WELCOME

to--
Cervical Technique Class!

Power Point Contents (Slide #s)
Intro Discussion: Slides 3 14
Visualization: Slides 15 17
Instrumentation: Slide 18
Inclinometry: Slides 19 30
Reflexes: Slides 31 34
Orthos: Slides 35 36
Derifield Leg
Exam: Slides 37 41
X-Ray: Slides 43 47
Motion Palpation Slides 48 81
Palmer-Gonstead Slides 82 116
Diversified Slides 117 160
Adjusting Info Slides 251 - 257




Power Point Contents: (Slide #s) -- for EXTRA practice


Practice Slides:
Motion Palpation -- (Listings): 70-71; 76-77; 178 181
(Figure examples): 78 - 80

Palmer-Gonstead -- (Listings only) 160-168; 226 227
(Figure examples): 182 209

Diversified -- (Listing only) -- 169-170; 236
(Figure examples): 210-214; 228-235
237-246

Review for Diversified & Final Practical (Listings):
247 - 249

CHIROPRACTIC THOUGHTS
Chiropractors adjust too many
segments.
Chiropractors adjust too often.
Chiropractors adjust too hard.**

**C. Gonstead, D.C.
Reference drawn from Gonstead Seminar,
Davenport, IA, July 2005

PATIENT PROTOCHOL
EXAM OF THE PATIENT MOVES FROM LEAST
INVASIVE
(Case History taking, Observation,
Visualization)
TOWARD MORE INVASIVE (Instrumentation,
Leg Balance Exam)
TO MOST INVASIVE (Range of Motion in degrees,
Orthopedic Tests, Neurological Reflexes, Static
& Motion Palpation Exams)

To Reiterate: PROGRESSION OF PATIENT
EXAM
LEAST INVASIVE

MORE INVASIVE

MOST INVASIVE

At any point in the exam, the doctor may stop the
exam, if to proceed would be contra-indicated.

Clinical Application of Patient Exam
1. Ask questions.
2. Listen to answers.
3. Observe (look & smell)
4. Scan (Do skin surface temperature scan)*

**Always consider cautions/contraindications to any
exams.

(Never hesitate to re-examine the patient at any time if care
is not moving toward a positive direction.)
Clinical Application of Patient Exam (continued)
5. Determine needed exams/tests*
i.e. Range of Motion Measure (ROM) of spine *
ROM is measured in degrees, using an instrument.
The measure is performed as ACTIVE ROMthe patient
performs the motion;the doctor measures motion amount)
6. Perform selected Orthopedic Exams to
determine structural stability*
*Always consider cautions/contraindications to
exams.




Clinical Application of Patient Exam
(continued)*
7. Perform Reflex Exams of selected cord levels &
nerves to assess basic functioning of the
nervous system ( the Reflex Arc)*
8. Touch (Palpate)*
Static & Motion review of a selected spinal area.

* Always consider cautions/contraindication to
exams.

Clinical Application of Patient Exam
(continued)
9. Assess Line Drawings on X-ray films to
determine structural departures from
established chiropractic normsto assist
with technique adjusting choice, & Line of
Correction (L.O.C.) when adjusting.

(Initially, x-rays are reviewed for pathology findings,
anomalies etc. prior to line drawing analysis.)
Manifestations of a Subluxation
Case History & Observation
Instrumentation
Leg Check Exam
Spinal Orthopedic/Neurological/Range of Motion
Exams
Static Palpation
Motion Palpation
X-Ray
See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class, Gindl, P.S., pages 1 8.
CASE HISTORY OF THE PATIENT2 Aspects
Todays Health Problem: History of patients
Chief Complaint.


Prior Health Problem(s): History of patient
(history of accidents, injuries,
surgeries, lifestyle, nutrition,
family history, outcomes of
health interventions etc. that
have occurred in the past)
See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class, Gindl P.S., pages 171-3




8 Parameters Determining
History of Chief Complaint
Date of onset
Duration/Frequency
Mode of onset
Type of pain
Location of complaint

Quality/severity
What aggravates or relieves
Previous treatment for
complaint?
Was previous treatment
helpful?
Other
complaints/dysfunctions;
other issues?
REFERENCE: Physical
Examination, Winchip &
Capogna. Material edited by
P. Mullin, D.C.
Visualization of the Patient
Perform Spinal Contour Analysis (i.e., Plumb Line Analysis)
Observe for:**
a) Head Tilt b) Shoulder Leveling
c) Pelvis Leveling d) Scoliosis
e) Asymmetrical Skin Folds
f) Asymmetrical Elbow Level
g) Asymmetrical Muscles :
Normal tonicity;
Hyper tonicity (Taut);
Hypo tonicity (Flaccid)
h) Foot Flare (Toe In, Toe Out)

** Stand behind the patient to observe. (Additional Plumb Line
Evaluation involves observation of the back, sides, and front
perspectives of the patient.)
See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class, Gindl P.S., pages 5-6.

Visualization Examples
Visually Scan for asymmetry
Head
Tilt
High
Shoulder
High
Hip
MORE VISUAL
EXAMPLES
Visually scan for asymmetry
High
Hip
Head
Tilt
High
Shoulder
Scoliosis
Instrumentation
DUAL PROBE INSTRUMENTATION

1. Definition of Clinical Significance Finding
(Break):
Deflection of the needle of 2 5 increments or more over one
segmental field
MARKING BREAKS
T1 Occiput Place mark inch below mid-thermocouples (at
inferior rim of probe)
C7 S2 Place mark inch above mid-thermocouples
GLIDE TIMES: Cervicals 20 seconds
Thoraco-Lumbar40 seconds
INTERPRETATION: Palpate what falls immediately beneath break
mark.
INCLINOMETRY
(or any attempt at ROM)
Contraindications:

Fractures, dislocation, sprain and strain, severe
pain.
Severe instability ( i.e. Rusts Sign)
Advanced atherosclerosis ( i.e. positive Georges
Sign/other circulatory evals.)
Severe bone weakening, such as osteomalacia;
osteoporosis
Range of Motion (in degrees)
Measures of joint motion range can help to
document ROM limitations related to:
1. Disease
2. Injury
3. Disuse*

* Daniels & Worthingham
ROM EXAM OF THE PATIENT
Motions measured in degrees with a variety
of instruments:
a) Flexion
b) Extension
c) Lateral Bending/Flexion
d) Rotation

See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class. Gindl P.S., pages 10 15.

RANGE OF MOTION (ROM)
Norms for Inclinometer:
Flexion 50 degrees
Extension 60 degrees
Lateral Flexion 45 degrees
Rotation 80 degrees


INCLINOMETRY
Cervical Extension
References: Top of Occiput & T1(some authorities use C7)
1. Head neutral. Inclinometers set
at zero degrees.
2. Observe both inclinometer angles as
extension occurs.
3. Subtract the T1 angle measure
from the Occiput angle measure.
Inclinometry -- Extension
(Lateral view)
INCLINOMETRY
Cervical Flexion
References: Top of Occiput & T1(some authorities use C7)
1. Head neutral, chin slightly tucked. Set
inclinometers at zero degrees.
2. Observe both angles as flexion occurs.
3. Subtract the T1 angle measure from the
occiput angle measure for degree of
flexion finding.
Inclinometry -- Flexion
(Lateral view)
INCLINOMETRY
Cervical Lateral Flexion (Lateral Bending)
References: Top of Occiput & T1(some authorities use C7)
1. Head neutral. Inclinometers set at zero degrees.
2. Observe both inclinometer angle measures as Lateral
Flexion/Bending occurs.
3. Subtract the T1 angle measure from the Occiput angle
measure to determine the degree amount.

Inclinometry Lateral Bending
(Right Lateral Bending shown)
(P-A view)
Inclinometry
Rotation
References:
1. Place one inclinometer on the patients
forehead (patient is supine, head fully supported by
the table).
2. Set the inclinometer at zero.
3. Observe the degree measure as the patient
rotates the head from the neutral postion , Right
and Left.

Inclinometry -- Rotation
(Birds eye view patient SUPINE)
Example of Right Rotation
R
NEUROLOGICAL REFLEXES --
(SUGGESTIONS)
Position patient well (comfortably)
Position yourself well
Dont let the patient assist with the exam
Apply the stroke for a rebound effect
Compare the reflexes bilaterally
See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class. Gindl, P.S., pages 21 28.
Neurological Evaluation
Bovee Evans & Mazion
Triceps Reflex: *Cord Level C6-C8 Cord Level C7-C8
Brachioradialis Reflex: *Cord Level C5-C6 Cord Level C5-C6
Biceps Reflex: *Cord Level C5-C6 Cord Level C5-C6





Reference: *Bovee, M., D.C.
ORTHOPEDIC/NEUROLOGIC
EXAMS
These evaluation tools are used in the decision
making process for care.
Remember that no finding is a finding
Positive Findings are what you find on the patient.
Such findings are usually present as some form of
pain.
Indications are associated with the physiological
problems suggested by the positive findings i.e. Disc
Bulge
Reference: Gindl P., Bovee M.
See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class. Gindl P.S., pages 16 - 19.
DEEP TENDON REFLEXES
Reflex Nerve
Triceps Reflex: Radial Nerve
Brachioradialis Reflex: Radial Nerve
Biceps Reflex: Musculocutaneous Nerve






Commonly used ORTHOPEDIC EXAMS ( To
assess stability of an anatomical area)
Foramina [Foraminal] Compression Test;
Jacksons Compression Test
Shoulder Depressor Test
Adsons Sign
(Scalenus Anticus Syndrome Test)
Soto Hall Test**
Derifield Leg Check (Cervical Part)
**See Technique Department Web SiteCervicalJohnsonWeek SectionSelect
the Week One Handouts-- Orth/Neuro material.
Synopsis of INDICATIONS OF POSITIVE (+)
ORTHOPEDIC EXAMS
(Foramina (Foraminal) Compression Exam: *Occlusion of IVF; disc bulge;
arthritic involvement; edema of a nerve root; edema of nearby
structures; **subluxation.) See Jacksons Compression Test.

Shoulder Depressor Test: *Radiculitis or pain from the muscle stretch;
adhesions of the dural sleeves;

Adsons Sign: *Spasm of the Scalenus Anticus muscle may compress the
subclavian artery; Nerve Root irritation at IVF; Cervical Rib;

Soto Hall: * Noticeable localized painvertebral fracture; Diffuse pain:
DJD; DDD; Sprain or strain (This is a general test.)

