Purpose:  To increase motion at the thoracic spine. 

Start:  The patient starts in supine or hooklying.  The therapist stands to one side of the patient. 

Procedure:  The therapist instructs patient to cross their arms over a pillow or towel roll, holding  and hugging the pillow/towel roll into the chest. If discomfort exists when the patient crosses their arms, have them place the opposite arm on top.  The therapist rolls the patient in the direction of their body and finds the target segment of thoracic spine.  The therapist flexes their fingers and extends the thumb of one hand, and places the hand along the target segment with the spinous processes fitting in the crevice between the knuckles and the palm.  The therapist can alter hand position, or grip a small object while performing the technique for their comfort. The top of the fist should lie just inferior to the target segment and acts to stabilize the lower segments. The therapist places their opposite hand on top of the patient’s elbow, providing pressure down through the table.  The therapist instructs the patient to take several deep breaths. While the patient exhales, the therapist can provide downward pressure to assess end range.  At the end of the next full exhale the therapist drops down 1-2 inches with pressure against patient’s elbows to provide HVLA thrust along the plane of the facets.

Comments: The target segment should have contact with a firm surface.  Be sure to clear and shoulder pathology prior to performing the technique. The therapist can also instruct the patient to lift head and neck off the table or to bridge up to alter targeted segments.