Cervical-Thoracic Forward Bending

Patient Position: The patient is positioned seated in a stool or chair.

Therapist Position: The therapist stands at the patients side.
Stabilizing / Mobilizing Hand: The therapist places the hand of the anterior arm on
top of the patients head (vertex hold). The therapists palms and fingers should be
relaxed and should follow the contour of the patients head. This hand is used to
create a forward bending movement.
Palpating Hand: The therapist palpates with the other hand placing the middle
finger in the interspinous space. The therapist will feel for separation of adjacent
spinous processes.
Segmental Test: The therapist forward-bends the patients head. The cephalic
spinous process will move upward on the caudal spinous process, creating a
separation. The therapist tests for the amount of separation of the segment, the
velocity of separation between the vertebrae and the resistance of the soft tissue to
movement.

University of Delaware Physical Therapy Advanced Orthopedics

Cervical-Thoracic Backward Bending

Patient Position: The patient is positioned seated in a stool or chair.

Therapist Position: The therapist stands at the patients side.
Stabilizing / Mobilizing Hand: The therapist allows the patients head to rest on
his/her anterior shoulder. The therapist then wraps this arm around the patients
head. The therapist cradles the patients head and grasps the occiput with a
conforming grip. This arm is used to create a backward bending movement.
Palpating Hand: The therapist palpates with the other hand placing the middle
finger in the interspinous space. The therapist will feel for approximation of
adjacent spinous processes.
Segmental Test: The therapist backward-bends the patients head. The cephalic
spinous process will move downward on the caudal spinous process, creating an
approximation. The therapist tests for the amount of approximation of the segment,
the velocity of approximation between the vertebrae and the resistance of the soft
tissue to movement.

University of Delaware Physical Therapy Advanced Orthopedics

Cervical-Thoracic Rotation

Patient Position: The patient is positioned seated in a stool or chair

Therapist Position: The therapist stands at the patients side.
Stabilizing / Mobilizing Hand: The therapist places the hand of the anterior arm on
top of the patients head (vertex hold). The therapists palms and fingers should be
relaxed and should follow the contour of the patients head. This hand is used to
create a rotation movement.
Palpating Hand: The therapist palpates with the other hand placing the middle
finger in the interspinous space. The therapist will palpate for the lateral excursion
of cephalic spinous process on the caudal spinous process.
Segmental Test: The therapist will rotate the patients neck towards him/her. The
therapist tests for the amount of lateral excursion of the adjacent spinous processes,
the velocity of excursion between the vertebrae and the resistance of the soft tissue
to movement.

University of Delaware Physical Therapy Advanced Orthopedics

Cervical-Thoracic Sidebending

Patient Position: The patient is positioned seated in a chair or a stool.

Therapist Position: The therapist stands at the patients side.
Stabilizing / Mobilizing Hand: The therapist places the hand of the anterior arm on
top of the patients head (vertex hold). The therapists palms and fingers should be
relaxed and should follow the contour of the patients head. This hand is used to
create a rotation movement.
Palpating Hand: The therapist palpates with the other hand placing the middle
finger in the interspinous space. The therapist will palpate for side bending
excursion of cephalic spinous process on the caudal spinous process.
Segmental Test: The therapist will side bend the patients neck towards him/her.
The therapist tests for the amount of side bending excursion of the adjacent spinous
processes, the velocity of excursion between the vertebrae and the resistance of the
soft tissue to movement.

University of Delaware Physical Therapy Advanced Orthopedics

Mid-Cervical Downglide in Neutral

Patient Position: The patient is positioned supine with a thin pillow under the
neck and the cervical spine in a neutral position.
Therapist Position: The therapist is standing or sitting at the head of the
treatment table.
Stabilizing / Mobilizing Hand: The therapist uses an MCP contact on the
articular pillar of the superior vertebra of the vertebral segment.
Supporting Hand: The therapist conformingly cradles the patients occiput
allowing the head to pivot in the palm of the hand.
Segmental Test: The therapist uses the mobilizing hand to provide a gentle
springing force in a caudal and medial direction following the plane of the
joint. The supporting head gently allows/facilitates rotation and sidebending to
the side of the joint being contacted. The amount of excursion and resistance to
motion are felt and compared to the opposite side and differences are identified.

