Joint mobilization and manipulation is an excellent tool for improving mobility and pain for patients. The effects also can include increased muscle function, improved sensation and more. One of the issues that can be seen, however, is that patients may come back repeatedly with the same joint restrictions, requiring continued manual work. This is where it’s important that we follow up our manual techniques with some sort of exercise to lock in the changes. I typically use a form of repeated motions to maintain and often increase joint restrictions.
A common area of impairment and restricted mobility is the CT junction. On our Insider Access Page, we have reviewed quite a few manual techniques for increasing CT junction mobility, but maintaining those mobility improvements is especially difficult due to common postural faults. As you likely have seen in the clinic, people tend to sit with a forward head posture frequently which results in prolonged time spine spine in the upper thoracic flexion. When the extension mobility is not used, the patient tends to become increasingly stiff in that region. In the past, I have given repeated cervical retraction with extension to focus the motion at the CT junction, when symptoms and restrictions are bilateral or central. When symptoms are unilateral, I’ll check cervical retraction (full retraction!) with sidebend and look for a passive and active asymmetry. The patient then can do repeated cervical retraction with SB for repeated loading. When used properly, the exercise is extremely effective, however, I often find patients have a difficult time maintaining full retraction during the exercise. As a result, they fail to mobilize the lower cervical spine.
Recently I have been using a modification for self mobilization of the CT region. The lower cervical spine and thoracic spine have ipsilateral coupling. This means that sidebending and rotation occur at the same side with loading due to facet alignment. This can be utilized during mobilization by rotating to the restricted side fully and then sidebending ipsilaterally. I have found this technique is very effective in increasing CT junction mobility and patients are less likely to perform the technique incorrectly. Check out the video below for an exact demonstration of the technique.
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