Cervical Technique Power Point M Johnson PDF

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 ROM—the patient
performs the motion;the doctor measures motion amount)
6. Perform selected Orthopedic Exams to

determine structural stability*
*Always consider cautions/contraindications to
exams.
(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.
(continued)
9. Assess Line Drawings on X-ray films to
determine structural departures from
established chiropractic norms—to 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. Gindl’s Essentials for Cervical-Upper Thoracic Technique Class, Gindl, P.S., pages 1 – 8.
CASE HISTORY OF THE PATIENT—2 Aspects
 Today’s Health Problem: History of patient’s

“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. Gindl’s Essentials for Cervical-Upper Thoracic Technique Class, Gindl P.S., pages 171-3
 8 Parameters Determining • Quality/severity
History of Chief Complaint • What aggravates or relieves
• Date of onset • Previous treatment for
• Duration/Frequency complaint?
• Mode of onset • Was previous treatment
• Type of pain helpful?
• Location of complaint • 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. Gindl’s Essentials for Cervical-Upper Thoracic Technique Class, Gindl P.S., pages 5-6.
Visualization Examples
Visually Scan for asymmetry
Head High
Shoulder
Tilt
High
Hip
MORE VISUAL
EXAMPLES
 Visually scan for asymmetry
Head
Tilt High
Shoulder
Scoliosis
High
Hip
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 ¼ inch below mid-thermocouples (at
inferior rim of probe)
– C7 – S2 – Place mark ½ inch above mid-thermocouples
– GLIDE TIMES: Cervicals– 20 seconds
Thoraco-Lumbar—40 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. Rust’s Sign)
• Advanced atherosclerosis ( i.e. positive George’s
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. Gindl’s 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 patient’s
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
(Bird’s eye view – patient SUPINE)
• Example of Right Rotation
R
NEUROLOGICAL REFLEXES --
(SUGGESTIONS)
Position patient well (comfortably)

Position yourself well
Don’t let the patient assist with the exam
Apply the stroke for a “rebound” effect
Compare the reflexes bilaterally
See: Dr. Gindl’s 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. Gindl’s 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;
Jackson’s Compression Test
 Shoulder Depressor Test
 Adson’s Sign
(Scalenus Anticus Syndrome Test)
 Soto Hall Test**
 Derifield Leg Check (Cervical Part)
**See Technique Department Web Site—Cervical—Johnson—Week Section—Select
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 Jackson’s Compression Test.
 Shoulder Depressor Test: *Radiculitis or pain from the muscle stretch;

“adhesions of the dural sleeves;”
 Adson’s Sign: *Spasm of the Scalenus Anticus muscle may compress the
subclavian artery; “Nerve Root irritation at IVF;” Cervical Rib;
 Soto Hall: * “Noticeable localized pain—vertebral fracture; Diffuse pain:

DJD; DDD; Sprain or strain” (This is a general test.)
 Reference for “Indications” in quotation marks: Dr. Gindl’s 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.]
mechanism…augment stretch reflexes.)
 Reference: Israel, C., D.C.
Derifield Leg Exam—Physiology
(#3)
Involves a 1st order neuron
Travels Dorsal Column: feet to cervical medullary
area
Decussates and synapses with 2nd order neuron
Reflex arc reaction affects leg length*
*Reference: Gindl P, Essentials for Cervical-Upper

Thoracic Technique Class, 9th ed., 2003, p. 20
 ** NOTE: Many theories exist concerning leg exam

findings for leg balance & imbalance.
Derifield Leg Exam—Procedure
(#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 patient’s head.
o Clinical significance is noted when the short leg does become even or
longer than the initial long leg when the patient’s head is turned.
o The finding is labeled and noted in the patient’s 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 patient’s head, right or left).
 Record finding: RCS; LCS; Bilateral CS;
(or NCS)
With a finding of Cervical Syndrome, palpate the patient’s side of

posterior body rotation (opposite side of the head turn that
produced the clinical significance finding—C2-C6 levels) for taut,
tender fibers or nodular swelling. Palpate the C2-C6 Lamina-Pedicle
Junction while the patient’s head remains in the “ head turned”
position.
ADDITIONAL PRACTICE/REVIEW FOR MO/PAL EXAM:
ORTHOPEDIC EXAMS (STABILITY EXAMS);REFLEXES;
RANGE OF MOTION (ROM)
 JACKSON’S COMPRESSION TEST