Reference for Indications in quotation marks: Dr. Gindls Essentials for Cervical-Upper
Thoracic Technique Class. Gindl P. S., 2003; Other commentary: *Bovee M.
Derifield Leg Examination (#1)
To assess finding of leg balance or
imbalance
IF imbalance is present, the exam is used
to help localize the possible vertebral level
clinically involved.
Clinical Possibilities:
**Right Cervical Syndrome (RCS)
**Left Cervical Syndrome (LSC)
**Bilateral Cervical Syndrome
**No Cervical Syndrome (NCS) See: Derifield Leg Exam Procedure slide #4 for steps.
Derifield Leg Exam (#2)
Thoughts Concerning Causes of Short Leg:

1. Bone deformities
2. Pathological causes
3. Traumatic causes
4. Unilateral breakdown of an arch
5. Spastic contracture of the extensor muscles of the lower spine
and pelvis due to neurological imbalance. (Manifested as
innervational overload to the extensor muscles and unilateral
contracture enhanced spinal stretch reflex.) (Central inhibitory
[brain] + central facilitory [cord, brain stem etc.]
mechanismaugment stretch reflexes.)
Reference: Israel, C., D.C.
Derifield Leg ExamPhysiology
(#3)
Involves a 1
st
order neuron
Travels Dorsal Column: feet to cervical medullary
area
Decussates and synapses with 2
nd
order neuron
Reflex arc reaction affects leg length*

*Reference: Gindl P, Essentials for Cervical-Upper
Thoracic Technique Class, 9
th
ed., 2003, p. 20

** NOTE: Many theories exist concerning leg exam
findings for leg balance & imbalance.
Derifield Leg ExamProcedure
(#4)
o Place Patient Prone Hy-LO Table is table of choice.
o Check first for leg balance or imbalance.
o If legs are balanced, the exam for the Cervical portion of the Derifield
Leg Exam is over.
o If legs are presenting imbalance, note the short leg side, and proceed to
the next step of the exam procedure:
o Have the patient turn his/her head to the Right and to the Left.
o Check to see if the short leg becomes even or longer than the initial long
leg on each turn of the patients head.
o Clinical significance is noted when the short leg does become even or
longer than the initial long leg when the patients head is turned.
o The finding is labeled and noted in the patients record according to the
side of the head turn that produces clinical significance.
Derifield Leg Exam (Cerv. Part)

Indication of Finding:
Cervical Syndrome (with finding representing clinical significance,
with the initial short leg becoming even or longer than the initial
long leg upon the turn of the patients head, right or left).
Record finding: RCS; LCS; Bilateral CS;
(or NCS)

With a finding of Cervical Syndrome, palpate the patients side of
posterior body rotation (opposite side of the head turn that
produced the clinical significance findingC2-C6 levels) for taut,
tender fibers or nodular swelling. Palpate the C2-C6 Lamina-Pedicle
Junction while the patients head remains in the head turned
position.
ADDITIONAL PRACTICE/REVIEW FOR MO/PAL EXAM:
ORTHOPEDIC EXAMS (STABILITY EXAMS);REFLEXES;
RANGE OF MOTION (ROM)
JACKSONS COMPRESSION TEST
(FORAMINAL COMPRESSION TEST)
SHOULDER DEPRESSOR TEST
ADSONS TEST SOTO HALL TEST
DERIFIELD LEG EXAM

TRICEPS REFLEX BICEPS REFLEX
BRACIORADIALIS REFLEX
INCLINOMETRY--ROM
FLEXION; EXTENSION; LATERAL BENDING; ROTATION


ASSIGNMENT PAGES FOR X-RAY LINE
DRAWING


Dr. Johnsons Reference Study Materials:
pages 1-45, 124-125
(Completed Film Examples & Directions for line construction
& interpretation) (See these examples on the Portal.)

Dr. Gindls Text, pages 39 - 103
Palmer-Gonstead X-Ray Line
Drawing/Analysis: Outcomes from Analysis
To identify departures from the norm,
structurally.
To suggest an idea of the most appropriate
choice for an adjustment in consideration of
the patients anatomy.
To suggest the most appropriate care plan for
the patient.
Application of X-ray Analysis
Identify signs of biomechanical stress at a particular
motion unit level

A Motion Unit is considered to be the top of one
vertebra, the bottom of another vertebra, and the
soft tissue structures in between.

Visual signs of motion unit disturbance are
thought to suggest signs of biomechanical stress.
Motion Unit disturbances are listed as departures
from the norm, structurally; these structural
departures may suggest chiropractic listings.
PALMER-GONSTEAD FULL-SPINE
X-RAY ANALYSIS
The Palmer-Gonstead Full Spine X-ray Analysis analyzes,
structurally, a segment to its foundation segment
immediately below it.
This foundation concept departs from the Palmer Toggle
Upper Cervical Specific X-ray Anaylsis that analyzes Atlas &
Axis to the condyle perspective (as a structural constant)
above those segments.
Therefore, at the Atlas or Axis levels, one analysis may
produce a particular listing, while the other analysis may
produce an entirely different listing. This disparity results
from the Full-Spine analysis reference of structure to a
segment below, the Upper Cervical analysis reference of
structure to a segment above.
X-RAY & IMPRESSION OF LATERAL SCOLIOSIS ON THE A-P
LOWER CERVICAL FILM
(Possibilities/rationale for Impression of Lateral
Scoliosis as observed, if present.) Reference: C. Israel
Presentation could be attributed to:
1) Chronic and/or acute subluxation complexes.
2) Trauma.
3) Poor posture.
4) Excessive loading.
5) Congenital deformity.
MOTION EXAM OF THE PATIENT
Motions to Palpate:
a) Extension
b) Lateral Bending/Flexion
c) Rotation

Clinical Finding Possibilities:
1. NORMAL SPINAL MOTION
2. ABNORMAL SPINAL MOTION (due to pathology/injury an example
might be resulting edema)
3. DECREASED OR RESTRICTED MOTION (hypo mobility)
4. INCREASED MOTION (hyper mobility)
5. ABSENT MOTION (Indicate why this finding.)

See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class. Gindl P.S., pages 29 - 38.


Additional Motion Exam of the
Patient (continued)
CAPSULAR PATTERNS (CYRIAX)

Definition: A Capsular Pattern is the limitation
of active and passive movements in characteristic
proportions for each joint. (In early capsular
patterns, the restriction may appear in only one
rangeand later progress to more ranges).
Reference: Cyriax
Motion Exam of the Patient
(continued)
Capsular Patterns (continued)
Irritation of the joint capsule or synovial membrane of the joint will
cause a limitation of passive joint movement in capsular
proportionsphysiological movements of the joint are limited in a
distinct order.
For the Cervical Spine, the capsular pattern is:
Equal limitation in ALL movements
except FLEXION.
For the Thoracic Spine, the capsular pattern is:
Limitation of EXTENSION, SIDE FLEXION,
ROTATION with less limitation of FLEXION.

Reference: Cyriax

Additional Motion Exam of the Patient
(continued)
End Feel: Sensation noted on Passive Motion
at the end of range.

Joint Play (Fluid Motion): Small amount of
motion noted on Passive Motion from the
neutral position.

Noncapsular Pattern
The presence of a noncapsular pattern
means only that irritation of the joint capsule
is not contributing to the limitation of
physiological movement [something else is].

Reference: Cyriax
Assessment of Patients Physiological
Movements
Record Information Concerning:
(Performed/Assessed Active)
1. Patients willingness to move
2. Range of Motion
3. Presence or absence of pain

Assessment of Patients Physiological
Movements
Record Information Concerning:
(Performed/Assessed Passive)
1. Range of motion
2. Presence or absence of pain
3. End-feel
4. Presence or absence of a capsular pattern
5. Findings relative to inert structures i.e. pinched bursa with passive
shoulder abduction; dural sheath of a nerve root stretched with passive
Straight Leg Raiser Exam.
6. Resisted movements are used to test contractile structures or muscles
and their attachments; such testing provides information on both
strength and pain.*
*Reference: Scully R.M., Barnes, M.R., (Editors) Physical Therapy, J. B.
Lippincott, Philadelphia, 1989.
Musculoskeletal Noises
1. Clicking
Causes: i.e. If applicable,
meniscal damage.
2. Clunk or Thunk
Frequently in knee.
Causes: i.e. irregularity of
cartilage or discoid meniscus
Musculoskeletal Noises (continued)
3. Snapping
Passage of soft tissue over a bony prominence i.e.
Greater Trochanteror at ankle or shoulder level or
trigger finger.
4. Grating
aka Grinding or Crunching
**Often heard or felt by the examiner
**Thought to be loss of articular cartilage in a joint and
results from direct contact of bone on bone.
**May be loud to the patient but not noticeable by the
doctor.
Causes unknown
Musculoskeletal Noises (continued)
5. Popping: As when pulling finger joints.
Explanation: Sudden opening of an adherent
crenation in the synovial lining of the capsule
probably produces a vacuum effect & the noise.
Not meaningful if performed by patient or
painless.
Note: When a back pops, followed by pain &
locking, consider facet joint dysfunction.

Musculoskeletal Noises (continued)
6. Crackling & Crepitus: Examiner can hear
& feel.
Note: Fine Crepitus suspect diseased
joint i.e. rheumatoid arthritis.
Note: Course Crepitus suspect
osteoarthritis
Note: Crepitus Over Tendon Sheath
suspect tenosynovitis (traumatic or infective).
Musculoskeletal Noises
References:

Gatterman, MI. Chiropractic Management of Spine
Related Disorders. Baltimore: Williams & Wilkins, 1990,
(2004)

Herzog, et al. Cavitation Sounds During Spinal
Manipulative Treatments. JMPT, 16 (8); Oct. 1993: 523
526
Musculoskeletal Noises
Reference:
Brodeur R., The Audible Release Associated with
Joint Manipulation. JMPT, 18 (3); March/April
1995: 155 164.
Musculoskeletal Noises
References:
Analysis of Zygapophyseal Joint Cracking During
Chiropractic Manipulation. JMPT, 18 (2), Feb.
1995: 65 - 71
MOTION PALPATION SCREENING
MOTIONS
For Occiput use Occipito/Atlanto
Extension (glide).
For Atlas determine tissue prominence
side i.e. side of tissue prominence is
thought to represent the side of posteriority
of atlas.
For C2 C7 use circumduction that
represents combined motions of lateral
bending, rotation and extension.
Notes Concerning Motion Palpation
Transient Fixation
Chiropractic Fixation
Quantity of fixation (compare motion from
side to side)
Quality of motion (compare side to sideis
one side smooth in motion compared to
tending to stick on the other side in
motion)
MOTION PALPATION PATTERNS
**OCCIPUT LEVEL
1. PS = EXTENSION
AS = FILM FINDING/OR FLEXION
2. LATERAL BENDING (FOR R OR LLat.))
3. ROTATION (FOR A OR P Rotation)
**ATLAS LEVEL
1. AS OR AI = FILM FINDING
2. LATERAL BENDING (FOR R OR L Lat.)
3. ROTATION (FOR A OR P Rotation)
**C2 L5 LEVELS --
1. P = EXTENSION
2. ROTATION (FOR R OR LLat.)
3. LATERAL BENDING (FOR S OR I WEDGE)
MOTION PALPATION EXAMPLES
OCCIPUT
PS-RS-RA =
PS would present as Decreased Extension, Occiput/C1;
RS would present as Decreased Right Lateral Bending, Occiput/C1;
RA would present as Decreased Right Rotation, Occiput/C1

AS-LS-LP =
AS is a Lateral Film Finding/Decreased Flexion, Occiput/C1;
LS would present as Decreased Left Lateral Bending, Occiput/C1;
LP would present as Decreased Right Rotation, Occiput/C1
PS-RS-RA
Decreased Extension Occ/C1
Decreased Right Lat. Bend. Occ/C1
Decreased Right Rotation Occ/C1
PRACTICE EXAMPLES
AS-LS-LA (MO/PAL)
AS = film finding, Occiput/C1 (FML is above APL at anterior of Lateral Film)
LS = decreased Left Lateral Bend,
Occiput/C1
LA = decreased Left Rotation (noted when palpating the
Right Mastoid tip & Right C1 TVP and performing Left
RotationOcciput found as presenting Posterior Rotation
on the RightOcciput seeming to stop in Rotation
motion when Atlas stops inferring Anterior Rotation
position of Occiput on the Left), Occiput/C1.


