You can only view 3 videos without an account. Become a Member to access all videos on the website.
Cervicothoracic Junction Manipulation
Cervicothoracic Junction Manipulation is a gentle, hands-on treatment technique used to help relieve neck and shoulder pain. This technique focuses on the areas between the neck and shoulder, including the muscles, ligaments, joints, and fascia. It can be used to improve mobility of the spine and related areas, decrease pain, improve posture, and promote relaxation. Cervicothoracic Junction Manipulation employs a combination of stretching, ligamentous and soft
Transcript
00:00:0400:00:07
This is Brent of the Brookbush Institute and
00:00:0400:00:07
in this video we're going to go over
00:00:0700:00:11
manipulations or high-velocity thrust techniques. I assume that if you're
00:00:1100:00:14
watching this video you're watching it for educational purposes, and that you
00:00:1400:00:18
are a licensed professional with high velocity thrust or manipulation
00:00:1800:00:24
techniques in your scope of practice. If you are not sure check with your state
00:00:2400:00:28
board. Most physical therapists, chiropractors and osteopaths you're in
00:00:2800:00:33
the clear. I believe that ATC's you can't do manipulations in the United States,
00:00:3300:00:38
although other countries again check your scope. Of course massage therapists
00:00:3800:00:41
and personal trainers these are generally not within your scope, of
00:00:4100:00:47
course you could continue to watch these videos just for educational purposes,
00:00:4700:00:51
learn a little Anatomy, learn a little biomechanics. If you're going to do these
00:00:5100:00:56
techniques please make sure that you have a good rationale for putting your
00:00:5600:01:00
hands on a patient. This should be based on assessmen,t and if you're going to
00:01:0000:01:06
assess I'm hoping that you'll assess, use these interventions and reassess to
00:01:0600:01:09
ensure that you're getting the result that you're looking for, and have good
00:01:0900:01:13
reason to continue using this technique. This video we're going to go over the
00:01:1300:01:17
cervical thoracic junction manipulation or upper thoracic manipulation, that area
00:01:1700:01:22
between C6 and we'll say T4. I'm going to have my friend a Yvette come out, she's
00:01:2200:01:25
going to help me demonstrate. Now keep in mind if you're doing manipulation
00:01:2500:01:28
techniques you're doing them to increase mobility, not just based on subjective
00:01:2800:01:33
symptoms but also based on objective signs. So in this case I would probably
00:01:3300:01:38
use something like cervical lateral flexion. Cervical lateral flexion
00:01:3800:01:43
goniometry is reliable although some of our other cervical goniometery
00:01:4300:01:47
assessments are not so reliable, and then i might try to find a thoracic rotation
00:01:4700:01:52
test that works well for reassessment. The last thing i would rely on is
00:01:5200:01:58
palpation, now i generally do two types of palpation with this particular area.
00:01:5800:02:03
I'll do my P-A's like I do when I'm doing mobilizations, and then I'll do this
00:02:0300:02:08
rotation palpation that I learned from the
00:02:0800:02:14
the Maitland workshops. So the P-A's here, you're going to go thumb over
00:02:1400:02:19
thumb or you can go your pisiform hamate grip, whichever you find more comfortable.
