The Complete Thomson Book Minardi Integrated Systems 1nbsped 0978148800 Compress

The Complete Thompson Textbook
Minardi Integrated Systems
Dr. John Minardi BHK, DC.

Contact: Dr. John Minardi BHK, DC.
Email: johnminardi@hotmail.com
Website: www.ThompsonChiropracticTechnique.com
Copyright © 2006 to Present:
This book is copyrighted. All rights are reserved. Under the

copyright laws, this book may not, in whole or in part, be
copied, photocopied, reproduced or reduced in any form
·without the expressed written consent of Dr. John Minardi.
Copyright © 2006 to Present.
All rights reserved.
ISBN: ISBN 0-9781488-0-0
Title: The Complete Thompson Textbook-Minardi Integrated Systems
Publisher I Author: Dr. John Minardi

Oakville, Ontario
Canada
II
From the Author
Th.is book was created to fill an essential need in the chiropractic profession. In my
teachings of this technique I was often asked by students if there was a textbook that included
the rational of why this technique works, as well as the actual step by step procedures of how to
perform the technique optimally. Since there was not such a textbook, I decided to create one.
My vision was to produce a systematic method which integrated all relevant theories and
procedures involved in Thompson, from its original work to the present day. This book will
detail a step by step procedure on how to perform the technique, including all neurological and
biomechanical rational. Furthermore, this book will also include all relevant moclifications and
alternatives that have been created over the years to help advance this technique.
The sole purpose of this extensive text is to advance and enhance the learning of
Thompson. In no way shape or form is it intended to take away from the original work
submitted by its creator, or other practitioners who have added to the technique over the years. In
contrast, this book's intention is to unify this body of work, including their proper rational, in a
pursuit to enhance the technique. My goal was to create a system that filled in any gaps that may
have existed in the past, in an attempt to optimise learning.
As founder and instructor of The Thompson Seminar Series, I have witnessed first
hand the tremendous enthusiasm that students possess when the technique is presented in a way
that encompasses all of the rationale and modifications detailed in this book. Fortunately, the
seminars have experienced tremendous praise from attendants regarding the organization,
practical application and detail to which this material is presented. I can only hope that this same
praise will be carried forward to this textbook.
I have been fortunate enough to learn from and be certified by world renowned lecturers
in this classic technique. I have always, and continue to have a great passion for this technique
and for Chiropractic. Thus, I strive to constantly improve my knowledge and teaching ability to
help motivate others. I hope that I can share this passion with you.
Dr. John Minardi BHI(, DC.
HI
Thank You
Thank you Sharron for all of your lo e, support and encouragement in this latest ambition.
Thank you Dr. Jim Thompson for your friendship and for believing in my vi ion. I hope that I
" as able to deli er.
Thank you Christie Swail for the endless amount of advice that you provided throughout this
entire creation process. Your photo editing and cover creation was outstanding. Quite simply
your wisdom, generosity and talent is why this book's appearance turned out so well.
Thank you Dr. David Rick for all of your help in the development of this book. Your
encouragement and countless hours taking photos was a tremendous help.
Thank you Dr. Richard Tutak for the many hours of picture taking to ensure this book was
represented optimally.
Thank you to my pediatric friends Sara, Evan and their mom Tanya Carlos for their special help
in the pediatric section.
Thank you Julie Roy, my student from Trois Rivieres, for the beautiful neurology picture and
overview chart that you graciously provided.
Thank you Vince Attisano for the use of the skeletal model present in many of the photos.
Thank you Dr. Joe Stucky, Dr. Rob Jackson and all other Thompson Pioneers for all the hard
work and dedication put into the development of this technique. I hope that I ha e made you all
proud.
Lastly, I would like to Thank You, the reader. I poured my heart and soul into this book, and I
hope it exceeds your expectations.
Acknowledgement
Musculoskeletal lmage of the semimembranosus/semitendino us, rectu femori vnstus mediali , iliop oas and pectorali minor are ourte y of
the niversity ofWashingion "Mu culoskeletal Atlas: A Mu culo kele1al Atlas of the HumanBody" by Carol Teitz, M.D. and Dan raney,
Ph.D. Copyright 2003-2004 University of Washington. All rights reserved including all phoiograph and image . o re-use, re-di tribution or
commercial use without prior written permission of the authors and the University ofWashington.
Mu ulo keletal Image of the pelvic, temoclavicular and co tot.rans erse articul:uions are courte y ofBartleby. m's edition f ray'
Anatomy of the Human Body.
Ant rior O ciput Di location X-ray i courte y of www.radiologyedu ation.com
I\I
Disclaimer
Th uth r would like to ackno ledge that this book is simply a guide to assist in the
e lishment of Thomp on Chiropractic Protocols and Minardi Integrated Systems. This
rextbook i intended to be used in conjunction with the Thompson Technique Seminar Series to
en u.re proper learning of the treatment protocols. The reader must remember that no set of
standards can dictate a complete treatment protocol for any given case, given the variables of
age, gender complicating factors indh iduaJ response to treatment, psychosocial factors, work
conditions, and other ariables that may present with any given case.
Treatment should only continue if objective improvement on the part of the patient is being made
within an acceptable time frame. If improvement is not being made, a reassessment should be
perfonned to determine if the diagnosis should be altered. Lack of improvement should also
prompt the clinician to consider a change in the treatment protocol, referral to another provider,
or release of the patient with maximal medical improvement. Good clinical judgement should
alv ays take precedent in decision making with regard to any particular patient. 1
I. Wordin of this disclaimer is credited to Lew Huff and David Brady's Instant Access to Chiropractic Guidelines and Prococols. Mosby. St.
Louis, ' . 1999.
"
Forward
The old adage that states that ''nothing is ever so good that it cannot be made better," is
very real to me. It speaks to the drive within all professions and all professionals to strive to find
a better way to do that which we do. The relentless process of taking a good idea to the next
level is truly what professionalism is all about.
With this thought in mind, it is my pleasure to introduce you to this book. I believe it is
an important step in the evolution of chiropractic.
From the early l 950's until the present, Thompson Terminal Point Technique has stood
the test of time and proved itself to be an efficient and effective approach to spinal analysis and
correction.
My personal relationship with its creator Dr. J. Clay Thompson involved hundreds of
hours of seminar time and personal interaction. Clay taught this work with passion, humour, and
his own unique brand of humanity, that all who experienced his presence will long remember.
This book is remarkable in that it does not contradict Clay's original thoughts and
teachings. The book does, however, proceed to add what Clay could not, due to the science
limitations of his era. Using the latest science in the fields of neurology and biomechanics, Dr.
Minardi has advanced this body of work into the present day. This book carefully details a step
by step approach of how to perform the technique, but more importantly, it also explains the
reasons why.
I know that many years of careful research and painstaking attention to detail have gone
into the creation of this book. I find it to be amazingly complete and know it will become the
authoritative text for the Thompson Technique.
It is almost as if J. Clay Thompson constructed the skeleton of the technique and John
Minardi has added the necessary flesh to make it a fully matured and useful tool for chiropractic.
My heartfelt thanks go to Dr. Minardi for the creation of this book. In my opinion, this is
the type of book that will help keep our profession strong. By enhancing Thompson's original
work, the book takes a good idea and makes it better. It is with no reservations that I state that
this textbook raises the bar in the advancement of Thompson. Those of us who use and teach this
technique should be proud.
Respectfully,
James V. Thompson BA, DC

Certified Thompson Instructor for 25 years
Former President of the ICPA
Forward
· ever in the course of human event ha so much been owed by so many to so few". This
famou remark wa made by Sir Winston Churchill following the "Battle of Britain". A small
number of heroic pilots flying Hurricanes and Spitfires defeated the mighty Luftwaffe in the
kies over Southern England. That victory prevented the German invasion of the British Isles
and aved civilization from the rule of a demented dictator and his sadistic minions. As a student
of WWII I think of that phrase often in reference to the mentors I've had in chiropractic and the
fulfilment I've enjoyed because of them.
During my years of lecturing and teaching chiropractic philosophy and technique, I've
encountered DC's that possess extraordinary enthusiasm, professional curiosity, inquisitiveness,
intensity and a burning desire to become a master. Such a person is Dr. John Minardi.
I first encountered this doctor while teaching in his native Canada (Toronto). He was a student at
CMCC, but regularly attended seminars to advance his knowledge. Using the Thompson
Terminal Point Table and the Thompson-Derefield Analysis & Technique as a basic framework,
this doctor recognized that I uniquely integrated techniques of other chiropractic greats
Gonstead and Pettibon into the work.
As I have perused this wor� it is apparent that Dr. Minardi has a complete and thorough grasp of
the principles taught and has elucidated them in a straight forward, easily understood format.
Having studied the works of others, it is my opinion that this is a compilation of the best.
It is my fervent hope and yes, prediction, that this outstanding treatise will become a standard
text in chiropractic colleges everywhere and will be sought after by practitioners who will want
to apply these advanced principles in their offices and clinics. A precise moment by moment full
spine analysis of vertebral subluxations and their specific correction should be the right of every
patient who seeks our services. Any doctor who attains a mastery of the material put forth by Dr.
Minardi will experience unequalled patient satisfaction and enthusiasm, as well as an ongoing
steady flow of referrals. That has been my personal experience and my observation of others
who diligently practice the work.
It has always grieved me that two of the finest chiropractors who ever adjusted me died without
having had the opportunity to share their vast experience and knowledge with others. When Dr.
Minardi called and asked if I thought it alright to teach the work of Dr. Thompson and others, I
responded with a hearty cheer. He has my unconditional support and recommendation.
My father taught that each of us has the responsibility to leave this world a better place than we
found it. Who has a better opportunity than a chiropractor who understands the Above Down/
lnside Out Principle. One who is able to consistently, effectively and efficiently deliver a service
that tells him what to do, where to do it, when to do it, and when not to do it. Does the all
trusting public deserve any less?
My hat is off to Dr. Minardi! I am pleased and proud to have played a small part in his education
and training. To quote my late brother, Dr. William Stucky of Thomasville, Georgia, (there are
16 Chiropractors in our family due to his example, encouragement and selfless dedication to the
philosophy, science and art of Chiropractic) "We serve best when we serve those who also
serve".
L. Joe Stucky DC, FICA(Hons).
VII
Table of Contents
SECTION ONE:
History 2
eurology 5
ReliabiUty and Validity of Leg Length Analysis 8
Patient Set Up on a 440 Drop Table 9
Patient Set Up on a Non-440 Drop Table 9
\Veighing a Patient on a 440 Drop Table 10
Weighing the Patient on a Non-440 Drop Table 11
Proper Leg Check Procedure 12
Prioritization of the Spine 14
Using the Drop Piece Mechanism to Assist the Adjustment 14
SECTION TWO: Primary Area - Cervical
Cervical Syndrome 16
Classic Cervical Syndrome
Classic Prone Side of the Table Adjustment 16
Modified Prone Head of the Table Adjustment 19
Double Cervical Lock 20
Modified Prone Head ofthe Table Adjustment 20
Atlas Subluxation 22
Classic Thompson Toggle Recoil Adjustment 22
Overcompensated Cervical Syndrome 25
Classic Thompson Prone Adjustment 25
Stucky Friction Lock 28
Classic Two Part Prone Adjustment 28
Stucky Stack 31
Classic Supine Adjustment 31
Anterior Cervical 33
Modified Prone Adjustment 33
Posterior Cervical 36
Modified Seated Adjustment 38
Cl Flexion Lock 39
Modified Prone Head ofthe Table Adjustment 39
C7-Tl Extension Lock 41
Cervical Syndrome Review Chart 43
SECTION THREE: Primary Area - Occiput Cervical
Normal 45
Bilateral Cervical Syndrome 46

Classic Prone Adjustment 46
Modified Study Supine Adjustment 48
VIII
fodifi d Toggle Board Adjustment 50
Modifi d Supine Lift Adjustment 50
Unilateral Occiput Syndrome 51
Toggle Set Adjustment 51
Modified Supine Adjustment 53
Posterior Occiput Syndrome 54
Exception Derefield
XD: Cervical Syndrome 56
XD: Derefield Negative 56
XD: Bilateral Cervical Syndrome 57
XD: Unilateral Occiput Syndrome 57
XD: Posterior Occiput Syndrome 57
Normal, BCS, UOS, POS and X-D Leg Length Analysis Review Chart 58
SECTION FOUR: Primary Area - Pelvis
Negative Derefield (D-) 60

Classic Thompson Two-Part Supine Adjustment 63
Classic Thompson Two-Part Prone Adjustment 65
Modified Stucky One Part Prone Adjustment 67
Modified Al Sacral Push Adjustment 69
Modified Stucky Bilateral Roll (Coup de Gras) Adjustment 71
Positive Derefield (D+) 73
Classic Thompson Prone Lower Boot Adjustment 75
Lower Boot Modified Leg Distraction Adjustment 76
Classic Thompson Supine Upper Boot Adjustment 78
SECTION FIVE: Secondary Area - Lumbar
Lumbar Spine 81
Classic Thompson Seated Adjustment 81
Modified Split-Leg Adjustment 84
Hyperactive Psoas 87
Classic Thompson Supine Adjustment 87
LS-St Distraction Adjustment (Acute Low Back) 89
Spondylolisthesis 91
Modified Institutional Adjustment 93
SECTION SIX: Tertiary Area - Thoracic
Thoracic Spine 96
Pottinger's Saucer 96
Classic Supine Adjustment 96
Lateral Listhesis 99
IX
Dorso- enical Thumb Pull 101
A1odifi d Prone Adjustment 101
Dorso-Cenical Thumb Push 103
Modified Cross Bilateral 105
Leg Length Analysis in the Flexed Position Review Chart 107
SECTION SEVEN: Clean Up Moves
Rotated Sacrum 109

