Cervical Technique Power Point M Johnson

8/22/2019 Cervical Technique Power Point M Johnson

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WELCOME

to--

Cervical Technique Class!


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Power Point Contents (Slide #s)

IntroDiscussion: Slides 314

Visualization: Slides 1517

Instrumentation: Slide 18

Inclinometry: Slides 1930

Reflexes: Slides 3134

Orthos: Slides 3536

Derifield Leg

Exam: Slides 3741

X-Ray: Slides 4347

Motion Palpation Slides 4881

Palmer-Gonstead Slides 82116

Diversified Slides 117160

Adjusting Info Slides 251 - 257


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Power Point Contents: (Slide #s) -- for EXTRA practice

Practice Slides:

Motion Palpation -- (Listings): 70-71; 76-77; 178181

(Figure examples): 78 - 80

Palmer-Gonstead -- (Listings only)160-168; 226227

(Figure examples): 182209

Diversified -- (Listing only) -- 169-170; 236

(Figure examples): 210-214; 228-235

237-246

Review for Diversified & Final Practical (Listings):

247 - 249


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CHIROPRACTIC THOUGHTS

Chiropractors adjust too manysegments.

Chiropractors adjust too often.

Chiropractors adjust too hard.**

**C. Gonstead, D.C.

Reference drawn from Gonstead Seminar,

Davenport, IA, July 2005


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PATIENT PROTOCHOL

EXAM OF THE PATIENT MOVES FROM LEAST

INVASIVE

(Case History taking, Observation,

Visualization)TOWARD MORE INVASIVE (Instrumentation,

Leg Balance Exam)

TO MOST INVASIVE (Range of Motion in degrees,Orthopedic Tests, Neurological Reflexes, Static

& Motion Palpation Exams)


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To Reiterate: PROGRESSION OF PATIENT

EXAM

LEAST INVASIVE

MORE INVASIVE

MOST INVASIVE

At any point in the exam, the doctor may stop the

exam, if to proceed would be contra-indicated.


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Clinical Application of Patient Exam

1. Ask questions.

2. Listen to answers.

3. Observe (look & smell)

4. Scan (Do skin surface temperature scan)*

**Always consider cautions/contraindications to anyexams.

(Never hesitate to re-examine the patient at any time if care

is not moving toward a positive direction.)


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Clinical Application of Patient Exam (continued)

5. Determine needed exams/tests*

i.e. Range of Motion Measure (ROM) of spine *

ROM is measured in degrees, using an instrument.

The measure is performed as ACTIVE ROMthe patient

performs the motion;the doctor measures motion amount)

6. Perform selected Orthopedic Exams todetermine structural stability*

*Always consider cautions/contraindications to

exams.


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(continued)*

7. Perform Reflex Exams of selected cord levels &

nerves to assess basic functioning of the

nervous system ( the Reflex Arc)*

8. Touch (Palpate)*Static & Motion review of a selected spinal area.

* Always consider cautions/contraindication to

exams.


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(continued)

9. Assess Line Drawings on X-ray films todetermine structural departures fromestablished chiropractic normsto assist

with technique adjusting choice, & Line ofCorrection (L.O.C.) when adjusting.

(Initially, x-rays are reviewed for pathology findings,

anomalies etc. prior to line drawing analysis.)


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Manifestations of a Subluxation

Case History & Observation

Instrumentation

Leg Check Exam

Spinal Orthopedic/Neurological/Range of Motion

Exams

Static Palpation

Motion PalpationX-Ray

See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class, Gindl, P.S., pages 1 8.


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CASE HISTORY OF THE PATIENT2 Aspects

TodaysHealth Problem: History of patientsChief Complaint.

Prior Health Problem(s): History of patient(history of accidents, injuries,surgeries, lifestyle, nutrition,family history, outcomes ofhealth interventions etc. thathave occurred in the past)

See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class, Gindl P.S., pages 171-3


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8 Parameters DeterminingHistory of Chief Complaint

Date of onset

Duration/Frequency

Mode of onset

Type of pain

Location of complaint

Quality/severity

What aggravates or relieves

Previous treatment forcomplaint?

Was previous treatmenthelpful?

Othercomplaints/dysfunctions;other issues?

REFERENCE: Physical

Examination, Winchip &Capogna. Material edited byP. Mullin, D.C.


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Visualization of the Patient

Perform Spinal Contour Analysis (i.e., Plumb Line Analysis)

Observe for:**

a) Head Tilt b) Shoulder Leveling

c) Pelvis Leveling d) Scoliosis

e) Asymmetrical Skin Folds

f) Asymmetrical Elbow Level

g) Asymmetrical Muscles :

Normal tonicity;

Hyper tonicity (Taut);

Hypo tonicity (Flaccid)

h) Foot Flare (Toe In, Toe Out)

** Stand behind the patient to observe. (Additional Plumb Line

Evaluation involves observation of the back, sides, and front

perspectives of the patient.)

See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class, Gindl P.S., pages 5-6.


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VisualizationExamples

Visually Scan for asymmetry

Head

Tilt

High

Shoulder

High

Hip


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MOREVISUAL

EXAMPLES

Visually scan for asymmetry

High

Hip

Head

Tilt High

Shoulder

Scoliosis


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Instrumentation

DUAL PROBE INSTRUMENTATION

1. Definition of Clinical Significance Finding

(Break): Deflection of the needle of 2 5 increments or more over one

segmental field

MARKING BREAKS

T1 Occiput Place mark inch below mid-thermocouples (atinferior rim of probe)

C7 S2 Place mark inch above mid-thermocouples GLIDE TIMES: Cervicals 20 seconds

Thoraco-Lumbar40 seconds

INTERPRETATION: Palpate what falls immediately beneath breakmark.


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INCLINOMETRY

(or any attempt at ROM)

Contraindications:

Fractures, dislocation, sprain and strain, severe

pain.

Severe instability ( i.e. Rusts Sign)

Advanced atherosclerosis ( i.e. positive Georges

Sign/other circulatory evals.)

Severe bone weakening, such as osteomalacia;

osteoporosis


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Range of Motion (in degrees)

Measures of joint motion range can help to

document ROM limitations related to:

1. Disease

2. Injury

3. Disuse*

* Daniels & Worthingham


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ROM EXAM OF THE PATIENT

Motions measured in degrees with a variety

of instruments:

a) Flexion

b) Extension

c) Lateral Bending/Flexion

d) Rotation

See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class. Gindl P.S., pages 10 15.


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RANGE OF MOTION (ROM)

Norms for Inclinometer:

Flexion 50 degrees

Extension 60 degrees

Lateral Flexion 45 degreesRotation 80 degrees


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INCLINOMETRY

Cervical Extension

References: Top of Occiput & T1(some authorities use C7)

1. Head neutral. Inclinometers set

at zero degrees.

2. Observe both inclinometer angles as

extension occurs.

3. Subtract the T1 angle measurefrom the Occiput angle measure.


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Inclinometry -- Extension

(Lateral view)


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INCLINOMETRY

Cervical Flexion

References: Top of Occiput & T1(some authorities use C7)

1. Head neutral, chin slightly tucked. Set

inclinometers at zero degrees.

2. Observe both angles as flexion occurs.

3. Subtract the T1 angle measure from the

occiput angle measure for degree of

flexion finding.


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Inclinometry -- Flexion

(Lateral view)


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INCLINOMETRY

Cervical Lateral Flexion (Lateral Bending)

References: Top of Occiput & T1(some authorities use C7) 1. Head neutral. Inclinometers set at zero degrees.

2. Observe both inclinometer angle measures as LateralFlexion/Bending occurs.

3. Subtract the T1 angle measure from the Occiput angle

measure to determine the degree amount.


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Inclinometry Lateral Bending

(Right Lateral Bending shown)

(P-A view)


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Inclinometry

Rotation

References:

1. Place one inclinometer on the patients

forehead (patient is supine, head fully supported bythe table).

2. Set the inclinometer at zero.

3. Observe the degree measure as the patient

rotates the head from the neutral postion , Right

and Left.


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Inclinometry -- Rotation

(Birds eye view patient SUPINE) Example of Right Rotation

R


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NEUROLOGICAL REFLEXES --

(SUGGESTIONS)

Position patient well (comfortably)

Position yourself well

Dont let the patient assist with the exam

Apply the stroke for a rebound effect

Compare the reflexes bilaterally

See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class. Gindl, P.S., pages 21 28.


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Neurological Evaluation

Bovee Evans & Mazion

Triceps Reflex: *Cord Level C6-C8 Cord Level C7-C8

Brachioradialis Reflex: *Cord Level C5-C6 Cord Level C5-C6

Biceps Reflex: *Cord Level C5-C6 Cord Level C5-C6

Reference: *Bovee, M., D.C.


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ORTHOPEDIC/NEUROLOGIC

EXAMS

These evaluation tools are used in the decisionmaking process for care.

Remember that no finding is a finding

Positive Findings are what you find on the patient.Such findings are usually present as some form ofpain.

Indications are associated with the physiological

problems suggested by the positive findings i.e. DiscBulge

Reference: Gindl P., Bovee M. See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class. Gindl P.S., pages 16 - 19.


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DEEP TENDON REFLEXES

Reflex Nerve

Triceps Reflex: Radial Nerve

Brachioradialis Reflex: Radial Nerve

Biceps Reflex: Musculocutaneous Nerve


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Commonly used ORTHOPEDIC EXAMS ( To

assess stability of an anatomical area)

Foramina [Foraminal] Compression Test;

Jacksons Compression Test

Shoulder Depressor Test

Adsons Sign

(Scalenus Anticus Syndrome Test)

Soto Hall Test**

Derifield Leg Check (Cervical Part)

**See Technique Department Web SiteCervicalJohnsonWeek SectionSelect

the Week One Handouts-- Orth/Neuro material.


