of thrust

— Amplitude of thrust

— Force of thrust

— Arrest of technique.

If you have experienced technique failure, follow the process of review outlined below:

Box C.1 General technique analysis

Incorrect selection of technique

• Practitioner too small and patient too large

• Practitioner has physical limitations that limit effective delivery of technique

• Practitioner inexperienced with selected technique

• Inability to position patient due to pain, discomfort or physical limitations

• Patient apprehension

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