Procedures

Question 1

REIL w/ Clinician Overpressure

Answer 1

Patient position: Prone lying ready to press up
Clinician position: Over patient, chest over hands
Hand position: 90/90 w/ heel of hypothenar eminences over TPs
Movement description: As patient presses up clinician provides symmetrical pressure, repeating up to 10 times

Question 2

Extension mobilization in neutral

Answer 2

Patient position: Prone lying
Clinician position: Over patient, chest over hands
Hand position: 90/90 w/ heel of hypothenar eminences over TPs
Movement description: Symmetrical pressure through arms, up to 10 times

Question 3

Extension mobilization in extension

Answer 3

Patient position: Prone lying in extension
Clinician position: Over patient, chest over hands
Hand position: 90/90 w/ heel of hypothenar eminences over TPs
Movement description: Symmetrical pressure through arms, up to 10 times

Question 4

Extension in lying with hips off center with clinician sagittal overpressure

Answer 4

Patient position: prone lying w/ hips off center away from side of pain
Clinician position: Over patient on side of hips, chest over hands
Hand position: 90/90 w/ heel of hypothenar eminences over TPs
Movement description: Symmetrical pressure through arms, up to 10 times

Question 5

Extension in lying with hips off center with clinician lateral overpressure

Answer 5

Patient position: prone lying w/ hips off center away from side of pain
Clinician position: side of patient on side of hips
Hand position: close hand side of ribs far hand on lateral pelvis
Movement description: Equal and opposite pressure applied by both hands as patient presses up, maintaining hips off center, repeated up to 10 times

Question 6

Rotation mobilization in extension (neutral) - bilateral technique

Answer 6

Patient position: prone lying
Clinician position: over patient, chest over hands
Hand position: 90/90 w/ heel of hypothenar eminences over TPs
Movement description: anteromedial force applied rhythmically in a rocking motion side to side

Question 7

Rotation mobilization in extension - unilateral technique

Answer 7

Patient position: prone lying
Clinician position: over patient, chest over hands, opposite of side being mobilized
Hand position: Heel of hand on TP, other hand over top
Movement description: Unilateral pressure through hand directed anteriorly and medially, repeated up to 10 times

Question 8

Manual correction of lateral shift

Answer 8

Patient position: standing, weightbearing evenly on both feet, arm by side and elbow flexed to 90 on shifted side
Clinician position: stride standing, feet wide, shoulder against bent over on shifted side, head behind patient
Hand position: Wrapped around contralateral illium
Movement description: shoulder gives pressure against patient’s bent arm while clinician’s hands pull inward on illium, attempting to correct shift, held for 3-5 seconds, pressure is then slightly released and then movement is performed again to further range, once over correction is achieved clinician support lower lumbar spine with forearm and patient performs REIS, performed as much as required

Question 9

Rotation mobilization in flexion

Answer 9

Patient position: supine, knees flexed to 45, towards side of bed where legs will go
Clinician position: on side of patient where legs will go
Hand position: same side arm on opposite anterior shoulder or ribs, opposite on top knee
Movement description: clinician flexes knees to at least 90 degrees while lowering legs off side of table so that they are resting on clinician’s upper thigh or groin, same side arm applies stabilizing pressure on patient’s upper shoulder or ribs and other hand provides mobilizing pressure downward on patient’s knee, sustained for up to 3 minutes

Question 10

Flexion in lying with clinician overpressure

Answer 10

Patient position: supine knees and hips flexed to 45
Clinician position: side of table
Hand position: top of anterior knees/shins
Movement description: patient brings both knees towards their chest, at end range clinician provides downward force w/ both hands on front of patient’s shins to achieve end range lumbar flexion, repeat up to 10 times

Question 11

Retraction in sitting with clinician overpressure

Answer 11

Patient position: sitting
Clinician position: standing to side of patient
Hand position: web space of chin, upper thoracic spine, forearms parallel
Movement description: clinician provides equal and opposite pressure w/ web space of hand on chin and other hand placed on upper thoracic spine parallel to spine once the patient retracts to end range, repeat 5 or 6 times

Question 12

Retraction mobilization in sitting

Answer 12

Patient position: sitting
Clinician position: standing to side of patient
Hand position: web space of chin, upper thoracic spine
Movement description: clinician passively retracts the patient with web space of hand on chin, this hand stabilizes position at end range while hand on upper thoracic spine provides mobilizing force anteriorly w/ heel of hand on SP, repeated 5 or 6 times