00:02:1900:02:24
Generally I find that I'm in this position when I'm working with neck and
00:02:2400:02:30
and upper back patients like this. So to go thumb over thumb is a little bit more
00:02:3000:02:34
convenient, and I'm just going to press all the way down to arthrokinematic
00:02:3400:02:39
end range and feel how these segments feel compared to one another,
00:02:3900:02:47
and compared to that internal model that I've built up over time with experience
00:02:4700:02:52
pressing on a lot of necks and upper-thoracic spines. I'm going to try to give
00:02:5200:02:59
myself a little bit of an indication of how stiff this area feels. Of course we
00:02:5900:03:06
could add another layer of this and go, hey Yvette how does that feel? Okay so
00:03:0600:03:11
that feels fine, that feels fine. We might get a little additional information like
00:03:1100:03:16
what if one of these segments is not only stiff it's actually part of the
00:03:1600:03:21
dysfunction that's causing her symptoms or complaints, and I can kind of go on
00:03:2100:03:26
through and do these P-A's. Now what I'm feeling with a Yvette is she definitely
00:03:2600:03:31
feels pretty good in her cervical spine as as far as motion goes, but then as I
00:03:3100:03:39
start moving down C6-C7, C7-T1 and then like C7 to T3, it's like really
00:03:3900:03:42
stif, it's actually really hard to get arthrokinematic motion. I don't think
00:03:4200:03:46
that's normal, I think that's an abnormal level of
00:03:4600:03:51
stiffness that maybe indicates I should do this manipulation technique. Now
00:03:5100:03:55
before I do this manipulation technique I've found that this rotation assessment
00:03:5500:03:59
that I learn from these workshops works really good and helping me determine
00:03:5900:04:04
which direction I should go, and all I'm going to do is I'm going to take my thumbs
00:04:0400:04:10
like so and put them each on a spinous process and rotate the spinous process
00:04:1000:04:16
in the opposite direction. So we'll go this way and then this way
00:04:1600:04:21
right. So I went this way and then this way. I rotated the upper segment
00:04:2100:04:31
to her right and then to her left, and then the same thing going on down, and
00:04:3100:04:36
what you'll start to notice a lot of times is people get stiff in one
00:04:3600:04:43
direction. So in a Yvette's case she actually moves better rotating to her
00:04:4300:04:50
left. Now I cannot explain what I'm about to tell you biomechanically, but it
00:04:5000:04:55
seems that this manipulation works better if rather than going into the
00:04:5500:05:01
resistance trying to manipulate to get more range of motion or decreased
00:05:0100:05:04
stiffness in the direction you're feeling in, it actually works better to
00:05:0400:05:12
go with the motion they already have. We could make an excuse and say well
00:05:1200:05:17
technically speaking if we're rotating in either direction the facets on
00:05:1700:05:22
both sides have to move. So at the very least we know if we get a good
00:05:2200:05:27
manipulation, everything's moving regardless. I really can't explain to you
00:05:2700:05:32
though why moving with the direction they already have motion tends
00:05:3200:05:36
to work better than moving them into the direction they have stiffness like every
00:05:3600:05:40
other manipulation. Experiment with this yourself, I think you will find the
00:05:4000:05:44
same thing. One thing about this technique is it's better to be right the
00:05:4400:05:47
first time because this is one of those techniques that if somebody is a little
00:05:4700:05:54
irritable, somebody is a little inflamed, flared up, you keep reaching back and
00:05:5400:05:58
trying to do the technique over and over again and you'll flare them up more. This
00:05:5800:06:03
is one of those techniques that you might get one, two, maybe three attempts
00:06:0300:06:09
at the most before you need to back off for the day and wait for them to come
00:06:0900:06:15
back in. So in Yvette's case I'm going go ahead and I'm going to rotate her this way,
00:06:1500:06:19
she moves better in this direction and like I said that tends to work better
00:06:1900:06:24
for this manipulation. Now I said she's stiff in all these
00:06:2400:06:31
segments going down here. There's two ways to block segments, and there's an
00:06:3100:06:34
easy way to set up the joint actions that we
00:06:3400:06:38
need to lock up the upper part of her cervical spine or the upper part of her
00:06:3800:06:42
thoracic spine as well. So what we're going to do is we can either use that
00:06:4200:06:47
thumb on a specific segment, or we can use our thenar eminence to block off
