Reference List of Chiropractic Techniques

Reference List of Chiropractic Techniques

I. Cervical Spine:

Patient Seated -

1. Digital Pad - Transverse Contact (C1-C2)

a. Patient Position - Seated with the buttocks to the back of the chair and feet on the floor.

b. Doctor Position - On the side of the patient, opposite from the side of the contact, and pull across the patient's body while supporting the patient's shoulder.

c. Contact Point - Distal digital pad of the middle finger on the transverse process, the posterior arch of C1, or the articular pillar of C2.

d. Stabilizing Hand - Palm of the hand cups the ears and cradles the inferior rim of the occiput and stabilizes C1.

e. Procedure - Rotate head away from the side of the contact and laterally flex the head over the contact point.

f. Line of Drive - Posterior to anterior with a thrust to induce rotation.

2. Distal Lateral Index - Spinous Contact (C2-C7)

a.       Patient Position - Patient seated with the head retracted into

the neutral position.

b. Doctor Position - Doctor stands posterior to the patient with a slight shift to the side of the contact.

c. Contact Point - Lateral surface of the distal index finger on the posterior inferior surface of the spinous of C2-C7.

d. Stabilizing Hand - On the contralateral side of the occiput with the fingers toward the spine.

e. Procedure - Doctor applies a posterior to anterior tissue pull, rotates the head away from the side of the contact, and laterally flexes the neck over the contact.

f. Line of Drive - Lateral to medial with a thrust to induce rotation and lateral flexion.

3. Distal Lateral Index - Lamina/AP Contact (C2-C7)

a. Patient Position - Patient seated.

b. Doctor Position - Doctor is positioned posterior to the patient and shifted slightly lateral to the side of the contact.

c. Contact Point - Lateral surface of the distal index finger at the pedicle-lamina junction (articular pillar).

d. Stabilizing Hand - On the contralateral side of the occiput with the fingers pointed toward the spine.

e. Procedure - Doctor applies a posterior to anterior tissue pull, rotate the head away, and laterally flex the head over the contact.

f. Line of Drive - Posterior to anterior, slight lateral to medial with thrust to induce rotation and lateral flexion (lateral flexion correction on the side to which head is tilted).

Patient Supine

1. Pisiform - Mastoid Contact (Occiput)

a. Patient Position - Patient supine (do not grab the chin).

b. Doctor Position - Doctor is positioned at the head of the table and slightly lateral toward the side of the contact.

c. Contact Point - Pisiform of the contact hand on the posterior occiput over the mastoid process.

d. Stabilizing Hand - Supports the contralateral side of the occiput.

e. Procedure - Doctor laterally flexes the patient's head toward the side that the doctor is standing and rotates the head away from the contact.

f. Line of Drive - Posterior to anterior, superior to anterior, and lateral to medial with a thrust to induce rotation and lateral flexion.

2. Lateral Index - TP/AP Contact (C1-C6) (Cervical Break)

a. Patient Position - Patient supine and head rotated 45 degrees to the contralateral side.

b. Doctor Position - Homolateral side: toggle stance at right angles to the patient.

c. Contact Point -Doctor applies posterior to anterior tissue pull with a lateral index contact on the posterior aspect of the AP.

d. Stabilizing Hand - Doctors hand cups the ear and supports the contralateral side of the occiput.

e. Procedure - Apply a tissue pull from posterior to anterior, and rotate the patient's head away from the side of the contact.

f. Line of Drive - Posterior to anterior and lateral to medial with a thrust to induce rotation.

Patient Prone

Lateral Index - AP Contact (C2-C6) (Malar)

a. Patient Position - Prone antigravity; rotate head to 45 degrees away from the side of the contact.

b. Doctor Position - Doctor may stand on either side of the contact point using a fencer stance, facing cephalad.

c. Contact Hand - Apply posterior to anterior tissue pull with a lateral index contact over the AP.

d. Stabilizing Hand - Palm of the hand cups the ear with the fingers pointing upward along the head.

e. Procedure - Rotate the head away from the side of the contact and laterally flex the head over the contact with the stabilizing hand, while tractioning the head cephalad; doctor breaks across and slightly cephalad in line with the facets.

f. Line of Drive - Posterior to anterior, lateral to medial with a thrust to induce rotation.

