Other cervical spine treatments

Below are several techniques that are less commonly taught at osteopathic schools and / or rarely tested on the COMLEX® exams. These lists are not fully inclusive but are meant to highlight some of the most common or useful applications of each technique. The exception to this is suboccipital release, which is very frequently used in practice and tested on examinations.

ARTICULATORY

Diagnosis: Cervical rotation somatic dysfunction

With the patient lying supine, rotate the head and neck to the side of restriction and support the patient’s head so that your forearm is across the cheekbone and your fingers are at the mandible
Cradle the occiput with your other hand
Use the edge of the proximal third finger to spring into the barrier, hold briefly, and return to neutral
Repeat motion in a slow, rhythmic fashion

Diagnosis: Cervical sidebending somatic dysfunction

With the patient lying supine, place the palmar aspect of third finger against a specific joint level at the lateral articular pillar; it will act as a fulcrum on the side opposite of the restriction
Grasp the posterior aspect of the head with the opposite hand
Use lateral translation to induce side bending against the barrier
Return to neutral and repeat in a slow, rhythmic fashion

BALANCED LIGAMENTOUS TENSION

OA Joint

Example diagnosis: OA E S_LR_R

With the patient lying supine, stand / sit at the head of the table and palpate the patient’s C1 transverse processes
Lift the C1 transverse processes to produce a relative position of ease at the OA joint (extended, side bent left, rotated right in this case)
Gently side bend left and rotate right until a point of balanced tension is palpated
Hold this position until a release is palpated

AA Joint

Example diagnosis: AA R_L

With the patient lying supine, stand / sit at the head of the table and palpate the patient’s C2 articular processes
Lift the C2 articular processes to produce a relative position of ease at C1 (rotated left in this case)
Gently rotate C1 to the right until a point of balanced tension is palpated
Hold this position until a release is palpated

C2–C7

Example diagnosis: C4 F S_RR_R

With the patient lying supine, stand / sit at the head of the table and palpate the patient’s C5 articular processes
Lift the C5 articular processes to produce a relative position of ease at C4 (side bent right, rotated right in this case)
Gently rotate C4 to the right, and add axial compression from the top of the head toward C4, until a point of balanced tension is palpated
Hold this position until a release is palpated

SOFT TISSUE

Supine traction

With the patient lying supine, sit at the head of the table
Cradle the occiput with one hand and place the other hand across the patient’s forehead or under the chin
Exert cephalad traction with both hands in a neutral and slightly flexed position to avoid extension
Apply and release the tractional force slowly; increase the amplitude per patient tolerance

Bilateral forearm fulcrum, forward bending method

With the patient lying supine, sit at the head of the table
Cross your arms under the patient’s head and place your palms on the anterior shoulders
Gently flex the patient’s neck with your forearms, producing a longitudinal stretch of the cervical paravertebral musculature

Suboccipital release

With the patient lying supine, sit at the head of the table
Place finger pads in the patient’s suboccipital region
Gently apply anterior and superior pressure into the tissues until a release is palpated

Lateral traction with shoulder block, supine

With the patient lying supine, sit at the head of the table
Place one palm on top of the patient’s shoulder on the side to be treated
Place your other hand across the patient’s head / face to contact the paravertebral musculature contralateral to that hand
Gently move the head until the restrictive barrier is met and hold the position for 3–5 seconds, then slowly return the head to neutral

Author: Arman Israelyan, OMS-III

Editor: Matt Lipinski, DO

Editor: Robyn Hughes, MScBMC

Other cervical spine treatments

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