Posterior Rocked Ischium 111
Posterior Sacral Apex 113
Anterior Coccyx 115
IN Ilium 117
EX Ilium 120
Elevated Rib Cage 123
Rotated Rib 125
Comprehensive Review Chart 127
SECTION EIGHT: Extremities
Shoulder Complex 129

Humerus
Glenohumeral Joint
Anterior Humerus 130
Posterior Humerus 132
Clavicle
Sternoclavicular Joint 134
Acromioclavicular Joint 136
Scapula
Medial Inferior Scapula 138
x
Rip
Modified Externally Rotated Hip Adjustment 140
Modified Internally Rotated Hip Adjustment 140
Patella
Superior Lateral Patella 142
Tibia
InternalJy Rotated Tibia 144
Fibula
Anterior Fibula 146
Temporomandibular Joint (TMJ) 148
Modified Stud.y Two Part Supine Adjustment 148
SECTION NINE: Pediatrics
Webster's In Utero Constraint Technique 151

Classic Two Part Adjustment 151
Pediatric 152
Case History 152
Protocols for Adjusting an Infant 153
Assessment of the Infant 154
Infant Neurological Reflexes and Spinal Assessment 155
Pediatric Cranial Assessment and Correction 158
Webster's Coronal Suture Adjustment 158
Pediatric Atlas Assessment and Correction 159
Modified Infant Toggle Board Adjustment 159
Pediatric Assessment and Correction of C2-C7 161
Modified Infant Toggle Board Adjustment 161
Modified Sustained Contact Adjustment 162
Pediatric Assessment and Correction of the Sacrum 163
Modified Sacral Base Adjustment 164
Modified Sacral Apex Adjustment 164
Pediatric Assessment and Correction of the Ilium 165
Modified Leg Distraction Adjustment 165
Pediatric Assessment and Correction of the Lumbar Spine 166
Pediatric Assessment and Correction of the Thoracic Spine 167
References 168
XI
ECTIO O E
Hi tory
eurology
Leg Length Analysis VaUdity
Patient Set Up on a 440 Drop Table
Patient Set Up on a Non-440 Drop Table
Weighing a Patient on a 440 Drop Table
Weighing the Patient on a Non-440 Drop Table
Proper Leg Check Procedure
Prioritization of the Spine
Using the Drop Piece Mechanism to Assist the Adjustment
Copyright 2006
Dr. John Minardi 1
HlSTORY
'"By eliminating spinal subluxations in an organized orderly fashion, from above down
and inside out, the Thompson practitioner will begin to verify the corrections he is making on the
patient's spine."
- J. Clay Thompson.
Dr. Joseph Clay Thompson became involved in chiropractic after a very interesting
experience. At the age of 27, Thompson developed diabetes mellitus after suffering a severe blow
to the head while unloading lumber from a truck. After Thompson did not respond to traditional
medical treatment, a physician gave Thompson two weeks to live. Thompson was then taken to a
chiropractor, Dr. J. Delk, with the thought that there was nothing left to lose at that point. Delk
adjusted Thompson for 16 consecutive days, after which Thompson no longer had any symptoms
of diabetes. Interestingly, Thompson did not become involved in chiropractic at this time. He first
established a career as a mechanical engineer for the American Armed Forces. It was not until ten
years later, at the age of 37, that Thompson's chiropractic studies began at Palmer College.'.2
At that time, Palmer Chiropractic College focussed on the toggle recoil adjustment, which
emphasized that the bigger the recoil... the better the adjustment. However, when Clay
Thompson delivered an adjustment, he felt his body pushing away from his patient, and felt as
though this was a shock to both himself and his patient. Having such an in-depth knowledge of
mechanics, Thompson knew that there must be a better way to deliver a high velocity thrust, with
less amplitude. 1 , Ironically, when Thompson first began practising, he purchased an old table
2
with a loose screw-jack that was used to elevate the headpiece. Because of this, the headpiece
gave way when the patient was adjusted. When Thompson bought a new table, his patients
complained, and he was not achieving the same results as he had with the old table. Around this
same time, Thompson observed a doctor adjust an infant in a way that would impact the rest of
his chiropractic career. The doctor would lay the baby on the mother's lap in a side posture
position. When he was ready to deliver the adjustment, he asked the parent to raise her heel off
the floor. As the doctor delivered the adjustment to the infant, the mother's heel dropped back to
the floor. 1
With these two observations, combined with Thompson's vast experience in engineering,
Clay realized that chiropractors could deliver an adjustment with less force if they utilized
Newton's first law of motion. In 1952, Clay invented the first drop head piece. B.J. Palmer was
so keenly interested in this innovation, that after its unveiling at the Palmer homecoming in 1952,
he asked to be adjusted, and stated that the drop-piece would revolutionize chiropractic. i,2 Dr.
W.H Quigley, B.J. Palmer's nephew, took the head-piece to the Clearview Sanitarium and used it
in his work with mentally deficient patients, achieving remarkable result�. Thompson went on to
construct the first drop-piece table incorporating cervical, dorsal, lumbar and pelvic drop-pieces
in 1957.
It is without question that the drop table is central to Thompson's technological
innovations. However, equally as important is the establishment of the leg check procedure,
which is central to the analytical perspective of the technique. Thompson credits Dr. Romer
Derefield of Michigan with much of the initial research collected with the leg length analysis.
Credit was also given to Dr. Alvin Niblo for adding a major pelvic dysfunction associated with
the leg length inequality. Thompson later added to this information by including further cervical,
pelvic, lumbar and thoracic subluxations. By chance, Thompson discovered that leg lengths could
change with rotation of the head. Further examination revealed a tender nodule along the lamina
pedicle junction, and that thrusting through the tender nodule would ameliorate prone leg length
inequalities. It is from this point that Thompson began to understand and incorporate other areas
of the spine, as they too had an effect on leg lengths.
Dr. John Minardi 2 Copyrlght2006

Philo ophical Perspectives
A belief in the innate ability of the body to maintain homeostasis and signal the presence
of organic disturbances by structural adaptation provide the basis for Thompson Technique. Clay
was a finn believer and ad ocate of the above down inside out (A.D.I.O. principal and promoted
the principles of allowing the body s innate intelligence to heal itself though the correction of
vertebral subluxations. He was as his technique espoused a strong proponent of the use of drop
table assisted adjusting for the correction of vertebral subluxations. These subluxations were
detected using leg length analysis x-ray, palpation and instrumentation. 3
The Thompson philosophy also includes Newton's fust law which states that' a body is
in equilibrium if no force is acting upon it. If at rest it remains so, if in action it persists in motion,
unless an opposing motion is met". Utilizing drop pieces, the thrust imparts motion to the
ertebral segment, which remains in motion until the conclusion of the drop, at which time all
other segments in contact with the drop piece cease, with the subluxated segment continuing to
move into its corrective position. This is precisely why the technique is called Thompson
Terminal Point Technique, because the correction is made at the terminal point at which the drop
piece stops.
Critical to Thompson philosophy is the concept of prioritising the spine into primary,
secondary and tertiary areas of subluxations. Primary subluxations are corrected fust, followed by
secondary and then tertiary areas of subluxations. The primary areas of the spine are the cervical
and pelvic areas, secondary are the C-T junction and lumbar spine, and tertiary area is the
remainder of the t-spine. Hence, Thompson is a full spine chiropractic approach to health care.
This concept is key and meshes with the leg check analysis, as one area is adjusted, then the legs
are rechecked to see if a balance is achieved. If there is balance, then no further adjustments are
preformed, if balance is not achieved then the chiropractor moves to the next area of subluxation.
This is done so that the chiropractor only adjusts the major subluxations, and not simply every
restriction that is noted. A final note on philosophy is that of sparing the chiropractor from
physical degeneration due to difficult manual manoeuvrers. Thompson technique was and
continues to be, a career sparing technique. 1• 3
Terminal Point in Adjusting
As mentioned earlier, terminal point refers to the table's drop piece which corrects
vertebral subluxations at the terminal or end-point of its travel distance. The use of the tenninal
point enables the chiropractor to provide an alternative to forceful or leverage type adjusting
techniques. Thompson has had a long relationship with the Williams Manufacturing company,
who have built and continually upgrade the Zenith series of Pneumatic drop tables. Thompson has
become synonymous with this Cadillac of adjusting tables due to the superiority of the pneumatic
drops to all other types. However, this table is not required to utilize the leg check analysis.
Furthermore, any good quality drop table can be utilized for this technique. With the Zenith drop
table, each point is weighted by the doctor using tension control regulating air flow to the
appropriate mechanism. There are four distinct drop sections, including cervical, dorsal lumbar
and pelvis, with the ability of having adjacent sections act in unison with one another. This
creates a more gentle technique that benefits not only acute patients but also the elderly and
children. 3
Analytical Procedures
There are four main analytical procedures in Thompson Technique: palpation, x-ray
analysis, instrumentation and leg check analysis. First, the Thompson practitioner must have
excellent palpation skills to assist in the detection of subluxations. With respect to x-ray,
Dr. John Minardi 3 Copyrlght200I
Thompson agreed with Dr. Russ Erhart in that x-rays are used to tell the doctor what not to adjust,
as much as what to adjust. Although Clay x-rayed many of his patients, he did not t�ly heavily on
x-ray analysis. Clay felt that an x-ray catches structures one moment in time, but does not indicate
the segment's function. Thompson believed that it was more important to have a balanced spine
than a straight one. Hence, the leg check always takes precedence over the x-ray for detecting
subluxarions in this technique. X-rays are used primarily as aids in distinguishing the type of
subluxation involved, to rule out pathology and to assist the doctor's leg check analysis.
Instrumentation was an important part of Thompson practice. Initially, Clay used a
neurocalometer (NCM) until the development of the derm therm-o-gram (DTG). Instrumentation
was used because it provided an indicator of autonomic function in the body, and can determine
neurophysiological dysfunction. Again, instrumentation was used as another tool to determine the
location of the subluxation.
Finally, the leg check analysis is used to detect neurophysiological dysfunction through
spastic muscular contractions. There are main subluxation categories associated with the leg
check analysis, from which several different sub-categories exist. Furthermore, several other
components incorporating rare and obscure subluxations are assessed by the leg check. There are
basically two scenarios that will be present when preforming a leg check. Following the initial
examination, the prone leg length analysis will reveal either even legs, or a contracted leg in the
extended position. Depending on what clinical signs and symptoms the patient displays, will
influence what the leg length analysis determines.
Technique Influences
Thompson lived during a time with many of the pioneers of chiropractic. Clay would
regularly discuss patients, protocol and new ideas with the likes of BJ. Palmer, Clarence
Gonstead and Major DeJarnette. Thus, it is obvious to those who observe or practise Thompson,
that the technique incorporates some of the ideas of these great leaders.
Contra-indications to Care
As in all manual adjustive therapy, any contra-indications must be observed. It is

important to note that Thompson is considered a less ballistic approach to adjustive therapy,
especially if the patient is properly weighed on the table. However, the force can still be
aggravating to an acute disc, spondylolisthesis greater than Grade 3 or an aortic aneurysm. 2 As in
all chiropractic procedures, if any contra-indications to care are present, no adjustment would be
provided to the affected area.
Copyright 2008
Dr. John Minardi
Neurology of the Short/Contracted Leg
As mentioned previously, Thompson technique gives a chiropractor a systematic

