Thompson / Upper CervicalTexas 3 step

Set the TableSet the PatientSet the Doctor

Thompson Highlights!!! Texas 3 step…Set the table, Set the patient, and Set the Doctor.

1) Set the table: Select the proper dial setting for the appropriate pads. I.e.: Cervical Adjustment setting would include the following. Dial set on “D”, plunger in, weighing the Cervical and Dorsal piece respectfully (More details in Lecture & Lab).

Thompson Highlights!!! Texas 3 step…Set the table, Set the patient, and Set the Doctor.

2) Set the Patient: Patient…prone or supine.

Table setting: Tilt the cervical head piece down & foot piece up.

Alignment: Cervical & Thoracic…Head rest paper is located 1 inch below the bottom of

the mandible. Pelvic adjusting (prone)…A.S.I.S’s are in the gap.

Thompson Highlights!!! Texas 3 step…Set the table, Set the patient, and Set the Doctor.

3) Set the Doctor: Must have proper stance, L.O.D., S.C.P.’s, etc…More in Lab.

Thompson Protocol Clear Cervicals and Occiput Clear Pelvic region Clear Lumbars Clear Thoracics Address Atlas via Upper Cervical tech.

Overcompensated Cervical Syndrome

There is no Leg length analysis for this condition.

The patient will demonstrate spinous laterality from C2 to C7 (Maximum spinous laterality will be observed at C2).

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Overcompensated Cervical Syndrome

Analysis: The patient will exhibit palpable tension and tenderness at the upper trapezius muscle--on the side of spinous laterality.

Alert the Chiro!!!

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Overcompensated Cervical Syndrome

The syndrome will be identified from the X-ray--spinous laterality.

Alert the Chiropractor with the tight trap.

(Patient must present with both findings before adjusting).

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Overcompensated Cervical Syndrome

O.C.S.’s are rare.

Always rule out an O.C.S. on the initial visit--if possible.

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Overcompensated Cervical Syndrome

Common findings :Patient presents with torticollis or a chronic, unresolving cervical problems.

Adjusted for an U.C.S. , B.C.S. , or a X.D.C.S. with no or minimal results.

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Overcompensated Cervical Syndrome

LLL-R or RRR-L: Left spinous rotation;

Left taut and tender trap; Left head Rotation; Right 1st rib adjustment

(Adjusting procedures on page 154 &155).

Watch the TMJ!!!

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Leg length Analysis

The most important step! Extension:

# 1) 3 point landing: Thumb on heels and I.F. and C.I.F. split the lateral maleoli.

#2) Take out inversion and eversion. #3) Slight headward pressure…not to much--not to

little--just right. #4) Sight between the heel counters and identify the

short leg.

Leg length Analysis

The most important step! Flexion:

#1) Raise the feet to 90. #2) Try to keep the feet apart--Don’t let them rub or touch when

bringing them to 90. #3) The shoe should be kept flat against the bottom of the heel

for proper analysis. #4) Sight between the heel counters, through the gluteal cleft,

and to the E.O.P. #5) Identify the short leg…either side!

Bilateral Cervical Syndrome Legs are even in extension Head left - left leg shortens. Head right - right leg shortens. Palpation may reveal tender nodules

bilaterally (occipital brim) and/ or tenderness of the C2 spinous process.

Bilateral Cervical Syndrome The Bilateral Cervical Syndrome is an

occipital fixation adjustment. Pisiform placement…Mastoid notches! Ulnar deviate. may also exhibit T.M.J. complaints due to

the direct osseous relationship.

Unilateral Cervical Syndrome

Short leg in extension that improves upon head rotation.

Syndrome is named for the side that lengthens the short leg.

Adjustment is performed on the contralateral side.

Unilateral Cervical Syndrome

Upon Palpation, a palpable, tender nodule will be found over the lamina of the involved vertebra.

L.O.D.’s: C2 & C3…P - A, I - S C4 & C5…P - A, straight across C6 & C7…P - A, S - I

Unilateral Cervical Syndrome

After Clearing an U.C.S. in extension…See flow chart on page 108--chapter 9.

