Pelvic Drop Table Technique Pelvic Drop Table Technique

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6/15/2015
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Copyright © 2014 Howard Pettersson
Pelvic Drop Table Technique
Pelvic Drop Table Technique is a synthesis of concepts
and ideas from Thompson, Gonstead, and Activator
chiropractic techniques. Chiropractic procedures
from each of these techniques are blended together
to create a fluid, easy to learn method for analyzing
and adjusting the pelvis. Students will come away
with a deeper appreciation for integration of
chiropractic techniques.
Pelvic Drop Table Technique
• Negative Derifield
– Thompson
• Derifield Leg Check
• Pelvic Drop Table Adjusting
– Gonstead
• SI Fluid Motion (Palmer Gonstead)
• Walking in Place for IN / EX (Gonstead Methodology Institute)
– Activator
• θY-Axis Isolation Test
• Articular Pressure Testing
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NEGATIVE DERIFIELD
Scenario #1
Posterior Rotation of the Sacrum
LEFT SI FLUID MOTION
Apply a firm continuous pressure
S-I, P-A, and medial-to-lateral
through the joint plane into the
table.
If both legs lengthen simultaneously, then the sacroiliac
joint on the side tested is fixed.
This test indicates sacroiliac joint
fixation for any one of the six
primary pelvic listings.
Left SI Fluid Motion
INITIAL DERIFIELD LEG CHECK
Perform the Initial Derifield Leg Check. If Negative Derifield
is presented, continue with the Negative Derifield Protocol.
Initial Derifield Leg Check has been adapted from:
Fuhr, AW, et al. Activator methods chiropractic technique,
second edition, St. Louis: Mosby-Elsevier, 2009.
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ANKLE INVERSION
Typically ankle inversion is
noted on the side of the
short leg in the prone
extended position.
(Potential left short leg).
If ankle inversion is on the
side opposite the short leg
in the prone position, it
may be due to a previous
ankle inversion sprain. Ask
the patient about their past
history.
Note the side of the short leg in the prone extended position
(left short leg).
If the left short leg in the
prone extended position
stays short when flexed to 90
degrees, the initial leg check
indicates Left Negative
Derifield. Negative Derifield
confirms a θY-Axis misalignment of the pelvis—EX Ilium,
Posterior Rotation of the
Sacrum, IN Ilium, or Anterior
Rotation of the Sacrum.
Next, perform the Left θYAxis Segmental Dysfunction
Test for the Pelvis.
Thompson Educational Workshops. The
thompson technique reference manual.
Elgin, IL: 1984.
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To perform the Left θY-Axis
Segmental Dysfunction Test
for the Pelvis, instruct the
patient to lock the knee on
the side tested. Next, extend
the lower extremity at the
acetabular hip to its end
range. And finally, extend the
hip into resistance a few
degrees to engage the sacroiliac joint on the side of
involvement.
Note the left short (indicator) leg in the prone extended position.
Left θY-Axis Segmental
Dysfunction Test – Left Posterior
Rotation of the Sacrum
If the reactive (indicator) leg
stays short in the prone extended
position and the leg on the side
tested (left) becomes long when
the legs are flexed to 90 degrees,
pressure test for Left Posterior
Rotation of the Sacrum and left
EX Ilium.
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Pressure test* for Posterior
Apply a Posterior-to-Anterior
and Medial-to Lateral
Pressure.
To pressure test for Left
Sacrum, apply a posterior-toanterior and medial-tolateral pressure on the left
sacral ala just lateral to the
first and second sacral
tubercles.
*Haas M, Peterson D, Panzer D, Rothman E, Solomon S, Krein R, et al.
Reactivity of leg alignment to articular pressure testing: evaluation of
a diagnostic test using a randomized crossover clinical trial approach.
J Manipulative Physiol Ther. 1993;16(4):220-7.
*Khauv KB, John C. Health-related quality of the improvements in
adult patients with chronic low back pain under low-force chiropractic
care: a practiced-based study, Chiropr J Aust. 2011; Dec;41(4):118122.
*Fuhr AW, et al. Activator methods chiropractic technique, second
edition. St. Louis: Mosby-Elsevier, 2009.
If the legs become even in the prone extended position
and flexed position upon pressure testing, adjust for
Left Posterior Rotation of the Sacrum.
Correct for Left Posterior
CP: #1b – hook of the hamate
SCP: Between S2 tubercle and PSIS
Stab: Wrap around stabilization
Deliver a straight P-A thrust through the
sacroiliac joint space. The LOD is P-A &
medial-to-lateral through the sacroiliac
joint space.
Copyright © 1999 & 2014 Howard Pettersson
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Post-Adjustment Leg Check: The legs should become
even in the prone extended and 90° flexion positions
after adjusting for Left Posterior Rotation of the Sacrum.
Post Ajustment: The leg on the
side tested should now lengthen
while the leg on the opposite
side remains stationary indicating
that the sacroiliac joint on the
side tested is now freely
moveable.