00:06:4700:06:54
several segments. This obviously is probably a little less specific and a
00:06:5400:07:00
little bit more aggressive. In Yvette's case I'd probably start here, being that
00:07:0000:07:03
she's not somebody who's accustomed to getting a lot of manipulations, she
00:07:0300:07:07
hasn't come in to see me before I probably want to start off a little bit
00:07:0700:07:15
more gentle and see how she responds. Now in order to get her all locked up I want
00:07:1500:07:20
to rotate her this way, side bend her towards me, so it's still that
00:07:2000:07:27
contralateral rotation, it's still the ipsilateral flexion and we're still
00:07:2700:07:30
needing a little bit of extension to get in the lock position just like we did
00:07:3000:07:35
with the cervical spine. The nice thing about this particular technique is if
00:07:3500:07:41
you just lift their head out of the head cradle and then rock their head
00:07:4100:07:47
on their chin just by turning their head, they do it automatically. So you
00:07:4700:07:51
can see if I just push her out of the head cradle, I'm there. Now I can
00:07:5100:07:57
tell in this case Yvette's guarding on me a little bit. One other thing I should
00:07:5700:08:01
probably bring up, that this table does naturally but some of you don't
00:08:0100:08:08
have tables with these arm thingies, is their arms need to be up, and the reason
00:08:0800:08:13
why is you want to take slack out of these muscles. If I was to try to rotate
00:08:1300:08:18
her this way with this arm down you can see I'm adding a lot of tension into her
00:08:1800:08:22
upper trap, and that's not going to be helpful for getting a manipulation, so
00:08:2200:08:25
you can bring both arms up. If we didn't have these arms cut out she could
00:08:2500:08:29
actually put her hands underneath her forehead like this, and we could just
00:08:2900:08:34
turn her forehead on her hands, it would still work the same way. All right so you
00:08:3400:08:39
can put your arms down, we're going to try not to guard. In the case of
00:08:3900:08:43
Yvette, if she is guarding and I feel like I keep getting pushed out of her spinous
00:08:4300:08:47
process and I can't hold it down with just my thumb, I might go back to my
00:08:4700:08:50
thenar eminence like this. So now I can really make sure
00:08:5000:08:56
I stabilize, I just have to try to be a little bit more careful to line up the
00:08:5600:09:02
end of my thenar eminence with whatever segment I'm trying to lock out from the
00:09:0200:09:07
bottom down. So in this case I want her about there, I can then bring
00:09:0700:09:13
her this way. You okay, no pain? Just relax, nice deep breath, try to just
00:09:1300:09:18
pretend like you're laying on your pillow on your belly. All right so I do
00:09:1800:09:21
find that that cue helps as I try to get them into like thinking about
00:09:2100:09:27
relaxing on a pillow. Okay now all we're going to do for the manipulation is
00:09:2700:09:31
add a little pressure this way. So I'm moving this hand this way to
00:09:3100:09:36
block out whether it's my thumb or my thenar eminence, and then I'm going to go
00:09:3600:09:40
this way with this hand because if I do that, I automatically push her into
00:09:4000:09:44
lateral flexion and rotation. So it ends up being a very easy for technique for
00:09:4400:09:49
us as long as you spend plenty of time getting your setup right, you make sure
00:09:4900:09:55
you get a really good lock out, get a nice deep breath, you okay? Deep
00:09:5500:10:02
breath, breathe out, and that's it. We actually got a pretty good cavitation on
00:10:0200:10:07
that one, I know Yvette felt it. You're seeing these manipulations
00:10:0700:10:11
done on somebody who does not get manipulations done. So I think
00:10:1100:10:15
that is important, that's a lot more realistic than some of the videos I see
00:10:1500:10:18
out there with people doing manipulations on people who get
00:10:1800:10:21
manipulations all the time. You do have to be careful, you do have to set
00:10:2100:10:25
somebody up well, you do have to help them with their expectations and be like
00:10:2500:10:30
hey this is this is not a big deal it's going to be over really quick, and you know
00:10:3000:10:34
take a nice deep breath and before you know it, click and then you just let them
00:10:3400:10:38
go, and a lot of times after I do manipulations like this I'll actually
00:10:3800:10:42
have somebody sit up take a second before I go ahead and do my next
00:10:4200:10:46
technique, so they don't feel like they're getting rapid-fire
00:10:4600:10:49
high-intensity manipulation one over the other.
