Download File - Logan Class of December 2011

Practical
Five Signs/Cardinal Signs (HELPS)
H
High Crest – Usually on same side as sacral subluxation
E
Erector Spinae Tension – Usually on same side as sacral subluxation. Palpated
at L4 level, up to 1 ½ inches lateral to SP
Lowest Freely Movable Vertebra – Once found determine side of rotation.
Usually L5, will rotate downhill
Pain – May or may not be present. In acute condition, may be overriding sign
and/or indicate side of contact for adjustment, least important
Sacrotuberous Ligament Tension – Indicates side of AI sacrum and side of
adjustment
L
P
S
Two most important: Lowest Freely Movable Vertebra & Sacrotuberous Ligament
Table position:
Normal
Head – level, make sure shoulders not up against it
Ab – unlocked
Pelvic – slight increase with bottom line raised ½ way up middle of Ab piece, adjust so
erectors are relaxed
Foot – 1st or 2nd notch, adjust so hamstrings are relaxed, ankle should touch, not shin
Hyperlordosis
Head – level, make sure shoulders not up against it
Ab – locked, raised up
Pelvic – raised, close to Ab piece, no more than 3 fingers width apart
Foot – down, ankle should touch, not shin (tension on hamstrings to pull pelvis back)
Hypolordosis
Head – level, make sure shoulders not up against it
Ab – unlocked, if not comfortable raise slightly or increase tension
Pelvic – raised with bottom line raised to top of Ab piece, adjust so erectors are relaxed
Foot – raised to third notch, adjust so hamstrings are relaxed, ankle should touch, not shin
Adjustive Procedures Order:
1.
2.
3.
4.
5.
6.
Hamstring Release
Piriformis Contact
Sacral Unlock
Apex, Ulnar or Notch Contact (Auxiliary & Abdominal performed concurrently)
Spinal Pressures
Cervical Pressures
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Adjustments:
Apex Contact – Unilateral AI Sacrum
Patient prone, ASIS at the top of the pelvis piece. Doctor seated opposite the side of
contact, hips level with patients hips. Contact point: apex of the sacrum where the
sacrotuberous ligament attaches to the sacrum, located 1/3 of the way between the
buttock line and the ischial tuberosity. Hand contact: lateral 1/3 of the thumb, hand
should be pronated, palm away from the adjustor, elbow down. The thumb should arc
headward, laterally and slightly posterior. The line of force/drive is always 90° between
the vertical line of the spine and a horizontal line from the apex of the sacrum lateral
toward the femur head. Line of force/drive must never cross the vertical line or past the
horizontal line. Auxiliary contacts may be taken with the opposite hand. When taking an
auxiliary contact or adjusting a region, direct the line of force/drive towards that segment
to release tension in that area: lumbar – towards greater trochanter, thoracic – towards
shoulder, cervical – towards the head.
Single Notch Contact – Unilateral AI Sacrum
Patient prone, ASIS at the top of the pelvis piece. Doctor seated either side, hips level
with patients hips or standing on either side, fencers stance towards the head of table.
Contact point: sacrosciatic notch, border of the sacrum that is part of the greater
sacrosciatic foramen, located between the apex of the sacrum and the PSIS at the
horizontal level of the femur head. Hand contact: distal 1/3 of the thumb, inverted, hand
held in a closed fist position, with the dorsum of the hand toward the adjustor. The line
of force/drive is towards the ceiling to correct the AI sacrum on the side of contact. If the
sacrum is more inferior than anterior, use left hand for right side and right hand for left
side. Otherwise, use right hand for right side and vice versa. The other hand is used to
support the pelvis. Auxiliary contacts may be taken with the opposite hand in lumbar
region only. At the conclusion of the adjustment a quick recoil thrust may be applied.
Double Notch Contact – Bilateral AI Sacrum
Patient prone, ASIS at the top of the pelvis piece. Doctor standing either side, fencers
stance towards the head of table. Contact point: inferior part of sacrosciatic notch. Hand
contact: distal 1/3 of the thumb, inverted, hand held in a closed fist position, with the
dorsum of the hand toward the adjustor. The line of force/drive is towards the ceiling to
correct the AI sacrum on the side of contact. No auxiliary contacts can be taken. At the
conclusion of the adjustment a quick recoil thrust may be applied.
Ulnar Contact – Alternate Apex, used when more force needed or cannot use thumb
Patient prone, ASIS at the top of the pelvis piece. Doctor seated opposite the side of
contact, hips level with patients hips. Contact point: apex of the sacrum where the
sacrotuberous ligament attaches to the sacrum, located 1/3 of the way between the
buttock line and the ischial tuberosity. Hand contact: distal point of the fifth metacarpal.
