O-A, A-A motion
O-A = 15 deg flex/ext
A-A = 45 deg rotation each side
Composite cervical motion
Total flexion/extensión = 126 deg
Total rotation = 144 deg
Total lateral flexion = 87 deg
What happens because of forward head posture
- Upper cervical extension
- Lower cervical flexion
- Upper thoracic flexion
What are safety considerations when evaluating C Spine
- Alar ligament test — done in seated. Slight lateral flexion — C2 SP contra rotation
- Vertebral artery test — supine, head of table — gotta keep eyes open and assess cog function during
What is craniovertebral locking
Method of protecting VA during cervical assessment and treatment
- Keeps vertebral foramen aligned — no kinking because the more movement we get from C2 the more impinging VA can occur
- You side bend to the side you want to assess and rotate away
- SUPER TINY MOVEMENTS
C2 movement during craniovertebral locking
Ex: L CVlocking
Side bend left — C2 moves to the right.
Don’t want that sucker moving and kinking VA
Rotate right — C2 gets back aligned to center = no kinking
What is direction of mobilization for a downslide in C spine
Inferior
Posterior
Little medial
What is direction of mobilization for upglide
Superior
Anterior
Slightly lateral
Contraindications for cervical manip
- Recent infection
- Connective tissue disease
- Congenital collagenous compromise — DS, ED
- Empty end feel
- Unwilling patient
- History of smoking
- Atherosclerosis
- HTN
- Long term steroid use
- Bleeding disorders
- Recent relevant trauma
- UMN lesion s/s
- Recent manip by another professional
O-A distraction manip
Ex: (R) side
1. Left arm cradles head right against the body, with left CMC thumb joint under patients left zygomatic arch
2. PT’s R hand index finger MCP joint is under the R mastoid process
3. PT’s right elbow should be above patient’s right shoulder and right against the right side of their chest
4. Use legs to create axial traction force
5. PRE-MANIP HOLD
6. CONSET
7. MANIIIPPPPPP
A-A Distraction manip
Side lying
What happens after the thrust?
Re-assess
Exercise!!!!!!!!!!!!
Work in the new motion - stretch, ROM, PPIVMS
What is a SNAG
Sustained natural apophyseal glides
— sustained repositioning of one articular surface on its neighbor while a movement of function is undertaken
— combo of sustained facet glides with movement
— always involved with end-range joint movement
HAS TO BE PAIN FREE
