Chiropractic practices Flashcards
when we talk about torque what do you think of
gonstead
where do we have axial plane facets and TPs
horizontal
upper cervicals
where do we have coronal plane facets and TPs
lower cervicals, thoracics
where do facets of the spine become sagittal
T12
what is facet tropism
1 sagittal facet + 1 coronal facet
diversified line of drive (LOD)
Posterior to anterior - PA
Lateral to medial - LM
Inferior to superior - IS
except for C1 which is SI
gonstead line of drive (LOD)
Posterior to anterior Lateral to medial Medial to lateral Inferior to superior Superior to inferior Clockwise Counterclockwise
when does gonstead use medial to lateral line of drive
mammillary process in lumbar spine only***
gonstead line of drive is always __
what about if we are talking about IS and SI LOD
perpendicular to the curve of the spine
above C3 - IS *C3- PA below C3- SI *T6 - PA blow T6 - IS *L3 - PA below L3 - SI
what are static listings
fixation, malposition, subluxation
where body or SP is stuck
you can cross them off when you see them - body is malpositioned to the right - body is to the right
what are motion listings
diminished
decreased
restrictred
where body or SP can not go
describe disc wedge or lateral bending listings
right superior TP/body and left inferior TP/body
always stand on side of convexity
need TORQUE LOD to fix
TORQUE all about lateral bending and disc wedging
describe rotation listings
DO NOT TORQUE ROTATION LISTINGS
PR - spinous right
BL - body left
all of gonstead listings start with what
P
except atlas then its A
what is the listing formula
- level base
- lateral flexion
STOP - stand on open wedge side - rotation - motion/static
- circle what they asked
Line of drive also can be said as
line of correction
open wedge is also up or down on side posture
up
T6 has decreased right rotation and anterior right TP
PR and BL
decreased right rotation and fixed to the left
PR and BL
decreased right sp rotation and malpositioned body to the right
PL and BR
tissue prominent on the left
PR and BL
patient can’t rotate head to the right and sp is malpositioned to the right
PR and BL
paraspinal spasm on the left
PR and BL
anterior transverse process on the right
PR and BL
body posterior on the right
and diminished right rotation of spinous
PL and BR
contracted mulifidi on the left
PL and BR
increased left body rotation and decreased right body rotation
PR and BL
hypo mobility to the left and sp has decreased rotation to the right
PL and BR
static malposition of SP right and right TP is limited from AP
PR and BL
concavity on the left
which type of scoliosis is this
right scoliosis
contracted intertransverssari on the left and patient is lying with right side up
left lateral flexion
open wedge on right
taut inter transverse ligament on the left
right lateral flexion
open wedge on left
lax annular fibers on the left
left lateral flexion
open wedge right
superior right TP and body lean left
left lateral flexion
open wedge right
decreased right lateral bending and sublimated laterally bending to the left
left lateral flexion
open wedge right
stacking on the left
right lateral flexion
open wedge left
counter clockwise torque and left stabilization hand
right lateral flexion
open wedge left
right towering
right lateral flexion
open wedge left
right segmental scoliosis and apical vertebrae on the right
left lateral flexion
open body right
stacking occurs on which side of scoliosis or lateral flexion
convexity
towering occurs on which side of the scoliosis and lateral flexion
concavity
what is the segmental contact for a sp right and scoliosis/left lateral flexion
diversified and gonstead
diversified
cervicals - sp
thoracic - double tp***
lumbar - sp
gonstead
cervicals - sp
thoracic - sp
lumbar - sp
what is the segmental contact for a sp left and scoliosis/right lateral flexion
diversified
cervicals - body
thoracic - body/double TP*****
lumbar - body
gonstead
cervicals - body
thoracic - body
lumbar - body
what is the segmental contact for a sp right
diversified
cervicals - body
thoracic - body
lumbar - body
gonstead
cervicals - sp
thoracic - sp
lumbar - sp
tissue pull is always in what direction
LOD or LOC
what is another term we could use for body in cervicals, thoracic, and lumbars
cervicals - lamina/pedicle
thoracic - TP
lumbar - mammillary
what are general rules of gonstead
contact the superior (open) side of the segmental wedge
except L5 - special listing
thrust through the plane line of the disc
clockwise and counterclockwise torque to close the open wedge
gonstead side posture and single hand instructions