The line of force/drive is always 90° between the vertical line of the spine and a
horizontal line from the apex of the sacrum lateral toward the femur head. Line of
force/drive must never cross the vertical line or past the horizontal line. Auxiliary
contacts may be taken with the opposite hand. When taking an auxiliary contact, direct
the line of force/drive towards that segment to release tension in that area.
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Ulnar contact is taken when more force is needed to assist in cases of sever fixation or
ankylosis.
Advanced Contacts
Auxiliary Contacts
These are taken while applying the apex, single notch or ulnar contacts. Vertebra, erector
spinae muscles, ramus of the jaw, scapula, and gluteal muscles are all acceptable
auxiliary contacts. Vertebra contacts: press down on high TP (or mamillary), push or pull
SP. Remember the Law of Thirteen:
T1, T2, T11, T12 – 1 interspinous space
T3, T4, T5, T8, T9, T10 – 1 ½ interspinous space
T6, T7 – 2 interspinous space
Abdominal Contacts
While holding apex contact, use other hand with fingers curled and pointing up. With
fingers find a hard area (hollow organ spasm) in the abdomen and press posteriorly.
While maintaining posterior pressure on the abdomen, vary the direction of your apex
contact until the hollow organ relaxes.
Sacral Unlock
This is performed on the side opposite of the AI sacrum. Stand on side opposite of the AI
sacrum at a 45° angle. Using your inferior hand use a thumb-web-index contact into the
thigh where the thigh meets the cheeks. Using your superior hand use a pollicus contact
on the sacrum about one inch below the PSIS. While maintaining anterior pressure have
the patient simulate walking by moving their hips. Continue this until you feel the
sacrum drop (should be about 10 simulated walking steps)
Hamstring Release
This performed on the side opposite of AI sacrum. Stand on side opposite of the AI
sacrum at a 45° angle. Run your fingers down the thigh a feel for any areas of
hypertonicity (trigger point). This should be located about a third of the way down.
Using a double thumb contact traction tissue superior and use an impulse thrust.
Reevaluate the area to see if it worked, the trigger point should be released.
Piriformis Contact
In an acute AI sacrum this contact is given on the side of AI sacrum, chronic AI sacrum
given on side opposite of AI sacrum. Doctor is seated facing patient at 90°. This contact
can be given with either the superior or inferior hand, with both the fist is closed with
thumb tightly abducted. When using the inferior hand the nail side of the thumb is
contacts the piriformis and lifts it posterior. The closed fist can be supported with your
knee. When using the superior hand the pad of the thumb contacts the piriformis and lifts
it posterior. The other hand is used to palpate and evaluate the erector spinae muscles.
Spinal & Cervical Pressures
After the apex, spinal and cervical pressures can be used to continue the work of auxiliary
contacts. Doctor stands on either side, using tips of chiropractic index contact
mamillary’s or TP’s bilaterally and have patient simulate walking by moving their hips.
Start with L5 and move up the spine. At T4 switch to cervical pressure. Stand at the
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head of table facing inferior. Use tips of chiro index contact TP’s bilaterally and continue
up to C1. With cervical pressure patient turns head as if “saying no”.
Complete Treatment of ‘Hot Low Back’ using Lumbar Pressures
1. Therapy – ice, ultrasound
2. Apex contact on side of pain (5-6 minutes)
3. Apex contact on opposite side for half that time
4. Lumbar Pressures: doctor standing 90° on side of pain. Table level, abdominal piece
unlocked. Superior hand pisiform on mamillary of L5 on opposite side, inferior hand
supporting. Have patient breath in and out, on the exhale increase pressure in a direction
through the disc plane, during inhalation release pressure. There is no thrust, just a
steady pressure. Continue up the lumbar spine repeating the above procedure. Repeat
standing on side opposite pain.
5. No other adjustments should be given to the patient that day. On the second visit you
may adjust other areas A to P only. No P to A adjustments during the treatment period.
6. Wrap patient with SI belt – 6 inch belt with pad over the injured area, make sure it is
tightly fastened. This holds the vertebra in place. This should be removed before
sleeping and put back on in the morning.. On the 3rd day it may be removed from noon to
3PM and then put back on. On the 6th day wear in the afternoon for 3 to 4 hours. By the
7th day it is no longer needed.
7. Patient to return home and ice the area.
8. Patient must be seen in your office for three days in a row. Then return for care on the
5th, 7th, 10th, and 14th days. No work for two weeks.
9. On the 3rd day home rehab may start. Cat curls, on hands and knees arch and then
droop back. Also lie on back with knees bent, sway knees from side to side.
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