Download Pelvis

Diversified V Final Review
All Adjustments
Page 1 of 15
Table Setup
- Prone: Headpiece slightly down, abdominal piece unlocked, pelvic piece GTC, foot piece 3rd notch
- Supine:
- Side Posture: Head piece up, abdominal piece locked, pelvic piece near abdominal piece, foot piece
lowered
- Unique:
o Accordian: Head piece up, abdominal piece UNLOCKED, pelvic piece AT LEVEL OF
TROCHANTER, and foot piece 3rd NOTCH. Basically, it’s prone table with headpiece up.
o Lateralisthesis: Head piece up, abdomal piece UNLOCKED, pelvic piece LOW ENOUGH TO
ALLOW ROOM FOR VERTEBRA, and foot piece on 3rd NOTCH
o Spondylolisthesis: Head piece ELEVATED, abdominal piece UNLOCKED, pelvic piece
BELOW ILIAC CRESTS and foot piece on 3rd NOTCH
Pelvis
- Prone
o Prone A [Prone Table]
 Fencer stance on side of listing
 Pisiform with inferior hand, support with superior hand
 LOD: Resistance, Anterior and hold
o Prone A Modified [Prone Table][pisiform, thenar]
 Fencer stance on side of listing
 Lift pt’s leg at the knee with inferior hand
 Superior hand either Pisiform [fingers medial] or pollicis with fingers lateral
 LOD: Lift leg, resistance, anterior and hold
o Prone B [Prone Table]
 Recoil stance on opposite side of listing
 Inferior hand pisiform on PSIS with fingers laterally.
 Superior hand under lower rib cage traction posteriorly
 LOD: Shoulder drop, anterior and hold
o Anterior Ilium [Prone Table] [ASIS contact, brace sacrum]
 Stand on side of subluxation
 Superior hand cup the ASIS
 Inferior hand pisiform/hand heel to block sacrum on sacral ala
 LOD: Traction posterior, short shoulder thrust posterior and hold
- Side Posture
o Posterior Ilium
 Table: Side posture
 Subluxation up, Superior hand shoulder contact, inferior hand Pisiform on PSIS fingers
directed laterally
 Arm perpendicular to the floor
 LOD: To resistance, Anterior and hold
o PI Ilium
 Same as above, but LOD and arm are anterior superior
o Anterior Ilium [ASIS and modified ASIS and Long Lever]
 ASIS Contact [Side Posture Table]
 Fencer stance subluxation up
 Superior hand cups pt shoulder
 Inferior hand ASIS contact, drape arm over back and block sacrum
 LOD: Resistance, posterior lunge and hold
 Ischial contact [Side Posture Table]
 Fencer stance subluxation up
Diversified V Final Review
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All Adjustments
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Traction pts’ legs up with your legs, overlap pt’s hands on torso after torquing
Superior hand on pts crossed hands
Inferior hand pisiform or hand heel on ischium
LOD: anterior along line of femur, lunge thrust and hold
o AS Ilium
 Same as ASIS contact, just now depicting posterior inferior LOD
o Superior Ilium [Side Posture Table] [John Travolta]
 Subluxatoin up, fencer stance
 Inferior hand – webindex contact in popliteal fossa
 Superior hand on shoulder
 Traction leg inferiorly and anterior, traction shoulder superior and posterior
 LOD: lunge thrust inferior and hold
o Inferior Ilium [Side Posture Table]
 Subluxation up, Fencer stance
 Superior hand cups shoulder
 Inferior hand hand heel contact on ischial tuberosity, fingers superior
 LOD: lunge thrust superior and hold
Lumbar
- Prone Single Hand Rotational
o Spinous Recoil [head toward, L1/2 Superior, L3 Either, L4/5 Inferior] [Prone Table]
 Recoil stance, Stand on side of spinous laterality, HAVE PT TURN HEAD TOWARDS
 LOD: Anterior medial
o Single mamillary [like prone B] [Prone Table]
 Stand on side of spinout laterality, recoil stance
 L1-L2
 Superior hand: pisiform on the high mamillary
 Inferior hand: cups ASIS
 L4-L5
 Superior hand: under lower ribs
 Inferior hand: pisiform on high mamillary
 LOD: Anterior with adjusting hand, slight posterior traction with non adjusting hand.