 (FORAMINAL COMPRESSION TEST)
 SHOULDER DEPRESSOR TEST
 ADSON’S 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. Johnson’s Reference Study Materials:

pages 1-45, 124-125
 (Completed Film Examples & Directions for line construction
& interpretation) (See these examples on the Portal.)
 Dr. Gindl’s 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 patient’s 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. Gindl’s 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
range…and 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
proportions…physiological 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 Patient’s Physiological
Movements
Record Information Concerning:
(Performed/Assessed Active)
1. Patient’s willingness to move
2. Range of Motion
3. Presence or absence of pain
Assessment of Patient’s 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 Trochanter…or 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”
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.
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).
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
Reference:
Brodeur R., The Audible Release Associated with
Joint Manipulation. JMPT, 18 (3); March/April
1995: 155 – 164.
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 side—is
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 “L”Lat.))
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 “L”Lat.)
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
Rotation…Occiput found as presenting Posterior Rotation
on the Right…Occiput 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
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.
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. Gindl’s 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
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
C2 – C7 (T3) - 2 Variations

PP: Cervical Chair
“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
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
doctor’s 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 patient’s
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 Laterality—weight forward).
 2. PRIMARY Stabilization: With index & chiropractic index fingers, tuck patient’s chin (gently). 10B of S.H. is placed
anterior to patient’s ear on side of stabilization, near the zygomatic. (The patient’s 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 patient’s chin to neutral (about 5 degrees) to relax the musculature.
 5. Stabilization hand laterally bends the patient’s head to the side of occiput laterality.
 6. If misalignment has a rotational component, stabilization hand rotates the patient’s 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 stabilization—specifically, #4 of the S.H. will stabilize Atlas. The thrust is a Linear Set & Hold, directed toward the
patient’s 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:
**What’s your D.S.? **What’s your C.P.?
**What’s your S.C.P.? **What’s your T.P.?
**What’s 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 patient’s 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 patient’s parietals; the doctor’s
forearms & elbows are held “in close” to the doctor’s rib cage.
6. Laterally bend the patient’s head to the side of Occiput laterality (to fixation, Occiput/C1).
7. If misalignment has a rotational component, rotate the patient’s 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.
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 patient’s chin (gently). 10B is
placed anterior to patient’s 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). Doctor’s contact hand forearm is level and in line with
the patient’s 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 patient’s 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 patient’s head—TOWARD
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 forearm…in line with patient’s shoulder on side of
stabilization). The fingers of your S.H. will support the lateral cervical musculature on the side of
stabilization—specifically, #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
patient’s 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 headpiece…”1)
 2. “Doctor’s stance is on the side of C1 laterality, ‘straight-away’ to the patient contact
area. The doctor’s 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 doctor’s] superior hand.”
 5. “Stabilization Hand (SH) is the doctor’s 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: 1—Bovee ML, Burns JR, Carrigg PM, et al. Palmer Technique Adjusting
Manual. Davenport, IA; March 1991/2006. 2—Ibid. 3—Palmer College. Course Packet; Dr.
J’s 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 patient’s chin (gently). 10B of
S.H. is placed anterior to patient’s ear on side of stabilization, near the zygomatic. (The patient’s 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 patient’s ear as
Lateral Bend of the head takes place in STEP 5).
 4. With Stabilization fingers, elevate the patient’s chin to neutral (about 5 degrees to relax the
musculature).
 5. Stabilization hand laterally bends the patient’s 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 stabilization—specifically, #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 patient’s 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 laterality—side of LAMINA S.C.P.—weight
forward, trunk of doctor slightly “turned,” so doctor’s contact forearm can align approximately 60
degrees to the patient’s shoulder on the side of contact).
 2. PRIMARY Stabilization: With index & chiropractic index fingers, tuck the patient’s chin (gently). 10B
of S.H. is placed anterior to patient’s ear on side of stabilization, near the zygomatic. (The patient’s 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 patient’s ear as lateral bend of the head takes place in STEP 5).
 4. With Stabilization fingers, elevate the patient’s chin to neutral (about 5 degrees).
 5. Stabilization Hand laterally bends the patient’s 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 stabilization—specifically, #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 patient’s eye on the side of contact (patient’s
SAME EYE as side of contact.)
DOCTOR’S FOREARM PLACEMENT—PALMER-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.”
DOCTOR’S ADJUSTING ARMS/EPISTERNAL NOTCH POSITON FOR
PALMER-GONSTEAD D. THUMB
Note: Episternal notch of doctor is “over spine of

