Name: Upper Cervical Manipulation
Uploaded: 2023-04-26T01:01:54.000Z
Duration: 14 min 17 s
Description: Learn the proper technique for upper cervical manipulation with this step-by-step instructional video for clinicians and movement professionals. As part of an evidence-based treatment plan, this manual mobilization may assist in restoring cervical alignment, reducing pain, and enhancing range of motion for patients with neck and headache dysfunction.

English captions

https://stream.mux.com/cuTRZuBuHf7UI2nYjwSEVhzwvpbiQsjkwvLsH01gvUn4.m3u8

Learn the proper technique for upper cervical manipulation with this step-by-step instructional video for clinicians and movement professionals. As part of an evidence-based treatment plan, this manual mobilization may assist in restoring cervical alignment, reducing pain, and enhancing range of motion for patients with neck and headache dysfunction.

Introduction to High-Velocity Thrust Techniques

Upper Cervical Spine Manipulations

Technique Preparation and Rationale

Manipulation of C1 and C2 Vertebrae

Close-Up Recap of Manipulation Techniques

Final Tips for Successful Manipulation

Upper Cervical Manipulation

This is Brent of the Brookbush Institute and in this video we're going to go over manipulations or high-velocity thrust techniques. I assume that if you're watching this video you're watching it for educational purposes, and that you are a licensed professional with high velocity thrust or manipulation techniques in your scope of practice. If you are not sure check with your state board. Most physical therapists, chiropractors and osteopaths you're in the clear. I believe that ATC's you can't do manipulations in the United States, although other countries again check your scope. Of course massage therapists and personal trainers these are generally not within your scope. Of course you could continue to watch these videos just for educational purposes, learn a little Anatomy, learn a little biomechanics. If you're going to do these techniques please make sure that you have a good rationale for putting your hands on a patient, this should be based on assessment and if you're going to assess I'm hoping that you'll assess, use these interventions and reassess, to ensure that you're getting the result that you're looking for and have good reason to continue using this technique. In this video we're going to go over the upper cervical spine manipulations. I'm going to have my friend a Yvette come out, she's going to help me demonstrate. Now keep in mind if I'm doing a manipulation I'm doing it as part of an integrated intervention routine that's going to include things like soft tissue techniques and exercise, and of course follow up with a whole exercise program and I'm basing this on more than just subjective assessment. Although upper cervical spine manipulation we might be able to think symptoms would be cervical spine or maybe cervicogenic related, we still want to have movement assessment to be able to reassess if we had any effectiveness. We're still going after stiffness in these joints so don't forget about your visual range of motion exams with like rotation, flexion- extension, lateral-flexion, maybe lateral-flexion goniometry. I know your upper cervical segments don't laterally flex much, that doesn't mean that stiffness in the upper cervical spine won't change muscle activity enough to affect lateral flexion goniometry, and then two ranges of motion to think about a little bit are jut, or forward head, and nod or chin tuck. If somebody can't get to the ends of range of motion for these right, the very extreme end range of motion, they're restricted, that's a good sign that some upper cervical stuff is going on, because it's your upper cervical spine that allows you to extend your head as your lower cervical spine is flexing, and then as your lower cervical spine is extending it's also your upper cervical spine that allows you to tuck your chin. So these two ranges of motion can be very indicative of upper cervical spine restriction outside of just like maybe rotation. Now before we go into this technique, a teaching tip if you're new to manipulations, don't start here. Go ahead and go back to our cervical manipulation video, in that video I go over mid and lower cervical manipulations. Those techniques are much easier for several reasons, including blocking out the lower segments is easier because you have more to grab on to, finding the lock out position is easier because there's more motion to work with, and then actually getting the manipulation is a little easier because what your palpating during that is not so small. I think if you started here you're going to have a hard time palpitating what you need to palpate, moving in the tiny ranges of motion that you need to move, and feeling that walkout position is not the easiest thing in the world on this particular technique. Now to get into this particular technique I can tell you that if you're familiar with the cervical manipulation video we're still using this basic motion. So that's lateral flexion away, rotation toward with a little extension. Some differences we're going to do a little bit more of a forward head jut, we're also going to do a little bit more of a side glide than just pure lateral flexion. So before we get into the extension thing we need to come into this forward head position. Before we just laterally flex we want to side glide as much as we can. Now other weirdnesses, rather than being able to use, yeah I made up a word weirdnesses, all right second MCP, rather than being able to use my second MCP to lock out the spinous process and then bend over it to find locked position. I could only do that if I'm C2 and up, right because C2 has a spinous process but C1 doesn't. So maybe you want to try second MCP, find the highest spinous process, you can try to get your MCP there, jut, side bend and then you know I use cradle grip on my cervical manipulations. You could use open hand if you want to, but since I use cradle grip on my other manipulations I tend to like to use it here. Once I get side glide, jut, blocked out for C2 then I could side-bend then rotate a little bit, maybe a little traction I find helps, get her all locked up and then I can do my manipulation. But here's the tricky part what if I need to do C1, what if I want to do C1 on the occiput, right the atlanto-occipital joint, the a/o joint. I don't have a spinous process to use my second MCP on. I need something else, and the way to go is to block the transverse process of C1. Now if you've never palpated the transverse process of C1 it is just underneath the mastoid process. So here's what I'm going to