Download Occiput Adjustments Posterior Superior Occiput

Occiput Adjustments
1. Posterior Superior Occiput - Supine
 IND: extension/lateral flexion restrictions
 CON: indications of VBAI, fractured odontoid, ligamentous instability
 P.P.: supine
 DR. P: squat @ 45 on side of lesion
 S.H.: cupping patient’s head and upper cervical spine, provides mild distraction
 C.H.:
i. Thumb web on the nuchal line wrist in slight extension, fingers toward ceiling
ii. Lateral index on the nuchal line, thumb on zygomatic arch
iii. Thenar on the nuchal line
 LoD:
i. P to A, S to I (with a scoop) in an arc
ii. Maintain traction with SH
 T: unilateral impulse maintaining traction
2. Posterior Superior Occiput - Seated
 IND: posterior/lateral flexion malpositions
 CON: indications of VBAI, fractured odontoid, ligamentous instability
 P.P.: seated with back support
 DR. P: standing behind patient on side of lesion
 S.H.:
i. Thenar on cheek with fingers pointing down the cervicals
ii. Provide some mild distraction
 C.H.:
i. Thumb web on the nuchal line wrist in slight extension, fingers toward anterior
ii. Lateral index on the nuchal line, thumb on zygomatic arch
 LoD:
i. P to A, S to I (with a scoop) in an arc
ii. Maintain traction with SH
 T: unilateral impulse maintaining traction
Atlas Adjustments
1. Lateral Atlas – Thumb contact supine
 IND: lateral flexion restriction
 CON: indications of VBAI, fractured odontiod, ligamentous laxity, increased ADI
 P.P: patient supine head piece neutral or slight flexion
 Dr.P: squat stance, facing feet at 45 to the side of lesion
 S.H: Cupping patient’s head and upper cervical spine, provides mild traction
 C.H: thumb web contact on TVP of C1, forearm at 90 parallel to floor
 LoD: lateral to medial
 T: unilateral pectoral thrust
2. Posterior Atlas – Thumb contact supine
 IND: rotation restriction
 CON: indications of VBAI, fractured odontiod, ligamentous laxity, increased ADI
 P.P: patient supine head piece neutral or slight flexion
 Dr.P: squat stance, facing feet at 45 to the side of lesion
 S.H: Cupping patient’s head and upper cervical spine, provides mild traction
 C.H: thumb web contact on posterior arch/TVP of C1, forearm at 45 toward ceiling
 LoD: P to A in an arc
 T: unilateral pectoral thrust with wrist action
3. Lateral Atlas – Thumb contact seated
 IND: lateral flexion restriction
 CON: indications of VBAI, fractured odontiod, ligamentous laxity, increased ADI
 P.P: patient seated with back support
 Dr.P: standing behind patient to the side of lesion
 S.H:
i. thenar on cheek with fingers pointing down cervicals
ii. provides mild traction
 C.H: thumb web contact on TVP of C1, forearm at 90 parallel to floor
 LoD: lateral to medial
 T: unilateral pectoral thrust
4. Posterior Atlas – thumb web contact seated
 IND: rotational restriction
 CON: indications of VBAI, fractured odontiod, ligamentous laxity, increased ADI
 P.P: patient seated with back support
 Dr.P: standing behind patient to the side of lesion
 S.H:
i. thenar on cheek with fingers pointing down cervicals
ii. provides mild traction
 C.H: thumb web contact on posterior arch/TVP of C1, wrist in slight ulnar deviation,
forearm parallel to floor
 LoD: P-A in an arc
 T: unilateral pectoral thrust
Cervical Adjustments
1. Bedside Cervical
 IND: rotational restriction (C2-6, depending on hand/neck size), patient bed ridden
 CON: indications of VBAI, fracture, neoplasm, ligamentous laxity
 P.P.: supine, neck in slight flexion (usually supported by a pillow)
 Dr.P: Fencer’s stance, facing patient, contralateral to side of lesion
 S.H:
i. Cups patient’s ear, web around ear
ii. Fingers pointing posterior and cephalad
iii. Provide mild traction
 C.H.: palmar surface of index or middle finger on articular pillar of segment to be
adjusted
 LoD: anterior in line with the disc plane
 T: unilateral pectoral thrust
2. Seated Cervical Pull
 IND:
i. rotational restriction (C2-6, depending on hand/neck size)
ii. lateral flexion restriction (C2-6)
 CON: indications of VBAI, fracture, neoplasm, ligamentous laxity
 P.P.: seated preferably with support