patient.” (In line with
the patient’s 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.
 Doctor’s 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.  PS-RS C.C.
 AS-RS C.C.  AS-RS-RA C.C.
 ASLA C.C.  ASLP C.C.
 AIRA K.C.  AIR K.C.
 PR C2 C.C.  PLS C2 C.C.
 PLI-L C4 C.C.  PL-L C4 C.C.
 PRI-L C6 D. THUMB  PR C6 D. THUMB
 PLS C5 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 options—Toggle; Palmer-Gonstead;
NUCCA; Blair, etc.
See: Dr. Gindl’s Essentials for Cervical-Upper Thoracic Technique Class. Gindl P.S., pp. 133-154.
See: Dr. Johnson’s 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
misalignment—Body/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
patient’s cervical spine is in the
neutral position.
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.
 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 doctor’s body
lined up with the mid-point of the patient’s shoulder tip.
--laterally bend the patient’s head to the side
of contact (for point of tension 1)
--rotate the patient’s head away from the side of contact
(for point of tension 2)
--ALWAYS take all “slack” out of the doctor’s adjusting arms
by bringing the doctor’s elbows in toward one another
or bringing the doctor’s elbows in against the doctor’s
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 patient’s shoulder.
S.C.P. C1 Posteriorly Rotated TVP
C.P. #4
T.P. P-A
S.P. #11 stabilized mastoid—fingers of
S.H. cupping ear and directed toward top of head
SeD – C1 Anteriority correction
 D.S. Side of Anterior C1 TVP; doctor’s midline
aligned with tip of patient’s 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 patient’s ear + directed toward
top of patient’s head.
*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
 Common adjusting patterns for SuD adjusting:
The doctor will ALWAYS:
**Stand favoring the side of
the SCP
**Laterally bend the patient’s
head to the side of
contact (point of tension 1)
**Rotate the patient’s head away
from the side of contact
(point of tension 2)
**Step around with or shift weight to the
doctor’s inferior foot as the patient’s
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
• 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
 **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)
• 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.
• 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
• 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 patient’s 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 – 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 patient’s head is
Turned toward the side of doctor contact/stance in order to
enhance the contact bond.
• Common patterns for Diversified Adjusting, patient prone:
• For the Axis Special/Only PD; C2 – C6 PD; MTM:

**The patient’s head is turned away from the side of
doctor contact.
**#11 of the doctor’s 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 is…a 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 linear…aiming toward
the patient’s opposite shoulder tip…
(S-I).”
• SuD Adjustments (C2 – C6): “The thrust is linear…aiming toward the
patient’s 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 patient’s
mouth (I-S & P-A).”
DIVERSIFIED ADJUSTING—THRUST
DESCRIPTION (Continued)
• MTM Adjustments: “The thrust is aimed (slightly) toward the patient’s
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 doctor’s 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 segment’s disc.”
•
• 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
• 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
Lamina”moves” 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
PATIENT’S 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
• PS-RS-RA C.C. ®
FML
APL TCL
TAL
+0X, -0Z,+0Y
• PS-RS-RP C.C. ®
+OX, -OZ,-OY
FML TCL
APL TAL
+OX, +OZ Occiput

• 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
• 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

• ASR C.C. ®
• -0X,-0Z C1 TAL
OL APL
OPL Axis Plane Line
L.O.C.: S-I, R-L; CW Torque

• ASLA C.C. ®
OL
APL TAL
OPL
Axis Plane Line -0X,+0Z,-0Y

• AILA KC R
OL
APL TAL
Axis Plane Line

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

• 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
R
C4
C5
• 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
• PR-L C2 C.C. ®
C2
C3
-0X,+0Y Convexity to Left

• PRS C6 D. THUMB ®
-OX,+OY,-OZ
Convexity to Right
C6
C7
• PR-L C2 D. Thumb ®
-OX, +OY, Convexity to Left
C2
C3
• ASRP C.C. R
• -0X,-0Z,-0Y L.O.C.: S-I, R-L, P-A CW Torque

• 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
• -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
• ASL C.C. ®
• OL -0X, +0Z
– APL TAL
OPL
Axis Plane Line

L.O.C.: S-I, L-R CCW Torque
• ASLP C.C. ®
• OL APL TAL
OPL
Axis Plane Line

-0X,+0Z,+0Y L.O.C.: S-I, L-R, P-A CCW Torque
• AIR K.C. R
+OX, -OZ
• ASLA C.C. ®
OL TAL
APL
OPL
Axis Plane Line
-0X,+0Z,-0Y L.O.C.: S-I, L-R, A-P CCW Torque

• PRS C4 C.C. ®
C4
C5
Convexity to Right -0X,+0Y,-0Z

“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 patient’s OPPOSITE eye.
– For C2-C7 Rotatory listings C.C., the landmark toward

which the thrust is aimed when delivering the
adjustment is the patient’s SAME eye as the contact side.
DIVERSIFIED PRACTICE
• AILP/ASLP SeD R
+0X, Other Choices

SuD
C.C.
K.C.
-0X
+0Z, +0Y
• ASRA/AIRA SeD ®
-0X, -0Z, +0Y Other Choices
C.C.
K.C.
+0X, -0Z, +0Y

