10 Adjustments to achieve appropriate pre-thrust tension
Add extension and slight sidebending to the right to provide a feeling of tension at the contact point. Extensive practice is necessary to develop an appreciation of the required tension. The extension and right sidebending are introduced by pivoting slightly via the legs and trunk so your trunk and upper body rotate to the left. Do not attempt to introduce sidebending by moving the hands or arms as this will lead to loss of contact and inaccurate technique.
Ensure the patient remains relaxed. Maintaining all holds, make any necessary minor changes in flexion, extension, sidebending or rotation until you can sense a state of appropriate tension and leverage at the contact point. The patient should not be aware of any pain or discomfort. You should introduce these final adjustments by slight movements of the ankles, knees, hips and trunk, not by altering the position of your hands or arms.
Relax and adjust your balance as necessary. Keep your head up; looking down impedes the thrust and can cause embarrassing proximity to the patient. An effective HVLA technique is best achieved if the operator and patient are relaxed and not holding themselves rigid. This is a common impediment to achieving effective cavitation.
12 Delivering the This is a difficult technique to master, as the thrust must be applied thrust along a curved plane. Apply a HVLA thrust to the posterior arch of the atlas in an anterior and superior direction along a curved plane which follows the shape of the occipto-atlantal articulation. Apply no simultaneous rapid increase of cervical rotation, extension or sidebending with the left hand (Fig. B1.2.2).
The thrust, although very rapid, must never be excessively forcible. The aim should be to use the absolute minimum of force necessary to achieve joint cavitation. A common fault arises from the use of excessive amplitude with insufficient velocity of thrust.
Atlanto-occipital joint C0-C1
Contact point on atlas Chin hold Patient supine
• Contact point. Right posterior arch of atlas.
• Applicator. Lateral border, proximal or middle phalanx.
• Patient positioning. Supine with the neck in a neutral relaxed position.
• Operator stance. Head of couch, feet spread slightly.
• Palpation of contact point.
• Fixation of contact point.
• Chin hold. Ensure your left forearm is over or slightly anterior to the ear.
• Vertex contact. Essential in this technique.
• Positioning for thrust. Step to the right and stand across the right corner of the couch. Optimal alignment for the thrust is in a curved plane. Keep your right elbow close to the couch in order to keep the contact point on the atlas (Fig. B 1.2.1).
• Adjustments to achieve appropriate pre-thrust tension.
• Immediately pre-thrust. Relax and adjust your balance.
• Delivering the thrust. The thrust must be applied along a curved plane, which follows the shape of the occipto-atlantal articulation (Fig. B1.2.2).
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