Rotation gliding Patient prone Operator at side of couch

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 (Figs Bl.13.1, Bl.13.2)

Fig. B1.13.1 Fig. B1.13.2

1 Contact point

2 Applicator

3 Patient positioning

Right side of spinous process of T3. Thumb of right hand.

Patient lying prone with the head and neck turned to the left and arms hanging over the edge of the couch or against the patient's sides (Fig. B1.13.3). Introduce a small amount of sidebending to the right by gently moving the patient's head to the right while in the rotated position. Do not introduce too much sidebending.

Fig. B1.13.3

4 Operator stance

Stand on the right side of the patient facing towards the head of the couch.

5 Palpation of contact point

Locate the spinous process of T3. Place the thumb of your right hand gently but firmly against the right side of this spinous process. Spread the fingers of your right hand to rest over the patient's right trapezius muscle with your fingertips resting on the patient's right clavicle (Fig. Bl.13.4). Ensure that you have good contact and will not slip off the spinous process of T3 when you apply a force against it. Maintain this contact point.

Fig. B1.13.4

Positioning for thrust

Keeping your position at the side of the couch, gently place your left hand against the left side of the patient's head. This hand will control the rotation and sidebending leverages. Increase rotation of the patient's head and neck to the left by applying gentle pressure to the patient's head until a sense of tension is palpated at the contact point. Move your right forearm so that it lines up with your thumb against the spinous process of T3 and forms an angle of approximately 90° at the elbow (Fig. Bl.13.5).

Fig. B1.13.5

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. Make these final adjustments by altering the pressure and direction of forces between the left hand against the patient's head and your right thumb at the contact point.

Immediately pre-thrust

Delivering the thrust

Relax and adjust your balance as necessary. Keep your head up and ensure that your contacts are firm and 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.

Apply a HVLA thrust to the spinous process of T3 in the direction of the patient's left shoulder joint. Simultaneously, apply a slight, rapid increase of head and neck rotation to the left with your left hand (Fig. Bl.13.6). The thrust induces local rotation of the T3 vertebra, focusing forces at the T2-3 segment. You must not overemphasize the thrust with your left hand against the patient's head. Your left hand stabilizes the leverages and maintains the position of the head against the thrust imposed upon the contact point. The thrust is induced by a very rapid contraction of the shoulder adductors.

Fig. B1.13.6

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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