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Synopsis of INDICATIONS OF POSITIVE (+)ORTHOPEDIC EXAMS

(Foramina (Foraminal) Compression Exam: *Occlusion of IVF; disc bulge;arthritic involvement; edema of a nerve root; edema of nearbystructures; **subluxation.) See Jacksons Compression Test.

Shoulder Depressor Test: *Radiculitis or pain from the muscle stretch;adhesions of the dural sleeves;

Adsons Sign: *Spasm of the Scalenus Anticus muscle may compress thesubclavian artery; Nerve Root irritation at IVF; Cervical Rib;

Soto Hall: * Noticeable localized painvertebral fracture; Diffuse pain:

DJD; DDD; Sprain or strain (This is a general test.)

Reference for Indications in quotation marks: Dr. Gindls Essentials for Cervical-Upper

Thoracic Technique Class. Gindl P. S., 2003; Other commentary: *Bovee M.


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Derifield Leg Examination (#1)

To assess finding of leg balance orimbalance

IF imbalance is present, the exam is used

to help localize the possible vertebral levelclinically involved.

Clinical Possibilities:

**Right Cervical Syndrome(RCS)

**Left Cervical Syndrome (LSC)

**Bilateral Cervical Syndrome

**No Cervical Syndrome (NCS) See: Derifield Leg Exam Procedure slide #4 for steps.


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Derifield Leg Exam (#2)

Thoughts Concerning Causes of Short Leg:

1. Bone deformities

2. Pathological causes

3. Traumatic causes 4. Unilateral breakdown of an arch

5. Spastic contracture of the extensor muscles of the lower spineand pelvis due to neurological imbalance. (Manifested asinnervational overload to the extensor muscles and unilateralcontractureenhanced spinal stretch reflex.) (Central inhibitory[brain] + central facilitory [cord, brain stem etc.]mechanismaugment stretch reflexes.)

Reference: Israel, C., D.C.


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Derifield Leg ExamPhysiology(#3)

Involves a 1st order neuronTravels Dorsal Column: feet to cervical medullary

area

Decussates and synapses with 2nd order neuron

Reflex arc reaction affects leg length*

*Reference: Gindl P, Essentials for Cervical-UpperThoracic Technique Class, 9th ed., 2003, p. 20

** NOTE: Many theories exist concerning leg examfindings for leg balance & imbalance.


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Derifield Leg ExamProcedure(#4)

o Place Patient ProneHy-LO Table is table of choice.

o Check first for leg balance or imbalance.

o If legs are balanced, the exam for the Cervical portion of the DerifieldLeg Exam is over.

o If legs are presenting imbalance, note the short leg side, and proceed tothe next step of the exam procedure:

o Have the patient turn his/her head to the Right and to the Left.

o Check to see if the short leg becomes even or longer than the initial longleg on each turn of the patients head.

o Clinical significance is noted when the short leg does become even orlonger than the initial long leg when the patients head is turned.

o The finding is labeled and noted in the patients record according to theside of the head turn that produces clinical significance.


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Derifield Leg Exam (Cerv. Part)

Indication of Finding: Cervical Syndrome (with finding representing clinical significance,

with the initial short leg becoming even or longer than the initiallong leg upon the turn of the patients head, right or left).

Record finding: RCS; LCS; Bilateral CS;

(or NCS)

With a finding of Cervical Syndrome, palpate the patients side ofposterior body rotation (opposite side of the head turn thatproduced the clinical significance findingC2-C6 levels) for taut,

tender fibers or nodular swelling. Palpate the C2-C6 Lamina-PedicleJunction while the patients head remains in the head turnedposition.


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ADDITIONAL PRACTICE/REVIEW FOR MO/PAL EXAM:

ORTHOPEDIC EXAMS (STABILITY EXAMS);REFLEXES;

RANGE OF MOTION (ROM)

JACKSONS COMPRESSION TEST (FORAMINAL COMPRESSION TEST)

SHOULDER DEPRESSOR TEST

ADSONS TEST SOTO HALL TEST

DERIFIELD LEG EXAM

TRICEPS REFLEX BICEPS REFLEX

BRACIORADIALIS REFLEX

INCLINOMETRY--ROM

FLEXION; EXTENSION; LATERAL BENDING; ROTATION


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ASSIGNMENT PAGES FOR X-RAY LINE

DRAWING

Dr. Johnsons Reference Study Materials:

pages 1-45, 124-125 (Completed Film Examples & Directions for line construction

& interpretation) (See these examples on the Portal.)

Dr. Gindls Text, pages 39 - 103


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Palmer-Gonstead X-Ray Line

Drawing/Analysis: Outcomes from Analysis

To identify departures from the norm,

structurally.

To suggest an idea of the most appropriate

choice for an adjustment in consideration of

the patients anatomy.

To suggest the most appropriate care plan for

the patient.


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Application of X-ray Analysis

Identify signs of biomechanical stress at a particularmotion unit level

A Motion Unit is considered to be the top of one

vertebra, the bottom of another vertebra, and thesoft tissue structures in between.

Visual signs of motion unit disturbance are

thought to suggest signs of biomechanical stress.Motion Unit disturbances are listed as departuresfrom the norm, structurally; these structuraldepartures may suggest chiropractic listings.


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PALMER-GONSTEAD FULL-SPINE

X-RAY ANALYSIS

The Palmer-Gonstead Full Spine X-ray Analysis analyzes,structurally, a segment to its foundation segmentimmediately below it.

This foundation concept departs from the Palmer ToggleUpper Cervical Specific X-ray Anaylsis that analyzes Atlas &

Axis to the condyle perspective (as a structural constant)above those segments.

Therefore, at the Atlas or Axis levels, one analysis mayproduce a particular listing, while the other analysis mayproduce an entirely different listing. This disparity results

from the Full-Spine analysis reference of structure to asegment below, the Upper Cervical analysis reference ofstructure to a segment above.


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X-RAY & IMPRESSION OF LATERAL SCOLIOSIS ON THE A-P

LOWER CERVICAL FILM

(Possibilities/rationale for Impression of Lateral

Scoliosis as observed, if present.) Reference: C. Israel

Presentation could be attributed to:

1) Chronic and/or acute subluxation complexes.2) Trauma.

3) Poor posture.

4) Excessive loading.

5) Congenital deformity.


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MOTION EXAM OF THE PATIENT

Motions to Palpate: a) Extension

b) Lateral Bending/Flexion

c) Rotation

Clinical Finding Possibilities:

1. NORMAL SPINAL MOTION

2. ABNORMAL SPINAL MOTION (due to pathology/injury an examplemight be resulting edema)

3. DECREASED OR RESTRICTED MOTION (hypo mobility)

4. INCREASED MOTION (hyper mobility)

5. ABSENT MOTION (Indicate why this finding.)

See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class. Gindl P.S., pages 29 - 38.


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Additional Motion Exam of the

Patient (continued)

CAPSULAR PATTERNS (CYRIAX)

Definition: A Capsular Pattern is the limitation

of active and passive movements in characteristicproportions for each joint. (In early capsularpatterns, the restriction may appear in only onerangeand later progress to more ranges).

Reference: Cyriax


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Motion Exam of the Patient

(continued)

Capsular Patterns (continued) Irritation of the joint capsule or synovial membrane of the joint will

cause a limitation of passive joint movement in capsularproportionsphysiological movements of the joint are limited in adistinct order.

For the Cervical Spine, the capsular pattern is:Equal limitation in ALL movements

except FLEXION.

For the Thoracic Spine, the capsular pattern is:Limitation of EXTENSION, SIDE FLEXION,

ROTATION with less limitation of FLEXION.

Reference: Cyriax


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Additional Motion Exam of the Patient

(continued)

End Feel: Sensation noted on Passive Motion

at the end of range.

Joint Play (Fluid Motion): Small amount of

motion noted on Passive Motion from the

neutral position.


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Noncapsular Pattern

The presence of a noncapsular pattern

means only that irritation of the joint capsule

is not contributing to the limitation of

physiological movement [something else is].

Reference: Cyriax


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Assessment of Patients Physiological

Movements

Record Information Concerning:

(Performed/Assessed Active)

1. Patients willingness to move

2. Range of Motion

3. Presence or absence of pain


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Assessment of Patients Physiological

Movements

Record Information Concerning: (Performed/Assessed Passive)

1. Range of motion

2. Presence or absence of pain

3. End-feel

4. Presence or absence of a capsular pattern

5. Findings relative to inert structures i.e. pinched bursa with passiveshoulder abduction; dural sheath of a nerve root stretched with passiveStraight Leg Raiser Exam.

6. Resisted movements are used to test contractile structures or musclesand their attachments; such testing provides information on both

strength and pain.* *Reference: Scully R.M., Barnes, M.R., (Editors) Physical Therapy, J. B.

Lippincott, Philadelphia, 1989.


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Musculoskeletal Noises

1. Clicking

Causes: i.e. If applicable,

meniscal damage.

2. Clunk or Thunk

Frequently in knee.

Causes: i.e. irregularity ofcartilage or discoid meniscus


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Musculoskeletal Noises (continued)

3. Snapping Passage of soft tissue over a bony prominence i.e.

Greater Trochanteror at ankle or shoulder level ortrigger finger.

4. Grating

aka Grinding or Crunching

**Often heard or felt by the examiner

**Thought to be loss of articular cartilage in a joint andresults from direct contact of bone on bone.

**May be loud to the patient but not noticeable by thedoctor.

Causes unknown


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5. Popping: As when pulling finger joints.