00:10:4900:10:53
So I'm going to show you from this side, if I was going to manipulate
00:10:5300:10:58
her other side I would just block this way, I would put her head on this side
00:10:5800:11:02
and Yvette I'm not going to manipulate you this way okay. So I would go
00:11:0200:11:06
ahead and put either her chin up on the table or maybe like in this case on this
00:11:0600:11:12
head cradle, her maxilla is actually resting at the end of that headrest, and
00:11:1200:11:17
then I'd get her right here and then I make sure I'm locked. If I need to change
00:11:1700:11:23
her head position I can, and I want to make sure everything's right. Again
00:11:2300:11:30
I have said this in every one of our manipulation videos, setup is 90% of this.
00:11:3000:11:36
If you get somebody locked up right, if you've done your assessment and you're
00:11:3600:11:41
on the right segment, the manipulation, the high velocity thrust is like the
00:11:4100:11:45
icing on the cake. In fact I think you will find that if you really get
00:11:4500:11:51
good at the locked position, you'll get people to like move, manipulate, cavitate
00:11:5100:11:55
before you even get the thrust to happened a fair percentage of the time.
00:11:5500:11:58
It's kind of interesting, like you'll just be like okay and you'll get them
00:11:5800:12:03
here, and they'll be click, click, and you're like oh okay I didn't even need to do the thrust.
00:12:0300:12:10
So again I could do my little rotation stuff, find the segment in this
00:12:1000:12:14
case I'm going to go with the easier motion, block out that bottom segment,
00:12:1400:12:20
make sure that I apply a little pressure this way and then I'm going to rotate
00:12:2000:12:24
the head this way which is going to push her into rotation a lateral flexion,
00:12:2400:12:31
while I block out this way. Last thing, and I don't want to
00:12:3100:12:34
come across the sounding arrogant on this but I think it's something that
00:12:3400:12:39
needs to be said for whatever reason because I own this education company and
00:12:3900:12:44
I'm available online, and I get a lot of individuals who come and find me after
00:12:4400:12:50
other practitioners didn't work for them, and I would say nine times out of ten
00:12:5000:12:55
I'm able to help somebody because something was missed. That shouldn't
00:12:5500:13:01
happen, I think this is one of those things that is very often missed. I can't
00:13:0100:13:10
tell you how many cervical spine patients I've had that were manipulated up here in their cervical spine,
00:13:1100:13:16
nobody ever looked at their CT Junction and they were never given any sort of
00:13:1600:13:21
like activation or stabilization exercise. With these type of patients a
00:13:2100:13:26
lot of times I can come in and I manipulate their cervical thoracic junction using
00:13:2600:13:30
this technique. I give them some deep cervical flexor activation, maybe some
00:13:3000:13:34
serratus anterior activation, maybe we'll work on some other stuff for scapular
00:13:3400:13:38
mechanics, all that stuff that gets left behind because their last
00:13:3800:13:43
practitioner only looked at their cervical spine and sure enough within a
00:13:4300:13:46
couple sessions they're on a home exercise program and they're good to
00:13:4600:13:51
self-manage. Keep this technique, although it's a little difficult,
00:13:5100:13:55
although it does have a little higher tendency to flare people up than some of
00:13:5500:13:59
the other techniques I've shown you. Get good at it, because like I said
00:13:5900:14:04
it will make you a lot of money and it's making me more money than it should. Stay
00:14:0400:14:08
tuned for the close-up recap. All right for the close-up recap remember
00:14:0800:14:12
we're going to start with our subjective assessment and objective assessments, and
00:14:1200:14:16
of course the last assessment we're going to do is our palpation to try to
00:14:1600:14:21
give us an indication of where and which way we should manipulate, and what you're
00:14:2100:14:28
seeing me do here is that thumb to thumb on spinous process P-A, and I'm just going
00:14:2800:14:34
all the way to the end of arthrokinematic range, trying to feel the
00:14:3400:14:40
relative stiffness joint to joint and then of course my own internal model
00:14:4000:14:46
