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 joint cavitation at T5-6
1 Contact points (a) Left transverse process of T6
(b) Patient's elbows and left forearm.
2 Applicators (a) Palm of the operator's right hand, held in a clenched position
(b) Operator's lower sternum or upper abdomen.
3 Patient Supine with the arms crossed over the chest and the hands passed positioning around the shoulders. The left arm is placed over the right arm
(Fig. B2.3.1). The arms should be firmly clasped around the body as far as the patient can comfortably reach.
4 Operator stance Stand on the right side of the patient, facing the couch.
5 Positioning for Reach over the patient with your left hand to take hold of the left thrust shoulder and gently pull the patient's shoulder towards you
(Fig. B2.3.2). With your right hand, locate the transverse processes of T6. Now place the thenar eminence of your right hand against the left transverse process of T6 (Fig. B2.3.3).
Keeping contact with the left transverse process of T6, roll the patient back towards the supine position. Rest your lower sternum or upper abdomen on the patient's elbows and left forearm (Fig. B2.3.4).
Initially, a slow but firm pressure is applied with your lower sternum or upper abdomen downward towards the couch. Maintaining this downward leverage, introduce left rotation of the patient's upper thorax by directing forces towards the patient's left shoulder along the line of the patient's left upper arm. By balancing these different leverages, tension can be localized to the TS-6 segment.
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 downward towards the couch and in the line of the patient's left upper arm via your lower sternum or upper abdomen. Simultaneously, apply a HVLA thrust with your right thenar eminence upward against the left transverse process of T6 (Fig. B2.3.S). The force is produced by rapid pronation of your right forearm.
A common fault is to emphasize the thrust via the patient's shoulder girdles at the expense of the thrust against the left transverse process. The hand contacting the transverse process of T6 must actively participate in the generation of thrust forces.
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.
• Different applicators can be used.
• Respiration can be used to make the technique more effective.
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