Shoulder drop and hold.
- Prone Bimanual Hand Rotational
o Thumb Pisiform [L1-L4] [Prone Table]
 Stand on side of spinous rotation, fencer stance
 Superior hand: thumb contact onto lateral side of spinous
 Inferior hand: pisiform contact onto high mamillary of same vertebra
 LOD: Medial with thumb, Anterior with pisiform, lunge and hold
o Pisiform Thumb [L4/L5 – face footward]
 L1-L2
 Stand on side of spinous rotation, fencer stance headward
 Supeiror hand: Pisiform contact on spinous
 Inferior hand: thumb contact on high mamillary
 L4-L5
 Stand on side of spinous rotation, fencer stance FOOTWARD
 Flat thumb on mamillary
 Pisiform on the spinous
Diversified V Final Review
All Adjustments
Page 3 of 15
 LOD: Medially with pisiform, Anterior with thumb. Lunge and hold
o Double Thumb [L5 or anywhere] [Prone Table]
 Stand on side of spinous rotation, fencer stance
 Supeiror hand: thumb contact onto lateral side of spinous
 Inferior hand: thumb contact onto high mamillary of same vertebra
 LOD: Medial with Supeiror hand and Anterior with Inferior hand
- Side Posture Rotational [Sideposture table] [Pisiform, hand-heel, thenar, thumb]
o Spinous laterality down, fencer stance
o Superior hand: shoulder
o Inferior hand: Pisiform/hand heel [fingers laterally], Thumb/thenar [fingers medially]
o LOD: Anterior, Lunge and hold
- Prone Disc
o Posterior Lateral L4 and up [Prone Table]
 Thumb Pisiform
 Stand on side of OW
 Thumb into OW, Pisiform on the high mamillary [slightly superior to OW],
episternal notch over adjusting area
 LOD: AM with Thumb, AS with pisiform, lunge and hold
 Double thumb [Prone Table]
 Stand on side of open wedge
 Superior thumb into open wedge, inferior thumb on high mamillary
 LOD: AM with sup thumb, AS with inferior thumb
o Posterior Lateral L5/S1 [Prone Table]
 Thumb Pisiform
 Stand on side of OW
 Thumb into OW, Pisiform on sacral ala, episternal notch over adjusting area
 LOD: AM with Thumb, AS with pisiform Lunge and hold 5 seconds
o Pisiform Leg lift [Prone Table] [L4/5 or L5/S1]
 Stand on side of open wedge, fencer stance
 Superior hand: pisiform into OW, fingers medially
 Inferior hand: Ant thigh traction leg posterior then lateral
 LOD: medially at resistance
o Bilateral Posterior Disc [double thumb in disc space]
 Stand on either side
 Flat thumb contacts into the disc space BL
 LOD: Anterior slightly inferior through disc plane
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Sideposture Disc Moves
o Pull Through [Side Posture Table] [L4/5 L5/S1]
 Open Wedge down, fencer stance
 Superior hand: shoulder contact, traction superior
 Inferior hand: roll pt forward to contact ASIS from behind, then roll back onto your arm
 LOD: Lift using your legs, and shoulder shrug and hold
o Accordion [Open wedge up, traction shoulder down, foot piece 3rd notch] [UNIQUE TABLE]
 Open wedge up, fencer stance
 Superior hand: shoulder contact, traction inferiorly
 Inferior hand: pisiform/hand-heel on sacral ala with fingers directed anterior
 LOD: Torque inf hand medially, lunge and hold
Non Rotational – Non Disc
o Retro Side Posture [Side Posture Table] [thumb web index on mamillary]
Diversified V Final Review
All Adjustments
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 Fencer stance
 Superior hand: shoulder
 Inferior hand: thumb/index on mamillary BL
 LOD: Inf  sup tissue slack, anteriosuperior thrust
o Retro Prone [Prone Table] [Double thumb, knife edge]
 Stand on either side, fencer stance
 Flat thumb BL onto the mamillary process
 LOD: Inferior  superior tissue slack, anteriorsuperior thrust
o Spondylolisthesis [Foot piece 3rd notch] [UNIQUE TABLE]
 Stand at foot of table
 Grasp pts ankles and traction inferiorly applying a thrust to both legs
 Immediately flex knees and hips bring lets up to pts chest and have pt hold this position
 Lean over the pts knees with your chest
 Place both hands on the PSIS lifting anteriorly
 LOD: body lunge thrust in Posterior direction
 NOTE: Can also contact pts popliteal fossa with inferior shoulder and arm bilaterally.