Explanation: Sudden opening of an adherent

crenation in the synovial lining of the capsule

probably produces a vacuum effect & the noise.Not meaningful if performed by patient or

painless.

Note: When a back pops, followed by pain &

locking, consider facet joint dysfunction.


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6. Crackling & Crepitus: Examiner can hear& feel.

Note: Fine Crepitus suspect diseased

joint i.e. rheumatoid arthritis.Note: Course Crepitus suspect

osteoarthritis

Note: Crepitus Over Tendon Sheathsuspect tenosynovitis (traumatic or infective).


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References:

Gatterman, MI. Chiropractic Management of SpineRelated Disorders. Baltimore: Williams & Wilkins, 1990,

(2004)

Herzog, et al. Cavitation Sounds During SpinalManipulative Treatments. JMPT, 16 (8); Oct. 1993: 523

526


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Reference:

Brodeur R., The Audible Release Associated with

Joint Manipulation. JMPT, 18 (3); March/April

1995: 155 164.


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References:

Analysis of Zygapophyseal Joint Cracking During

Chiropractic Manipulation. JMPT, 18 (2), Feb.

1995: 65 - 71


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MOTION PALPATION SCREENING

MOTIONS

For Occiput use Occipito/Atlanto

Extension (glide).

For Atlasdetermine tissue prominence

side i.e. side of tissue prominence isthought to represent the side of posteriorityof atlas.

For C2 C7 use circumduction thatrepresents combined motions of lateralbending, rotation and extension.


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Notes Concerning Motion Palpation

Transient Fixation

Chiropractic Fixation

Quantity of fixation (compare motion from

side to side)

Quality of motion (compare side to sideis

one side smooth in motion compared to

tending to stick on the other side in

motion)


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MOTION PALPATION PATTERNS

**OCCIPUT LEVEL 1. PS = EXTENSION

AS = FILM FINDING/OR FLEXION2. LATERAL BENDING (FOR R OR LLat.))3. ROTATION (FOR A OR P Rotation)

**ATLAS LEVEL 1. AS OR AI = FILM FINDING2. LATERAL BENDING (FOR R OR L Lat.)3. ROTATION (FOR A OR P Rotation)

**C2 L5 LEVELS --1. P = EXTENSION2. ROTATION (FOR R OR LLat.)3. LATERAL BENDING (FOR S OR I WEDGE)

MOTION PALPATION EXAMPLES


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OCCIPUT

PS-RS-RA =PS would present as Decreased Extension, Occiput/C1;

RS would present as Decreased Right Lateral Bending, Occiput/C1;

RA would present as Decreased Right Rotation, Occiput/C1

AS-LS-LP =AS is a Lateral Film Finding/Decreased Flexion, Occiput/C1;

LS would present as Decreased Left Lateral Bending, Occiput/C1;

LP would present as Decreased Right Rotation, Occiput/C1


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PS-RS-RA

Decreased Extension Occ/C1Decreased Right Lat. Bend. Occ/C1

Decreased Right Rotation Occ/C1


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PRACTICE EXAMPLES

AS-LS-LA (MO/PAL)AS = film finding, Occiput/C1 (FML is above APL at anterior of Lateral Film)

LS = decreased Left Lateral Bend,Occiput/C1

LA = decreased Left Rotation (noted whenpalpating theRight Mastoid tip & Right C1 TVP and performing LeftRotationOcciput found as presenting Posterior Rotationon the RightOcciput seeming to stop in Rotationmotion when Atlas stops inferring Anterior Rotation

position of Occiput on the Left), Occiput/C1.


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MOTION PALPATION EXAMPLES--ATLAS

ASR = AS is a Lateral Film Finding;(APL & OPL diverge at ant., Lat. F.)

R presents as Decreased Right Lateral Bending;

there would be No Decrease in Right or Left

Rotation

AILA = AI is a Lateral Film Finding;(APL and OPL converge at anterior on the Lateral Film.)

L presents as Decreased Left Lateral Bending; Awould present as Decreased Left Rotation



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Lower Cervicals (C2C7)

PLS, C4 =The P component of the listing would present Decreased Extension, atC4;

the L component of the listing would present Decreased Left Rotation,C4;

the S component of the listing would present Decreased Left Lateral

Bending, C4/C5. PRI-L, C2 =

The P component of the listing would present Decreased Extension atC2;

the R component of the listing would present Decreased RightRotation at C2;

the I component of the listing would be inferred by Decreased LeftLateral Bending, C2/C3.



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Upper Thoracics: T1T4

PL-T, T2 =Decreased Extension, T2;

Decreased Left Rotation, T2;

No Decrease in Right or Left Lateral

Bending, T2/T3

PRS, T3 =

Decreased Extension, T3;

Decreased Right Rotation, T3;

Decreased Right Lateral Bending, T3/T4


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MO/PAL PRACTICE

PS-RS-RA AS-LS-LPDecreased: Decreased:

Extension O/C1 AS = Film Finding FML is above APL at ant., L.F.Rt. Lat. Bend O/C1 Lft. Lat. Bend O/C1

Rt. Rotation O/C1 Rt. Rotation O/C1AILA Decreased: Lft. Lat. Bend C1/C2 Lft. Rotation C1/C2

PLS C4 PLI-L C2 PR C3

PRS T2 PL T3 PR-T T1

MOTION PALPATION PRACTICE


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EXAMPLES:

Occiput: PS-LS-LPOcciput: AS-RS-RA

Atlas: AIL ASRP

C2-C7: PRS C3 PLI-L C5

T1-T3: PL T2 PRI-T T3

Derifield Leg Exam


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Description of Motion Palpation Exam

The Motion Palpation Exam will be worth 20 Points (4 pointsper procedure) and will consist of:

**Demonstration of the Derifield Leg Exam

** Motion demonstration for an Occiput

level listing**Motion demonstration for an Atlas level

listing

**Motion demonstration for a C2C7 levellisting

**Motion demonstration for a T1 T3 levellisting

EXAMPLE OF MOTION PALPATION


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EXAMPLE OF MOTION PALPATION

EXAM (5 Exam Procedures)

AS-LS-LA (Motion Palpation)

AIRP (Motion Palpation)

Derifield Leg Exam

PLS C3 (Motion Palpation)

PRI-T T2 (Motion Palpation)


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PRACTICAL EXAM EXAMPLE

EXAMPLE:


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What are these listings?

1. Given: C1 = +0X, +0Z

2. Given: C1 = -0X, -0Z, -0Y

3. Occiput/Atlas ExtensionRight Lateral Bending

Left Rotation

4.


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MO/PAL Practice

PS-LS-LP

AS-RS-RA

AIRP PRS C2

PLI-L C4


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MO/PAL PRACTICE

PS-RS-RA PS-LS

AS-LS-LP

AIR ASRP PR C2 PLS C4

PRI-L C6 PL C4

PLI-T T2 PR T3 PRS T2


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MO/PAL PRACTICE

C2 Right Side


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MO/PAL PRACTICE

C4 Right Side


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MO/PAL PRACTICE

T 3 Right Side

P l G d Adj i


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Palmer-Gonstead Adjusting

See: Palmer-Gonstead Charts in YellowCover Text,Reference Study Materials

Johnson, Pages 69-89; 130 135; 148 152

**Power Point: Slides (on

Technique Department Web Site

& Palmer Portal)

See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class,Gindl, P.S., pages 106, 107; 111 130.

PERSPECTIVE OF PALMER-


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PERSPECTIVE OF PALMER

GONSTEAD ADJUSTING

IT IS HANDS ON ADJUSTING DR. GONSTEAD FELT THAT THE KEY COMPONENT OF THE MOTION UNIT

OF THE SPINE, C2 L5 WAS THE DISC.

DR. GONSTEAD TALKED ABOUT A LEVEL DISC CONCEPT OR AN OPTIMALRELATIONSHIP OF THE DISCS.

THE PALMER-GONSTEAD ADJUSTMENT IS DESCRIBED AS SHORT LEVER,HIGH VELOCITY AND LOW AMPLITUDE.

THE SET-UP PROCESS IS DESIGNED TO ADDRESS A LINE OFCORRECTION FOR A PARTICULAR SUBLUXATION.**

Reference: Gran, D., D.C.; Palmer College Homecoming presentation.


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Palmer-Gonstead Adjusting Technique

Occiput - 2 variations

PP: Cervical Chair PS GroupPS PS-RS PS-LS

PS-RS-RA PS-LS-LA

PS-RS-RP PS-LS-LP

AS GroupAS AS-RS AS-LS

AS-RS-RA AS-LS-LA

AS-RS-RP AS-LS-LP


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Atlas - 2 variations

PP: Cervical Chair - AS GroupASR ASRA ASRP

ASL ASLA ASLP

PP: Knee Chest - AI GroupAIR AIRA AIRP

AIL AILA AILP

G A j i i


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C2 C7 (T3) - 2 Variations

PP: Cervical Chair

Simple Listing GroupP, PR, PRS, PL, PLS

(SCP): Spinous Contact

Rotatory Listing Group--PR-L, PRI-L, PL-L, PLI-L

(SCP): Lamina oppositeSpinous Laterality

P l G d Adj i T h i


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Alternate Prone Adjusting2 variations

PP: Prone (Knee Chest/Hy-lo)

Simple Listing Group--P, PR, PRS, PL, PLS

(SCP: spinous contact)

Rotatory Listing Group--PR-L, PRI-L, PL-L, PLI-L

(SCP: Lamina opposite SpinousLaterality)

Description of Thrust Palmer-


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Description of Thrust Palmer

Gonstead

PS occiput listingsLinear set & hold(toward opposite eye of patient).

As occiput listingsArc-like action of

doctors adjusting arms.AS atlas listings Linear set & hold

delivery.

