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Gonstead Technique Study SheetFall 2006
ListingPatient Position(P.P.)Contact Point(C.P.)Segmental ContactPoint (S.C.P.)General FingerPositionApproximateLine of Correction (L.O.C.)Miscellaneous
Lower Cervical Adjustments (C2-C7)
PRSeatedRight index, distal-lateral portionRight posterior inferiorspinous processCH - Rat hole, IH-fingers down neckP-A, R-L through ptsopposite eye, *** alongplane line of diskPLSeatedLeft index, distal-lateral portionLeft posterior inferiorspinous processCH - Rat hole, IH-fingers down neckP-A, L-R through pt'sopposite eye, *** alongplane line of diskPR-LaSeatedLeft index, distal-lateral portionLeft lamina of involvedsegment (opposite ofthe listing)CH - Rat hole, IH-fingers down neckP-A through pt's same sideeye, *** along plane line ofdiskPL-LaSeatedRight index, distal-lateral portionRight lamina of involvedsegment (opposite ofthe listing)CH - Rat hole, IH-fingers down neckP-A through pt's same sideeye, *** along plane line ofdiskPRSSeatedRight index, distal-lateral portionRight posterior inferiorspinous processCH - Rat hole, IH-fingers down neckP-A, R-L through ptsopposite eye, CW torque,*** along plane line of diskPLSSeatedLeft index, distal-lateral portionLeft posterior inferiorspinous processCH - Rat hole, IH-fingers down neckP-A, L-R through pt'sopposite eye, CCW torque,*** along plane line of diskPRI-LaSeatedLeft index, distal-lateral portionLeft lamina of involvedsegment (opposite ofthe listing)CH - Rat hole, IH-fingers down neckP-A through pt's same sideeye, De-rotate spinous withP-A, CCW torque, ***along plane line of diskPLI-LaSeatedRight index, distal-lateral portionRight lamina of involvedsegment (opposite ofthe listing)CH - Rat hole, IH-fingers down neckP-A through pt's same sideeye, De-rotate spinous withP-A, CW torque, *** alongplane line of disk
GENERAL NOTES FOR LOWER CERVICALS:
> Cervical adjustments as presented at this level, should be performed in the Cervical Chair.( More advanced techniques may take advantage of the knee-chest, and the Zenith Hi-Lo table)> The line of correction should include a slight lift at the beginning of the thrust to bring the vertebra up "into the saddle" and then follow the disk plane line> Modify the disk plane to suit the individual patient during a thrust.> Stabilization hand should be held steady and not "whipped". Too much thenar pressure will cause a "whip" of the head> Stabilization hand should contact the antero-lateral neck at the level below the one you are adjusting.You should think about "catching" the vertebra you are adjusting at the MCP or distal portion of your index and middle finger of the stabilizing han> Extension of the neck should not bring the chin past level; only enough to cause the segment you are adjusting to just begin to move.> Spinous contacts are at the posterior, inferior lateral aspect of the Spinous.> The location of the lamina contact is approximately 1/8" lateral and 1/8" superior to the cervical spinous process.> Torques: Right side contacts are clockwise, and left side contacts are counter-clockwise (we are always contacting the open wedge side).> Remember to "squash the grape" when you thrust - it will give you speed and help with the appropriate torque.> Keep your muscles relaxed until you actually thrust, a tight muscle has no speed. Most of the speed and depth occur within the first 1-1 1/2 inches.> All gonstead adjustments are a thrust and HOLD for a beat - this takes advantage of ligamentous creep.LOC must take into account facets anddisk plane. Disk planes vary frompatient to patient so set angles areinappropriate. The doctor must alignhim/herself with the patient's disk andthen align slightly lower toaccommodate the facets.Each segment will require an I-S lift(relative to that segment) and then thethrust should aim along the plane of thedisk (which is essentially perpendicularto the patien's back at that level).
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Gonstead Technique Study SheetFall 2006
ListingPatient Position(P.P.)Contact Point(C.P.)Segmental ContactPoint (S.C.P.)General FingerPositionApproximateLine of Correction (L.O.C.)Miscellaneous
Atlas AS Cervical Adjustments (C1)
ARSeatedThumbpad, RighthandRight Lateral TVP R-LALSeatedThumbpad, LefthandLeft Lateral TVP L-RASRSeatedThumbpad, RighthandRight Lateral TVP R-L, CW torqueASLSeatedThumbpad, LefthandLeft Lateral TVP L-R, CCW TorqueASRASeatedThumbpad, RighthandRight Lateral TVPR-L, CW torque, prestressposteriorly (nose towardcontact)ASLASeatedThumbpad, LefthandLeft Lateral TVPL-R, CCW Torque,prestress posteriorly (nosetoward contact)ASRPSeatedThumbpad, RighthandRight Lateral TVPR-L, CW torque, prestressanteriorly (nose away fromcontact)ASLPSeatedThumbpad, LefthandLeft Lateral TVPL-R, CCW torque,prestress anteriorly (noseaway from contact)
Atlas AI Cervical Adjustments (C1)
AIRProneSoft Pisiform ofRight handRight Lateral TVP R-L, CCW torqueAILProneSoft Pisiform ofLeft handLeft Lateral TVP L-R, CW torqueAIRAProneSoft Pisiform ofRight handRight Lateral TVP R-L, CCW torque, A-PEpisternal notch anterior to ContactPointAILAProneSoft Pisiform ofLeft handLeft Lateral TVP L-R, CW torque, A-PEpisternal notch anterior to ContactPointAIRPProneSoft Pisiform ofRight handRight Lateral TVP R-L, CCW torque, P-AEpisternal notch Posterior to ContactPointAILPProneSoft Pisiform ofLeft handLeft Lateral TVP L-R, CW torque, P-AEpisternal notch Posterior to ContactPointFor AS listings: Pt is in the cervical chair. LOC is across the line of the shoulders, through the plane of the atlas> Hand position, AS listings: Somewhat flat hand, thumb pulled in tight, slight wrist extension, lateral index finger along suboccipital musculature.Line of Drive: across the plane line of the atlas (send your thrust out the opposite TVP of atlas)For AI listings: The patient is on the knee-chest table with the side of laterality turned upward. The doctor is standingon the side the patient's face is turned toward (i.e. AIR: Rule - RIGHT side up, RIGHT hand contact, Doc on the Pt's RIGHT)remember: "right,right,right/left,left,left"> "squashing the grape" under your arm as you thrust helps you produce the appropriate torque and improves your speed.> AS listings may be performed on the knee -chest with reversed torque. AI listings may be performed in the chair with the patient's chin raisedand torque reversed; the notes in the grid above represent, however, the preferred methodsContact hand is slightly cupped, thumbin tight, wrist in slight extension.A relaxed hand is much faster here.Let the lateral portion of your indexfinger lay along the base of thepatient's skull to monitor the tension onthe sub-occipital musculature. Raisethe patient's chin slightly until thesemuscles relax.