MOTION PALPATION EXAMPLES--ATLAS
ASR = AS is a Lateral Film Finding;(APL & OPL diverge at ant., Lat. F.)
R presents as Decreased Right Lateral Bending;
there would be No Decrease in Right or Left
Rotation

AILA = AI is a Lateral Film Finding;
(APL and OPL converge at anterior on the Lateral Film.)
L presents as Decreased Left Lateral Bending; A
would present as Decreased Left Rotation
MOTION PALPATION EXAMPLES
Lower Cervicals (C2 C7)
PLS, C4 =
The P component of the listing would present Decreased Extension, at
C4;
the L component of the listing would present Decreased Left Rotation,
C4;
the S component of the listing would present Decreased Left Lateral
Bending, C4/C5.
PRI-L, C2 =
The P component of the listing would present Decreased Extension at
C2;
the R component of the listing would present Decreased Right
Rotation at C2;
the I component of the listing would be inferred by Decreased Left
Lateral Bending, C2/C3.
MOTION PALPATION EXAMPLES
Upper Thoracics: T1 T4
PL-T, T2 =
Decreased Extension, T2;
Decreased Left Rotation, T2;
No Decrease in Right or Left Lateral
Bending, T2/T3

PRS, T3 =
Decreased Extension, T3;
Decreased Right Rotation, T3;
Decreased Right Lateral Bending, T3/T4
MO/PAL PRACTICE
PS-RS-RA AS-LS-LP
Decreased: Decreased:
Extension O/C1 AS = Film Finding FML is above APL at ant., L.F.
Rt. Lat. Bend O/C1 Lft. Lat. Bend O/C1
Rt. Rotation O/C1 Rt. Rotation O/C1
AILA Decreased:
Lft. Lat. Bend C1/C2 Lft. Rotation C1/C2

PLS C4 PLI-L C2 PR C3

PRS T2 PL T3 PR-T T1


MOTION PALPATION PRACTICE
EXAMPLES:

Occiput: PS-LS-LP
Occiput: AS-RS-RA
Atlas: AIL ASRP
C2-C7: PRS C3 PLI-L C5
T1-T3: PL T2 PRI-T T3
Derifield Leg Exam
Description of Motion Palpation Exam
The Motion Palpation Exam will be worth 20 Points (4 points
per procedure) and will consist of:
**Demonstration of the Derifield Leg Exam
** Motion demonstration for an Occiput
level listing
**Motion demonstration for an Atlas level
listing
**Motion demonstration for a C2 C7 level
listing
**Motion demonstration for a T1 T3 level
listing

EXAMPLE OF MOTION PALPATION
EXAM (5 Exam Procedures)
AS-LS-LA (Motion Palpation)

AIRP (Motion Palpation)

Derifield Leg Exam

PLS C3 (Motion Palpation)

PRI-T T2 (Motion Palpation)
PRACTICAL EXAM EXAMPLE
EXAMPLE:
What are these listings?
1. Given: C1 = +0X, +0Z
2. Given: C1 = -0X, -0Z, -0Y
3. Occiput/Atlas Extension
Right Lateral Bending
Left Rotation
4.

MO/PAL Practice
PS-LS-LP
AS-RS-RA
AIRP
PRS C2
PLI-L C4
MO/PAL PRACTICE
PS-RS-RA PS-LS
AS-LS-LP
AIR ASRP
PR C2 PLS C4
PRI-L C6 PL C4
PLI-T T2 PR T3 PRS T2
MO/PAL PRACTICE
C2 Right Side
MO/PAL PRACTICE
C4 Right Side
MO/PAL PRACTICE
T 3 Right Side
Palmer-Gonstead Adjusting
See: Palmer-Gonstead Charts in Yellow
Cover Text,Reference Study Materials
Johnson, Pages 69-89; 130 135; 148 152
**Power Point: Slides (on
Technique Department Web Site
& Palmer Portal)
See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class,
Gindl, P.S., pages 106, 107; 111 130.

PERSPECTIVE OF PALMER-
GONSTEAD ADJUSTING
IT IS HANDS ON ADJUSTING
DR. GONSTEAD FELT THAT THE KEY COMPONENT OF THE MOTION UNIT
OF THE SPINE, C2 L5 WAS THE DISC.
DR. GONSTEAD TALKED ABOUT A LEVEL DISC CONCEPT OR AN OPTIMAL
RELATIONSHIP OF THE DISCS.
THE PALMER-GONSTEAD ADJUSTMENT IS DESCRIBED AS SHORT LEVER,
HIGH VELOCITY AND LOW AMPLITUDE.
THE SET-UP PROCESS IS DESIGNED TO ADDRESS A LINE OF
CORRECTION FOR A PARTICULAR SUBLUXATION.**



Reference: Gran, D., D.C.; Palmer College Homecoming presentation.
Palmer-Gonstead Adjusting Technique
Occiput - 2 variations
PP: Cervical Chair PS Group
PS PS-RS PS-LS
PS-RS-RA PS-LS-LA
PS-RS-RP PS-LS-LP
AS Group
AS AS-RS AS-LS
AS-RS-RA AS-LS-LA
AS-RS-RP AS-LS-LP

Palmer-Gonstead Adjusting Technique
Atlas - 2 variations
PP: Cervical Chair - AS Group
ASR ASRA ASRP
ASL ASLA ASLP
PP: Knee Chest - AI Group
AIR AIRA AIRP
AIL AILA AILP
Palmer-Gonstead Adjusting Technique
C2 C7 (T3) - 2 Variations
PP: Cervical Chair
Simple Listing GroupP, PR, PRS, PL, PLS
(SCP): Spinous Contact
Rotatory Listing Group--PR-L, PRI-L, PL-L, PLI-L
(SCP): Lamina opposite
Spinous Laterality
Palmer-Gonstead Adjusting Technique
Alternate Prone Adjusting
2 variations
PP: Prone (Knee Chest/Hy-lo)

Simple Listing Group--P, PR, PRS, PL, PLS
(SCP: spinous contact)
Rotatory Listing Group--PR-L, PRI-L, PL-L, PLI-L
(SCP: Lamina opposite Spinous
Laterality)
Description of Thrust Palmer-
Gonstead
PS occiput listings Linear set & hold
(toward opposite eye of patient).
As occiput listings Arc-like action of
doctors adjusting arms.
AS atlas listings Linear set & hold
delivery.
AI atlas listings A Modified Toggle set &
hold delivery (minimal equal elbow bend).

Description of Thrust Palmer-Gonstead
Adjusting
C2 C7 Simple Listings Short set & hold. Thrust
is Linear with lift up & in (toward opposite eye
of patient).
C2 C7 Rotatory Listings Short set & hold.
Thrust is Linear with lift up & in (toward patients
eye on same side as contact).
Double Thumb C2 C7 Short set & hold
(doctor presents minimal equal elbow bend).
TECHNIQUE TERMINOLOGY
DEFINITIONS:
Line of Correction
The direction the segment being adjusted
moves (responds in some amount for some
amount of time) in response to the adjusting
thrust.
Line of Drive
The direction the thrusting hand will move when
the adjusting force is delivered to the segment.
STEP BY STEP SET-UP PROCEDURE FOR PS
OCCIPUT, PALMER-GONSTEAD TECHNIQUE
1. Establish Doctor Stance (Scissors, to side of Occiput Lateralityweight forward).

2. PRIMARY Stabilization: With index & chiropractic index fingers, tuck patients chin (gently). 10B of S.H. is placed
anterior to patients ear on side of stabilization, near the zygomatic. (The patients head rests against your upper chest to
prevent tipping backward.)

3. On side of contact, palpate & take contact with 10A (with S-I Tissue Pull) on the SupraMastoid Groove (on side of
laterality). Thumb rests behind ear, fingers of C.H. wrap around the back of the Occiput. Keep C.H. forearm in against
your ribcage.

4. With Stabilization fingers, elevate the patients chin to neutral (about 5 degrees) to relax the musculature.

5. Stabilization hand laterally bends the patients head to the side of occiput laterality.
6. If misalignment has a rotational component, stabilization hand rotates the patients head TOWARD the side of
contact for Anterior Rotation misalignmentS , AWAY from the side of contact for Posterior Rotation misalignments. These
motions are slight, as fixation is usually reached quickly.
7. SECONDARY Stabilization: Pivot on your S.H. 10B, allowing your S.H. elbow and forearm to move anterior (forward)
in opposition to your contact forearm. The fingers of your S.H. will support the lateral cervical musculature on the side
of stabilizationspecifically, #4 of the S.H. will stabilize Atlas. The thrust is a Linear Set & Hold, directed toward the
patients opposite eye.
PRACTICE
PS-RS C.C. P-A, S-I, R-L
No Torque

PS-RS-RP C.C. P-A, S-I, R-L, P-A
No Torque

PS-LS-LA C.C. P-A, S-I, L-R, A-P
No Torque
TECHNIQUE QUESTIONS TO
PONDER
The Occiput is fixed in extension.
There is also Occiput/Atlas fixation on Right
Lateral Bending.
Right Rotation of Occiput to Atlas is restricted.
** What is the Occiput Listing? If Occiput is
determined to be subluxated:
**Whats your D.S.? **Whats your C.P.?
**Whats your S.C.P.? **Whats your T.P.?
**Whats your L.O.C. & Torque?
PRACTICE
PS-RS L.O.C.:
P-A, S-I, R-L, No Torque

PS-RS-RP L.O.C.:
P-A, S-I, R-L, P-A, No Torque

PS-LS-LA L.O.C.:
P-A, S-I, L-R, A-P, No Torque

AS-LS-LP L.O.C.:
P-A, S-I, L-R, P-A, No Torque


STEP BY STEP SET-UP PROCEDURE FOR AS
OCCIPUT, PALMER-GONSTEAD TECHNIQUE
Note: BOTH hands (#4 of both hands) serve as CONTACT POINTS for this technique adjusting procedure.
1. Establish Doctor Stance in close behind the patient, feet parallel, shoulder width apart, slightly
favoring the side of Occiput Laterality.
2. Palpate for the patients Segmental Contact Point (SCP)the GLABELLA.
3. Take PRIMARY CONTACT with Primary #4 (associated with the side of Occiput Laterality). Take the
contact using Superior to Inferior TISSUE PULL (S-I) down onto the Glabella.
4. Take SECONDARY CONTACT with Secondary #4 of the other hand, placing it immediately above the
Primary C.P. #4.
5. The palms of both hands will rest gently but firmly against the patients parietals; the doctors
forearms & elbows are held in close to the doctors rib cage.
6. Laterally bend the patients head to the side of Occiput laterality (to fixation, Occiput/C1).
7. If misalignment has a rotational component, rotate the patients headTOWARD the side of contact
for Anterior Rotation misalignments, AWAY from the side of contact for Posterior Rotation
misalignments. These motions are slight, as fixation is usually reached quickly.
8. The thrust is an arc-like action.
NOTE: Stabilization of Atlas is achieved by use of a Condyle Block or by third party stabilization.