 Dr.P: straight away stance, facing patient @ 45, contralateral to side of lesion
 S.H:
i. Cups patient’s ear, web around ear
ii. Fingers pointing posterior and cephalad
iii. Provide mild traction
 C.H.: palmar surface of index or middle finger on articular pillar of segment to be
adjusted
 LoD: anterior in line with the disc plane
 T: unilateral pectoral thrust
3. Prone Cervical
 IND:
i. rotational restriction (C2-7)
 CON: indications of VBAI, fracture, neoplasm, ligamentous laxity
 P.P.: prone, headpiece below horizontal
 Dr.P: straight away stance with squat, facing caudad@ 45, ipsilateral to side of lesion
 S.H:
i. Thumb web contact on patient’s trap opposite to side of lesion
ii. Use forearm to laterally flex patient to side of contact
iii. Provide mild traction
 C.H.: lateral index articular pillar of segment to be adjusted
 LoD: PtoA in line with the disc plane, forearm 45 to floor
 T: unilateral pectoral thrust
 This adjustment can be done by standing on the ipsilateral side of the patient,
fencer stance, facing the top of the table
4. Seated Cervical – modified thumb contact
 IND: rotational restriction C2-7
 CON: indications of VBAI, fractured odontiod, ligamentous laxity, neoplasm
 P.P: patient seated with back support
 Dr.P: standing behind patient to the side of lesion
 S.H:
i. thenar on cheek with fingers pointing down cervicals
ii. provides mild traction
 C.H: thumb web contact on articular pillar
 LoD: P-A in an arc and in line with disc plane
 T: unilateral pectoral thrust
Pelvic Adjustments
1. PI Ilium – Forearm Contact
 IND: anterior glide restriction (flexion malposition)
 CON: hip/knee pathology on side of lesion, grade 3+spondylolisthesis
 P.P:
i. lateral recumbent, top thigh flexed, foot in popliteal space
ii. lower leg straight
iii. arms crossed over chest (patient to hold their elbows or arms)
 Dr.P:
i. fencer stance in front of patient, facing patient at 45
ii. Doctor’s inferior thigh to contact patient’s thigh and pushes femur into
acetabulum to gap the joint
 S.H.:
i. Contact deltopectoral groove or the distal arm/elbows
ii. Provide oblique traction (avoid pining the shoulder to the table this is too much
torque)
 C.H.: mid point of forearm is placed just inferior to the posterior lateral aspect of the
iliac crest (roll forearm into position to pad the ulnar ridge)
 LoD: P to A and I to S
 T: pectoral/body drop
 Doctor should keep shoulder against rib cage as this adjustment is to
decrease stress on the shoulder/wrist of the doctor
2. AS ilium- Forearm Contact
 IND: posterior glide restriction (extension malposition)
 CON: hip/knee pathology on side of lesion, grade 3+spondylolisthesis
 P.P:
i. lateral recumbent, top thigh flexed, foot in popliteal space
ii. lower leg straight
iii. arms crossed over chest (patient to hold their elbows or arms)
 Dr.P:
i. fencer stance in front of patient, facing patient at 45
ii. Doctor’s inferior thigh to contact patient’s thigh and pushes femur into
acetabulum to gap the joint
 S.H.:
i. Contact deltopectoral groove or the distal arm/elbows
ii. Provide oblique traction (avoid pining the shoulder to the table this is too much
torque)
 C.H.: mid point of forearm is placed just posterior to the ischial tuberosity
 LoD: P to A and S to I ( try to create innominate flexion)
 T: pectoral/body drop
 Doctor should keep shoulder against rib cage as this adjustment is to
decrease stress on the shoulder/wrist of the doctor
Lumbar Adjustments
1. Lumbar Spinous Pull
 IND: rotational restriction
 CON: fractured spinous, neoplasm, spondylolisthesis, severe pain on set up
 P.P:
i. lateral recumbent, top thigh flexed, foot in popliteal space
ii. lower leg straight
iii. arms crossed over chest (patient to hold their elbows or arms)
 Dr.P:
i. fencer stance in front of patient, facing patient at 45
ii. Doctor’s inferior thigh to contact patient’s thigh and pushes femur into
acetabulum to bring tension to area
 SH:
i. contact deltopectoral groove or the distal arm/elbows
ii. provide oblique traction (avoid pining the shoulder to the table this is too much
torque)
 CH:
i. Hook distal phalanx of middle or index finger (may reinforce) onto the down
