Thrust to occipitoatlantal joint supine

This technique is useful for breaking fixation in a sidebending or rotation direction. Leave the head on the pillow and take a small step to the corner of the table. Slip your upper hand under the occiput so that the fingertips just curl under the base of the skull. Pull gently upwards under the occiput on the lower side as you apply the other hand to the maxilla and mandible on the upper side. Use a small compression between the hands to hold the head firmly, but avoid excessive pressure on the mandible as otherwise the temporo-mandibular joint can be strained. Tip the head into very slight extension to take the posterior tissues off tension, but not enough to reach the end of range of movement in the occipito-atlantal joints.

Increase the rotation to about 50% of full range and then balance all the components together until tension accumulates on the occipital condyle nearer the table. Apply a short amplitude thrust into sidebending with the maxilla hand while tugging upwards with the occiput hand. Note that this thrust can also become a rotation thrust with the maxilla hand around the fixed axis of the underneath hand. This will have the effect of gapping the upper condyle rather than the lower as in the sidebending thrust.

Tips: Most useful in cases of sidebending restriction. Least useful in patients who have a very mobile mid cervical spine as the force will too easily dissipate there and not accumulate at the occipito-atlantal joint. Extra considerations: Try using this position as a firm articulation procedure, but do not carry it on for very long as the forces generated are very strong and will provoke discomfort.

22.15 • Thrust to occipito-atlantal joint 'flywheel' technique (hand hold) This technique is a complex one where both hands work in opposition to hold the axis and rotate the occiput on it. The axis hand is to be placed with the thumb gently applied in front of the transverse process and the reinforced middle finger posterior to the transverse process on the other side. The chin hand will be rotating the head to one side as the atlas is held to the other. Even though momentum is used, the head should not reach full rotation even at the end of the technique. It is the effect of the one hand pulling back on the atlas as the head is rotated which causes the joint to gap, not full rotation of the head on the neck.

22.16 • Thrust to occipito-atlantal joint 'flywheel' technique Stand to one corner at the head of the table. Take up the chin hold with one hand while using the other to take a hold on the atlas. The atlas hand is applied with the thumb placed just in front of the transverse process. The reinforced middle finger is placed on the other side just behind the transverse process of the atlas. As you drop the elbow of the atlas hand toward the table while pulling carefully back on the transverse process you will rotate the atlas slightly back toward the neutral position. As you rotate the head toward the pillow, you will tend to carry the atlas with the head. Make a few gentle rotation movements with both hands moving in the same direction of movement of the chin toward the pillow. At the optimum moment accelerate the chin hand to rotate the head sharply toward the pillow. At the same time grip for as short a time as possible on the atlas to hold it from joining the head rotation. Release the atlas immediately the technique is completed as the transverse process is usually very tender to pressure.

Tips: Most useful in fairly flexible necks where the mobility makes normal locking techniques difficult. Least useful in stiff necks with degenerative changes as the torsional forces, however carefully applied, can be potentially problematical. Extra considerations: Try tipping the head into very slight extension to take the posterior tissues off tension and make the atlas more accessible. At the moment of thrust try pushing the head into the pillow to add a compression component that may help in localization.

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