Component Locking Cervical Spine: Flexion vs Extension

One of the things I try to emphasize the most is that what we do does not have to be rocket science. When I teach spinal manipulation, I make locking as simple as possible.

To start out, I know that specificity is not needed and is also not possible for manual therapy, mobilization, and thrust manipulation. I still teach and use it for the cervical spine, because the technique is more comfortable, and most likely safer to use it in mid-range rather than end ranges.

Here are the rules

1) It should be pain free

if you're causing the patient pain, they will not be relaxed, and it's also possible you won't be either
you both have to be - patients can sense the difference between tense and relaxed hands

2) The components for locking are the same whether regardless of the thrust or mob direction

traditionally (including my original OMPT training) states

start in cervical flexion when doing a rotational (gapping) mob/manip
start in cervical extension when doing a translational (closing) mob/manip

why stick with tradition?
starting with a slight P/A on the level(s) you plan on applying force to starts the technique in closing, which makes for an easy lock

the head is still on the table and the techhnique is easier to control and the patient is more relaxed
you may sit with this starting component, and roll the stool over to the side you're delivering the opening or closing to to line up your forearm with the force

starting with flexion, you're relying on a ligament lock, and if the patient is systemically hypermobile like many of my TMD patients are, this is not a lock at all

now the head is off the table, you're most likely standing, and both pt and clinician are now not as relaxed

the components are

slight P/A
slight sidebend toward
slight sideshift away
slight rotate away
slight shear medially with both hands
slight axial traction
noticing a pattern?

Every component is slight, a little bit of everything gives you a barrier to mob or manip to or through (respectively) that is in mid range, not end range
the other pattern is that component locking can and should be used also for mobs as well as manips, it makes both techniques much more comfortable, with most likely the same neurophysiologic effects