Assume somatic dysfunction (A-R-T-T) is identified and you wish to use an extension gliding thrust, parallel to the apophysial joint plane, to produce joint cavitation at T5-6 (Figs B2.1.1, B2.1.2)
1 Contact points
(a) Spinous process of T6
(b) Patient's elbows.
(a) Operator's sternum, with or without cushion or small rolled towel, applied to the T6 spinous process (Fig. B2.1.3)
(b) Operator's flexed fingers, hands and wrists applied to the patient's elbows.
3 Patient positioning
4 Operator stance
Sitting with arms crossed over the chest and hands passed around the shoulders. The arms should be firmly clasped around the body as far as the patient can comfortably reach.
Stand directly behind the patient with your feet apart and one leg behind the other. Bend your knees slightly to lower your body.
Place the thrusting part of your sternum, with or without a cushion or small rolled towel, firmly against the spinous process of T6. Place your hands over the patient's elbows. Lean forwards with the thrusting part of your chest against the spinous process of T6 (Fig. B2.1.4). Introduce a backwards (compressive) and upwards force to the patient's folded arms. These combined movements introduce local extension to the thoracic spine. By balancing these different leverages, the tension can be localized to the TS-6 segment. Maintaining all holds and pressures, bring the patient backwards until your body weight is evenly distributed between both feet.
6 Adjustments to achieve appropriate pre-thrust tension
7 Immediately pre-thrust
Ensure your patient remains relaxed. Maintaining all holds, make any necessary changes in flexion, extension, sidebending or rotation until you can sense a state of appropriate tension and leverage at the TS-6 segment. The patient should not be aware of any pain or discomfort. Make these final adjustments by slight movements of the ankles, knees, hips and trunk. A common mistake is to lose the chest compression during the final adjustments.
Relax and adjust your balance as necessary. Keep your head up and ensure that your contacts are firm and the patient's body weight is well controlled. 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.
The shoulder girdles and thorax of the patient are now a solid mass against which a thrust may be applied. Apply a HVLA thrust towards you and slightly upwards in a cephalad direction via your hands. Simultaneously, apply a HVLA thrust directly forwards against the spinous process of T6 via your sternum (Fig. B2.l.S).
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.
This technique has many modifications:
• Different shoulder girdle holds can be used.
• Respiration can be used to make the technique more effective.
• A certain degree of momentum is often necessary for success in the technique.
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