The patient sits across the table near the end. Stand at the end of the table and reach around the neck with the front hand so that the lateral border of the hand can pull forward on the far side articular process. Place the thumb of the pronated posterior hand on the far side of the spinous process of the next lower vertebra. Maintain a small amount of sidebending away from you by firm pressure against the side of the spinous process. The thrust will be applied with both hands. One is pulling forward from behind the articular process, and the other pushing the spinous process toward you. This will produce a contra-rotation force between the adjacent vertebrae.
21.49 • (see previous page, bottom right) Thrust into rotation sitting The hold described in photograph 21.48 is applied. Rotate the head using both hands until it is approximately in mid rotation. Apply some sidebending to the opposite side. Maintain the rotation and opposite sidebending and circumduct the patient's body through a small arc keeping the vertex directly over the sacrum. When tension accumulates in the target segment, apply the thrust with a short sharp pulling action with the front hand while aiding it with the other. Note that firm compression between the hands is a critical part of this technique.
Tips: It sometimes helps to ask the patient to exhale just before the thrust to produce an optimum state of relaxation. Another useful relaxation aid is to ask the patient to let the shoulders drop; as they do this, there will be an interval of 2 or 3 seconds when the thrust is more easily performed.
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