Presentation on theme: "Thompson / Upper Cervical"— Presentation transcript:
1Thompson / Upper Cervical Texas 3 stepSet the TableSet the PatientSet the Doctor
2Thompson 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).
3Thompson Highlights!!!Texas 3 step…Set the table, Set the patient, and Set the Doctor.2) Set the Patient: Patient…prone or supine.Table setting: Tilt the cervical head piece down & foot piece up.Alignment:Cervical & Thoracic…Head rest paper is located 1 inch below the bottom of the mandible.Pelvic adjusting (prone)…A.S.I.S’s are in the gap.
4Thompson Highlights!!!Texas 3 step…Set the table, Set the patient, and Set the Doctor.3) Set the Doctor: Must have proper stance, L.O.D., S.C.P.’s, etc…More in Lab.
5Thompson Protocol Clear Cervicals and Occiput Clear Pelvic region Clear LumbarsClear ThoracicsAddress Atlas via Upper Cervical tech.
6Overcompensated Cervical Syndrome There is no Leg length analysis for this condition.The patient will demonstrate spinous laterality from C2 to C7 (Maximum spinous laterality will be observed at C2).R
7Overcompensated 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
8Overcompensated Cervical Syndrome The syndrome will be identified from the X-ray--spinous laterality.Alert the Chiropractor with the tight trap.(Patient must present with both findings before adjusting).R
9Overcompensated Cervical Syndrome O.C.S.’s are rare.Always rule out an O.C.S. on the initial visit--if possible.R
10Overcompensated Cervical Syndrome Common findings :Patient presents with torticollis or a chronic, unresolving cervical problems.Adjusted for an U.C.S. , B.C.S. , or a X.D.C.S. with no or minimal results.R
11Overcompensated 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!!!R
12The most important step! Leg length AnalysisThe most important step!Extension:# 1) 3 point landing: Thumb on heels and I.F. and C.I.F. split the lateral maleoli.#2) Take out inversion and eversion.#3) Slight headward pressure…not to much--not to little--just right.#4) Sight between the heel counters and identify the short leg.
13The most important step! Leg length AnalysisThe most important step!Flexion:#1) Raise the feet to 90.#2) Try to keep the feet apart--Don’t let them rub or touch when bringing them to 90.#3) The shoe should be kept flat against the bottom of the heel for proper analysis.#4) Sight between the heel counters, through the gluteal cleft, and to the E.O.P.#5) Identify the short leg…either side!
14Bilateral Cervical Syndrome Legs are even in extensionHead 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.
15Bilateral 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.
16Unilateral 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.
17Unilateral Cervical Syndrome Upon Palpation, a palpable, tender nodule will be found over the lamina of the involved vertebra.L.O.D.’s:C2 & C3…P - A, I - SC4 & C5…P - A, straight acrossC6 & C7…P - A, S - I
18Unilateral 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!
19Left Unilateral Cervical Syndrome :(Pages 156 &157) Short leg in extension.Head RotationThe syndrome is named by the direction of head rotation that produces an improvement / evening of the short leg in extension.LR
20Left Unilateral Cervical Syndrome :(Pages 156 &157) B.R. Malposition; Spinous Left; - Y.Rotation to the Right--Increase subluxation. Rotation to the Left--Decrease subluxation.An increase will shorten the short leg.A Decrease will lengthen the short leg.LR
21X-Derifield Cervical Syndrome X-DCS and UCS are the same.Same adjusting protocol as U.C.S.
25Positive DerifieldAnalysis: Short leg in extension--lengthens to some degree upon flexion.Reference point: P.S.I.S.
26Positive Derifield Pivot point: Acetabulum “True” P.I. Ilium Resistance may be felt with analysis
27Positive Derifield Set the table: Foot piece up, Dial set on LP, Directional drop up (S to I), Head piece tilted down with plunger out.
28Positive Derifield Set the Patient: Patient Prone. Align the A.S.I.S.’s in the gap between the L & P pads.
29Positive Derifield Set the Doctor: Dr. stands on either side--Right + D…Right Thenar.Stabilize with other hand--mid heel or M.C.P of the index finger.
30Positive Derifield S.C.P.’s: Medial, inferior aspect of the P.S.I.S. on the involved side.Posterior, inferior aspect of the ischial tuberosity on the uninvolved side.
