Full Spine I

Tech 614

Cervical
Spine

Dr. Ron R. Castellucci

Professor
Sherman College of
Chiropractic

Revised 2015
 Full Spine Technique
The fundamental emphasis of Sherman College’s technique program is the location, analysis and correction of
vertebral subluxation. The College’s full spine technique program is a blend of Diversified, Gonstead,
Thompson and Pierce techniques.

An adjustment incorporates two distinct yet inseparable parts, the analysis and the force application. Applying a
force without a proper analysis is not an adjustment and is simply random manipulation. Therefore, it is
expected that the student understand and is able to perform muscle and motion palpation analysis as well as
being proficient in leg check procedures.

A major component of the art of chiropractic involves the ability to establish the most precise line of correction
for each individual subluxation thereby increasing the specificity of the adjustment. It is expected that the
student understand and be able to interchange the listing systems used in this class namely Palmer, Gonstead
and Malposition listings.

Pattern analysis gives the chiropractor an opportunity to track patterns in the patients spine related to
subluxation and specifically nerve interference. A subluxation will present with a persistent pattern of findings
i.e. thermographic, muscle, motion or leg length.

Daily visit spinal analysis protocol:

 thermography
 leg checks
 muscle palpation
 motion palpation
 adjustment
 post check

X-ray are incorporated as clinically necessary

Orthopedic, neurological and physical exam procedures
are used when necessary if the findings will affect the
choice of adjusting method, patient safety & outcomes.

General Considerations for all Full Spine Adjusting

 Attend to the patients’ comfort: when the patient is relaxed,

there is less muscle tension present.
 Gentle tissue pulls/pushs are often in the direction of the LOC
 A proper set-up is key to a successful adjustment
 Proper support instills trust in the patient and helps them relax
 Pre-stress immediately prior to the thrust eliminates joint
slack/play. Pre-stress in not necessary when using the drop
 The thrust is quick, gentle and controlled
 You, must be relaxed and in a balanced, comfortable stance
 Specificity is dependent upon your attention to detail

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 Prone Adjusting Techniques
Occiput prone

Occiput AS (thompson technique)

Listing: AS; AS-RS; AS-LS (gonstead); extension, lateral flexion (mal-position)

Findings: A-P glide restriction
Patient position: prone with head in slight flexion
Doctor position: pivoted stance, body positioned inferior to the segment, close to table, shoulders parallel with
patients, elbows in
Contact Hand/Arm: bilateral thenar contacting behind the mastoid process with thumbs oriented superior
Support Hand/Arm: N/A
Manual Contact point: thenar eminence
Segmental Contact Point: posterior aspect of mastoid process
Tissue pull/push: none
Line of Correction: in an arc from I-S
Thrust: quick-gentle-controlled with a slight body drop and using drop mechanism-with no pre-stress

Occiput PS (thompson technique)

Listing: PS-RS; PS-LS (gonstead); flexion, lateral flexion (mal-position)

Findings: P-A glide restriction
Patient position: prone with head in slight extension
Doctor position: pivoted stance, body positioned level with the segment, close to table, shoulders parallel with
patients, elbows in
Contact Hand/Arm: bilateral thenar contacting behind the mastoid process with thumbs oriented superior
Support Hand/Arm: N/A
Manual Contact point: thenar eminence
Segmental Contact Point: posterior aspect of mastoid process
Tissue pull/push: none
Line of Correction: in an arc from S-I
Thrust: quick-gentle-controlled with a slight body drop and using drop mechanism-with no pre-stress

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 Lower Cervical prone

C2-C7 lamina contact (diversified and thompson techniques)

Listing: PR, PL, PRI, PLI (gonstead); rotation, lateral flexion (mal-position)
Findings: restrictions: rotation, lateral flexion, f/e, P-A glide
Patient position: prone, foot-piece elevated, head rotated opposite side of contact 90o (for situations where it
would be beneficial to limit a patients cervical rotation, rotate only 45o) slight extension (chin up)
Doctor position: pivoted stance facing superior, close to table, bend at hips, shoulders parallel with patients
Contact Hand/Arm: lateral index contact superior hand, wrist ulnar deviated, fingers relaxed, forearm parallel to
floor, elbow comfortably in (arm drops as patient turns head away, follow LPJ with contact)
Support Hand/Arm: thenar on mastoid with fingers spread out on head pointing superior, slight pressure
downward and towards the superior
Manual Contact point: lateral aspect of index finger (lateral aspect of proximal interphalangeal joint)
Segmental Contact Point: posterior LPJ (aka pillar/facet)
Tissue pull/push: SP-LPJ
Line of Correction: P-A (slight I-S may be incorporated if possible following the plane of the facet joint)
Thrust: quick-gentle-controlled with a slight body drop; no pre-stress if using drop mechanism