AI atlas listings A Modified Toggle set &hold delivery (minimal equal elbow bend).

Description of Thrust Palmer-Gonstead


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Description of Thrust Palmer Gonstead

Adjusting

C2 C7 Simple ListingsShort set & hold. Thrustis Linear with lift up & in (toward opposite eyeof patient).

C2C7 Rotatory ListingsShort set & hold.

Thrust is Linear with lift up & in (toward patientseye on same side as contact).

Double Thumb C2 C7Short set & hold(doctor presents minimal equal elbow bend).

TECHNIQUE TERMINOLOGY


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C N QU NO OG

DEFINITIONS:

Line of Correction The direction the segment being adjusted

moves (responds in some amount for some

amount of time) in response to the adjustingthrust.

Line of Drive

The direction the thrusting hand will move whenthe adjusting force is delivered to the segment.

STEP BY STEP SET-UP PROCEDURE FOR PS


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STEP BY STEP SET UP PROCEDURE FOR PS

OCCIPUT, PALMER-GONSTEAD TECHNIQUE

1. Establish Doctor Stance (Scissors, to side of Occiput Lateralityweight forward).

2. PRIMARY Stabilization: With index & chiropractic index fingers, tuck patients chin (gently). 10B of S.H. is placedanterior to patients ear on side of stabilization, near the zygomatic. (The patients head rests against your upper chest toprevent tipping backward.)

3. On side of contact, palpate & take contact with 10A (with S-I Tissue Pull) on the SupraMastoid Groove (on side oflaterality). Thumb rests behind ear, fingers of C.H. wrap around the back of the Occiput. Keep C.H. forearm in againstyour ribcage.

4. With Stabilization fingers, elevate the patients chin to neutral (about 5 degrees) to relax the musculature.

5. Stabilization hand laterally bends the patients head to the side of occiput laterality.

6. If misalignment has a rotational component, stabilization hand rotates the patients head TOWARD the side ofcontact for Anterior Rotation misalignmentS , AWAY from the side of contact for Posterior Rotation misalignments. Thesemotions are slight, as fixation is usually reached quickly.

7. SECONDARY Stabilization: Pivot on your S.H. 10B, allowing your S.H. elbow and forearm to move anterior (forward)in opposition to your contact forearm. The fingers of your S.H. will support the lateral cervical musculature on the sideof stabilizationspecifically, #4 of the S.H. will stabilize Atlas. The thrust is a Linear Set & Hold, directed toward thepatients opposite eye.

PRACTICE


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PRACTICE

PS-RS C.C. P-A, S-I, R-LNo Torque

PS-RS-RP C.C. P-A, S-I, R-L, P-ANo Torque

PS-LS-LA C.C. P-A, S-I, L-R, A-PNo Torque

TECHNIQUE QUESTIONS TO


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Q Q

PONDER

The Occiput is fixed in extension. There is also Occiput/Atlas fixation on Right

Lateral Bending.

Right Rotation of Occiput to Atlas is restricted.

**What is the Occiput Listing? If Occiput isdetermined to be subluxated:

**Whats your D.S.? **Whats your C.P.?

**Whats your S.C.P.?**Whats your T.P.?

**Whats your L.O.C. & Torque?

PRACTICE


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PRACTICE

PS-RS L.O.C.:P-A, S-I, R-L, No Torque

PS-RS-RP L.O.C.:

P-A, S-I, R-L, P-A, No Torque

PS-LS-LA L.O.C.:

P-A, S-I, L-R, A-P, No Torque

AS-LS-LP L.O.C.:P-A, S-I, L-R, P-A, No Torque

STEP BY STEP SET-UP PROCEDURE FOR AS


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OCCIPUT, PALMER-GONSTEAD TECHNIQUE

Note: BOTH hands (#4 of both hands) serve as CONTACT POINTS for this technique adjusting procedure.1. Establish Doctor Stance in close behind the patient, feet parallel, shoulder width apart, slightlyfavoring the side of Occiput Laterality.

2. Palpate for the patients Segmental Contact Point (SCP)the GLABELLA.

3. Take PRIMARY CONTACT with Primary #4 (associated with the side of Occiput Laterality). Take thecontact using Superior to Inferior TISSUE PULL (S-I) down onto the Glabella.

4. Take SECONDARY CONTACT with Secondary #4 of the other hand, placing it immediately above thePrimary C.P. #4.

5. The palms of both hands will rest gently but firmly against the patients parietals; the doctorsforearms & elbows are held in close to the doctors rib cage.

6. Laterally bend the patients head to the side of Occiput laterality (to fixation, Occiput/C1).

7. If misalignment has a rotational component, rotate the patients headTOWARD the side of contactfor Anterior Rotation misalignments, AWAY from the side of contact for Posterior Rotationmisalignments. These motions are slight, as fixation is usually reached quickly.

8. The thrust is an arc-like action.

NOTE: Stabilization of Atlas is achieved by use of a Condyle Block or by third party stabilization.

PRACTICE


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PRACTICE

PS-LS L.O.C. -- P-A,S-I, L-R

No Torque, C.C.

AS-RS-RP L.O.C.- A-P, S-I, R-L, P-A

No Torque

PALMER-GONSTEAD AS OCCIPUT


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PRACTICE

AS-LS C.C., L.O.C.: S-I, A-P, L-RNO TORQUE

AS-RS-RA C.C., L.O.C.: S-I, A-P, R-L, A-P

NO TORQUE

AS-LS-LP C.C., L.O.C.: S-I, A-P, L-R, P-ANO TORQUE

STEP BY STEP SET-UP PROCEDURE FOR AS


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ATLAS, PALMER-GONSTEAD TECHNIQUE

1. Establish Doctor Stance (in close to the patient, favoring the side of Atlas laterality, feet parallel,shoulder width apart.)

2. Primary Stabilization: With index & chiropractic index fingers, tuck patients chin (gently). 10B isplaced anterior to patients ear, near zygomatic.

3. Palpate & take contact with Contact Point #9 [thumb pad] (with Roll-In Tissue Pull) on the Atlastransverse process (on side of Atlas laterality). Doctors contact hand forearm is level and in line withthe patients shoulder on the side of contact.

4. With Stabilization fingers, elevate chin to neutral (about 5 degrees) to relax musculature.

5. Stabilization hand laterally bends patients head to side of Atlas laterality a tad to point offixation/restriction C1/C2.

6. If misalignment has a rotational component, stabilization hand rotates the patients headTOWARDthe side of contact for Anterior Rotation misalignments, AWAY from the side of contact for PosteriorRotation misalignments.

7. Secondary Stabilization: Pivot on your S.H. 10B, allowing your S.H. elbow and forearm to moveSLIGHTLY forward (in opposition to your contact forearmin line with patients shoulder on side of

stabilization). The fingers of your S.H. will support the lateral cervical musculature on the side ofstabilizationspecifically, #4 of the S.H. will stabilize Axis.

8. Thrust is Linear set & hold delivery (across the articulation).

AS ATLAS PALMER-GONSTEAD


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ADJUSTING

ASR S-I, R-L, CW Torque C.C.

ASRP S-I, R-L, P-A CW Torque

C.C.

ASLA S-I, L-R, A-P, CCW Torque

C.C.

STEP BY STEP SET-UP PROCEDURE FOR AI ATLAS


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PALMER-GONSTEAD ADJUSTING

1. Patient placement: Knee Chest Table; Hy-Lo Table; Pelvic Bench. Additional PatientPlacement Considerations: Prone with head turned toward side of Atlas laterality, withpatients arm on that side of C1 laterality placed on the headpiece above the crown of thehead. The Axis will be placed onto the inferior portion of the slot in the headpiece1) 2. Doctors stance is on the side of C1 laterality, straight-away to the patient contactarea. The doctors episternal notch is superior to the C1 SCP. (Episternal notch alignmentfollows the alignments used in Toggle Recoil Atlas adjusting for the various Atlas listings.) 3. Segmental Contact Point (SCP) is the lateral aspect of the C1 TVP on the side of Atlaslaterality. 4. Tissue Pull is taken in accordance with the LOC.(1) 4. Contact Point (CP) is the fleshy pisiform (#1) of [the doctors] superior hand. 5. Stabilization Hand (SH) is the doctors inferior hand with pisiform over pisiform orknuckle over pisiform positioning. 6. Note: The doctor presents minimum equal elbow bend set-up positioning. Torque forall Right C1 laterality corrections is counterclockwise (CCW); torque for all Left C1laterality corrections is clockwise (CW). Thrust Description: A Modified Toggle set andhold delivery. (2,3,4) References: 1Bovee ML, Burns JR, Carrigg PM, et al. Palmer Technique AdjustingManual. Davenport, IA; March 1991/2006. 2Ibid. 3Palmer College. Course Packet; Dr.Js Topic Study Sheets for Cervical Technique Class. Davenport, IA; August 1994. 4Johnson, MR. Training for Clinical Excellence in Chiropractic: A Practical Guide to Cervicaland Upper Thoracic Evaluation. Davenport, IA; 2006.

AI ATLAS, PALMER-GONSTEAD


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ADJUSTING

AIR, K.C. S-I, R-L CCW TORQUE

AILP, K.C. S-I, L-R, P-A CW TORQUE

AILA, K.C. S-I, L-R, A-P CW TORQUE

PRACTICE EXAMPLES:


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Palmer-Gonstead Adjusting

AILA K.C.L.O.C.: S-I, L-R, A-P; CW TORQUE

AIRP K.C.

L.O.C.: S-I, R-L, P-A; CCW TORQUE

ASL C.C.

L.O.C.: S-I, L-R, CCW TORQUE

ASRA C.C.