OR can use forearm contact applied to patients anterior legs delivering the turst [women]
o Laterallisthesis [Ab unlock, Foot piece 3nd notch, Thumb, thenar, pisiform] [UNIQUE
TABLE]
 Fencer stance
 Superior hand: shoulder
 Inferior hand: Thumb contact on spinolaminar junction with elbow close to body
 LOD: medially, lunge and hold
Thoracics
- Prone
o Spinous Recoil [head toward, T1-6 Inferior, T6-12 Superior]
 Same as lumbar recoil, TURN HEAD TOWARDS, just switch hand position from
lumbar recoil
o Single Transverse [Prone Table]
 Stand on side of high TVP,fencer stance andTURN PTS HEAD TOWARD YOU!
 Inferior hand: pisiform on TVP
 Superior hand: support pisiform
 LOD: Anterior
o Thumb move [T1-3] [Prone Table]
 Stand on side of spinous rotation
 Adjusting hand Flat thumb against spinous
 Non adjusting hand on the head and laterally flex and rotate head toward side of spinous
laterality
 LOD: Medially
 NOTE: Can also stand at opposite side, or at head of table
o Superior Transverse [T1-3][Prone Table]
 Stand at head of table
 Side of spinous laterality, flat thumb contact on high TVP
 Non adjusting hand cups mastoid process, lift, rotate and laterally flex toward spinous
laterality
 LOD: Anterior with adjusting hand
o Pisiform Crossover [T1-T4] [Prone Table]
 Stand at the head
 Pisiform contact on the high TVP
Diversified V Final Review
All Adjustments
Page 5 of 15
 Non adjusting hand cups mastoid, lifting, flex and rotate away from adjusting hand
 LOD: Anterior Inferior with adjusting hand
o Bimanual rotation [thumb pisofirm etc]
o Counter rotation [LOD – ALS]
 Double Transverse [Pisiform Crossover] [Prone Table]
 Stand on side of high TVP of lowest segment
 Inferior hand: TVP of inferior vertebra
 Superior hand: TVP of superior vertebra
 LOD: Anterior Lateral Superior
 Double Pollicus [Prone Table]
 Stand on either side
 Place pollicus contacts on the high transverse processes
 LOD: Anterior, lateral superior
o Rib – [J move, DBL pollicus block spinous, Single pisiform]
 NOTE: Ribs subluxate superior and laterally. Correction is inferiorly and medially
 Double pollicus
 Roll a DBL pollicus onto the rib at its angle from superiolateral
 Place 2nd pollicus onto the spine for stabilization
 LOD: Inferior, medial and anteriorsuperior
 Single Pisiform J Move
 Inferior hand pisiform on the angle of the rib, applying inferior traction then
shifting medialy
 LOD: anterior and superior
o Retro – [DBL Pollicus ONLY!, Inf  Sup.][Prone Table]
 Stand on either side, fencer stance
 Pollicus contact onto the spinolaminar junction with skin traction INFSUP
 LOD: Anterior along disc plane
o Bilateral Posterior Disc – [DBL Pollicus ONLY! Sup  Inf][Prone Table]
 Stand on either side of table, fencer stance
 Double pollicus onto the spinolaminar junction with skin traction SUPINF
 LOD: Anterior along disc plane
o Lateral Flexion with Rotation
 Typical [am/as]
 Pollicus Pisiform [T3 – T12] [Prone Table]
o Stand on side of open wedge, same side is spinous rotation, fencer stance
o Superior hand: Pollicus into the disc space
o Infeiror hand: Pisiform against the high TVP
o LOD: AM with superior hand, AS with inferior hand
 Pisiform Pollicus
 Thumb pisiform
 Thumb pollicus
 Atypical [am/ms]
 Pollicus Pisiform
o Stand on side of open wedge, opposite spinous rotation, fencer stance
o Superior hand: pollicus contact into the open wedge
o Infeiror hand: pisiform contact on the spinous process
o LOD: AM with superior hand, MS with inferior hand
 Pisiform Pollicus
 Thumb Pisiform