31Negative DerifieldAnalysis: Short leg in Extension that remains short in flexion7 reflex points – 3 tender points
32Negative Derifield Posterior innominate misalignment Fulcrum point is located at the sacral auricular surfaceTwo part Adjustment
33Negative 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.
34Negative 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.
35Negative Derifield Set the Doctor: Part 1: Dr. Stands on the involved side and will adjust with their inferior hand.Part 2: Dr. on the involved side and will adjust with their superior hand.
36Negative Derifield S.C.P.’s: Part 1: Anterior, inferior aspect of the ischial tuberosity on the involved side.Part 2: Mid inguinal ligament on the involved side.
37Negative Derifield Reflex points: Achilles tendonInternal condyle Ischial tuberosityP.S.I.S.Pubic tubercleErector Spinae and psoasT2/3 intercostal spaceThe patient must exhibit palpable tenderness at three of the seven reflex points--before adjusting!!!
38+ Derifield & - Derifield Positive DerifieldSet the table: Foot piece up, Dial set on LP, Directional drop up (S to I), Head piece tilted down with plunger out.Negative DerifieldSet 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.
39+ Derifield & - Derifield Positive DerifieldSet the Patient: Patient Prone. Align the A.S.I.S.’s in the gap between the L & P pads.Negative DerifieldSet 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.
40+ Derifield & - Derifield Positive DerifieldSet the Doctor: Dr. stands on either side--Right + D…Right Thenar. Stabilize with other hand--mid heel or M.C.P of the index finger.Negative DerifieldSet the Doctor:Part 1: Dr. Stands on the involved side and will adjust with their inferior hand.Part 2: Dr. on the involved side and will adjust with their superior hand.
41+ Derifield & - Derifield Positive DerifieldS.C.P.’s:Medial, inferior aspect of the P.S.I.S. on the involved side.Posterior, inferior aspect of the ischial tuberosity on the uninvolved side.Negative DerifieldS.C.P.’s:Part 1: Anterior, inferior aspect of the ischial tuberosity on the involved side.Part 2: Mid inguinal ligament on the involved side.
42Posterior Ischium No leg length analysis Taut and tender gastrocnemius Dial “P”: No directional drop activationS.C.P.: Ischial tuberosity--on the involved side.
43IN Ilium No leg length analysis “Toe out” foot flare Wide gluteal and “Flattened” P.S.I.S.Wider Ilium on X-rayNarrow obturator foramen on X-ray
44EX Ilium No leg length analysis for the EX Ilium “Toe in” foot flare Narrow gluteal and prominent P.S.I.SNarrow ilium on X-rayWide obturator foramen on X-ray
45IN Ilium Adjustment procedure: Dial on “P” & D.D.H. A.S.I.S.’s in the gapS.C.P.: Medial aspect of the Ischial tuberosity on the involved side.
46IN Ilium Superior hand contact (C.P. Pisiform) L.O.D.: Medial to Lateral, slight P-A with an axial torque.
47EX IliumAdjustment procedure: Dial “P” & D.D.H.A.S.I.S.’s in the gap
48EX 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 20 degrees
49IN & EX AlternativesThe IN & EX supine moves are used as an alternate method when the prone method does not accomplish the desired degree of correction.Pg. 179 & IN AlternativePg. 180 & EX Alternative
50Sacral Analysis No leg length analysis Stabilized, prone leg raiser test to identify the Left or Right Sacral subluxation or the Base posterior
51Sacral Analysis Patient is prone Doctor assumes a straight away stance Places heel of the superior hand on the sacral base with fingers pointing inferior
52Sacral AnalysisApply P - A pressure…appropriate amount to stabilize the sacrumInstruct the patient to raise the left or right leg of the table, while maintaining a straight leg
53Sacral AnalysisObserve the elevation of the leg being raised…then have the patient to raise the opposite leg…compare the two heightsThe leg that does not raise as high is considered the side of sacral subluxationThe sacrum should be listed and adjusted on the low leg side
54Sacral Analysis List the sacral subluxation on the low leg side: A) 4 inch or > difference between the left and right legB) Less than 4 inch height difference; difficulty and or pain when raising the low legC) If neither leg raises off the table and there is pain and/or difficulty--Base Posterior.