University of Delaware Physical Therapy Advanced Orthopedics

Mid-Cervical Downglide in Forward Bending

Patient Position: The patient is positioned supine with a thin pillow under the
neck and the cervical spine in a forward-bent position.
Therapist Position: The therapist is standing or sitting at the head of the
treatment table.
Stabilizing / Mobilizing Hand: The therapist uses an MCP contact on the
articular pillar of the superior vertebra of the vertebral segment. The therapist
conformingly cradles the patients occiput allowing the head to pivot in the
palm of the hand.
Supporting Hand: The therapist conformingly cradles the patients occiput
allowing the head to pivot in the palm of the hand.
Segmental Test: The therapist uses the mobilizing hand to provide a gentle
springing force in a caudal and medial direction following the plane of the
joint. The supporting head gently allows/facilitates rotation and sidebending to
the side of the joint being contacted. The amount of excursion and resistance to
motion are felt and compared to the opposite side and differences are identified.
University of Delaware Physical Therapy Advanced Orthopedics

Mid-Cervical Downglide in Backward Bending

Patient Position: The patient is positioned in supine with a thin pillow under the
neck and the cervical spine in a backward-bent position.
Therapist Position: The therapist is standing or sitting at the head of the
treatment table.
Stabilizing / Mobilizing Hand: The therapist uses an MCP contact on the
articular pillar of the superior vertebra of the vertebral segment. The therapist
conformingly cradles the patients occiput allowing the head to pivot in the
palm of the hand.
Supporting Hand: The therapist conformingly cradles the patients occiput
allowing the head to pivot in the palm of the hand.
Segmental Test: The therapist uses the mobilizing hand to provide a gentle
springing force in a caudal and medial direction following the plane of the
joint. The supporting head gently allows/facilitates rotation and sidebending to
the side of the joint being contacted. The amount of excursion and resistance to
motion are felt and compared to the opposite side and differences are identified.
University of Delaware Physical Therapy Advanced Orthopedics

Mid-Cervical Downglide Test Interpretation

Right-sided Downglide Restriction felt in Neutral
-

IF the restriction is more noticeable in forward bending and less noticeable in

backward bending, THEN the restriction is an UPGLIDE restriction on the LEFT.

IF the restriction is less noticeable in forward bending and more noticeable in

backward bending, THEN the restriction is a DOWNGLIDE restriction on the
RIGHT.

Right-sided Downglide Hypermobility felt in Neutral

-

IF the hypermobility is more noticeable in forward bending and less noticeable in

backward bending, THEN the restriction is an UPGLIDE hypermobility on the
LEFT.

IF the hypermobility is less noticeable in forward bending and more noticeable in

backward bending, THEN the hypermobility is a DOWNGLIDE restriction on the
RIGHT.

***More or Less Noticeable refers to the relative difference of the segmental mobility in
the bilateral comparison.***

University of Delaware Physical Therapy Advanced Orthopedics

O-A Forward Bending (SMT)

Patient Position: The patient is positioned supine with the head on the table.
Therapist Position: The therapist is standing or seated at the head of the table.
Stabilizing / Mobilizing/Palpating Hand: The therapist cradles the occiput with
both hands and lays his/her thumbs on both zygomas.
Segmental Test: The therapist creates a forward bending force-couple between
the cradling fingers on the occiput and the thumbs resting on the zygoma. The
amount of excursion and the resistance to movement are palpated through the
thumbs.

University of Delaware Physical Therapy Advanced Orthopedics

O-A Backward Bending (SMT)

Patient Position: The patient is positioned supine with the head on the table.
Therapist Position: The therapist is standing or seated at the head of the table.
Stabilizing / Mobilizing/Palpating Hand: The therapist cradles the occiput with
both hands and lays his/her thumbs on both zygomas.
Segmental Test: The therapist creates a backward bending force-couple
between the cradling fingers on the occiput and the thenar eminences resting on
the zygoma. The amount of excursion and the resistance to movement are
palpated through the thenar eminences.