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Gonstead Technique Study SheetFall 2006
ListingPatient Position(P.P.)Contact Point(C.P.)Segmental ContactPoint (S.C.P.)General FingerPositionApproximateLine of Correction (L.O.C.)Miscellaneous
Occipital Listings (C0)
AS-RSSeatedOverlaid Pisiformsor 2nd-4thphalangesRight Supra-orbitalridge A-P, S-I, R-L in a scoopingmotion toward the reion ofthe Dr's opposite kidneyPreload condyles by turning chinslightly down and laterally flexing headto rightAS-LSSeatedOverlaid Pisiformsor 2nd-4thphalangesLeft supra-orbital ridgeA-P, S-I, L-R in a scoopingmotion toward the reion ofthe Dr's opposite kidneyPreload condyles by turning chinslightly down and laterally flexing headto leftAS-RS-RPSeatedOverlaid Pisiformsor 2nd-4thphalangesRight Supra-orbitalridge A-P, S-I, R-L in a scoopingmotion toward the reion ofthe Dr's opposite kidney.Pt's head is pre-positionedin left rotation.Preload condyles by turning chinslightly down, laterally flexing head toright and turning nose away fromcontactAS-RS-RASeatedOverlaid Pisiformsor 2nd-4thphalangesRight Supra-orbitalridge A-P, S-I, R-L in a scoopingmotion toward the reion ofthe Dr's opposite kidney.Pt's head is pre-positionedin right rotation.Preload condyles by turning chinslightly down, laterally flexing head toright and turning nose toward contactAS-LS-LPSeatedOverlaid Pisiformsor 2nd-4thphalangesLeft supra-orbital ridgeA-P, S-I, L-R in a scoopingmotion toward the reion ofthe Dr's opposite kidney.Pt's head is pre-positionedin right rotationPreload condyles by turning chinslightly down, laterally flexing head toleft and turning nose away from contactAS-LS-LASeatedOverlaid Pisiformsor 2nd-4thphalangesLeft supra-orbital ridgeA-P, S-I, L-R in a scoopingmotion toward the reion ofthe Dr's opposite kidney.Pt's head is pre-positionedin left rotation.Preload condyles by turning chinslightly down, laterally flexing head toleft and turning nose toward contactPS-RSSeatedPalmar aspect ofthe metacarpo-phalangeal joint ofthumb.Right Supra-mastoidnotch P-A, S-I, R-L through theC0-C1 joint plane line, in ascooping motionPreload condyles by bringing chinslightly up and laterally flexing head tothe rightPS-LSSeatedPalmar aspect ofthe metacarpo-phalangeal joint ofthumb.Left Supra-mastoidnotch P-A, S-I, L-R through theC0-C1 joint plane line, in ascooping motionPreload condyles by bringing chinslightly up and laterally flexing head tothe leftPS-RS-RPSeatedPalmar aspect ofthe metacarpo-phalangeal joint ofthumb.Right Supra-mastoidnotch P-A, S-I, R-L through theC0-C1 joint plane line, in aslight scooping motion.Pt's head is prepositionedin left rotationPreload condyles by bringing chinslightly up, laterally flexing head to theright and turning nose away from thecontactPS-RS-RASeatedPalmar aspect ofthe metacarpo-phalangeal joint ofthumb.Right Supra-mastoidnotch P-A, S-I, R-L through theC0-C1 joint plane line, in aslight scooping motion.Pt's head is prepositionedin right rotationPreload condyles by bringing chinslightly up, laterally flexing head to theright and turning nose toward thecontactPS-LS-LPSeatedPalmar aspect ofthe metacarpo-phalangeal joint ofthumb.Left Supra-mastoidnotch P-A, S-I, L-R through theC0-C1 joint plane line, in aslight scooping motion.Pt's head is prepositionedin right rotationPreload condyles by bringing chinslightly up, laterally flexing head to theleft and turning nose away from thecontactPS-LS-LASeatedPalmar aspect ofthe metacarpo-phalangeal joint ofthumb.Left Supra-mastoidnotch P-A, S-I, L-R through theC0-C1 joint plane line, in aslight scooping motion.Pt's head is prepositionedin left rotationPreload condyles by bringing chinslightly up, laterally flexing head to theleft and turning nose toward thecontact> All AS listings require a cervical blocker> To make it easier to remember which hand to use and which side to contact, think of the first and third letters of the listing. I.e. PS-RS-RAThe first letter "P" and the the third letter "R" tell you to put your "R"ight hand on the "P"osterior "R"ight side of the patient's head, and then lean the
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Gonstead Tech Study Sheet
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