Activator Special Technique (Track 1: Basic Protocols)

10/8/05
Activator Methos !ssential Scan Protocol "ksh
#ees $ist %or class:
1& Activator (''' is %ine)
(& Paper)ack la) )ook: Activator Methos Technique
Slies:
*istor+:
,ouners: "arren $ee an Arlan ,uhr
o -r $o.an sai so/e a+ there 0oul )e a 1push2)utton3 0a+ to a4ust
Basic
o !5peri/ente 0/ ental i/pactor tools6 center punch6 st+lis instru/ent6 etc
*a//er/anvil principle ental instru/ent (use to split 0iso/
teeth) /an+ protot+pes )e%ore /oern activator tool esi.ne
o 1Mechanical %orce paper3 7 .oo )ecause insurance requires a /anual
thrust )e per%or/e %or rei/)urse/ent
o -i%% ,orce Settin.: retain *8 %req %or spec a/t o% ti/e to sti/ulate
su%%icient /echanoreceptors
Act '': up to 50 *8 activate in the %acets (settin. 9 ( is the hi.hest
%orce)
Act ''': : *8
Preloa a/penin.2 r can use as /uch preloa 0/out
chan.in. the %orce co/in. %ro/ the instru/ent
The /ore /echanoreceptors +ou activate6 the /ore nociceptors are
inhi)ite

o ;MPT: pu)lishe /an+ articles o% Act research

o <esearch: Pins riven into SP=s then /sr urin. a4ust/ent sho0e
/otion : interse./entall+ (proven Act is osseous6 not re%le5 technique)
o ((> increase in stren.th 0hen a4 re/ove spinal sti%%ness (0hat is the
lastin. e%%ect???)
o 'n4ection o% saline in apoph+seal 4ts (technicall+ .aps the 4oint sa/e as
0hat happens 0/ /anual a4ustin.@@@@

-e%n: 1A /otion se./ent in 0hich ali.n/ent6 /ove/ent inte.rit+ an/or

ph+siolo.ical %5 are altere althou.h contact )et0een 4t sur%aces re/ain intact&3
Aatter/an B *ansen
Cieo )+ ,uhr: use optoelectric techn to start relia)ilit+ testin.6 isolation tests 0/
li.ht e/ittin. ioes on )o+
*+pothetical <elationship )et0een le. len.th inequalit+ an $BP (in )ook)
Bio/echanical !%%ects o% $$'
'nvesti.ate the e.ree o% $$' require to i/pose pelvic rotation (o)liquit+ or
AS/P')
A linear relationship 0as %oun )t0n the : in pelvic o)liquit+ an the a/t o% $$'
%ro/ (/8 to D/8 o% an inch
1An+ a/t o% pelvic o)l results in as+//etrical loain. o% assoc li.s preispose
the/ to chronic strain& This /a+ result in s+/pto/atolo.+3
$e. $en.th 'nequalit+ an MM alterations
<eporte : activit+ in the $/S )ack // in response to arti%iciall+ inuce $$'
$$' o% E10 // 7 %oun to elicit an !MA response
Anato/ical vs& ,unctional
o Anato/ical $$'
Actual as+//etr+ or ano/al+ present 0/in the $!
Ma+ )e either con.enital or acquire
Ma+ require *eel $i%t
o ,unctional $$'
Pelvic -e%icienc+
Postural As+//etr+6 Su)
Forrecta)le
'nter2e5a/iner <elia)ilit+ (,uhr)
G !5a/iners visuall+ anal+8e H0 su)4ects in the prone position (relia)ilit+ 0as
,air to Aoo
'solation Tests
( !5a/iners checke %or le. reactivit+ %ollo0in. F1/( isolation test (chin tuck)
Moerate <elia)ilit+ 0as %oun
-e0itt
o Iptoelectric s+ste/: /sr $$' usin. instru/ent
o ( .roups o% su)4ects: 8 pts 0/ chronic spinal co/J&
Su//ar+ o% <elia)ilit+
Metho <elia)ilit+ <atin.