side of spinous process ( for a LP listing the patient would have right side down
so that the spinous is toward the table)
ii. Place forearm across the ilium to provide some traction as the patient is
brought forward on the table
iii. Careful not to place the elbow on the piriformis or sciatic nerve
 LoD: pull the pelvis anterior with the CH forearm to pull the spinous toward midline
 T: body drop with forearm pull
 Useful for small doctor treating a large patient
2. Lumbar Spinous Push
 IND: rotational restriction
 CON: fractured spinous, neoplasm, spondylolisthesis, severe pain on set up
 P.P:
i. lateral recumbent, top thigh flexed, foot in popliteal space
ii. lower leg straight
iii. arms crossed over chest (patient to hold their elbows or arms)
 Dr.P:
i. fencer stance in front of patient, facing patient at 45
ii. Doctor’s inferior thigh to contact patient’s thigh and pushes femur into
acetabulum to bring tension to area
 SH:
i. contact deltopectoral groove or the distal arm/elbows
ii. provide oblique traction (avoid pining the shoulder to the table this is too much
torque)
 CH:
i. Finger tip contact (may reinforce) onto the up side of spinous process ( for a LP
listing the patient would have left side down so that the spinous is toward the
doctor)
ii. Place forearm across the ilium to provide some traction as the patient is
brought forward on the table
iii. Careful not to place the elbow on the piriformis or sciatic nerve
 LoD: pull the pelvis anterior inferior with the CH forearm to take up the joint slack,
stabilizing the spinous process contact and pushing toward midline
 T: body
 Useful for small doctor treating a large patient
3. Sitting Lumbar
 IND: rotational restriction L1-L5 (can also be used for lower thoracic spine
 CON: acute disc, spondylolisthesis (grade 2+)
 P.P.:
i. seated at the end of the table/head piece
ii. arms crossed in front of chest with hands on opposite shoulders (lesion side arm
on top)
 Dr.P: wide squat stance behind patient
 CH: pisiform on mamilliary process
 S.H.: grasp elbow/arm/ or shoulder of side of lesion and rotate patient
 LoD: P-A in a line consistent with the facets (I-S L1-2; straight at L3; S-I at L5-4)
 T:
i. Pectoral impulse with body weight behind the thrust
ii. Can tuck elbow of thrusting arm into hip and use more body twist if extra
power is required
4. Thoraco-lumbar Push/Pull
 IND: rotational restriction (T10-L3)
 CON: fractured spinous, neoplasm, spondylolisthesis, severe pain on set up
 P.P:
i. lateral recumbent, top thigh flexed, foot in popliteal space
ii. lower leg straight
iii. inferior arm patient puts hand in opposite armpit
iv. superior arm holds onto opposite elbow
 Dr.P:
i. fencer stance or straight away in front of patient, facing patient perpendicular
ii. Doctor’s inferior thigh to contact patient’s thigh and pushes femur into
acetabulum to bring tension to area
 CH:
i. Superior arm is placed through patient’s arm and finger tip contacts up side of
spinous process of the vertebra directly superior to lesion
ii. Inferior hand uses a finger tip contact to hook the vertebra to be adjusted with
the forearm going across the innominate to provide traction
iii. Careful not to place the elbow on the piriformis or sciatic nerve
 LoD:
i. pull the pelvis anterior inferior with the CH forearm to pull inferior spinous
process toward midline
ii. have patient tighten down on doctor’s superior arm to tighten upper thoracic
musculature
iii. Doctor provides oblique traction with superior arm
 T: body drop with forearm pull (inferior arm)
 Useful for small doctor treating a large patient
 Extremely useful for transitional area
 Can be done with a kick pull
Thoracic Adjustments
1. Combination Adjustment
 IND: rotational restriction of T2-T4 (transitional region)
 CON: hypokyphosis; advanced osteopenic disease
 P.P: patient prone with the head piece below horizontal
 Dr.P: fencer stance with the forward leg anterior to your contact
i. (medial malleolus level with patient’s ear)
 C.H.:
o high chiropractic arch
o pisiform on TVP



o elbow straight
S.H.
