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Techniques for C-T jxn manipulation

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Techniques for C-T jxn manipulation - January 16, 2008 11:15:47 AM   
ptdan23

 

Posts: 224
Joined: November 6, 2003
From: Orlando, FL
Status: offline 		Just curious so I thought I would ask --- what techniques have you found most beneficial for manipulation of the cervicothoracic junction?

Dan
Post #: 1
RE: Techniques for C-T jxn manipulation - January 16, 2008 1:23:58 PM   
USAPT

 

Posts: 275
Joined: January 14, 2004
Status: offline 		Dan,
I perform the sitting rotation mobilization at C7/T1, T1/2, T2/3 (if able) to improve cervical AROM and is typically my favorite.

(in reply to ptdan23)
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RE: Techniques for C-T jxn manipulation - January 17, 2008 5:46:45 PM   
OAK

 

Posts: 183
Joined: September 1, 2003
Status: offline 		Seated traction manipulation works good for me.

(in reply to USAPT)
Post #: 3
RE: Techniques for C-T jxn manipulation - January 18, 2008 8:00:40 AM   
Sebastian Asselbergs

 

Posts: 1061
Joined: September 29, 1999
From: Barrie, Canada
Status: online 		OAK, you mean the "Double Nelson" technique ? If so, I agree.

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Mundi vult decipi

(in reply to OAK)
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RE: Techniques for C-T jxn manipulation - January 18, 2008 12:21:15 PM   
jesspt

 

Posts: 69
Joined: April 3, 2007
From: Illinois
Status: offline 		I use the "double nelson" for this as well, but I have found that I have difficulty with the technique in patients who have a lot of ROM of their shoulders and scapulae - I struggle with "locking out" the spine. Any suggestions/hints, etc?



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Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy

(in reply to Sebastian Asselbergs)
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RE: Techniques for C-T jxn manipulation - January 18, 2008 1:13:38 PM   
OAK

 

Posts: 183
Joined: September 1, 2003
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quote:

ORIGINAL: Sebastian Asselbergs

OAK, you mean the "Double Nelson" technique ? If so, I agree.


That's the one!

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RE: Techniques for C-T jxn manipulation - January 18, 2008 2:06:06 PM   
TexasOrtho


Posts: 338
Joined: December 22, 2007
Status: offline 		I've seen this performed but am not familiar with it.  What is the rationale for having the hands placed behind the head?

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Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com

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RE: Techniques for C-T jxn manipulation - January 18, 2008 2:49:49 PM   
Kaden

 

Posts: 243
Joined: June 17, 2007
Status: offline 		Rod,

Rationale for hands placed behind the head is to help lock the cervical spine.  You can have the patient cup the cervical spine and then your hands come over theirs to provide a gross compression to the cervical spine so when traction force is applied it tries to localize to the C-T junction.

Jess, I agree this manip is difficult to do in those without the necessary shoulder motion.  I haven't found any great tips - just haven't been able to use it.

A question to the rest of you.  Why choose a traction manip over a flexion or extension manipulation?  Just curious.  I was always taught distraction manips were probably the safest but wondering what others have been taught.  Along the same lines when do you choose to use a traction mobilization say for ankle versuse a posterior glide. etc. 

(in reply to TexasOrtho)
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RE: Techniques for C-T jxn manipulation - January 18, 2008 3:00:11 PM   
Kaden

 

Posts: 243
Joined: June 17, 2007
Status: offline 		Rod,

Here is an article in JOSPT if you have acess showing the manipulation that has been described above.


Intermittent cervical traction and thoracic manipulation for management of mild cervical compressive myelopathy attributed to cervical herniated disc: a case series. (includes abstract) Browder DA; Journal of Orthopaedic & Sports Physical Therapy, 2004 Nov; 34 (11): 701-12

(in reply to ptdan23)
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RE: Techniques for C-T jxn manipulation - January 18, 2008 6:56:36 PM   
TexasOrtho


Posts: 338
Joined: December 22, 2007
Status: offline 		Thanks Kaden.  I've seen some really significant improvements in CROM with cervicothoracic mobilization.  I've done a very generalized mobilization that is empirically effective.