<aio.raph+ ,air to !5cellent
Isseous Pain ,air to !5cellent
ST Pain ,air to Aoo
Prone $e. Fheck ,air to Aoo
Ther/al -evice Poor to Moerate
Motion Palpation Poor to Mo
Static palpation Poor
Su)lu5 Theor+
,acilitate Se./ent: A spinal se. 0hich respons to various sti/ in a /ore
intense an prolon.e /anner than nor/al
'solation Test:
o A .roup o% /otion se. screene %or %acilitation via passive /ove/ent or
active // contraction
o '% %acilitation is present6 an e5.J&&
$e. Fheck
1& Proper patient positionin. on the ta)le (Activator *i.h/$o0 ta)le)
a& -on=t let pt co/e up on their toes
)& Shins /eet )otto/ o% ta)le
c& Fheck pockets %or thin.s %alse positive %or pelvic o)liquit+ (shirt
pocket6 )elt )uckles6 etc)
& Ik to hol on 0/ hans %or pt co/%ort 0hen lo0erin. ta)le (instruct6 touch
pt)
e& '% usin. %lat ta)le: .et on %ro/ en o% ta)le an 0alk the/selves o0n to
l+in. position (.ap o% %eet an ta)le %or le. checks)
%& Ma+ have to put on a4ustin. )oots: %lip %lops are too loose6 0ork )oots
(& Cisuall+ o)serve to eter/ine pelvic o)liquit+
a& $ookin. %or inversion/eversion: )o+=s 0a+ to correct short le.@@@
i& Fheck pts shoes %or 0here the+ are 0orn o0n reco//en ne0
shoes 0hen necessar+
H& Fup /alleoli an )rin. to.ether in /iline (on=t put pressure on the %eet an
ankles a%%ect achilles tenon an arti%iciall+ len.then le.)
a& <elease the %eet
G& Makin. the call (1K pt lanin.3)
a& Thu/) uner the heel o% shoe (%lat6 not %in.ertip)
)& 'ne5 %in.er post to lat /alleoli an /ile %in.er ant to lat /alleoli
c& -r stans in scissor stance (lean in to take out the %lare) eter/ine short
le. <elease the le.s then .o to pale 0heel
& "/ %in.er catch at /etatarsal2phalan.eal 4unction (like a pale 0heel)
e& Aet plantar %le5ion6 rock )ack6 then )rin. up to Position (
5& Position (: release le.s %ro/ the K pt lanin.
a& Brin. %eet up at L0M
)& ,in.er alon. )ase o% shoe 0here sole an leather /eet 0/ thu/) on
)otto/ o% shoe at the toes
c& Tr+ to %latten out %eet (N plantar %le5ion)
& 1Mirror i/a.e3 o% %eet
e& Fontrainications %or Position (: achiles rupture/s5
%& $ookin. at the !IP %or /iline check the 1C3 )et0een the shoe heels
i& "ant to see i% the le. len.thens or shortens
Onees B ,eet:
Three Possi)ilities o% $e. Fheck ,inin.s:
1& Short le. len.thens in Position 9( (//c) )e.in 0/ knee B %eet
Start 0/ Onees:
o Pressure test con%ir/s /eial knee o% the P- le.: a4 thru MF$ into the
/eniscus in in%/lat .lie a4ust the talus (o0n %ro/ /e /alleolus in
PS$at $I- )ecause it su)lu5es in an A'Me irection)
<epeat on opp sie
M/F involve/ent o% /eial knee o% P- le. (0ill )e tener@@@)
o Pressure test con%ir/s lat knee o% P- le.: a4 thru $F$ into the /eniscus
in in%//e .lie a4ust cu)oi (/e sie o% %oot 2 su)lu5 A'$at6 a4ust
PSMe $I-)
<epeat on opp sie
o Inl+ a4ust area that i/prove $$' upon Pressure test@@@@
Ao to Pelvis:
o Sche/atic o% Pelvis (prone position) 7 in )ook (K pt pelvic pattern)