Question 13

Retraction in supine with clinician overpressure

Answer 13

Patient position: supine, to side of table where clinician is standing, off edge of table to T4 (axilla)
Clinician position: side of table
Hand position: , close hand w/ web space on chin, opposite hand supports occiput and neck in neutral, patient’s head at waist level
Movement description: patient fully retracts, at end range overpressure is applied by clinician bending at the knees and force applied through chin w/ hand, repeat 5 or 6 times

Question 14

Retraction mobilization in supine

Answer 14

Patient position: supine, to side of table where clinician is standing, off edge of table to T4 (axilla)
Clinician position: side of table
Hand position: close hand w/ web space on chin, opposite hand supports occiput and neck in neutral, patient’s head at waist level
Movement description: Clinician fully retracts patient’s head by bending knees, at end range force is applied through chin perpendicular to the ground, repeat 5 to 6 times

Question 15

Retraction in prone with clinician overpressure

Answer 15

Patient position: propped on elbows, close to side of table where clinician is standing
Clinician position: side of table
Hand position: one hand web space on chin, other heel of hand on upper thoracic vertebrae, forearms parallel
Movement description: patient fully retracts, clinician provides equal and opposite forces with both hands at end range, return to starting position, repeated 5 or 6 times

Question 16

Retraction mobilization in prone

Answer 16

Patient position: propped on elbows, close to side of table where clinician is standing, looking towards floor @ 45 degree angle
Clinician position: side of table
Hand position: one hand web space on chin, other heel of hand on upper thoracic vertebrae, forearms parallel
Movement description: clinician fully retracts patient, chin hand stabilizes and an anterior mobilizing force is applied on the thoracic spine with the other hand, repeated 5 or 6 times

Question 17

Retraction and extension with rotation and clinician traction in supine

Answer 17

Patient position: supine off edge of table to T4 (axilla)
Clinician position: standing or kneeling at end of table
Hand position: one hand under occiput, other hand cradles mandible
Movement description: longitudinal traction is applied with both hands and is maintained throughout the procedure. The clinician then fully retracts the patient’s head and neck. From this position the head and neck is slowly extended towards end range. At the end range of extension five to six repetitions of a small amplitude rotation are applied, traction is maintained while returning to start position then released, repeated 5 or 6 times

Question 18

Lateral flexion in sitting with clinician overpressure

Answer 18

Patient position: sitting upright, partially retracted
Clinician position: behind patient
Hand position: neck hand thumb on SP and or 1st MCP joint against articular pillar at appropriate spinal level, other hand rests on top of patient’s head, forearms parallel
Movement description: while partially retracted, patient laterally flexes, at end range equal pressure is given by clinician downwards on head and towards opposite axilla with spine hand, repeated 5 or 6 times

Question 19

Lateral flexion mobilization in sitting

Answer 19

Patient position: sitting upright, partially retracted
Clinician position: behind patient
Hand position: neck hand thumb on SP and or 1st MCP joint against articular pillar at appropriate spinal level, other hand rests on top of patient’s head, forearms parallel
Movement description: clinician partially retracts and then laterally flexes patient to end range, hand on head stabilizes position while spine hand provides a mobilizing force towards opposite axilla

Question 20

Lateral flexion with clinician overpressure in supine

Answer 20

Patient position: supine, head and neck off edge of table at height of clinician’s abdomen
Clinician position: 45 degrees angle to patient, stride standing
Hand position: one hand cradles mandible with head resting on forearm, other hand w/ 1st MCP on articular pillar
Movement description: while partially retracted, patient laterally flexes, at end range clinician provides equal and opposite forces with each hand, repeated 5 or 6 times

Question 21

Lateral flexion mobilization in supine

Answer 21

Patient position: supine, head and neck off edge of table (axilla) at height of clinician’s abdomen
Clinician position: 45 degrees angle to patient, stride standing
Hand position: one hand cradles mandible with head resting on forearm, other hand w/ 1st MCP on articular pillar
Movement description: clinician partially retracts patient, laterally flexes, chin hand stabilizes while lateral flexion force is provided towards axilla, repeated 5 or 6 times

Question 22

Rotation in sitting with clinician overpressure (cervical)

