operator has his fingers close together and is hooking them so that they can pull cephalically under the occiput into localized traction. The backs of the forearms will be applied to the pillow with the elbows over the end of the table. This will allow him to produce traction partly by pulling, and partly by levering his forearms against the end of the table.
22.7 • Traction to occiput supine Apply the hand hold shown in photograph 22.6. Lower your elbows over the end of the table to form a fulcrum, and fix your hooked fingers under the occiput. As you lower your elbows, the traction force accumulates automatically. Although this would not seem to be very powerful, it does reach very specifically to the occiput and can be very useful if localized traction is desired.
22.8 • Thrust to occipito-atlantal joint sitting (hand hold) This hold is used for a specific thrust technique to be applied to the occipito-atlantal joint on the far side from the operator. The upper hand will be applied around the frontal bone, temporal bone and maxilla of the patient. The lower hand is to be applied with the index or middle finger placed gently in front of the transverse process of the atlas. The palm will be cupping the occipital bone.
22.9 • (top right) Thrust to occipito-atlantal joint sitting The hold illustrated in photograph 22.8 has been applied. Stand to the side and slightly behind the seated patient. Fix the frontal bone with your biceps avoiding the eyes. The forearm of the upper arm lies around the temporal bone and the inside of the elbow is in contact with the maxilla. The technique will not work effectively if the hand of the upper arm is in contact with the patient. The grip is only performed with the medial aspect of the forearm. Your lower hand grips gently around the anterior aspect of the transverse process of the atlas with the pad of the index or middle finger. Pull carefully backwards on the atlas while performing a bowing movement with your body. As the head is in contact with your chest this bowing action will form a sidebending action of the neck so that the atlas is driven slightly toward you.
You must simultaneously supinate your upper forearm. The patient's body is now in sidebending away from you, and you can rock into circumduc-tion from your ankles. As the barrier accumulates, increase the compression of the head toward you, and momentarily grip the atlas firmly as you adduct both arms. The cumulative effect of this is to produce a rotation of the head toward you, and of the atlas away.
Tips: Most useful in cases where it is best to avoid excess rotation of the head on the neck. This technique works with the head in any degree of rotation so it is hardly necessary to torsion the neck at all. It is probably the safest of the thrust techniques that can be applied to this joint. Least useful if the atlas is extremely sensitive to touch as the pressure may be unacceptable. Extra considerations: Ensure that firm compression of the head into your body is maintained throughout. Only pull back on the transverse process of the atlas for as short a time as possible to avoid excess discomfort.
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