8.1 Atlanto-occipital joint C0–C1

Contact point on occiput

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. 8.7).

Figure 8.7

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 occiput. Medial and posterior to the mastoid process.

2 Applicator

Lateral border, proximal or middle phalanx of the 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 the occiput and palpate the contact point on the occiput with the tip of your index or middle finger. Ensure that you are medial to, and not on, the mastoid process. Slowly but firmly slide your right index finger, in close approximation to the suboccipital musculature, downward (towards the couch) along the occiput until it approximates the middle or proximal phalanx. Several sliding pressures may be necessary to establish close approximation to the contact point. It is important to obtain a contact point as far along the underside of the occiput as possible and into the suboccipital musculature. This thrust uses a curved plane of movement to produce a cavitation and this positioning ensures that the applicator will not slip during the thrust.

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