PRACTICE
PS-LS L.O.C. -- P-A, S-I, L-R
No Torque, C.C.

AS-RS-RP L.O.C. - A-P, S-I, R-L, P-A
No Torque


PALMER-GONSTEAD AS OCCIPUT
PRACTICE
AS-LS C.C., L.O.C.: S-I, A-P, L-R
NO TORQUE


AS-RS-RA C.C., L.O.C.: S-I, A-P, R-L, A-P
NO TORQUE

AS-LS-LP C.C., L.O.C.: S-I, A-P, L-R, P-A
NO TORQUE
STEP BY STEP SET-UP PROCEDURE FOR AS
ATLAS, PALMER-GONSTEAD TECHNIQUE
1. Establish Doctor Stance (in close to the patient, favoring the side of Atlas laterality, feet parallel,
shoulder width apart.)

2. Primary Stabilization: With index & chiropractic index fingers, tuck patients chin (gently). 10B is
placed anterior to patients ear, near zygomatic.

3. Palpate & take contact with Contact Point #9 [thumb pad] (with Roll-In Tissue Pull) on the Atlas
transverse process (on side of Atlas laterality). Doctors contact hand forearm is level and in line with
the patients shoulder on the side of contact.
4. With Stabilization fingers, elevate chin to neutral (about 5 degrees) to relax musculature.
5. Stabilization hand laterally bends patients head to side of Atlas laterality a tad to point of
fixation/restriction C1/C2.
6. If misalignment has a rotational component, stabilization hand rotates the patients headTOWARD
the side of contact for Anterior Rotation misalignments, AWAY from the side of contact for Posterior
Rotation misalignments.
7. Secondary Stabilization: Pivot on your S.H. 10B, allowing your S.H. elbow and forearm to move
SLIGHTLY forward (in opposition to your contact forearmin line with patients shoulder on side of
stabilization). The fingers of your S.H. will support the lateral cervical musculature on the side of
stabilizationspecifically, #4 of the S.H. will stabilize Axis.

8. Thrust is Linear set & hold delivery (across the articulation).
AS ATLAS PALMER-GONSTEAD
ADJUSTING
ASR S-I, R-L, CW Torque C.C.

ASRP S-I, R-L, P-A CW Torque
C.C.

ASLA S-I, L-R, A-P, CCW Torque
C.C.


STEP BY STEP SET-UP PROCEDURE FOR AI ATLAS
PALMER-GONSTEAD ADJUSTING
1. Patient placement: Knee Chest Table; Hy-Lo Table; Pelvic Bench. Additional Patient
Placement Considerations: Prone with head turned toward side of Atlas laterality, with
patients arm on that side of C1 laterality placed on the headpiece above the crown of the
head. The Axis will be placed onto the inferior portion of the slot in the headpiece1)
2. Doctors stance is on the side of C1 laterality, straight-away to the patient contact
area. The doctors episternal notch is superior to the C1 SCP. (Episternal notch alignment
follows the alignments used in Toggle Recoil Atlas adjusting for the various Atlas listings.)
3. Segmental Contact Point (SCP) is the lateral aspect of the C1 TVP on the side of Atlas
laterality.
4. Tissue Pull is taken in accordance with the LOC.(1)
4. Contact Point (CP) is the fleshy pisiform (#1) of [the doctors] superior hand.
5. Stabilization Hand (SH) is the doctors inferior hand with pisiform over pisiform or
knuckle over pisiform positioning.
6. Note: The doctor presents minimum equal elbow bend set-up positioning. Torque for
all Right C1 laterality corrections is counterclockwise (CCW); torque for all Left C1
laterality corrections is clockwise (CW). Thrust Description: A Modified Toggle set and
hold delivery. (2,3,4)
References: 1Bovee ML, Burns JR, Carrigg PM, et al. Palmer Technique Adjusting
Manual. Davenport, IA; March 1991/2006. 2Ibid. 3Palmer College. Course Packet; Dr.
Js Topic Study Sheets for Cervical Technique Class. Davenport, IA; August 1994. 4
Johnson, MR. Training for Clinical Excellence in Chiropractic: A Practical Guide to Cervical
and Upper Thoracic Evaluation. Davenport, IA; 2006.


AI ATLAS, PALMER-GONSTEAD
ADJUSTING
AIR, K.C. S-I, R-L CCW TORQUE

AILP, K.C. S-I, L-R, P-A CW TORQUE

AILA, K.C. S-I, L-R, A-P CW TORQUE
PRACTICE EXAMPLES:
Palmer-Gonstead Adjusting
AILA K.C.
L.O.C.: S-I, L-R, A-P; CW TORQUE
AIRP K.C.
L.O.C.: S-I, R-L, P-A; CCW TORQUE
ASL C.C.
L.O.C.: S-I, L-R, CCW TORQUE
ASRA C.C.
L.O.C.: S-I, R-L, A-P; CW TORQUE
STEP BY STEP SET-UP PROCEDURE FOR SIMPLE C2-C7
LISTINGS, C.C., PALMER-GONSTEAD TECHNIQUE
1. Establish Doctor Stance (scissors, to side of SPINOUS LATERALITY)weight forward.
2. PRIMARY Stabilization: With index & chiropractic index fingers, tuck patients chin (gently). 10B of
S.H. is placed anterior to patients ear on side of stabilization, near the zygomatic. (The patients head
rests against your upper chest to prevent tipping backward.)
3. On side on contact, palpate & take contact with #6 of Contact Hand on the POSTERIOR, INFERIOR,
LATERAL aspect of the involved spinous on the side of spinous laterality. (Take this contact with I-S & L-
M Tissue Pull.) Keep the C.H. forearm in against your ribcage. The THUMB PAD of the C.H. is kept
extended (it will form a RAT HOLE or ARCH when it comes to rest anterior to the patients ear as
Lateral Bend of the head takes place in STEP 5).
4. With Stabilization fingers, elevate the patients chin to neutral (about 5 degrees to relax the
musculature).
5. Stabilization hand laterally bends the patients head to the side of spinous laterality to the point of
fixation/restriction for the segmental level involved.
7. SECONDARY Stabilization: Pivot on your S.H. 10B, allowing your S.H. elbow and forearm to move
anterior (forward) in opposition to your contact forearm. The fingers of your S.H. will support the
lateral cervical musculature on the side of stabilizationspecifically, #4 of the S.H. will stabilize the
segment below the segment being adjusted.
(The C.H. THUMB PAD forms the RAT HOLE or ARCH as it comes to rest against the area anterior to
the ear on the side of contact. This serves to stabilize the C.H.)
The THRUST is a Linear Set & Hold, directed toward the patients opposite eye.
PRACTICE
PR C2 C.C. P-A, I-S, R-L, IN THE
PLANE LINE OF THE DISC
NO TORQUE

PRS C2 C.C. P-A, I-S, R-L, IN THE PLANE LINE
OF THE DISC CW TORQUE
STEP BY STEP SET-UP PROCEDURE FOR ROTATORY
C2-C7 LISTINGS, C.C., PALMER-GONSTEAD TECHNIQUE
1. Establish Doctor Stance (scissors, to side OPPOSITE spinous lateralityside of LAMINA S.C.P.weight
forward, trunk of doctor slightly turned, so doctors contact forearm can align approximately 60
degrees to the patients shoulder on the side of contact).
2. PRIMARY Stabilization: With index & chiropractic index fingers, tuck the patients chin (gently). 10B
of S.H. is placed anterior to patients ear on side of stabilization, near the zygomatic. (The patients head
rests against your upper chest to prevent tipping backward.)
3. On side of contact, palpate & take contact with #6 of C.H. on the LAMINA OPPOSITE spinous
laterality. (Take this contact with I_S & M_L Tissue Pull.) Keep the C.H. forearm in against your ribcage.
The THUMB PAD of the C.H. is kept extended (it will form a RAT HOLE or stabilizing ARCH for the C.H.
when it comes to rest anterior to the patients ear as lateral bend of the head takes place in STEP 5).
4. With Stabilization fingers, elevate the patients chin to neutral (about 5 degrees).
5. Stabilization Hand laterally bends the patients head to the side of contact to the point of
fixation/restriction of the involved segment.
6. SECONDARY Stabilization: Pivot on your S.H. 10B, allowing your S.H. elbow and forearm to move
anterior (forward)in opposition to your contact forearm. The fingers of your S.H. will support the
lateral cervical musculature on the side of stabilizationspecifically, #4 of the S.H. will stabilize the
segment below the segment being adjusted.
7. The C.H. THUMB PAD forms the RAT HOLE or ARCH as it comes to rest against the area anterior to
the ear on the side of contact.
8. The THRUST is a Linear Set & Hold, directed toward the patients eye on the side of contact (patients
SAME EYE as side of contact.)
DOCTORS FOREARM PLACEMENTPALMER-GONSTEAD
CERVICAL CHAIR ADJUSTING

Lower Cervical Adjusting:
C2 + C3 levels C.H. elbow below contact for
best disc plane line perspective.
C4 C. H. elbow about level with contact for best
disc plane line perspective.
C5, C6, + C7 levels C.H. elbow slightly above
contact for best disc plane line perspective.
PRACTICE
PS-LS-LA C.C.
LOC: P-A, S-I, L-R, A-P, No Torque
AS-RS C.C.
LOC: A-P, S-I, R-L, No Torque
ASRP C.C.
LOC: S-I, R-L, P-A, CW Torque
PLS C4 C.C.
LOC: I-S, P-A, Relative to Disc Plane Line, L-R, CCW Torque
PL-L C2 C.C.
LOC: I-S, P-A, Relative to Disc Plane Line, Right Lamina moves forward or
anterior; indirectly, spinous responds L-R, No Torque
PRACTICE
PRS C2 C.C. L.O.C.: I-S, P-A, RELATIVE TO THE DISC PLANE
LINE, R-L, CW TORQUE


PL-L C4 C.C. L.O.C.,: I-S, P-A, RELATIVE TO THE DISC PLANE
LINE, RIGHT LAMINA MOVES ANTERIOR OR FORWARD,
SPINOUS PROCESS MOVES INDIRECTLY LEFT-RIGHT, NO
TORQUE.
Practice Examples
PLS C2 C.C.

