I've only hand quilted 2 quilts, a twin and a full sized quilt. I can only quilt toward me and have found that sitting on the sofa or on my bed where I can throw the rest of the quilt is the only way I can do it. The twisting just comes with it and you get used to it. Every once in a while I have to jab the needle into the top of the quilt (not all the way through!) and untwist, before picking my needle back up and starting again. And I usually have the tv or the radio on for some noise in the background. Good luck!