Diversified V Final Review
All Adjustments
 Thumb Pollicus
Page 6 of 15
o Pisiform Traction [turn head to open wedge, LOD – AM] [Prone Table]
 Stand at side of table facing inferiorly
 Slowly turn pt’s head towards side of OW
 Non adjusting hand places palmar surface on the suboccipital region, with pisirorm on
EOP
 Adjusting hand takes pisiform into the OW
 Slight traction while flexing the head towards the OW
 LOD: anteriomedial
Cervicals
- Prone
o Capsiular Trauma [C1/2 LOD – Ant/Sup, C3/4 LOD – Ant, C4/7 LOD – Ant/Inf]
 Stand on side of subluxation, fencer stance
 Superior: Flat thumb or lateral index on the capsule
 Inferior: thenar contact on opposite mastoid process cupping ear. Superior lateral traction
 LOD: anterior inferior through disc plane
 NOTE: Can be done from the head, use flat thumb
o Lushka [Contact: Lateral most aspect of vertebra] [Prone Table]
 Stand on side of involvment, fencer stance
 Superior: lateral index contact on the most lateral aspect of the level
 Inferior: Cup the mastoid process, lifting and laterally flexing toward adjusting hand
 LOD: Medially
 NOTE: Can be done on opposite side or at head of table
o Retro
 Bimanual Recoil
 Prone, but lift the headpiece!
 Place lateral index contact of each hand against the lamina and articular process
BL
 Inferior  Superior tissue slack
 LOD: Anterior superior with recoil motion. Apply double thumb pressures
against posterior facets after adjustment to assist tissue accommodation
 Thumb Index
 Inferior: thumb index onto bilateral facet capsules [InfSup]
 Superior: cup the forehead directing head into extension
 LOD: Lunge anterior superior
o C1 PI/ C2 SP Hold C1 Adjust C2 [Cant hold C2 prone!]
 Stand on side of spinous laterality of C2
 Lateral index contact on C2
 Flat thumb contact on the TVP of C1
 Flex head laterally toward lateral index contact, rotating slightly
 LOD: Anterior superior
o Atlas – Occiput
 Lateral index contact on C1 TVP
 Thumb contact on occiput on opposite side
 Flex laterally, rotating away
 LOD: anterior medial on C1
o Axis – Occiput
 Standon side of spinous laterality of axis
Diversified V Final Review
All Adjustments
Page 7 of 15
 Inferior: Lateral index contact on C2
 Supeiror: flat thumb on occiput, fingers directed superior. Flex laterally toward the C2
contact
 LOD: anterior superior
o Occiput
 Inferior Occiput – ulnar contact, pull anterior
 Infeiror occiput side up
 Non adjusting hand: hand heel on pts trapexius on side of inferiority to hold
soulder
 Ulnar contact on pts mastoid process
 LOD: Anterior
 Anterior Occiput – ulnar contact, pull posterior
 Anteiror occiput side facing upward
 Non adjusting hand: hand heel on pts trapezius on side of anteriority to hold
shoulder
 Ulnar contact on the patients mastoid process
 LOD: posterior
- Seated
o Capsiular Trauma [C1/2 LOD – Ant/Sup, C3/4 LOD – Ant, C4/7 LOD – Ant/Inf]
 Standing on opposite side at 45
 Chiropractic index on the open facet, traction lateral to medial
 Non adjusting hand place hand heel contact on the occiput, superior and slightly posterior
traction
 LOD: Based on level, but always anterior __________
o Lushka [Contact: Lateral most aspect of vertebra, stand on side opposite 90 and pull towards]
 Stand on opposite side at 90
 Chiro index on the lateral most aspect of the neck at the level of involvmnet
 Non adjusting hand contact mastoid process while cupping the ear
 LOD: Non adjusting lift and push away until resistance. Adjusting hand pull medially
o Posterior atlas [45 and contact TP of C1]