PRI-L C2 C.C.
NOTE: The PLS adjusting would have a
Posterior, Inferior, Left aspect of the C2 Spinous as
S.C.P. The PRI-L adjusting would have a C2 Left
Lamina as S.C.P.
ALTERNATE PLACEMENT (PALMER-GONSTEAD
TECHNIQUE) C2 C7 LEVELS PRONE PATIENT
PLACEMENT (AKA D.THUMB)
SIMPLE LISTING VARIATION (STACKED
THUMB)
STEP 1: DS on side of Spinous Lat.
Step 2: Palpate & take TP L-M with SP thumb
(#9). Step 3:
Maintain TP and take contact on Posterior,
Inferior Lateral margin of spinous with CP(#9)
thumb. Step 4:
Place (stack) SP on top of CP.
Step 5: Establish equal, min. elbow bend.
Thrust Description: Short set & hold

ALTERNATE PLACEMENT CONSIDERATIONS__(Palmer-Gonstead
Technique) C2 C7 LEVELS PRONE PATIENT PLACEMENT
(AKA MARRIED OR KISSING THENARS) D. Thumb
ROTATORY LISTING VARIATION (MARRIED
OR KISSING THENARS)
STEP 1: DS on side Opposite Spinous Lat.
(side of body rotation)
STEP 2: Palpate & take TP M-L from spinous
onto Right & Left LAMINA with #9 CP & #9
SP.
STEP 3: Bring thenars in to a touching
position (to stabilize adjusting hands)
STEP 4: Establish equal, min. elbow bend.
Thrust Description: Short set & hold.
DOCTORS ADJUSTING ARMS/EPISTERNAL NOTCH POSITON FOR
PALMER-GONSTEAD D. THUMB
Note: Episternal notch of doctor is over spine of
patient. (In line with
the patients spine.)
To relate L.O.C. to plane line of the disc, align
episternal notch slightly below contact for C2, C3
contacts, even with contact for C4 contact, and
slightly above contact for C5, C6, C7.
Doctors elbow bend is minimal & equal.
PRACTICE
PS-LS-LA C.C.
LOC: P-A, S-I, L-R, A-P NO TORQUE
AS-RS-RP C.C.
LOC: A-P, S-I, R-L, P-A NO TORQUE
ASLP C.C.
LOC: S-I, L-R, P-A CCW TORQUE
PR C2 C.C.
LOC: I-S, P-A, Relative to the Disc Plane Line, R-L, NO TORQUE
PLI-L C4 C.C.
LOC: I-S, P-A, Relative to the Disc Plane Line, Right Lamina responds forward or anterior, INDIRECTLY
bringing the spinous, L-R, CW TORQUE
PR C2 D. THUMB
LOC: I-S, P-A, Relative to the Disc Plane Line, R-L, NO TORQUE
PLI-L C4 D. THUMB
LOC: I-S, P-A, Relative to the Disc Plane Line, Right Lamina responds forward or anterior, INDIRECTLY
bringing the spinous, L-R, CW TORQUE


C.C. & D. Thumb PRACTICE
PS-LS-LP C.C.
AS-RS C.C.
ASLA C.C.
AIRA K.C.
PR C2 C.C.
PLI-L C4 C.C.
PRI-L C6 D. THUMB
PLS C5 D. THUMB

PS-RS C.C.
AS-RS-RA C.C.
ASLP C.C.
AIR K.C.
PLS C2 C.C.
PL-L C4 C.C.
PR C6 D. THUMB
PRI-L C3 D. THUMB

ADDITIONAL PALMER-GONSTEAD
PRACTICE VARIATIONS
PS-RS-RA C.C. :
L.O.C. - P-A, S-I, R-L, A-P; NO TQ

AS-LS-LP C.C. :
L.O.C. - A-P,S-I, L-R, P-A; NO TQ

ASRP C.C. :
L.O.C. S-I, R-L, P-A; CW TORQUE

PL C2 :
L.O.C.- I-S,P-A, RELATIVE TO THE PLANE LINE OF THE DISC, L-R, NO TORQUE

PLI-L C4 :
L.O.C.- I-S, P-A, RELATIVE TO THE PLANE LINE OF THE DISC, RIGHT LAMINA MOVES FORWARD OR ANTERIOR,
INDIRECTLY BRINGING THE SPINOUS L-R, CW TORQUE

PRS C5 D. THUMB:
L.O.C.- I-S, P-A, RELATIVE TO THE PLANE LINE OF THE DISC, R-L, CW TORQUE

PR-L C3 D. THUMB:
L.O.C.- I-S, P-A, RELATIVE TO THE PLANE LINE OF THE DISC, LEFT LAMINA MOVES FORWARD OR ANTERIOR, INDIRECTLY
BRINGING THE SPINOUS R-L, NO TORQUE

AILA K.C.
L.O.C. S-I, L-R, A-P, CW TORQUE


EXAMPLE OF PALMER-GONSTEAD
PRACTICAL EXAM LISTINGS:
(10 listings, each worth 4 points = 40 points possible for practical exam)
PL-L C6, D. Thumb PLI-L C6 D. Thmb
PRS C3, D. Thumb PL C5 D. Thmb
PS-RS-RA, C.C. PS-RS C.C.
AS-LS-LP, C.C. AS-LS-LA C.C.
PS-LS, C.C.
ASLA, C.C.
ASR, C.C.
ASRP, C.C.
PLI-L, C4, C.C. PR-L C2 C.C.
PR, C2, C.C. *AIRA K.C.
Diversified Adjusting Technique
This adjusting technique is not associated with any named individual,
rather it represents a compendium of adjusting possibilities that have
been part of chiropractic practice for most of the decades that
chiropractic has been in existence.

Diversified Cervical Adjusting, however, is not necessarily the technique
of choice for every patient. Diversified adjusting represents a
traction/leverage approach to application of the adjustment. Therefore,
patients must be screened by the chiropractor as to this adjusting choice,
i.e. a patient with a positive circulatory screening exam may be better
served, chiropractically, by what might be considered to represent more
conservative chiropractic adjusting optionsToggle; Palmer-Gonstead;
NUCCA; Blair, etc.

See: Dr. Gindls Essentials for Cervical-Upper Thoracic Technique Class. Gindl P.S., pp. 133-154.
See: Dr. Johnsons Power Point slides, 115 158.
DIVERSIFIED ADJUSTING PATIENT
PLACEMENT
Patient Seated, Backless Chair:
For selected Atlas listings:
2 variations
(to correct Posterior Rotation)
(to indirectly correct Anterior
Rotation)
For selected Axis listings:
1 variation
(to correct C2 Body/Spinous
Rotation)
DIVERSIFIED ADJUSTING--PATIENT
PLACEMENT
SUPINE (SuD):
3 variations:
For selected Occiput listings
(to correct Posterior
Rotation)
For selected Atlas listings
(to correct Posterior
Rotation)
For selected C2 C6 listings
(to correct Body/Spinous
Rotation)
DIVERSIFIED ADJUSTING--PATIENT
PLACEMENT
PRONE(PD)
5 variations:

**For Axis Subluxations (when there is more than the usual amount of Rotation
misalignmentBody/Spinous):
Axis Special (Only) PD (Prone Diversified)

** For C2 C6 Subluxations (when Rotation of the Body/Spinous
is the primary misalignment):
C2-C6, PD (Prone Diversified)

**For C7 T2 Subluxations (when Spinous Laterality is the primary
misalignment)
MTM(Modified Thumb Move)

**For C7 T2 Subluxations (when Spinous Laterality is the primary
misalignment)
DP(Diversified Pisiform)

**For T1 T3 Subluxations (when Rotation is the primary misalignment with a
Rotatory listing)
MDP(Modified Diversified Pisiform)



Diversified Adjusting
Patient Placement: Backless Chair
*Seated Diversifed Adjusting (SeD)
For C1 Rotation listings (P & A)
For C2 Spinous/Body Rotation
listings
NOT FOR C2 listings:
P, PRS, PLS
Diversified Adjusting (continued)
Common set-up patterns for Seated
Diversified adjusting (SeD):
The three variations (2 for Atlas level adjusting
and 1 for Axis level adjusting)
ALL require that the patient be seated in a
BACKLESS CHAIR. This will ensure that the
patients cervical spine is in the
neutral position.

Diversified Adjusting (continued)
Common patterns for SeD set-ups
(continued):
**The doctor will ALWAYS stand on the side
of Atlas Anterior Rotation for the Atlas
variation set-ups.
**The doctor will ALWAYS stand on the side
of Spinous Laterality for the Axis variation
set-up.
Diversified Adjusting (continued)
Common patterns for SeD adjusting:
**The doctor will ALWAYS :
--take P-A Tissue Pull onto the SCP
--Use #11 of the Stabilization Hand
to stabilize
--begin the set-up with the DS as
feet parallel, shoulder width
apart, mid line of the doctors body
lined up with the mid-point of the patients shoulder tip.
--laterally bend the patients head to the side
of contact (for point of tension 1)
--rotate the patients head away from the side of contact
(for point of tension 2)
--ALWAYS take all slack out of the doctors adjusting arms
by bringing the doctors elbows in toward one another
or bringing the doctors elbows in against the doctors
rib cage.

Diversified SeD listings
ASRP AIRP
ASLP AILP

ASRA AIRA
ASLA AILA

PR PR-L PRI-L BODY LEFT
PL PL-L PLI-L BODY RIGHT
SeD Adjusting--Practice
ASLP SeD

AIRA SeD

PLI-L SeD


SeD -- C1 Posteriority correction
D.S. Side of Anterior C1 TVP, midline of doctor
aligned with tip of patients shoulder.
S.C.P. C1 Posteriorly Rotated TVP
C.P. #4
T.P. P-A
S.P. #11 stabilized mastoidfingers of
S.H. cupping ear and directed toward top of head
SeD C1 Anteriority correction
D.S. Side of Anterior C1 TVP; doctors midline
aligned with tip of patients shoulder.
S.C.P. C1 Posterior arch on side of C1 Posterior
rotation.
C.P. #4
S.P. #11 of S.H. stabilizes mastoid; fingers
cupping ear + directed toward
top of head. T.P. is P-A

SeD -- Axis
D.S. Side of spinous laterality, feet parallel,
shoulder width apart
S.C.P. Axis Lam/Ped on side of C2 body
rotation
C.P. #4
S.P. #11 of S.H. stabilizes Atlas TVP, fingers
cupping the patients ear + directed toward
top of patients head.
Diversified Adjusting (continued)
*Supine Diversified Adjusting (SuD)
For Occiput Posterior Rotation
listings
For C1 Posterior Rotation listings
For C2 C6 Spinous/Body
Rotation listings
NOT FOR C2:
P, PRS, PLS
Diversified Adjusting (continued)
Common adjusting patterns for SuD adjusting:
The doctor will ALWAYS:
**Stand favoring the side of
the SCP
**Laterally bend the patients
head to the side of
contact (point of tension 1)
**Rotate the patients head away
from the side of contact
(point of tension 2)
**Step around with or shift weight to the
doctors inferior foot as the patients
head is laterally bent to the side of
contact (this will allow the doctor to
maintain a secure contact bond)


SuD Occiput & Atlas Adjusting
For Occiput Listings: PSLP PSRP
For Atlas Listings: AILP ASLP
AIRP ASRP

For C2 C6 Listings:
PR, PRI-L, PR-L, Body Left
PL, PLI-L, PL-L, Body Right
***Not for PRS, PLS, P

