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3.9.IB. Specific techniąue to increase rota-tion to the right of the atlas on the axis.

Traction techniąue; P supine.

Starting Position: P; Supine; head beyond end of couch with the axis positioned at couch edge; shoulders and thorax may be stabilized with a belt. T: Standing at head of couch to the right of P’s head.

Grip: T's right index finger and thumb stabilize P's axis, preventing it from rotating to the right. T's left hand grips the left side of P’s occiput, stabilizing P's head against T’s chest and abdo-men. P’s left ear should lie comfortably in the palm of T’s left hand, with Ts arm positioned to avoid discomfort to P's ntandible. The radial side of T’s left index finger lies along the posterior arch and transverse process on the left side of P’s atlas.

Procedurę: (Traction is the only treatment modal-ity of this techniąue. The procedurę comprises two steps.) Step one: Using this grip, T positions P’socciput'and the atlas in fuli rotation to the right (and a slight lateral flexion to the left), thus fully stretching the tissues.

Step two: Maintaining this position, T applies traction between P's atlas and the axis by moving his/her body together with P’s head. These steps are repeated until considerable improvement is attained.

Stimulation of Antagonists: T retains grip, and asks P to look upwards, to the right, and rearwards, and then move his/her head further in the direction just stretched. T resists that move-ment to stimulate P's antagonists.

Notes: The transverse ligament of the atlas may be pathologically weakened. If so, it must not be strained in treating. T prevents strain by using left shoulder to push P's head dorsally, applying morę force than when rotating with left hand. This moves P’s atlas dorsally. By simultaneously press-ing C2 ventrally, T can press the odontoid process (dens) against the anterior arch of the atlas, preventing pressure on the transverse ligament.

Step two is the key part of the procedurę, as further rotation to the right depends on traction. With slight lateral flexion to the left, the rotation to the right also increases, which prevents the joints from being compressed.

The atlas on the axis is the most vulnerable segment of the cervical spine. Using this safe, gentle techniąue and slight, gentle forces when rotating, minimizes the risk of therapist error.

Fig. 61 a. Starting Position.