Purpose:  To increase motion at the thoracic spine. 

Start:  The patient starts in prone with their head turned toward either side or resting in the face hole.  The therapist stands to the side of the patient. 

Procedure: The therapist locates target area to be mobilized, then places the pisiform of one hand on transverse process of the contralateral target segment with fingers pointing away from therapist. The therapist places the pisiform of the free hand on the transverse process of the ipsilateral target segment while rotating the hand 180 degrees so that fingers point toward therapist. The therapist performs a skin lock by applying pressure and turning the hands 90 degrees so that fingers now point in a superior/inferior direction. 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 provides a HVLA thrust along the plane of the facets.