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Flexion/Distraction
Table Introduction
Move the lever from
medial to lateral to
release the handlebars
for adjustment to your
patient’s arm length
Table Introduction
Move this lever from
superior to inferior to
release the cervical
piece to be able to
raise or lower it.
Table Introduction
The cervical piece is
adjustable to 4
positions by simply
lifting it: all the way
in towards the table,
one click up (provides
for S-I drop), two
clicks up (provides for
I-S drop), and all the
way out away from the
table.


Table Introduction
Squeezing this
lever will allow the
table to be laterally
flexed to the left
and right.
Table Introduction
First support the
abdominal pad at the
caudal end and then
release the lever to
lower it.
Table Introduction
Lift the pelvic pad to
set the drop. Use
outside black knob
weigh the patient for
the drop.


Variable speeds
Normal flexion
speed…majority of
time.
Muscle
toning…myofascial
protocols.
Table Introduction
Use the squeeze
mechanism under the
ankle pad to release it
to be able to adjust it
out to the dorsum of
your patient’s feet.
Table Introduction
Align the foot pad to
dorsum of the feet.
Do a leg analysis at
this time…identify the
short leg.
Patient Placement
First position your
patient so that the top
of their iliac crest is at
the top of the pelvic
pad.
Patient Placement
Next support the
abdominal pad and
release the lever so
you can gently lower
it.
Patient Placement
Position the ankle pad
to the dorsum of your
patient’s feet and
check their leg length.
Short side may
indicate lateral atlas on
that side and a
posterior TVP of C5
on the long leg side.
Patient Placement
Adjust the
handlebars so that
your patient’s arms
are in slight flexion.
Patient Placement
Warn them
that should
they
experience
pain or
numbness to
release their
grip from the
handlebars
and rest their
arms on the
forearm rests.
Patient Placement
Simultaneously rock
your patient’s pelvis,
verbally warn them
that you are going to
start the table, and step
on the actuating pedal
to start the table.
Sacrothoracic Stretch
Inferior hand is across
sacrum perpendicular
to your patient’s spine
Superior hand P-A
paraspinal musculature
Lock your legs, lock
your arms, and rock
your body to effect the
massage pressure as
the table moves into
full flexion
Iliothoracic Stretch
Move your inferior
hand to your patient’s
ilium.
Ipsi, ipsi; ipsi, contra;
contra, ipsi; or contra
contra paraspinal
musculature.
Occipital Stretch
Flair your elbows,
finger tips point 45°
superiorly, and gently
resist the rocking
action of the occiput
with your thenars as
the table goes into full
flexion.
Rotation Sacrothoracic
Same as Sacrothoracic
except your patient
can turn their head
either left or right.
Lateral Sacrothoracic Stretch
Same as Sacrothoracic
Stretch, except that
you lateral flex the
table. Stand on either
side but…only work
the convex side!
Sacroscapular Stretch
Lock your superior
elbow into your waist
and use your body to
rock forward
stretching the inferior
pole of the scapula I-S
Alternate: The Doctor
may use the heel of
their hand with a stiff
arm.
Lateral Costal Stretch
Lateral flex the table
away from you.
Stabilize ilium and use
superior hand along
mid-axillary line.
Make sure forearms
are parallel with floor
to insure lateral to
medial line of drive.
Diagnostic Tool
Advantages of motorized flexion-distraction
procedures:
– The doctors hands are free to motion palpate and observe
increases or decreases in long axis distraction of a specific
joint, or between two or more fixed spinal segments.
– The freedom to motion palpate with both hands and
observe motion of the articular joints in lateral flexion
and/or rotation.
– After a corrective spinal adjusting technique has been
applied, changes can be observed.
– Apply specific inter-articular long axis distraction and /or
