Return to List of Clinical Pearls

Clinical Pearl Details

May 2010

Kevin E. Baker, MSR, PT, FAAOMPT -
Blair Johnson, PT, RN, ATC, FAAOMPT -
Chris Frentz, DPT -

Technique: Muscle energy rotational mobilization of the atlanto-axial joint.
General: PRECAUTION: This maneuver should not be painful, nor provoke headache. Either is cautionary.
Indication: 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.
Positioning: 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.
Instruction: 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 of relief.
References: Taught by Bjorn Svendsen, DHSc, PT, FAAOMPT
figure 1
Figure 1
figure 2
Figure 2

figure 3
Figure 3