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University of Delaware Physical Therapy Advanced Orthopedics
Cervical-Thoracic Forward Bending
Patient Position: The patient is positioned seated in a stool or
chair. Therapist Position: The therapist stands at the patients
side. Stabilizing / Mobilizing Hand: The therapist places the hand
of the anterior arm on top of the patients head (vertex hold). The
therapists palms and fingers should be relaxed and should follow
the contour of the patients head. This hand is used to create a
forward bending movement. Palpating Hand: The therapist palpates
with the other hand placing the middle finger in the interspinous
space. The therapist will feel for separation of adjacent spinous
processes. Segmental Test: The therapist forward-bends the patients
head. The cephalic spinous process will move upward on the caudal
spinous process, creating a separation. The therapist tests for the
amount of separation of the segment, the velocity of separation
between the vertebrae and the resistance of the soft tissue to
movement.
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University of Delaware Physical Therapy Advanced Orthopedics
Cervical-Thoracic Backward Bending
Patient Position: The patient is positioned seated in a stool or
chair. Therapist Position: The therapist stands at the patients
side. Stabilizing / Mobilizing Hand: The therapist allows the
patients head to rest on his/her anterior shoulder. The therapist
then wraps this arm around the patients head. The therapist cradles
the patients head and grasps the occiput with a conforming grip.
This arm is used to create a backward bending movement. Palpating
Hand: The therapist palpates with the other hand placing the middle
finger in the interspinous space. The therapist will feel for
approximation of adjacent spinous processes. Segmental Test: The
therapist backward-bends the patients head. The cephalic spinous
process will move downward on the caudal spinous process, creating
an approximation. The therapist tests for the amount of
approximation of the segment, the velocity of approximation between
the vertebrae and the resistance of the soft tissue to
movement.
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University of Delaware Physical Therapy Advanced Orthopedics
Cervical-Thoracic Rotation
Patient Position: The patient is positioned seated in a stool or
chair Therapist Position: The therapist stands at the patients
side. Stabilizing / Mobilizing Hand: The therapist places the hand
of the anterior arm on top of the patients head (vertex hold). The
therapists palms and fingers should be relaxed and should follow
the contour of the patients head. This hand is used to create a
rotation movement. Palpating Hand: The therapist palpates with the
other hand placing the middle finger in the interspinous space. The
therapist will palpate for the lateral excursion of cephalic
spinous process on the caudal spinous process. Segmental Test: The
therapist will rotate the patients neck towards him/her. The
therapist tests for the amount of lateral excursion of the adjacent
spinous processes, the velocity of excursion between the vertebrae
and the resistance of the soft tissue to movement.
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University of Delaware Physical Therapy Advanced Orthopedics
Cervical-Thoracic Sidebending
Patient Position: The patient is positioned seated in a chair or
a stool. Therapist Position: The therapist stands at the patients
side. Stabilizing / Mobilizing Hand: The therapist places the hand
of the anterior arm on top of the patients head (vertex hold). The
therapists palms and fingers should be relaxed and should follow
the contour of the patients head. This hand is used to create a
rotation movement. Palpating Hand: The therapist palpates with the
other hand placing the middle finger in the interspinous space. The
therapist will palpate for side bending excursion of cephalic
spinous process on the caudal spinous process. Segmental Test: The
therapist will side bend the patients neck towards him/her. The
therapist tests for the amount of side bending excursion of the
adjacent spinous processes, the velocity of excursion between the
vertebrae and the resistance of the soft tissue to movement.
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University of Delaware Physical Therapy Advanced Orthopedics
Mid-Cervical Downglide in Neutral
Patient Position: The patient is positioned supine with a thin
pillow under the neck and the cervical spine in a neutral position.
Therapist Position: The therapist is standing or sitting at the
head of the treatment table. Stabilizing / Mobilizing Hand: The
therapist uses an MCP contact on the articular pillar of the
superior vertebra of the vertebral segment. Supporting Hand: The
therapist conformingly cradles the patients occiput allowing the
head to pivot in the palm of the hand. Segmental Test: The
therapist uses the mobilizing hand to provide a gentle springing
force in a caudal and medial direction following the plane of the
joint. The supporting head gently allows/facilitates rotation and
sidebending to the side of the joint being contacted. The amount of
excursion and resistance to motion are felt and compared to the
opposite side and differences are identified.