Answer 22

Patient position: seated, partially retracted
Clinician position: behind patient, on side where patient is rotating
Hand position: opposite side hand placed over clavicle/trap, thumb on opposite side of SP of segment being mobilized, same side hand wraps around to grab articular pillar of opposite side being rotated towards
Movement description: patient partially retracts, rotates to end range, clinician adds rotation by rotating with same side hand and applying pressure in the same direction w/ thumb on SP w/ mobilizing hand, repeated 5 or 6 times

Question 23

Rotation mobilization in sitting

Answer 23

Patient position: seated, partially retracted
Clinician position: behind patient, on side where patient is rotating
Hand position: opposite side hand placed over clavicle/trap, thumb on opposite side of SP of segment being mobilized, same side hand wraps around to grab articular pillar of opposite side being rotated towards
Movement description: clinician partially retracts patient, passively rotates w/ stabilizing hand and stabilizes at end range, counterpressure is applied w/ mobilizing thumb on SP, repeated 5 or 6 times

Question 24

Rotation in supine with clinician overpressure

Answer 24

Patient position: supine, off table to T4 (axilla), table at heigh of lower abdomen of clinician
Clinician position: one hand wraps around and cradles mandible, head resting between chest and cradled in forearm, stride standing in direction of force being applied
Hand position: one hand on mandible cradling, other hand radial surface of MCP of index finger applied along lateral surface of articular pillar of level being mobilized
Movement description: patient partially retracts and rotates to end range, at end range, clinician applies overpressure by adding rotation w/ jaw hand and adding rotary pressure w/ mobilizing hand on spine, repeat 5 or 6 times

Question 25

Rotation mobilization in supine

Answer 25

Patient position: supine, off table to T4 (axilla), table at heigh of lower abdomen of clinician
Clinician position: one hand wraps around and cradles mandible, head resting between chest and cradled in forearm, stride standing in direction of force being applied
Hand position: one hand on mandible cradling, other hand radial surface of MCP of index finger applied along lateral surface of articular pillar of level being mobilized
Movement description: clinician partially retracts patient, passively rotates to end range, jaw hand stabilizes while spine hand adds mobilizing rotary force, repeat 5 or 6 times

Question 26

Flexion in supine with clinician overpressure

Answer 26

Patient position: supine, head and neck off treatment table, T4 (axilla)
Clinician position: end of treatment table
Hand position: one hand cradling occiput, other over opposite clavicle/shoulder
Movement description: patient flexes to end range, at end range clinician lifts up on occiput and pushed down on shoulder to increase flexion range, repeat 5-6 times

Question 27

Flexion mobilization in supine

Answer 27

Patient position: supine, head and neck off treatment table, T4 (axilla)
Clinician position: end of treatment table
Hand position: one hand cradling occiput, other over opposite clavicle/shoulder
Movement description: patient is passively flexed to end range, shoulder hand stabilizes as flexion mobilization force is provided by lifting up on occiput, repeat 5 or 6 times

Question 28

Extension in sitting with clinician overpressure

Answer 28

Patient position: sitting or end of treatment table
Clinician position: to side of patient
Hand position: one hand under both of patients elbows, other heel of hand on SP of T-spine level to be mobilized
Movement description: patient actively extends thoracic spine by lifting elbows, at end range clinician further lifts patient’s elbows and applies equal counterpressure w/ hand on T-spine, repeat 5 or 6 times

Question 29

Extension mobilization in sitting

Answer 29

Patient position: sitting or end of treatment table
Clinician position: to side of patient
Hand position: one hand under both of patients elbows, other heel of hand on SP of T-spine level to be mobilized
Movement description: patient is passively extended to end range by lifting elbows, at end range, mobilization pressure is applied w/ hand on T-spine, repeat 5 or 6 times

Question 30

Rotation in sitting with clinician overpressure (thoracic)

Answer 30

Patient position: sitting in chair or corner/end of table
Clinician position: side of patient opposite of movement
Hand position: one hand front of shoulder towards rotation movement, other on back of contralateral rib angle
Movement description: patient rotates to end range, equal and opposite pressure is applied with both hands, repeat 5 or 6 times

Question 31

Rotation mobilization in sitting (thoracic)

Answer 31

Patient position: sitting in chair or corner/end of table
Clinician position: side of patient opposite of movement
Hand position: one hand front of shoulder towards rotation movement, other on back of contralateral rib angle
Movement description: patient is passively rotated to end range, at end range anterior shoulder hand stabilizes and a rotation force is provided w/ the posterior shoulder hand, repeat 5 or 6 times