recommend you do, find your earlobe, find your mastoid process, go just underneath your mastoid process if you don't feel a bump like a peg coming at you into your finger side bend away, and that transverse process should pop right into your finger. Once you do that on yourself try that little trick on hopefully your friend or colleague when you start, not a flared up patient I do not recommend practising these on flared up patients. So there's her transverse process of C1 right there, transverse process of C1 right there, right underneath each mastoid process. Great, so now I know what they are what do I do with them? Well what I'm going to do is if I'm trying to do a manipulation on this side, I'm actually going to wrap my hand around so i can use a comfortable hand position, because I'm usually using that second MCP. But this time I'm going to use my middle finger, and I'm going to push it into the back of the transverse process of C1, and push up this way to block out that vertebra. So that when I go to do my manipulation, this is blocked and I'm twisting on this blocked out vertebra. So the way that would look is here, find my transverse process, I can use both hands you got it locked in. Now I can use this palm to help control her head a little bit. Alright I can get into my quasi-cradle grip here, jut, side-bend, good. Now I can laterally flex, rotate, extend or flex, and I find a little traction helps a lot, and once I get her all locked up right if I feel like she's tense I'll have her do the breath thing. Breathe in, breathe out and then rotation is my primary movement, just like that. You notice I just tip. Alright so I tipped here, I did keep pressure with my forearm against her head right so that I got a little bit of lateral flexion too. At the very least when I rotated I don't want her coming out of lateral flexion. I'll show you what that looks like on the other side. All right so I'm going to find her transverse process, and remember you can use both hands. It's okay, take your time. Setup is 99% of this. I keep saying 90 in the other videos, I think 99% is where it's at, because even when I'm watching the videos I'm like I spent 15 minutes talking about setup, and the actual manipulation was nothing. So there's her transverse process, I'm going to make sure my fingers there right I can use this palm still to help control her head a little bit. I'm going to use this kind of quasi-cradle grip here. I'm going to jut a little bit, side glide this way, all right so I'm kind of, you can think of like kind of opening up the joint that you're trying to manipulate, side glide, rotate this way, lateral-flexion some extension on this side, I'm just kidding we're going to save that one for the close-up recap. So there you have it C1, fingertip via transverse process, C2 you can use your second MCP just like you did on the mid-cervical techniques. The only difference is it's harder to get on that spinous process because it's so close to the occiput, and you have to jut and side glide first to really make this technique work for you. Stay tuned for our close-up recap. For the close-up recap I'm going to show you the atlanto-occipital joint manipulation. I think you have the blocking of C2 with your second MCP down pretty good, but this ability to block out the C1 transverse process with the middle finger is a little complicated. So my suggestion is use both hands to find first the mastoid process and then the transverse process of C1, and you can use a little lateral flexion away to have that poke you right in the finger, and then I'm going to use this finger to get underneath that transverse process so that I can really get underneath it and like block it. Like right now I can, not that this would be great technique for a mobilization, but I can literally mobilize C1 on her occiput. Alright so if I feel like I got that type of purchase, that's when I'm ready to do this manipulation. So now I would jut, alright so pull her into a little bit of this forward head position, and I've removed the pillow this time just to make it a little easier for you to see. I'm now going to side glide towards the camera, alright so towards you and I'm going to try to use open hand technique here so you can the motions that I'm doing, because if I do cradle grip this close to the camera I'm going to block everything. But I'm going to keep my finger there, forward, side-glide, lateral flexion, rotation, get her all locked up; and then once I know I have her locked up maybe a little traction, and I can just rotate, and that's the manipulation. All right so I'm not quite as good as that open hand technique, for me and be a little bit more comfortable to get in here. Remember you're only going to go ahead and do your high-velocity thrust when you feel lock, and deep breath, and just like so. All right so a little scary for Yvette there, but no pain right. All right so practice that, remember you have your fingertips here, that you have to block the joint out with. A little bit of forward, a little bit of side glide, and a little bit of traction really helps with this technique, which then you can do your normal cervical manipulation motions; and then I would say the other big difference with this manipulation is it's almost totally a rotation for the actual manipulation. If you have any questions leave them in the comments box below. A couple of points to recap, knowing your Anatomy and knowing your biomechanics will certainly help you choose the right technique for the right patient. If you're unsure whether manipulations are appropriate due to their higher intensity, it's okay to do mobilizations. Nost research points to manipulations being slightly more effective but mobilizations being very effective, and of course we have those videos for you if you want to start with those less intense techniques. Make sure that if you are doing any technique that it is based on assessment, and then of course that you're reassessing, ensuring that the technique is effective for the patient that you're working on; and when it comes to all manual techniques, manipulations maybe more than any other, look for opportunities to get live education. Although I know videos are convenient and I'm happy to have these up for you to watch, it would be so much more helpful to use those videos as a recap of one-on-one attention with somebody who's experienced with manipulation techniques. At the very least grab a colleague and grab a friend, and start practising these before you bring them into clinic and start using them on patients and clients. I hope you enjoyed this video, if you have any questions please leave them in the comments box below.