2. Thumb - SP Contact (C7) (Bench TM)

a. Patient Position - Prone antigravity; head turned away from the contact.

b. Doctor Position - Fencer stance facing cephalad; cephalad foot on level with the patient's shoulder.

c. Contact Point - Thumb tip on the lateral aspect of the SP of C7.

d. Stabilizing Hand - Palm of hand cups the ear.

e. Procedure - Lateral to medial tissue pull is applied; thumb pad on the C7 spinous, doctor rotates face away and laterally flexes the head toward the side of the contact.

e. Line of Drive - Lateral to medial with a thrust to induce rotation.

II. Thoracic Spine:

Patient Prone

1. Pisiform/Hypothenar - TP with head stabilization (T1-T3) (Combo)

a. Patient Position - Prone antigravity.

b. Doctor Position - Doctor stands homolateral to the side of the contact positioned ina fencer stance.

c. Contact Point - Pisiform contact on the TP with medial to lateral tissue pull and arms straightened.

d. Stabilizing Hand - Palm of hand cups the ear.

e. Procedure - Doctor has to lean cephalad above the contact so that the thrust, a straight arm body drop, is inferior and anterior.

f. Line of Drive - Posterior to anterior and superior to inferior with a thrust to induce rotation.

2. Pisiform/Hypothenar - SP with head stabilization (T1-T2)

a. Patient Position - Prone antigravity; head turned away from the contact.

b. Doctor Position - Fencer stance with the doctor facing cephalad; cephalad foot on level with the patient's shoulder.

c. Contact Point - Pisiform/Hypothenar contact on the lateral surface of the SP of T1-T2.

d. Stabilizing Hand - Palm of hand cups the ear.

e. Procedure - Lateral to medial tissue pull is applied; pisiform/hypothenar contact on SP, rotates the patient's head away from the side of the contact, and laterally flex the head toward the side of the contact point.

f. Line of Drive - Lateral to medial with a thrust to induce rotation.

3. Unilateral Reinforced Pisiform/Hypothenar - SP Contact (T1-T12)

a. Patient Position - Prone antigravity.

b. Doctor Position - Fencer stance on the same side as the contact point, perpendicular to the contact; straight arm angulated slightly.

c. Contact Point - Tissue pull is applied medial to lateral with a pisiform/hypothenar contact on the lateral side of the SP; cephalad hand contact is used when above T6 with fingers pointing caudad (below T6, use caudad hand with the fingers pointing cephalad.

d. Stabilizing Point - Reinforces the contact.

e. Procedure - Lateral to medial tissue pull is applied, grasping the wrist of contact hand.

f. Line of Drive - Posterior and anterior and lateral to medial with a thrust to induce rotation and lateral flexion.

4. Unilateral Reinforced Pisiform/Hypothenar - TP Contact (T1-T12)

a. Patient Position - Prone antigravity.

b. Doctor Position - Fencer stance on the same side of the contact point, perpendicular to the contact; straight-arm perpendicular to the body surface.

c. Contact Point - Tissue pull is applied medial to lateral with a pisiform/hypothenar contact over the TP; add torque to the tissue pull.

d. Stabilizing Hand - Reinforces the contact.

e. Procedure - Lateral to medial tissue pull is applied, grasping the wrist of contact hand.

f. Line of Drive - Posterior to anterior with a thrust to induce rotation.

5. Bilateral Crossed Pisiform/Hypothenar - TP Contact without Counter- Rotation.

a. Patient Position - Prone antigravity.

b. Doctor Position - Fencer stance, facing cephalad on the side of the contact; lean directly over the contacts; hand closest to the doctor is the one that induces the rotation.

c. Contact Point - Pisiform contact on TP with tissue pull medial to lateral.

d. Stabilizing Hand - Contralateral TP at the same level of the affected segment.

e. Procedure - Medial to lateral tissue pull applied, contact the TP and the other TP at the same level (crossed hands)

f. Line of Drive - Posterior to anterior with a thrust to induce flexion or rotation.