side posture - doctor forearm must be in line with thrust
single hand - episternal notch must be in line with thrust
gonstead key terms and question clues
cervical chair knee chest decreased extension torque P first in listing single hand
basic gonstead cervical set up
occiput
- patient - seated
- PS listing - contact theanr on mastoid or ear - thrust PA and SI in scooping motion
- AS listing - contact surface of 3rd digit contact glabella - thrust AP and SI in scooping motion
atlas
- patient - seated
- contact - tip of thumb on lateral atlas
- stabilize - base of occiput
- thrust - PA or AP and lateral to medial
C2-7
- patient - seated
- contact - tip of index on lateral spinous or lamina
- stabilize - cupped hand on segment below
- thrust - PA through the plane line of the disc
basic gonstead thoracic set up
thoracic
- patient - prone
- doctor - on side of segmental contact - fencer stance for simple listings and straight away for 4 part listings
- contact - pisiform on lateral SP or TP
- stabilize - contact patient wrist
- thrust - PA through the plane of the disc
basic gonstead lumbar set up
always have involved side (side of segmental contact) up except for spinous pull moves
lumbar
- patient - side posture or knee-chest table
- push moves - contact pisiform on lateral spinous or mammillary - stabilize shoulder - thigh to thigh - thrust PA through the plane of the disc, lateral to medial, plus any torque
- pull moves - contact pad of 2/3rd digit on lateral spinous or mammillary - stabilize shoulder to knee - thigh to thigh - thrust PA through the plane line of the disc
- LOD - spinous = lateral to medial for push and pull moves - mammillary = medial to lateral for push pull techniques
basic gonstead L5 special listing set up
if L5 disc wedge (convexity) is on the right,
and scoliosis convexity is opposite of lumbar disc convexity,
then the doctor must contact L5 sp or mammillary ON THE SIDE OF THE SCOLIOSIS
basic gonstead sacrum set up
involved side UP
patient - side posture
contact - pisiform contact medial to PSIS (PR and PL) - pisiform contact on the first sacral tubercle (base posterior)
stabilize - shoulder, thigh to thigh
thrust - PA through the SI joint plane
basic gonstead anterior coccyx set up
patient - prone
contact - covered thumb tissue pull from base
thrust - superior ward (IS and PA)
diversified occiput set up
flexion malposition = extension restriction= AI/PS
- to adjust extend head
- prone: hypothenar or thenar
extension malposition = flexion restriction = PI/AS
- to adjust flex head
- prone: thenar
diversified atlas and cervicals set up
prone cervical - LF subluxation - stand on side of contact - lateral flexion over contact and rotate head opposite of contact, slight flexion - PUSH
supine cervical - rotation subluxation - stand on side of contact - lateral flexion over contact and rotate head opposite of contact, slight flexion - PUSH
seated rotary - rotation subluxation - stand on opposite side of contact - lateral flexion over the contact and rotate head opposite of contact, slight flexion - PULL
master cervical - hyperlordosis - distraction to avoid adjusting into the curve (distraction reduces curve)
diversified says to stabilize the level __
gonstead says to stabilize the level __
stabilize level above
stabilize level below
gonstead cervical chair will put the patient into __
extension
cervical quiz
seated cervical
cervical chair
prone cervical
supine cervical
which is gonstead
seated cervical - PULL - stabilize above - doctor stands on OPPOSITE side of contact - LOD PA LM IS
cervical chair - PUSH - stabilize BELOW - doctor stands on SAME side of contact - LOD PALM IS SI CW CCW
prone cervical - PUSH - stabilize above - doctor stands on SAME side of contact - LOD PA LM IS
supine cervical - PUSH - stabilize above - doctor stands on SAME side of contact - LOD PA LM IS
what is our line of drive for diversified
PALM IS
PA
LM
IS
how do you fix a PLS cervical chair
GONSTEAD patient seated doctor behind contact left SP distal index on left SP stabilize below
how do you fix a body right seated cervical
DIVERSIFIED patient seated doctor in front contact right side pad of middle digit in right lamina pedicle junction stabilize above
diversified thoracic set up
AP thoracic (anterior thoracic, anterior-dorsal, flexion, flexion extension disc relationship)
- patient supine, standing, or seated
- contact segment BELOW
- LOD - AP and IS
PA thoracic (extension)
- patient prone
- contact SP
- LOD - PA and IS
when do you use knife edge (ulnar surface) contact in diversified
thoracic extension malposition
when do you used combination moves
