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PHYSIO  February 1999

PHYSIO February 1999

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Subject:

Re: Whiplash - atlas, dura & SIJs

From:

David Felhendler <[log in to unmask]>

Reply-To:

[log in to unmask]

Date:

Thu, 04 Feb 1999 23:10:32 +0100

Content-Type:

text/plain

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Parts/Attachments

text/plain (138 lines)

Hi,

Due to all private requests about the mobilisation of the OA joints I
thought I just post the description of the technique directly to the
lists.

So here it is.

One of my primary interests in my work is the spine and I'm always
looking for ways to improve my skills. I scan the Internet regularly to
find new approaches, inspiration, etc.

During one of those searches I came across some material and that really
caught my eye. I must admit that the OA joint was something that I
hadn't paid all that much attention to. That is until I realized its
potential after reading these papers, especially the one about the fat
pad entrapment (which I think is a quite plausible theory). You find
that one on:

http://www.life.edu/newlife/crj/42knutsn.html

After that I devoured all information I could find on OA joint and UpC
on the Web.

In Sweden X-ray is only allowed to be used at hospitals and by dentists,
therefor I have to rely on palpation skills. Since I know that motion
palpation lacks precision I chose palpation of Atlasís static position.
The palpation points I use is:

- The lateral aspect of the proc. transversii in standing with patient
  looking straight ahead. Palpating for laterality.

- The inferior aspect of the proc. transversii in supine with patient
  looking straight ahead. Palpating to find what side is more cranial.

- The superior to the proc. transversii in supine with patient looking
  straight ahead. Palpating for muscle tension.

- The posterior aspect of Atlas in supine with patient looking straight
  ahead. Palpating for rotation of the Atlas.

- The posterior aspect of the proc. transversii in supine with patient
  looking straight ahead. Palpating for rotation of the Atlas.

- Obliquus capitis inferior (diagonally between proc. spinosus on Axis
  and proc. transversii on Atlas) in supine with patient looking
  straight ahead. Palpating for muscle tension. The muscle will be tense
  on the side which has rotated forward.

To make the judgment of laterality I must find:

- Laterality (in standing).
- Superior proc. transversus on the same side (in supine).
- Muscle tension superior to the proc. transversus on the same side (in
  supine).

To make a judgment of rotation I must find:
- The same palpatory findings on both locations (posterior aspect of
  Atlas and posterior aspect of the proc. transversus).
- Increased tension in Obliquus capitis inferior on the side the
  palpatory findings indicate as forward rotation.

Since Iím not trained in cervical manipulation Iíve tried to find
another way of correcting the hypomobile atlas. Going through the
material on UpC I found a variety of ways to perform a correction of the
Atlas. One way (sorry, I donít remember the name of the technique) was
that after deciding the vector using a continuos pressure rather than a
thrust of any kind, the correction was made.

This sounded that something I could use, however I thought that since
the muscles around the Atlas will be working against my force I would
need more force than I felt comfortable with. What to do? Well luckily
enough Iím trained in something called Acupoint Therapy (AT) where you
use a blunt-tipped tool to stimulate acupoints. The techniques of AT
enables me to cause a very high degree of relaxation very selectively.

I will here describe how you with the stimulation of only 3 acupoints
can very effectively relax the Rectus capitis anterior, Rectus capitis
lateralis, the Obliquus capitis superior and Obliquus capitis inferior. 

First a short description of the stimulation technique itself. The
technique is performed with a blunt-tipped tool called therapy stick (we
use the same tool as the dentist uses to push down the filling into the
tooth). It consists of a handle with a small (2 mm diameter) ball-point
at each end, one of the ends is hooked. The stimulation of individual
acupoints is achieved with a gliding pressure over the acupoint applied
with the therapy stickís hooked end. Hold the therapy stick as a pencil,
stretch the tissue around the acupoint with the thumb and index finger
of the other hand. Then press the ball-point gently into the tissue and
pull it towards you in a short, about 5 mm, straight and rapid movement.
Keep the hand and therapy stick as parallel as possible with the skin to
get the best effect. Avoid any digging or scooping movements, since they
are more likely to damage the skin. The stimulation is confirmed when
the patient feels a slight stinging sensation.

Occipital point 1. The point is situated on the occipital border, 1.5
cun (cun = the width  of the IP joint of the thumb) lateral of the
midline, stimulate on the opposite side of the laterality. This causes a
relaxation of Rectus capitis lateralis and Rectus capitis anterior on
the side of the laterality and thereby reduces the laterality.

Frontal point 1. The point is situated just above the eyebrow, on the
superior edge of margo supra-orbitalis, straight above the medial corner
of the eye, stimulate bilaterally. This causes a relaxation of Obliquus
capitis superior bilaterally and thereby reduces the rotation.

Frontal point 2. The point is situated 0.5 cun lateral of frontal point
1, stimulate bilaterally. This causes a relaxation of Obliquus
capitis inferior bilaterally and thereby reduces the rotation.

When the points are stimulated I let the patient stand up, I give a
slight traction (just enough to take the weight of the head of Atlas) by
lifting with one hand below the occiput and the other under the
mandible. While maintaining the traction I ask the patient to swing his
arm forward and up (to 180į) and then repeat this movement with some
speed until I can feel Atlas moving on the same side. I do this
bilaterally, but always start on the side with the laterality. This
technique is designed to cause a gapping in the OA joints.

If the above is not enough to create a complete correction I use the
following technique. The patient sits and I stand on the side of the
laterality. I have slightly bent legs, I let the patients chin rest in
the crook of my elbow and gently squeeze the head to my body. I place my
other thumb on the proc. transversus. I give a slight traction (just
enough to take the weight of the head of Atlas) by straightening my
legs. The patient takes deep breath and holds it and I push gently but
firmly along the optimal vector (which is opposite the laterality and
rotation), the patient exhales and I maintain the pressure a few
seconds. The technique is repeated if needed.

Please try the above and let me know your opinion.

All the best,

David


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