specific muscle stretching for therapeutic purposes.
Joint Dysfunction
Two types of clinical presentation that are
most commonly seen in chiropractic offices:
1) Traumatic
2) Overuse injuries-- usually seen at soft tissue level
Joint Dysfunction
The capsular ligament is the primary soft tissue affected. The
capsular ligament has poor blood supply so when damage
occurs, which is by sprain, healing is slow. But during the
reparative stage and if further macro-trauma or micro-trauma is
occurring by repetitive forces, fibroblasts will infiltrate the
damaged area. These fibroblasts secrete collagen. The
fibroblasts come mainly from the damaged ligaments or by
blood supply from other areas, and will form in irregular patterns
thus creating scar tissue or adhesions. Once adhesions are
formed, which can take place in six to eight weeks, functional
disability to the area can occur.
Joint Dysfunction
Therefore, the object of any manipulative
procedure/treatment, such as motion flexion/distraction, is
restoration of full and painless range of motion. Forced
movement as in manipulation, ruptures adhesions about a
joint and is curative. By the usage of motion
flexion/distraction, the principle is to affect the soft
tissue problem with the use of manipulation & passive
motion…thus, effecting the fibrosis. By affecting the
fibrosis and breaking up adhesions, new blood flow will
occur…especially in areas that had been ischemic…Thus,
creating new movement into a hypomobile joint, and
allowing synovial fluid to reoccur.
F/D Benefits
1) Increase of the intervertebral disc height to
remove annular distortion in the pain sensitive
peripheral annular fibers.
2) Allow the nucleus pulposus to assume it’s central
position within the annulus and relieve irritation of
the pain sensitive fibers.
3) Restore vertebral joints to their physiological
relationships of motion
4) Improve posture and motion while relieving pain
and improving body function
Contraindications
Distraction should be discontinued if a
patient complains of dizziness, nausea,
undue discomfort or pain, motor
weakness or other adverse sensory
changes such as numbness. Any
condition for which immobilization
would be indicated would have traction
contraindicated.
TMAP
Begin thoracic motion
assisted palpation by
contacting the spinous
processes with IF and
CIF (alternate
contact… interspinous
space).
Spinous processes
should separate as the
table flexes (Long
Axis Distraction:
LAD)
TMAP
Identify and note
where the FSU
does not separate…
this represents a
segmental long axis
fixation (LAF)
TMAP
Leave your fingers on
the spinous processes
and have the patient
turn their head to the
left and then to the
right…compare the
distance traveled with
each head rotation.
TMAP
After the patient has
rotated their head, left
or right, palpate the
interspinous space to
verify joint separation.
The side that restores
some motion is the
side of TVP
posteriority.
TMAP
Have your patient turn
their head to the other
side
Contact the posterior
TVP
Stabilize the
inferior/superior TVP
on the other side
Adjust in full flexion
Anterior adjustment
Extension malposition can
be corrected with a knife
edge contact on the
inferior tip of the spinous
process. Adjust briskly
and while the table is in
full flexion.
Alternate adjustment:
Turn table off; Raise
abdominal piece; Turn the
patient over and adjust for
an Anterior segment.
TMAP
Recheck for
restored motion
Proceed to evaluate
next segment
TMAP – Myofascial Protocol
Utilize the following Myofascial
protocol…if needed.
Serratus Anterior
Subscapularis
Rhomboids
Levator Scapulae…Part I, II, III
LMAP
There should be
separation between the
lumbar spinous
processes during full
flexion (LAD)
Where there is no
separation, label as
long axis fixation
(LAF)
LMAP
Leave your fingers on
the spinous processes
and laterally flex the
table left and right

