kirksville crunch

Kirksville Crunch, What is it and How to do It: OMM Technique

The Kirksville Crunch, or commonly called thoracic hvla is a technique that helps you fix thoracic somatic dysfunction, which is typically located in the thoracic spine.

It’s not uncommon for people to experience pain in their back after sitting at a desk for hours on end. The problem with this is that it can become chronic and lead to more serious problems like slipped discs or even worse, arthritis.

More importantly though, this article will help you learn the Kirksville crunch well enough to get more points on test day.

How to diagnose the somatic dysfunction

Diagnosing the somatic dysfunction means finding the restrictive barrier. You do this by side bending and/or rotating the patient’s head or thorax to find the posterior transverse processes.

As the patient bends you will note over the area of pain that there may be a more posterior transverse process.

This helps you identify the way that the vertebrae is rotated.

Then after you identify the way it is rotated, you have the patient go into flexion and extension by bending their head and/or chest forward and backward.

kirksville crunch

This will tell you if the dysfunction gets better in flexion or extension, and helps identify the type of somatic dysfunction present.


If you note a more posterior transverse process on the left, that means the vertebrae is rotated left.

If the transverse process becomes less protuberant when the patient flexes or extends that means that it is a flexed or extended somatic dysfunction depending on which one made it better.

If flexion made it better (less protuberant), then it is flexed. The opposite is true for extension.

By knowing if it is flexed or extended and the rotation of the vertebrae, then you can make a diagnosis, which will help you with knowing the restrictive barriers and how to properly treat the thoracic somatic dysfunction.

Example description:

Diagnosis: T6 FRSLeft: This means the T6 vertebrae is flexed, rotated and sidebent to the left.

How to perform the Kirskville Crunch

Step 1: Figure out what the actual diagnosis is as mentioned above.

Step 2: Stand on the opposite side of the rotational dysfunction. (IF rotated left, then stand on the right).

Step 3: Cross the arms over each other, with the rotational dysfunction side arm on top of the other.

Step 4: Push down(toward the opposite hip) on the patients elbows with your hand that is more toward the patients head.

Step 5: Place the thenar eminence on the transverse process that is more posterior.

Step 6: Then move your top hand, and place your sternum over the top of the patients elbows.

Step 7: Use your other hand and flex the patients cervical spine and head up until you feel motion at the segment.

Step 8: For a type 2 dysfunction, side bend toward you. Type 1 dysfunction you will side bend away from you.

Step 9: Keep the patient in the above position, have them take a deep breath, then the physician does a downward thrust toward the table.

That is the basic outline of performing the Kirksville Crunch.

How thoracic HVLA presents in a question

In medical School the focus is on learning the techniques and actually treating the body.

On Test questions the focus turns to making a diagnosis based on data given to you and then focusing on how to properly set up and go through the movement of the treatment for that issue.

Typically the question will focus on:

The patient had some kind of trauma, now they have a painful area or point on their body and then they will give you data points to help you make the diagnosis.

They will often give you information from the opposite sides than what it typically would be, and this is to test your understanding of the concept, or to try and trick you… the verdict isn’t out on that one.

Example Kirksville Crunch Question:

You diagnose a patient with T6 FRSLeft, how would you position the patient to perform thoracic HVLA via the Kirksville Crunch?

Answer: Stand on the opposite side of the rotated vertebrae, with the patients spine down toward the bed. Make sure the patient is side bending toward you, place your thenar eminence on the posterior transverse process, then flex the patient up by the neck, and apply a downward force to the dysfunctional segment and this should correct the dysfunction in all planes.

Essentially, you are just walking through how to perform thoracic HVLA in the answer.

HVLA Contraindications

Common contraindications that might cause pain or complications are:

  • – Spinal Cord Injuries
  • – Thoracic Disk Disease
  • – Lumbar Discitis
  • – Ankylosing Spondylitis
  • -Acute Whiplash
  • -Pregnancy

These contraindications are going to be pain-related, but if there is a contraindication that you don’t know or just forgot about it would be best to not do the treatment.

