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Clinical Pearl Details
Kevin E. Baker, MSR, PT, FAAOMPT -
Blair Johnson, PT, RN, ATC, FAAOMPT -
Chris Frentz, DPT -
||Muscle energy rotational mobilization of the atlanto-axial joint.
This maneuver should not be painful, nor provoke headache. Either is cautionary.
||Indicated for limited cervical rotation,
sub-occipital soft tissue tightness, tension headaches. Palpation
reveals hyper-tonicity in the sub-occipital area. Cervical rotation is
limited by upper cervical tightness. Actual or impending tension-type
headaches might be present.
||The patient is supine with their head at the edge of
the table. The table height is adjusted for therapist comfort. The
therapist is positioned to the left of the patient's head which is in
contact with the right side of the therapist's chest (Figure 1). The
therapist's left hand (web space of digits I and II) is positioned to
block C2. The palm of the right hand cradles the occiput while digit II
rests just proximal to digit II of the left hand.
||The therapist tightens the contacts and asks the
patient to turn their head to the left (against the therapist's
immovable chest). The isometric force is sustained about 6 seconds
(Figure 2). As the patient relaxes, the head is rotated to the right
(active, passive or active assisted) until C2 abuts the left hand
contact. At this point, rotation to the right is stopped and the
maneuver is repeated (Figure 3). This maneuver can be repeated several
times as long as rotation is increasing or the patient reports a sense
||Taught by Bjorn Svendsen, DHSc, PT, FAAOMPT