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Mobilizing the CT Junction

10/21/2015

5 Comments

 
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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.

-Chris



You may have seen some posts earlier on our site about OPTIM Physical Therapy. Several months ago, Chris and Jim joined OPTIM Physical Therapy to create a COMT program based out of Scottsdale, AZ. The mission of the program is to create a residency-like experience for those who are unable to make the financial and location commitment. The program consists of 6 weekend-long courses on-site, in addition to Medbridge courses and online mentoring between classes. Throughout the year, the class as a whole will improve their clinical skills and reasoning while working as a team. Check out www.optimfellowship.com for more information. Only a few spots remain for the year's cohort!
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Like this post? Then check out the Insider Access Page for advanced content! And check out similar posts below!
Repeated Motions Exam & Treatment: Why You Should Be Using It
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Communication is Key When Assessing Repeated Motions
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5 Comments
Lindsy Campbell link
10/21/2015 08:56:33 am

Hey Chris, Thanks for this post. If a patient has equal cervical side bending and rotation to the L & R but definitive L sided pain with radicular symptoms down the L UE, to which direction would you suggest they rotate/side bend? Do you find a consistent pattern as far as rotating/side bending towards or away from the side of pain or is trial and error necessary while monitoring symptom response to determine the correct motion?

Reply
Chris link
10/21/2015 05:30:29 pm

Hi Lindsy,

Thanks for your question. What I recommend is check the passive mobility for each of those first and look for an asymmetry. Typically you will find a loss of motion to the involved side (it may be subtle). You then want to repeated load the involved side, if hypomobile. This would mean in your patient's case to do so on the L. This is assuming all other factors are equal.

Reply
Lindsy Campbell link
10/23/2015 08:59:03 am

That worked! thanks

Glenn
10/21/2015 01:43:15 pm

My neuro professor said there has been no evidence through research conducted regarding spinal manipulations and their influence on the nervous system.

Reply
Chris link
10/21/2015 05:28:59 pm

Hi Glenn,

Thanks for your comment. While no direct studies have been produced that demonstrate that, it is the most accepted theory currently due to the high amount of evidence against biomechanical changes. Shirley Sahrmann has said herself that it will be impossible to "prove" changes via the nervous system.

Reply



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  • Home
  • About Us
  • Insider Access
    • About Insider Access
  • Online Courses
    • Hooper's Knee
    • Physical Therapist Entrepreneur Course
    • Physical Therapist Consultant Course
    • Orthopedic Management of the Cervical Spine
    • Return to Sport Essentials Course
  • Resources
    • Newsletter
    • Business Minded Sports Physio Podcast
    • Day in the Life of a Sports PT
    • Residency Corner
    • Special Tests >
      • Cervical Spine >
        • Alar Ligament Test
        • Bakody's Sign
        • Cervical Distraction Test
        • Cervical Rotation Lateral Flexion Test
        • Craniocervical Flexion Test (CCFT)
        • Deep Neck Flexor Endurance Test
        • Posterior-Anterior Segmental Mobility
        • Segmental Mobility
        • Sharp-Purser Test
        • Spurling's Maneuver
        • Transverse Ligament Test
        • ULNT - Median
        • ULNT - Radial
        • ULNT - Ulnar
        • Vertebral Artery Test
      • Thoracic Spine >
        • Adam's Forward Bend Test
        • Passive Neck Flexion Test
        • Thoracic Compression Test
        • Thoracic Distraction Test
        • Thoracic Foraminal Closure Test
      • Lumbar Spine/Sacroiliac Joint >
        • Active Sit-Up Test
        • Alternate Gillet Test
        • Crossed Straight Leg Raise Test
        • Extensor Endurance Test
        • FABER Test
        • Fortin's Sign
        • Gaenslen Test
        • Gillet Test
        • Gower's Sign
        • Lumbar Quadrant Test
        • POSH Test
        • Posteroanterior Mobility
        • Prone Knee Bend Test
        • Prone Instability Test
        • Resisted Abduction Test
        • Sacral Clearing Test
        • Seated Forward Flexion Test
        • SIJ Compression/Distraction Test
        • Slump Test
        • Sphinx Test
        • Spine Rotators & Multifidus Test
        • Squish Test
        • Standing Forward Flexion Test
        • Straight Leg Raise Test
        • Supine to Long Sit Test
      • Shoulder >
        • Active Compression Test
        • Anterior Apprehension
        • Biceps Load Test II
        • Drop Arm Sign
        • External Rotation Lag Sign
        • Hawkins-Kennedy Impingement Sign
        • Horizontal Adduction Test
        • Internal Rotation Lag Sign
        • Jobe Test
        • Ludington's Test
        • Neer Test
        • Painful Arc Sign
        • Pronated Load Test
        • Resisted Supination External Rotation Test
        • Speed's Test
        • Posterior Apprehension
        • Sulcus Sign
        • Thoracic Outlet Tests >
          • Adson's Test
          • Costoclavicular Brace
          • Hyperabduction Test
          • Roos (EAST)
        • Yergason's Test
      • Elbow >
        • Biceps Squeeze Test
        • Chair Sign
        • Cozen's Test
        • Elbow Extension Test
        • Medial Epicondylalgia Test
        • Mill's Test
        • Moving Valgus Stress Test
        • Push-up Sign
        • Ulnar Nerve Compression Test
        • Valgus Stress Test
        • Varus Stress Test
      • Wrist/Hand >
        • Allen's Test
        • Carpal Compression Test
        • Finkelstein Test
        • Phalen's Test
        • Reverse Phalen's Test
      • Hip >
        • Craig's Test
        • Dial Test
        • FABER Test
        • FAIR Test
        • Fitzgerald's Test
        • Hip Quadrant Test
        • Hop Test
        • Labral Anterior Impingement Test
        • Labral Posterior Impingement Test
        • Long-Axis Femoral Distraction Test
        • Noble Compression Test
        • Percussion Test
        • Sign of the Buttock
        • Trendelenburg Test
      • Knee >
        • Anterior Drawer Test
        • Dial Test (Tibial Rotation Test)
        • Joint Line Tenderness
        • Lachman Test
        • McMurray Test
        • Noble Compression Test
        • Pivot-Shift Test
        • Posterior Drawer Test
        • Posterior Sag Sign
        • Quad Active Test
        • Thessaly Test
        • Valgus Stress Test
        • Varus Stress Test
      • Foot/Ankle >
        • Anterior Drawer
        • Calf Squeeze Test
        • External Rotation Test
        • Fracture Screening Tests
        • Impingement Sign
        • Navicular Drop Test
        • Squeeze Test
        • Talar Tilt
        • Tarsal Tunnel Syndrome Test
        • Test for Interdigital Neuroma
        • Windlass Test