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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James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
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