L.O.C.: S-I, R-L, A-P; CW TORQUE

STEP BY STEP SET-UP PROCEDURE FOR SIMPLE C2-C7


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LISTINGS, C.C., PALMER-GONSTEAD TECHNIQUE

1. Establish Doctor Stance (scissors, to side of SPINOUS LATERALITY)weight forward.

2. PRIMARY Stabilization: With index & chiropractic index fingers, tuck patients chin (gently). 10B ofS.H. is placed anterior to patients ear on side of stabilization, near the zygomatic. (The patients headrests against your upper chest to prevent tipping backward.)

3. On side on contact, palpate & take contact with #6 of Contact Hand on the POSTERIOR, INFERIOR,LATERAL aspect of the involved spinous on the side of spinous laterality. (Take this contact with I-S & L-M Tissue Pull.) Keep the C.H. forearm in against your ribcage. The THUMB PAD of the C.H. is keptextended (it will form a RAT HOLE or ARCH when it comes to rest anterior to the patients ear asLateral Bend of the head takes place in STEP 5).

4. With Stabilization fingers, elevate the patients chin to neutral (about 5 degrees to relax themusculature).

5. Stabilization hand laterally bends the patients head to the side of spinous laterality to the point offixation/restriction for the segmental level involved.

7. SECONDARY Stabilization: Pivot on your S.H. 10B, allowing your S.H. elbow and forearm to moveanterior (forward) in opposition to your contact forearm. The fingers of your S.H. will support thelateral cervical musculature on the side of stabilizationspecifically, #4 of the S.H. will stabilize thesegment below the segment being adjusted.

(The C.H. THUMB PAD forms the RAT HOLE or ARCH as it comes to rest against the area anterior to

the ear on the side of contact. This serves to stabilize the C.H.) The THRUST is a Linear Set & Hold, directed toward the patients opposite eye.

PRACTICE


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PRACTICE

PR C2 C.C. P-A, I-S, R-L, IN THEPLANE LINE OF THE DISC

NO TORQUE

PRS C2 C.C. P-A, I-S, R-L, IN THE PLANE LINE

OF THE DISC CW TORQUE

STEP BY STEP SET-UP PROCEDURE FOR ROTATORY


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C2-C7 LISTINGS, C.C., PALMER-GONSTEAD TECHNIQUE

1. Establish Doctor Stance (scissors, to side OPPOSITE spinous lateralityside of LAMINA S.C.P.weightforward, trunk of doctor slightly turned, so doctors contact forearm can align approximately 60degrees to the patients shoulder on the side of contact).

2. PRIMARY Stabilization: With index & chiropractic index fingers, tuck the patients chin (gently). 10Bof S.H. is placed anterior to patients ear on side of stabilization, near the zygomatic. (The patients headrests against your upper chest to prevent tipping backward.)

3. On side of contact, palpate & take contact with #6 of C.H. on the LAMINA OPPOSITE spinouslaterality. (Take this contact with I_S & M_L Tissue Pull.) Keep the C.H. forearm in against your ribcage.The THUMB PAD of the C.H. is kept extended (it will form a RAT HOLE or stabilizing ARCH for the C.H.

when it comes to rest anterior to the patients ear as lateral bend of the head takes place in STEP 5). 4. With Stabilization fingers, elevate the patients chin to neutral (about 5 degrees).

5. Stabilization Hand laterally bends the patients head to the side of contact to the point offixation/restriction of the involved segment.

6. SECONDARY Stabilization: Pivot on your S.H. 10B, allowing your S.H. elbow and forearm to moveanterior (forward)in opposition to your contact forearm. The fingers of your S.H. will support thelateral cervical musculature on the side of stabilizationspecifically, #4 of the S.H. will stabilize thesegment below the segment being adjusted.

7. The C.H. THUMB PAD forms the RAT HOLE or ARCH as it comes to rest against the area anterior to

the ear on the side of contact. 8. The THRUST is a Linear Set & Hold, directed toward the patients eye on the side of contact (patients

SAME EYE as side of contact.)

DOCTORS FOREARM PLACEMENTPALMER-GONSTEAD

CERVICAL CHAIR ADJUSTING


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CERVICAL CHAIR ADJUSTING

Lower Cervical Adjusting:C2 + C3 levelsC.H. elbow below contact for

best disc plane line perspective.

C4 C. H. elbow about level with contact for bestdisc plane line perspective.

C5, C6, + C7 levelsC.H. elbow slightly abovecontact for best disc plane line perspective.

PRACTICE


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PRACTICE

PS-LS-LA C.C. LOC: P-A, S-I, L-R, A-P, No Torque

AS-RS C.C.

LOC: A-P, S-I, R-L, No Torque

ASRP C.C.

LOC: S-I, R-L, P-A, CW Torque PLS C4 C.C.

LOC: I-S, P-A, Relative to Disc Plane Line, L-R, CCW Torque

PL-L C2 C.C.

LOC: I-S, P-A, Relative to Disc Plane Line, Right Lamina moves forward oranterior; indirectly, spinous responds L-R, No Torque

PRACTICE


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PRACTICE

PRS C2 C.C. L.O.C.: I-S, P-A, RELATIVE TO THE DISC PLANELINE, R-L, CW TORQUE

PL-L C4 C.C. L.O.C.,: I-S, P-A, RELATIVE TO THE DISC PLANELINE, RIGHT LAMINA MOVES ANTERIOR OR FORWARD,

SPINOUS PROCESS MOVES INDIRECTLY LEFT-RIGHT, NO

TORQUE.

Practice Examples


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Practice Examples

PLS C2 C.C.

PRI-L C2 C.C.

NOTE: The PLS adjusting would have a

Posterior, Inferior, Left aspect of the C2 Spinous as

S.C.P. The PRI-L adjusting would have a C2 Left

Lamina as S.C.P.

ALTERNATE PLACEMENT (PALMER-GONSTEAD


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TECHNIQUE) C2 C7 LEVELS PRONE PATIENTPLACEMENT (AKA D.THUMB) SIMPLE LISTING VARIATION (STACKEDTHUMB) STEP 1: DS on side of Spinous Lat.Step 2: Palpate & take TP L-M with SP thumb

(#9). Step 3:Maintain TP and take contact on Posterior,Inferior Lateral margin of spinous with CP(#9)thumb. Step 4:Place (stack) SP on top of CP.Step 5: Establish equal, min. elbow bend. Thrust Description: Short set & hold

ALTERNATE PLACEMENT CONSIDERATIONS__(Palmer-GonsteadTechnique) C2 C7 LEVELS PRONE PATIENT PLACEMENT


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(AKA MARRIED OR KISSING THENARS) D. Thumb

ROTATORY LISTING VARIATION (MARRIEDOR KISSING THENARS) STEP 1: DS on side Opposite Spinous Lat.(side of body rotation) STEP 2: Palpate & take TP M-L from spinousonto Right & Left LAMINA with #9 CP & #9SP. STEP 3: Bring thenars in to a touchingposition (to stabilize adjusting hands) STEP 4: Establish equal, min. elbow bend. Thrust Description: Short set & hold.

DOCTORS ADJUSTING ARMS/EPISTERNAL NOTCH POSITONFOR


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PALMER-GONSTEAD D. THUMB

Note: Episternal notch of doctor is over spine ofpatient. (In line with

the patients spine.)

To relate L.O.C. to plane line of the disc, alignepisternal notch slightly below contact for C2, C3

contacts, even with contact for C4 contact, and

slightly above contact for C5, C6, C7.

Doctors elbow bend is minimal & equal.

PRACTICE


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PRACTICE

PS-LS-LA C.C.LOC: P-A, S-I, L-R, A-P NO TORQUE

AS-RS-RP C.C.

LOC: A-P, S-I, R-L, P-A NO TORQUE

ASLP C.C.

LOC: S-I, L-R, P-A CCW TORQUE

PR C2 C.C.LOC: I-S, P-A, Relative to the Disc Plane Line, R-L, NO TORQUE

PLI-L C4 C.C.

LOC: I-S, P-A, Relative to the Disc Plane Line, Right Lamina responds forward or anterior, INDIRECTLYbringing the spinous, L-R, CW TORQUE

PR C2 D. THUMB

LOC: I-S, P-A, Relative to the Disc Plane Line, R-L, NO TORQUE

PLI-L C4 D. THUMB

LOC: I-S, P-A, Relative to the Disc Plane Line, Right Lamina responds forward or anterior, INDIRECTLYbringing the spinous, L-R, CW TORQUE

C.C. & D. Thumb PRACTICE


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C.C. & D. Thumb PRACTICE

PS-LS-LP C.C.AS-RS C.C.

ASLA C.C.

AIRA K.C.

PR C2 C.C.

PLI-L C4 C.C.

PRI-L C6 D. THUMB

PLS C5 D. THUMB

PS-RS C.C.AS-RS-RA C.C.

ASLP C.C.

AIR K.C.

PLS C2 C.C.

PL-L C4 C.C.

