Cervical spine

Question 1

Consent

Answer 1

Any dizziness, Any hvts in the past
Shouldn’t be painful is safe
Evaluating all risk factors
You are not in that category however given your age and overall health
Obligated to tell you there is a risk of a stroke
Most you’ll have is 24/48hr soreness
Going to put you in a position where your neck may feel a bit tight and then put a quick motion through
You may hear a slight cavitation (a click) this is not bone moving on bone or realigning you in any way, this is just nitrogen and Co2 being released from the joint, its a soft tissue technique.
Think it would benefit you - Main emphasis is on the quick movement to improve ROM
Can say stop at any time you feel uncomfortable there are other options

Question 2

What would you do before hvt

Answer 2

Instability tests:
Lateral shear
Anterior translation
Distraction

Question 3

Lateral shear

Answer 3

2nd mcp on tp of C1

Other Mcp tp of C2, going over the top of your other hand

approximate the hands

Then repeat with swapped hands

Question 4

Anterior translation

Answer 4

Right hand holding both TPs of C2

Other hand pushing up on the posterior body of C1

Question 5

Distraction

Answer 5

Right hand holding both TPs of C2

Other hand pushing up on the posterior body of C1

Drop the elbow

Question 6

HVT set up

Answer 6

2nd mcp contact on the side of the dysfunction - no pain
Identify specific motion segment
Contact the posterolateral aspect of the articular pillar of the vertebrae above
Flex up to the segment to be manipulated to a chin tuck position, all from palpating hand and Introduce sidebending maximally while following the position of the head with the thorax
Introduce opposing rotation to engage the barrier (you may wish to use sideshift)
Then RETEST

Question 7

Contact points

Answer 7

2nd mcp contact on articular pillar the side of the dysfunction
on segment above.

Question 8

Direction of trust

Answer 8

Rotation and away
Lower segments (6-7) - thrust is more towards axilla
Middle segments (4-5) - Thrust is more in line with the mouth
Upper segments (2-3)- Thrust is more towards the eye
This is tailored to the individual patient.

Question 9

accumulation of bind

Answer 9

Flexion, SB and rotation away