8.2 Atlanto-occipital joint C0–C1

Contact point on atlas

Chin hold

Patient supine

Anterior and superior thrust in a curved plane

Assume somatic dysfunction (S-T-A-R-T) is identified and you wish to use a thrust in the plane of the C0–C1 apophysial joint to produce cavitation on the right (Fig. 8.10).

Figure 8.10

Key

Stabilization

Applicator

Plane of thrust (operator)

Direction of body movement (patient)

Note: The dimensions for the arrows are not a pictorial representation of the amplitude or force of the thrust.

1 Contact point

Right posterior arch of atlas.

2 Applicator

Lateral border, proximal or middle phalanx of operator’s right index finger.

3 Patient positioning

Supine with the neck in a neutral relaxed position. If necessary, remove pillow or adjust pillow height. The neck should not be in any significant amount of flexion or extension.

4 Operator stance

Head of couch, feet spread slightly. Adjust couch height so that the operator can 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 contact point

Place fingers of both hands gently under the occiput. Lift the head slightly and gently rotate it to the left, taking the weight of the head in your left hand. Remove your right hand from occiput and palpate the contact point on the right posterior arch of the atlas with the tip of your index or middle finger. Slowly but firmly slide your right index finger, in close approximation to the suboccipital musculature, downwards (towards the couch) along the posterior arch of the atlas until it approximates the middle or proximal phalanx. Several sliding pressures may be necessary to establish close approximation to the contact point.

6 Fixation of contact point

Keep your right index finger firmly pressed on the contact point while you flex the other fingers and thumb of the right hand so as to clasp the back of the occiput and head, thereby locking the applicator in position. You must now keep the applicator on the contact point until the technique is complete. Keeping the hands in position, return the head to the neutral position.

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