HVLA - Upper Cervical Spinal Manipulation - Chin Grip Technique Description

Setup
Cervical Hold Chin hold
Contact Point Right posterior occiput
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
Palpation of Contact Point Ensure that you are medial to, and not on, the mastoid process
Fixation of Contact Points
Chin Hold Ensure your left forearm is over or slightly anterior to the ear
- 5 points of contact: fingers, the heel of the hand, forearm, biceps, and pectoralis of the left upper extremity
Vertex Contact Optional
Positioning for thrust Step to the right and stand across the right corner of the plinth. The optimal alignment for the thrust is in a curved plane. Keep your right elbow close to the plinth to keep the contact point on the occiput
Levers The extension and right side-bending are introduced by pivoting slightly via the legs and trunk so that your trunk and upper body rotate to the left. Do not attempt to introduce side-bending by moving the hands or arms, as this will lead to loss of contact and inaccurate technique. This technique does not use facet apposition locking.
Adjustments for Pre-load and Thrust
Immediately Pre-thrust Relax and adjust your balance
Delivering the thrust The thrust must be applied, using both hands, along a curved plane that follows the shape of the occipito-atlantal articulation
- External motor cues for thrust:
o “scoop snow and throw it over the left shoulder.”
o “armpit monkey fart motion.”