o C1 PI/ C2 SP [can only adjust C1 as posterior atlas]
o Atlas-Occiput
 Stand at 45, opposite side of atlas posteriority
 Lateral index contact on C1 TVP
 Non adjusting hand: hand heel contact on mastoid process
 LOD: anterior superior on C1
o Axis-Occiput
 Stand on side of spinous rotation of C2, 45
 Chirorpactic index on C2 articular pillar
 Hand heel on mastoid
 LOD: anterior superior on C2
o Occiupt - PIA
 Posterior occiput [opposite side]
 Stand on side opposite posteriority, 45
 Lateral index on posterior occiupt
 Hand heel on occiput on opposite side
 LOD: anteiror
 Inferior occiupt [Same side 90 and thrust anterior]
 Stand on side of infeior occiput, 90
Diversified V Final Review
All Adjustments
Page 8 of 15
 Lateral index on opposite occiput
 Hand heel on the inferior occiupt
 LOD: Superior
 Anterior occuput [same side thrust posteior]
 Stand 45 on side of anteriority
 Non adjusting hand: lateral index on occiput, laterally flex and have pt rest head
in this hand
 Adjusting hand: Pollicus contact on mastoid process
 LOD: medial superior pressure with posterior thrust
- Supine
o Capsular
 Lateral index on the posterior aspect of open facet
 Non adjusting hand contact occiput and direct head into slight extension and rotation
facing away from the adjusting side
 LOD: Anterior inferior
o Lushka [Supine table]
 Stand at head of table
 Lateral index on the lateral most aspect of neck
 Hand heel contact on occiput on side opposite and laterally flex head toward subluxation.
Turn head slightly away from adjusting side
 LOD: Arm parallel to floor and medial
o Atlas-Axis [Hold C2, adjust C1]
 Lateral index contact on TVP of C1
 Lateral index contact on articular pillar of C2
 LOD: anterior superior on C1
o Axis-Atlas
 Hold C1/Adjust C2
 Lateral index contact the C2 articular process
 Lateral index contact on the C1 transverse process
 LOD: anterior superior on C2
o Atlas-Occiput
 Lateral index contact on TVP of C1
 Lateral index contact on the occiput
 Laterally flex toward, rotate away
 LOD: anterior medial on C1
o Axis-Occiput
 Lateral index contact on C2
 Lateral index contact on C0 with lateral flexion and some rotation away from C2 contact
 LOD: anterior supeiror
o Ant Atlas / DISH [ant atlas up, anterior atlas down]
 Lateral index on C1
 Lateral index on occiput
 Can be with anterior side UP or DOWN
o Occuput - SIP
 Inferior occput [Involved side down, hook mastoid, fingers inferior, pull up]
 Infeior side down
 Non adjusting hand: hand heel contact on zygomatic arch with fingers directed
inferior
 Adjusting hand: hooking mastoid process
Diversified V Final Review
All Adjustments
Page 9 of 15
 LOD: superior
 Post. Occiupt [Involved side up, hook mastoid, fingers lateral]
 Posterior side up
 Non adjusting hand: Hooking the mastoid process
 Adjusting hand: hand heel contact on zygomatic arch with fingers directed
anterior
 LOD: anterior
Extremity Adjusting
Hand and Wrist
- Distal Intermetacarpal Joints
o Thumb index contact at distal ends of metacarpals
o AP/PA glide checked by shearing
- Metacarpal-Carpal Joints
o Long axis extension
 Thumb web index – like you are shaking the hand of pt
 Other hand grasps the forearm
 Steady long axis extension to open the fjoints
 Impossible to isolate levels
o Rotation
 Thumb web index contacting wrist at intercarpal joints
 Other hand contacts the metacarpals
 Rotate in figure 8
o AP/PA Glide
 Thumb web index on distal row of carpals
 Distal hand on proximal heads of metacarpals
 AP/PA shear
- First Metacarpal-Trapezium
