The Seated Nodding Test for O-A Atlas TPs

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Phebe Mills
5 years ago
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1 Anterior is at the top of the illustrations. Putting the occiput on the atlas would be like closing facing pages of a book. Atlas superior facets converge anteriorly; their surfaces slope superiorly going from anteromedial to posterolateral. In other words, anterior is downhill on the atlas facets, when the atlas is in a mid-range position ( neutral ). The occipital condyles are approximately congruent with these surfaces. Their anterior convergence in relation to each other limits the forward and backward sliding of the occipital condyles much more than it would be if the two joint tracks were parallel. Nevertheless, the full flexion to extension range of the O-A joint is about 15 degrees, moving in the sagittal plane. 18 For each individual O-A condylar joint the capsule probably allows a longer slide of the condyle. These unilateral arthrokinematic actions are common, as one condyle serves as a relative stable pivot while the other side extends (slides forward) or flexes (slides backward). In fact, this is what occurs when the neck twists to turn the face to one side. It is not likely that one condyle ever extends while the other simultaneously flexes, as suggested by Kapandji 18 (Figure 21). 22A & 21.1Q 32!

Kapandji s illustrations 23 and 24 18 show the uppermost cervical joints in positions of extreme flexion (23) and extreme extension (24).

2 Kapandji s illustrations 23 and show the uppermost cervical joints in positions of extreme flexion (23) and extreme extension (24). We see the arthrokinematics of the left side of the paired condylar and facet joints.! The atlas vertebra is flexed on the axis as evidenced by the increased distance between the spinous processes of C1 and C2. The arthrokinematic posterior translation of the inferior facet of the atlas on the axis may not be a completely accurate representation of the flexion movement. It is more likely a small amount of atlas anterior translation accompanies A-A flexion. Flexion of the head (osteokinematically) requires a posterior glide of occipital condyles (arthrokinematically) on the superior facets of the atlas. The path of condylar flexion glide is posterior and superior, because that is the shape of the superior facets on the atlas. Even in the mid-position the posterior parts of the atlas facets is more superior than the anterior parts. When the extension arthrokinematics of the O-A joint is described as anteriorinferior glide, the occipital condyle is looked at relative to the atlas vertebra in mid-position, not hyperextended as shown in the Kapandji drawing, which shows the atlas being flexed and extended through a range of 17 degrees on the axis, its normal range in the sagittal plane. 21B. MEM vol. 1. Also seen on 21.1F&G white on blue background 35!

3 The Seated Nodding Test for O-A Atlas TPs. Stay in touch with (keep your attention focused on) the atlas transverse processes. Rotation is best observed at the anterior or posterior corners of these processes. Either corner may be tender; the 11th cranial nerve runs across the posterior corner, and the anterior corner is a Chapman s reflex to the paranasal sinuses. Recall the importance of gentleness in this test. Palpating the atlas TPs requires focused attention on the landmarks with the aid of mental imagery. Initially determine the atlas s position relative to the cardinal planes of the head. Rotated position of the atlas will cause TP antero-posterior asymmetry. Also, notice if the atlas is displaced (translated) left or right, in relation to the mastoid processes. 56!

4 Sagittal plane bending of the atlas on the axis is about 17 degrees. Note the rocking chair action at the A-A facets. This is probably accompanied by small A-P translations, just as is seen in the flexion/extension movements of cervical vertebrae 2 through 7. 65!

These transverse processes are inherently tender. Finger pad contact on the atlas transverse processes should be very light. Greater pressure does not enhance your palpatory sensitivity.

5 These transverse processes are inherently tender. Finger pad contact on the atlas transverse processes should be very light. Greater pressure does not enhance your palpatory sensitivity. Focus your mind and attention. When rotating the atlas, the fingers palpating its transverse processes should not be pulling or pushing the vertebra. The head is rotated with your supporting hands. The palpating fingers just go along for the ride to detect feel of the barriers. The upper two pictures show the flexed testing position. The lower two show the extended rotation test. Note that extension is easily obtained by having the patient allow trunk flexion at the hips while the examiner steps back and carries the head with him. Compare degrees of angular rotation visually. 76!

Treating ESRRight requires translating atlas to the right by pushing on the left atlas transverse process. The seated patient must relax into the translation, which includes the whole body.

6 Treating ESRRight requires translating atlas to the right by pushing on the left atlas transverse process. The seated patient must relax into the translation, which includes the whole body. You stand on the left side of the patient with your left thumb on the atlas transverse process. Your right hand reaches over the top of the patient s head and holds the chin. Your forearm must keep the patient s head erect during the translation. The joint must be kept gapped during de-rotation. 79!

An alternative (or an addition) to the sagittal plane synkinesis (eyes) can be a light isometric sidebending contraction: Use one ounce of force to push your ear toward your (left, right) shoulder.

7 An alternative (or an addition) to the sagittal plane synkinesis (eyes) can be a light isometric sidebending contraction: Use one ounce of force to push your ear toward your (left, right) shoulder. (One second) Relax. Look for an increase of lateral atlas translation during relaxation. The breathing synkinesis should have done the same thing, but not everyone s reflexes are wired up the same. 80!

8 Facet gapping is experienced as a sudden increase in easy atlas translation in the path of least resistance. Finding the path of least resistance to lateral translation of the atlas can provide confirmation of the diagnosis. Starting positions are determined by where the path of least resistance can be found. Each of the pictures above can be the last stage of the treatment for the condition represented by the other picture showing starting position for a different dysfunction. AAFSRRTxPhase1.jpg; AATXESRLPhases2.jpg 81!

9 Summary of treatment. An alternative (or an addition) to the sagittal plane synkinesis (eyes) can be a light isometric sidebending contraction: Use one ounce of force to push your ear toward your (left, right) shoulder. (One second) Relax. Look for an increase of lateral atlas translation during relaxation. The breathing synkinesis should have done the same thing, but not everyone s reflexes are wired up the same. 82!

10 In the seated A-A treatment techniques your arm always rests against the side of the head where the atlas-axis is to be gapped. The hand holding the chin may rotated the head in either appropriate direction, in this case, to the left, for FSRright. For ESRLeft, look at the pictures from right to left, like reading Hebrew or Arabic. 83!

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