Supine Adjusting Techniques

The key for all successful supine cervical adjusting methods is gaining the patient’s trust. The chiropractor
must be confident in their technique and certain in their analysis. Here are a few tips to keep in mind:

 An adjustment is made from a relaxed position, when the doctor is relaxed the patient will relax.
Therefore, have a relaxed stance, upper body, arms and hands. You will need to do this consciously at
first until it becomes habit.
 Support is the key. You will have the patient’s head in your hands so for them to trust you, you must
give good support. The patient will gain trust and confidence in you through your touch.
 instills trust in the patient and helps them relax
 In supine adjusting, pre-stress is performed by moving both hands which adds another variable and a
potential degree of loss of control. The pre-stress MUST stop at the point when the thrust begins
otherwise the patients cervical experiences increased shearing forces on the disc/facets and a lessened
degree of specificity.
 The thrust is quick, gentle and controlled and comes mostly from the pectoral muscles. Remember the
exercises in toggle class.
 Lateral flexion limits rotation and, always remembers to limit the amount of extension.

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 Lower Cervical supine

C2-C7 lamina contact (diversified technique)

Listing: PR, PL, PRI, PLI (gonstead); rotation, lateral flexion (mal-position)
Findings: restrictions: rotation, lateral flexion, f/e, P-A glide
Patient position: supine, head-piece elevated slightly, head laterally flexed to side of contact, rotated away with
minimal extension
Doctor position: at the head of the table, close to table, bend at hips, elbows in, step around facing the side of
the table while laterally flexing patient’s cervical spine
Contact Hand/Arm: lateral index contact, wrist ulnar deviated, fingers relaxed, thumb anchored on side of
face/chin, forearm parallel to floor, elbow comfortably in (follow LPJ with manual contact)
Support Hand/Arm: thenar in front of tragus, thumb pointed towards feet, arch hand to cup ear, index on base of
occiput, other fingers spread out on back of occiput, some part of hand resting on the table
Manual Contact point: lateral aspect of index finger (lateral aspect of proximal interphalangeal joint)
Segmental Contact Point: posterior LPJ (aka pillar/facet)
Tissue pull/push: SP-LPJ
Line of Correction: P-A (slight I-S may be incorporated if possible following the plane of the facet joint)
Thrust: quick-gentle-controlled with pre-stress (thrust comes from pectoral muscles with slight arm movement)

C2-C7 spinous contact (diversified technique)

Listing: PR, PL, PRS, PLS (gonstead); rotation, lateral flexion (mal-position)
Findings: restrictions: rotation, lateral flexion, f/e, A-P glide
Patient position: same as lamina contact
Doctor position: same as lamina contact
Contact Hand/Arm: lateral index contact, wrist ulnar deviated, fingers relaxed, thumb anchored on side of
face/chin, forearm 45o to floor, elbow comfortably in (follow SP with contact)
Support Hand/Arm: same as lamina contact
Manual Contact point: lateral aspect of index finger (lateral aspect of proximal interphalangeal joint)
Segmental Contact Point: lateral aspect of spinous
Tissue pull/push: LPJ-SP
Line of Correction: L-M & A-P (slight I-S may be incorporated if possible following the plane of the facet joint)
Thrust: quick-gentle-controlled with pre-stress (thrust comes from pectoral muscles with slight arm movement)

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 Atlas supine

Atlas Posterior (diversified technique)

Listing: AIRP, AILP, ASRP, ASLP (palmer)

