Patient supine. Therapist at cranial end of table facing the patient. The radial side of the left index finger is placed to provide fixation on the left side of the caudal vertebra on the posterior medial side of the TP. The radial side of the therapist’s right index finger is placed on the right side of the cranial vertebra just posterior medial of the TP. The right hand moves the cranial vertebra in lateral direction. Test on both sides. Evaluate range and quality of movement, including endfeel. May be used to identify hypermobility.
 
Joint mobilizations
Upper cervical manual traction, seated
Cup hands under occiput. Slightly extend the head to put O - A in the resting position. Distract.
Upper cervical manual distraction, supine
One hand cups the chin, the other molds around the occiput. Put little finger and hypothenar on occipital edge. Primary traction force is at the occiput.
Flexion mobilization O - A
Web space and index finger on occiput. Index finger other hand on C 1. Delto-pectoral groove on fore head. Flex head. Roll is provided by hand under occiput, glide provided by delto-pectoral groove pushing in A - P direction.
Alternative: One hand on patient forehead, thumb and indexfinger of other hand stabilize C1. Hand on forehead produces upper cervical flexion.
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