Flexion to the Left extension to the Right o

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9.3.1 Flexion/Left Lateral Flexion/Left Rotation (o Fig. 9.1 c, d)

Patient Position

The patient is sitting. You are standing behind the patient to the right of center.

Grip

Put the finger tips of your right hand under the patient's chin. Hold the top of the patient's head with your left hand, just left of center. Your left hand and fingers point in the line of the diagonal. Give the resistance with the fingers and palm of that hand. To apply traction with your proximal hand, hook the carpal ridge of your left hand under the patient's occiput and lift in the line of the diagonal.

Elongated Position

The chin is elevated and the neck elongated. The extension is evenly distributed among the cervical and upper thoracic vertebrae. The head is rotated and tilted to the right. The chin, nose, and crown

of the head are all on the right side of the patient's midline. You should see and feel that the anterior soft tissues on the left side of the patient's neck are taut. None of the vertebral joints should be in a close-pack position. If you give traction through the neck, the patient's trunk lengthens and rotates to the right.

Body Position and Mechanics

Stand behind the patient, slightly to the right. Your shoulders and pelvis face the diagonal, your arms are aligned with the motion. Allow the patient's motion to pull your weight forward. Allow your body to move slightly forward.

Traction

Apply gentle traction by elongating the entire pattern.

Command

"Tuck your chin in. Bend you head down. Look at your left hip."

Movement

The patient's mandible depresses as the chin tucks with rotation toward the left. The neck flexes, following the line of the mandible, bringing the patient's head down towards the chest.

Resistance

Your right hand on the patient's chin gives traction along the line of the mandible and resists the rotation to the left. Your left hand on the patient's head gives a rotational force to the head back toward the starting position.

To give traction with this hand, hook the carpal ridge of your hand under the patient's occiput.

End Position

The patient's head, neck, and upper thoracic spine are fully flexed. The rotation and lateral flexion bring the nose, the chin, and the crown of the head to the left of the midline. The patient's nose points towards the left hip.

Alternative Patient Position

The patient may be prone on the elbows (with the therapist standing behind (O Fig. 9.2), or with the therapist standing in front (O Fig. 9.3), supine (O Fig. 9.4), or in a side lying position (O Fig. 9.5).

Side Lying Hip Flexion Extension

Fig. 9.2a,b. Neck flexion to the left, prone on elbows

Fig. 9.2a,b. Neck flexion to the left, prone on elbows b a

Fig. 9.3a,b. Neck flexion to the left, prone on elbows with therapist in front
Fig. 9.4a,b. Neck flexion to the left, in supine

9.3.2 Extension/Right Lateral Flexion/ Right Rotation (o Fig. 9.6)

Patient Position

The patient is sitting. You are standing behind the patient to the right of center.

Grip

Put your right thumb on the center of the patient's chin. Hold the top of the patient's head with your left hand, just right of center. Your left hand and fingers point in the line of the diagonal. With this hold, give the resistance with the palm and carpal ridge of your hand. To traction with your proximal hand, hook the carpal ridge under the occiput.

Elongated Position

The chin is tucked and the neck flexed. The head is rotated and tilted to the left. The patient's chin, nose, and crown of the head are all on the left side of the midline. You should see and feel that the posterior soft tissues on the right side of the patient's neck are taut. None of the vertebral joints should be in a close-pack position. If you give traction through the neck, the patient's trunk flexes and rotates to the left.

Body Position and Mechanics

Stand behind the patient, slightly to the right. Your shoulders and pelvis face the diagonal, your arms are aligned with the motion. Allow the patient's motion to push your weight back, and allow your body to move away from the patient.

Traction

Apply gentle traction to the skull to elongate the neck. Gently compress on the chin through the line of the mandible.

Command

"Lift your chin. Lift your head. Look up." Movement

The patient's mandible protrudes and the chin lifts with rotation toward the right. The neck and upper thoracic spine extend, following the line of the mandible. The patient's neck and upper spine elongate as the head comes up.

Resistance

Your right hand on the patient's chin compresses along the line of the mandible and resists rotation to the right. Your left hand on the patient's head gives a rotational force to the head back toward the starting position. Use traction through the head during a

Fig. 9.6a,b. Neck extension to the right in sitting

Fig. 9.6a,b. Neck extension to the right in sitting a

Prone Elbows Head Flexion Cough

Fig. 9.7a,b. Neck extension to the right, prone on elbows

Fig. 9.7a,b. Neck extension to the right, prone on elbows the first part of the motion. As the neck approaches the extended position, you may apply gentle compression through the top of the patient's head.

End Position

The patient's head, neck, and upper thoracic spine are extended with elongation. The rotation and lateral flexion bring the nose, the chin, and the crown of the head to the right of the midline.

! Caution

Do not allow excessive extension in the mid-cervical area. The neck must elongate, not shorten.

Alternative Patient Positions

The patient may be prone on the elbows with the therapist standing behind (O Fig. 9.7) or standing in front, supine, or in a side lying position.

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