6. Thumb - SP Contact (T1-T2) (Bench TM)

a. Patient Position - Prone antigravity.

b. Doctor Position - Fencer stance, facing cephalad; cephalad foot on level with the patient's shoulder.

c. Contact Point - Tip of the thumb against the lateral aspect of the SP of T1-T2.

d. Stabilizing Hand - Palm of hand cups the ear.

e. Procedure - Lateral to medial tissue pull; thumb pad on the SP, rotate the head away, and laterally flex the head over the contact point.

f. Line of Drive - Lateral to medial with a thrust to induce rotation.

7. Knife-Edge - TP (T3-T12)

a. Patient Position - Prone antigravity; bilateral knife-edge contact over the TP's.

b. Doctor Position - Fencer stance with the doctor on either side of the patient.

c. Contact Point - Knife-edge contact on TP, bilaterally with hands close together; the contact hand closest to the doctor is the hand that induces the rotation.

d. Stabilizing Hand - Contacting the contralateral TP at the same level.

e. Procedure - Medial to lateral, inferior to superior tissue pull, knife-edge on the TP's bilaterally.

f. Line of Drive - Posterior to anterior, inferior to superior to induce flexion or rotation.

8. Bilateral Thenar - TP Contact (T3-T12)

a. Patient Position - Prone antigravity.

b. Doctor Position - Fencer stance, facing cephalad at the level of the patient's low back.

c. Contact Point - Bilateral thenar contact with hands close together; the contact hand closest to the doctor is the hand that induce the rotation.

d. Stabilizing Hand - Contacting the contralateral TP at the same level.

e. Procedure - Medial to lateral, inferior to superior tissue pull, bilateral thenar on the TP's bilaterally.

f. Line of Drive - Posterior to anterior, inferior to superior to induce flexion or rotation.

Patient Supine

1. Thenar/Index (Cupped Hand/Clenched Fist) - TP Contact (T3-T12).

a. Patient Position - Patient starts in the seated position, and is lowered by the doctor.

b. Doctor Position - Either side of the patient in a fencer stance.

c. Contact Point - Inferior vertebra of the subluxated joint with flat hand/clenched fist on the TP's.

d. Stabilizing Hand - Grasping the back of the lower cervical spine as the patient's body is lowered to the supine position.

e. Procedure - Take the contact and stabilize the cervical spine and lower the patient's flexed trunk until the patient's body is over the contact point.

f. Line of Drive - Posterior to anterior, inferior to superior with a thrust to induce flexion.

III. Lumbar Spine:

Patient Prone

1. Unilateral Reinforced Pisiform/Hypothenar - SP Contact (L1-L5)

a. Patient Position - Prone antigravity.

b. Doctor Position - Fencer stance on the same side as the contact angulated point, perpendicular to the contact; straight-arm slightly.

c. Contact Point - Tissue pull is applied medial to lateral with a pisiform/hypothenar contact on the lateral side of the SP.

d. Stabilizing Point - Reinforces the contact.

e. Procedure - Lateral to medial tissue pull is applied, grasping the wrist of contact hand.

f. Line of Drive - Posterior and anterior and lateral to medial with a thrust to induce rotation and lateral flexion.

2. Unilateral Reinforced Pisiform/Hypothenar - MP Contact (L1-L5)

a. Patient Position - Prone antigravity.

b. Doctor Position - Fencer stance on the same side of the contact point, perpendicular to the contact; straight arm perpendicular to the body surface.

c. Contact Point - Tissue pull is applied medial to lateral with a pisiform/hypothenar contact over the MP; add torque to the tissue pull.

d. Stabilizing Hand - Reinforces the contact.

e. Procedure - Lateral to medial tissue pull is applied, grasping the wrist of contact hand.

f. Line of Drive - Posterior to anterior with a thrust to induce rotation.