o Long axis extension
 Support wrist and take thumb web index contact over the joint
 Take thumb index contact on proximal head of 1st metacarpal
 Squeeze thumb index to separate the joint
o Adjustment
 Test position
 Pollicus-Chiropractic index over joint space
 Impuse thrust with reinforced hand
- Intercarpal Joints
o Extension – evaluates distal row
 Chiropractic index on the joint over the dorsal side of hand
 Thumbs placed on palmar surface over metacarpsls
 Wrist is extended
 Adjustment: test position
o AP/PA Glide
 Block distal and proximal rows
 Shear
- Triquetrum – only one to be assessed individually
o Support elbow so that wrist is free floating in air
o Thumb/index contact over triquetrum
o Secondary hand contact supports radius and metacarpals to minimize movement
o AP/PA Glide
Diversified V Final Review
All Adjustments
Page 10 of 15
- Ulno-Meniscal-Triquetral
o Handshake like contact but allows index finger to slide distal to the dip of the ulna
o Secondary hand grasps 2/3 proximal forearm
o Long axis extension, wrist is deviated radially and impulsed
- Carpal-Radial Joints
o Flexion – proximal rows
 Flex the wrist
 Index and chiropractic index on the joint space on the palmar side of the wrist
 Thumbs placed over distal aspect of metacarpsls
 Impulse from test position or with double thumb on palmar side
o AP/PA glide
 Thumb web index on distal radius/ulna
 Thumb web index on proximal row of carpals
 AP/PA Shear
o Medial and Lateral deviation
 Lateral index contact on radial and ulnar sides of wrist
 Tilt medially and laterally
 Impulse into restriction
- Distal Raidal Ulnar Joints
o AP/PA glide
 Pollicus 4th and 5th fingers on the radius and ulna bilaterally
 Thumb 2nd and 3rd fingers on the metacarpals
 Shear AP/PA
o Supination
 Supinate wrist
 Thumb/index contact on radius and also unla [index fingers on palmar side]
 Pull radius towards you while pushing ulna away
 Adjustment: impulse from test, or double thumb
o Pronation
 Pronate the rist
 Thumb/index contact on radius and also unla [index fingers on palmar side]
 Pull radius towards you while pushing ulna away
 Adjustment: impulse from test, or double thumb
Elbow
- Long axis extension
o Flex elbow to 90 thumb-web index at distal humerus
o Grasp distal radius/ulna
o Apply distraction and feel for negative pressure as distraction is released
- PA glide
o Evaluated in extension. Supinate and extend forearm
o Take thumb-index contact over olecranon with either hand
o Stabilize the forearm on the volar surface with secondary hand
o Apply PA pressure on forearm when extended
- Medial/Lateral Tilt
o Checked with elbow slightly flexed. Pollicis contact with each hand over the joint line,
overlapping thumbs
o Apply medial and lateral stress
- Rotation – Radial Hed
o Support the elbow with thumb on proximal radial head
Diversified V Final Review
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o With other hand grasp the pts right wrist and hold it in the flexed position
o As forearm is rotated, head of radius rotates under thumb.
o The adjustment is made with forearm extended by adding an impulse thrust from palpating
position
o LOD: impulse from test position before in full extension
- Superior Glide
o Pt supine. Stand on side of arm testing.
o Flex forearm to 90.
o Inferior hand: take pollicis contact over the patients pollicis, gripping the patients thumb with
web-index contact
o Superior hand: palpate proximal radius head
o Push on the hand with inferior line of drive assessing head of radius.
