Treatment Techniques

Question 1

How do you perform Occiput-atlas traction manipulation?

Answer 1

patient position: sitting
Therapist position: standing beside patient stabilizing head against chest
hand 1: supporting occiput
hand 2: placed over C1
Grade I or II: Pt. inhales then exhales as therapist stabilizes occiput and gives gentle caudal traction
Grade III or IV: Therapist firmly stabilizes C1 while traction applied to occiput.
NO OSCILLATION

Question 2

How do you perform the Occiput-atlas flex/ext manipulation?

Answer 2

Same as traction manip but add post. gliding of occipital condyles to improve flexion while ant. gliding to improve extension.

Question 3

How do you perform a CPA vertebral pressure?

What are primary indications for this technique?

Answer 3

Same as for CPA eval of glides, but as tx.
Procedure: Oscillatory. 3-4 max sets of 10-20 oscillations
Indications: centralized symptoms and degenerative changes.

Question 4

How do you perform a UPA vertebral pressure?

Answer 4

Same as CPA but thumbs on lat. masses.

Indicated for unilateral pain.

Question 5

True/False: Maitland suggests that is pain is the main problem, incline UPA pressures laterally and if stiffness is the main problem to incline pressures medially.

Answer 5

True

Question 6

How do you perform Maitland Side-gliding of the Atlas?

When would this be indicated?

Answer 6

pt. position: prone with head rotated 30-40°. MUST have pt’s forearm or towel under face so it doesn’t get smashed.
Therapist puts pressures on top side and directs pressures toward opposite ear.
Indicated when trying to improve OA rotation.

Question 7

How do you perform a postero-anterior unilateral vertebral pressure (C2 in 30° rotation)?
When would this be indicated?

Answer 7

Pt. position: prone with head to painful side
Therapist: stands at head of patient
Procedure: unilateral PA glides on C2 on the painful side toward mouth
Indicated when trying to improve AA rotation

Question 8

How do you perform transverse vertebral pressures?

Answer 8

Pt. position: prone with chin tucked in to expose spinous processes
Therapist: stands beside pt. with thumbs on spinous process of the vertebra to be mobilized.
Procedure: Oscillatory motion while the wrists are kept horizontal. Mobilize TOWARDS the painful side as this will cause rotation of the vertebrae away from the pain. Stabilize either the top or bottom vertebra with one hand to help localize mobilization.

Question 9

True/False: Manual traction may be used prior to commencing mechanical traction as a way of screening for possible adverse effects.

Answer 9

True

Question 10

When do you perform manual stretching?

Answer 10

When spinal exam does not reproduce comparable sign (and soft tissue does) or when symptoms don’t allow for complete examination. Still need to screen for VAI, instability, etc.

Question 11

How do you stretch them suboccipital extensors?

Answer 11

pt. position: supine
Therapist: stand at head of pt.
left hand: radial border of index finger between occiput and C1 as fulcrum
right hand: under occiput to apply traction
shoulder: on forehead of patient pushing downwards

Question 12

How do you stretch the anterior and middle scalenes?

Answer 12

pt. position: supine
Therapist: stand at head of pt.
hand 1: supporting occiput
hand 2: over clavicle with thumb on first rib of the side to be stretched
Procedure:
ipsilateral rotation
contralateral sidebending
slight flexion
On inspiration, barrier engaged. On expiration, head taken to more sidebending and rotation while rib is depressed.

Question 13

How do you stretch the upper traps?

Answer 13

pt. position: supine.
Therapist: stands at head of pt.
hand 1: on top of shoulder
hand 2: on the occiput
Depression of the shoulder, contralateral side bending with moderate amount of flexion.

Question 14

How do you stretch the SCM?

Answer 14

pt. position: supine
Therapist: stands at head of pt.
hand 1: over pt's forehead
hand 2: over the occiput
Upper cervical flexion
contralateral sidebending combined with ipsilateral rotation
extension (gentle)

Question 15

How do you muscle energize the AA junction?

Answer 15

Position: Atlas rotated to the right
Motion restriction: Atlas restricted to left rotation on axis
pt. position: supine with neck flexed to 45°
Therapist: supports head with both hands
1. Therapist rotate head left to barrier
2. Pt is asked to rotate head to right while therapist gives light resistance so isometric contraction is produced
3. Held here for 3-5 seconds
4. Rotate head to new range
5. Repeat 3-5x

Question 16

How do you muscle energize the OA junction?

Answer 16

Position: Occiput extended, sidebent right, and left rotated
Motion restriction: forward bending, left side bending, and right rotation
pt. position: supine with head supported by therapist
Therapist: At head of table
Right hand: web of hand under occiput (hand supinated)
Left hand: supporting the chin, index finger on front of chin and middle finger under the chin
1. Upper c-spine is forward flexed by combined action of both hands
2. L upper cervical spine bending is introduced and this causes coupled right rotation.
3. Pt. isometrically into upper cervical extention.
4. Held here for 3-5 seconds
5. Rotate head to new range
6. Repeat 3-5x

Question 17

How do you release the suboccipitals?

Answer 17

pt. position: supine
Therapist: sitting at head of table with pads of flexed fingers placed betweeen the occiput and C1.
Therapist introduces slight traction until barrier reached. Position held till a release is felt.

Question 18

How do you perform a paravertebral posteromedial stretch?

Answer 18

pt. position: prone
Therapist: Stands beside pt. with fingers around paraspinals
Paraspinals lifted and held for 5-10 s.