title: Occipitoatlantoaxial Manipulation for Immediate Increase to Cervical Rotation.
abstract: BACKGROUND
  The assessment of the range of motion (ROM) of the cervical spine is common in physical therapy practice. An ROM assessment is used as an integral part of a physical examination, both in symptomatic and asymptomatic populations. Spine manipulation has shown several benefits, including an increased range of passive rotation of the upper cervical spine.
  
  
  OBJECTIVE
  The study intended to analyze the immediate effects of manipulation of the occipitoatlantoaxial (OAA) joint on the ROM of the cervical rotation and its relationship to an individual's most limited side on Mitchell's test.
  
  
  METHODS
  The study used a single-subject experimental design.
  
  
  METHODS
  The study took place at Hospital Universitário Gaffrée e Guinle in Rio de Janeiro, Brazil.
  
  
  METHODS
  A convenience sample of 40 healthy participants with a limited ROM in respect to the rotation of the cervical spine, who were selected in the outpatient physical therapy team (professionals and students).
  
  
  METHODS
  The OAA joint manipulation was performed by an independent therapist on all participants, on the side with the greater ROM restriction only.
  
  
  METHODS
  Cervical rotation using a ROM fleximeter and the Mitchell's test was performed.
  
  
  RESULTS
  At baseline, 25 of the participants (62.5%) had a reduction in movement for the right-side rotation, whereas 15 of the participants (37.5%) had restricted movement for left-side rotation. After the OAA manipulation, the ROM was increased on both sides independent of the side that had the most restriction to movement. The right-side rotation increased by 9.75°, whereas the left-side rotation increased by 8.26°. Despite a bilateral ROM increase, a difference was observed in the magnitude of the changes between the more-restricted sides and the other sides when the Mitchell's tests were considered, with large clinical effects.
  
  
  CONCLUSIONS
  The OAA manipulation increased the ROM for bilateral cervical rotation, irrespective of the side of the restriction, and the increase was more pronounced when considering the results of the Mitchell's test.
authors.forename: Maria Silveira
authors.initials: MS
authors.lastname: Mello
authors.forename: Maria Alice
authors.initials: MA
authors.lastname: Pagnez
authors.forename: Raíza de Sousa
authors.initials: Rde S
authors.lastname: Cabral
authors.forename: Charles
authors.initials: C
authors.lastname: Taciro
authors.forename: Leandro Alberto Calazans
authors.initials: LA
authors.lastname: Nogueira
mesh_terms: D002574:Cervical Vertebrae / Q000502:physiology*; D006801:Humans; D026201:Musculoskeletal Manipulations / Q000379:methods* / Q000706:statistics & numerical data; D016059:Range of Motion, Articular / Q000502:physiology*