approach for the location and correction of the ertebral subluxations. The technique utili zes the
contracted leg as a tool for detennining which area of the spine should be addressed first, and th e
Thomp on table is used to gi e a low force, high-velocity adjustment. What then is the short leg
concept? Why is this analysis chosen? To understand the short leg analysis, the reasoning behind
the contracted leg must be explained.
Originally, Thompson emphasised that the term contracted leg indicated the origin of a
neurological imbalance, which appears as an innervational overload to the extensor muscles,
causing unilateral spastic muscle contractions and unequal extremities. Normally the facilitory
mechanisms increases the normal spinal stretch reflex, while the inhibitory mechanisms act to
decrease the reflex. The systems constantly react to maintain postural balance. The cortex notes
l;. ,.,,.., , ... ...
normal values of body function, while the actual state of the body is monitored and compared to
the cortical data by the cerebellum and the hypothalamus.
Many individuals are under the impression that the Thompson
" leg length inequality(LLO
analysis is based on the dentate ligament theory(DLT). This assumption is incorrect. The DLT
may in fact have an influence on leg lengths, however, it is not a Thompson theory, it is a
Grostic upper cervical technique theory.
The primary reason that a contracted leg exists with a subluxation, is based on the
neurological response of the muscle spmdle, as well as the proprioceptive changes that are
tl' "
detected in the facet joint, intervertebral disc and Golgi tendon organ. Lets quickly review these
four stmctures and the .
' changes that occur with a subluxation.
The muscle spmdle contains both intrafusal and extrafusal muscle fibres. Contained
within the intrafusal muscle fibres are two specific types of nerve fibres. I) Nuclear bag fibres
also referred to as annulospiral endings, are contained mainly within the belly of the muscle
spindle, and detect dynamic/quick stretches that occur. 2) Nuclear chain fibres also referred to
as flower-spray endings, appear throughout the entire length of the muscle spindle and detect
slow stretches. As the extrafusal muscle fibres are stretched with a subluxation the intrafusal
nerve fibres will detect the change.
The second structure directly affected by the subluxation is the facet joint. The facet joint
is involved in both proprioception as well as pain sensation. A subluxation causes a distortion of
the facet joint, which results in an accumulation of inflamation within the capsule. This
accumulation adds to the stretch of the capsule and attracts an accumulation of asoactive
mediators such as prostaglandins, potassium and bradykinin within the facet joint. These
chemical mediators are the critical elements involved with the pain associated in a subluxation.
As bradykinin accumulates within the capsule, this will irritate the nociceptive nerve endings
located within the facet joint, resulting in an increased sensation of pain. This increase in fluid
also adds to the stretch of the capsule.
The third structure affected is the Golgi tendon organ (GTO). The GTO functions to
detect the amount of tension that the muscle exerts on the tendon. Any distortion to the
connecting musculature produces an increased tension to the tendon, causing the GTO to be
increasingly stimulated by the activity.
The fourth structure affected is the intervertebral disc. A subluxation causes a distortion
to the connecting intervertebral discs. This distortion is detected by the proprioceptive receptors
located in the disc's fibrocartilage, sending stimuli of the aberrant mechanics.
• J.T ''• "C
Therefore, when a subluxation exists, the aberrant mechanics associated with the
misalignment produces a distortion of the muscle spindle, facet joint, intervertebral disc and
Golgi tendon organ attached to the segment. This distortion/change is detected by the nuclear
chain and nuclear bag fibres within the muscle spindle, the GTO within the tendon, and
proprioceptive receptors located in the facet capsule and intervertebral disc. All four of these
Dr. John Minardi 5
structures are innerv ated by Type IA nerve fibres. When the distortion produced by the
subluxation is detected, these structures send this infonnation via the Type 1 A afferent fibres.
Type I A afferent nerves send this information to the cerebellum through two primary ascending
tracks; the entral and dorsal spinocerebellar tracts. These tracts'g'at'her this proprioceptive
information and send it to the cerebellum. The cerebellum is primarily responsible for
proprioception and motor control, and tells the brain what is happening in the body(ie. it senses
the stretch information). This cerebellar information is sent to the thalamus, which is the main
integrator of the brain. The thalamus takes the information and sends it to the motor and sensory
cortex. Simultaneously, pain originating in the facet joint, caused by the increase in bradykinin,
irritates the free nerve ending within the capsule. This pain information wilJ ascend by C fibres,
through the lateral spinothalamic tract to the thalamus. The thalamus then integrates this
information and sends it to the primary sensory cortex. The motor and sensory cortex contain
information about what should be happening within the body(ie. the distortion should not be
occurring).
If the information of the cerebellum and motor cortex are the same, then everything is
normal and no response is sent.
However, if the information differs, which is the case with a subluxation, then the
motor/sensory cortex will send a response through the brainstem using four primary descending
tracks, which fire simultaneously. 1) The tecto-spinal tract is responsible for head and eye
movements, due to sight and sound stimulus 2) the rubro-spinal tract responsible for bringing
information from the cerebellum and red nucleus, 3) the reticulo-spinal tract responsible for
intraspinal reflex loops and 4) the vestibulo-spinal tract.
The vestibulospinal tract is most important with regards to the short/contracted leg
because unlike the other spinal tracts, the vestibulospinal tract is always excitatory
0
and always
facilitates postural muscles, primactly located in the 1o{ve'tffi:.ib and i,eYvi� girdle. Thus, when
"'
this descending tract fires, it travels down through gamma efferents to the intrafusal muscle
fibres, activating a gamma motor neuron and causes a l��gth��g of those intrafusal fibres. The
activated gamma motor neuron sends a response to an inter-neuron within the spinal cord, which
results in two events Iiappiri'g simultaneously. Firstly, the inter-neuron activates an alpha motor
neuron of the agonist muscles. This results in a physiological shortening/contraction of the
extrafusal fibres of the postural muscles, thus causing a short/contracted leg. Secondly, the inter
neuron also inhibits the antagonistic muscle group.
The last mechanism involved with the subluxation response occurs within the cortical
inhibitory tracts. Under normal circumstances, these tracts provide an inhibitory response to
balance facilitory tracts. However, when a subluxation exists, the cortex inhibits this inhibitory
tract. This phenomena is termed "dis-inhibition" and refers to the fact that when an inhibitory
tract is inhibited, it results in an activation. The:ifore, furthei-""encouraging the contracted leg.
The reason that the leg length inequality balances so quickly after the subluxation is
corrected, is because the Type IA afferent nerve fibres that carried the aberrant infonnation are
the fastest nerve fibres contained within the body. They have a large diameter, are myelinated
and travel at a speed of 80-l 20m/second. Thus, when the problem is corrected, changes in leg
lengths are seen instantly because the aberrant afferent information from the muscle spindle,
facet joint, GTO and disc are no longer being sent. Therefore, no corrective response needs to be
sent by the cortex to compensate.4• The reason that an area may continue to be painful after an
5
adjustment is because time is required for the lymphatic system to clear out the inflammation and
chemical mediators that irritate the nerve fibres. (See Figure Titled "Thompson's Basic
Neurology")
Dr. John Minardi

Thompson's Basic Neurology
5
Cbrtu fas U. ,nb ol "'11!11 4
SHOLL.D hifipe,aig ,n the Thalarrus ,s the main
btq, the do in tie inlegraix of Iha brain
corl ,s nd the same as ,ie
cwwbeltm.
68 3
6A lrlubllS it's°"'" cortical Cerabdlum receives all
inhibilion ll"BCI = proprioception (conscious &
-,,
ltllllil serd a corrective
�e thtougl 4 main DIS.//l#fBfTKJN incorr;clous). The lnfxmallon
�,
decending traclS: (resulting ,nan contained inthe cerebellum k
sctivation) ,, wha IS ha,:penirg in the body
I I
1. Tectosplnal:
Detects changes in head
Corf/ca/ descending
tracts: I
\
'.
& ned< mo� based
Originates tom cortex
on sight & sound
Usualy inhibitJry
'
2. Rubrosplna/: I
Motor coordination 2
I Ascending tracts
3. Reticulospinal: (proprlootption)
lrtrasegmenta/ Reflex 1. Dorsal spin<>cErebel/ar Ir.
1. Ventra spino-cerabelartr.
'.
4. Vestibu lospinal: /NTRARJSAL FIBERS:
AIMBys FACVTORY (no ...;, r-.lJdear bag fiber,;
inhibition tract in it) -> (annulo-,p1ral endings):
facilitate postural m,scles in tre center. detect
located in LB arr! pfillis quickstmtch
...;, r-.lJdearchain fibe,s
(11 ov.er ,pray endingSj:
I \
Contraclion olthe tn)Ofibri/les
In entire mus::I e ,pindl e,
deled elow streiches
I
--"Both lnne,vated by
Lenr;/ltering of Ile intrafusa f. type 1 a afferents
Caitracfonofthe extrafusal f EXTRAFUSAL FIBERS:
---,
Contrac6on d the m,sc/e
---,
--
--
-i�,fl en ....
I;:
Twe 1 a afferent
fibers are the
faslast fbErS
(80-120 rrr'sec)
-- --
(.) inlf>e body
�
--
----- .. - .,,.
- _,
Q) (large diamelBr
.,,, I & m;@lirn saled)
............ Inhibition of the
.._ ............ I
'--- .._
antagonist muscle
I ...... � .._ - - - .,,
a rrotor ne uron /
(postural rm,) "'
..,
h the f a:et capsue.

pan associated with
cremi:als medators
of lnflanmaticn, travel
in C fbera by the
iatera spino-thalarric
Iract to the thaiatnJs
Facet Disc M.Jscle Golgi
Joint Spindle Tendon
- Facet capsule Is hlgHy If dislorsion Also Senses
dependert on lnflanmation present= inervated tensiontha
Charges can be seen so quckly - Distasi:ln --> nflanmation i propriocepdve by type 2 a ITIJSCie
alter a carecliai, because the -> bradykrlin, prostoglandns Input to type fibers exerceon
l;pe 1e afferents no laiger daect & K -> sensltivly of 1a fbers atend:>n
lheslralr:h oflhe swlUJCation noclceptille aidlngs ->
sensation of pan
(!raveling in C fibers)
( Subluxation Alters These 4 Structures
Dr. John Minardi 7

Reliability and Validity of Leg Length Analysis
For years. many individuals questioned the reliability and validity of the Thompson
technique because of its use of the leg length analysis. Many critics have claimed that there is no
cientific literature supporting the reliability and validity of the leg len�h analysis and thus
should not be preformed. These comments are simply incorrect, and s· tatea-by individuals who
ob iously ne er completed a proper literature search regarding leg length inequalities(LLD.
Pioneer research on LU, and the reliability of there utilization as a clinical tool began in the late
70's and early 80's. In that time period, researchers concluded that the gold standard for LU was
by using x-ray. 9 Further research then focussed on prone and supine visual LLI observations, as
researchers in the l 980's indicated that visual methods of measurement did not differ significantly
from the x-ray method of measuring LLI. In fact, when compared, the literature demonstrated that
there is a strong relationship between visual and x-rays methods of measurements. 10 In 1988,
more detailed research of the Thompson leg check was performed and demonstrated that the
clinicians studied could reliably measure a LLI to less than 3mm, with both intra and inter
examiner reliability. 11 DeBeor ( 12) also found good agreement, as welJ as significant interclass
correlation between the examiners studied. More recent literature by Rhodes et al (13) indicated
that the intraexaminer reliability was excellent for the prone leg check, and that prone
measurements were highly correlated with x-ray measurements. In the only study done that
observed the validity of LLI, the researchers found that when comparing prone leg lengths to x
ray measurements, 54% of the prone measurements were within 3rnm of the x-ray measurement,
showing a strong correlation (.71). 14 However, the same study demonstrated that in 12% of the
subjects tested, the opposite legs were viewed as being shorter. Thus the research concluded that
despite the strong correlation between x-ray and prone measurements of LLI, more research was
needed. 14 One should keep in mind, however, that even though x-ray is seen as the gold
standard, it is usually taken weight bearing, and prone measurements are viewed non-weight
bearing, which may account for some of these millimetre discrepancies. More recent literature
continues to indicate good reproducibility to detect LLI using either prone or supine protocols,
15·16
and are also beginning to use LLI for the detection of other dysfunctions. For example, Brink
( 17) found a statistically significant association between LLI and the side of radiating pain in
patients with lumbar disc herniations. Thus, LLI may be used as an inexpensive and quick tool for
evaluating these types of disorders, but more literature and clinical experience is needed.
I've only touched the surface of the literature that is available for using LLI as a clinical
tool. Thus, most individuals should read the literature on LLI further before making blanket
statements regarding unreliability or invalidity. We should remember that all diagnostic,
orthopaedic and palpatory assessments have been criticised and in some cases disproved in the
literature, however, none of these have been discarded. LLI as any other assessment tool bas its
limitations, but we should incorporate as many tools as possible when assessing a patient to
ensure that we are correcting the primary problem.
In closing, Dr. Thompson was a major pioneer in the field of chiropractif .�Voducing
new ideas, concepts and adjustive procedures. He was an avid researcher who headed the Palmer
Research Institution for l O years, and his technique has Weathe�ed over 50 years of professional
L n not only wanted a technique that was comfortable and patient friendly, he 1
scrutiny. 1).qlJl,RS�
wanted to lengthen the life of the chiropractors career, "adding 15 years of solid productivity". .2
Dr. John Minard I

PATIE T SET UP ON THE THOMPSON 440 TABLE
I. Make sure that all of the four pieces are in the dmvn position and le el before beginning.
2. Bring the table into the upright position using the either the side kick plate or the arrow
buttons at the top of the table.
• t -
3. Have the patient remove anything bulky (keys, wallet etc ... ) from of his/her pockets.
4. Have the patient step onto the footplate, facing the table.
, .I"'
A hf'
5. ave the patient's nose centred into the headpiece, by loosening the star knob on the upper
ccJriage and using the power handle to raise or lower the heigit as needed. Tighten the star knob
once it is in place. The upper carriage is now in the ready position for the patient. (If working on a
Automatic 440 table, simply use the arrow keys at the side of the headpiece to raise or lower the
upper carriage as needed).
6. Loosen the star knob on the bottom carriage and adjust the pelvic piece to align with the ASIS.
If this is not possible due to the patient's body structure, provide a 3 finger width difference
between the bottom of the lumber piece and the top of the pelvic piece. Tighten the star knob
once it is in place. The bottom carriage is now in the ready position for the patient.
7. Have the patient lean forward and rest against the table.
8. Place the patient's arms on the arm rests.

