8.11 Cervical spine C2–7

Down-slope gliding

Chin hold

Patient supine

Assume somatic dysfunction (S-T-A-R-T) is identified and you wish to use a downward and backward gliding thrust, parallel to the apophysial joint plane, to produce cavitation at C4–5 on the right (Figs. 8.53, 8.54).

Figure 8.53

Figure 8.54

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

Lateral aspect of the right articular pillar of C4.

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 you 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. Rotate the head to the left, taking its weight in your left hand. Remove your right hand from the occiput and palpate the right articular pillar of C4 with the tip of your index or middle finger. Slowly but firmly slide your right index finger downwards (towards the couch) along the articular pillar 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 upon the contact point while you flex the other fingers and thumb of the right hand so as to clasp the back of the neck and thereby lock 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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