Hello world!
Thank you for your many replies.
I saw the patient last Saturday.I'll tell you the progress.

Before seeing him,I talked with an orthopedist about him.
I said,"Could you see a C2 fracture patient today?An obsolete C2 fracture
patient wants me to make it easy to rotate his head and trunk in driving.
I have done a stretch of his occipital-neck muscle and had him a little
better.
Then I want to mobilize his upper thoracic verrry softly and slowly."
She said as expected,"Treating muscle is OK.But Treating spine is dangerous.
I'm afraid his spine will be unable to endure the exerted pressure and will
induce paralisis."
I thought she would also say so in ordinary back pain.I have never heard of
an
orthopedist who refers OMPT to PT in Japan.
When I saw the patient,I asked him to consult an orthopedist 4 meters
distant
from us in a same room before my treatment.But,to my surprise,he refused my
proposal.He insisted,"I know my body best of all the people including
doctor.
One month ago I was diagnosed to be no problem by the director of this
clinic."
So I had only to do usual inhibitive distraction.But his neck muscle was so
inhibited that his head dropped into my hands soon.
And in this technique,pressure must be on the base of the skull and not on
the
atlas or axis.Though I said to the orthopedist that I had treated his neck
muscle,it seemed that I was in danger zone to treat atlas or axis.
I thought I had better stop this treatment,though my patient was satisfied
with
my treatment.
Then which way should I choose?
1.I tell the patient that I cannot make you better from now on and stop a
  treatment hereafter.This is the safest and easiest way.
  I cannot refer him to OT to make adaptations to his daily life.As OT is
more
  unknown than PT in Japan,there isn't private practice OT.
2.I try gentle upper thoracic(C7-T3) rotation mobilization,though I cannot
  distinguish the movement of thoracic by my finger even now and there is
  no permission of an orthopedist.Before I do it,I must check osteoporosis
by
  x-rays and decide how much force should be given.The force cannot be
taught
  by internet.And I should have malpractice insurance before this treatment.
   In the course of Paris S1,I was taught the evaluation of upper thoracic
  rotation.So I think it helps head rotation.
3.I make a patient stretch muscles of neck and trunk actively using Yoga
  by himself.All movement must be done in tolerable feeling of stretch in
Yoga.
(1)Trunk forward bending
　a)sit upright with his both knees flexed
　b)with exhalation,place his both hands in front of him
　c)with inhalation,bend backward his neck and trunk with a image that his
top
    of skull is pulled towards cephalid.At that time head self-traction is
more
    important than backward bending.
  d)relax and with exhalation bend forward his neck and trunk with both
upper
    limbs stretching. hold the last position for 1 minute,if possible.
  e)go back to the first position slowly and calmly
  f)rerax and rest for 1 minute.
(2)Trunk rotation
  a)starting position is same as above
  b)place left hand on a floor facing forward in front of right knee.
   place right hand facing backward joined at the posterior side of both
wrists.
　　with exhalation,bend forward his neck and trunk.
　c)same as above c)
  d)with exhalation,let left palm slip over the floor and stretch forward.
    and at the same time right palm stretch backward.Then his neck and trunk
    will bend right forward.Let left hand stretch more right so that his
side
    abdominal muscles can be stretched.hold this position for 1 minute.
　e)with inhalation,go back to starting position slowly and calmly.
　f)relax and rest for 1 minute.
  g)do the opposite side in a same manner.

Please give me advice.
Thanks in advance.
Hiro
Japan
------- original mail ---------
Hello world! from Japan
It's a long time since I posted last.
Could you teach me the treatment of C2 fracture patient?
1.Patient's profile
76 years old retired male.He can drive a car and sometimes plow.
2.History
When he was 20 years old,he suffered from TB(tuberculosis) and had his rib1
to rib 6 removed by operation.
When 30 years old,he dropped from 4 meter height head over heels and had C2
(cervical) fractured.Mybe compression fracture I guess.
After that he had his neck pulled all day long on a bed for a long time.
No paralysis until now.
He had been often told 'miracle',I heard.
When 40 years old,he suffered from vertebral compression fracture but
location is unknown,maybe lower thoracic or lumber.
3.Other disease
(1)Arrhythmia (herat disease) for 20 years
(2)DM
(3)Hepatitis
(4)Intractable Dermatitis
4.Main complaint
(1)When he is driving a car,he cannot rotate his head in either way easily
and
   also has such a temporary spasm in his both thighs that he is afraid of
being
   unable to put on the brake.But he has no spasm in the morning.
(2)Paresthesia in left 1st and 2nd finger.
5.Evaluation
(1)Structure
   Neck is rightside bending on the trunk.
　 Scoliosis of cervical-thoracic-lumber line with right side bending
(2)Active movement
   a)neck FB(forward bending)--ROM is severely limitted.5 to 10 degree.
   b)neck SB -----Both is severly limitted and left is more limitted.
   c)neck Rot.----same as neck SB.
(3)X-rays
   I cannot grasp the pathology by x-rays,though I don't know whether it is
due
   to my poor ability of seeing x-rays or unclear x-rays.
   There is no MRI.
(4)Neurological testing
   a)Muscle power -- all normal
   b)Sensation  ---- almost normal except left hand
6.Treatment
At first I hesitated to treat him aggresively to hear he had C2 fractured
before and he had many other internal diseases.
So I only did craniosacral therapy - inhibitive distraction for 10 minutes
in each three times.
He was satisfied with my treatment.The result was a little good.Recently he
wanted me to make him much better while he was alive.Fortunately he has
placed
his hopes on my treatment while other past patients not so much.
But I have only received Paris S1 course and no supervisor for my
treatment.
7.Question
May I advance passive motion test ie.mid cervical sidebending?Does it hurt
fractured C2 bone?Is there any 'must not'?Had I better join medical
incident
insurance,which is recommended by Japan PT association,before going ahead?
What influence will take place to his musculoskeletal condition when he had
his rib1 to 6 removed?

Thanks in advance.
Hiro
Japan