Shoulder
- Assessment/Adjusting
o Anterior Glide
o Lateral Glide
o 10 degree superior
o 90 degree superior
 Block scapula during adjustment
o Posterior glide
o Lateral inferior
o Internal/External rotation
o Circumduction
AC Joint
- Assessment
o Seated, stand behind and palpate AC joint
o Assess in following
 Long axis extension
 Abduct into extension
 Circumduction
- Adjustment
o Seated
 Similar to posterior glide of glenohumeral but DO NOT BLOCK SCAPULA
 Flex arm to 90 and impulse while reaching around patient
o Supine
 Same side and put pisiform over the joint with inferior hand  impulse
 Supeiror hand stabilize other clavicle with pollicus
 Double pisiform cross over
SC Joint
- Assessment
o Stand behind the patient, palpate the SC joint
o Raise the arm and perform the following
 Abduct arm to 90 degrees, bring arm back in extension
 Abduct arm to 110 degrees and put into circumduction
- Adjustmnet
o Seated
 Reach around and stabilize other clavicle with pisiform or hand heel
 With other hand pisiform or hand heel on the clavicle that needs adjusting
 Posterior pressure and impulse thrust
o Supine
Diversified V Final Review
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 PUT THE ARM UNDER THE HEAD OF PATIENT ON SIDE OF ADJUSTING
 Single pisiform
 Pisiform cross over [blocking other SC joint]
Scapula
- Patient is prone with arm laying on back [90 degree bent]
- Stand on side adjusting
- Superior hand on the spine of the scapula
- Inferior hand: thumb web index on the angle of the scapula
- Lift, rotate, circumduct and add impulse to clear restriction
- Can also be done sideposture in same manner
First Rib
- Assessment
o Seated patient dr behind the patient
o Index of chiropractic index fingers at the root of the neck, just posterior to clavicle and anterior
to trap
o With other hand, contact the pts forehead and rotate away from side being assessed. Extend and
laterally flex C spine toward that side
o First rib should DROP away from the fingertis
- Adjustment
o Seated: Impulse from assessment position
o Supine
 Same as assessment just in supine position
 Will have to pull patient to side of the table to get this one accomplished
o Prone
 Stand at head of table
 Lateral index contact on the involved side
 Other hand laterally flexes head toward side of adjustment with slight rotation
away
 LOD: Inferior
 Standing along side patient
 Same thing just at side of pt
TMJ
- Movement evaluated in seated position with Dr. behind patient
- Place lateral index on TMJ and have patient slowly open jaw
- That which is moving LAST or LEAST is the side that should be adjusted
- Adjustment
o Supine, with head turned so that affected side is up
o Stabilize the head with fingers directed towards the occipt
o Adjsting hand is pisiform contact on the angle of the jaw, fingers directed along the jaw
o Open the pts mouth, impuse thrust
Foot
-
-
Intermetatarsal Joints
o AP/PA Glide
 Contact distal heads with thumbs on palmar side, index on dorsal side
 Shear AP/PA
 LOD: Test position
iRotation Metararsal-Tarsal Joints
o Cup the calcaneus with either hand
o Thumb-web-index contact over the proximal metatarsals
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o Roll in figure 8
o LOD: impulse in restrictions
- AP/PA Glide Cuneifirm-Metatarsal
o Each one checked individually
o Thumb index on cuneiform
o Block metatarsals with other hand
o Shear AP/PA
o Adjustment:
 Dorsal Subluxation
 Lateral index over cuneiform, reinforced with opposite hand
 Dorsiflex, evert and impulse in inferior line
 Palmar Subluxation [Locke’s Maneuver]
 Pt standing with affected side furthest from wall
 Double thumb contact over segment adjusted
 Rotate foot in circle to relax patient
 Quickly drop the foot towards the floor applying pressure with thumbs, do not
plantar flex the foot
- AP/PAof Cuneiform/Cubiod – Metararsal joints [distal row]
o Inferior hand place thumb web index over metatarsals
o Superior hand thumb web index over cuneiforms/cubiod
o Shear in AP/PA motion
o LOD: Impuse from test position
- AP/PA Cuboid
o Thumb index over the cuboid bone
o Other hand blocks metatarsals, especially 5th
o Shear in AP/PA motion
o Adjustmnet
 Impulse from test position
 Dorsal Subluxation