Only one thrust---for all cervical adjustments!

Left Unilateral Cervical Syndrome :(Pages 156 &157)

Short leg in extension. Head Rotation

The syndrome is named by the direction of head rotation that produces an improvement / evening of the short leg in extension. RL

Left Unilateral Cervical Syndrome :(Pages 156 &157)

B.R. Malposition; Spinous Left; - Y.

Rotation to the Right--Increase subluxation. Rotation to the Left--Decrease subluxation.

An increase will shorten the short leg.

A Decrease will lengthen the short leg.

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X-Derifield Cervical Syndrome

X-DCS and UCS are the same.

Same adjusting protocol as U.C.S.

Stationary Tables & Patient Protocols

Patient Placement--Prone: Pg 16 Patient Placement--Supine: Pg 16 Patient Positioning & Basic table operation :

Pg 17 Corrective Thrusts: Pg18 Table Activation: Pg 19

Stationary Tables & Protocols Thompson Analysis and Adjusting protocol: Pg

100 “Mini” Cervical Protocol: Pg 102 Thompson Protocol flowchart: Pg 108 Texas 3 Step: Pg 112

Thompson Flow Chart

Positive DerifieldA sh ort leg in exten s ion

th a t len g th en s u p on flexion

Negative DerifieldA sh ort leg in exten s ion

th a t rem a in s sh ort u p on flexion

Posterior IschiumTau t an d ten d er g as trocn em iu s

Correct Cervical SubluxationsO .C .S .

U .C .S . & X -D .C .S .B .C .S .

Positive Derifield Analysis: Short leg in

extension--lengthens to some degree upon flexion.

Reference point: P.S.I.S.

Positive Derifield Pivot point: Acetabulum

“True” P.I. Ilium

Resistance may be felt with analysis

Positive Derifield

Set the table: Foot piece up, Dial set on LP, Directional drop

up (S to I), Head piece tilted down with plunger out.

Positive Derifield

Set the Patient: Patient Prone. Align the A.S.I.S.’s in the gap

between the L & P pads.

Positive Derifield

Set the Doctor: Dr. stands on either side--Right + D…Right

Thenar. Stabilize with other hand--mid heel or M.C.P of

the index finger.

Positive Derifield

S.C.P.’s: Medial, inferior aspect of the P.S.I.S. on the

involved side. Posterior, inferior aspect of the ischial

tuberosity on the uninvolved side.

Analysis: Short leg in Extension that remains short in flexion

7 reflex points – 3 tender points

Negative Derifield

Posterior innominate misalignment

Fulcrum point is located at the sacral auricular surface

Two part Adjustment

Negative Derifield

Negative Derifield

Set the table: Foot piece down, Pelvic blocker in

place, Dial set on LP, Directional drop down (I to S), Head piece tilted up with plunger out.

Negative Derifield

Set the Patient: Patient Supine. Align the Sacral base with

the top of the pelvic blocker (PSIS’s--1 inch inferior to the top of the pelvic pad).

Part 1: Involved leg flexed, foot on the table. Part 2: Uninvolved leg flexed, foot on the

table.

Negative Derifield

Set the Doctor: Part 1: Dr. Stands on the involved

side and will adjust with their inferior hand.

Part 2: Dr. on the involved side and will adjust with their superior hand.

Negative Derifield

S.C.P.’s: Part 1: Anterior, inferior aspect of the

ischial tuberosity on the involved side. Part 2: Mid inguinal ligament on the

involved side.

Negative Derifield

Reflex points: Achilles tendon Internal condyle

Ischial tuberosity P.S.I.S. Pubic tubercle Erector Spinae and

psoas T2/3 intercostal

space

The patient must exhibit palpable tenderness at three of the seven reflex points--before adjusting!!!

+ Derifield & - Derifield

Positive Derifield

Set the table: Foot piece up, Dial set on LP, Directional drop up (S to I), Head piece tilted down with plunger out.