PR C6 D. THUMB

PRI-L C3 D. THUMB

ADDITIONAL PALMER-GONSTEAD

PRACTICE VARIATIONS


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PRACTICE VARIATIONS

PS-RS-RA C.C. :

L.O.C. - P-A, S-I, R-L, A-P; NO TQ

AS-LS-LP C.C. :L.O.C. - A-P,S-I, L-R, P-A; NO TQ

ASRP C.C. :L.O.C. S-I, R-L, P-A; CW TORQUE

PL C2 :L.O.C.- I-S,P-A, RELATIVE TO THE PLANE LINE OF THE DISC, L-R, NO TORQUE

PLI-L C4 :L.O.C.- I-S, P-A, RELATIVE TO THE PLANE LINE OF THE DISC, RIGHT LAMINA MOVES FORWARD OR ANTERIOR,INDIRECTLY BRINGING THE SPINOUS L-R, CW TORQUE

PRS C5 D. THUMB:L.O.C.- I-S, P-A, RELATIVE TO THE PLANE LINE OF THE DISC, R-L, CW TORQUE

PR-L C3 D. THUMB:L.O.C.- I-S, P-A, RELATIVE TO THE PLANE LINE OF THE DISC, LEFT LAMINA MOVES FORWARD OR ANTERIOR, INDIRECTLYBRINGING THE SPINOUS R-L, NO TORQUE

AILA K.C.L.O.C.S-I, L-R, A-P, CW TORQUE

EXAMPLE OF PALMER-GONSTEAD

PRACTICAL EXAM LISTINGS:


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PRACTICAL EXAM LISTINGS:(10 listings, each worth 4 points = 40 points possible for practical exam)

PL-L C6, D. Thumb PLI-L C6 D. Thmb PRS C3, D. Thumb PL C5 D. Thmb

PS-RS-RA, C.C. PS-RS C.C.

AS-LS-LP, C.C. AS-LS-LA C.C.

PS-LS, C.C.ASLA, C.C.

ASR, C.C.

ASRP, C.C.

PLI-L, C4, C.C. PR-L C2 C.C.

PR, C2, C.C. *AIRA K.C.

Diversified Adjusting Technique


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Diversified Adjusting Technique

This adjusting technique is not associated with any named individual,rather it represents a compendium of adjusting possibilities that havebeen part of chiropractic practice for most of the decades thatchiropractic has been in existence.

Diversified Cervical Adjusting, however, is not necessarily the technique

of choice for every patient. Diversified adjusting represents atraction/leverage approach to application of the adjustment. Therefore,patients must be screened by the chiropractor as to this adjusting choice,i.e. a patient with a positive circulatory screening exam may be betterserved, chiropractically, by what might be considered to represent moreconservative chiropractic adjusting optionsToggle; Palmer-Gonstead;NUCCA; Blair, etc.

See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class. Gindl P.S., pp. 133-154.

See: Dr. Johnsons Power Point slides, 115 158.

DIVERSIFIED ADJUSTINGPATIENT

PLACEMENT


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PLACEMENT

Patient Seated, Backless Chair:For selected Atlas listings:

2 variations

(to correct Posterior Rotation)

(to indirectly correct AnteriorRotation)

For selected Axis listings:

1 variation

(to correct C2 Body/SpinousRotation)

DIVERSIFIED ADJUSTING--PATIENT

PLACEMENT


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PLACEMENT

SUPINE (SuD):3 variations:

For selected Occiput listings

(to correct Posterior

Rotation)For selected Atlas listings

(to correct PosteriorRotation)

For selected C2 C6 listings

(to correct Body/Spinous

Rotation)

DIVERSIFIED ADJUSTING--PATIENT

PLACEMENT


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PLACEMENT

PRONE(PD)

5 variations:

**For Axis Subluxations (when there is more than the usual amount of RotationmisalignmentBody/Spinous):

Axis Special (Only) PD (Prone Diversified)

** For C2 C6 Subluxations (when Rotation of the Body/Spinousis the primary misalignment):

C2-C6, PD (Prone Diversified)

**For C7 T2 Subluxations (when Spinous Laterality is the primarymisalignment)

MTM(Modified Thumb Move)

**For C7 T2 Subluxations (when Spinous Laterality is the primarymisalignment)

DP(Diversified Pisiform)

**For T1 T3 Subluxations (when Rotation is the primary misalignment with aRotatory listing)

MDP(Modified Diversified Pisiform)

Diversified Adjusting


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j g

Patient Placement: Backless Chair

*Seated Diversifed Adjusting (SeD)

For C1 Rotation listings (P & A)

For C2 Spinous/Body Rotation

listings

NOT FOR C2 listings:

P, PRS, PLS

Diversified Adjusting (continued)


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j g ( )

Common set-up patterns for SeatedDiversified adjusting (SeD):

The three variations (2 for Atlas level adjusting

and 1 for Axis level adjusting)ALL require that the patient be seated in a

BACKLESS CHAIR. This will ensure that the

patients cervical spine is in the

neutral position.



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j g ( )

Common patterns for SeD set-ups(continued):

**The doctor will ALWAYS stand on the side

of Atlas Anterior Rotation for the Atlasvariation set-ups.

**The doctor will ALWAYS stand on the side

of Spinous Laterality for the Axis variationset-up.



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j g ( )

Common patterns for SeD adjusting:

**The doctor will ALWAYS :

--take P-A Tissue Pull onto the SCP

--Use #11 of the Stabilization Hand

to stabilize

--begin the set-up with the DS as

feet parallel, shoulder width

apart, mid line of the doctors bodylined up with the mid-point of the patients shoulder tip.

--laterally bend the patients head to the side

of contact (for point of tension 1)

--rotate the patients head away from the side of contact

(for point of tension 2)

--ALWAYS take all slack out of the doctors adjusting arms

by bringing the doctors elbows in toward one another

or bringing the doctors elbows in against the doctors

rib cage.

Diversified SeD listings


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g

ASRP AIRPASLP AILP

ASRA AIRAASLA AILA

PR PR-L PRI-L BODY LEFTPL PL-L PLI-L BODY RIGHT

SeD Adjusting--Practice


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j g

ASLP SeD

AIRA SeD

PLI-L SeD

SeD -- C1 Posteriority correction


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y

D.S. Side of Anterior C1 TVP, midline of doctoraligned with tip of patients shoulder.

S.C.P. C1 Posteriorly Rotated TVP

C.P. #4T.P. P-A

S.P. #11 stabilized mastoidfingers of

S.H. cupping ear and directed toward top of head

SeD C1 Anteriority correction


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y

D.S. Side of Anterior C1 TVP; doctors midlinealigned with tip of patients shoulder.

S.C.P. C1 Posterior arch on side of C1 Posteriorrotation.

C.P. #4

S.P. #11 of S.H. stabilizes mastoid; fingerscupping ear + directed toward

top of head. T.P. is P-A

SeD -- Axis


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D.S. Side of spinous laterality, feet parallel,shoulder width apart

S.C.P. Axis Lam/Ped on side of C2 body

rotationC.P. #4

S.P. #11 of S.H. stabilizes Atlas TVP, fingers

cupping the patients ear + directed towardtop of patients head.



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*Supine Diversified Adjusting (SuD)For Occiput Posterior Rotation

listings

For C1 Posterior Rotation listingsFor C2 C6 Spinous/Body

Rotation listings

NOT FOR C2:P, PRS, PLS



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j g ( )

Common adjusting patterns for SuD adjusting:

The doctor will ALWAYS:

**Stand favoring the side of

the SCP

**Laterally bend the patientshead to the side of

contact (point of tension 1)

**Rotate the patients head away

from the side of contact

(point of tension 2)

**Step around with or shift weight to the

doctors inferior foot as the patients

head is laterally bent to the side ofcontact (this will allow the doctor to

maintain a secure contact bond)

SuD Occiput & Atlas Adjusting


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For Occiput Listings: PSLP PSRPFor Atlas Listings: AILP ASLP

AIRP ASRP

For C2 C6 Listings:

PR, PRI-L, PR-L, Body Left

PL, PLI-L, PL-L, Body Right

***Not for PRS, PLS, P

Practice


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PSRP SuD

AIRP SuD

******************

AILA SeD ASLP SeD

PRI-L SeD PR SeD

PRACTICE


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PSLP SuD AIRP SuDASLA SeD AIRP SeDPRI-L SeD PL SeD

Practice


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PL C2 SuD

PR-L C4 SuD

PSRP SuD

ASLP SuD

PRACTICE


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PL-L C2 SuD PR C4 SuDPSRP SuD AILP SeDASLP SuD ASRA SeD

PRI-L SeD

Supine Diversified Practice


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PLI-L C2 SuD PR C4 SuD PSLP SuD ASRP SuD



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Patient Prone(Headpiece Deflection toward the floor is

always present with these adjusting

procedures:C2 C6 Levels = 10 15 degrees

deflection

C7 T3 Levels = 15 20 degrees

deflection)

HEADPIECE DEFLECTION


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PRONE DIVERSIFIED ADJUSTING: Headpiece Deflection toward the floor is 10 degrees to 15

degrees for the following Prone Diversified adjusting

procedures:

Axis Special (PD) (aka Axis Only PD)

C2 C6 Prone Diversified (PD)

(For segmental levels C2 C6)

HEADPIECE DEFLECTION


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Headpiece Deflection for Diversified ProneAdjusting (continued): For segmental levels C7 T3: Headpiece Deflectiontoward the floor is 15 degrees to 20 degrees Headpiece Deflection for Diversified Prone

Adjusting at 15 degrees to 20 degrees toward thefloor will be utilized for the following adjustingprocedures: MTM C7 T2 DP C7 T2 MDP T1 T3



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**Prone Diversifed Adjusting (PD)

For Axis (Special/Only) listings

(when much C2 Spinous and

Body Rotation are involved)

Body Right, Spinous Left;

Body Left, Spinous Right

For C2 C6 Spinous/Body Rotationlistings (PD)

For C7 T2 Spinous Laterality

correction (MTM)For C7 T2 Spinous Laterality correction (DP)

For T1 T3 Rotatory listings (MDP)(to indirectly correct Spinous Laterality)



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Prone Diversified(Axis Special/only)

Body Right, Spinous Left PD

(Axis Special/only)

Body Left, Spinous Right PD

(Axis Special/only)

**Chosen for adjustment approach when more than the usual amount ofRotation of Axis is present in the misalignment.

**This adjustment has 2 CPs & 2 SCPs.

**The only other adjustment choice is Palmer- Toggle

**The headpiece is deflected toward the floor, 10 degrees to 15

degrees.



