Which step is part of posterior tibia HVLA?

• A. Patient prone; flex knee to 90 degrees with the foot on the shoulder, wrap hands around proximal tibia, apply anterior traction, then a tibial thrust anteriorly
• B. Patient seated; apply posterior thrust to the tibia
• C. Patient supine; apply medial thrust to the tibia while flexing the knee
• D. Pt lies on their back; rotate the tibia laterally and thrust posteriorly

Answer: (A)

In this HVLA move, you want a setup that gives precise control of the proximal tibia while delivering a fast, directed impulse. Having the patient lie face down with the knee flexed to about 90 degrees and the foot resting on the clinician’s shoulder positions the tibia so you can access the proximal segment and stabilize the thigh. Wrapping the hands around the proximal tibia lets you control the bone and preload the joint by applying a gentle anterior traction, which loads the tissues just before the thrust. Then a quick, high-velocity thrust is applied anteriorly to the tibia, producing the impulse needed to restore motion at the tibiofemoral articulation. The other positions described would not provide the same stable access or the correct vector for this particular tibial adjustment, so they’re not consistent with posterior tibia HVLA.