0 •
9. Lower the patient down, using either the side kick plate or the arrow buttons at the top of the
table. While the table lowers to its horizontal position, keep your hand on the patient's back to
eliminate any shifting or distortions.
PATIENT SET UP ON ANY DROP TABLE (without a Hi-Lo function)

4..J �· I(
Although this section concentrates on set-up on the Thompson 440 table, any quality drop table
will be sufficient in the practice of the this technique.
1. Make sure that all of the four pieces are in the down position and level before beginning.
2. Have the patient remove anything bulky (keys, wallet etc ... )out of his/her pockets.
.. � ... " ... ,11 ., ••
3. Have the patient step behind the table, kneel on the edge of the table and bring him/herself
down to a prone position.
4. Have patient's arms resting on the armrests.
5. Ensure that the patient's nose is centred in the headpiece.
6. When adjusting the pelvis, have the patient positioned so that the ASIS are level with the top of
the pelvic piece.
Or. John Minardi 9

"\VEIGHING" THE PATIENT TO ENSURE PROPER TENSION IS SET ON THE
THOMPSON ZENITH 440
Cervical
C."lfrl ,r.. w c.c,�,u. 11,,.11•
J . Set the select

(
knob to "D' with the cervical button pushed in, or cervical latch down.
2. Tight�� the cervical tension knob at the head of the table (turning to the right).
3. Step on the white foot strip and hold foot down until both the cervical and dorsal pieces raise.
Once both have raised, step off of foot strip.
4. Looseh the cervical tension knob (turning to the left) until the piece drops.
5. Tum the cervical tension knob 2-3 turns to the right to set tension.
6. Tum "Silver Dot" on DL tension knob to sit midway between the thoracic and lumbar pieces.
7. Step on the white foot strip and hold foot down until the cervical and dorsal pieces raise again.
Once raised, step off of the foot strip. The table is now ready for the cervical adjustment.
Thoracic
1. Set the select knob to "D" with the cervical button pulled out to an off position.
2. Step on the white foot strip and hold foot down until the dorsal piece raises. Release foot strip.
3. Tum the dorsal /lumbar tension knob so that the "Silver Dot" points away from the dorsal piece
(moving towards the lumbar piece).
4. Once the dorsal piece drops, return the "Silver Dot" slightly towards the thoracic piece. This
will provide the necessary tension required.
5. Step on the white foot strip and hold foot down until the dorsal piece raises again. Release foot
strip. The table is now ready for the thoracic adjustment.
Lumbar
I. Set the select knob to "L"

2. Step on the white foot strip and hold foot down until the lumbar piece raises. Release foot strip.
3. Tum the dorsal/lumbar tension knob so that the "Silver Dot" points away from the lumbar
piece (moving towards the dorsal piece).
4. Once the lumbar piece drops, return the "Silver Dot" slightly towards the lumbar piece. This
will provide the necessary tension required.
5. Step on the white foot strip and hold your foot down until the lumbar piece raises again.
Release the foot strip. The table is now ready for the lumbar adjustment.
Thoracic and Lumbar Pieces Simultaneously
I. Set the select knob to "DL"

2. Position the tension knob so that the "Silver Dot" is at the midpoint of both pieces.
3. Step on the white foot strip and hold foot down until both the thoracic and lumbar pieces raise.
Release foot strip.
4. If either the lumbar or thoracic piece drops, tum the "Silver Dot" slightly toward the fallen
piece, this will provide an increase in tension to that area. The key is to have the "Silver Dot" in a
position between the thoracic and lumbar pieces in that both pieces stay in the raised position.
For Example:
When both pieces are raised, the thoracic piece drops, while the lumbar piece stays raised. Turn
the "Silver Dot" towards the thoracic piece slightly, and re-set the drop pieces. If both pieces stay
raised, the table is in a ready position. However, if the thoracic piece drops again, then tum the
Dr. John lllrwdl 10

·• ii r Dot" towards the thoracic piece slightly again. Repeat thls until both pieces stay rai sed
hen stepping on the white foot strip.
5. Table is now ready for a thoraco-lumbar adjustment.
Pelvis
1. Set the select knob to "P".

2. Tighten the pelvic tension knob at the side of the table (turning to the right).
3. Step on the white foot strip and hold foot down until the pelvic piece raises. Release foot strip.
4. Loosen the pelvic tension knob (turning to the left) until the piece drops.
5. Turn the pelvic tension knob 2-3 turns to the right, to set tension.
6. Step on the white foot strip and hold foot down until the pelvic piece raises again.
7. Keep your foot on the strip and set the clutch located on the side of the table to set the direction
of the pelvic drop. (Positioning the clutch straight will have the pelvic piece drop straight down.
Pelvic Clutch set 45 degrees cephalad will have the pelvic piece drop down and up toward the
head of table.
Pelvic Clutch set 45 degrees caudad will have the pelvic piece drop down and back toward the
foot of table.
Release foot strip.
8. The table is now ready for the pelvic adjustment.
Lumbar and Pelvic Pieces Simultaneously
1. Set the select knob to "LP"

2. Position the tension knob so that the "Silver Dot" is at the midpoint of both thoracic and
lumbar pieces.
3. Step on the white foot strip and hold foot down until both the pelvic and lumbar pieces raise.
Release foot strip.
4. If the lumbar piece drops, tum the "Silver Dot" slightly toward the lumbar piece, this will
provide an increase in tension to that area. If the Pelvic piece drops, turn the pelvic tension knob
to the right 2-3 times. Re-set both drops and repeat this procedure until both pieces stay in the
raised position after stepping on the white foot strip.
Note: In the majority of lumbo-pelvic adjustments, the pelvic clutch is set in the straight position,
in order for the pelvis to drop straight down as the lumbar piece drops.
5. Table is now ready for a lumbo-pelvic adjustment.
WEIGHING THE PATIENT ON A NON-440 DROP TABLE
Weighing the patient on a any other drop table, other than a 440 table, is a much easier process.
1. Simply raise the drop piece that is needed using either the hand or foot lever, located at the side
of the table.
2. Loosen (turning to the left) the tension knob located adjacent to the piece, at the side of the
table, until the drop piece falls.
3. Increase the tension by turning the knob to the right 3-4 turns.
4. Re-set the drop piece using the hand or foot lever.
5. Table is now ready for the doctor to deliver an adjustment.
Dr. John Minardi 11

Proper Leg Check Procedure
The leg check has mistakenly been interpreted as a simple procedure. In fact, an accurate leg
check analysis is one of the most difficult aspects of the Thompson anaJysis. Quite simply, if the
leg analysis is inaccurate the entire Thompson procedure will be compromised. There ore, to
ensure accuracy and consistency in the leg length analysis, the following must be performed:
I)_ Once the patient has been placed on the table, make sure he/she is comfortable and does not
shift. Lower the table to its horizontal position.
If not working on a Thompson 440, Have the person step from the backi of the table, Kneeling
down into the proper prone position. When in the prone position, t,\i�fly lift the patient's hips and
legs off of the table to decrease any distortion of musculature.
o,r
2) If working on a Thompson 440 table, Raise the footrest so that the patient's toes do not touch
the footplate. This is necessary, because if the patient's toes touch the footplate, it will result in
excessive dorsi-flexion, which will increase the tension in the musculature of the legs, and
decrease the accuracy of the leg check.
3) Place the hands around the ankJes so that the index and middle fingers separate around the
lateral malleoli, and the thumb rests under the calcaneus. This is referred to as the "Guns
Position". If the doctor has incredibly small hands, an acceptable alternative is to grasp the foot so
that the palmar surface of all index finger are on the dorsum of the patient's foot, while the thumb
rests under the calcaneus. Whichever is chosen, it is imperative that the doctor perform it the
exact same way each time, as it will increase the accuracy and reliability of the leg check.
4) Be sure that the thumb applies

JCAt ,A
no excessive cephalad pressure. Apply only enough cephalad
pressure to have the patient's shoe touch the plantar surface of their foot. Excessive pressure will
make the leg check inaccurate, and will make assessing the subtle changes in the leg length very
difficult.
5) Raise the feet 3-4 inches off of the footrest. This is important to decrease any friction between
the table and the patient's legs. Do not leave them on the table, it does make a difference!
6) Remove any dorsi or plantar flexion, as well as inversion or eversion that may be present in the
feet. However, any foot flare (toeing in or out) can remain present, as it will provide clues for
pelvic subluxations discussed later on.
7) Bring the feet closer together, leaving approximately one half inch space from each other.
Without touching the feet together, look where the upper meets the sole of the shoe. It is
import.ant to use this area of the shoe for our sight marking, as this area will be the same
bilaterally. The doctor should not use the bottom of the shoe for sight markings, as different wear
patterns on the sole of the shoe will cause inaccuracies.
8) To ensure the accuracy of our leg length analysis, line up the space between the shoes with
centre of the spine. Accomplish this by sighting that space through the gluteal crease, continuing
through the spinous processes and ending at the external occipital protuberance (EOP).
9) Make a mental note of which leg is contracted (short) if any.
12
l K ing th hand in the ame position bring the legs to 90 degrees flexion. Again, sight
\vn th v elt of the shoe through the gluteal crease, continuing through the spinous processe
nd nding at the EOP making a note of the position of the previously contracted leg.
Checking the Patient's Legs while in the Extended Position
"" ,, p� I
Uneven Even
.11 ll
• cs •N
• D- • BCS
• D+ • uos
• POS
• X-D
Figure 1 Leg Length Analysis in the Extended Position.
Simply put, when a doctor checks a patient's leg lengths, only one of two things will be observed.
The patient will have a contracted (short) leg, which occurs 80 percent of the time or the patient
will have even legs. (See Figure 1)
If the patient has a short leg, then the patient can only have three possibilities of categories:
• Cervical Syndrome
• Derefield Negative
• Derefield Positive
If the patient has even legs, then the patient can only have five possibilities of categories:
• Normal
• Bilateral Cervical Syndrome
• Unilateral Occiput Syndrome
• Posterior Occiput Syndrome
• Exception Derefield
Dr. John Minardi 13 eopyriQ/ltzaol

Prioritization of the Spine
m ntion d pre iously Thompson is a full spine chiropractic approach to detecting and
rr ting ubluxations. Critical to Thomp on philosophy is the concept of prioritising the spine
into primary, econdary and tertiary areas of subluxations. Primary subluxa6ons are corrected
first, followed by secondary and then tertiary areas of subluxations. Thompson s game plan is to
adjust the highest and lowest subluxations first and working its way to the centre of the spine
onJy if neces ary. The primary areas of the spine are the cervical and pel ic areas secondary are
the C-T junction and lumbar pine, and tertiary area is the remainder of the thoracic spine. (See
Figure 2 This concept is key and meshes with the leg check analy is, as one area is adju ted then
the legs are rechecked to see if a balance is achieved. If there is balance then no further
adjustments are preformed if balance is not achieved then the chiropractor moves to the next area
of subluxation. This concept of checking, correcting and rechecking is termed 'Chasing the
Derefield.. and is done so that the chiropractor only adjusts the major subluxations and not
imply every restriction that is noted.
1'
ct- D1 2'
3'
-'-
lut16AL j,,.,f ---:---
2'
\} 1'
Figure 2 Prioritizing of the Spine into Primary, e ondary
and Tertiary Areas ofSubluxations.
Using the Drop Piece Mechanism to Assist the Adjustment
As mentioned previously in the philosophy of Thompson, drop pieces are utilized to incorporate
ewton's First Law of Physics - The Law of Inertia. Newton s First Law basically states that a
body in motion will stay in motion unless acted upon by an equal and opposite force. When at
rest, it remains at rest, when in motion it remains in motion. When the doctor positions a patient
correctly using a drop piece, a combination of the doctors thrust, and the falling of the drop piece
sets the subluxated vertebrae in motion. When the drop hits its terminal point the vertebrae will
continue to fall using the Law of Inertia, until it sets into its neutral position. Furthermore, the
doctor can decrease the amplitude of thrust, as the drop piece mechanism increases the velocity of
the adjustment, resulting in a less jarring and more comfortable adjustment for the patient.
The use of the drop piece will also provide less physical stress to the doctor, thereby increasing a
doctor's career considerably.
Dr. John Minardi 14 Copyright2006

SECTIO TV 0:
PRIMAR AREA: CERVICAL
Cervical Syndrome

Classic Prone Side of the Table Adjustment
Modified Prone Head of the Table Adjustment
Double Cervical Lock

Atlas Subluxation
Classic Thompson Toggle Recoil Adjustment
Overcompensated Cervical Syndrome

Classic Thompson Prone Adjustment
Stucky Friction Lock

Classic Two Part Prone Adjustment
Stucky Stack
Classic Supine Adjustment
Anterior Cervical
Modified Prone Adjustment
Posterior Cervical
Modified Seated Adjustment
Cl Flexion Lock
C7-Tl Extension Lock

Cervical Syndrome Review Chart
Dr. John Minardi

15
CERVICAL YNDROME (CS)
Classic Side Table Position
One of the primary areas of sub I uxation, and one of rhe most powerful areas of correction, is the
cervical spine. When adjusted properly, the cervical correction has tremendous effect . With this
in mind, the cervical yndrome is the initial problem that a Thompson practitioner must rule in or
out within the patient. The following procedures are required to detect and correct the cervical
yndrome ubluxation:
I. Patient must pre ent with a contracted leg in extension.

• Doctor instructs the patient to tum his/her head to the left then to the right.
• In order for a cervical syndrome to be diagnosed, the patient's legs must balance upon
head rotation to one or both sides. If the patient's legs balance with head rotation, the
cervical syndrome is then labelled a left or right cervical syndrome according to the side
of head rotation. (See Figures 3&4)
• For example, if the patient presents with a contracted right leg, and head turning to the
left balances the patient's legs, then this would be labelled a left cervical syndrome,
simply because the patient's head is turned to the left. However, the actual problem is
located on the opposite side of head rotation. In this example the problem would be on
the patient's right side.
• The doctor must note that the patient's legs must balance I 00 percent with head rotation
in order for a cervical syndrome to be present. If the legs partially correct but do not
become completely balanced, this would not be considered a cervical syndrome, and the
doctor would continue to the next area of concern prior to adjusting the cervical spine.
Following correction of that area, the doctor will re- isit the cervical spine by ha ing the
patient tum their head to both sides again to verify if a cervical syndrome is now present.
Figure 4 Left or Right Head Rotation Produces Even Legs.
2. Palpate along the lamina-pedicle junction from C2-C7 contralateral to the side of head
rotation (right side in our example above) for a tender "P�·��Shaped" nodule. This nodule is an
inflamed facet capsule, which is extremely tender due to inflammatory mediators that are
(�\,.,.,
gathered within the capsule. It is important to locate the capsule itself, and not simply contracted
musculature in the cervical region. Thus, a simple test to confirm the capsule is the "Roll Test":
• When the doctor finds the pea shaped nodule, he rolls the mass between his fingers up
and down and side to side. If the omass is able to be rolled, then
fun•
the doctor is on muscle.
� �
The facet capsule is located beneath this muscle mass is firm and does not move. This
nodule confirms the location of the cervical subluxation.
Dr. John Minardi 16 Copyright 2006