The patient lays supine with a 1/2 foam roll placed at approximately T1-C7.  This is a sustained stretch for 15-30 seconds.  The foam roll is slid down to the middle-third of the thoracic spine and repeated...the lower thoracic spine follows.  It's basically a prolonged static thoracic extension mob.  From a strictly anecdotal perspective, I have seen significant improvements in both terminal shoulder flexion and cervical extension and rotation with this activity.



_____________________________

Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com

(in reply to Kaden)
Post #: 10
RE: Techniques for C-T jxn manipulation - January 21, 2008 7:26:32 PM   
ptdan23

 

Posts: 224
Joined: November 6, 2003
From: Orlando, FL
Status: offline
quote:

ORIGINAL: USAPT

Dan,
I perform the sitting rotation mobilization at C7/T1, T1/2, T2/3 (if able) to improve cervical AROM and is typically my favorite.


USAPT,
I like this technique as well.  Only downside is that it can be a thumb-killer!
Dan

(in reply to USAPT)
Post #: 11
RE: Techniques for C-T jxn manipulation - January 21, 2008 7:30:18 PM   
ptdan23

 

Posts: 224
Joined: November 6, 2003
From: Orlando, FL
Status: offline
quote:

ORIGINAL: TexasOrtho

Thanks Kaden.  I've seen some really significant improvements in CROM with cervicothoracic mobilization.  I've done a very generalized mobilization that is empirically effective.

The patient lays supine with a 1/2 foam roll placed at approximately T1-C7.  This is a sustained stretch for 15-30 seconds.  The foam roll is slid down to the middle-third of the thoracic spine and repeated...the lower thoracic spine follows.  It's basically a prolonged static thoracic extension mob.  From a strictly anecdotal perspective, I have seen significant improvements in both terminal shoulder flexion and cervical extension and rotation with this activity.




TexasOrtho,
I like this technique as well.  Tolerated by some better than others.  I will sometimes add in UE movements to promote the backward bending motion.
Dan

(in reply to TexasOrtho)
Post #: 12
RE: Techniques for C-T jxn manipulation - January 21, 2008 7:30:44 PM   
ptdan23

 

Posts: 224
Joined: November 6, 2003
From: Orlando, FL
Status: offline 		Anyone have any thrust techniques that they use?

Dan

(in reply to ptdan23)
Post #: 13
RE: Techniques for C-T jxn manipulation - January 21, 2008 9:10:38 PM   
bonez

 

Posts: 156
Joined: August 29, 2007
Status: offline 		As the Chiro in the group I would be wrong not to respond to this question. Yes there are several thrust techniques to treat this area

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Post #: 14
RE: Techniques for C-T jxn manipulation - January 22, 2008 11:41:00 AM   
ptdan23

 

Posts: 224
Joined: November 6, 2003
From: Orlando, FL
Status: offline 		Bonez,
I know there are thrust techniques for this area - I use them.  I was just asking if anyone has some techniques that they have found particularly effective or maybe more effective than others.
Dan

(in reply to bonez)
Post #: 15
RE: Techniques for C-T jxn manipulation - January 26, 2008 1:48:02 AM   
wvupt03

 

Posts: 3
Joined: January 18, 2007
Status: offline 		I too ues the "double nelson" technique. I learned it from Dr. Erhard, with the justification that it is a relatively safe technique and quite effective. I have performed it quite often with usually good success.

(in reply to ptdan23)
Post #: 16
RE: Techniques for C-T jxn manipulation - January 26, 2008 9:41:06 AM   
jma

 

Posts: 2301
Joined: August 24, 2000
From: NY
Status: offline 		Thanks for the article link.

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Post #: 17
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