This protocol is used to evaluate and mobilize the Atlantooccipital joint. It contains a few different approaches to Atlas mobilizations.
NOTE: This protocol is for mindful review by an experienced therapist. It is not intended to be used for learning without the hands-on training of a professional instructor. One should not attempt this without the necessary expertise to understand contraindications. It is important to use proper technique so that the treatment is safe and effective.
The client is supine. The practitioner’s fingers are under the occipital bone with the fingertips along the inferior nuchal line, pointed to the space between the atlas and occipital bone. This is a small and often very restricted space. If the practitioner is unsure of positioning, it is better to be a bit superior in the first part of the release until the superficial tissues release and the palpation of deeper structures becomes possible.
- With gentle, sustained pressure, sink into the posterior sub-occipital tissues. Directing the pressure slightly superior helps to lift to occipital bone off the atlas. This release can be a short, gentle release on supple necks or a sustained release that softens layer after layer and unwinds the dural tube.
Some practitioners will straighten the distal fingers creating a ‘picket fence’ that presses into the A/O joint while lifting the head so that it is suspended in the air. Over several minutes, the fingers sink deeply into the sub-occipital tissues and the anterior neck releases, allowing the head to tilt back into the palms of the practitioner. This creates a more significant release of the anterior cervical muscles.
The practitioner can initiate the release by rocking the head onto the more restricted side. Rocking starts the release by using the weight of the head to apply pressure for a gentler initial release
A deeper myofascial version of this can be done by sinking the fingertips in the center section of the sub-occipitals and, using the weight of the head, allow the fingers gradually sink into the sub-occipital space as they steadily travel laterally to the mastoid processes
Atlas Mobilization – Transverse Processes
- Locate the transverse process of the atlas posterior to the mandible, anterior to the mastoid process, and inferior to the styloid process.
- Gently mobilize the atlas with static pressure on the most prominent transverse process for direct release.
- Alternate sides until the atlas is bilaterally mobile
- Apply gentle static pressure to the anterior aspect of the most anterior transverse process until it softens. Feel for the other transverse process to move anteriorly
- Alternate sides until the rotation seems even from side to side
Atlantooccipital Mobilization – Intraoral
The atlas can be mobilized posteriorly with intra-oral technique. It is less comfortable for the client and can be awkward for the therapist but seems to be more effective than mobilizing the atlas with the transverse processes.
⦁ With this technique, the therapist reaches into the oral cavity along the roof of the mouth toward the uvula. The atlas feels like a rounded knuckle. Light, sustained pressure will lead to a gentle softening. Mobilizing the atlas may occur more fully and easily with light pressure on the transverse process at the same time. Assess the atlas to see of this lateral mobilization is appropriate and in which direction.
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