3. Bilateral Thenar/Thumb - MP Contact (L1-L5)

a. Patient Position - Prone antigravity.

b. Doctor Position - Fencer stance, facing cephalad at the level of the patient's low back.

c. Contact Point - Bilateral thenar contact with hands close together; the contact hand closest to the doctor is the hand that induce the rotation.

d. Stabilizing Hand - Contacting the contralateral TP at the same level.

e. Procedure - Medial to lateral, inferior to superior tissue pull, bilateral thenar on the TP's bilaterally; use a Dutchmans Roll or a pillow to induce flexion.

f. Line of Drive - Posterior to anterior, inferior to superior to induce flexion or rotation.

Patient Side-Lying

1. Digital - Spinous Contact Pull (L1-L5) (Kick)

a. Patient Position - Side-lying.

b. Doctor Position - Perpendicular to the table with digital contact on the lateral (upside) surface of the SP.

c. Contact Point - Digital contact on the lateral surface (downside) of the SP with a tissue pull that is lateral to medial (i.e. for right rotation: left side of the patient is the upside, and the doctor is on the right (downside) of the SP).

d. Stabilizing Hand - Palmar contact on the anterior aspect of the upper shoulder.

e. Procedure - Apply a tissue pull lateral to medial; drive the segment anterior while assisting with the leg (kick).

f. Line of Drive -Posterior to anterior to induce rotation.

2. Digital - Mammillary Process Contact Pull (L1-L5) (Kick)

a. Patient Position - Side-lying.

b. Doctor Position - Perpendicular to the table with digital contact on the upside MP.

c. Contact Point - Digital contact over the upside MP with a tissue pull that is medial to lateral (i.e. for right rotation: left side of the patient is the upside, and the doctor is on the upside MP).

d. Stabilizing Hand - Palmar contact on the anterior aspect of the upper shoulder.

e. Procedure - Apply a tissue pull medial to lateral; drive the segment anterior while assisting with the leg (kick).

f. Line of Drive -Posterior to anterior to induce rotation.

3. Pisiform/Hypothenar - SP Contact Push (L1-L5)

a. Patient Position - Side-lying.

b. Doctor Position - Fencer stance, facing cephalad; thigh on thigh procedure.

c. Contact Point - Pisiform/Hypothenar contact on the lateral surface (upside) of the SP (i.e. for right rotation or right lateral flexion: the patients right side is the upside, and the doctor contacts the upside surface of the SP).

d. Stabilizing Hand - Palmar contact on the anterior aspect of the upper shoulder, but minimize lumbar twisting by keeping the shoulders square.

e. Procedure - Pisiform/Hypothenar contact on the upside surface of the SP with the doctors arm slightl;y angulated from parallel to the body surface; roll the patient slightly and drop using a thigh on thigh technique, while pushing the SP anterior and medial.

f. Line of Drive - Posterior to anterior, lateral to medial to induce rotation and lateral flexion.

4. Pisiform/Hypothenar - MP Contact Push (L1-L5)

a. Patient Position - Side-lying.

b. Doctor Position - Fencer stance, facing cephalad; thigh on thigh procedure.

c. Contact Point - Pisiform/Hypothenar contact on the upside MP (i.e. for right rotation: the patients left side is the upside, and the doctor contacts the upside MP).

d. Stabilizing Hand - Palmar contact on the anterior aspect of the upper shoulder, but minimize lumbar twisting by keeping the shoulders square.

e. Procedure - Pisiform/Hypothenar contact on the upside MP with the doctors arm perpendicular to the body surface; roll the patient slightly and drop using a thigh on thigh technique, while pushing the MP anterior.

f. Line of Drive - Posterior to anterior to induce rotation.