LMAP
The side that restores
some motion is the
side of spinous
rotation

LMAP
Lateral flex the table away from
the side that restored motion
Contact the involved spinous
process, and adjust P-A in full
flexion
Alternate contacts: P.O.T.,
S.H.C., Side Posture.
P.O.T. & S.H.C.(Neutral
position)
Side Posture (Table off…flex
table towards the Doctor)
Side Posture
Leave abdominal
piece lowered.
Raise cervical piece to
match angle of
abdominal piece.
Find segmental
contact point
Side Posture
Maintain segmental
contact point while
you lateral flex the
table towards you to
take the segment to
tension.
Side Posture
Adjust…Push or Pull.
Your choice…make
sure the correct side is
up!!!
LMAP
Recheck for
restored motion
Proceed to evaluate
next segment

Spondylolisthesis
Only treat
symptomatic spondylo
For Grade 3 or worse
symptomatic spondy
leave the abdominal
piece up
Top of the iliac crest
about in the middle of
the abdominal pad
Spondylolisthesis
Turn table down 50%
Contact L4 and S2
Gently separate as table
flexes
First day, approximately 5
stretches. Next visit, place
the patient more inferior
on the table and apply 10
to 15 stretches.
Continue to move patient
lower on the table and
increase repetitions on
subsequent visits
8 step protocol – Q.L.
8 step protocol for the
Q.L. (Set table speed to muscle
toning for all myofascial work).
#1) Work the Q.L. next to
the spinous processes.
#2) Slide approximately
1inch lateral and work the
lateral border of the Q.L.
#1 & 2 occur during
flexion of the table.


8 step protocol – Q.L.
8 step protocol…

#3) Same as #1…just in the
opposite direction.
#4) Same as #2…just in the
opposite direction.
Apply #3 & 4 as the table
returns to a full extension
position.

8 step protocol – Q.L.
8 step protocol…
#5) Isolate the 12th rib,
and work medial to
lateral as the table
moves to full extension
#6) Isolate the Iliac
crest on the long leg
side…work medial to
lateral as the table
moves in full flexion.


8 step protocol – Q.L.
8 step protocol…
#7) With a thumb contact,
apply pressure at a 45°
angle with respect to the
spinous processes. Apply
pressure as the table moves
into full flexion.
(Evaluate the lateral
border of each spinous
of the lumbar spine for
taut and tender nodules)

8 step protocol – Q.L.
8 Step protocol…
#8) Table off!!!
After turning the table off, lateral
flex the patient opposite the tight
Q.L. (Divide the full lateral
flexion of the table into
thirds…i.e., 10° then have patient
to pull back to midline…continue
to end of table R.O.M.).
Have the patient to grasp the “T”
bar and pull back to midline with
20% of their strength.
The Doctor will stabilize the
pelvis with their superior hand and
lower limbs with their inferior
hand…the Doctor is also kneeling
on the same side as the tight Q.L.
P.I. Ilium
Adjusting SCP for a
P.I. Ilium is the PSIS.
The Stabilizing SCP
for a P.I. Ilium is the
opposite Ischial
Tuberosity.
Pelvis
Note: The S.I. joints
have approximately a
set 45° angle between
the Ilium and the
Sacral articulation.
Pelvis
P. I. Ilium adjustment
P.I. Ilium:
Set the Patient: Patient Prone. Align
the top aspect of the Iliac crest with the
top of the pelvic pad.
Set the table: Turn the table on.
Elevate the pelvic pad opposite P.I.
listing. Activate the directional drop on
the PI side.
Set the Doctor: Dr. stands on either
side--Right P.I.…Right Thenar.
Stabilize with other hand--mid heel or
M.C.P of the index finger.
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.
Adjust: Adjust in full flexion…3 times
if needed!
P.I. Ilium adjustment
Raise the pelvic piece
that’s opposite the P.I.
Ilium…too help with the
P.I. adjustment!!!
With the elevation of the
opposite pelvic pad, a 90°
angle will be obtained…
approximately. Thus,
allowing the Doctor to
adjust with greater ease.
P.I. Ilium adjustment
Adjust in full flexion
SCP: Adjust with
superior hand on the
PSIS.
SCP: Stabilize with
the inferior hand on
the Ischial tuberosity.
IN Ilium
Set drop on IN side
Contact posterior
ischium
Adjust in full flexion /
Extension…either
position will work.
Posterior Ischium
Set drop on Posterior
Ischium side
Contact Posterior
Ischium with fingers
pointing caudally
Adjust when table
comes back up to
neutral.
EX Ilium
Set drop on EX side
Contact PSIS
Adjust in full flexion
Sacral Check
Table is off
Stabilize patient’s
sacrum with firm
pressure
Sacral Check
Have patient lock one
leg and try to raise it.
Repeat with the other
leg.
Positive findings are:
…difficulty raising one
leg
…pain raising one leg
…4” height differential
Sacral Adjustment
Cross the indicated
side over the other leg
Sacral Adjustment
Stabilize PSIS with
opposite hand (i.e. if it
was a right leg, set up
on left PSIS with left
hand)
Turn table back on and
adjust apex of sacrum
with lateral to medial
drive at full flexion
Sacral Check
Turn table off and then
re-assess sacrum
Coccyx
Use pisiform over
thumb contact and
check for restrictions.
Adjust in full flexion
Cervicals
CMAP…with table on. Find
the LAF.
Turn table off
Have patient turn their head
opposite the posterior segments.
RP…Head rotation to the Left.
L.P….Head rotation to the
right. Slide the head over on
the far face pad.
Palpate lower cervical spine for
subluxation, and work up the
spine.
Cervical Adjustment
Maintain contact and
use elbow against knee
to move patient medial
to lateral to tension
Stabilize head with
inferior hand
Adjust with inferior
hand at full tension
UCS…Thompson
style adjusting.
Scoliosis
Medial side
Correcting Straps are
placed medially on
bracket
Holding straps are
placed laterally on the
bracket
Lateral side
Scoliosis
Correcting straps
bracket goes opposite
the convexity of the
patient’s curvature
Holding straps bracket
goes on the same side
as the convexity
Scoliosis
Straps are laid out
across the table before
the patient gets on
them
Abdominal piece is
not lowered
Scoliosis
The patient is
positioned so that the
apex of the curvature
is at the middle of the
correcting straps…
“X” marks the spot!
Secure the straps tight
enough to barely get
one finger under them
Scoliosis
Next secure the
holding straps
Activate table
Time of treatment is
20-30 minutes 5 days
per week.
Re-evaluate after two
weeks of treatment
Scoliosis
In the case of a double
curve, laterally flex
the table towards the
convexity of the
lumbar curve.
8 step protocol – Q.L.
8 step protocol for the
Q.L. (Set table speed to muscle
toning for all myofascial work).
#1) Work the Q.L. next to
the spinous processes.
#2) Slide approximately
1inch lateral and work the
lateral border of the Q.L.
#1 & 2 occur during
flexion of the table.


