10.1 Thoracolumbar spine T10–L2
Neutral positioning
Assume somatic dysfunction (S-T-A-R-T) is identified and you wish to use a rotation gliding thrust to produce cavitation at T12–L1 on the left (Figs 10.10, 10.11).
1 Patient positioning
Lower body. Straighten the patient’s lower (right) leg and ensure that the leg and spine are in a straight line, in a neutral position. Flex the patient’s upper hip and knee slightly and place the upper leg just anterior to the lower leg. The lower leg and spine should form as near a straight line as possible, with no flexion at the lower hip or knee.
Upper body. Gently extend the patient’s upper shoulder and place the patient’s left forearm on the lower ribs. Using your right hand to palpate the T12–L1 interspinous space, introduce left rotation of the patient’s upper body down to the T12–L1 segment. This is achieved by gently holding the patient’s right elbow with your left hand and pulling it towards you, but also in a cephalad direction towards the head end of the couch. Be careful not to introduce any flexion to the spine during this movement. Left rotation is continued until your palpating hand at the T12–L1 segment begins to sense motion. Take up the axillary hold. This arm controls the upper body rotation.
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