Transcript Negative Derifield

Thompson / Upper
Cervical
Texas 3 step
Set the Table
Set the Patient
Set 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.
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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.
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3) Set the Doctor: Must have proper stance, L.O.D., S.C.P.’s,
etc…More in Lab.
Thompson Protocol
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Clear Cervicals and Occiput
Clear Pelvic region
Clear Lumbars
Clear Thoracics
Address Atlas via Upper Cervical tech.
Overcompensated Cervical
Syndrome

R

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).
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!!!
R
Overcompensated Cervical
Syndrome


R

The syndrome will be
identified from the Xray--spinous laterality.
Alert the Chiropractor
with the tight trap.
(Patient must present
with both findings before
adjusting).
Overcompensated Cervical
Syndrome
R

O.C.S.’s are rare.

Always rule out an
O.C.S. on the initial
visit--if possible.
Overcompensated Cervical
Syndrome

R
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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.
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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R
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Leg length Analysis

The most important step!

Extension:

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# 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:




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#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.
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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:


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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)
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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.
L
R
Left Unilateral Cervical Syndrome
:(Pages 156 &157)
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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.
L
R
X-Derifield Cervical Syndrome

X-DCS and UCS are the same.

Same adjusting protocol as U.C.S.
Stationary Tables & Patient Protocols
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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
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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
Correct Cervical Subluxations
O.C.S.
U.C.S. & X-D.C.S.
B.C.S.
Positive Derifield
Negative Derifield
Posterior Ischium
A short leg in extension
that lengthens upon flexion
A short leg in extension
that remains short upon flexion
Taut and tender gastrocnemius
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
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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:

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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
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S.C.P.’s:
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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
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Analysis: Short
leg in Extension
that remains
short in flexion
7 reflex points –
3 tender points
Negative Derifield
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
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Posterior innominate
misalignment
Fulcrum point is
located at the sacral
auricular surface
Two part Adjustment
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:


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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
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Set the Doctor:

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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
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S.C.P.’s:

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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

The patient must
exhibit palpable
tenderness at three of
the seven reflex
points--before
adjusting!!!
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points:
Achilles tendon
Internal condyle
Ischial tuberosity
P.S.I.S.
Pubic tubercle
Erector Spinae and
psoas
T2/3 intercostal
space
+ Derifield & - Derifield

Positive Derifield

Negative Derifield

Set the table: Foot piece

Set the table: Foot
up, Dial set on LP, Directional
drop up (S to I), Head piece
tilted down with plunger out.
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

Negative Derifield

Set the Doctor: Dr. stands on

Set the Doctor:
either side--Right + D…Right
Thenar. Stabilize with other hand-mid heel or M.C.P of the index
finger.


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
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Positive Derifield
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Negative Derifield
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S.C.P.’s:
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S.C.P.’s:
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Medial, inferior aspect of
the P.S.I.S. on the involved
side.
Posterior, inferior aspect of
the ischial tuberosity on
the uninvolved side.
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Part 1: Anterior,
inferior aspect of the
ischial tuberosity on
the involved side.
Part 2: Mid inguinal
ligament on the
involved side.
Posterior Ischium

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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
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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
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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.
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A.S.I.S.’s in the gap
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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.

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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:


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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:
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Prone
A.S.I.S.’s in the gap
Cross the involved leg
Sacral Adjustment

Set the Doctor:

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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:

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#1) Field Method
#2) Institutional Method.
Spondylolisthesis

Field Method: No Thrust---Only pressure until table drops.

Institutional Method: 3 Thrust!!!
Lumbar Analysis
 Single
Hand Contact
 Pisiform Over Thumb
 Double Thumb
Lumbar Spine

Lumbar pad activation - Dial on L.

Patient prone

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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:

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
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:

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#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 Cervical
C1 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 Table
 Set the Patient
 Set 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
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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 Table
 Set the Patient
 Set 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
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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