8 step protocol – Q.L.
8 step protocol…

#3) Same as #1…just in the
opposite direction.
#4) Same as #2…just in the
opposite direction.
Apply #3 & 4 as the table
returns to a full extension
position.

8 step protocol – Q.L.
8 step protocol…
#5) Isolate the 12th rib,
and work medial to
lateral as the table
moves to full extension
#6) Isolate the Iliac
crest on the long leg
side…work medial to
lateral as the table
moves in full flexion.


8 step protocol – Q.L.
8 step protocol…
#7) With a thumb contact,
apply pressure at a 45°
angle with respect to the
spinous processes. Apply
pressure as the table moves
into full flexion.
(Evaluate the lateral
border of each spinous
of the lumbar spine for
taut and tender nodules)

8 step protocol – Q.L.
8 Step protocol…
#8) Table off!!!
After turning the table off, lateral
flex the patient opposite the tight
Q.L. (Divide the full lateral
flexion of the table into
thirds…i.e., 10° then have patient
to pull back to midline…continue
to end of table R.O.M.).
Have the patient to grasp the “T”
bar and pull back to midline with
20% of their strength.
The Doctor will stabilize the
pelvis with their superior hand and
lower limbs with their inferior
hand…the Doctor is also kneeling
on the same side as the tight Q.L.
Atlas Rotational Device
A device to help isolate
and determine C1
subluxations.
A.R.D.
Have patient to look
straight ahead…eyes
even with the Horizon.
The patient will place
their head in their
neutral position…in
the center of their
body.

A.R.D.
Have the patient to close
their eyes and move their
head through all R.O.M.’s.
After the patient is
finished with
R.O.M.’s…have them to
return to the center /
neutral position with the
eyes closed.
Evaluate circles for
misalignments.

C1 Rotation
Right / Left rotation of
atlas.
Pre-stress by turning
the patient’s head to
the side of rotation
while the doctor shifts
their weight.
Lateral Atlas
Patient’s head is a
neutral position. The
axial lift will
neutralize the
laterality.
Bilateral Anterior Atlas
Pre-stress by having
the patient extend their
head slightly.
Bilateral Posterior Atlas
Have patient to
slightly flex their
head…chin down.
The Doctor applies a
lighter thrust.