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University of Delaware Physical Therapy Advanced Orthopedics
Mid-Cervical Downglide in Forward Bending
Patient Position: The patient is positioned supine with a thin
pillow under the neck and the cervical spine in a forward-bent
position. Therapist Position: The therapist is standing or sitting
at the head of the treatment table. Stabilizing / Mobilizing Hand:
The therapist uses an MCP contact on the articular pillar of the
superior vertebra of the vertebral segment. The therapist
conformingly cradles the patients occiput allowing the head to
pivot in the palm of the hand. Supporting Hand: The therapist
conformingly cradles the patients occiput allowing the head to
pivot in the palm of the hand. Segmental Test: The therapist uses
the mobilizing hand to provide a gentle springing force in a caudal
and medial direction following the plane of the joint. The
supporting head gently allows/facilitates rotation and sidebending
to the side of the joint being contacted. The amount of excursion
and resistance to motion are felt and compared to the opposite side
and differences are identified.
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University of Delaware Physical Therapy Advanced Orthopedics
Mid-Cervical Downglide in Backward Bending
Patient Position: The patient is positioned in supine with a
thin pillow under the neck and the cervical spine in a
backward-bent position. Therapist Position: The therapist is
standing or sitting at the head of the treatment table. Stabilizing
/ Mobilizing Hand: The therapist uses an MCP contact on the
articular pillar of the superior vertebra of the vertebral segment.
The therapist conformingly cradles the patients occiput allowing
the head to pivot in the palm of the hand. Supporting Hand: The
therapist conformingly cradles the patients occiput allowing the
head to pivot in the palm of the hand. Segmental Test: The
therapist uses the mobilizing hand to provide a gentle springing
force in a caudal and medial direction following the plane of the
joint. The supporting head gently allows/facilitates rotation and
sidebending to the side of the joint being contacted. The amount of
excursion and resistance to motion are felt and compared to the
opposite side and differences are identified.
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University of Delaware Physical Therapy Advanced Orthopedics
Mid-Cervical Downglide Test Interpretation Right-sided Downglide
Restriction felt in Neutral
- IF the restriction is more noticeable in forward bending and
less noticeable in backward bending, THEN the restriction is an
UPGLIDE restriction on the LEFT.
- IF the restriction is less noticeable in forward bending and
more noticeable in
backward bending, THEN the restriction is a DOWNGLIDE
restriction on the RIGHT.
Right-sided Downglide Hypermobility felt in Neutral
- IF the hypermobility is more noticeable in forward bending and
less noticeable in backward bending, THEN the restriction is an
UPGLIDE hypermobility on the LEFT.
- IF the hypermobility is less noticeable in forward bending and
more noticeable in
backward bending, THEN the hypermobility is a DOWNGLIDE
restriction on the RIGHT.
***More or Less Noticeable refers to the relative difference of
the segmental mobility in the bilateral comparison.***
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University of Delaware Physical Therapy Advanced Orthopedics
O-A Forward Bending (SMT)
Patient Position: The patient is positioned supine with the head
on the table. Therapist Position: The therapist is standing or
seated at the head of the table. Stabilizing / Mobilizing/Palpating
Hand: The therapist cradles the occiput with both hands and lays
his/her thumbs on both zygomas. Segmental Test: The therapist
creates a forward bending force-couple between the cradling fingers
on the occiput and the thumbs resting on the zygoma. The amount of
excursion and the resistance to movement are palpated through the
thumbs.
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University of Delaware Physical Therapy Advanced Orthopedics
O-A Backward Bending (SMT)
Patient Position: The patient is positioned supine with the head
on the table. Therapist Position: The therapist is standing or
seated at the head of the table. Stabilizing / Mobilizing/Palpating
Hand: The therapist cradles the occiput with both hands and lays
his/her thumbs on both zygomas. Segmental Test: The therapist
creates a backward bending force-couple between the cradling
fingers on the occiput and the thenar eminences resting on the
zygoma. The amount of excursion and the resistance to movement are
palpated through the thenar eminences.