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Prone Diversified -- C2 C6PL PD PR PD

PL-L PD PR-L PD

PLI-L PD PRI-L PD

Body Right PD Body Left PD

**Headpiece Deflection toward the floor is: 10

degrees to 15 degrees



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Modified Thumb Move (MTM)(C7 T2)

P

PL MTM PR MTM

PLS MTM PRS MTM

Headpiece Deflection toward the floor is: 15 degreesto 20 degrees

This is the ONLY Prone Diversified Adjustment that hasthe doctor stand and contact on the side ofspinouslaterality.

Diversified Adjusting Examples,

Patient Prone


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Body Right, Spinous Left, (Axis Only or Axis Special) PD Utilized as an adjustment choice when Body/Spinous Rotation is VERY pronounced.

LOC I-S, P-A, Spinous responds L-R, Right Lam-Ped responds anterior or forward,indirectly assisting the Spinous to respond L-R.

PL C2 PD LOC I-S, P-A, Right Lam-Ped moves anterior, with spinous indirectly responding

L-R

PRI-L C6 PD LOC I-S, P-A, Left Lam-Ped moves anterior or forward, with spinous indirectly

responding R-L

PRS T1 MTM LOC I-S, P-A, (Spinous) R-L

Note: For ALL of the above PRONE DIVERSIFIED ADJUSTMENTS, the doctor ALWAYSuses #11 to Stabilize the segment above that being adjusted; the patients head isALWAYS turned away from the side of doctor stance (and contact) to enhance thecontact bond; classic scissors stance is ALWAYS the D.S.



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Diversified Adjusting Patient Prone (Headpiece Deflection toward the floor is

15 20 degrees for these two adjusting procedures.)

DIVERSIFIED PISIFORM (DP)

C7 T2 Levels

For listings: P, PR, PRS, PL,PLS

MODIFIED DIVERSIFIED PISIFORM (MDP)

T1 T3 Levels

For listings: PL-T, PLI-T, PR-T, PRI-T

**For the DP and MDP adjustments, the patients head isTurned toward the side of doctor contact/stance in order to

enhance the contact bond.



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Common patterns for Diversified Adjusting, patient prone:

For the Axis Special/Only PD; C2 C6 PD; MTM:

**The patients head is turned away from the side of

doctor contact.**#11 of the doctors Stabilization Hand stabilizes on

the segment above that being adjusted.

**The doctor steps either: up and out, up and in, or

shifts his/her weight forward.

DIVERSIFIED ADJUSTING

THRUST DESCRIPTION


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SeD Adjustments: The thrust isa quick motion of the contact handcoming toward the doctor. (The stabilization hand is used as a brake to

prevent over thrusting.)

SuD Adjustments (Occiput & C1): The thrust is linearaiming toward

the patients opposite shoulder tip

(S-I). SuD Adjustments (C2 C6): The thrust is linearaiming toward the

patients mouth (I-S & P-A)

Axis Special (Axis Only), PD Adjustments: The thrust is a rachet [or

screw like] motion produced by [the doctor] dropping [his/her] elbow

down. C2 C6 PD Adjustments: The thrust is aimed toward the patients

mouth (I-S & P-A).

DIVERSIFIED ADJUSTINGTHRUST

DESCRIPTION (Continued)


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MTM Adjustments: The thrust is aimed (slightly) toward the patientsmouth (I-S); there is minimal P-A, with the hoped for response beingeither L-R or R-L, using the spinous as a lever to receive the adjustment.(The doctors episternal notch should be slightly inferior and lateral tothe S.C.P. in a line corresponding to the L.O.C.. All thrust is directedthrough the contact hand.)

DP Adjustments: The thrust is directed through the contact hand,aiming I-S and L-R or R-L, using the spinous as the lever to receive theadjustment.

MDP Adjustments: The thrust is directed through the contact arm,while weight is shifted to allow for a gentle body drop P-A, & in linewith the adjusted segments disc.



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NOTE: ALL of the below listings within each group wouldLOOK THE SAME

when performing the set-up:

Group 1 Group 2

ASLP SeD AILA SeD

AILP SeD ASLA SeD

Group 3 Group 4

PR SeD PL SeD

PR-L SeD PL-L SeDPRI-L SeD PLI-L SeD

Body Left SeD Body Right SeD



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ALL of the below listings within each group would LOOK THE SAME whenperforming the set-ups:Group 5 Group 6

PSRP SuD PSLP SuD

Group 7 Group 8

AILP SuD ASRP SuDASLP SuD AIRP SuD

Group 9 Group 10

PR SuD PL SuD

PR-L SuD PL-L SuDPRI-L SuD PLI-L SuD

Body Left SuD PLI-L SuD

EXAMPLES OF DIVERSIFIED

ADJUSTING PROCEDURES


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ASRP SeD AIRA SeD

PLI-L SeD

PSLP SuD AILP SuD

PR-L SuD C4

Body Left, Spinous Right (Axis Special/Only)PD

PL C5 PD PL T2 DP PRS T1 MTM PLI-T T3 MDP

REVIEW FOR DIVERSIFIED PRACTICAL

PATIENT SEATED


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DIVERSIFIED ADJUSTING: AIRP SeD

ASLA SeD

PR SeD

PALMER-GONSTEAD ADJUSTING: PS-LS-LP C.C.

AS-RS-RA C.C.

ASRP C.C.

PR C2 C.C. PRI-L C4 C.C.

REVIEW FOR DIVERSIFIED

PRACTICAL EXAM


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PATIENT SUPINE: PSLP SuD PSRP SuD

AIRP SuD ASLP SuD

PRI-L C4 SuD PL C2 SuD

REVIEW FOR PRACTICAL EXAM


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PATIENT PRONE

BODY RIGHT, SPINOUS LEFT (AXIS SPECIAL) PD

PR C5 PD

PL C7 MTM ** PL C7 DP

PR-T T2 MDP

PLS C6 D. THUMB**

PLI-L C3 D. THUMB **Of ALL of the above PRONE adjusting procedures, the MTM and the D.

Thumb (Simple Listings) are the only instances of doctor stance on theside of spinous laterality. Otherwise, the D.S. is on the side of bodyrotation.

REVIEW FOR PRACTICAL

EXAM: Patient Prone


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EXAM: Patient Prone

Body Right, Spinous Left (Axis

Special/Only) PD

PR C5 PD

PL C7 MTM **** PL C7 DP

PLI-T T2 MDP

PRS C6 D. Thumb **** PR-L C3 D. Thumb

Practical Technique Exam Information


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1. The Diversified Practical will be composedof 10 set-ups: 8 Diversified; 2 Palmer-

Gonstead

2. The Final Practical will be composed of 10set-ups:

5 Diversified; 5 Palmer-Gonstead

EXAMPLE OF DIVERSIFIED PRACTICAL

EXAM: (10 SET-UPS, 4 POINTS EACH = 40 POINTS POSSIBLE)


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PLS, T1, DP PRI-L, C5, D. Thumb

Body Left, Spinous Right (AxisSpecial) PD

PL-L, C3, PD

PR, C7, MTM

ASLP, C.C.

PL, SeD

PSRP, SuD

AIRP, SuD

PR, C4, SuD

EXAMPLE OF FINAL PRACTICAL EXAM:(10 set-ups, 4 points each = 40 points possible for exam.)


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AS-RS-RP C.C.ASLA C.C.

PL-L, C4, C.C.

PRS, C3, C.C.

AIRA, SeDPSLP, SUD

PRS, C6, D. Thumb

PRI-L, C2, PD

Body Left, Spinous Right, (Axis Special) PDPL-T, T2, MDP

HIERARCHY OF ADJUSTING

CHOICESSUGGESTIONS -- FYI


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ROTATION AS PRIMARY MISALIGNMENT FINDING OFSUBLUXATION

SEATED DIVERSIFIED (SeD) (MOST ROTATIONINFLUENCE)

SUPINE DIVERSIFIED (SuD)

C2 C6 PRONE DIVERSIFIED (PD)*

*(50% ROTATION/50%POSTERIORITY INFLUENCE)

CERVICAL CHAIR (CC)

DOUBLE THUMB (D. THUMB) (MOST POSTERIORITYINFLUENCE)

POSTERIORITY AS PRIMARY MISALIGNMENT FINDING OFSUBLUXATION

PRACTICE


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PS-RS-RP C.C.L.O.C.: P-A, S-I, R-L, P-A NO TORQUE

PS-RS C.C.

L.O.C.: P-A, S-I, R-L NO TORQUE

PS-LS-LA C.C.

L.O.C.: P-A, S-I, L-R, A-P NO TORQUE

PRACTICE


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PS-RS-RP L.O.C. = P-A, S-I, R-L, P-A NO TORQUE

AS-LS-P-A L.O.C. = A-P, S-I, P-A No TORQUE

PRACTICE


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AS-RS C.C. L.O.C.: A-P, S-I, R-L NO TORQUE

AS-LS-LP C.C.

L.O.C.: A-P, S-I, L-R, P-A NO TORQUE

AS-RS-RA C.C.

L.O.C.: A-P, S-I, R-L, A-P NO TORQUE

PRACTICE


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ASR C.C. L.O.C.: S-I, R-L, CW TORQUE

ASLP C.C.

L.O.C.: S-I, L-R, P-A, CCW TORQUE

ASRA C.C.