IV. Pelvis and Sacrum:

Patient Prone

1. Reinforced Pisiform/Hypothenar - PSIS Contralateral Contact Push (Ilium)

a. Patient Position - Prone antigravity.

b. Doctor Position - Doctor is positioned contralateral to the side of the contact.

c. Contact Point - Pisiform/Hypothenar contact on the inferomedial aspect of the PSIS on the contralateral side of the body.

d. Stabilizing Hand - Reinforces the wrist of the contact hand.

e. Procedure - Inferior to superior and medial to lateral tissue pull is applied, angle the straightened arm and anterior, lateral, and superior.

f. Line of Drive - Posterior to anterior, inferior to superior, and medial to lateral with a thrust to induce SI Extension.

Patient Side-Lying

1. Pisiform/Hypothenar - PSIS Contact Push (Ilium)

a. Patient Position - Side-lying with the affected side up.

b. Doctor Position - Fencer stance, facing cephalad; thigh on thigh technique used.

c. Contact Point - Pisiform/Hypothenar contact over the inferior surface of the upside PSIS.

d. Stabilizing Hand - Palmar contact on the anterior aspect of the upper shoulder.

e. Procedure - Pisiform/Hypothenar contact over the inferior surface of the upside PSIS; roll the patient forward slightly and drop using a thigh on thigh technique.

f. Line of Drive - Posterior to anterior and inferior to superior with a thrust to induce SI extension.

2. Digital - PSIS Contact Pull (Ilium) (Kick)

a. Patient Position - Side-lying with the affected side up.

b. Doctor Position - Toggle stance with the doctor perpendicular to the table; leg assist technique to be used.

c. Contact Point - Digital contact over the upside PSIS.

d. Stabilizing Hand - Palmar contact on the anterior aspect of the upper shoulder.

e. Procedure - Digital contact over the upside PSIS; Use leg assist technique to pull the segment anterior and superior.

f. Line of Drive - Posterior to anterior and inferior to superior with a thrust to induce SI extension.

3. Pisiform/Hypothenar - Ischium Contact Push (Ilium)

a. Patient Position - Side-lying with the affected side up.

b. Doctor Position - Fencer stance, facing cephalad; thigh on thigh technique used.

c. Contact Point - Pisiform/Hypothenar contact over the ischial tuberosity with a posterior ischium contact, using thigh on thigh technique.

d. Stabilizing Hand - Palmar contact on the anterior aspect of the upper shoulder.

e. Procedure - Pisiform/Hypothenar contact over posterior upside ischial tuberosity; roll the patient forward slightly and drop using a thigh on thigh technique.

f. Line of Drive - Posterior to anterior with a thrust to induce SI flexion (like our lower SI extension adjustment).

4. Pisiform/Hypothenar - Sacral Base Contact Push (Sacrum)

a. Patient Position - Side-lying.

b. Doctor Position - Fencer stance, facing cephalad; thigh on thigh technique used.

c. Contact Point - Pisiform/Hypothenar contact directly over the S2 tubercle, using thigh on thigh technique.

d. Stabilizing Hand - Palmar contact on the anterior aspect of the upper shoulder.

e. Procedure - Pisiform/Hypothenar contact over S2 tubercle; roll the patient forward slightly and drop using a thigh on thigh technique, while pushing anterior.

f. Line of Drive - Posterior to anterior with a thrust to induce sacral flexion (our nutation adjustment).

5. Pisiform/Hypothenar - Sacral Base Contact Involved Side Up Push (Sacrum)

a. Patient Position - Side-lying with the involved side up.

b. Doctor Position - Fencer stance, facing cephalad; thigh on thigh technique used.

c. Contact Point - Pisiform/Hypothenar contact lateral to the S2 tubercle and medial to the PSIS, using thigh on thigh technique.

d. Stabilizing Hand - Palmar contact on the anterior aspect of the upper shoulder.

e. Procedure - Pisiform/Hypothenar contact lateral to the S2 tubercle and medial to the PSIS; roll the patient forward slightly and drop using a thigh on thigh technique, while pushing anterior.

f. Line of Drive - Posterior to anterior with a thrust to induce sacral flexion (our nutation adjustment).

