Component Locking Cervical Spine: Flexion vs Extension | Modern Manual Therapy Blog

Component Locking Cervical Spine: Flexion vs Extension

One of the things I try to emphasize the most is that what we do does not have to be rocket science. When I teach spinal manipulation, I make locking as simple as possible.

To start out, I know that specificity is not needed and is also not possible for manual therapy, mobilization, and thrust manipulation. I still teach and use it for the cervical spine, because the technique is more comfortable, and most likely safer to use it in mid-range rather than end ranges.

Here are the rules

1) It should be pain free
  • if you're causing the patient pain, they will not be relaxed, and it's also possible you won't be either
  • you both have to be - patients can sense the difference between tense and relaxed hands
2) The components for locking are the same whether regardless of the thrust or mob direction
  • traditionally (including my original OMPT training) states 
    • start in cervical flexion when doing a rotational (gapping) mob/manip
    • start in cervical extension when doing a translational (closing) mob/manip
  • why stick with tradition?
  • starting with a slight P/A on the level(s) you plan on applying force to starts the technique in closing, which makes for an easy lock
    • the head is still on the table and the techhnique is easier to control and the patient is more relaxed
    • you may sit with this starting component, and roll the stool over to the side you're delivering the opening or closing to to line up your forearm with the force
  • starting with flexion, you're relying on a ligament lock, and if the patient is systemically hypermobile like many of my TMD patients are, this is not a lock at all
    • now the head is off the table, you're most likely standing, and both pt and clinician are now not as relaxed
  • the components are
    • slight P/A
    • slight sidebend toward
    • slight sideshift away
    • slight rotate away
    • slight shear medially with both hands
    • slight axial traction
    • noticing a pattern? 
      • Every component is slight, a little bit of everything gives you a barrier to mob or manip to or through (respectively) that is in mid range, not end range
      • the other pattern is that component locking can and should be used also for mobs as well as manips, it makes both techniques much more comfortable, with most likely the same neurophysiologic effects

So there you have it! Component locking, not just for thrust manipulation! Use it for grades I-IV and your patients will appreciate it!


  1. Good points here Dr. E. I do like the statement of using these components for non-thrust manipulation too. I treat quite an older crowd and not appropriate for thrusting (not good barriers, significant amount of sclerosis, etc) so instead of P/A glides in prone (they can't get in prone!), I use these components to assist in joint mobility. So, needless to say they work well even with a tougher joint!

  2. Thanks HV! I'd say they work even better for a tougher joint b/c they're more comfortable and pts can tolerate them very easily. Also I'm not a fan of having the patient go prone, then supine, then sitting, then prone again, during Tx... I do most in either sitting or supine if possible

  3. Yeh thats true. Patients can sense your fluidity in treatment this way, which has a direct response to confidence I think too.

  4. Well written!.. Cervical spine trauma is a common problem with a wide range of severity
    from minor ligamentous injury to frank osteo-ligamentous instability
    with spinal cord injury. The emergent evaluation of patients at risk
    relies on standardized clinical and radiographic protocols to identify
    injuries; elucidate associated pathology; classify injuries; and predict
    instability, treatment and outcomes. The unique anatomy of each region
    of the Cervical Laminoplasty demands a review of each segment individually. Thanks