L.O.C.: S-I, R-L, A-P, CW TORQUE

PRACTICE


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AIL K.C. L.O.C. = S-I, L-R, CWTorque

AIRP K.C. L.O.C. = S-I, R-L, P-A,

CCW Torque

PRACTICE


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PS-RS-RA C.C. L.O.C.: P-A, S-I, R-L, A-P NO TORQUE

AS-LS-LP C.C.

L.O.C.: A-P, S-I, L-R, P-A NO TORQUE

ASRP C.C. L.O.C.: S-I, R-L, P-A CW TORQUE

AIL K.C.

L.OC.: S-I, L-R, CW TORQUE

PRACTICE


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AIR K.C. LOC: S-I, R-L CCW TORQUE

AILA K.C.

LOC: S-I, L-R, A-P CW TORQUE

PS-RS-RA C.C.

LOC: P-A, S-I, R-L, A-P NO TORQUE

AS-LS-LP C.C.

LOC: A-P, S-I, L-R, P-A NO TORQUE

ASLA C.C.

LOC: S-I, L-R, A-P CCW TORQUE

ASR C.C.

LOC: S-I, R-L CW TORQUE

PRACTICE


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PRS C3 D. Thumb L.O.C. I-S, P-A, Relative tothe Plane Line of the Disc, R-L, CW torque

PR-L C5 D. Thumb L.O.C. I-S, P-A,Relative to the Plane Line of the Disc, LeftLaminamoves forward or anterior, spinousindirectly responds R-L. No Torque

Palmer-Gonstead Technique Practice


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PS-LS-LP C.C.L.O.C.: P-A, S-I, L-R, P-A

No Torque

AS-RS-RA C.C.L.O.C.: A-P, S-I, R-L, A-P

No Torque

ASRP C.C.L.O.C.: S-I, R-L, P-A, CW Torque

PRACTICE


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SEATED C.C. & SeD

ASRP SeD PS-LS-LA C.C.

AILA SeD ASLP C.C.

PR-L SeD PRS C4 C.C. PRI-L C3 C.C.

SUPINE SuD

PSLP SuD

AIRP SuD

PL C2 SuD

PRONE DIVERSIFIED & DOUBLE THUMB

BODY RIGHT, SPINOUS LEFT (AXIS SPECIAL) PD

PRI-L C5 PD PRS C5 D. THUMB

PL T1 MTM PRI-L C4 D. THUMB PL T1 DP

PLI-T T2 MDP

PRACTICE


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PLS T1 DP (Diversified Pisiform)

PR C7 DP

PLI-T T2 MDP (Modified Diversified Pisiform)

PR-T T1 MDP

COURSE GRADE INFORMATION


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TOTAL POINTS FOR THE COURSE: 200

188+ = GRADE OF A FOR THE COURSE

BONUS POINTS FOR THE COURSE


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PALMER TECHNIQUE CLASS PORTFOLIO 10 POINTS

X-RAY ANALYSIS ON SELF: 3 POINTS

PATIENTS RAD REPORT: 2 POINTS

_________

TOTAL BONUS POINTS: 15 POINTS

(Additional Bonus Points may be added at the discretion of the instructor.)

COURSE GRADE INFORMATION


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TOTAL REGULAR POINTS FOR COURSE: 200

TOTAL BONUS POINTS OFFERED: 15

(Additional Bonus Points may be offered at the discretion of the instructor.)

FINAL WRITTEN ESSAY EXAM INFO


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If your score BEFORE the Final Written exam isat 188 or above: You do not HAVE TO take the

Final Written Exam (but you may if you wish,

as anyone may elect to take the Final WrittenExam for the experience).

Cervical Technique Class Power Point

Presentation References


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The author of these slides wishes to note that the materialin the slides was drawn from the various TechniqueDepartment classes offered over the years by PalmerCollege. In particular, Drs. Gindl, Burns, and Gran are to bethanked. Dr. Carson Israel is the source of information

concerning the Derifield Short Leg Exam as well as thegraphics for the Palmer-Gonstead Alternate Prone Adjusting.

That material was most helpful and its organization muchappreciated.

Copyright, Marjorie Johnson, D.C., Ph.D.; May, 2011

ADDENDUM


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THE FOLLOWING POWERPOINT INFORMATION MATERIALS

ARE IN SUPPORT OF EARLIER TOPICS IN THIS SERIES.

Technique Discussion Question


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What is distinct about thechiropractic adjustment?

Mo/Pal Example


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PS-RS-RP Decreased Extension, Occ/C1

Decreased Right Lateral Bend, Occ/C1

Decreased Left Rotation, Occ/C1

(For listing: PS-RS-RA, the RA would

present with Decreased Right Rotation.)

Mo/Pal Example


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ASLP AS = Film Finding

Decreased Left Lateral Bend, C1/C2

Decreased Right Rotation, C1/C2

Mo/Pal Example


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PRS, C2 Decreased Extension, C2

Decreased Right Rotation, C2

Decreased Right Lateral Bend,

C2/C3

Mo/Pal Example


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PLI-T, T2 Decreased Extension, T2

Decreased Left Rotation, T2

Decreased Right Lateral Bend,T2/T3

PALMER-GONSTEAD PRACTICE


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PS-RS C.C. +OX, -OZ

FML

TCL

APL

L.O.C. : P-A, S-I, R-L No Torque TAL

Palmer-Gonstead Practice


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PS-LS-LP C.C.

FML APL TCL

TAL

+0X,+0Z,+0YL.O.C.: P-A, S-I, L-R, P-A; No Torque



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PS-RS-RA C.C. FML

APL TCL

TAL

+0X, -0Z,+0Y



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PS-RS-RP C.C. +OX, -OZ,-OY

FML TCL

APL TAL



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+OX, +OZ Occiput



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AS-RS-RA C.C. FML TCL

APL

TAL

-0X,-0Z,+0YL.O.C.: A-P, S-I, R-L, A-P; No Torque



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AS-LS-LP C.C. FML

APL

TCL

TAL

-0X,+0Z,+0Y L.O.C.: A-P, S-I, L-R, P-A No Torque



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ASR C.C.

-0X,-0Z C1 TALOL APL

OPL Axis Plane Line

L.O.C.: S-I, R-L; CW Torque



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ASLA C.C. OL

APL TAL

OPL

Axis Plane Line -0X,+0Z,-0Y



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AILA KC ROL

APL TAL

Axis Plane Line

+0X, +0Z,-0Y L.O.C.: S-I, L-R, A-P; Clockwise Torque



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PRS C2 C.C. R

C2

C3 -0X, +0Y,-0Z

Convexity to Right L.O.C.: I-S, P-A, R-L, Relative to DPL; CW Torque



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PLS C3 C.C.

C3 Listing Line

C4 Base Line -0X, -0Y, +0Z

Convexity to Left L.O.C.: I-S, P-A, L-R, Relative to DPL; CCW Torque

PRACTICE


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PLI-L C4 C.C. -0X,-0Y,-0Z, C4

C4 Listing Line

C5 Base Line Convexity to Right L.O.C.: I-S, P-A, Relative to DPL; RightLamina moves anterior; Spinous on Left responds indirectly L-R; CW Torque



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R

C4

C5



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PR-L C2 D. Thumb R

C2 Listing Line

C3 Base Line

-0X,+0Y, Convexity to Left



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PL C4 C.C. -0X, +0Y Convexity to Left

C4

C5

Other Adjusting Choices:D. Thumb; SuD; PD



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PR-L C2 C.C. C2

C3

-0X,+0Y Convexity to Left



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PRS C6 D. THUMB

-OX,+OY,-OZConvexity to Right

C6

C7



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PR-L C2 D. Thumb -OX, +OY, Convexity to Left

C2

C3



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ASRP C.C. R

-0X,-0Z,-0Y L.O.C.: S-I, R-L, P-A CW Torque



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PLS C4 C.C. -OX, -OY,+OZ ; Convexity on the Left

C4

C5L.O.C.: P-A, I-S, Relative to the DPL, L-R CCW Torque



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PLI-L C3 C.C.

-0X,-0Y,-0Z C3Convexity on Right C3

C4L.O.C.: P-A, I-S, Relative to the DPL; Right Lamina moves anterior,

Spinous responds indirectly L-R; CW Torque



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ASL C.C. OL -0X, +0Z

APL TAL

OPL

Axis Plane LineL.O.C.: S-I, L-R CCW Torque



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ASLP C.C.

OL APL TAL

OPL

Axis Plane Line

-0X,+0Z,+0Y L.O.C.: S-I, L-R, P-A CCW Torque



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AIR K.C. R+OX, -OZ



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ASLA C.C. OL TAL

APL

OPL

Axis Plane Line

-0X,+0Z,-0Y L.O.C.: S-I, L-R, A-P CCW Torque



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PRS C4 C.C.

C4

C5

Convexity to Right -0X,+0Y,-0Z



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PLI-L C3 C.C.

ALWAYS STATEMENTS

For Occiput Atlas and Simple listings C2-C7 C C


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For Occiput, Atlas, and Simple listings, C2-C7 C.C.,you will ALWAYS stand on the side of laterality ofthe listing and ALWAYS contact on the side oflaterality (Palmer-Gonstead Adjusting).

For Occiput and C2-C7 Simple listings C.C., the landmarktoward which the thrust is aimed when delivering theadjustment is the patients OPPOSITE eye.

For C2-C7 Rotatory listings C.C., the landmark toward

which the thrust is aimed when delivering theadjustment is the patients SAME eye as the contact side.

DIVERSIFIED PRACTICE


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AILP/ASLP SeD R

+0X, Other Choices

SuD

C.C.K.C.

-0X

+0Z, +0Y

DIVERSIFIED PRACTICE


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ASRA

Cervical Technique Power Point M Johnson

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