This article goes into great detail on the most common problems that can develop if you perform HVLA despite these contraindications.

Texas Twist OMM

This texas twist a easy OMM technique that can be used to treat patients pain and dysfunction quickly and easily. Most medical students like this technique for it’s simplicity.

It is a texas twist because the patient’s spine is rotated to each side as it is being flexed and moved, in order to get an even stretch.

This technique can be used for those patients who have pain that persists despite other treatments or medications. The texas twist also has a higher success rate than some of the alternatives methods such as chiropractic or spinal manipulation.

This is often preferred by patients because it does not rely on the use of medication, concentrating instead on a more natural and holistic approach to treatment.

kirksville crunch

The texas twist is applied in an HVLA technique which can improve pain for type-I dysfunction and type II dysfunction.

HVLA Medical abbreviation

HVLA stands for high velocity low amplitude. It is the type of treatment that we have been discussing in this article so far, and it has been shown to be an effective way to address a variety of spinal dysfunctions

The high velocity low amplitude HVLA technique can help to reduce pain, increase mobility, and improve joint range of motion. It is a very effective treatment for many different types of problems that have developed as a result of dysfunction or injury.

Why is it important to know the medical abbreviation? You could have a patient come in for treatment and they are not sure what you mean when you say high velocity low amplitude. It would be good if before your start any treatments or procedures, that the patient and the medical provider have a common understanding of what is going to happen with that treatment.

It is important to know what high velocity low amplitude HVLA does because there are many different types of high velocity low amplitude HVLA techniques.

What high-velocity, low-amplitude technique is often used for patients who have chronic pain or dysfunction?

There are many high-velocity, low-amplitude techniques that are often used for patients who have chronic pain or dysfunction. The one that is most popular and commonly discussed is the Kirksville Crunch technique.

HVLA Osteopathic Manipulation

HVLA is a high-velocity, low amplitude technique that is used for osteopathic manipulation.

High velocity low amplitude HVLA techniques are often performed by physicians and other medical professionals to correct somatic dysfunctions found in the thoracic spine. In many cases, high-velocity, low amplitude HVLA can be an effective alternative to surgery for patients with chronic high-velocity low amplitude HVLA treatments.

Physicians who perform high velocity, low amplitude HVLA techniques are often specially trained in this type of treatment for the spine and will have had additional training specific to treating dysfunction found in the thoracic region of the body.

It is important for high-velocity, low amplitude HVLA techniques to be performed by a qualified medical professional.

It is best for high velocity, high amplitude treatment if the patient has no contraindications and it would only cause harm in certain cases of dysfunction or injury.

The high-velocity, high amplitude technique can cause more damage than high-velocity, low amplitude HVLA.

High velocity high amplitude has been shown to be an effective treatment for chronic pain or dysfunction when used with other treatments such as medications and chiropractic care.

Is HVLA Safe?

High-velocity, high amplitude HVLA techniques are safe when used appropriately.

It is not always appropriate to use high velocity high amplitude for patients who have chronic pain or dysfunction that has persisted despite other treatments such as medications and chiropractic care.

The high-velocity high amplitude technique can cause more damage than low-amplitude high velocity HVLA techniques.

It is important to know the difference between high-velocity, low amplitude and high-velocity high amplitude so you can provide the best treatment for your patient.

When it comes to safety, high-velocity high amplitude is not always safe for chronic pain or dysfunction, while high-velocity low amplitude HVLA techniques can be.


I’m sure many of you have encountered a question on your tests that had to do with the thoracic HVLA technique. The Kirksville crunch is an effective treatment for pain, but it also happens to be very popular among teachers who like adding it in as one more thing students need to know before the exam. What types of questions did you encounter that had to do with HVLA?

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