I felt really confident in my spinal manipulations, however I was told by some students the year above that it is a game changer, and that it makes you second guess your manipulations and makes them more efficient, and boy did they ever.

I have to admit my attendance was not the greatest, however I always made an effort to catch up on what I missed. 

I found that most manipulations were not majorly different to what I had learned previously, some postural changes, a couple more levers and a slightly different approach, all together making a massive difference.

What I had learned the most? LEAN ON THE BAR

LSP Manipuation
In this technique, the wind up was similar, the magic came in via the levers. 
There were so many levers to use. It was drilled into our heads that we needed to always check our primary lever, in this case rotation. I seemed to have a bad habit of adding multiple levers then checking the rotation, then adding the levers on again, which is not too bad of a way, but less efficient. The hardest lever being flexion and extension, achieved through us rotating. 
However, adding these levers I put the drop through and no cavitation. With some advice from Mr Thomas, telling me to get more body contact by 'leaning on the bar', my drop was more efficient and then cavitation.

This is similar for the T/L and L/S. For the T/L you shift leaning on the bar and the compress from above till you narrow the focus on to the T/L. I find a combination of rotational thrust down towards the plinth and a bit towards the asis works best.
With the L/S, you can compress from the front down to the L/S, thrust down towards the femur.

Head and Neck
I believe that this is, or should I say was, my strong point. We started on the cervical spine. 
Upper cervical spine: My preferred order of Levers included, rotation to test, side bending, test rotation, traction, test rotation, anterior and lateral shift, test rotation. Before applying thrust, arms tucked in by side, contraction of my pectorals to add that element of compression, then quick rotational thrust.

Extension was discussed, but not recommended as a lever in the cervical spine. 

O/A rotation thrust – in my opinion, THE hardest manipulation to do via advanced manipulation. When first doing this, I had failed so many times. What took the biscuit was that I had done it the old way and got cavitation both sides. So I knew I was doing the technique wrong.
I believe my thrust was decent, it was the wind up. With O/A wind ups it seems there is no definitive locking of the joint, a barrier or indicator in when to apply the thrust. In the end, I still have not manipulated the O/A the advanced way. I am still practicing, and I do feel that I am getting closer.

C/T junction
This was done supine. I must say this was a hard technique but quite effective, even if there is no cavitation. I do believe tho u need to release of the soft tissue before you attempt this. Again, same concept to the other manipulations. In this, you do need to remove a lot of soft tissue slack. This can be done by using you first finger push the UFT inferiorly, then slide your applicator on the the articular pillar. 

Add some nuchal tension, slight nod of the chin. The importance I believe is in the rotation as so little comes from the C/T. Levers include, rotation, side bending, test rotation, potentially flexion and then thrust. You can also do this for side bending just reverse the levers and maybe not use flexion as much. 

Prone: I have to say, whilst not blowing my own trumpet,  I do believe my C/T manipulations and 1st rib prone are at a very god standard. It is the technique I am most proud of. I already do what was taught in advanced spinal manipulation, by checking my levers, probably as this is my most practiced HVT.

Thoracic Spine
I do believe this technique is the simplest of all techniques. It did not take long to get used to this and doing this HVT the advanced way, I feel it makes patients more comfortable.
Primary lever traction, you can add element of first, compression, flexion, side bending and/or rotation. Between each check the traction of the segment. A last minute helper is the trusty pronation of the applicator, to increase contact point.
Done :) 

First apply your standard wind up. For anterior thrust, you rotate them even more towards you. The caudal arm then fixes on to the psis and the thrust is a drop with a pectoral twitch. Your caudal hand thrusts down towards the plinth causing anterior rotation.
For posterior rotation of the SIJ, the trust is from the caudal arm taking the sacrum away from the innominate. Similar wind up describes, but your caudal forearm is wrapped against the ischial tuberosity, therefore the thrust will be into the side of your body causing posterior rotation of the innominate.

Mr Thomas always reminded me to always bring them towards you and that little extra.

Revision session
Had my HVT checked by The tutors. All techniques seem reasonable and adequately done, except from the O/A which im still battling with to this day.

As I said, my attendance was not the greatest, but I have to thank the tutors for allowing me to continue and still help me. I have learned a lot from this class and will continue to practice these new techniques.



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    May 2013