$e%t Sie P-: P' 'liu/ is on the $e%t
Contact Pts for PI
Ilium (on PD side) LOD
Contact Pts for AS
Ilium LOD
Spine o% 'schiu/
(SMe %ro/ ischial
tu)erosit+)
PS$at Post& Base o% sacru/ P lat to 1
st
sacral
tu)ercle
Qner Sacrotu)&
$i. to0ar S' 4t
PS$at Frest o% 'liu/ A'Me
'liac ,ossa AS 'schial Tu)erosit+ A'
Inl+ a4ust 0here $$' i/prove upon Pressure test@@@@@
Ao to Pu)ic Bones:
o Pt squee8e knees to.ether .et $$' pt .oes supine %or a4ust/ent
o P- sie has Sup pu)ic )one in% $I-
'n% pu)ic )one opp sie o% P- (has .one 'n%)
o Technique: r han on top o% pt han start /e to AS'S an .o o0n
till %eel )one resistance ask pt to re/ove han6 r con%ir/s contact an
a4ust thru r thu/)
o $I#A2S*I<T <ule: (%or isolation test)
(& Shortenin. o% the short le. in Position 9( )e.in at $G
H& $evel le.s in Position 91 an in 9( )e.in )+ squee8in. knees to.ether (pu)es)
-e%n o% Ter/s:
Stress Test: per%or/e )+ -<
o Aentle pressure in irection o% su)lu5ation
o '% i/proves $$'6 correct in opp irection o% test
Pressure Test: per%or/e )+ -< (1
st
test a%ter %in P-)
o Aentle pressure in the irection o% correction
o '% i/proves $$'6 correct in irection o% test
o Must .et pelvis line up )e%ore .et correct results 0/ rest o% the spine
'solation Test: per%or/e )+ PT
o Basic Protocol %or clearin. the spine
o Long-Short Rule: if test causes PD Leg to lengthen=sulu! on PD side
If test causes PD Leg to shorten =sulu! on OPP side
Be.in:
Pt steps on M'--$! o% plat%or/: nothin. in %ront pockets (prop )o+ up)
o Shins a.ainst the plat%or/
o Fan hol on to sies o% ta)le (especiall+ .eriatrics) -< han on lo0
)ack 0hen .oin. o0n or co/in. up
o Talk to patient as to 0hat is .oin. on
#eutral prone position: 0here testin. )e.ins (ar/s at sies 0/ pal/s up)
Steps:
o Cisual o)servation: e5cessive shoe 0ear6 inversion (ti) ant //)6 etc
*o0 ol are shoes? (/a+ nee orthotics in K /os6 or i% ( +rs .et
ne0 pair o% shoes
o Fup /alleoli 7 )rin. into the center hans co/e o%%
o Si5 Point $anin.: -< at scissor stance6 contact )oth %eet at the sa/e
ti/e (thu/)s %lat uner heel o% shoe)R sli.ht hea0ar pressure
Take out an+ supination6 inversion
o Aoin. to position (: /ile %in.er at /etatarsals6 li%t up into 1si52shooter3
position (rock )ack 7 archin. /otion up to position ()
Flear Pelvis (see a)ove notes thru pu)ic )ones)
$u/)ar spine $56 $G6 $(
SS$evels )ase on %requenc+ o% su)lu5ations an transitional se./ents
CB $evel Pt per%or/s !5tra
$5 P- ar/ on lo0 )ack
$G Ipp P- ar/ on lo0 )ack
$( Both hans on lo0 )ack
T1( P- ar/ up ne5t to hea Fheck ri): sa/e test )ut inhale B hol
T8 Both ar/s up Aall)laer
TK "urn head to side of PD## Sto/ach
TG SS$i%t P- shouler o%% ta)le Asth/a
T1 SSShru. shoulers an rela5 *eart
T 1
st
<i) SSShru. an roll the ri)s <aicular s+/pto/s@@ (pull traps )ack
0hen /akin. a4ust/ent 7 'n%)
Scapula SSSquee8e P- ar/ into sie
(check opp sie %or relate
su)lu5ation )+ squee8in. opp ar/
into sie)
'n% )orer su)lu5ate to0ar tall le.
