Anterior and superior thrust in a curved plane

Assume somatic dysfunction (A-R-T-T) is identified and you wish to use a thrust in the plane of the CO-C1 apophysial joint to produce cavitation on the right (see below)

1 Contact point

2 Applicator

3 Patient positioning

4 Operator stance

Right posterior arch of atlas.

Lateral border, proximal or middle phalanx of operator's right index finger.

Supine with the neck in a neutral relaxed position. If necessary, remove pillow or adjust pillow height. The neck should not be in any significant amount of flexion or extension.

Head of couch, feet spread slightly. Adjust couch height so that the operator can stand as erect as possible and avoid crouching over the patient as this will limit the technique and restrict delivery of the thrust.

5 Palpation of contact point

6 Fixation of contact point

7 Chin hold

8 Vertex contact

9 Positioning for thrust

Place fingers of both hands gently under the occiput. Lift the head slightly and gently rotate it to the left, taking the weight of the head in your left hand. Remove your right hand from occiput and palpate the contact point on the right posterior arch of the atlas with the tip of your index or middle finger. Slowly but firmly slide your right index finger, in close approximation to the suboccipital musculature, downward (towards the couch) along the posterior arch of the atlas until it approximates the middle or proximal phalanx. Several sliding pressures may be necessary to establish close approximation to the contact point.

Keep your right index finger firmly pressed on the contact point while you flex the other fingers and thumb of the right hand so as to clasp the back of the occiput and head, thereby locking the applicator in position. You must now keep the applicator on the contact point until the technique is complete. Keeping the hands in position, return the head to the neutral position.

Keep your right hand in position and slide the left hand, slowly and carefully, forwards until the fingers lightly clasp the chin. Ensure that your left forearm is over or slightly anterior to the ear. Placing the forearm on or behind the ear puts the neck into too much flexion. The head is now controlled by balancing forces between the right palm and left forearm. Maintain the applicator in position.

Move your body forward slightly so that your chest is in contact with the vertex of the patient's head. The head is now securely cradled between the left forearm, the flexed left elbow, the right palm and your chest. Vertex contact is essential in this technique.

Step to the right and stand across the right corner of the couch, keeping the hands firmly in position and taking care not to lose pressure on the contact point. Gently introduce a little rotation of the head to the left. Straighten your right wrist so that the radius and first metacarpal are in line. While maintaining firm applicator pressure, allow the right index finger to roll slightly on the contact point as you move your right elbow towards the patient's right shoulder. This facilitates optimal alignment for the thrust, which is in a curved plane because of the shape of the apophysial joint. It is important that your applicator has a firm contact on the atlas so that you do not slip when applying the thrust along a curved facet plane. Keep your right elbow close to the couch in order to keep the contact point on the atlas (Fig. B1.2.1).

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