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)
1 Contact point
3 Patient positioning
Left side of the spinous process of T2. Thumb of left hand.
Patient sitting with back towards the operator.
4 Operator stance Stand behind the patient.
5 Palpation of contact point
Locate the spinous process of T2. Place the thumb of your left hand gently but firmly against the left side of this spinous process. Spread the fingers of your left hand to rest over the patient's left trapezius muscle with your fingertips resting on the patient's left clavicle (Fig. B1.15.1). Ensure that you have good contact and will not slip off the spinous process of T2 when you apply a force against it. Maintain this contact point.
7 Adjustments to achieve appropriate pre-thrust tension
Keeping your position behind the patient place your right hand and forearm alongside the right side of the patient's head and neck and gently rest the palm of your hand over the top of the patient's head (Fig. B1.15.2). Ensure that your forearm remains anterior to, and just over, the patient's ear. This hand will introduce and control the rotation and sidebending leverages.
Use your left hand to slightly rotate the patient's trunk to the left while using your right hand to introduce head and neck rotation to the right until a sense of tension is palpated at the contact point (Fig. B1.15.3). Now gently introduce cervical sidebending to the left by allowing the patient's body weight to fall slightly to the right. Keeping the patient's head centred over the sacrum, guide the neck into left sidebending with your right arm against the right side of the patient's head. A vertex compression force can be added to assist in localizing forces to the T2-3 segment. Ensure that your applicator thumb forms a straight line with your left forearm.
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. 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.
Immediately Relax and adjust your balance as necessary. Keep your head up and pre-thrust ensure that your contacts are firm and that the patient's body weight and position are 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 side of the spinous process of T2 in thrust the direction of the patient's right axilla. At the same time, slightly increase head and neck sidebending to the left with your right arm (Fig. Bl.15.4). The thrust on the spinous process of T2 and the slight increase in neck sidebending to the left focus forces at the T2-3 segment and cause cavitation at that level. The thrust is induced by a very rapid contraction of the shoulder adductors.
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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