The foot of the stationary leg
may demonstrate moderate
toe-out foot flare, which is
considered a normal variant.
Copyright © Howard Pettersson 2014
NEGATIVE DERIFIELD FLOWCHART
Left SI Fluid Motion Fixation
Right or Left Negative Derifield Leg Check confirms a θY-Axis misalignment of the pelvis—
Posterior Rotation of the Sacrum, EX Ilium, IN Ilium, or Anterior Rotation of the Sacrum.
Perform the Left θY-Axis Segmental Dysfunctional Test for the Pelvis.
If the side tested flexed leg becomes long,
Articular pressure test for P-L and Left EX Ilium.
If the legs become even in the extended and flexed positions
Upon articular pressure testing for
P-L, adjust P-L.
The legs should be even in the extended and flexed positions upon post-adjustment Derifield leg check,
and post-adjustment Right SI Fluid Motion should now be freely moveable.
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NEGATIVE DERIFIELD
Scenario #2
EX Ilium
Walking in Place: Instruct the patient to line the tips of their
shoes on the yellow line. Next, instruct the patient to place
their fingertips on the wall to stabilize themselves while they
walk in place.
Walking in Place: Instruct
the patient to close their
eyes and walk in place for
30 seconds. After 30
seconds, instruct the patient
to stop. Next, observe the
position of their feet. Look
for relative toe-in and toeout foot flare. Also, note
whether one foot is in front
of the other. If one foot is in
front of the other, and also
has relative toe-in foot flare;
this may indicate potential
EX Ilium on that side.
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EX ILIUM ANECDOTAL FINDINGS
• The patient may experience sciatic-like
pain down the back of the thigh.
EX ILIUM VISUALIZATION
• Observe the contour of the gluteal
musculature that extends about two
inches laterally from the PSIS. This strip
of muscle, normally about two inches
wide, appears narrow and hunched
compared to the opposite side.
Right Gluteal Hunching
Note the right gluteal hunching
and the left gluteal flattening.
Gluteal hunching is a visual
finding for EX Ilium.
Right
Left
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EX ILIUM TRIGGER POINTS
• The gluteus medius trigger points may be
tender upon palpation. One is located
two inches, and the other four inches
lateral of the PSIS, respectively. These
trigger points may be present even
though the problem may be an IN ilium
on the opposite side.
RIGHT SI FLUID MOTION
table.
Right SI Fluid Motion
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ANKLE INVERSION
extended position.
history.
(left short leg).
Next, perform the Right θYAxis Segmental Dysfunction
Elgin, IL: 1984.
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To perform the Right θY-Axis
degrees to engage the
sacroiliac joint on the side of
involvement.
Right θY-Axis Segmental
Dysfunction Test –
Right EX Ilium
stays short in the prone
extended position and the
leg on the side tested (right)
becomes long when the legs
are flexed to 90 degrees,
pressure test for Right EX
Ilium and right posterior
rotation of the sacrum.
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Pressure test* for Right EX Ilium.
Apply an arcing tissue pull, roll in
from inferior-to-superior and
lateral-to-medial against the
lateral, inferior aspect of the PSIS
to pressure test for Right EX
ilium.
*Haas M, Peterson D, Panzer D, Rothman E, Solomon S, Krein R, et al. Reactivity
of leg alignment to articular pressure testing: evaluation of a diagnostic test
using a randomized crossover clinical trial approach. J Manipulative Physiol
Ther. 1993;16(4):220-7.
*Khauv KB, John C. Health-related quality of the improvements in adult patients
with chronic low back pain under low-force chiropractic care: a practiced-based
study, Chiropr J Aust. 2011; Dec;41(4):118-122.
*Fuhr AW, et al. Activator methods chiropractic technique, second edition. St.
Louis: Mosby-Elsevier, 2009.
Right EX Ilium.
Correct for Right EX Ilium.
Elbow-in torque
Apply a straight
down P-A
stabilization.
Perform an arcing tissue pull,
roll in from I-S, and lateral-tomedial until 10b (proximal
thenar – green dot) butts up
against the bony ridge
separating the iliac ala from
the PSIS.
Utilize a curvilinear thrust I-S,
P-A, and lateral-to-medial.
The elbow is torqueing “in”
from lateral-to-medial up the
articulation.
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after adjusting for Right EX Ilium.
moveable.
Copyright Howard Pettersson 2014
Right SI Fluid Motion Fixation
Perform the Right θY-Axis Segmental Dysfunctional Test for the Pelvis.
If the side tested flexed leg becomes long,
Articular pressure test for P-R and Right EX Ilium.
Right EX Ilium, adjust Right EX Ilium.
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NEGATIVE DERIFIELD
Scenario #3
IN Ilium
IN ILIUM ANECDOTAL FINDINGS
• The patient may experience inguinal
area/groin pain.
