Technique Highlight: AA Rotation Non Thrust Manipulation in Sitting | Modern Manual Therapy Blog

Technique Highlight: AA Rotation Non Thrust Manipulation in Sitting

Today's technique is one of my favorites. Like the Unilateral OA Nod, it can double as a PIVM since it tests accessory motion. The patient is sitting in front of you, to improve left rotation, you block lateral to the SP of C2 on the left with your right thumb. Reach around the patient's forehead cradling the patient's head with your left arm; keep the line of pull in the horizontal plane, or the plane of the AA. Blocking with your thumb, rotate the head to the left until it stops. Rotating the head moves C1 to the left on C2. Note, because you expect 90 degrees of motion, if you are stabilizing correctly at C2, the head should not rotate more than 45 degrees. This is because up to 50% of cervical rotation comes from the AA joint. You may hold which is uncomfortable or use grade 3-4 oscillations. I also use isometrics at the end range if blocked before 45 degrees as either a direct technique (resist left rotation) or indirect technique (resist right rotation). After I learned this technique, I stopped doing AA thrust manipulation as this works just as well and most likely without the 1 in 10 million risk. That my professional decision. Watch the video for a demonstration.


  1. I've had great success with this. thanks so much for posting.

  2. No problem, glad it worked for you, it is a great technique!