Negative Derifield

Set the table: Foot piece down, Pelvic blocker in place, Dial set on LP, Directional drop down (I to S), Head piece tilted up with plunger out.

+ Derifield & - Derifield

Positive Derifield

Set the Patient: Patient Prone. Align the A.S.I.S.’s in the gap between the L & P pads.

Negative Derifield

Set the Patient: Patient Supine. Align the Sacral base with the top of the pelvic blocker (PSIS’s--1 inch inferior to the top of the pelvic pad). Part 1: Involved leg flexed, foot on the table. Part 2: Uninvolved leg flexed, foot on the table.

+ Derifield & - Derifield

Positive Derifield

Set the Doctor: Dr. stands on either side--Right + D…Right Thenar. Stabilize with other hand--mid heel or M.C.P of the index finger.

Negative Derifield

Set the Doctor: Part 1: Dr. Stands on

the involved side and will adjust with their inferior hand.

Part 2: Dr. on the involved side and will adjust with their superior hand.

+ Derifield & - Derifield

Positive Derifield

S.C.P.’s: Medial, inferior aspect of

the P.S.I.S. on the involved side.

Posterior, inferior aspect of the ischial tuberosity on the uninvolved side.

Negative Derifield

S.C.P.’s: Part 1: Anterior,

inferior aspect of the ischial tuberosity on the involved side.

Part 2: Mid inguinal ligament on the involved side.

Posterior Ischium

No leg length analysis Taut and tender gastrocnemius Dial “P”: No directional drop activation S.C.P.: Ischial tuberosity--on the involved side.

IN Ilium

No leg length analysis “Toe out” foot flare Wide gluteal and “Flattened” P.S.I.S. Wider Ilium on X-ray Narrow obturator foramen on X-ray

EX Ilium

No leg length analysis for the EX Ilium “Toe in” foot flare Narrow gluteal and prominent P.S.I.S Narrow ilium on X-ray Wide obturator foramen on X-ray

IN Ilium Adjustment procedure: Dial on “P” & D.D.H.

A.S.I.S.’s in the gap

S.C.P.: Medial aspect of the Ischial tuberosity on the involved side.

IN Ilium

Superior hand contact (C.P. Pisiform)

L.O.D.: Medial to Lateral, slight P-A with an axial torque.

EX Ilium

Adjustment procedure: Dial “P” & D.D.H.

A.S.I.S.’s in the gap

EX Ilium S.C.P.: Lateral aspect of the P.S.I.S on the

involved side

Superior hand contact--when in doubt!

L.O.D.: Lateral to Medial…forearm @ 20 degrees

IN & EX Alternatives

The IN & EX supine moves are used as an alternate method when the prone method does not accomplish the desired degree of correction. Pg. 179 & 180 -- IN Alternative Pg. 180 & 181 -- EX Alternative

Sacral Analysis

No leg length analysis

Stabilized, prone leg raiser test to identify the Left or Right Sacral subluxation or the Base posterior

Sacral Analysis

Patient is prone

Doctor assumes a straight away stance

Places heel of the superior hand on the sacral base with fingers pointing inferior

Sacral Analysis

Apply P - A pressure…appropriate amount to stabilize the sacrum

Instruct the patient to raise the left or right leg of the table, while maintaining a straight leg

Sacral Analysis Observe the elevation of the leg being raised…

then have the patient to raise the opposite leg…compare the two heights

The leg that does not raise as high is considered the side of sacral subluxation

The sacrum should be listed and adjusted on the low leg side

Sacral Analysis List the sacral subluxation on the low leg

side: A) 4 inch or > difference between the left and right leg B) Less than 4 inch height difference; difficulty and or pain when

raising the low leg C) If neither leg raises off the table and there is pain and/or

difficulty--Base Posterior.

Sacral Adjustment Set the table:

Dial on “P” & D.D.H.