• If the pain is severe it may radiate a short
distance into the anterior-medial thigh.
• In some cases testicular pain may also be
present.
Walking in Place: Instruct the patient to line the tips of their
shoes on the yellow line. Next, instruct the patient to place
their fingertips on the wall to stabilize themselves while they
walk in place.
14
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Walking in Place: Instruct
the patient to close their
eyes and walk in place for
30 seconds. After 30
seconds, instruct the patient
to stop. Next, observe the
position of their feet. Look
for relative toe-out and toein foot flare. Also, note
whether one foot is behind
the other. If one foot is
behind the other, and also
has relative toe-out foot
flare; this may indicate
potential IN Ilium on that
side.
IN ILIUM VISUALIZATION
• Observe the contour of the gluteal
musculature that extends about two
inches laterally from the PSIS. This strip
of muscle, normally about two inches
wide, appears flattened compared to the
opposite side.
Left Gluteal Flattening
Note the right gluteal hunching
and the left gluteal flattening.
Gluteal flattening is a visual
finding for IN Ilium.
Right
Left
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table.
ANKLE INVERSION
extended position.
history.
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(left short leg).
Next, perform the Left θYAxis Segmental Dysfunction
Elgin, IL: 1984.
To perform the Left θY-Axis
degrees to engage the sacroiliac joint on the side of
involvement.
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Left θY-Axis Segmental
Left IN Ilium
stays short in the prone
extended position and the leg
on the side tested (left)
becomes short when the legs
pressure test for Left IN Ilium
and left anterior rotation of
the sacrum.
Pressure test* for IN Ilium.
Apply an arcing tissue pull,
roll in from superior-toinferior and medial-tolateral against the medial
PSIS to pressure test for Left
IN ilium.
*Haas M, Peterson D, Panzer D, Rothman E, Solomon S, Krein R, et
al. Reactivity of leg alignment to articular pressure testing:
evaluation of a diagnostic test using a randomized crossover clinical
trial approach. J Manipulative Physiol Ther. 1993;16(4):220-7.
adult patients with chronic low back pain under low-force
chiropractic care: a practiced-based study, Chiropr J Aust. 2011;
Dec;41(4):118-122.
18
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Left IN Ilium.
Left IN Ilium
Elbow-out torque
Perform an arcing tissue pull,
roll in from S-I and medial-tolateral until 1b (hook of the
hamate – green dot) butts up
against the medial aspect of
the left PSIS.
Utilize a medial-to-lateral and
slight P-A line of correction.
The elbow is torqueing “out”
from medial-to-lateral down
the articulation.
after adjusting for Left IN Ilium.
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moveable.
Left SI Fluid Motion Fixation
Perform the Left θY-Axis Segmental Dysfunctional Test for the Pelvis.
If the side tested flexed leg becomes short,
Articular pressure test for A-L and Left IN Ilium.
Left IN Ilium, adjust Left IN Ilium.
NEGATIVE DERIFIELD
Scenario #4
Anterior Rotation of the Sacrum
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table.
ANKLE INVERSION
extended position.
history.
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(left short leg).
Next, perform the Right θYAxis Segmental Dysfunction
Elgin, IL: 1984.
To perform the Right θY-Axis
degrees to engage the
sacroiliac joint on the side of
involvement.
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Right θY-Axis Segmental
Right Anterior Rotation
of the Sacrum
If the left reactive (indicator)
leg stays short in the prone
extended position and the leg
on the side-tested (right)
becomes short when the legs
pressure test for Right
Anterior rotation of the
sacrum and right IN Ilium.
Pressure test* for Right
Anterior Rotation of the
Sacrum.
Apply a straight lateral-tomedial tissue up against the
mid-lateral aspect of the
inguinal ligament.
*Haas M, Peterson D, Panzer D, Rothman E, Solomon S, Krein R, et al.
Reactivity of leg alignment to articular pressure testing: evaluation of
a diagnostic test using a randomized crossover clinical trial approach.
J Manipulative Physiol Ther. 1993;16(4):220-7.
adult patients with chronic low back pain under low-force chiropractic
care: a practiced-based study, Chiropr J Aust. 2011; Dec;41(4):118122.
23
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Right Anterior Rotation of the Sacrum.
Elbow-in torque
Correct for Right
Anterior Rotation
of the Sacrum
The thrust is a lateral-tomedial (elbow-in) torquing
thrust. Do not apply an
intentional anterior-toposterior component to
this thrust.
after adjusting for Right Anterior Rotation of the Sacrum.
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moveable.
Right SI Fluid Motion Fixation
Perform the Right θY-Axis Segmental Dysfunctional Test for the Pelvis.
If the side tested flexed leg becomes short,
Articular pressure test for A-R and Right IN Ilium.
A-R, adjust A-R.
25

Pelvic Drop Table Technique Pelvic Drop Table Technique

Transcription

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