Assume somatic dysfunction (A-R-T-T) is identified and you wish to use a sidebending gliding thrust, parallel to the apophysial joint plane, to produce cavitation at the T2-3 apophysial joint (see below)
Right side of the spinous process of T2. Thumb of left hand.
Patient lying on the left side. Flex the patient's knees and hips for stability.
Stand facing the patient and gently place your right arm under the head, lightly spreading your fingers around the patient's occiput. The head should now be cradled in your right arm with your upper arm against the patient's forehead and your forearm and hand supporting the head and neck.
5 Palpation of contact point
Locate the spinous process of T2. Place the thumb of your left hand gently but firmly against the right side of this spinous process. Spread the fingers of your left hand to enable firm contact of your thumb. This will ensure that you have good contact and will not slip off the spinous process when you apply a force against it. Maintain this contact point but do not press too hard, as it can be uncomfortable.
Using your right arm, sidebend the patient's head and neck to the right until a sense of tension is palpable at the contact point. This sidebending is achieved by gently lifting the patient's head, within the cradle of your right arm (Fig. B1.16.1).
Gently introduce cervical rotation to the left until a sense of tension is palpated at the contact point (Fig. B1.16.2). If necessary, you may add a compression force to the patient's shoulder girdle, from your chest, to stabilize the upper torso before applying the thrust.
7 Adjustments to achieve appropriate pre-thrust tension
8 Immediately pre-thrust
Ensure the 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 contact point. The patient should not be aware of any pain or discomfort. Make these final adjustments by balancing the pressure and direction of forces between the left hand against the contact point and the right hand and forearm against the patient's head and neck.
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.
Apply a HVLA thrust to the spinous process of T2 down towards the couch in the direction of the patient's left shoulder. The thrust is accompanied by a simultaneous downward application of force with your chest to the patient's right shoulder girdle. At the same time, introduce a slight increase in head and neck sidebending to the right with your right arm (Fig. B1.16.3). The thrust on the spinous process of T2 and slight increase in neck sidebending to the right focus forces at the T2-3 segment and cause cavitation at that level. Do not apply excessive sidebending at the time of the thrust as this can cause strain and discomfort.
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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