Findings: restrictions: rotation, L-M glide, P-A glide
Patient position: supine, head-piece elevated slightly, head laterally flexed to side of contact, rotated away with
minimal extension
Doctor position: at the head of the table, close to table, bend at hips, elbows in, step around to the top corner of
the table while laterally flexing patient’s cervical spine
Contact Hand/Arm: lateral index contact, wrist ulnar deviated, fingers relaxed, thumb anchored on side of
head/face, elbow comfortably in, forearm parallel to floor, arm directed to patients axilla,
Support Hand/Arm: thenar in front of tragus, thumb pointed towards feet, arch hand to cup ear, index on base of
occiput, other fingers spread out on back of occiput, some part of hand resting on the table
Manual Contact point: lateral aspect of index finger (lateral aspect of proximal interphalangeal joint)
Segmental Contact Point: posterior arch of atlas
Tissue pull/push: S-I sliding down off the occiput
Line of Correction: P-A, S-I, L-M (aim approximately towards the axilla)
Thrust: quick-gentle-controlled with pre-stress (thrust comes from pectoral muscles with slight arm movement)

Atlas Lateral (diversified technique)

Listing: AIR, AIL, ASR, ASL (palmer)

Findings: restrictions: L-M glide
Patient position: same as posterior atlas
Doctor position: same as posterior atlas
Contact Hand/Arm: same as posterior atlas forearm 45o to floor, arm directed to patients opposite shoulder
Support Hand/Arm: same as posterior atlas
Manual Contact point: lateral aspect of index finger (lateral aspect of proximal interphalangeal joint)
Segmental Contact Point: lateral aspect of atlas TP
Tissue pull/push: S-I sliding down off the mastoid process
Line of Correction: L-M, S-I across condyles (aim approximately towards the top of the opposite shoulder)
Thrust: quick-gentle-controlled with pre-stress (thrust comes from pectoral muscles with slight arm movement)
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 Occiput Lateral supine

Occiput thenar contact (diversified technique)

Listing: RS, LS (gonstead) lateral flexion (mal-position)

Findings: restrictions: L-M glide
Patient position: supine, head-piece level, head rotated with lateral side up
Doctor position: comfortable stance facing the side of the table, close in, bend at hips, elbows comfortably in
Contact Hand/Arm: thenar contact on zygomatic arch side of laterality, wrist ulnar deviated, fingers relaxed,
thumb pointed towards feet, elbows comfortably in, forearms parallel to floor
Support Hand/Arm: index on mastoid process and base of occiput, cup side of head/occiput with rest of hand
Manual Contact point: thenar eminence
Segmental Contact Point: zygomatic arch side of laterality
Tissue pull/push: none
Line of Correction: S-I on side of laterality, I-S of opposite side
Thrust: quick-gentle-controlled with pre-stress (thrust comes from both hands)

Occiput pisiform contact (diversified technique)

Listing: RS, LS (gonstead) lateral flexion (mal-position)

Findings: restrictions: L-M glide
Patient position: supine, head-piece level, head rotated with lateral side up
Doctor position: comfortable stance at the side of the table, close to table, bend at hips
Contact Hand/Arm: pisiform contact behind mastoid process side of laterality, fingers relaxed on side of patents
head, elbows over patients shoulder, forearm parallel to floor
Support Hand/Arm: index hooking opposite mastoid process and base of occiput, cup side of head/occiput with
rest of hand
Manual Contact point: pisiform
Segmental Contact Point: mastoid process side of laterality
Tissue pull/push: none
Line of Correction: S-I on side of laterality, I-S of opposite side
Thrust: quick-gentle-controlled with pre-stress (thrust comes from both hands)

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 Seated Adjusting Techniques
Seated cervical adjusting is derived from Gonstead technique. When adjusting cervicals from the seated
position, it is critical that the patient is positioned correctly and with good support. Again, the key for all
successful seated cervical adjusting methods is gaining the patient’s trust through the doctor’s touch.

Occiput seated

Occiput AS (gonstead technique)

Listing: AS (gonstead); extension (mal-position)

Findings: A-P glide restriction
Patient position: seated comfortably, head in slight flexion, hands on lap, chair upright
Doctor position: stance square directly behind the chair, close in, shoulders parallel with the patient’s, cradle
patients head with arms elbows in, must use condyle block
Contact Hand/Arm: PIP of middle finger or pisiform of either hand just above patient’s glabella
Support Hand/Arm: PIP of middle finger (interlace fingers) or pisiform (stack contacts) on top of contact hand
Manual Contact point: PIP of middle finger or pisiform
Segmental Contact Point: just above patient’s glabella
Tissue pull/push: none
Line of Correction: in an arc from A-P & S-I using a scooping motion
Thrust: quick-gentle-controlled with pre-stress (thrust comes from both hands)

Occiput AS, AS-RS, AS-LS (gonstead technique)