modified diversified
upper thoracic
fencer stance
stabilization hand is above malar and TRACTION
what is the bilateral transverse contact used for
diversified
(aka double pisiform or bilateral TP)
USED FOR COUNTERROTATION vertebrae
stand on and contact HIGH TP side or open wedge side
contact both TPs of same segment
what is the bilateral thenar contact used for
diversified
(aka double pollicis)
lower thoracics
fencer stance
what is the bilateral thumb contact used for
GONSTEAD
(aka double thumb)
adults knee chest
lumbars
what is the unilateral thumb contact used for
diversified
(aka covered thumb and thumb pisiform)
decrease amplitude because you contact with thumb and then cover with other hand and thrust through thumb
kyphotic adult
osteporosis
dowager hump
what the modified thumb contact used for
diversified
(aka bench thumb or thumb move)
lower cervicals and upper thoracic
LOD LM - spinous rotated to right then contact right and blast it to china
diversified rib set up
rib prominence is felt where
anterior, posterior, seated, standing
PMS most common subluxation - cranky rib - PMS
contact angle of the rib - NOT rib head
rib prominence felt on side of vertebral body rotation
first rib usually subluxates __
superior
PMS most common
diversified lumbar set up
side posture preferred
prone or seated can also be done
diversified spondylolisthesis adjustment
SUPINE knee chest
diversified tropism adjustment
decreased rotation due sagittal facet
thoracic quiz
T4-5 extension malposition
T4-5 flexion subluxation
T6-7 flexion extension disrelationship
Pt position
LOD
contact
T4-5 extension malposition
Pt position - prone
LOD - PA IS
contact - T4
T4-5 flexion subluxation
Pt position - supine
LOD - AP IS
contact - T5
T6-7 flexion extension disrelationship
Pt position - supine
LOD - AP IS
contact - T7
diversified sacrum set up
diversified and Thompson
contact contra apex
RAI
gonstead sacrum set up
contact ipsilateral base
PIR
diversified coccyx set up
internal correction held 40 seconds with opposing hand applying external pressure on sacrum
avoid ganglion of impar
no correlation between coccyodynia and coccyx angulation
what adjustment is contradicted in spondylolisthesis
PRONE
prone lumbars are associated with what
knee chest
prone knee chest
GONSTEAD
pelvic adjustment set up
GONSTEAD AND DIVERSIFIED side posture preferred
AS ilium - extension malposition and flexion restriction - supine push down on ASIS and pull in ischial tub - prone push down on the ischial tub - side pull or push
PI ilium - flexion malposition and extension restriction - prone push down on PSIS and pull up knee - side pull or push - glut max spasm and low gluteal fold
explain ilium position and its association with glut max and obturator height and width as well as palpatory tenderness
AS, PI, IN, EX
ilium position in relation to GM and obturator
AS - GM short, short obturator
PI - GM long, long obturator
IN - GM flat wide, narrow obturator
EX - GM hunch narrow, wide obturator
ASIN - long leg
PIEX - short leg
palpatory findings AS - inferior PI - superior IN - none EX - medial
pelvis orientation and iliac crest and femoral head relationship in the prone position and standing xray
prone:
- PI - high
- AS - low
standing X-ray:
- PI - low
- AS - high
ilium listing set up
diversified and gonstead very similar in terms of ilium
PI
AS
patient - side posture
EX - involved side down, with digit pull on PSIS
ASEX - involved side down, with digits pull on iliac crest
PI
- contact PSIS - pull: pisiform / push: 2/3rd digit
- stabilize shoulder - pull: knee to knee / push: thigh to thigh
- thrust - PA and IS (IN)
AS
- contact ischial tuberosity with - pull: 2/3rd digit / push: pisiform
- stabilize shoulder - pull: knee to knee / push: thigh to thigh
- thrust - PA and SI (IN)
point tenderness along PSIS
pelvic listing?
PI
gluteal hunching on right
low gluteal fold on right
pelvic listing?
Right PIEX
toe in
superior PSIS point tenderness
pelvic listing?
PIEX
superior ASIS on the right
pelvic listing?
right PI
left lower femoral head on xray
pelvic listing?
left PI
posterior ischial tuberosity
pelvic listing?
AS
superior PSIS on left
what is the right ilium listing?
right PI
flexion fixation of ilium
flat gluteus Maximus
pelvic listing?
PI IN
tall obturator
pelvic listing?
PI
wide ilium or inominate
pelvic listing?
IN
wide obturator
pelvic listing?
EX
longest inominate on xray
pelvic listing?
PI
superior PSIS
foot flare
pelvic listing?
AS IN
short obturator
narrow ilium
pelvic listing?
AS EX
sacral anterior inferior
pelvic listing?
PI
extension restriction
pelvic listing?