3. Bi m h m yndr me ubluxation.
Th following diagram i0ur 5) dem n trate the biomechanic involved in a cervical

yndrom pr ent anywhere from 2- 7. ote that the affected egment ubluxates posterior
and rotate pinou proc away from the ide of the nodule black arrow . The subluxation
pattern stretche the facet cau ing inflamation to build and re ult in a palpatory nodule within
the facet joint (gr y arrow).
CS Subluxation
p A
C3
C4
Figure 5 Cervical Syndrome.
Based on these biomechanics, the doctor must correct for the both the posteriority and rotational
components of the subluxation. This is accomplished by the doctor t�sting P-� perpendicular
to the facet, and parallel to the disc plane. In order for this to be achieved, the doctor s line of
correction must change throughout the cervical spine to compensate for a patient s natural
cervical lordosis. Therefore, in superior cervical segments, the line of correction will be
cephalad, and will gradually become caudad with each inferior segment. (See Figure 6&7)
l\:phalad
p A
Caudad
Figure 6 Line of Drive C2-C7. Figure 7 ervi I pine Line f Ori, e - Parallel
to the Dis Plane.
from
The diagram (Figure 6) and x-ray (Figure 7) display how the angle of the di and f th fa ets in the cervi al pin change
C2-C7. To correct for both the po terior and rotational aspe t of the ublux ti n, the d t r mu t thru t perp nd1c ular to th
ph l d in th higher egm nt , gradually beCiJO if]g
l
facets and in line with the disc. Therefore, the doctor's lin of correcti n i
more caudad when adju ting the lower egment . By thru ting in thi dire ri n, th d t r imultaneou l correct for bo th
posterior and rotational components of the subluxated egment.
Dr. John Minardi 17 Copyright#Jf

4. Po itioning: Clas ic Side Po ture Cer vical Syndrome Correction: (See Figures 8&9)
Doctor: Side of table.
Patient: Prone.
Table: Cervical Piece in the ready po ition.
Contact: MCP or PIP joint on the LPJ (location of nodule).
Stabilization: Oppo ite side zygomatic arch or parietal bone.
LOC - P-A, L-M perpendicular to the facet joint and in line with disc plane.
Figure 8 CS Correction. PIP Contact on Affected LPJ. Figure 9 CS. Side of Table Doctor Positioning.
The anterior to posterior thrust corrects for the posteriority of the subluxation and the unilateral
contact on the lamina-pedicle junction corrects for the rotational component in olved. Thus the
doctor will be thrusting into the patient's natural cervical lordosis, restoring the affected segment
back into a normal position. The doctor must note that the tenderness within v� the•"facet capsule
4AJQ.#L JC
will persist at the lamina-pedicle junction. Although this tenderness will be slig tly decreased
immediately following the adjustment, the body requires time to flush out the inflammation
caused by the subluxation.
5. Recheck the legs, and continue analysis for other subluxations.
Sample Ca e:
A 35 year old female presents to the clinic with neck pain. Following a complete examination Thompson anal sis
reveals a short right leg in extension. The doctor instructs the patient to tum her head to the right, which produces
no change to the leg lengths. The doctor then instructs the patient to turn her head to the left, which results in
balanced leg lengths. Left head turning producing balanced legs indicate a Left Cervical Syndrome but the
problem is on the opposite side. The doctor will then palpate along the lamina pedicle junction on the patient'
right side. A tender nodule is present at CS. The doctor is of small stature and decides to utilize the side of the
table cervical syndrome correction. The doctor will talce his/her contact at the site of the nodule, and thru t P-A in
line with the disc and perpendicular to the facet. The doctor will then re-check the leg lengths and mo e on to the
next area of problem.

CERVICAL SYNDROME - Modified Head of Table Position
The head of the table modification may be more biomechanically advantageous to the doctor of a
larger frame, as the original side posture position is more comfortable to those doctors of a
smaller frame. The result to the patient is identical in both, provided that the adjustment is
performed correctly. This modification is strictly for doctor comfort.
1. All components are the same as pre iously discussed, with the exception of positioning.
2. Po itioning: Cerv ical Syndrome Head of the Table Modification: (See Figures 10&1 l)
Doctor: Head of table.
Patient: Prone.
Table: Cervical piece in the ready position.
Contact: MCP or PIP joint on the LPJ (location of the nodule).
Stabilization: Opposite side zygomatic arch or parietal bone.
LOC: P-A, L-M perpendicular to the facet joint and in line with disc plane.
When performing this alternative adjustment, the doctor must be sure to position himself behind
his contact to maintain a biomechanical advantage. This positioning will ensure optimal speed
and proper line of correction.
Figure 11 CS. Head of the Table Doctor Positioning.
3. Recheck the legs, and continue analysis for other subluxations.
Sample ase:
A 35 year old female presents to the clinic with neck pain. Following a complete examination, Thomp on anal
reveals a short right leg. The doctor instruct the patient to turn her head to the right which produce no chang
to the leg lengths. The doctor then instructs the patient to turn her head to the left which result in balanced 1 g
lengths. Left head turning producing balances legs indicates a Left Cervical Syndrome, but th problem i on the
oppo ite ide. The doctor will then palpate along the lamina pedicle junction on the patient' right side. A tend r
nodule i pre ent at 5. The doctor is not of small tature and decides to utilize the moclified head of th tabl
cerv ical yndrome correction. The doctor will take hi /her contact at the site of the nodule, and thru t P- in line
with the di c and perpendicular to the facet. The doctor will then re-che k the leg length and mo e on to th next
area of problem.

CERVIC L ORO.ME - DOUBLE CERVIC L LOCK (D L)
There are o ca ion � here both ide of the cerv ical pine are ubluxated and require
adju tment. Thi phenomenon i labelled a Double Cervical Lock, and i confirmed when the
patient pre ent � ith a ontracted leg that i balanced with head rotation to both ide . The
doctor would then palpate for the nodule at the lamina-pedicle junction bilaterally, and correct
a ordingly. The doctor hould alway begin by adjusting the higher egment, followed by th
lo\l. r egment. It i al o important for the doctor to remember to re-check the leg following the
fir t orrection, a the lower ertebra may only be a secondary compen ation and may not
require adju ting. Therefore, if the doctor re-checks the legs and they remain balanced with head
rotation following the fir t correction, then the second(lower) segment i not required to be
adju ted. However, if the patient's leg continues to pull short following the fir t adju tment and
continue to balance with head turning, then the lower segment requires an adju tment a well.
The following procedure are required to detect and correct a Double Cervical Lock:
1. Patient pre ent with a contracted leg in extension. Head rotation to the left and to the right
balance the leg
2. Palpate along the lamina-pedicle junction from C2-C7, on both the left and right ide for a
tender "Pea haped" nodule.
3. Biomechanics of a Double Cervical Lock is identical to the Cervical Syndrome previou ly

de cribed. Figure 12 demonstrates how the angle of the disc and of the facets in the cervical
pine change from C2-C7. To ensure that the doctor is thrusting perpendicular to the facet and
in line with the disc, the doctor's line of correction is cephalad in the higher egment gradually
becoming more caudad when adjusting the lower segments. Figure 13 di play how two
independent nodules, one on either side, would be present in a DCL. In thi example nodule are
pre ent at C3 and C5 (black dots). The doctor would correct the superior egment C3) re-check
the legs, and then proceed to adju t the inferior segment (C5) if nece ary.
C.:ph.ilatl
<{ID>
p A
Caudad
Lateral View A-P View

Figure 12 Linc of Drive For All ule Found
r.i I yndr me. Thru t
Perpendi ular to the Fa , nd
Paroll I to th 01

rr ti n: Double er v ical Lock: (See Figure 14& l 5)
D tor: Head of table.
Pati nt: Pron
T bl : er v ical pie e in the ready po ition.
nta t: .f P on LPJ (I cation of the nodule of Superior egment.
t bilizati n: Opp ite ide zyg matic arch or parietal bone.
L P- , L-M perpendicular to the facet joint and in line with disc plane.
Re- h k leg and repeat for inferior egment if necessary.
Figure 15 Double Cervical Lock. Doctor Po itioning on the lnfenor

Vertebra.
4. Re heck the legs and continue analysis for other subluxations.
ample Ca e:
A 22 ear old male occer player presents to the clinic with neck stiffness. Following a complete examination,
Thompson analysi reveal a hort left leg. The doctor instructs the patient to turn his head to the right which
produce a balance to the leg length . The doctor then instructs the patient to turn his head to the left, which al o
r suit in balanced leg lengths. Left and right head turning producing balanced legs indicates that the patient ha
a Cervical ndrome bilaterally, called a Double Cervical Lock. The doctor will then palpate along the lamina
pedicle junction on the patient' left and right sides. A tender nodule is present at C3 on the left and C6 on the
right. The doctor will take bis/her initial contact at the site of the superior nodule (C3) and thrust P-A in line with
the di c and perpendicular to the facet. The doctor will then repeat this procedure with the inferior nodule (C6).
The doctor will then re-check the leg lengths and move on to the next area of problem.
CopyrlghtZOol
Dr. John Minardi 21
R I L YNDROME - TL UBLUXATIO
Toggle Correction
Th ti nd it neurological influence are integral to chiropractic. There are technique within

h1r pra tic that focus olely on the atla , due to the important neurological consequences that
x1 1- when it become ubluxated. In the Thomp on Tecbnjque, the atlas subluxation is
n ompa ed in the Cervical Syndrome family. Howe er, its detection i slightly different then
the detection of a C--C Cervical yndrome, and aries completely in i correction.
I. The leg analy i i identical when detecting any Cerv ical Syndrome, including the atla :
Patient mu t present with a contracted leg in extension.
• Have the patient tum his head to the left then to the right. In order for a cervical
yndrome to be diagno ed, the patient legs must balance upon head rotation to one or
both ide . The cervical yndrome i then labelled a left or right cervical yndrome
according to the ide of head rotation.
For example, if the patient presents with a contracted right leg, and bead turning to the
left balance the patient's legs, then trus would be labelled a left cervical syndrome
imply becau e the patient' head is turned to the left. However, the actual problem is
lo ated on the opposite ide of head rotation. In our example, the problem would be on
the patient right side.
2. Palpate along the lamina- edicle junction from C2-C7, on the affected side right side in our
example a o e) for a ten�er�'P�-Shaped" nodule.
• 0 no u e 1s resent.
• When a cervical s ndrome erists (head rotation balances the leg yet the doctor_§Q!Lot
locate a nodule this indicates that the atlas is the subluxated cervical ertebrae.
• Remember that the atlas has no lamina- edicle junction for t ate.
Therefore, trus cer ical syndrome is ruled in when no nodules are resent
v
The biomecharuc of an atlas subluxation is completely different than those located from C2-C7.
As mentioned pre iously, cervical subluxation from C2-C7 ubluxate po terior \l ·th rotation.
The atlas, however, subluxates lateral, superior and slightly posterior folio ing the occipital
condyles. The subluxation occurs to the side where the doctor would ha e found a nodule if the
ubluxation had occurred in a lower cervical segment.
For example, if the patient presented with a hort leg in ex ten ion that balanced with the
patient's head turned to the left, the doctor would palpate th right ide for a nodule.
When no nodules are found, this implicate atla a the ublu ation. The atla would
ubluxate lateral, superior and lightly po terior on the right ide. See Figure 16)
C 1 Subluxation
co
Cl
C2
upmor and P terior.
Dr. John llinwl 22 Copyrlght200CS

e recoil adjustment is used.
Corr ect ion : W hen correc(moa the atlas, the toggl -
3.
ure� 17-19)
4. Positioning: (See Fig
Doct or· Behind patient. . . . .
. · S1.de pos ture. Ankles together & m hoe with spme. Superior hand str
Patient: . a1.ght
. . c ·or hand in a figu re 4 . .
pos1t1o n a I ong stomach . Laterahty side of
along s1de, mien
the atlas up. (See Fig ure 17)
Figure 17 Patient Positioning for a Toggle Recoil Adjustment.
Table: Cervical headpiece in the ready position.

Contact: Pisiform on lateral1�6A<,
aspect
.. IH�
of TVP of atlas.
Stabilization: Anatomical snuffbox of contact hand.
LOC: L-M
.
The doctor must be sure that the headpiece is level and raised the same height as the patient's
shoulder size, in order to keep the patient's head in a neutral position.
Figure 18 Atlas Toggle

Rec oil Correction. Pisifo
Lateral Aspect of the CI nn Contact on the
TYP.
Figure 19 tlas Toggle Recoil Doctor

. Positioning.
5. �1t the patient up
patients may exhib for1 15-30 se c
'-b2�q�tand che. ck for any arasympathetic response. sorn
e
it 1 ug
�· ·h·ter g ot\,
' 1 gglmg, sweatmg or rean s
p rovi.ded that the
y are tem pora y ess. These are nonnal response doctor
r and subside within 30 secon If mptoms p rsist b e
ds. sy e ,t
Dr. John Min
ardi
- --' �,,,z(IJ6
- - - �
m t m nit r th ti nt fuJly and be prepared to refer for medical assistance if necessary.
g , and continue analysis for other subluxations.
Th t gl r oil is a unique adjustment that corrects the atlas during the re oil phase of the
rre rion. When adjusting the atlas in this fashio� the doctor must e'iivi'si�n the correction not
hammering in a nail, but rather compressing a spring and allowing it to expand and retract as
the pre sure is quickly released. Because the patient is positioned with the subluxation laterality
up, the atlas is in effect being over-corrected with the initial thrust and drop of the headpiece.
Howe er it is the recoil of the adjustment that allows the atlas to spring back into its normal
position.
The doctor will be positioned behind the patient, primarily due to the slight posteriorif;' involved
in the subluxation. By simply positioning behind the patient, the thrust will eii;o;;.pa�s an
'" • 1. ""
anterior component assisting in the corrective process. Furthermore, the doctor positioned
behind the patient is done as a courtesy, as the head position is in the same alignment as the
doctor s private area.
The doctor can position himself at the head of the table if the atlas has subluxated more
uperiorly with its lateral displacement. This increased superiority would be discovered either
through x-ray analysis or palpatory findings.
Sample Case:
A 40 year old female patient presents to the clinic with headaches. Following a complete examination Thompson
analysis re eals a short right leg. The doctor instructs the patient to tum her bead to the left which produces no
change to the leg lengths. The doctor then instructs the patient to turn her bead to the right, which results in
balanced leg lengths. Right bead turning producing balances legs indicates a Right Cervical Syndrome but the
problem is on the opposite side. The doctor will then palpate along the lamina pedicle junction on the patient s
left side. o tender nodule is present along the lamina pedicle junctions, indicating an atlas subluxation. The
doctor will position the patient on her right side (lesion side up), and will toggle the atlas into po ition. The doctor
will then sit the patient up for 15-30 seconds to check for any parasympathetic responses. Finally the doctor re-
heck the leg lengths, and moves on to the next area of problem.
Dr.John ..... 24 Copyright 200e

O R OMPE TED ERVI L YNDROME (0 )
d er v ical yndr me is the first area where the Thompson technique

intr urr nc fa sec ndary compen ati n ccurring a a re ult of a primary
pr bl m pr ent her in the pine. This particular categ ry is an excellent example in
adju ting the p ifi ar a fpr bl m, rather than imply cha"ing pain. The pecificity in the
adju tment alwa tran lat into p iti e patient re ult and ati faction. ln order to acc urately
d t t and rre t for an , th fi II wing mu t occur:
I .The 1 g anal i i identi al when detecting any ervical Syndrome.