 Index contact on dorsum of foot contacting cuboid
 Flat thumb blocks metatarsals on plantar surface
 Ring hand such that you are pushing cuboid infeirorly
 Plantar subluxation
 Flat thumb contact on cuboid
 Other hand blocks metatarsals
 Ring hands such that cuboid is lifted superiorly
Ankle
- Mortise Joint
o AP/PA Glide
 Leg at 45, ankle on table with toes off the table
 Infeiror hand thumb web index on the talus
 Supeiror hand thumb web index on tibia
 AP/PA Shear
o Long axis extension [Supine]
 Lateral index contact on anterior aspect of talus and one over posterior talus
 Apply long axis extension
 Can also doe this prone
 Place knee on their thigh
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 Flex their knee and then take thumb web index contact with each hand on anterior
and posterior aspect of talus
 Pull upward in extension
 Impulse from test position
- Subtalar – Calcaneal Joint
o Medial and Lateral Tilt
 Cup calcaneous with one hand
 Brace superior portion of foot with other
 Apply medial and lateral stress
 Impulse from test position
o Inferior Glide
 Prone, flex knee at 90 degrees
 Thumb web index on talus antieor
 Thumb web index on calcaneus posterior
 Shear by squeezing hands together
o Distal Fibula AP/PA Glide
 Thumb web index on distal fibular head
 AP/PA motion
 Impulse from test position
 OR evaluate and adjust from side posture positoin
Knee
- Patellofemoral joint [Supine table]
o Place thumb-web index
o Assess in all ranges of motion
o Adjustment: Impulse in test position
- Femorotibial joint
o AP/PA Glide [Supine Table]
 Stand on side of involvment, flex knee and hip to 90
 Place inferior thigh under pts thigh
 Superior hand: thumb-index over tibial condyles
 Inferior hand: Over tibial tuberosity for Posterior glide, Under calf for Anterior glide
 Adjustment: Impulse in test position
o Internal and External Rotation [Supine Table]
 Superior hand: over tibial condyles
 Inferior hand: grasp distal tibia-fibula with inferior hand and rotate in both directions
 Adjustment: thumbs overlapped and fingers interlaced, immpuse in test position
o Medial to lateral Tilt
 Flex knee to 10 degrees
 Stabilize ankle between your knees and then grab pts knee with both hands
 Varus and Valgus Stress
 Adjust before it gets to full extension
o Superior Glide of Fibula [Supine Position]
 Superior hand: thumb-index contact on proximal head of fibula
 Inferior hand: dorsiflexion of foot
 LOD: Impuse from test position
o Anterior and Posterior glide of Fibula [Supine]
 Leg flexed to 45 degrees, foot flat on table
 Thumb-index onto proximal head of fibula with lateral hand
 Medial hand stabilize the tibia with thumb web index
Diversified V Final Review
All Adjustments
 LOD: impulse from test position
o Adjustments
 Prone – Tibial adjusment
 Stand on the side of knee involvment
 Superior hand: Lateral index into popliteal fossa
 Inferior hand: Distal tibia, flex the leg over superior hand
 LOD: impulse thrust with the inferior hand
 Prone – Fibular adjustment
 Stand on side opposite of knee involvment
 Reach across to opposite knee
 Supeiror hand: lateral index into popliteal fossa
 Infeiror hand: Distal tibia, flex the leg over superior hand
 LOD: imuplse thrust with superior hand in anterior line
Hip
Assessments
- Flexion [Supine table]
o Stand on side of involvement, flex thigh and hip with leg over your shoulder
o Both hands contact thigh and induce flexion of hip
- Extension [Prone Table] – Like Yoemans Test
o Stand on side of involvement
o Superior hand: pisiform over SI joint
o Inferior hand: lift leg posterior
- Internal and External Rotation [Prone Table]
o Stand on side of involvement
o Superior hand: Pisiform contact on SI joint
o Inferior hand: flex leg to 90, grasp distal tibia and internally and externally rotate
Adjustments
- Long axis extension [Supine Table]
o Have pt grasp the side of table
o Grasp distal tibia-fibula and flex hip to 10 degrees
o LOD: Infeiror, feel seperation. Impulse in test position
- Side posture long axis extension [Sideposture Table]
o Involved hip up
o Supeior hand: shoulder
o Inferior hand: hand heel contact on greater trochanter
o LOD: Lunge thrust, towards floor
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