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.

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.

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.

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.

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.

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.

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.

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.***

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.

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.

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.

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.

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.

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.

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.