• Pati nt mu t pr nt with a contracted leg in extension.
• H the p ti nt turn his head to the left then to the right. In order for a cervical
yndr me t b diagno ed, the patient's legs must balance upon head rotation to one or
b th ide .
• The cervical yndrome is then labelled a left or right cervical syndrome according to the
ide fhead rotation.
• or example, ifthe patient presents with a contracted right leg, and head turning to the
left balance the patient' legs, then this would be labelled a left cervical yndrome,
imply becau e the patient' head is turned to the left. However the actual problem i
lo ated on the oppo ite ide ofhead rotation. In this example, it would be on th patient'
right ide.
d ctor find that the patient i pre enting with a chronic and re-occurring 2 ublu ation,
h uld be u pected. This suspicion is reinforced when the patient is not re ponding to
al yndrome adjustment . Furthermore, adjusting C2 does not balance the
2. H we r, t c nftnn the pre ence ofan OCCS, five specific criteria must be met:
1) ontracted leg.
2) hronic 2.
3) Trigger point in the trapeziu - on the opposite side ofthe C2 nodule.
4) Fi ation of 1 1 rib co to-tran verse joint - on the same side as C2 nodule.
5) tair tepping on an A-P cervical x-ray. (See Figures 20&2 l)
Figur 20 pinous Proce Deviation on n A-P

erv 1 al X-ra (A-P twr Lepping).
Th diagram and x-ra ab di play how th pin u

t, in which a h pinou fr m 2- I rota! egm nt.
....
ZOo'
Dr. John Minardi 25 eopyrlgllt
If ll fiv rit ri ar pre ent, then the primary subluxation is an OCCS. The biomechanical
1 :i n of an OCC i a two-fold problem. First, TI subluxates posterior, and rotates spinous
pr toward the ame ide as the original C2 nodule. Secondly the first rib head ha
ubluxated ephalad.(See Figures 22&23) Therefore, C2 o ercompensates by subluxating in the
oppo ite direction of the primary Tl/fir t rib ubluxation. However, C2 is not the primary
problem, which explain why the legs do not balance after the C2 correction.
occs
t
Nonnal
Figure 22 Figure 23
The diagrams display the difference between nonnal and an OCCS. Note how in a OCCS subluxation, the head of
the first rib elevates in addition to the T l vertebrae rotating spinous toward the side of the elevated rib (arrows).
Each of the five criteria must be present in order to confirm an OCCS as each is associated with
this subluxation pattern. The contracted leg must be present for any cervical syndrome. The
chronic C2 problem that is not correcting with typical cervical syndrome adjustment is required
as the presence of the overcompensation itself. The trigger/tender points along the trapezius on
the opposite side of the C2 nodule is present due to the tension produced in the mu cle as it is
pulled by the subluxated spinous process of T 1. The fixation of the costo-tran er e joint on the
same side of the C2 nodule is present, as this is the actual primary subluxation. Finally stair
stepping of the spinous processes on an A-P cervical x-ray is needed to confinn the pre ence that
the overcompensation is taking place. This A-P stair stepping is NOT the same a stair stepping
on a lateral view, in which there is a break in George's Line and may indicate in tability. The
stair stepping found in the OCCS is found on an A-P x-ray and i u ing the pinou process as
the reference point.
Figure 24 ostal Articulations. ums orean1 bycom"stdmonoror:i •

Anatomy or lh• Hwruin Body.
The diagram abo e di play the co tal ani ulations of the thoracic egments. Note that the rib head has articulation
on both the venebral body and the tran ver e proce s (thick black arrow ).
5 Ho
t<lo
26 Copyrlght2006
4. Positioning for the C S Adju tment: See Figures 25&26
Patient: Prone.
D ct r: Head f table.
Table: rv ical and Th raci piece in the ready position.
totran er e j int f fir t rib & lateral a pect of Tl pinou
pr ce
pe ific onta t: M P joint and thumb.
.
tabilization: Opp ite zygomatic arch r parietal b ne.
L : Primaril -I, L-M, with t rque.
To n ure that the doct r i properly po itioned behind the contact, thi adjustment should
alv a be perform d at the head of the table. Thi will optimize the peed and accuracy of the
adju trn nt, a well a decrea e any chance of injury occun-ing to the doctor.
Figure 26 OCCS Doctor Positioning at the Head of the Table.
ample a e:
A 29 year old female patient pre ent to the clinic with neck pain. Following a complete examination, Thompson
analy is reveals that a erv ical yndrome is present, with the nodule appearing at C2. Over the ne t several
week , the patient presents with the same 2 cervical syndrome, but the patient's
symptoms do not impro e, nor
do the patient' legs balance following correction of the C2 segment. Because
the patient i not improving, and
has a chronic 2 ubluxation, the doctor u pect and checks for all five criteria
necessary for an OC S. The
doctor find that all fi e criteria are pre ent in this patient. The doctor
now s�it�he bis/her contact from the 2
nodule, to the fir t rib and T l subluxation. The doctor will now thrust
S-1 with torque to correct for the el at d
rib and rotated TI. The doctor will then re-check the leg lengths and
move on to the next area of problem.
Dr. John Minardi

27
•c
TUCKY FRJCTIO LOCK

(Pre- tres adjustment for the Cenical yndrome)
Dr. J tu k')' i a chiropractor from Eau Clair Wi con in, who added certain component to the
original Thomp on Te hnique. He combined Gon tead, Thomp on and hi mvn t chnique to
r at the tu ky Integrated Methods. The Stucky Friction Lock i be t utilized in tho e patient
\\ho pre ent with a Cervical Syndrome. but al o uffer from moderate to evere degeneration in
the ervi al pine. Due to the chronicity of the ubluxation, the joints ha e had limited motion.
A a re ult, th rypi al C2-C Cer vical Syndrome adjustment are ometime not ufficient in
fully corre ting th ubluxation. Thu Dr. Stucky re-de eloped the one part Cervi al Syndrome
adju tment, into a two part adju tment. Part One being the friction lock a a pre- tre
adju tment to introduce a mall amount of mo ement within the segment. Part Two being a full
thru t to orrect the ubluxated ertebra. Thi pre-stress adjustment is performed on the contra
lateral larnina-pedicle jun tion, of the ame egment that the nodule wa found. Thus the
chiropractor i in effect increa ing the ubluxation pattern with the fir t part. Ho\J e er thi
imply introduce motion into the egment to prepare it for the econd part. Part t wo i the
cla ic Cervical Syndrome adju tment, performed on the original nodule. . -�
An analogy for thi type of pre-stre s manoeu er i loosening a rusty bolt. If the bolt
,. ... " • •.. I.A.
refu e to loo en by turning it in the pro er manner sometime quickly turning the
oppo ite direction, in effect tighte�ing the 'bolt e en further"(pre- tre pro ides a mall
amount of mo ement. ow the bolt can be loosened properly correction .
Thi Friction Lock adju tment i performed when the do tor i ha ing problems corre ting a
cervical ubluxation with the typical cervical yndrome adjustment. Thi is typi all due to
ubluxation that are chronic, and ha e de eloped osteoarthritis and degenerati e joint di ea e.
Procedure:
I. Leg Analy i is identical when detecting any Cervical Syndrome.

• Patient ha a contracted leg in the extended po ition.
Head rotation to one ide balance the leg .
Typical Cer v ical Syndrome correction ha e been un uc ful the p ti nt xhibit chroni
ubluxation , ith se ere degeneration. (See Figur 27)
The x-ray in Figure 27 di play degeneration and

o t oarthriti in the cer v ical pine arrows). In ituation
like the e cla ic Cervical Syndrome adju tment are
ometime un uc e ful ther fore a Friction Lock
adju tment i needed to re tore proper moti n into the
c rvi al pine.
2. P hap d odul i lo ated at the LPJ a befi re.
3. P ti nt r tate head in opp ite dir tion.
4. D tor nta involv d rt bra on th oppo ite LPJ. Opp ite id of n dul .
Dr. John llln•rd 28 Copyright2006

5. Correction: tuck Friction Lock with ervical Syndrome Adjustment
Part ne: Pre- tre s/Preparation thru t: (See Figure 28-30)

Doctor: ide of table, or modified head of table position.
Patient: Prone.
Table: ervical piece in the ready position.
ontact point: LP J oppo ite ide of tender nodule.
tabilization: Oppo ite ide zygomatic arch or parietal bone.
pecific contact point: MCP or PIP Joint.
L : P- , L-M perpendicular to the facet joint and in line with disc plane.
ot : do not thru t fully (less depth) on the friction lock.
'
Part l
Friction Lock
Figure 28
Part Two: orre ti e adju tment: (See Figure 28, 31 &32)

Doctor: Side of table, or modified head of table position.
Patient: Prone.
Table: erv ical piece in the ready position.
Contact point: LP J same side of tender nodule.
Stabilization Hand: Opposite side zygomatic arch or parietal bone.
Specific contact point: MCP or PIP Joint.
LOC: P-A, L-M perpendicular to the facet joint and in line with disc plane.
Figure 30 Friction Lo k Part I. Doctor Posinorung.
Dr. John Minardi '>O _______ coa trtZOo'

Figure 31 Friction Lock Correction Part 2. PIP Contact on Affected Figure 32 Fricuon Lock Part 2. Doctor Positioning.
ide LPJ.
6. Continue analysi for other subluxations.
Sample Case:
A 65 year old male retired hockey player presents to the clinic with chronic neck pain and lack of movement.
Following a complete examination, x-rays are taken due to the chronicity of the problem. X-ray analysis reveals
severe degeneration and osteoarthritis. Thompson analysis reveals a Right Cervical Syndrome is present at C4.
The doctor adjusts the segment using Classic CS corrections for six visits and is not achie ing de irable results.
Due to the amount of degeneration present, and the lack of success with the Classic CS correction , the doctor
now performs a Friction Lock adjustment. In this case, the patient has a right CS, nodule appearing at the left C4
lamina pedicle junction. The doctor performs part one "pre-stress" on the patient's right lamina pedicle junction
of C4 to initiate some motion, followed by part two "correction" on the left lamina pedicle junction of C4. The
doctor will then re-check the legs and move on to the next problem.
I have often been asked ifa doctor should still assess the cervical spine ifthe patient's
only complaint is low back pain. When using the Thompson analysis, the doctor hould always
rule out the presence ofa cervical problem regardless ofthe complaint. Thi may puzzle some
doctors, as it is well documented that low back pain can be treated effecti ely with chiropractic
treatment ofthe lumbar and pelvic area. 1 •3•5•8• 1 However, many researchers al o indicate that low
back pain can be successfully treated by adjusting only the cervical spine. 4· 1 1• 12·13• 14•1 6·1 A ariety
of research indicates that chronic low back pain and post surgical low back pain syndrome
which have previously been unresponsive to medical treatment, could be successfully treated
through chiropractic cervical adjustments. • • According to the literature a complex
4 14 17
neurological interaction between proprioceptors, pinal cord distortion and efferent facilitation
ha connected a significant link between the cervical and lumbar segments ofthe spine. 10• 11 • 15
Ironically, Kumrnel ( 1996) found that patients with decreased cervical and shoulder motion had
an increased incidence oflow back pain. 6 Furthennore, other studies indicate that cervical
treatment produced significant changes in the hip and lumbar mu culature 10• 12• 1 3 and other
suggest that when a cervical adjustment was delivered incorrectly iatrogenic low back pain
would re ult. 7 Additionally Lew and Bri s (1997) indicate that there is a direct neurolo ical
relationshi between the cervical s ine and the hamstrin muscle 9 and Brown and Vaillancourt
( 1993) found that an individual with kne in re p,on e favourabl to a cervical adju tment
QTOtocol. 2 This briefreview ofliterature simply reinforce the fact that the doctor hould a e
the patient th�o;oughly, and correct the affected areas detected and not imply the location of
pain.

CER ICAL SYNDROME - STUCKY STACK
(Chronic C2 Subluxation)
The Stucky Stack, a de eloped to correct a chronic C2 problem. As discussed previously with
the Stucky Friction Lock chronic cer v ical subluxation sometimes do not respond to the clas ic
Cervical S ndrome adjustments. The Stucky Stack is a manual adjustment that was created
specifically for a chronic C2 ubluxation however it can be performed at any cervical level.
Con idering the fact that the ertebra subluxates posterior and rotates spinous process away from
the nodule, thi problem will result in a decrease in the natural cervical lordosis. Thus the
purpo e of this adjustment, is to re-align the cervical spine by compressing the facet joints back
into a closed packed po ition. Furthermore, the line of correction is concentrated anteriorly,
restoring the natural cervical lordosis.
1. Leg Analysi i the same in detecting any Cervical Syndrome.

