8.13 Cervical spine C2–7

Down-slope gliding

Patient sitting

Operator standing to the side

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 8.63, 8.64).

Figure 8.63

Figure 8.64

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

Palmar aspect, proximal or middle phalanx of operator’s left index or middle finger.

3 Patient positioning

Sitting with the neck in a neutral relaxed position. The neck should not be in any significant amount of flexion or extension.

4 Operator stance

Stand to the left of the patient, 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 (Fig. 8.65).

Figure 8.65

5 Palpation of contact point

Place the fingers and palm of your right hand over the left side of the patient’s head and neck, gently covering the left ear. Reach in front of the patient with your left hand and palpate the right articular pillar of C4 with the tip of your left index or middle finger. Slowly but firmly slide your applicator along the articular pillar of C4 until it approximates the proximal or middle phalanx. Several sliding pressures may be necessary to establish close approximation to the contact point.

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