(optional S - I directional drop can be utilized)

Sacral Adjustment

Set the Patient:

Prone A.S.I.S.’s in the gap Cross the involved leg

Sacral Adjustment Set the Doctor:

Facing the feet Superior hand on the uninvolved P.S.I.S

(pisiform/knife edge contact) Inferior hand (pisiform/knife edge contact) on the

uninvolved sacral notch

Sacral Adjustment L.O.C.:

Rt. - CCW torque Lt. - CW torque Scissor action to create a torquing of the

sacrum…slight P - A

Base Posterior

Set the table:

Dial on “P” & D.D.H.

Base Posterior

Set the Patient:

A.S.I.S.’s in the gap

Base Posterior

Set the Doctor: Inferior hand contact…Mid heel contact on

Superior aspect of the sacral base--in midline

Base Posterior

L.O.C.: P - A, S - I through the lumbo sacral angle

Spondylolisthesis Analysis,Table, and Patient: Page 140

Adjustments: Two Types:

#1) Field Method #2) Institutional Method.

Spondylolisthesis

Field Method: No Thrust---Only pressure until table drops.

Institutional Method: 3 Thrust!!!

Lumbar Analysis

Single Hand ContactPisiform Over ThumbDouble Thumb

Lumbar Spine

Lumbar pad activation - Dial on L.

Patient prone Foot pad up A.S.I.S.’s in the gap (Pg 17) Head piece tilted down, weigh the pt.

Either side for Posterior listings--double thumb contact!

Lumbar Spine Side of posterior body rotation when using a mamillary process

S.C.P.

T1,2,3 & L4,5---Use an inferior hand contact. All other contacts use a superior hand contact (Single Hand Contact and Pisiform Over Thumb Contact).

Lumbar Spine

Double thumb: Posterior listing - D.S. on either side. Body rotation - D.S. on side of rotation.

L.O.C…Plane line of the Disc!

Thoracic Analysis & Adjustment Analysis and Patient positioning: (Pg 143)

Adjustment: #1) Single Hand Contact #2) Pisiform Over Thumb #3) Double Transverse #4) Double Thenar…(pg 143-146)

Thoracic Analysis & Adjustment

S.H.C. and P.O.T.:

Use the same rules that you applied in the Lumbar region!

Thoracic Analysis & Adjustment

Double Transverse: Doctor Stance--on side of rotation. Place the I.H.C. down first: Inferior

Hand Contacts TVP on the side of posterior body rotation. Superior Hand Contacts TVP opposite the body rotation--usually one to two segments below (pg 145). Use between the general levels of T4 to T10.

Thoracic Analysis & Adjustment

Double Thenar: Either side for Posterior listing--E.S.N. over midline. Scissor stance on

the side of posterior body rotation. 4 to 8 inches lateral to midline--when adjusting body rotation. Posterior--No stabilization--both thenars thrust. Body Rotation--Opposite TVP--mainly for stabilization.

Anterior Thoracic--Chap.12

Identified through palpation of the spinous processes.

Flattened thoracic kyphosis or “dishing” (Pottinger Saucer).

“Dishing” will frequently be compensatory to a loss of the cervical lordosis.

Anterior Thoracic--Chap.12 Dorsal pad activation

The anterior thoracic blocker should contact the patient at the TVP of the vertebra below the anterior subluxation or at the bottom of the anterior stack or “dish” when observed.

Two choices: Mid sternal stabilization & Mid axillary stabilization

Anterior Thoracic--Chap.12

Patient positioning: Supine, with arm on the side opposite the Doctor’s stance crossed over the top.

3 thrust…However, the Thoracic subluxation will usually correct with one thrust…If this occurs, the second and third thrust will not be necessary.

Costal Analysis and Adjustment--Chap. 17

The majority of Rotated Ribs presentations involve a superior misalignment of the posterior aspect and an inferior misalignment of the anterior aspect of the rib.

Costal Analysis and Adjustment--Chap. 17

Posterior contact: Contact the Rib tubercle with the Superior hand--pointing towards the opposite shoulder.