• Patient presents with a contracted leg in extension.
• Head rotation to one side balances the legs.
2. There are two criteria required to justify the use of the Stucky Stack:
1) Loss of proper cervical curve as seen on x-ray.(See Figure 34).
2) Chronic C2 cervical syndrome.
3. Subluxation Biomechanics. (See Figure 33) The C2 vertebrae subluxates posterior with
rotation away from the side of the nodule (thick black arrow), which causes the facet joints to
separate (thin black arrow). The line of drive (dashed grey arrow) is focussed P-A to correct the
subluxation and restore the cervical lordosis.
C2 Subluxation
C2
C3
Figure 33 C2 ubluxation Biomechanics (black
arrows) and Line of orrection (grey arrow).
Current research has demonstrated a statistically significant a ociation between a de reased

cervical lordo is and neck pain. The study suggests that a cervical Iordo is of 31 degrees to 40
degree hould be maintained, and hould be a clinical goal for chiropractic tr atment. 19 Patient
having a cervical lordosis less than 3l degree had a higher incidence of neck pain. 19
Dr. John Minardi 31

-
4. 1rrecti n: tu t...-y tack Adjustment: (See Figures 35&36)
P tient: upine. Table at a 45 degree incline (if working on a hi-lo table).
Do tor: Head of table, facing caudad.
Contact: Thumb pad on LPJ (nodule of C2.
Stabilization: Cradle the patient s head. Ha e them rest their head aero your arm. while
imultaneou ly holding their chin. The head will be turned away from the contact.
LOC: P-A. 1-S.
Figure 35 C2 Stack Correction. Thumb Pad Contact on the Affected

C2 Facet Joint.
Because this adjustment was developed for a chronic C2 subluxation the doctor mu t also rule
out the possibility of an overcompensated cervical syndrome (OCCS) di cu ed pre iou ly.
If the patient has a chronic C2 subluxation that is not re ponding to the typical Cerv ical
Syndrome adjustments:
The doctor must assess if the patient has all 5 criteria nece ary to determine if an
overcompensated cervical syndrome is present.
• If all five criteria for the OCCS exi t then the doctor, ill correct for the OCC
If any of the OCCS criteria are mi ing the Stucky tack hould be performed pro ided
that it two criteria are pre ent.
If the OCCS criteria, a w II a the Stucky tack crit ria are not fulfilled then the do t r
will continue to adju t 2 with the cla i ervical yndrome orr ction .
Dr. John Mln•rdl 32 Copyrlght2�

L Y DROME- TERIOR CERVICAL
Th ant ri r c r. ical ublu, ati n i al o c n idered a part of the cervical yndrome category.
How \ r. th bi me hanic f thi erv ical yndrome i completely different than any oth r
r. i I ubluxati n ·. The d t r h uld only con ider an anterior cervical ubluxation if th
p tient ha- b n und r are fi r h rt \! hile, yet continues to pre ent with the ame ce rvical
) ndr m \ r nd ver again. Furthermore, the patient now complains that hi /her ymptom
ar b ming w r·e. T a urately detect and correct an anterior cervical ubluxation, th doctor
will und rg the foll wmg:
l. Leg Len0 th Anal is re eal a contracted leg in extension. Head rotation to one side bala nc
th patient' l g . thu , a ervical Syndrome is present.
'-· Palpation of th c rvical spine's lamina pedicle junction reveals that a nodule is pre ent.
Doctor ha been corr cting the cervical subluxation with classic cervical syndrome adjustment ,
howe er, the patient now complains that his/her symptoms are becoming worse.
3. The cervical mu culature along the nodular side is visualized to have a flaccid tonicity.
4.When an Anterior Cervical is suspected, there are three criteria that are required to confirm a
doctor' su picion.
l) Cervical Syndrome nodule is present.
2) Ip ilateral posterior cervical muscular concavity and or flaccidity is pre ent.
3) A-P cervical x-ray reveals spinous deviation toward the side of the nodule.
5. ubluxation Biomechanics: The Anterior Cervical subluxates anterior with spinou rotation
toward the nodule ide. This is the exact opposite of the Classic Cervical Syndrome which
explain why the patient's symptoms become worse with initial treatment. (See Figure 37-39)
Classic CS A. Cervical
p A p A
Figure 37 Cervical Syndrome. Subluxates Figure 38 Anterior ervical. ublw ate

Posterior with Rotation A\.\ay from the odule. Anterior with Rotation Toward the odule.
Figure 37 and 3 display the differences occurring between a Clas ic Cervical Syndrome ubluxation and 1111
Anterior ervical subluxation. Note that the clas ic ervical Syndrome sublu ate po terior with light pino
rotation away from the nodule (thick grey arrow). The Anterior Cervical ubluxate anterior and ha a gr at r
rotational component with pinous deviation toward the nodule (thick black arrow). Al o note that the nodul IXC�
at the ame facet location. However, with the classic ervical Syndrome, the uperior ertebrae ublu ; at an�
l
cau e the facet to tretch through the segment's inferior articular facet (thin black arrow). The Ant rior er,ica
ul;)(
ubluxat the inferior ertebrae producing the stretch on the facet capsule through the egrnent' uperior aroc
facet (thin grey arrow).
Dr. John Minardi 33

nnal cs
G)
o?•
(!)
Fioure 39 Loc3110n of).odule (grey x) \\ 1th re·pe t to pinous de,iation (circle ).
Figure 40 uperior and lnfenor rti ular
Fa ets.
Figure 39 di play the palpatory difference , a -. ell a the i ual difference found on an A-P cervical -ra
b t w en a Cla ·ic Cerv i al Syndrome and an Anterior Cervical. ote that on the Cla ic CS, the pinou de iation i
to the ontralateral ide of the nodule, wherea the nterior Cervical ha pinou de iation i to the ip ilateral ide.
This \·i ·ual aid i pre ent becau e of the biomechanical difference that occur betw een the Cla ic C and the
Anterior C r\'i al. The lateral cervical x-ra in Figure 40 pro ide a better i ualization of the inferior and uperior
ani ulation in\'Ol\'ed in the Cer vical Syndrome and the Anterior Cerv ical.
6. The doctor must instruct the patient to slow! raise hi er head (from prone po ition) and
lower it. When an Anterior Cervical i present the doctor will notice a premature rela ation of
the mu culature on the in olved side. This further confirm the pre ence of thi ubluxation.
7. Correction: Anterior Cervical Adjustment: (See Figures 41 &42)

Patient: Prone.
Doctor: On the invol ed side head of table.
Table: Cervical piece in the ready position dor al piece inclined.
Contact: PIP of index finger on the anterior aspect of affected TVP and tip of the thumb
on the lateral aspect of the spinous process (on the in ol ed side).
Stabilization: Opposite zygomatic arch or parietal bone.
LOC: A-P with rotation.
Fi&urt 41 Anterior C erv ical Correction. PfP onta ton the Anterior
Aspectof the TVP, and Thumb Contacton Lateral A pect of the
pinous Proce
Dr, John Mlntrdl Copyright 2006

In thi adju tinent, the -P thru t with rotational torque corrects for two biomechanical
components of the ubluxati n. The thumb contact on the lateral aspect of the spinous pr oce IS
riti al with re pe t to th rrection of the rotational aspect of thi subluxation pattern.
Wb rea , the inde finger conta t on the anterior a pect of the TVP corrects for the anteriority.
The d rsaJ pie light! in lin d t create additional room for the doctor's contact hand.
It i important to n te that the d ctor cannot change the contact to posterior aspect of the
p ite tran er e proce . Th doctor must alway be cogniti e of the biomechanic involved
with th ubluxation:
• Th oppo ite tran er e proce is not subluxated posterior, it is in its neutral position.
It i nl po terior relati e to the subluxated anterior transverse process on the affected
ide.
• If th oppo ite tran erse process is contacted, the doctor will move the entire complex
ant rior and thu cause a greater problem.
• Ther fore contacts on the anterior aspect of the TVP and lateral aspect of the spinou
pro e of the affected segment are required to properly correct the anterior cervical
ubluxation.
. Re-check the leg , mo e on to the next subluxation.
ample as :
A 21 ear old female dancer presents to the clinic with neck pain following a strenuous rehearsal. Following a
ompl te e amination, Thompson analysis reveals a short right leg. The doctor instructs the patient to turn her
head to th right, " hich produces no change to the leg lengths. The doctor then instructs the patient to turn her
h d to the left, which re ult in balanced leg lengths. Left head turning producing balanced leg indicate a Left
Cervical yndrome, but the problem is on the opposite side. The doctor will then palpate along the lamina pedi I
junction on the patient's right side. A tender nodule is present at C3. The doctor will take his/her contact at the
ite of the nodule and thru t P-A in line with the disc and perpendicular to the facet. 0 er the next few treatments,
th do tor continu to find the same cervical subluxation occurring. Also, the patient now complain that h r
ymptom are getting wor e with each treatment. Because the doctor is unable to clear the reoccurring cervical
ubluxation, combined\ ith the fact that the patient's symptoms are getting worse, the doctor\ ill now con id ra
po ible Anterior erv ical. In this ca e, the painful nodule, muscular concavity and spinous deviation were all on
the ip ilateral ide. The e three criteria have now confirmed the presence of an Anterior Cervical. The docton1 ill
corre t the ubluxation contacting the anterior aspect of the TVP and the lateral aspect of the spinous ofC3,
thrusting A-P with rotation. The patient's symptoms will begin to subside, and the legs will balance following the
adjustment. The doctor will then re-check the leg lengths and move on to the next area of problem.
Dr. John Minardi 35

RVICAL YNDROME - POSTERIOR CERVICAL
(Prone Correction)
Another unique ituation within the Cervical Syndrome category is the Posterior Cervical
-ubluxation. This ub]uxation pattern differs from the classic Cervical Syndrome in that there is
no rotational component involved in the subluxation. In the Posterior Cervical, just as its name
implies, the entire cervical segment subluxates posteriorly. In order for the doctor to adequately
detect and correct the problem, the following steps must be taken:
I. A in all Cervical Syndromes the patient presents with a contracted leg in extension.
2. The doctor has the patient tum their head left and right, and detects that head turning to both
ide balance the legs.
3. The doctor palpates the C2-C7 lamina pedicle junctions on the patient's left and then palpates
the lamina pedicle junctions on the patient's right. Nodules are discovered on the left and right
lamina pedicle junctions of the same vertebrae.
4. X-ray analysis confirms a decreased cervical lordosis (military neck), caused by the Posterior
Cervical subluxation pattern. (See Figure 43)
Normal f Lordosis
Cephalad ,...-, Cephalad
\
\
'I
p I
A p A
I
I
I
..
I '<0
�
Caudad audad
Fi ure 43 Military eek Cau ed by a Po terior Cerv ical ubluxation.
The illustrated diagram above Figure 43) demon trates how a ingl po teriorly subluxated ertebrae 4) can
affect the entire cervical lordo i causing the military neck appearance. Note that a one ert brae ubluxat
po terior the vertebra directly above and below the affected egment shift lightly po teri r a well. The lateral
cervical x-ray clearly demon trate the hypolordo i (military neck found in a Posterior rvical.
Re earcher state that patient with a cervical lordosi of 20 degree or le were more likely to
have cervicogenic ymptom . Furthermore, patient having a cervical complaint were 1 time
more likely to have a decreased cervical lordo i . 19 Proper correction of a Po terior Cervical
ubluxation can re tore a normal lordosi , and e]iminate cervicogenic ymptom .
It i important to note that if a cervical kypho i ' goo
e neck deformity or bent tick d fonnity i
pre ent on x-ray (Figure 44), the doctor mu t rule out in tability prior to adju ting. If any
instability i pre ent, it i a complete contra-indication to treatment.
Dr. John Minardi 36 Copyrlght200e

C. Kyphosis Gooseneck Bentstick
ephalad
p A
,
Caudad Caudad Caudad
Figure 44 Cer ical Kyphosis, Gooseneck Defonnity and Bentstick Defonnity. If these are found on x-ray,
v
in tability must be ruled out prior to any adjusting.
5. Correction: Prone P-A Cervical Adjustment: (See Figures 45&46)

Patient: Prone.
Doctor: Fencer stance, on either side of table.
Contact: Pincer or web contact on bilateral LPJ of involved vertebrae.
Stabilization: Supporting contact hand.
LOC: P-A (1-3 consecutive times).
6. Re-check the legs, move on to the next area of subluxation.
Figure 45 Posterior Cervical Prone Correction. Pincer Contact on Figure 46 Posterior Cervical Prone Correction Doctor
Bilateral LPJ. Positioning.
Sample Case: A 42 year old male factory worker presents to the clinic with neck stiffnes . Following a complete examination.
Thomp on analysis reveals a short left leg. The doctor instructs the patient to turn hi head to the right, which produ e
balanced leg lengths. The doctor then instructs the patient to turn his head to the left, which al o result in balanced leg
length . Left and right head turning producing balanced legs indicates that the patient has a cervical problem bilaterall . The
doctor must now rule out a Double Cervical Lock or a Posterior Cervical as the subluxation. The doctor will then palpate
along the lamina pedicle junction on the patient's left and right sides. A tender nodule is pre ent at 4 on the left and on the
right. This rules out a Double Cervical Lock, as the nodules would need to appear at different cervical segment . The doctor
rule the problem as a Posterior ervical as the nodules were present at the arne vertebrae bilaterally. The doctor will talce a
pincer contact at the site of the posterior segment (C4) and thrust P-A. The doctor will then re-check the leg length and move
on to the next area of problem.
Dr. John Minardi 37 ___ CMvrffJhf

DROI\fE - PO TERJOR CER JC L
\\ 11 n drop table. or drop pie e i not a ailable for the doctor. a manual m difi ation an b
1mplem med to orrect for the Po t rior Cervical ubluxation. Thi modifi tion i tak n from
Dr. 1 e tucky· Integrated Method and i an effective alternative in orr ting fi r th
P t rior C n i al, a well a re toring the cerv ical lordo i .
I. L g l ngth anal i and ubluxation pattern are the ame a ed pr iou I
3 .. 'o drop piece are available.
4. Corr tion: Modified Seated P-A Cervical: (See Figures 47&4

Patient: eated.
Doctor: Standing behind patient. Starting on either LPJ of the affected egment.
Contact: MCP or PIP contact on one LPJ of in ol ed ertebrae.
tabilization: Oppo ite parietal bone. Head rotated away from contact.
LOC: P-A. Repeat correction on opposite ide.
For thi adju tment the doctor mu t po ition him/herself posterior to the contact to properl
deliver anteriority in the thru t. The doctor should ne" er merely adju t into lateral fle ion or
rotation. as the e do not addre the problem.
5. Recheck the leg and continue on to the next ubluxation.
It i important for the doctor to rule out a Double er vical L ck before a urning that the
problem i a Po terior ervical ba ed olely on the leg length analy i .
• - If head rotation to b th ide balance the leg and the nodule are at diffi rent le el ,
then the doctor mu t adju t tho e ertebrae eparately .
.Qnly if the nodule are found bilaterally on the ame ertebral egment can the P terior
Cervical b orrect d.
If the doctor doe not rule out the Double ervical Lo k when it i indeed th pr blem,
then the Po terior Cervical correction will cau e ubsequent damage.

