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:
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.