Anterior contact: Contact the Anterior/Inferior aspect of the rib--2” to 3” lateral to the costosternal articulation.

Practice “patient accommodation or protection”

Elevated Rib Cage Patient presentation:

1) A unilateral elevation of the shoulder, clavicle and scapula 2) A visual elevation of the inferior border of the rib cage 3) Radiographic presentation of rib cage elevation 4) Patient presentation of respiratory, cardiac or digestive

complaints. 5)****A tender nodule on the involved side of elevation, at the

level of the second intercostal space, within the pectoralis major muscle, approximately 2” lateral to the sternum.

Table: Dial on D.L.---Only time we use this setting (T.Q.)

Upper CervicalC1 and C2 Listings!

Atlas Listings 12 possible listings

3 views: L.C.N.: Attitude of the Atlas Nasium: Laterality of the Atlas Base posterior: Rotation of the Atlas

Texas 3 step

Set the TableSet the PatientSet the Doctor

Patient Placement

Patient Placement: Chapter 12 (pg 99)

Align the pt’s fingertips with the headpiece.

Align the inferior tip of the mastoid process with inferior aspect of the drop headpiece.

Patient Placement

Align the Anterior view: Glabella; Tip of the nose; Tip of Chin.

Align the lateral view: E.A.M., Shoulder, and femur head.

Align the Posterior view: E.O.P. & V.P.

Atlas Protocol Approach: Eye level…Superior leg Pivot: 30° or 80° Stance Palpate Tissue Pull Place Pisiform Activate Head Piece Stabilize Elbow Position ESN Position Stance Visualize Thrust Recoil

Atlas Alternative--Chp. 18 3 reasons:

1) Patient’s mastoid processes are elongated and overlap the TVP.

2) Patient’s Atlas TVP are short and small. 3) The Doctor’s hands are too large for the

patient…I.e.: See Peter for details!!!

Axis Listings 9 possible listings…Pg 56

A-P open mouth…X-ray line analysis

4 lines: O.O.L., S.B.L., I.B.L., and V.M.L.

Axis Listings Interpretations: Part I & Part II

Part I: Compare the reference dot on the Laminae with the reference dot at the base of the odontoid. Listings: Sp Rt. B.p. or Sp Lt. B.P.

Part II: Compare the reference point at base of the odontoid with the V.M.L.. Listings: ESR or ESL

Texas 3 step

Set the TableSet the PatientSet the Doctor

Patient Placement Patient Placement: Chapter 17 (pg 149)

Align the pt’s fingertips approximately 1/4 of an inch past the bottom portion of the headpiece.

Align the TVP of the Atlas with inferior aspect of the drop headpiece.

Patient Placement Align the Anterior view: Glabella; Tip of the

nose; Tip of Chin.

Align the lateral view: E.A.M., Shoulder, and femur head.

Align the Posterior view: E.O.P. & V.P.

Axis Protocol Approach: Superior leg…approximately 6 inches down from the top edge of the body

cushion. (pg149) Pivot: 80° Stance Palpate Tissue Pull Place Pisiform Activate Head Piece Stabilize Elbow Position ESN Position…2 1/2 to 3 inches down from the top edge of the B.C. Stance Visualize Thrust Recoil

Axis Protocol S.C.P.’s

Spinous Rt./Lt. - Body pivot: Lateral, inferior margin of the spinous process of

Axis.

Axis Protocol Spinous Rt./Lt. - Body pivot:

L.O.D.: I - S, P - A, R - L/ L -R, & C.W. or C.C.W torque

C2 Alternative: Pg 157…No Torque…L.O.D. the same.

Doctor stance…Behind the Patient

Axis Protocol

S.C.P.’s

E.S.R. & E.S.L.: Lamina Pedicle junction of the Axis.

Axis Protocol

E.S.R. & E.S.L.: L.O.D.: I - S, P - A, R - L/ L -R, & C.W. or C.C.W

torque