Practice
PSRP SuD
AIRP SuD

******************
AILA SeD ASLP SeD
PRI-L SeD PR SeD





PRACTICE
PSLP SuD AIRP SuD

ASLA SeD AIRP SeD

PRI-L SeD PL SeD
Practice
PL C2 SuD
PR-L C4 SuD
PSRP SuD
ASLP SuD

PRACTICE
PL-L C2 SuD PR C4 SuD

PSRP SuD AILP SeD

ASLP SuD ASRA SeD
PRI-L SeD

Supine Diversified Practice

PLI-L C2 SuD
PR C4 SuD
PSLP SuD
ASRP SuD
Diversified Adjusting
Patient Prone
(Headpiece Deflection toward the floor is
always present with these adjusting
procedures:
C2 C6 Levels = 10 15 degrees
deflection
C7 T3 Levels = 15 20 degrees
deflection)
HEADPIECE DEFLECTION
PRONE DIVERSIFIED ADJUSTING:
Headpiece Deflection toward the floor is 10 degrees to 15
degrees for the following Prone Diversified adjusting
procedures:
Axis Special (PD) (aka Axis Only PD)
C2 C6 Prone Diversified (PD)
(For segmental levels C2 C6)



HEADPIECE DEFLECTION
Headpiece Deflection for Diversified Prone
Adjusting (continued):
For segmental levels C7 T3: Headpiece Deflection
toward the floor is 15 degrees to 20 degrees
Headpiece Deflection for Diversified Prone
Adjusting at 15 degrees to 20 degrees toward the
floor will be utilized for the following adjusting
procedures:
MTM C7 T2
DP C7 T2
MDP T1 T3
Diversified Adjusting (continued)
**Prone Diversifed Adjusting (PD)
For Axis (Special/Only) listings
(when much C2 Spinous and
Body Rotation are involved)
Body Right, Spinous Left;
Body Left, Spinous Right
For C2 C6 Spinous/Body Rotation
listings (PD)
For C7 T2 Spinous Laterality
correction (MTM)
For C7 T2 Spinous Laterality correction (DP)
For T1 T3 Rotatory listings (MDP)
(to indirectly correct Spinous Laterality)
Diversified Adjusting (continued)
Prone Diversified (Axis Special/only)
Body Right, Spinous Left PD
(Axis Special/only)
Body Left, Spinous Right PD
(Axis Special/only)

**Chosen for adjustment approach when more than the usual amount of
Rotation of Axis is present in the misalignment.
**This adjustment has 2 CPs & 2 SCPs.
**The only other adjustment choice is Palmer- Toggle
**The headpiece is deflected toward the floor, 10 degrees to 15
degrees.
Diversified Adjusting (continued)
Prone Diversified -- C2 C6
PL PD PR PD
PL-L PD PR-L PD
PLI-L PD PRI-L PD
Body Right PD Body Left PD
**Headpiece Deflection toward the floor is: 10
degrees to 15 degrees

Diversified Adjusting
Modified Thumb Move (MTM)
(C7 T2)
P
PL MTM PR MTM
PLS MTM PRS MTM

Headpiece Deflection toward the floor is: 15 degrees
to 20 degrees
This is the ONLY Prone Diversified Adjustment that has
the doctor stand and contact on the side of spinous
laterality.
Diversified Adjusting Examples,
Patient Prone
Body Right, Spinous Left, (Axis Only or Axis Special) PD
Utilized as an adjustment choice when Body/Spinous Rotation is VERY pronounced.
LOC I-S, P-A, Spinous responds L-R, Right Lam-Ped responds anterior or forward,
indirectly assisting the Spinous to respond L-R.
PL C2 PD
LOC I-S, P-A, Right Lam-Ped moves anterior, with spinous indirectly responding
L-R
PRI-L C6 PD
LOC I-S, P-A, Left Lam-Ped moves anterior or forward, with spinous indirectly
responding R-L
PRS T1 MTM
LOC I-S, P-A, (Spinous) R-L
Note: For ALL of the above PRONE DIVERSIFIED ADJUSTMENTS, the doctor ALWAYS
uses #11 to Stabilize the segment above that being adjusted; the patients head is
ALWAYS turned away from the side of doctor stance (and contact) to enhance the
contact bond; classic scissors stance is ALWAYS the D.S.

Diversified Adjusting (continued)
Diversified Adjusting Patient Prone
(Headpiece Deflection toward the floor is
15 20 degrees for these two adjusting procedures.)

DIVERSIFIED PISIFORM (DP)
C7 T2 Levels
For listings: P, PR, PRS, PL,PLS

MODIFIED DIVERSIFIED PISIFORM (MDP)
T1 T3 Levels
For listings: PL-T, PLI-T, PR-T, PRI-T
**For the DP and MDP adjustments, the patients head is
Turned toward the side of doctor contact/stance in order to
enhance the contact bond.
Diversified Adjusting (continued)
Common patterns for Diversified Adjusting, patient prone:

For the Axis Special/Only PD; C2 C6 PD; MTM:
**The patients head is turned away from the side of
doctor contact.
**#11 of the doctors Stabilization Hand stabilizes on
the segment above that being adjusted.
**The doctor steps either: up and out, up and in, or
shifts his/her weight forward.
DIVERSIFIED ADJUSTING
THRUST DESCRIPTION
SeD Adjustments: The thrust isa quick motion of the contact hand
coming toward the doctor. (The stabilization hand is used as a brake to
prevent over thrusting.)
SuD Adjustments (Occiput & C1): The thrust is linearaiming toward
the patients opposite shoulder tip
(S-I).
SuD Adjustments (C2 C6): The thrust is linearaiming toward the
patients mouth (I-S & P-A)
Axis Special (Axis Only), PD Adjustments: The thrust is a rachet [or
screw like] motion produced by [the doctor] dropping [his/her] elbow
down.
C2 C6 PD Adjustments: The thrust is aimed toward the patients
mouth (I-S & P-A).



DIVERSIFIED ADJUSTINGTHRUST
DESCRIPTION (Continued)
MTM Adjustments: The thrust is aimed (slightly) toward the patients
mouth (I-S); there is minimal P-A, with the hoped for response being
either L-R or R-L, using the spinous as a lever to receive the adjustment.
(The doctors episternal notch should be slightly inferior and lateral to
the S.C.P. in a line corresponding to the L.O.C.. All thrust is directed
through the contact hand.)
DP Adjustments: The thrust is directed through the contact hand,
aiming I-S and L-R or R-L, using the spinous as the lever to receive the
adjustment.
MDP Adjustments: The thrust is directed through the contact arm,
while weight is shifted to allow for a gentle body drop P-A, & in line
with the adjusted segments disc.

Diversified Adjusting (continued)
NOTE: ALL of the below listings within each group would
LOOK THE SAME
when performing the set-up:
Group 1 Group 2
ASLP SeD AILA SeD
AILP SeD ASLA SeD

Group 3 Group 4
PR SeD PL SeD
PR-L SeD PL-L SeD
PRI-L SeD PLI-L SeD
Body Left SeD Body Right SeD
Diversified Adjusting (continued)
ALL of the below listings within each group would LOOK THE SAME when
performing the set-ups:
Group 5 Group 6
PSRP SuD PSLP SuD

Group 7 Group 8
AILP SuD ASRP SuD
ASLP SuD AIRP SuD

Group 9 Group 10
PR SuD PL SuD
PR-L SuD PL-L SuD
PRI-L SuD PLI-L SuD
Body Left SuD PLI-L SuD
EXAMPLES OF DIVERSIFIED
ADJUSTING PROCEDURES
ASRP SeD AIRA SeD
PLI-L SeD
PSLP SuD AILP SuD
PR-L SuD C4
Body Left, Spinous Right (Axis Special/Only)
PD
PL C5 PD PL T2 DP
PRS T1 MTM PLI-T T3 MDP
REVIEW FOR DIVERSIFIED PRACTICAL
PATIENT SEATED
DIVERSIFIED ADJUSTING:
AIRP SeD
ASLA SeD
PR SeD
PALMER-GONSTEAD ADJUSTING:
PS-LS-LP C.C.
AS-RS-RA C.C.
ASRP C.C.
PR C2 C.C.
PRI-L C4 C.C.


REVIEW FOR DIVERSIFIED
PRACTICAL EXAM
PATIENT SUPINE:
PSLP SuD PSRP SuD

AIRP SuD ASLP SuD

PRI-L C4 SuD PL C2 SuD
REVIEW FOR PRACTICAL EXAM
PATIENT PRONE
BODY RIGHT, SPINOUS LEFT (AXIS SPECIAL) PD
PR C5 PD
PL C7 MTM ** PL C7 DP
PR-T T2 MDP
PLS C6 D. THUMB**
PLI-L C3 D. THUMB
**Of ALL of the above PRONE adjusting procedures, the MTM and the D.
Thumb (Simple Listings) are the only instances of doctor stance on the
side of spinous laterality. Otherwise, the D.S. is on the side of body
rotation.
REVIEW FOR PRACTICAL
EXAM: Patient Prone
Body Right, Spinous Left (Axis
Special/Only) PD
PR C5 PD
PL C7 MTM ****
PL C7 DP
PLI-T T2 MDP
PRS C6 D. Thumb ****
PR-L C3 D. Thumb
Practical Technique Exam Information
1. The Diversified Practical will be composed
of 10 set-ups: 8 Diversified; 2 Palmer-
Gonstead
2. The Final Practical will be composed of 10
set-ups:
5 Diversified; 5 Palmer-Gonstead
EXAMPLE OF DIVERSIFIED PRACTICAL
EXAM: (10 SET-UPS, 4 POINTS EACH = 40 POINTS POSSIBLE)
PLS, T1, DP
PRI-L, C5, D. Thumb
Body Left, Spinous Right (Axis
Special) PD
PL-L, C3, PD
PR, C7, MTM
ASLP, C.C.
PL, SeD
PSRP, SuD
AIRP, SuD
PR, C4, SuD

EXAMPLE OF FINAL PRACTICAL EXAM:
(10 set-ups, 4 points each = 40 points possible for exam.)
AS-RS-RP C.C.
ASLA C.C.
PL-L, C4, C.C.
PRS, C3, C.C.
AIRA, SeD
PSLP, SUD
PRS, C6, D. Thumb
PRI-L, C2, PD
Body Left, Spinous Right, (Axis Special) PD
PL-T, T2, MDP
HIERARCHY OF ADJUSTING
CHOICES SUGGESTIONS -- FYI
ROTATION AS PRIMARY MISALIGNMENT FINDING OF
SUBLUXATION
SEATED DIVERSIFIED (SeD) (MOST ROTATION
INFLUENCE)
SUPINE DIVERSIFIED (SuD)
C2 C6 PRONE DIVERSIFIED (PD)*
*(50% ROTATION/50%
POSTERIORITY INFLUENCE)
CERVICAL CHAIR (CC)
DOUBLE THUMB (D. THUMB) (MOST POSTERIORITY
INFLUENCE)
POSTERIORITY AS PRIMARY MISALIGNMENT FINDING OF
SUBLUXATION

