Technique Highlight: Lateral Atlas Press | Modern Manual Therapy Blog

Technique Highlight: Lateral Atlas Press


This is a helpful technique to improve upper cervical/subcranial sidebending and rotation.

The lateral atlas press restores accessory motion of the atlas, which moves opposite the occipital condyles roll. Arthrokinematically, that means if the head SB left, the atlas relatively moves left as the condyles roll left and glide right. In cranial FB and BB, the condyles roll anteriorly and posteriorly (relatively), but glide in the opposite direction. Gliding in the opposite direction is relative atlas movement in the same direction.

Bottom line:

  • if your patient is limited in cervical SB left or right, press the atlas in the same direction you want to improve the motion
  • if your patient is limited in rotation, press the atlas in the opposite direction because rotation and SB occur in opposite directions at the upper cervical/subcranial spine
I love arthrokinematics! The upper cervical arthrokinematics is a post in itself, so any more Q&A, just comment below.

Pt: supine
PT:
  • sitting above patient's head
  • mob hand lat border of 2nd MCP on the lateral mass of the atlas
  • stabilizing hand flexed at wrist to cup mandible for head control
Tech:
  • slightly SB head toward the direction of the limitation, i.e. limited SB left, SB head left
  • mob hand on the contralateral lateral mass of atlas to push medially (it's called lateral atlas press for the area, not the direction of force), in this case pushing right to left improves OA SB left
  • oscillate grade 3-4 with forearm in line with force, perform for 30 seconds to 1 minute, 2-3 sets
  • the atlas often "sticks" and starts moving with relative ease
Use:
  • improves ipsilateral SB, contralateral rotation
  • helps to prep area with FR or IASTM to bony contours of occiput and postero lateral cervical spine C1-3 in proximal to distal direction
Having trouble getting the vid to play? Watch it here!

8 comments:

  1. Thanks for the great technique post Erson. I just have a question:
    If a patient of mine is restricted into either R or L rotation, I would probably want to look at axis anterior and or posterior glides in apposition to atals lateral glides. If CV region rotation is limited, the most likely cause is a restricted AA joint, wouldn't you agree?

    I really appreciate the video for fixing side bending though as this can be tough to get back. I do feel the U-joints play a roll in this limitation as does soft tissue (scalene/SCM) tonicity too.

    Great video!!

    ReplyDelete
  2. HarrisonvaughanptMay 28, 2012 at 3:45 PM

    Great video and content Dr. E! Very good explanations and smooth techniques. I would love to read a post on upper c spine arthrokinematics when you get a chance !

    Ill be honest though and say even if I feel a restriction in one direction or the other, I typically would perform the technique bilaterally. I may concentrate more on one side or other, but I find the patient enjoys it more and I believe there is some research saying if AA or AO is involved, mobilizing one direction, the other, or both sides gives same results. What I am mainly saying is that arthrokinematics is important to know in asymptomatics, but when it comes to dysfunction, how much do we really need to know?

    Hv

    ReplyDelete
  3. HarrisonvaughanptMay 28, 2012 at 4:14 PM

    Yeh I agree. We don't want to turn into shotgun therapists because specificity of treatment is limited. For most, hitting one side or other usually works; it's the knowledge that you have such as in this case that separates you from other therapists where they have given up or jus not getting results. It cn then provide the patient with a centered exercise program based on the fault you found.

    Hv

    ReplyDelete
  4. I actually just used the lateral atlas press technique today so it was serendipitous that I should see your video. My patient had a history of neck pain related to an episode of viral meningitis two years ago.

    He resolved but cervical sidebending left stiffened up and caused left temporal headaches and neck pain.

    In response to Harrison Vaughan, PT I almost always find unilateral involvement when atlas is symptomatic - that is, movement in one direction of sidebending is obviously less than the other.

    I only performed the mobilization on the involved side. By the second visit he was all better.

    I would be interested in seeing a link to the research showing that non-specific atlas mobilization is beneficial.

    Thanks for posting the video.

    Tim Richardson, PT
    http://www.PhysicalTherapyDiagnosis.com

    ReplyDelete
  5. I do agree that if rotation is limited, I would look at AA first. However, this is my third defense after AA rotation in sitting, followed by isometrics, and then MWM if rotation is still limited and the rest of the c-spine and CT are cleared (along with soft tissues of course)

    ReplyDelete
  6. Thanks Tim, so you've taken Paris' S3 or did you learn it somewhere else? I normally only perform on the involved side as well, as it's normally better after that. In terms of the research, not sure whether HV is quoting specific research or just what it generally has been supporting that non-specific, and more bilateral mobs/manips have the same effect. I will still try one movement first, mostly finding the direction of the limitation is the one that improves the motion first, similar to directional preference.

    As much as I appreciate all the research showing one technique is not better than the other, and outcomes are similar no matter what exercise approach you use, highlighting the importance of training the CNS, I think it takes away from our clinical decision making, saying pts should respond to anything we choose, and we all know that is not the case in 100% of patients.

    ReplyDelete
  7. I agree that the AA is most likely involved if restricted in rotation. My thought process normally goes to that joint first, then OA pushing contralateral to the direction of rot limitation next. This is also after some subcranial IASTM.

    ReplyDelete
  8. We know what the research says about specificity. I was using the explanation from my original Paris training regarding this technique. It sounds better when teaching than saying, try this if someone has trouble SB or rotating and other non specific techniques are not working. In reality, that's my current thought process. I still believe some directional preference to repeated motion and also manual techniques works otherwise just any technique and movement would work to improve motion and relieve pain.

    ReplyDelete