(P- le. T /eial scapula /ost o% the
ti/e
FD Return head to neutral <aicular s+/pto/s
F5 $i%t hea o%% ta)le (4ust li%t chin)
F( Tuck chin to chest '% shortens T F( su)lu5 opp P- sie
(heaaches)
F1 Tuck chin '% len.thens T F1 su)lu5 on P- sie
Icciput #eutral )o+ position
$on. short rule %or a4ustin. (len.thens in Position ( T on sie o% P-)
$I- T AS in the spine (%ollo0 AP curves)
Fontact points:
o $/ST /a/illar+
o T/ST TP
o F/ST peicle/la/inar 4unction ($I- T AS in plane o% %acet)
Atlas su)lu5 $I- strai.ht Me
A4ust thru -< thu/)nail (unless have Activator 'C .un)
o Icciput T 'n% #uchal line ($I- T strai.ht A thru thu/)) check occiput
(5 (possi)le to have on )oth sies 7 su)occ *A=s6 sinus)
*eaache that starts at occiput Q/$ an co/es over hea to the
ipsilateral e+e (su)occipital *A ue to .reater/lesser occipital n=s)
Flinicall+: 0ant to kno0 i% ha $BP 1
st
or le. pain 1
st
(vice versa)
o '% le. pain 1
st
T /a+ )e a isc (*#P6 )ul.e)
o '/portant to have /sr o% cal% //=s 0eekl+ (lookin. %or atroph+)6 sen pt
to !< i% )e.in to have pro)le/s urinatin.@@ co/pressive in4ur+
T102T( su)lu5ation T A$SI o the opp ri) ('$at)
o ,loatin. ri)s: o pressure test to %in correct $I-
&
&
&
Long-short Rule
$en.thens in
position ( T
a4ust on sie
o% P-
Shortens in
position ( T
a4ust on opp
sie o% P-
'% !ven T /ove
on to ne5t
isolation test
Practice Tips:
1& Fall ne0 patients evenin. a%ter their %irst visit to check an see ho0 the
a4ust/ent 0ent&
(& Sen out 0elco/e letters %or ne0 patients&
a& (
n
visit is the <I,
H& Billin./-ocu/entation: )ill %or ( t/t areas 7 .et lon.er ti/e %or treat/ent an not
re %la. )+ sa+in. ever+ area in the spine 0as a pro)le/ (/ust )e a)le to )ack up
clai/ /ore than 4ust a su)lu5 in the area 7 prove it is causin. hlth pro))
G& Oeep ti/e 0/ pts as short as possi)le 0hile still keepin. the personal touch&
a& '% pt has a question that 0ill take a 0hile6 have the/ leave their 9 an U=s
at %ront esk an call the/ )ack
)& Al0a+s keeps pro/ise to a patient (no /atter 0hat@@)
5& Activities o% ail+ livin.: ask pt 0hat it is the+ 0ant to o that their conition is
inhi)itin. the/ %ro/ oin.&
a& Aives +ou a .oal to help the pt reach 7 /ore co/pliant to +our t/t
)& !V: pla+ .ol% thru H
r
hole 0/out painR )e a)le to 0alk at the 8oo/pla+ 0/
kis6 etc
i& "t loss: ' can treat +ou at the 0t +ou are no0 0/ .oo results6 )ut
0e 0ill 0ork on this to.ether to .et )etter results (le. len.th
as+//etr+ coul )e causin. pain urin. 0alkin. an causin. the
pain keeps the/ %ro/ e5ercisin.)