PRACTICE
PS-RS-RP C.C.
L.O.C.: P-A, S-I, R-L, P-A NO TORQUE
PS-RS C.C.
L.O.C.: P-A, S-I, R-L NO TORQUE
PS-LS-LA C.C.
L.O.C.: P-A, S-I, L-R, A-P NO TORQUE
PRACTICE
PS-RS-RP L.O.C. =
P-A, S-I, R-L, P-A NO TORQUE

AS-LS-P-A L.O.C. =
A-P, S-I, P-A No TORQUE



PRACTICE
AS-RS C.C.
L.O.C.: A-P, S-I, R-L NO TORQUE
AS-LS-LP C.C.
L.O.C.: A-P, S-I, L-R, P-A NO TORQUE
AS-RS-RA C.C.
L.O.C.: A-P, S-I, R-L, A-P NO TORQUE
PRACTICE
ASR C.C.
L.O.C.: S-I, R-L, CW TORQUE
ASLP C.C.
L.O.C.: S-I, L-R, P-A, CCW TORQUE
ASRA C.C.
L.O.C.: S-I, R-L, A-P, CW TORQUE
PRACTICE
AIL K.C. L.O.C. = S-I, L-R, CW
Torque
AIRP K.C. L.O.C. = S-I, R-L, P-A,
CCW Torque


PRACTICE
PS-RS-RA C.C.
L.O.C.: P-A, S-I, R-L, A-P NO TORQUE
AS-LS-LP C.C.
L.O.C.: A-P, S-I, L-R, P-A NO TORQUE
ASRP C.C.
L.O.C.: S-I, R-L, P-A CW TORQUE
AIL K.C.
L.OC.: S-I, L-R, CW TORQUE



PRACTICE
AIR K.C.
LOC: S-I, R-L CCW TORQUE
AILA K.C.
LOC: S-I, L-R, A-P CW TORQUE
PS-RS-RA C.C.
LOC: P-A, S-I, R-L, A-P NO TORQUE
AS-LS-LP C.C.
LOC: A-P, S-I, L-R, P-A NO TORQUE
ASLA C.C.
LOC: S-I, L-R, A-P CCW TORQUE
ASR C.C.
LOC: S-I, R-L CW TORQUE
PRACTICE
PRS C3 D. Thumb L.O.C. I-S, P-A, Relative to
the Plane Line of the Disc, R-L, CW torque

PR-L C5 D. Thumb L.O.C. I-S, P-A,
Relative to the Plane Line of the Disc, Left
Laminamoves forward or anterior, spinous
indirectly responds R-L. No Torque

Palmer-Gonstead Technique Practice
PS-LS-LP C.C.
L.O.C.: P-A, S-I, L-R, P-A
No Torque
AS-RS-RA C.C.
L.O.C.: A-P, S-I, R-L, A-P
No Torque
ASRP C.C.
L.O.C.: S-I, R-L, P-A, CW Torque

PRACTICE
SEATED C.C. & SeD
ASRP SeD PS-LS-LA C.C.
AILA SeD ASLP C.C.
PR-L SeD PRS C4 C.C. PRI-L C3 C.C.
SUPINE SuD
PSLP SuD
AIRP SuD
PL C2 SuD
PRONE DIVERSIFIED & DOUBLE THUMB
BODY RIGHT, SPINOUS LEFT (AXIS SPECIAL) PD
PRI-L C5 PD PRS C5 D. THUMB
PL T1 MTM PRI-L C4 D. THUMB
PL T1 DP
PLI-T T2 MDP
PRACTICE
PLS T1 DP (Diversified Pisiform)

PR C7 DP

PLI-T T2 MDP (Modified Diversified Pisiform)
PR-T T1 MDP
COURSE GRADE INFORMATION
TOTAL POINTS FOR THE COURSE: 200



188+ = GRADE OF A FOR THE COURSE
BONUS POINTS FOR THE COURSE
PALMER TECHNIQUE CLASS PORTFOLIO 10 POINTS
X-RAY ANALYSIS ON SELF: 3 POINTS
PATIENTS RAD REPORT: 2 POINTS

_________
TOTAL BONUS POINTS: 15 POINTS

(Additional Bonus Points may be added at the discretion of the instructor.)
COURSE GRADE INFORMATION
TOTAL REGULAR POINTS FOR COURSE: 200
TOTAL BONUS POINTS OFFERED: 15

(Additional Bonus Points may be offered at the discretion of the instructor.)
FINAL WRITTEN ESSAY EXAM INFO
If your score BEFORE the Final Written exam is
at 188 or above: You do not HAVE TO take the
Final Written Exam (but you may if you wish,
as anyone may elect to take the Final Written
Exam for the experience).
Cervical Technique Class Power Point
Presentation References
The author of these slides wishes to note that the material
in the slides was drawn from the various Technique
Department classes offered over the years by Palmer
College. In particular, Drs. Gindl, Burns, and Gran are to be
thanked. Dr. Carson Israel is the source of information
concerning the Derifield Short Leg Exam as well as the
graphics for the Palmer-Gonstead Alternate Prone Adjusting.
That material was most helpful and its organization much
appreciated.
Copyright, Marjorie Johnson, D.C., Ph.D.; May, 2011
ADDENDUM

THE FOLLOWING POWERPOINT INFORMATION MATERIALS
ARE IN SUPPORT OF EARLIER TOPICS IN THIS SERIES.






Technique Discussion Question
What is distinct about the
chiropractic adjustment?
Mo/Pal Example
PS-RS-RP
Decreased Extension, Occ/C1
Decreased Right Lateral Bend, Occ/C1
Decreased Left Rotation, Occ/C1

(For listing: PS-RS-RA, the RA would
present with Decreased Right Rotation.)
Mo/Pal Example
ASLP
AS = Film Finding
Decreased Left Lateral Bend, C1/C2
Decreased Right Rotation, C1/C2
Mo/Pal Example
PRS, C2
Decreased Extension, C2
Decreased Right Rotation, C2
Decreased Right Lateral Bend,
C2/C3
Mo/Pal Example
PLI-T, T2
Decreased Extension, T2
Decreased Left Rotation, T2
Decreased Right Lateral Bend,
T2/T3
PALMER-GONSTEAD PRACTICE
PS-RS C.C.
+OX, -OZ
FML

TCL
APL



L.O.C. : P-A, S-I, R-L No Torque TAL
Palmer-Gonstead Practice
PS-LS-LP C.C.
FML APL TCL


TAL
+0X,+0Z,+0Y
L.O.C.: P-A, S-I, L-R, P-A; No Torque
PALMER-GONSTEAD PRACTICE
PS-RS-RA C.C.
FML

APL TCL



TAL

+0X, -0Z,+0Y
Palmer-Gonstead Practice
PS-RS-RP C.C.
+OX, -OZ,-OY
FML TCL

APL TAL
Palmer-Gonstead Practice



+OX, +OZ Occiput


Palmer-Gonstead Practice
AS-RS-RA C.C.
FML TCL


APL
TAL

-0X,-0Z,+0Y
L.O.C.: A-P, S-I, R-L, A-P; No Torque
PALMER-GONSTEAD PRACTICE
AS-LS-LP C.C.
FML


APL
TCL




TAL

-0X,+0Z,+0Y L.O.C.: A-P, S-I, L-R, P-A No Torque
Palmer-Gonstead Practice
ASR C.C.
-0X,-0Z C1 TAL
OL APL

OPL Axis Plane Line


L.O.C.: S-I, R-L; CW Torque

Palmer-Gonstead Practice
ASLA C.C.

OL
APL TAL

OPL





Axis Plane Line -0X,+0Z,-0Y

PALMER-GONSTEAD PRACTICE
AILA KC R
OL
APL TAL





Axis Plane Line
+0X, +0Z,-0Y L.O.C.: S-I, L-R, A-P; Clockwise Torque

Palmer-Gonstead Practice
PRS C2 C.C. R

C2




C3 -0X, +0Y,-0Z

Convexity to Right L.O.C.: I-S, P-A, R-L, Relative to DPL; CW Torque
Palmer-Gonstead Practice
PLS C3 C.C.
C3 Listing Line





C4 Base Line -0X, -0Y, +0Z
Convexity to Left L.O.C.: I-S, P-A, L-R, Relative to DPL; CCW Torque

PRACTICE
PLI-L C4 C.C.
-0X,-0Y,-0Z, C4

C4 Listing Line




C5 Base Line Convexity to Right L.O.C.: I-S, P-A, Relative to DPL; Right
Lamina moves anterior; Spinous on Left responds indirectly L-R; CW Torque
PALMER-GONSTEAD PRACTICE
R



C4




C5
PALMER-GONSTEAD PRACTICE
PR-L C2 D. Thumb R

C2 Listing Line


C3 Base Line

-0X,+0Y, Convexity to Left
PL C4 C.C.
-0X, +0Y Convexity to Left

C4



C5
Other Adjusting Choices:
D. Thumb; SuD; PD
Palmer-Gonstead Practice
PR-L C2 C.C.

C2




C3

-0X,+0Y Convexity to Left

Palmer-Gonstead Practice
Palmer-Gonstead Practice
PRS C6 D. THUMB
-OX,+OY,-OZ
Convexity to Right
C6



C7
Palmer-Gonstead Practice
PR-L C2 D. Thumb
-OX, +OY, Convexity to Left

C2


C3
PALMER-GONSTEAD PRACTICE
ASRP C.C. R




-0X,-0Z,-0Y L.O.C.: S-I, R-L, P-A CW Torque

PALMER-GONSTEAD PRACTICE
PLS C4 C.C.
-OX, -OY,+OZ ; Convexity on the Left


C4


C5
L.O.C.: P-A, I-S, Relative to the DPL, L-R CCW Torque
PALMER-GONSTEAD PRACTICE
PLI-L C3 C.C.
-0X,-0Y,-0Z C3
Convexity on Right C3




C4
L.O.C.: P-A, I-S, Relative to the DPL; Right Lamina moves anterior,
Spinous responds indirectly L-R; CW Torque
PALMER-GONSTEAD PRACTICE
ASL C.C.
OL -0X, +0Z
APL TAL

OPL



Axis Plane Line
L.O.C.: S-I, L-R CCW Torque

PALMER-GONSTEAD PRACTICE
ASLP C.C.
OL APL TAL

OPL



Axis Plane Line
-0X,+0Z,+0Y L.O.C.: S-I, L-R, P-A CCW Torque
Palmer-Gonstead Practice
AIR K.C. R
+OX, -OZ


Palmer-Gonstead Practice
ASLA C.C.
OL TAL

APL

OPL

Axis Plane Line

-0X,+0Z,-0Y L.O.C.: S-I, L-R, A-P CCW Torque
Palmer-Gonstead Practice
PRS C4 C.C.

C4


C5


Convexity to Right -0X,+0Y,-0Z
Palmer-Gonstead Practice
PLI-L C3 C.C.
ALWAYS STATEMENTS
For Occiput, Atlas, and Simple listings, C2-C7 C.C.,
you will ALWAYS stand on the side of laterality of
the listing and ALWAYS contact on the side of
laterality (Palmer-Gonstead Adjusting).

