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NMT: Cervical Spine


NMT 3 and 5 notes

ASSESSMENTS
C0-C1 (Egg on spoon)
Lateral Flexion
Cervical Leg Length

SOFT TISSUE TECHNIQUES
Cranial Base Release
Thoracic Inlet Release
PIR stretch
-SCM
-Ant Scalene
-Upper Trap
-Lev Scap

MOBILIZATIONS
Occipital Drawer Pull
MET C0-C1 flexion
Lateral flexion
Rotation: Cross Body Pull and Bucket Handle

****************************************************

ASSESSMENTS

C0-C1 (Egg on spoon)
pt supine
hands spanning from pinkies at occiput to thumbs at crown
neck straight, rock head forward on C1
side bend to each side and rock forward

Lateral Flexion
hold head in one hand, press lateral bodies with other
work down from mastoid on one side
side bending neck toward sensing hand
while pressing vert to see if they move

Cervical Leg Length
pt supine
assess leg length at medial malleolus with feet talus neutral
(evert & dorsiflexed)
release feet
have pt turn head on headrest
reassess leg length
let go, have pt turn neutral
reassess
turn other way
reassess
turn neutral
if findings, assess and fix cx spine
reassess in neutral and in head turn where findings were

SOFT TISSUE
Cranial Base Release
pt supine
slide fingertips from occiput posteriorly into groove with suboccipital muscles
rest pts head on fingertips of both hands
my fingers straight, using lumbrical muscles and stacked bone to hold weight of head
pts neck gradually releases, faster with conscious relaxation, breathing
hold a minute or more
head eventually falls into palm
give C1 the finger
mid finger to sp of C1 to traction between C1 and C0
hold a few seconds
release

Thoracic Inlet Release
pt supine
seated on stool at pt head, poised, no slumping
thumbs behind pts neck
fingers splay across clavicles
both thumbs and forefingers contact skin
move three directions:
1) shift laterally L and R
slowly, wait at each resistance to see if it will release more
breathe
2) shift rotationally like steering wheel
3) press each side down and let other lift
4) do slow circles around pt's long axis (not on test)

PIR stretch
medium stretch 1st
then stabilize pts body in long muscle position and have them resist
attempt to contract the long muscle against your hold
isometrically so that neither you nor they move
the goal not being to overpower, but rather to tire the muscle
have pt hold exertion 5-7 seconds
passively or actively assist stretch between
muscle may gain considerable length but don't push it
repeat 3 times ish
end with stretch
passively return to supported neutral position
I don't understand why this has to be passive
is it possible that the stretched muscle might be so far extended
that it couldn't lift the limb
against gravity
without risking injury?
Or is there some other reason?
I just overstretched my own left anterior scalene.
This shit's dangerous, don't try it at home.

-SCM
R SCM, rot R, side bend L, extend
ask pt to rotate to L into hand

-Ant Scalene
extend and lat flex away
anchor clavicle
have pt flex forward vs hand on forehead

-Upper Trap
side bend away
anchor shoulder
cross arms
move head vs hand
relax
shrug vs hand
relax

-Lev Scap
seated pt
arm on shoulder
grab head with forearm
pt look at opp thigh
lift head and shrug alternating
relax and stretch between

-General neck--
Dr Irving doesn't target just one muscle
has a set of neck PIR that he uses to generally mobilize a tight neck

MOBILIZATION

Occipital Drawer Pull
using egg on spoon find restriction at C0-C1
sidebend away from rstrx (unless it's bilateral)
sink fingers into mm below side of occiput
Agresta uses side of index finger under occipital ridge
rotate head onto hand
place other fore-hand on TMJ
traction occiput up and away from nose
anchoring temple twd body and occiput
this stretches the capsule and ligaments
Agresta thinks grade 5 works best: thrust involves pull with lower hand, push with upper

MET C0-C1 flexion
do egg on spoon double chin motion and hold
have pt lift chin vs resistance of thumbs
hold a few secs then relax, passively flex head farther

Lateral flexion (mb concurrent with rotation restriction, bucket handle may work)
locate vertebra to be mobilized
on that vert take tissue push toward floor with side of index finger
cave neck around finger, rot away
execute grade 1-5 mobilization

ROTATION: Cross Body Pull and Bucket Handle

BUCKET HANDLE
very effective high payoff maneuver
doc position at head feet and shoulders parallel, knees bent
locate misaligned vertebra
place lateral side of index finger below 1st IP joint
on posterior pillar, allows wrist movement
fingers on posterior aspect of lateral body of stuck vert
tissue pull is central to lateral (upward too)
cave toward (laterally flex), translate vert away, last: rotate away
may step to side to rotate away, keep moving until pt locks up
elbow of skull hand is out: bucket handle
mobilize with thrust toward upper lip or so, at angle of facet plane
doc shoulder should not move

DR BECK'S VARIATION
like bucket handle except thumb on posterior pillar
fingers splay across cheek

CROSS BODY PULL
locate vertebra with rotation restriction, leave finger on posterior pillar of it
realign body across from finger
replace finger with opp hand middle finger, take tissue pull
cave toward, translate, and rot away
don't wobble around at endpoint, just hold and thrust
mobilize

SOURCES
lectures by Drs Agresta, Frangos, Irving

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