PI
what aggravates an SI
trochanteric belt
side posture thigh to thigh means you’re pushing or pulling
push
thigh to thigh is same as drop
side posture knee to knee means you’re pushing or pulling
pulling
knee to knee is same as kick
side posture EX pull is fencer stance or straight stance
straight stance
which means perpendicular to the patient
elbow above or below contact for ASIN push
below
elbow above or below contact for PIEX pull
above
elbow above or below contact for EX pull
above
L3 PRI-M side posture
pull or push RL or LR
pull or push right to left
L4 PRS side posture
pull or push RL or LR
pull or push right to left
L2 body malpositioned in right rotation and left lateral flexion (knee chest)
pull or push left to right
L4 seated lumbar with decreased right lateral flexion and right rotation
pull or push right to left
C6 has left SP rotation and left body lateral flexion is ___ body limited rotation and __ scoliosis
gonstead listing
L body limited rotation
right scoliosis
PLI - Lamina contact
CW torque
C4 body left and inferior has restricted right rotation and limited right lateral bending
contact with doctors __ hand and lateral flex the patients head to the __
gonstead listing
Right
right
PRS
CW torque
right scoliosis, left SP would have reduced __ leaning and body restricted from rotating to the __
gonstead listing
right
left
PLI
CW torque
posterior and superior right TP has __ towering and spinous reduced from rotating __
gonstead listing
left
right
PLI
CW torque
decreased spinous extension and body has decreased right rotation and right lateral flexion
gonstead listing
PRS
CW torque
decreased right lateral flexion and left body rotation. motion segment has a right convexity and right posterior TP
gonstead listing
PLI
CW torque
anterior TP is on right and superior
gonstead listing
PRS
CW torque
thigh to thigh contact means
knee to knee contact means
drop
kick
what are motion, gonstead, and static listings
motion listings - body reference - where the body is not - restriction
gonstead - SP reference - always starts listing with P
static listings - TP or body reference - where the body is
which listings are national or medicare listings
static listings
LOD for gonstead or diversified?
T8 PRS
G - PA LM IS CW
LOD for gonstead or diversified?
C4 body right and superior
patient is supine
D - PALMIS
LOD for gonstead and diversified?
C5 PLI-I
G - PA LM SI CW
LOD for gonstead and diversified?
use knee chest to adjust L4 which has decreased right body rotation, left lateral flexion, and extension
G - PA ML SI CCW
LOD for gonstead and diversified?
use double pisiform maneuver for T9 right TP anterior and superior
D - PA LM IS
LOD for gonstead and diversified?
L2 has PLI-M
G - PA ML IS CW
right ilium PSIS has superior tenderness and limited foot flare. what is the listing
PIEX
what is the segmental contact point (SCP)
c4 prs
right SP
what is the segmental contact point (SCP)
T1 PR
right SP
what is the segmental contact point (SCP)
T6 posterior right TP
right TP
if there is no wedging (contact open wedge), you’re gonna be on the body side! ***
what is the segmental contact point (SCP)
PLI M
right mammillary process
what is the segmental contact point (SCP)
limited ilium flexion
ischial tuberosity
what is dr stance (same or opp) of contact
modified combo diversified
same side
what is dr stance (same or opp) of contact
diversified seated cervical
opposite side
what is dr stance (same or opp) of contact
T1 - PR
same side
what is dr stance (same or opp) of contact
gonstead cervical chair
same side
what is dr stance (same or opp) of contact
double thenar
same side
where to stabilize for gonstead?
cervical chair c4 PRS
below
where to stabilize for gonstead?
single hand t4 PLI
grasp wrist
where to stabilize for gonstead?
L4 PRS side posture push
stabilize right shoulder
with doctor right hand
(open wedge up!)
where to stabilize for gonstead?
seated ASLP atlas
occiput with contact hand
what hand is used to stabilize for gonstead?
PR sacrum
superior hand
cephalad
what’s the torque for the listing?
PRS
PI-R sacrum
CW
CCW
what are the planes and axis of movement
sagittal - x - flexion and ext
transverse - y - rotation
coronal - Z - ab and add
what are the dozen adjusting rules
- vertebra = body = vertebral body
- D and G both contact superior side of segment or convex side of disc wedge
- D will contact high TP and stabilize opposite TP (doctor stands on convex side of wedge)
- stand on the side of convexity
- put the involved side up or open wedge up
- use a push if there’s a correct choice between push and pull
- pathology (PI pelvis is accompanied with AI sacrum) and physiology (PI pelvis is accompanied with AS sacrum)
- body and SP rotate opposite
- anterior TP = SP listing
- posterior TP = body listing
- static listings - malposition, fixation, subluxation
- motion listings - decreased, limited, restrictions
sacrum contact point for diversified and Gonstead for a RAI or PI-R sacrum
diversified RAI - contra apex
gonstead PI-R- ipsi base
for thoracics contact wear and stand where
contact high TP
stand on open wedge side
when is straight away stance used
4 part thoracic listings