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Learning cervical spine anatomy (bones, joints, actions, ligaments, muscles, palpation) is essential for addressing neck pain and optimal motion.

Cervical Spine Anatomy

Joint manipulations for the cervical spine. Types of manipulations, manipulations vs. mobilizations of the spine and cervical spine. Optimal intervention for forward head, shoulders elevate, arms fall, cervicogenic headache, radiculopathy, posture, jaw, shoulder, and elbow dysfunction. The risk of adverse events, accuracy vs sensitivity, screening, reliability, and validity of cervical spine manips. 

Joint Manipulation: Cervical Spine

It is recommended that mid-cervical manipulation is learned before this tricky technique.

The patient should be supine, with head and neck extending beyond the head of the table, or at the end of the table with a pillow as pictured in the video (either position can work for this technique).

The table should be as high as possible to reduce the amount of forward bending the therapist must perform to get into position.

It is recommended that these techniques are done with the therapist standing behind the patient's head.

Sitting is not recommended. It is very challenging, to achieve the ideal motion and velocity in a seated position.

It is not possible to use the "piano grip" for stiffness assessment for the upper cervical spine considering the occiput and C1 do not have spinous processes.

unilateral posterior-to-anterior cervical mobilization

 or by subjective assessment of "jut" and "nod"

Blocking the lower segment for C1/C2 can be performed similarly to the mid-cervical spine:

Press into the laminar trough and the highest spinous process you can palpate (C2 is the first vertebrae with a spinous process), on the side opposite the closed facet, with the second metacarpophalangeal (MCP) joint (the pad at the base of your index finger). It helps to press into the segment obliquely, in a lateral and vertical direction toward the opposite side ceiling.

Blocking for Occ./C1 requires a different hand position:

Wrap your hand under the cervical spine, and use the fingertip of the 2nd or 3rd finger to firmly press into the posterior aspect of the transverse process of C1 on the opposite side. Keep in mind, you are trying to block rotation in the same direction as your manipulation. It may also be helpful to attempt simultaneously blocking the spinous process of C2 with the MCP of the same finger/hand. This is tricky and takes practice.

Use the other hand to either cup the back of the head firmly with an open hand, or use the head cradle position. The head cradle position is recommended if new to this technique.

In the head cradle position the back of the crown of the patient's head is placed in the crease of the elbow, the top of the patient's head is often pressed against the upper chest, and the forearm courses behind or over the back of the ear toward the patient's cheekbone. The hand wraps around the bottom of the jaw. The head should be able to be controlled by the pressure between the chest forearm, and the opposite hand blocking the lower segment. Little if any pressure should be necessary on the chin.

Note: Again, this sounds more complicated than it probably is. Once the position is learned, it is fairly easy to replicate.

Maintaining pressure with the "blocking hand", gently protract (jut), side-glide away (generally, this takes a slight increase in pressure from the blocking hand as well to not lose lock of the bottom segment)

Contralaterally rotate the neck to end-range rotation. Adding a small amount of traction may help.

Add a little extension and adjust rotation and lateral flexion until you hit a relatively "solid" end feel. This is the lock position.

Important Note: 90% of manipulation technique is set-up. If you have not achieved lock-out in the previous steps, having great "thrust technique" will be rendered useless.

The motion is mostly contralateral rotation with a little lateral flexion.

You will need to rapidly twist the head and simultaneously increase pressure with the blocking hand to ensure you do not lose the block on the lower segment spinous process.

Visualize this small motion (maybe 2 - 3".). You are trying to force "one joint" past its resistance barrier.

Tip: have the patient take a deep breath or wiggle their toes. Your goal is to distract them so that they allow you to passively control their head and neck with as little muscle activity as possible.

Quickly, thrust the patient into the new position.

Without letting go of the patient's head, gently return the head to neutral position and passively test range of motion.

Upper Cervical Manipulation

Cuboid Manipulation

Sacroiliac Joint Chicago Technique

Thoracic Pistol Manipulation

Radial Head Manipulation

Shotgun (Pubic Symphysis) Manipulation

Lumbar Spine Joint Manipulation (High Velocity Thrust)

Wrist Manipulation

Talocalcaneal Manipulation

Talonavicular and Cuneonavicular Joint Manipulations

Proximal Tibiofibular Joint Manipulation

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