55Sacral Adjustment Set the table: Dial on “P” & D.D.H. (optional S - I directional drop can be utilized)
56Sacral Adjustment Set the Patient: Prone A.S.I.S.’s in the gap Cross the involved leg
57Sacral Adjustment Set the Doctor: Facing the feet Superior hand on the uninvolved P.S.I.S (pisiform/knife edge contact)Inferior hand (pisiform/knife edge contact) on the uninvolved sacral notch
58Sacral Adjustment L.O.C.: Rt. - CCW torque Lt. - CW torque Scissor action to create a torquing of the sacrum…slight P - A
59Base PosteriorSet the table:Dial on “P” & D.D.H.
60Base PosteriorSet the Patient:A.S.I.S.’s in the gap
61Base Posterior Set the Doctor: Inferior hand contact…Mid heel contact on Superior aspect of the sacral base--in midline
62Base PosteriorL.O.C.:P - A, S - I through the lumbo sacral angle
63Spondylolisthesis Analysis,Table, and Patient: Page 140 Adjustments: Two Types:#1) Field Method#2) Institutional Method.
64SpondylolisthesisField Method: No Thrust---Only pressure until table drops.Institutional Method: 3 Thrust!!!
65Lumbar AnalysisSingle Hand ContactPisiform Over ThumbDouble Thumb
66Lumbar Spine Lumbar pad activation - Dial on L. Patient prone Foot pad upA.S.I.S.’s in the gap (Pg 17)Head piece tilted down, weigh the pt.Either side for Posterior listings--double thumb contact!
67Lumbar SpineSide 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).
68Lumbar Spine Double thumb: L.O.C…Plane line of the Disc! Posterior listing - D.S. on either side.Body rotation - D.S. on side of rotation.L.O.C…Plane line of the Disc!
69Thoracic Analysis & Adjustment Analysis and Patient positioning: (Pg 143)Adjustment:#1) Single Hand Contact#2) Pisiform Over Thumb#3) Double Transverse#4) Double Thenar…(pg )
70Thoracic Analysis & Adjustment S.H.C. and P.O.T.:Use the same rules that you applied in the Lumbar region!
71Thoracic 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.
72Thoracic 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.
73Anterior 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.
74Anterior Thoracic--Chap.12 Dorsal pad activationThe 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
75Anterior 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.
76Costal 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.
77Costal 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”
78Elevated Rib Cage Patient presentation: 1) A unilateral elevation of the shoulder, clavicle and scapula2) A visual elevation of the inferior border of the rib cage3) Radiographic presentation of rib cage elevation4) 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.)
80Atlas Listings 12 possible listings 3 views: L.C.N.: Attitude of the AtlasNasium: Laterality of the AtlasBase posterior: Rotation of the Atlas
81Texas 3 stepSet the TableSet the PatientSet the Doctor
82Patient 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.
83Patient PlacementAlign 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.
84Atlas Protocol Approach: Eye level…Superior leg Pivot: 30° or 80° StancePalpateTissue PullPlace PisiformActivate Head PieceStabilizeElbow PositionESN PositionVisualizeThrustRecoil
85Atlas 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!!!
86Axis Listings 9 possible listings…Pg 56 A-P open mouth…X-ray line analysis4 lines: O.O.L., S.B.L., I.B.L., and V.M.L.
87Axis 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
88Texas 3 stepSet the TableSet the PatientSet the Doctor
89Patient 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.
90Patient PlacementAlign 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.
91Axis ProtocolApproach: Superior leg…approximately 6 inches down from the top edge of the body cushion. (pg149)Pivot: 80°StancePalpateTissue PullPlace PisiformActivate Head PieceStabilizeElbow PositionESN Position…2 1/2 to 3 inches down from the top edge of the B.C.VisualizeThrustRecoil
92Axis Protocol S.C.P.’s Spinous Rt./Lt. - Body pivot: Lateral, inferior margin of the spinous process of Axis.
93Axis Protocol Spinous Rt./Lt. - Body pivot: L.O.D.: I - S, P - A, R - L/ L -R, & C.W. or C.C.W torqueC2 Alternative: Pg 157…No Torque…L.O.D. the same.Doctor stance…Behind the Patient
94Axis Protocol S.C.P.’s E.S.R. & E.S.L.: Lamina Pedicle junction of the Axis.
95Axis 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