University of Delaware Physical Therapy Advanced Orthopedics

O-A Side Bending (SMT)

Patient Position: The patient is positioned supine with the head on thin pillow.
Therapist Position: The therapist is standing or sitting at the head of the table
Stabilizing / Mobilizing/Palpating Hand: The therapist cradles both sides of the
patients head with the palm of the hands. The therapists fingers are pointing
towards the patients feet. The long finger of each hand palpates the transverse
process of the atlas and the proximal aspect of the long finger palpates the
mastoid process bilaterally.
Segmental Test: The therapist tilts the patients head into side bending on the
atlas with a force couple generated between the two hands. Approximation
between the mastoid and the transverse process on the same side is palpated.

University of Delaware Physical Therapy Advanced Orthopedics

A/A Rotation in Forward Bending

Patient Position: The patient is positioned in supine with a flat pillow under the
head and the head held in FULL forward bending.
Therapist Position: The therapist is standing at the head of the table.
Stabilizing / Mobilizing Hand: The therapist cradles each side of the patients
head with the palms on the occiput and the thumbs resting on both zygomas.
Segmental Test: The therapist brings the patients neck into FULL forward
bending to take-up the soft-tissue slack in the mid-cervical spine. The therapist
then brings the patients head into rotation to one side. The amount of motion
and resistance to motion are assessed and compared bilaterally.

University of Delaware Physical Therapy Advanced Orthopedics

A-A Rotation in Side Bending with Counter Rotation

Figure A

Figure B

Patient Position: The patient is positioned supine with the head on a thin pillow.
Therapist Position: The therapist is standing at the head of the table.
Stabilizing / Mobilizing Hand: The therapist cradles each side of the patients
head with the palms on the occiput and the thumbs resting on both zygomas.
Segmental Test: The therapist brings the patients head and neck into end-range
side bending (Figure A). The therapist then rotates the patients head in the
opposite direction of the side bending (Figure B). The amount of motion and
the resistance to motion are assessed and compared bilaterally. This A-A test is
the most specific.

University of Delaware Physical Therapy Advanced Orthopedics

The Vertebral Artery Test

Figure A

Figure B

Figure C

Patient Position: The patient is positioned supine with the head on a pillow.
Therapist Position: The therapist is positioned sitting or standing at the head of the
table.
Stabilizing / Mobilizing Hand: The therapist cradles both sides of the patients
head with the thumbs resting on the mandible and pointing towards the patients
feet.
Segmental Test: The therapist gently backward bends the patients occiput (Figure
A). The therapist then slowly moves the patients head into side bending to endrange (Figure B). Third, the therapist then rotates the patients head in the same
direction as the side bending (Figure C). The therapist should engage the patient in
light conversation and observe the patients eyes for nystagmus, pupillary changes
or visual disturbances. Question the patient regarding vertigo/dizziness. STOP the
test if the patient demonstrates any of the previously mentioned signs or symptoms.

University of Delaware Physical Therapy Advanced Orthopedics

O-A Forward Bending Mobilization

Patient Position: The patient is positioned supine with the head on a thin pillow.
Therapist Position: The therapist is sitting or standing at the head of the table.
Stabilizing / Mobilizing Hand: The therapist cradles the patients occiput with
one hand and places his/her anterior shoulder on the patients forehead. The
opposite hand rests along the ramus of the mandible with the fingertips resting
on the tip of the mandible.
Mobilization: To create a forward bending mobilization force at the right O-A,
the therapist places the patients head in a few degrees of left side-bending and
right rotation at O-A. He/she then creates a forward bending force-couple
between his/her shoulder and the hand that is cradling the occiput. The
opposite hand resting on the mandible provides gentle assistance to maintain
the neck in axial extension. The magnitude of the mobilizing force and
amplitude are determined by the patients reactivity level.

University of Delaware Physical Therapy Advanced Orthopedics