6. Digital - Sacral Base Contact Involved Sides Up Pull (Sacrum)

a. Patient Position - Side-lying with the involved side up.

b. Doctor Position -Toggle stance, perpendicular to the patient; leg assist technique to be used.

c. Contact Point - Digital contact lateral to the S2 tubercle and medial to the PSIS, using thigh on thigh technique.

d. Stabilizing Hand - Palmar contact on the anterior aspect of the upper shoulder.

e. Procedure - Digital contact lateral to the S2 tubercle and medial to the PSIS; pull the sacrum anterior with a leg assist.

f. Line of Drive - Posterior to anterior with a thrust to induce sacral flexion (our nutation adjustment with a kick).

7. Pisiform/Hypothenar - Sacral Base Contact Involved Side Down Push (Sacrum)

a. Patient Position - Side-lying with the involved side down.

b. Doctor Position - Fencer stance, facing cephalad; thigh on thigh technique used.

c. Contact Point - Pisiform/Hypothenar contact lateral to the S2 tubercle and medial to the PSIS on the downside, using thigh on thigh technique.

d. Stabilizing Hand - Palmar contact on the anterior aspect of the upper shoulder.

e. Procedure - Pisiform/Hypothenar contact lateral to the S2 tubercle and medial to the PSIS on the downside; roll the patient forward slightly and drop using a thigh on thigh technique, while pushing anterior.

f. Line of Drive - Posterior to anterior with a thrust to induce sacral flexion (our nutation adjustment).

8. Pisiform/Hypothenar - Sacral Apex Contact Involved Side Down Push (Sacrum)

a. Patient Position - Side-lying with the involved side down.

b. Doctor Position - Fencer stance, facing cephalad; thigh on thigh technique used.

c. Contact Point - Pisiform/Hypothenar contact lateral aspect of the sacral apex on the downside, using thigh on thigh technique.

d. Stabilizing Hand - Palmar contact on the anterior aspect of the upper shoulder.

e. Procedure - Pisiform/Hypothenar contact the lateral aspect of the sacral apex on the downside; roll the patient forward slightly and drop using a thigh on thigh technique, while pushing anterior.

f. Line of Drive - Posterior to anterior with a thrust to induce sacral extension (our cross-fix adjustment).

V. Extremity

Patient Seated

1. Reinforced Palmar - Olecranon Contact AP Glide Pull (Anterior Shoulder)

a. Patient Position - Patient seated with shoulder and elbow flexed at 90 degrees.

b. Doctor Position - Behind the patient and at the same level as the patient in order to block to motion of the scapula; doctor reaches around patients chest to contact the olecranon.

c. Contact Point - Reinforced palmar contact over the olecranon of the affected arm, while wrapping both the doctors arms around the patients torso.

d. Stabilizing Hand - Palmar contact over the contact hand to reinforce with stabilization of the scapula.

e. Procedure - Reinforced palmar contact over the olecranon of the affected arm with shoulder at 90 degrees of flexion, while the doctor stabilizes the patients scapula; pull posterior with an impulse thrust.

f. Line of Drive - Anterior to posterior along the humeral axis with a thrust to induce anterior to posterior accessory joint motion.

2. Reinforced Palmar - Olecranon Contact AP Glide Pull (Anterior Shoulder)

a. Patient Position - Patient seated with shoulder and elbow flexed at 25-45 degrees.

b. Doctor Position - Behind the patient and at the same level as the patient in order to block to motion of the scapula; doctor reaches around patients chest to contact the olecranon.

c. Contact Point - Reinforced palmar contact over the olecranon of the affected arm, while wrapping both the doctors arms around the patients torso.

d. Stabilizing Hand - Palmar contact over the contact hand to reinforce with stabilization of the scapula.

e. Procedure - Reinforced palmar contact over the olecranon of the affected arm with shoulder at 25-45 degrees of flexion, while the doctor stabilizes the patients scapula; pull posterior and superior with an impulse thrust.

f. Line of Drive - Anterior to posterior and inferior to superior along the humeral axis with a thrust to induce anterior to posterior and inferior to superior accessory joint motion.

