HVLA - Mid Cervical (C3-C6) Spine Manipulation Technique - Hand Hold Positions, Supine Techniques

Cervical C2-7 - Rotary HVLA Thrust (cradle hold)
Setup
Cervical Hold Cradle Hold
Contact Point Posterolateral aspect of the right C4 articular pillar
Applicator Lateral border, proximal or middle phalanx
Patient Position Supine with the neck in a neutral, relaxed position
Operator Stance Head of plinth, feet spread slightly
Palpation of Contact Point Palpate the region of the right articular pillar of target segment with the tip of your index or middle finger side to right index finger downwards along the posterior arch of the atlas until it approximates the middle or proximal phalanx
Fixation of Contact Points
Cradle Hold The weight of the patient's head and neck is predominantly on the pillow
Short Lever Applicator: Right articular pillar of the target segment and inferior to the zygomatic arch
Long Lever Applicator: broad contact over left zygomatic arch lobe superior and anterior to the left ear
Vertex Contact None
Positioning for thrust Stand upright at the head of the couch. The elbows are held close to or only slightly away from your sides. Introduce primary leverage of rotation to the left and a small degree of secondary leverage of side bending right. Maintain the contact point on the posterolateral aspect of the C4 articular pillar
Levers Primary: Rotation toward
Secondary: Side bending away
Tertiary: Side glide toward
Additional: PA shift at target segment and compression
Adjustments for Pre-load and Thrust
Immediately Pre-thrust Relax and adjust your balance
Delivering the thrust The thrust is directed towards the patient's left eye. Simultaneously, apply a slight, rapid increase of rotation of the head and neck to the left with no increase of side-bending to the right