HVLA - Upper Cervical (C1-2) Spinal Manipulation - Rotation, Cradle Hold Technique

Cervical C1-2
Setup
Cervical Hold Cradle hold
Contact Point Right posterior arch of atlas
Applicator Lateral border, proximal or middle phalanx
Patient Position Supine with the neck in a neutral, relaxed position
Operator Stance Head of the plinth, feet spread slightly, feet angled at 45° in the direction of the thrust
Palpation of Contact Point Palpate the region of the right posterior arch of the atlas with the tip of your index or middle finger side to right index finger downwards along the posterior arch of the atlas until it approximates the middle or proximal phalanx
Fixation of Contact Points
Cradle Hold The weight of the patient's head and neck is predominantly on the pillow
Short Lever Applicator: Right posterior arch of atlas and inferior to the zygomatic arch
Long Lever Applicator: broad contact over left temporal lobe superior to the left ear
Vertex Contact None
Positioning for thrust Stand upright at the head of the couch. The elbows are held close to or only slightly away from your sides. Use primary leverage of rotation with minimal secondary leverage. Your direction of thrust is towards the patient's mouth and into the rotation.
Levers Primary: Rotation toward
Secondary: Side bending away
Tertiary: Side glide toward
Additional: PA shift at target segment and compression
Adjustments for Pre-load and Thrust
Immediately Pre-thrust Relax and adjust your balance
Delivering the thrust The thrust is directed towards the corner of the patient's mouth. Simultaneously, apply a rapid low-amplitude increase of head rotation to the left. The occiput and atlas move as one unit during the thrust