There has been a vast influx of evidence lately showing benefits of thoracic mobilization/manipulation, particularly the upper thoracic spine, cervical spine, lumbar spine, shoulder pain, elbow pain; well just about every type of pain!  It has been shown to be beneficial in all levels of evidence, including type 1 here.  A few pictures below:
Cross et al. JOSPT. September 2011.
Gonzales-Iglesias et al. JOSPT. 2009.
Here is a video of myself performing a version below.  To capture the hybrid component, I was saying in the video to look up (facilitate neck extension) and squeeze shoulders (facilitation retraction). Pending the type of patient that comes in the door, you can modify the technique for most appropriate action. Feel free to add comments.  
 
Positive: I like this technique as shown above for several reasons.
1.  This technique facilitates the opposite posture, or as Mike Reinold has coined (at least where I first read it): reverse posturing.  
 
2.  I am a huge fan of addressing the cervicothoracic junction.  There are many techniques for this area but many others put the patient in awkward positions and are simply not appropriate in many cases.  This technique can be used on majority of patients.
 
3.  You can provide as much force and perform what grade you feel is appropriate for the patient.  Meaning, you can perform high thrust or if not indicated, can perform more of a distraction pull, or even oscillate in a cephalad/posterior direction.  
 
Negative: reasons I don’t like this technique.
1.  Do ‘yourself’ no harm. For obvious reasons, don’t hurt yourself when working on large patients.  Ouch, my back!
2.  You can’t ‘feel’ the joints(s) to determine end feel as you can with other techniques.  There are not as many levers involved (you could technically put other levels into play) so this tends to lead to more force.  Some clinicians just yank the patients!  I don’t like this approach.
3. For individuals with quite a bit of pain and restrictions in GHJ, this position can be awkward for them.  
4. This technique is quite non-specific.  You can claim to work anywhere from lower cervical spine to upper thoracic spine.  Not a bad thing though and may should be filed under positive as studies have shown we are not as specific with our techniques as we think.  
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4 comments

  1. Great post Harrison. I really the the “Do yourself no harm” comment. I often find I employ some techniques in my practice that really leave a strain on me. So your comment was accurate as far as I’m concerned.

    If you were to thrust in the position you have your client in your video, would simpely just pull up with a high velocity thrust creating a quick tracttion at or about the CT junction?

    Thanks for the post!

  2. Jesse,
    Thanks for the comment. Yes, I typically would thrust in a posterior/cephalic direction in a high velocity manner. I always read you shouldn’t “lift” the person off the table per say, even though some clinicians name this the T1-3 lift-off maneuver.

    Someone of larger size (but not too large!) and notable hypomobility of the cervicothoracic junction will usually cavitate more than a lean individual.

    Hv

  3. Hi Harrison,

    great post. I’m an osteopath and as part of my role as a clinical educator, I spend most of my time trying to get my students to change they way they do things to minimise harm to themselves. Please don’t take offense, but I wanted to suggest a few modifications to address your “negative points” (simply because I think you might be able to get more out of this. If I’m wrong, apologies and mea culpa). I also adress the C/T junction on a regular basis and use a similar (yet different technique)
    1 – having your leg/knee up on the plinth I think automatically places greater balancing strain on your back. Have you tried simply having both feet on the floor, but with the plinth slightly higher?
    2 – I tend to place my hands clasped together at the level above the joint I’m targeting, with my palms touching the patient’s neck. their hands then rest on top of mine. It still doesn’t give you the same palpatory feedback as a pure supine thoracic thrust, or a supine cervical thurst method, but it helps.
    3: can’t argue there.
    4: Point number two helps with the specifity I find, as your hands allow you to block the joint above the area you want. I personally use my sternum as a applicator for below the joint, too, when patient morphology allows it.

    again please don’t take these the wrong way, I just want to help 🙂
    Phil

    1. Hey Phil,
      No problems at all, thanks for your feedback. I do agree with you on the leg positioning on the plinth. I do it both ways…pending on the table I have available at the office (such as the one this video is completed on is not high/low, and I’m just too short for the other way). I’ve changed my ways a bit more since this video was shot in that I will perform more repeated movements in CTJ Extension (such as leaning back in a chair with hands behind head) with or without P/A gliding or overpressure for bigger individuals.

      I’ll work on your other advice, definitely in this to learn and spread information; thanks for your feedback. I appreciate you checking out the blog, maybe I could get some videos or pics to link back to you somehow? What do you think?

      Harrison

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