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University of Delaware Physical Therapy Advanced Orthopedics
O-A Side Bending (SMT)
Patient Position: The patient is positioned supine with the head
on thin pillow. Therapist Position: The therapist is standing or
sitting at the head of the table Stabilizing / Mobilizing/Palpating
Hand: The therapist cradles both sides of the patients head with
the palm of the hands. The therapists fingers are pointing towards
the patients feet. The long finger of each hand palpates the
transverse process of the atlas and the proximal aspect of the long
finger palpates the mastoid process bilaterally. Segmental Test:
The therapist tilts the patients head into side bending on the
atlas with a force couple generated between the two hands.
Approximation between the mastoid and the transverse process on the
same side is palpated.
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University of Delaware Physical Therapy Advanced Orthopedics
A/A Rotation in Forward Bending
Patient Position: The patient is positioned in supine with a
flat pillow under the head and the head held in FULL forward
bending. Therapist Position: The therapist is standing at the head
of the table. Stabilizing / Mobilizing Hand: The therapist cradles
each side of the patients head with the palms on the occiput and
the thumbs resting on both zygomas. Segmental Test: The therapist
brings the patients neck into FULL forward bending to take-up the
soft-tissue slack in the mid-cervical spine. The therapist then
brings the patients head into rotation to one side. The amount of
motion and resistance to motion are assessed and compared
bilaterally.
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University of Delaware Physical Therapy Advanced Orthopedics
A-A Rotation in Side Bending with Counter Rotation
Figure A Figure B
Patient Position: The patient is positioned supine with the head
on a thin pillow. Therapist Position: The therapist is standing at
the head of the table. Stabilizing / Mobilizing Hand: The therapist
cradles each side of the patients head with the palms on the
occiput and the thumbs resting on both zygomas. Segmental Test: The
therapist brings the patients head and neck into end-range side
bending (Figure A). The therapist then rotates the patients head in
the opposite direction of the side bending (Figure B). The amount
of motion and the resistance to motion are assessed and compared
bilaterally. This A-A test is the most specific.
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University of Delaware Physical Therapy Advanced Orthopedics
The Vertebral Artery Test
Figure A Figure B
Figure C
Patient Position: The patient is positioned supine with the head
on a pillow. Therapist Position: The therapist is positioned
sitting or standing at the head of the table. Stabilizing /
Mobilizing Hand: The therapist cradles both sides of the patients
head with the thumbs resting on the mandible and pointing towards
the patients feet. Segmental Test: The therapist gently backward
bends the patients occiput (Figure A). The therapist then slowly
moves the patients head into side bending to end-range (Figure B).
Third, the therapist then rotates the patients head in the same
direction as the side bending (Figure C). The therapist should
engage the patient in light conversation and observe the patients
eyes for nystagmus, pupillary changes or visual disturbances.
Question the patient regarding vertigo/dizziness. STOP the test if
the patient demonstrates any of the previously mentioned signs or
symptoms.
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University of Delaware Physical Therapy Advanced Orthopedics
O-A Forward Bending Mobilization
Patient Position: The patient is positioned supine with the head
on a thin pillow. Therapist Position: The therapist is sitting or
standing at the head of the table. Stabilizing / Mobilizing Hand:
The therapist cradles the patients occiput with one hand and places
his/her anterior shoulder on the patients forehead. The opposite
hand rests along the ramus of the mandible with the fingertips
resting on the tip of the mandible. Mobilization: To create a
forward bending mobilization force at the right O-A, the therapist
places the patients head in a few degrees of left side-bending and
right rotation at O-A. He/she then creates a forward bending
force-couple between his/her shoulder and the hand that is cradling
the occiput. The opposite hand resting on the mandible provides
gentle assistance to maintain the neck in axial extension. The
magnitude of the mobilizing force and amplitude are determined by
the patients reactivity level.