o Thumb under occiput
o Index and/or middle finger on temporal bone
o rotate and distraction applied to take out joint slack
LoD: P-A; consistent with facets (T2-3 is more S-I due to the kyphosis)
T:
o body drop with straight arm
o Maintain distraction on head but DO NOT THRUST
2. Hypothenar Interspinous (knife edge)
 IND: flexion restriction/extension malposition T4-10
 CON: fractured spinous; advanced osteopenia
 P.P.: fencer stance facing cephalad
 C.H.:
i. pull skin slack cephalad
ii. place hypothenar (knife edge) 90 to spine, under the SP to be adjusted
iii. keep wrist straight, fingers closed and stiff
 S.H: toggle grip
 LoD: I-S with slight P-A
 T: unilateral impulse and/or body drop with supporting hand
3. Carver Bridge (Bilateral Hypothenar)
 IND: hypokyphosis flexion restriction T4-12
 CON: advanced osteopenia
 P.P: prone
 Dr.P: prone
 C.H.:
i. Padded pisiform
ii. Contact either side of SP at level of TVPs
iii. Take up skin slack from I-S
 LoD:
i. Lean cephalad into contact to remove joint slack
ii. Radial deviate to produce a scooping motion
 T: bilateral impulse with body drop
4. Anterior Thoracic
 IND: flexion restriction; hypokyphosis (T3-T12)
 CON:
i. Fracture, fractured rib
ii. Cardiomegaly
iii. Hyperkyphosis
iv. Advanced osteopenic disease
 P.P.: supine with arms crossed midline, hands on opposite shoulders
 Dr.P: fencer stance on either side of patient
 C.H.: fleshy thenar between spinous of lesion and the one below
 S.H.:
i. Heel of hand on the elbows with fingers facing caudad
ii. Use hand to traction elbows inferiorly and tuck elbows down
iii. This also provides some separation between the doctor and patient
 LoD:
i. Dr.s body takes out slack from ant to posterior
ii. Cephalad distraction is applied by shifting dr.s pelvis anterior
iii. Have patient lift pelvis off table for higher listings to be brought into contact
hand
 T: body drop A-P and slight I-S
5. Anterior Thoracic
 IND: rotational restriction T3-T12
 CON: as above
 P.P: as above
 Dr. P: as above
 C.H.: fleshy thenar on the TVP
 S.H.: as above
 LoD: as above
 T: body drop with A-P, M-L and slight I-S
6. Anterior Thoracic (Rib modification)
 IND: posterior subluxation of the rib
 CON: as above
 P.P.: as above
 Dr.P: fencer stance contralateral to lesion
 C.H.: thenar eminence on the non-articulating tubercle
 S.H.: as above


LoD:
i. Lateral and into the A-P (into the table)
ii. Contact acts as a fulcrum over which the patient is slowly rocked to direct the
rib upward or downward depending on restriction findings
T: slow, progressive weight transfer with a sudden small amplitude body drop at end
feel
7. Modified Thumb Move (top of the table)
 IND:
i. rotational restriction (C6-T3)
 CON: indications of VBAI, fracture, neoplasm, ligamentous laxity, fractured spinous
 P.P.: prone, headpiece below horizontal
 Dr.P: straight away stance with squat, facing caudad@ 45, ipsilateral to side of lesion
 S.H:
i. Thumb web contact on patient’s trap opposite to side of lesion
ii. Use forearm to laterally flex patient to side of contact
iii. Provide mild traction
 C.H.: thumb on spinous, wrist is ular deviated, forearm parallel to floor
 LoD: PtoA and L-M
 T: unilateral pectoral thrust
 This adjustment can be done by standing on the ipsilateral side of the patient,
fencer stance, facing the top of the table
8. Modified Thumb Move (Pisiform contact)
 IND:
i. rotational restriction (C6-T3)
 CON: indications of VBAI, fracture, neoplasm, ligamentous laxity, fractured spinous
 P.P.: prone, headpiece below horizontal
 Dr.P: straight away stance with squat, facing caudad@ 45, ipsilateral to side of lesion
 S.H:
i. Thumb web contact on patient’s trap opposite to side of lesion
ii. Use forearm to laterally flex patient to side of contact
iii. Provide mild traction
 C.H.: pisiform on spinous, wrist is extended, forearm parallel to floor
 LoD: PtoA and L-M
 T: unilateral pectoral thrust
 This adjustment can be done by standing on the ipsilateral or contralateral
side of the patient, fencer stance, facing the top of the table
9. Prone First Rib
 IND:
i. Elevated first rib or restriction of inferior motion
 CON: fracture, apical neoplasm
 P.P.: prone, headpiece below horizontal
 Dr.P: straight away stance with squat, facing caudad, ipsilateral to side of lesion
 S.H:
i. Thumb web contact on patient’s trap opposite to side of lesion
ii. Use forearm to laterally flex patient to side of contact, slight rotation
iii. Provide mild traction
 C.H.: MCP on non articulating tubercle, wrist is ulnar deviated, forearm 45 to floor
 LoD: PtoA and , S-I, slightly medial
 T: unilateral pectoral thrust
 Can tuck elbow into thigh and use a body push if additional force is required