3. Thumb - Radial Head Contact PA Glide Push (Posterior Radius)

a. Patient Position - Patient seated with elbow slightly bent

b. Doctor Position - Standing on the side of the affected arm at the side of the contact.

c. Contact Point - Thumb contact on the posterior radial head

d. Stabilizing Hand - Grasping the distal forearm or wrist to induce pronation of the elbow.

e. Procedure - Patients elbow starts in flexion, and the posterior radial head contact is maintained while the elbow is extended; an impulse thrust is applied anteriorly.

f. Line of Drive - Posterior to anterior with a thrust to induce posterior to anterior accessory joint motion of the radiohumeral joint.

4. Reinforced Thumb - Individual Carpal Contact PA Glide Push (Posterior Carpal)

a. Patient Position - Patient seated with elbow extended and pronated

b. Doctor Position - Standing on the side of the affected arm.

c. Contact Point - Reinforced thumb over the carpal bone in question.

d. Stabilizing Hand - Reinforcing the contact hand.

e. Procedure - Reinforced thumb contact over the carpal bone in question; the wrist is extended, and an impulse thrust is applied anteriorly by extending the elbows.

f. Line of Drive - Posterior to anterior with a thrust to induce posterior to anterior glide of the carpal bone in question.

5. Palmar - Distal Radius Contact Pull (Radiohumeral Distraction)

a. Patient Position - Seated with arm press against the patients axilla and the elbow flexed to 90 degrees.

b. Doctor Position - Standing on the side of the affected arm.

c. Contact Point - Grasping the forearm in order to distract the radiohumeral joint.

d. Stabilizing Hand - Palmar contact grasping the biceps muscle of the affected arm and pushing posteriorly.

e. Procedure - Palmar contact on the forearm while the humerus is stabilized; pull anteriorly with an impulse thrust.

f. Line of Drive - Pull the forearm with a thrust to induce long axis distraction at the radiohumeral joint.

Patient Standing

1. Palmar or Thumb/Index - Olecranon Contact Push (Ulnohumeral Extension)

a. Patient Position - Patient standing with arm extended.

b. Doctor Position - Doctor standing on the side of the affected arm.

c. Contact Point - Palmar or thumb/index contact on the olecranon of the affected arm.

d. Stabilizing Hand - Grasping the forearm or the wrist of the affected arm, pushing the elbow into extension.

e. Procedure - With the contact hand apply pressure to the olecranon in an anterior direction (upward) through the ulnohumeral joint.

f. Line of Drive - Posterior to anterior with a thrust to induce ulnohumeral extension.

Patient Supine

1. Bimanual - Proximal Humerus Contact (GH Circumduction)

a. Patient Position - Patient supine with arm extended.

b. Doctor Position - Doctor standing on the side of the affected arm.

c. Contact Point - Grasp the proximal humerus with both hands.

d. Stabilizing Hand - Grasping the proximal humerus in order to provide GH circumduction; distal forearm stabilized under the doctors arms or betwwen the doctors knees.

e. Procedure - With the both hands apply traction to the GH joint while giving motion to the GH joint in a figure 8 fashion.

f. Line of Drive - Bimanual contact grasping the proximal humerus allows the line of drive to be circumduction and distraction, and this motion must be performed in both directions.

2. Bimanual - Proximal Humerus Contact (Internal/External Rotation)

a. Patient Position - Patient supine with arm extended and against the axilla.

b. Doctor Position - Doctor standing on the side of the affected arm.

c. Contact Point - Grasp the proximal humerus with both hands with the thumbs pointing upwards.

d. Stabilizing Hand - Grasping the proximal humerus in order to provide GH internal and external rotation; Distal forearm stabilized against the doctors body.

e. Procedure - With the both hands apply traction to the GH joint while giving motion to the GH joint in a internal and external rotation.

f. Line of Drive - Bimanual contact grasping the proximal humerus allows the line of drive to be internal and external rotation, as well as distraction.

