Purpose: To increase motion and decrease pain at the cervicothoracic junction.  

Start:  The patient starts in prone with their head turned toward the left and a pillow case under their head, looking away from the therapist.  The left arm is placed next to the head in 90 degrees of shoulder abduction with 90 degrees of elbow flexion and the right arm resting down at their side.  

Procedure: The therapist finds target segment at the CT junction and places the thumb of their right hand firmly along the right lateral aspect of the spinous process of the target vertebrae.  The therapist brings the patient into full cervical extension, then uses the base of their thenar and hypothenar eminences on left hand to provide overpressure into extension through the patient’s zygomatic arch until end range is felt.  With the patient’s eyes open, hold this position for 30 seconds to assess signs or symptoms of arterial dysfunction. The direction of force through the right thumb is toward the left side, and the direction of force through left hand is toward the right side.  At end range, provide HVLA thrust manipulation. This can be repeated on the opposite side.