For Occiput and C2-C7 Simple listings C.C., the landmark
toward which the thrust is aimed when delivering the
adjustment is the patients OPPOSITE eye.

For C2-C7 Rotatory listings C.C., the landmark toward
which the thrust is aimed when delivering the
adjustment is the patients SAME eye as the contact side.
DIVERSIFIED PRACTICE
AILP/ASLP SeD R

+0X, Other Choices
SuD
C.C.
K.C.


-0X

+0Z, +0Y
DIVERSIFIED PRACTICE
ASRA/AIRA SeD

-0X, -0Z, +0Y Other Choices
C.C.
K.C.


+0X, -0Z, +0Y
DIVERSIFIED PRACTICE
PL; PL-L; PLI-L SeD





DIVERSIFIED PRACTICE
BODY RIGHT SeD
Convexity to Right Other Choices
-0X, -0Y, -0Z SuD
PD
C.C.
D. Thumb
DIVERSIFIED ADJUSTING
PRACTICE SeD
ASRP R AILA R PL-L R
Review for Practical Exam -- Patient Supine
PSLP SuD
L.O.C.: P-A, S-I, some L-R

Other adjusting possibilities:
Palmer-Gonstead, C.C. (PS-LS-LP)

Review for Practical Exam -- Patient Supine
PSRP SuD
L.O.C.: P-A, S-I, some R-L

Other adjusting possibilities:
Palmer-Gonstead, C.C. (PS-RS-RP)
Review for Practical Exam -- Patient Supine
AIRP SuD

L.O.C.: P-A, S-I, some R-L

Other adjusting possibilities:
SeD
Palmer-Gonstead, K.C.
Toggle Recoil
Review for Practical Exam Patient Supine
ASLP SuD

L.O.C.: P-A, S-I, some L-R

Other adjusting possibilities:
SeD
Palmer-Gonstead, C.C., K.C.
Toggle Recoil
Review for Practical Exam -- Patient Supine
PRI-L C4 SuD

L.O.C.: P-A, I-S, indirect R-L

Other adjusting possibilities:
PD
Palmer-Gonstead, C.C., D. Thumb
Could also be noted as: BL/Body Left
Review for Practical Exam Patient Supine
PL C2 SuD
L.O.C.: P-A, I-S, indirect L-R

Other adjusting possibilities:
PD
SeD
Palmer-Gonstead, C.C., K.C.
Could also be noted as: BR/Body Right
REVIEW FOR PRACTICAL EXAM
PATIENT PRONE
Body Right, Spinous Left (Axis Only/Special)
PD

Other adjusting possibilities:
Toggle Recoil (Spinous Left-Body Pivot-Entire Segment Right)


L.O.C.: P-A, I-S, Indirect spinous L-R
REVIEW FOR PRACTICALPATIENT
PRONE
PR C5 PD

L.O.C.: P-A, I-S, indirect spinous R-L

Other adjusting possibilities:
SuD
Palmer-Gonstead C.C.,
Palmer-Gonstead D. Thumb
REVIEW FOR PRACTICALPATIENT
PRONE
PL C7 MTM

L.O.C.: I-S, P-A, L-R

Other adjusting possibilities:
DP
Palmer-Gonstead C.C.
Palmer-Gonstead D. Thumb


REVIEW FOR PRACTICALPATIENT
PRONE
PRS T1 DP

L.O.C.: I-S, P-A, R-L

Other adjusting possibilities:
MTM
Palmer-Gonstead C.C.
Palmer-Gonstead Single Hand Contact (SHC)
REVIEW FOR PRACTICALPATIENT
PRONE
PR-T T2 MDP

L.O.C.: I-S, P-A, through the plane line of the
disc, indirect spinous R-L

Other adjusting possibilities:
Palmer-Gonstead C.C.
Palmer-Gonstead Single Hand Contact (SHC)
REVIEW FOR PRACTICAL EXAM--
PATIENT PRONE
PLS C6 D. THUMB

L.O.C.: I-S, P-A, Relative to the plane line of the disc, L-R,
CCW torque

Other adjusting possibilities:
Palmer-Gonstead C.C.
REVIEW FOR PRACTICAL EXAM
PATIENT PRONE
PL-L C3 D. THUMB

L.O.C.: I-S, P-A, Relative to the plane line of
the disc, Right Lamina moves
forward, spinous indirectly moves L-R; No Torque
Other adjusting possibilities:
Palmer-Gonstead C.C.
SuD
PD



DIVERSIFIED PRACTICE
PSLP SuD
FML L.O.C.: S-I, L-R, P-A


APL TCL


+0X, +0Z, +0Y
Other Adj. Choices:
C.C. TAL
Supine Diversified Adjusting
PSRP SuD
FML L.O.C.: S-I, R-L, P-A




+0X,-0Z,-0Y
Other Adj. Choices:
C.C. (PS-RS-RP)
DIVERSIFIED PRACTICE
ASRP/AIRP SuD
-0X, or +0X, -0Z,-0Y Other Adjusting Choices:
SeD; C.C.;
K.C.
L.O.C.: S-I, R-L,P-A

Supine Diversified Adjusting
ASLP/AILP SuD
-0X, or +0X, +0Z, +0Y Other Adj. Choices:
SeD ; C.C.;
K.C.
L.O.C.: S-I, L-R,P-A

Supine Diversified
Practice
PSRP AILP
FML R
Supine Diversified Adjusting
C2-C6 Levels
PRI-L C2 SuD R -0X, +0Y,+0Z
C2 Other Adjusting Choices:
PD
C.C.
D. Thumb
C3 Convexity to Left
Supine Diversified Adjusting, Levels: C2-C6
PL C4 SuD
-0X, -0Y Convexity to Left Other Adj. Choices:
C4 PD
C.C.
D. Thumb

C5
Supine Diversified Adjusting
C2 C6 Levels
BODY LEFT C3 SuD
C3
Other Adjusting Choices:
PD
C.C.
C4 D. Thumb
L.O.C.: I-S, P-A, Left Lam-Ped moves anterior/forward; spinous
indirectly moves R-L
DIVERSIFIED ADJUSTING --
PRONE
AXIS ONLY (AXIS SPECIAL) PD

C2 - C6 PD

MODIFIED THUMB MOVE C7 T2 (MTM)
AXIS SPECIAL (ONLY) PD
Body Left, Spinous Right
VML Other Choice: Toggle Recoil
R


AXIS SPECIAL (ONLY) PD
BODY RIGHT, SPINOUS LEFT
Other Choice: Toggle Recoil
R
VML

C2 C6 PD (PRONE DIVERSIFIED)

PLI-L C2 PD Other Adjusting Choices:
C2 Disc Plane Line R SuD
C2 C.C.
D. Thumb
C3 Disc Plane Line
-0X, -0Y, -0Z C3
Right Convexity







-0X,-0Y,-0Z
Right Convexity

C2-C6 Prone Diversified (PD)
PR-L C6 PD Other Choices:
R SuD
C6 C.C.
D. Thumb



C7
-0X,+0Y
Left Convexity
MODIFIED THUMB MOVE
PRS C7 MTM R




-0X, +0Y, -0Z C7
Right Convexity
Other Choices:
DP; C.C.; SHC, P-G
D. Thumb T1

MODIFIED THUMB MOVE
PL T2 MTM
Thin Disc; Visual Posteriority,
T2 Other Choices
T2 DP; C.C.; SHC, P-G
- 0X,- 0Y
Convexity to Left
T3
DIVERSIFIED PISIFORM
PRS T2 D.P.
Thin Disc, T2 Other Choices
T2 C.C.; MTM
S.H.C. , P-G;




T3
L.O.C.: I-S, P-A, R-L No Torque -0X, +0Y, -0Z T2

DIVERSIFIED PISIFORM (D.P.)
PL C7 R


C7



T1
OTHER CHOICES:
C.C.; D.THUMB; D.P.;
-0X, -0Y; Left Convexity L.O.C.: I-S, P-A, L-R;
No Torque
Modified Diversified Pisiform
PLI-T T3 M.D.P.
Visual Posteriority, T3 Other Choices
C.C.
S.H.C. P-G
L.O.C.: I-S, P-A, Relative to
the DPL; T3 Rt. TVP
moves P-A; T3
Spinous moves
indirectly L-R

-0X, -0Y, -0Z

MODIFIED DIVERSIFIED PISIFORM
PR-T T2 M.D.P.
R


T2



T3
OTHER CHOICES: C.C.; SHC, P-G
L.O.C.: I-S, P-A, RELATIVE TO DPL; LEFT TVP
MOVES P-A;SPINOUS MOVES INDIRECTLY R-L
-0X,-0Y CONVEXITY TO LEFT
PP PRACTICE REVIEW--
PRONE
BODY RIGHT, SPINOUS LEFT; (AXIS
SPECIAL/ONLY) PD
PRI-L C6 PD
PLS C7 MTM
PLS C7 DP
PL-T T2 MDP
PR C3 D. THUMB
PR-L C5 D. THUMB
PP Seated Review
C.C. & SeD
AIRP SeD
AILA SeD
PRI-L SeD
PS-LS-LP C.C.
AS-RS-RA C.C.
ASLA C.C.
PL-L C4 C.C.
PLS C3 C.C.
PRACTICE REVIEW
SUPINE & SEATED
ASRP SeD
PSRP SuD
AILP SuD
PLI-L C2 SuD
PR C4 SuD
PRS C3 C.C.
ASLA C.C.


CLINICAL EXAMPLE
Martha, a fifty-five year old female patient of yours, is in the
office today because she says she hurt her back yesterday
when lifting her 20-month-old grandson, Terry. She recalls
hearing her back pop. She thought the discomfort would
go away. But, now, in addition to her low back pain, her
neck has started to hurt. Her x-rays are a year old. Describe
how you would proceed to evaluate this patient,
chiropractically.
CLINICAL EXAMPLE
A patient of long standingTom,a forty year old male
reported to your office for care following a car accident that
morning. He tells you he was stopped at a stop sign, and the
car behind him hit him, traveling about 15 mph. He felt his
head go back and forth, but he does not believe he turned
his head during that time. He reports slight dizziness and
some slight discomfort in his mid-cervicals. His x-rays are a
year old. Describe how you would proceed to evaluate this
patient, chiropractically.
CLINICAL EXAMPLE
Reed, a twenty-five year old roofer, tells you he
twisted his right ankle and wrenched his back and
neck two (2) days ago while alighting from a ladder
on his job. He has continued to work, but this
morning he reports that he could barely get out of
bed. Your x-rays on him are a year old. Describe
how you would proceed to evaluate this patient,
chiropractically.
SUGGESTED TIMEFRAME FOR
PATIENT ADJUSTING WORK-UP
Case History Up-date: 5 minutes
Visualization: 2 minutes
Instrumentation: 4 minutes
Leg Check: 2 minutes
Range of Motion: 4 minutes
Ortho/Neuro Exams: 7 minutes
Static Palpation: 3 minutes
Motion Palpation: 4 minutes
X-ray Review 4 minutes
Adjustment 5 minutes
(includes table & 40 minutes
equipment set-up)