3. Bimanual Thumb Web - Patellar Contact (general mobilization)

a. Patient Position - Patient supine with leg extended.

b. Doctor Position - Doctor standing on the side of affected leg.

c. Contact Point - Grasp the medial and lateral poles of the patella of the affected leg with both hands as the web of each hand straddles the patella.

d. Stabilizing Hand - Grasping with the contact hand.

e. Procedure - General mobilization of the patellofemoral joint is performed by motioning the patella medial to lateral, lateral to medial, inferior to superior, and superior to inferior.

f. Line of Drive - Lateral, medial, inferior, and superior mobilization of the patella of the affected leg.

4. Reinforced interphalangeal - Anterior Talus Contact Pull (Ankle Distraction)

a. Patient Position - Patient supine with leg extended and hip flexed to 45 degrees.

b. Doctor Position - Doctor standing on the side of affected leg at the foot of the table.

c. Contact Point - Reinforced interphalangeal contact over the anterior talus, and the doctors hands wrapped around the feet, so that the thenar eminences are on the plantar aspect of the foot with the thumb pointing upward.

d. Stabilizing Hand - Grasping the foot with a reinforced interphalangeal contact while passively flexing the hip joint to 45 degrees in the affected leg.

e. Procedure - With a reinforced interphalangeal contact and the hip flexed at 45 degrees, traction is applied to the ankle joint, along with dorsiflexion, effersion, and internal rotation of the entire leg.

f. Line of Drive - Distraction along the axis of the tibia.

5. Bimanual - Distal Tibial Contact Pull (Coxofemoral Distraction)

a. Patient Position - Patient supine with leg extended.

b. Doctor Position - Doctor standing on the side of affected leg at the foot of the table.

c. Contact Point - Grasp the distal tibia with both hands, so that the thumb overlap on the anterior tibia.

d. Stabilizing Hand - Grasping the distal tibia with both hands and crossing the thumbs over the ridges of the tibia.

e. Procedure - Grasping the distal tibia with both hands and crossing the thumbs over the ridges of the tibia, distract the coxofemoral joint in a long axis of extension fashion with an impulse thrust inferiorly.

f. Line of Drive - Distraction along the long axis of the femur and the coxofemoral articulation.

6. Reinforced Thumb - Fibular Head Contact AP Glide (Anterior Fibula)

a. Patient Position - Patient supine with leg extended and hip and knee flexed to 45 degrees.

b. Doctor Position - Doctor standing on the side of affected leg at the foot of the table.

c. Contact Point - Thumb on the anterior surface of the fibular head.

d. Stabilizing Hand - Supports the tibia medially with a thumb contact over the anterior fibular head.

e. Procedure - Stabilizing hand supports the tibia medially with a thumb contact over the anterior fibular head; other hand reinforces the thumb with a hypothenar contact over the thumb; impulse thrust is made posteriorly through the tibiofibular joint.

f. Line of Drive - Anterior to posterior with a thrust into AP glide in the proximal tibiofibular joint.

7. Bimanual - Proximal Tibial Contact Pull (Tibiofemoral Distraction)

a. Patient Position - Patient supine with leg extended.

b. Doctor Position - Doctor standing on the side of affected leg at the foot of the table.

c. Contact Point - Both hands grasp the proximal tibia.

d. Stabilizing Hand - Grasping the proximal tibia along with the contact hand; distal tibia and fibula are stabilized between the knees of the doctor (which are in slight flexion), which then contribute to the distraction of the knee joint.

e. Procedure - An impulse thrust in an inferior direction is applied by the knees extending and the bimanual contact distracting the tibiofemoral joint.

f. Line of Drive - Distraction along the long axis of the tibia to create long axis of extension in the knee.

Kirk CR, Lawrence DJ, and Valvo NL. States Manual of Spinal, Pelvic and Extravertebral Techniques. Department of Chiropractic National College of Chiropractic. Lombard, Il., 2nd ed. 1985.

Part IV

Board Review

Chiropractic

Technique