Still technique is a passive technique, meaning the patient should not be actively contracting their muscles. It is both indirect and direct. Remember that Still technique is performed by placing the patient in a position of ease (indirect portion), applying a vector force (compression or, less commonly, distraction), then moving the dysfunctional area back to the position of restriction (direct portion). The starting position will always be the patient’s somatic dysfunction (position of ease), and the final position will always be the patient’s restriction (barrier). Since compression is used more frequently than distraction as a vector force, this technique’s sequence can easily be remembered as “ease, compress, barrier.”

Refer to the “Diagnosing thoracic spine somatic dysfunction” learn page to obtain a proper diagnosis prior to beginning treatment with Still technique. Supine treatment of the thoracic spine with Still technique is limited to only a few upper vertebrae; only seated treatment is discussed here as it can be used to treat all thoracic vertebrae.

Treatment

1. With the patient seated, stand on the side of side bending
2. Hand placement is similar to other “walk around” techniques (used in muscle energy and HVLA)
   • Place one hand at the dysfunctional segment to monitor motion
   • Ask the patient to grab the back of their neck with the hand opposite you, then reach across their torso and grab their arm (providing a lever to more easily manipulate their torso)
3. Flex or extend, side bend, and rotate the torso into the patient’s somatic dysfunction (position of ease)
4. Apply gentle axial compression from the patient’s shoulders down to the level of the dysfunctional segment by pushing down with your body weight
5. While maintaining the compression, reverse the flexion / extension, side bending, and rotation component until they are positioned into their restriction (barrier)
6. Gently release the compression and return the torso to neutral position

Refer to the “Diagnosing lumbar spine somatic dysfunction” learn page to obtain a proper diagnosis prior to beginning treatment with Still technique.

Treatment (neutral and flexion somatic dysfunctions)

1. With the patient supine, stand on the side of the rotational component
2. Place one hand on the dysfunctional segment and grab around the patient’s knee or proximal leg with the other hand
3. Flex the ipsilateral knee and hip, and internally rotate and adduct the hip until tissue ease is sensed at the dysfunctional segment (position of ease)
4. Apply gentle compression from the top of the knee (anterior patella) to the dysfunctional lumbar segment
5. While maintaining the compression, externally rotate and abduct the hip in a smooth arc of motion (barrier)
6. Gently release the compression and return the lower extremity to neutral position

Treatment (extension somatic dysfunction)

1. With the patient supine, stand on the side of the rotational component
2. Place one hand on the dysfunctional segment and hold around the patient’s knee or proximal leg with the other hand
3. Flex the ipsilateral knee and hip, and externally rotate and abduct the hip until tissue ease is sensed at the dysfunctional segment (position of ease)
4. Apply gentle compression from the top of the knee (anterior patella) to the dysfunctional lumbar segment
5. While maintaining the compression, internally rotate and adduct the hip in a smooth arc of motion (barrier)
6. Gently release the compression and return the lower extremity to neutral position