of stiffness at these joints based on my experience. To add another layer we could
00:14:4600:14:53
of course ask Yvette hey how does this feel? Sometimes what you'll get is the
00:14:5300:14:57
patient will complain about pain when you press on a particular segment which
00:14:5700:15:01
might help us get a little bit more dialed in with our manipulation
00:15:0100:15:05
techniques or soft tissue techniques. Then the other thing I'm going to do of
00:15:0500:15:09
course is that rotation, all right so you can see I'm on either side of spinous
00:15:0900:15:13
process and then I'm just zip zip, alright and then I'm going to
00:15:1300:15:16
switch my thumbs so that I rotate the other way. You
00:15:1600:15:20
see how that works, I think with a little bit of practice you will
00:15:2000:15:24
get pretty good at going all the way down the spine and starting to determine
00:15:2400:15:28
the direction here, and then we found that she
00:15:2800:15:36
moves, she gets stiffer as she goes down here so we might want to block like so,
00:15:3600:15:41
or we can block with a thumb like so on that spinous process just below the
00:15:4100:15:46
segment that we think is stuck, and then we're moving with the direction that she
00:15:4600:15:51
moved better. I know that's very odd and doesn't make a lot of sense but it does
00:15:5100:15:56
tend to work better based on assessment and outcomes, and then of course we're
00:15:5600:16:03
going to turn her head off the face hole here, or the face cut out of
00:16:0300:16:08
on this table which is immediately going to put us into extension, rotation and
00:16:0800:16:12
lateral flexion, and I'll spend a couple extra seconds trying to get a good
00:16:1200:16:15
lockout position, maybe a little bit more extension, maybe try a little bit more
00:16:1500:16:22
flexion, maybe try position a different part of her face, see if that helps. Try
00:16:2200:16:28
my thumb try my thenar eminence see which one gets the better lock. You do
00:16:2800:16:34
want to be quick in the sense that nobody likes to be in lockout position
00:16:3400:16:38
for long, but don't be in a hurry. Everything is set up 90-percent of this
00:16:3800:16:45
is finding that lockout position, and then once you find it all you have to do
00:16:4500:16:51
is one quick thrust and be done with it. So it's all set up, the thrust
00:16:5100:16:55
is just the icing on the top of the cake. If you have any questions on this
00:16:5500:16:59
whatsoever please feel free to leave them in the comments box below. A couple
00:16:5900:17:03
of points to recap, knowing your anatomy and knowing your biomechanics will
00:17:0300:17:07
certainly help you choose the right technique for the right patient. If
00:17:0700:17:11
you're unsure whether manipulations are appropriate due to their higher
00:17:1100:17:17
intensity it's okay to do mobilizations, most research points to manipulations
00:17:1700:17:21
being slightly more effective but mobilizations being very effective, and
00:17:2100:17:25
of course we have those videos for you if you want to start with those less
00:17:2500:17:30
intense techniques. Make sure that if you are doing any technique that is based on
00:17:3000:17:34
assessment, and of course that you're reassessing, ensuring that the technique
00:17:3400:17:38
is effective for the patient that you're working on, and when it comes to all
00:17:3800:17:43
techniques manipulations maybe more than any other look, for opportunities to
00:17:4300:17:49
get live education. Although I know videos are convenient and I'm happy to
00:17:4900:17:54
have these up for you to watch, it would be so much more helpful to use
00:17:5400:18:00
those videos as a recap of one-on-one attention with somebody who's
00:18:0000:18:07
experienced with manipulation techniques. At the very least grab a colleague, grab
00:18:0700:18:11
a friend and start practicing these before you bring them into clinic and
00:18:1100:18:16
start using them on patients and clients. I hope you enjoyed this video, if you
Related Videos
Upper Cervical Manipulation
Cervical Spine Manipulation
Cervicothoracic Junction Manipulation
Thoracic Spine Manipulation
Combined Deep Cervical Flexor and External Rotator Activation
Sacroiliac Joint Chicago Technique
Thoracic Pistol Manipulation
Radial Head Manipulation
Shotgun (Pubic Symphysis) Manipulation