• PL; PL-L; PLI-L SeD ®
• BODY RIGHT SeD ®
• Convexity to Right Other Choices
• -0X, -0Y, -0Z SuD
PD
C.C.
D. Thumb
DIVERSIFIED ADJUSTING
PRACTICE SeD
• ASRP AILA
R 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)
• PSRP SuD
L.O.C.: P-A, S-I, some R-L

Palmer-Gonstead, C.C. (PS-RS-RP)
• AIRP SuD
– L.O.C.: P-A, S-I, some R-L

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

SeD
Palmer-Gonstead, C.C., K.C.
Toggle Recoil
• PRI-L C4 SuD
– L.O.C.: P-A, I-S, indirect R-L

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

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

 Toggle Recoil (Spinous Left-Body Pivot-Entire Segment Right)
 L.O.C.: P-A, I-S, Indirect spinous L-R

REVIEW FOR PRACTICAL—PATIENT
PRONE
• PR C5 PD
L.O.C.: P-A, I-S, indirect spinous R-L

SuD
Palmer-Gonstead C.C.,
Palmer-Gonstead D. Thumb
PRONE
• PL C7 MTM
L.O.C.: I-S, P-A, L-R

DP
Palmer-Gonstead C.C.
Palmer-Gonstead D. Thumb
PRONE
• PRS T1 DP
L.O.C.: I-S, P-A, R-L

MTM
Palmer-Gonstead Single Hand Contact (SHC)
PRONE
• PR-T T2 MDP
L.O.C.: I-S, P-A, through the plane line of the

disc, indirect spinous R-L

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

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
 Palmer-Gonstead C.C.
 SuD
 PD
• 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)
• 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
• 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
• 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
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
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 standing—Tom,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)

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• Intro – Discussion: Slides 3 – 14

Palmer-Gonstead -- (Listings only) – 160-168; 226 – 227

Diversified -- (Listing only) -- 169-170; 236

Review for Diversified & Final Practical (Listings):

**C. Gonstead, D.C.

EXAM OF THE PATIENT MOVES FROM LEAST

 At any point in the exam, the doctor may stop the

**Always consider cautions/contraindications to any

(Never hesitate to re-examine the patient at any time if care

5. Determine needed exams/tests*

6. Perform selected Orthopedic Exams to

 * Always consider cautions/contraindication to

 (Initially, x-rays are reviewed for pathology findings,

 Today’s Health Problem: History of patient’s

 Prior Health Problem(s): History of patient

 ** Stand behind the patient to observe. (Additional “Plumb Line

 DUAL PROBE INSTRUMENTATION

 1. Definition of Clinical Significance Finding

• Fractures, dislocation, sprain and strain, severe

* Daniels & Worthingham

– 1. Head neutral. Inclinometers set at zero degrees.

Position patient well (comfortably)

 Bovee Evans & Mazion

 Reference: *Bovee, M., D.C.

 (Foramina (Foraminal) Compression Exam: *Occlusion of IVF; disc bulge;

 Shoulder Depressor Test: *Radiculitis or pain from the muscle stretch;

 Soto Hall: * “Noticeable localized pain—vertebral fracture; Diffuse pain:

 To assess finding of leg balance or

*Reference: Gindl P, Essentials for Cervical-Upper

 ** NOTE: Many theories exist concerning leg exam

With a finding of Cervical Syndrome, palpate the patient’s side of

 JACKSON’S COMPRESSION TEST

 TRICEPS REFLEX BICEPS REFLEX

 Dr. Johnson’s Reference Study Materials:

 Dr. Gindl’s Text, pages 39 - 103

“ A ‘Motion Unit’ is considered to be the top of one

“Visual signs of motion unit disturbance are

(Possibilities/rationale for “Impression of Lateral

 Clinical Finding Possibilities:

Definition: “A Capsular Pattern is the limitation

Joint Play (Fluid Motion): Small amount of

5. Popping: As when pulling finger joints.

6. Crackling & Crepitus: Examiner can hear

Gatterman, MI. Chiropractic Management of Spine

Herzog, et al. Cavitation Sounds During Spinal

For Occiput – use Occipito/Atlanto

Decreased Extension Occ/C1

“R” presents as Decreased Right Lateral Bending;

AILA = “AI” is a Lateral Film Finding;

“L” presents as Decreased Left Lateral Bending; “A”

 The Motion Palpation Exam will be worth 20 Points (4 points

 AIRP (Motion Palpation)

 Derifield Leg Exam

 PLS C3 (Motion Palpation)

 PRI-T T2 (Motion Palpation)

C2 Right Side

C4 Right Side

 Reference: Gran, D., D.C.; Palmer College Homecoming presentation.

PP: Knee Chest - “AI” Group

C2 – C7 (T3) - 2 Variations

Alternate Prone Adjusting

“Simple Listing” Group--P, PR, PRS, PL, PLS