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PART 3

THERAPY TECHNIQUES FOR THE

SPINE AND TEMPORO-MANDIBULAR JOINT

3.    THE CERVICAL SPINE

4.    THE TEMPORO-MANDIBULAR JOINT

5.    THE THORACIC SPINE AND RIBS

6.    THE LUMBAR SPINE

7.    THE COCCYX

3. THE CERVICAL SPINE (Occiput on Cl to C7

on Tl)

3.1.    Therapy Guide

3.1.1.    Mandatory Examination

Restrictions of the cervical spine of pathologic etiology contraindicate manuał therapy; patients affected should be referred to relevant medical specialists. Therefore, all patients must be ex-amined prior to and continuously monitored during treatment of the cervical spine, least any existing pathological condition be worsened. in-creasing the risk of injury.

Prior to treatment: Assure, by test or test report, that DeKleyn’s, Hautand’s and Romberg's tests are negative. Positive tests contraindicate manuał therapy. Pathological hypermobility in a segment contraindicates stretching of that segment.

During treatment: Patient dizziness, nausea, radiating pain, or other severe discomfort during treatment may be signs of vascular spasm, anoma-lous blood vessels. fractures, ruptured ligaments. instability, herniated discs, or other pathological conditions that contraindicate manuał therapy. The patient should be continuously monitored for these signs: If they appear, therapy should be stopped immediately.

3.1.2. Treatment Guidelines

Caution is the watchword in treating the spine. Therefore, in treating any restriction. perform the non-specific techniques first. Perform specihc tech-niques only if the non-specific techniąues elicit no contraindications to further therapy.

All manuał therapy techniques for the cervical spine involve traction. basically to prevent poten-tially hazardous compression. The therapist ap-plies traction through a firm grip on the patient's head. The grip should be adequate for the traction needed, and should be positioned to avoid discomfort in sensitive areas. such as the ears, nose, eyes, mandible and larnyx. This is most easily done if the therapist fixes the patient’s head and then moves his/her own body to induce the movement required. Controlled movement of the therapist's body and the patient’s head as a unit also helps prevent unwanted movements.

The therapist may instruct or direct patient eye movements and respiration to aid therapy. Eye movements evoke refiex responses, such as “lead-ing” movements of the head. Directing eye movement then gives the therapist control over patient head movement. Respiration: Normal breathing, particularly exhaling, promotes relaxa-tion, while inhaling or holding the breath are often naturally evoked when producing muscular force. Therefore, instructing the patient to exhale aids

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