ii& Fan onl+ take responsi)ilit+ %or 0hat +ou o can=t chan.e the
thin.s the pt is in control o% (e5: o% entist re/ovin. cavities )ut
can=t prevent the/ ' can re/ove su)lu5ations )ut ' can=t chan.e
+our li%est+le)
iii& Aol%er/)o0lin./tennis: %i.ure torsion in4ur+
1& < hane .ol%er .ets $ torsion (e5plain la+ers o% the isc
cause isc to separate/e.enerate
(& T0ist on cart to the ri.ht an hol %or 10 sec (o on o 9
holes6 etc)
K& Ba)ies: (in%ant up to 0alkin.) 7 put in .roove o% ta)le l+in. on )ack (/o/ on
other sie o% ta)le)
a& <oll knees to.ether len.th assess/ent (look at creases on achilles
tenon6 use ruler/)ook across the heel %or 1K point lanin.3
)& A4ust Atas (strai.ht /eial) on P- sie (91 settin. thru thu/))
c& "hen ki can 0alk 7 treat as ault (epenin. on hei.ht6 either lo0er like
nor/al or pick up an put knees as certain point (le.s in ri.ht place) an
have the/ 0alk hans o0n strai.ht
& Act quickl+ )ecause the+ 0on=t hol still (.et .oo rea on pelvis)
i& Tip: .et P- an o knees all at once (( %in.ers on each sie o% )oth
knees usuall+ not a knee pro)le/R i% .et a pos 7 have to stress
test all
ii& #e5t stress test AS an P' then a4ust 0hat +ou %in
D& "hen +ou .et a pt co/in. into +our o%%ice %or non2/usculoskeletal conitions
+ou are oin. +our 4o)@@@
a& Ti/e pt is on the ta)le 7 use %or pt eucation (chie% co/plaint is
constipation6 etc@)
)& <e%errals %or other conitions also
8& Acute Patients:
a& Antal.ic6 1hot lo0 )ack3 7 can=t tolerate /anual a4ustin.
i& "ith activator 7 can a4ust 0hile the+ are in acute pain (.et relie%)
ii& Tips: not ever+ one can .o o0n %lat 7 pain /a+ increase as lo0er
ta)le 7 /a+ nee to stop ta)le an .ive ti/e to catch their )reath
then keep lo0erin. i% the+ 1hike up the hip3 7 can put in SIT
)locks to allo0 the/ to )e lo0ere the rest o% the 0a+ tr+ to
0ork )lock out i% possi)le (0ill a%%ect the $$')
1& Block accorin. to the P- %inin.: )lock at crest on AS
sie an trochanter at P' sie
(& Bio%ree8e an /assa.e 1hot3 S' 4t (leave on )locks %or
a0hile)
H& "hen )rin. up tell pt the+ /a+ have pain:
a& '% %eel 1re hot poker at S' area3 T support pt an
have the/ 0alk aroun a little (1( steps 0t )earin.)
put )ack on the ta)le an recheck the le. %i5
a.ain (not ver+ sta)le) .ive instructions an sen
the/ ho/e (on=t 0ant the/ han.in. aroun the
o%%ice)
)& '% 4ust %eel i%%use pain: ice (2G5 a a+6 on=t sit
lon.er than H0 /in at a ti/e (keep /otion in 4t)6
on=t sit in strai.ht/upri.ht chair (ischial tu)e stress
ri.ht into S')R see to/orro0
L& Scoliosis: %in /a4ors ()ase6 ape56 top)
a& *ave to clinicall+ assess 0hich ones are the /ost i/portant (0ill %in
/an+ su)lu5 in the )asic scan 7 on=t a4ust all@
)& <eistri)ute stresses an keep the/ out o% pain (not .oal to strai.hten
spine i/prove %5 an activities o% ail+ livin.)
c& '% /ake pro/ises to strai.hten6 +ou set +oursel% up to %ail 0/ pt i% it
oesn=t happen (i% it oes6 the pt is that /uch /ore trustin. in +our a)ilit+)
10& Post2a4ust/ent soreness: ha it %or a 0hile6 li.=s/// aapt '=/ correctin. it
an the )o+ has to no0 reaapt to ne0 position (e5: )races: orthoontist ti.htens
an it hurts until the teeth reali.n so/e /ore 7 on=t 4ust crank into 1ri.ht
position3 )ut in sta.es)
11& Pt that asks i% that is all +ou are .oin. to o toa+? 7 Analo.+ o% sur.on re/ovin.
appeni5 an ecies to re/ove the spleen 0hile he is in there
1(& -ou)le a/putee 7 a%ter isolation tests6 check their ar/ reach a)ove hea