Assume somatic dysfunction (A-R-T-T) is identified and you wish to use a rotation gliding thrust, parallel to the apophysial joint plane, to produce cavitation at the T2-3 apophysial joint (see below)
Transverse process of T3 on the left. Hypothenar eminence of left hand.
Patient prone with the point of the chin resting on the couch and the arms hanging over the edge of the couch or against the patient's sides. Introduce a small amount of sidebending to the right by gently lifting and moving the patient's chin to the right (Fig. B1.14.1). Do not introduce too much sidebending.
Head of the couch, feet spread slightly. 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 Locate the transverse process of T3 on the left. Place the hypothenar contact point eminence of your left hand gently but firmly against the transverse process of T3 on the left. Ensure that you have good contact and will not slip across the skin or superficial musculature when you apply a caudad and downward force towards the couch against the transverse process of T3. Maintain this contact point.
6 Positioning for Keeping your position at the head of the couch, gently place your thrust right hand against the left side of the patient's head and neck. While maintaining the right sidebending introduced earlier, begin to rotate the cervical and upper thoracic spine to the left by applying gentle pressure to the left side of the patient's head and neck with your right hand (Fig. Bl.14.2). Maintaining all holds and pressures, complete the rotation of the patient's head and neck until a sense of tension is palpated at your left hypothenar eminence. Keep firm pressure against the contact point.
7 Adjustments to achieve appropriate pre-thrust tension
Ensure the patient remains relaxed. Maintaining all holds, make any necessary changes in extension, sidebending or rotation until you can sense a state of appropriate tension and leverage. The patient should not be aware of any pain or discomfort. You make these final adjustments by altering the pressure and direction of forces between the right hand against the patient's head and neck and your left hypothenar eminence against the contact point.
Relax and adjust your balance as necessary. Keep your head up and ensure that your contacts are firm and that your body position 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.
9 Delivering the Apply a HVLA thrust to the left transverse process of T3 down thrust towards the couch and in the direction of the patient's left axilla.
Simultaneously, apply a slight, rapid increase of head and neck rotation to the left with your right hand (Fig. Bl.14.3). The thrust induces local rotation of the T3 vertebra, focusing forces at the T2-3 segment. You must not overemphasize the thrust with your right hand against the patient's head and neck. Your right hand stabilizes the leverages and maintains the position cervical spine against the thrust imposed upon the contact point. The thrust is induced by a very rapid contraction of the triceps, shoulder adductors and internal rotators.
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.
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