Listing: AS-RS/AS-LS (gonstead); extension & lateral flexion (mal-position)

Findings: A-P & L-M glide restriction
Patient position: same as AS
Doctor position: same as AS
Contact Hand/Arm: 5th MCP mid supra-orbital ridge (place right hand first for RS left hand first for LS)
Support Hand/Arm: 5th MCP (stack contacts) on top of contact hand
Manual Contact point: 5th MCP
Segmental Contact Point: mid supra-orbital ridge
Tissue pull/push: none
Line of Correction: in an arc from A-P & S-I, using a scooping motion. note: for anterior listings (LA/RA) rotate
head slightly towards contact, for posterior listings (LP/RP) rotate head slightly away from contact
Thrust: quick-gentle-controlled with pre-stress (thrust comes from both hands)
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Occiput PS, PS-RS, PS-LS (gonstead technique)

Listing: PS-RS; PS-LS (gonstead); flexion & lateral flexion (mal-position)

Findings: P-A, L-M glide restriction
Patient position: seated comfortably, head in slight extension, hands on lap, chair upright
Doctor position: pivoted stance behind chair favoring contact side
Contact Hand/Arm: thenar eminence just behind and above mastoid (thumb behind ear anterior to the mastoid)
cup head with hand and fingers of middle finger or pisiform of either hand just above patient’s glabella
Support Hand/Arm: on opposite side of head, elbow out (catch the thrust)
Manual Contact point: thenar eminence
Segmental Contact Point: just behind and above mastoid
Tissue pull/push: none
Line of Correction: P-A & S-I along the plane of the condyle note: for anterior listings (LA/RA) rotate head
slightly towards contact, for posterior listings (LP/RP) rotate head slightly away from contact
Thrust: quick-gentle-controlled with pre-stress

Atlas seated
Atlas lateral, lateral & posterior, lateral & anterior (gonstead technique)
Listing: ASL/ASLP/ASLA; AIL/AILP/AILA; ASR/ASRP/ASRA; AIR/AIRP/AIRA (gonstead)
Findings: L-M glide restriction; limited during protraction (I) or retraction (S), limited during lateral flexion
Patient position: seated comfortably, hands on lap, chair upright, head neutral (then laterally flex)
Doctor position: square, outside the chair (one foot inside the legs of the chair), shoulders parallel with patients,
flex at waist, favor contact side
Contact Hand/Arm: palmar surface of thumb, squeeze thumb against hand, palm up, pinky and ring fingers
lightly anchor on back of occiput, forearm against body, (arms should form a rectangle)
Support Hand/Arm: on opposite side of head (arms should form a rectangle), elbow out (catch the thrust),
position patients head with support hand
Manual Contact point: palmar surface of thumb
Segmental Contact Point: antero-lateral portion of atlas TP
Tissue pull/push: none
Line of Correction: L-M & S-I note: for anterior listings (A) rotate head slightly towards contact, for posterior
listings (P) rotate head slightly away from contact. Torque; fingers move superior for S, inferior for I
Thrust: quick-gentle-controlled with pre-stress

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 Lower Cervical seated
C2-C7 (gonstead technique)
Listing: PR, PRS, PRI-L, PL, PLS, PLI-L (gonstead)
Findings: rotation, lateral flexion, F/E & glide restriction
Patient position: seated comfortably, hands on lap, chair upright, head neutral (extend then laterally flex)
Doctor position: pivoted behind the chair, shoulder of adjusting arm back, knees bent comfortable stance
Contact Hand/Arm: palm up fingers curved thumb out (wrist in extension & ulnar deviation), elbow at side,
forearm parallel to floor, distal lateral index contact under spinous, thumb contact side of head (rat hole)
Support Hand/Arm: on opposite side of head, fingers pointed inferior, elbow out (catch the thrust), stack and
extend and laterally flex with support hand
Manual Contact point: distal lateral index
Segmental Contact Point: under spinous process (on lamina for I listings)
Tissue pull/push: none
Line of Correction: P-A through plane of disc while lifting the segment onto the disc
Torque; none
Thrust: quick-gentle-controlled with pre-stress, squeeze elbow of adjusting arm against side of body

References

 Reinert, Spinal Biomechanics and Specific Adjusting

 Bergmann & Peterson, Chiropractic Technique: Principles and Procedures, 3nd edition
 States, Manual of Diversified Spine and Pelvis Technique