CERVICAL SYNDROME - Cl FLEXIO LOCK
A mentioned pre iou ly, the atla generally subluxate lateral superior and poste rior. How r,
there i another ituation in which the atla ubluxate but doe not fo]l w the general 1
ublu ation patt m. In thi situati n, in addition to the lateral ubluxation the atla ubluxate i
a fle ed po ition in which the p steri r arch of atlas approximate the occiput. ln order for thi n
to be differentiated from the lat ral 1 ubluxation th doctor mu t adh re to the followino· o·
1. Patient pre nts with a contract d leg in e tension, that balances with head rotation to on
ide, thti° ''indicating th pre enc of a Cer v ical Syndrome.
2. Upon doct r palpation of the lamina pedicle junction no nodule is present.
3. Du to th fact that no nodules are present, yet a cervical syndrome indeed exi t ba ed on the
leg length analysi the atlas is implicated. Thus, correction is performed with the toggle recoil
adju tment, a di cu ed previously.
4. After a few treatments, the doctor realizes that the toggle correction alone is not correcting the
probl m.
• Once the toggle is ineffective in correcting an atlas problem the doctor mu t re- isit
hi /her clinical notes to determine if the patient had originally presented with a Bilateral
Cervical Syndrome (BCS).
• The BCS i explained in great detail in a future section, but basically the B S mean that
the occiput has subluxated Anterior Superior (AS).
The C 1 flexion lock is most often caused by the doctor trying to originally correct for the
AS occiput, but mistakenly let his/her contacts slip from the occiput to the posterior
arche of atlas. The results of which led to C1 approximating the occiput in the flexed
position.
5. Confirmation of a C 1 Flexion Lock through palpation and x-ray analysis.

Palpation re eals that the posterior arch of atlas has approximated the occiput.
• Lateral cervical x-ray confirms that the posterior arch of atlas approximates the occiput
(See Figure 50), therefore, a cervical flexion x-ray is taken.
N. Flexion Xray Flexion Lock
co co
Cl Cl
2 C2
igure 49 Fl ion tudy demon trating normal distance ratio , and how the le ion Lock Figure 50
Lateral
ubluxation d1 tort thos alue .
In a normal c rvical x-ray flexion study, l should not approximate the occip�t, keepi�g
9
a di tance ratio of 1/3 between occiput and Cl and 2/3 between CI and C2. (Figure 4
Dr. John Minardi 39 eopyrlflht ZOo'
11 (. I approximat the occiput. it will di tort the normal distance ratio between CO, CI
and �- and therefore confirm that it i locked in flexion. ( ee Figure 49)
It 1. • nllal to incorporate all a pect of our evaluation into the diagno i , and not rely on one
1 olat d a pect. X-ra1 . palpation and leg length anal i all mu t point to the CI Flexion Lock.
not \-ra1 alone.
For example. a CI Flexion Lock and an AS Occiput appear imilar on x-ray.
Howe\ er. an occiput ubluxation pre ent with even leg , unlike the contracted leg found
m the Flexion Lock.
Palpatory finding would re ea! the po terior arch of atla locked in the flexed po ition in
the CI Flexion Lock, wherea and A Occiput would be palpated by the occiput locked
in exten ion.
Therefore. the doctor" leg length analy i , x-ray information and palpation mu t all indicate the
atla 1m oh ement in order to correct for the CI Flexion Lock.
6. orrection: CI Fie ion Lock Adju tment: (See Figures 51 & 52)
Patient : Prone, chin tucked.
Doctor: Either ide - Head of the table.
Contact: Pincer contact on uperior a pect of the po terior arch of CI.
tabilization: Palmar upport on contact.
LOC: One thru t. P-A, S-I.
Figure 51 I Flex1on Lock Correcuon. Pincer

Postenor Arch of Atlas.
ample Ca e: long time patient pre ent to your offi e with recent n t headache . Folio, ing many weeks of
even leg pre entation, you are urpri ed that on today' vi it, Thomp on analy i re eal a hort right leg in
exten ion. The doctor in truct the patient to tum her head to th left v hi h produce no change to the leg
lengths. The doctor then in truct the patient to tum her head to the right, ,; hich re ult in balanced leg length .
Right head turning producing balanced leg indicate a Right Cerv ical yndrome, but the problem i on the
oppo ite ide. The doctor will then palpate along the lamina pedicle junction on the patient's left ide. o tender
nodule i pre ent along the lamina pedicle junctions, indicating an atla ubluxation. The doctor will po ition the
pati nt on her right ide (le ion ide up), and will toggle the atla into po ition. The doctor,; ill th n it the patient
up for any para ympathic re pon e . After e eral vi it , the patient continue to pre nt with th ame finding .
The doctor r - i it the patient' file and di cover that the patient had originally been treated for a A occiput for
everal w eks prior to thi current pre entation. The doctor now uspect that the atla ma al o be ubluxated in
a flexed po ition, and take x-ray to erify. X-ray analy is confirms that the atla i ublu; ated in a flexed
po ition, more than likely cau ed by the d tor when trying 10 correct for the original S occipu1. The doctor
tands at the head of the table and contact the po terior arc he of atla thru ting -I P-A correcting the atla
ubluxation. Finally, the doctor re-chec the leg lengths, and move on to the next area of problem.
Dr. John Minardi ,o Copyright 2006

CERVICAL SYNDROME - C7-Tl EXTENSION LOCK
The C7-T l Extension Lock is a subluxation pattern that usually occurs as a secondary cervical
syndrome due to it location in the C-T junction. In this case, the doctor will locate on e or more
nodule v ithin the cerv ical pine. One nodule is present at C7 and another nodule will be pre sent
el ewhere v ithin the cervical spine. The doctor begins correcting the C7 subluxation using the
clas ic Cervical Syndrome adjustment, however, the doctor discovers that the classic correction
doe not produce a balance in the patient's leg lengths. Furthermore, specific clinical symptoms
that the patient is experiencing become exacerbated. In these cases, the doctor must adhere to the
following protocol to determine if a C7-T I Extension Lock subluxation is present:
1. Patient presents with a contracted leg in extension, that balances with head rotation. Thus,
indicating the presence of a Cervical Syndrome.
2. The doctor considers that a C7-T 1 Extension Lock may be present because he/she palpates
one of the following scenarios:(See Figure 53)
Two nodules are palpated on the same side. One at C7, and the other at another segment.
Two nodules are palpated, on opposite sides. One at C7, the other located on the opposite
side at another segment.
Only one nodule is present at C7, and is not correcting fully with a classic CS correction.
c2Q
O•
0
0
0
0#
On
Figure 53 Three Possible Scenarios Palpated with the C7-TI Extension
Lock. Spinous Processes (circles) and Nodules (grey x) are displayed.
3. The doctor confirms with both static and motion palpation that C7 is
locked in Extension. + Lordosis
I �phJIJJ
4. The patient complains of tension across the shoulders, as well as

shooting pain from C7-T 1 to the medial border of the scapula upon neck
extension. The patient further comments that he/she has difficulty with
neck flexion and extension. ...
p
5. X-Ray findings (See Figure 54), also collaborate the presence of a C7-
T 1 Extension Lock. The cervical lateral neutral view demonstrates an
anterior translation of cervical spine relative to C7 (dashed arrow), a hypo
lordosis, and the spinous process of C7 approximates T 1 (grey arrow). A
cervical extension view demonstrates that the spinous processes of C7-T I
vertebrae do not further approximate one another, whereas a normal c�
extension view would demonstrate approximation between these t54 C7-Tl Elli.act
Flpr
segments. Furthermore, a cervical flexion view demonstrates no separation findiqsCII ec,vo! X-"1·
r playing between C and Tl. whereas a normal flexion iew would demonstrate splaying
n, n the egments.
The Ex ten ion Lock of C indicate that the vertebrae has subluxated po terior and inferior,
re ulting in the exten ion malposition.
6. Corre tion: C Exten ion Lock Adjustment: (See Figures 55 & 56)
Patient: Prone.
Doctor: Either side.
Table: Cervical and Dorsal pieces in the ready positions.
Contact: Knife-edge on inferior a pect of affected spinous proces
tabilizing: Stabilizes contact hand.
LOC: P-A and 1-S.
Figure 55 C -Tl Extension Lock Correction. Knife-Edge Contact Figure 56 C7-Tl Extension Lock Doctor Po itioning.
Inferior to C Spinou Proce
The doctor must roll the knife-edge contact into the segment being adjusted. It is optimal to take
up tissue slack as the doctor rolls his/her contact into place. This will increa e the comfort of the
contact and ensure that the contact is inferior to the C7 spinous process. The uperiority of the
thru t corrects for the inferiority of the subluxation, whereas the anteriority of the thru t and drop
piece corrects for the posteriority of the subluxation.
7. Recheck the legs, continue on to the next area of ubluxation.
It is always important for the doctor to rule out the po ibility of an O CS any time that the C-T
junction area is involved. Therefore, always check if the pre ence of the fi e criteria necessary
for an aces are present.
Sample Case:
A 22 year old male soccer player pre ent to the clinic with shooting pain into the houlder blade commencing after a game
la t week. Following a complete examination, Thomp on analy i re eals a hort left leg. The doctor in truct the patient to
turn his head to the right, \ hich balances the leg length . The doctor then in truct the patient to tum hi head to the left,
which also baJances the leg lengths. Left and right head turning producing balanced leg indicate that the pati nt ha a
cervical problem bilaterally. The doctor mu t rule out a Double Cervical Lock, a Po terior ervical, or a 7-Tl E ten ion
Lo k as the ubluxation. The doctor will then palpate along the lamina pedicle junction on the patient's left and right ide .
tender nodule i pre ent at C3 on the left and at C7 on the right. This mies out a Po terior ervical as the nodule \ ere
pre ent at different egment. The doctor must no decide if the ubluxation is a Doubt Cervical Lock or a C7-T l E ten ion
Lock. The do tor -ray the affected area, which confirm the patient' symptom , indicating that C7 i ubluxated into
exten ion. Thi rule out the Double ervical Lock if the symptoms and x-ray finding were not pr sent, th doctor would
treat thi ca e a a DCL). The doctor will then take hi /her contact at the inferior a pect of the C7 pinous proces and thru t
1-S and P-A. Th doctor will then re-check the leg length and move on to the ne t area of problem.

Cervical Syndrome Leg Length Analysis Review
Adjustment Balances Legs Re-Check Legs

Confnms
& Move On
If All 5 Criteria for OCCS Present Re-Check Legs

Nodule Found at LPJ of C2-C7 Chronic C2? Correct First RJb and T1 & MoveOn
Indicates Cervical Syndrome Either
Stucky Stack or OCCS If One OCCS Cnteria is M1ss1ng
Correct C2 Using a Stucky Stack
CS Not Correcting Correct Subluxated Segment Re-Check Legs

Due to Chronic OA Using a Fric!Jon Lock & Move On
Head Rotation to One Side

Balances Legs C1 Toggle Adjustment Re-Check Legs
Produces
& Move On
No Nodule Found Balanced Legs
Indicates
cs· Atlas Subluxat1on C1 Toggle Adjustment Does Not Re-Check legs
Verify & Correct
Produce Balanced Legs
C 1 Flexion Lock & Move On
& Patient Has History of a BCS
Classic CS Adjustment Re-Check Legs

At C7 Produces
& Move On
Nodule only Found at C7 Balances Legs
Indicates
Possible C7-T1 Extension Lock Classic CS Adjustment At C7 Verify and Correct Re-Check Legs
Does Not Balance Legs
C7 Extenson Lock & Move On
& Symptoms Point to C7 Ext Lock
-
Nodules Found Bilaterally
At Different Segments
Indicates Double Cervical Lock
- Adjusting Both Nodules
Produces
Balanced Legs H Re-Check Legs
& Move On
I
- CSIndicates
Adjustments At Both Nodules
Balanced Legs
Double Cervical Lock H Re-Check Legs
& Move On
I
Nodules Found Bilaterally
Head Rotation to Both Side
Balances Legs �t But One of the Nodules is at C7
Indicates DCL or C7 Ext. Lock CS Adjust Does Not Balance Legs
Venfy and Correct Re-Check Legs
- & Symptoms Point to C7 Ext Lock
Indicates C7 Ext Lock -{ C7 Extension Lock & Move On
I
Nodules Found Bilaterally Correct for
Re-Check Legs
On the Posterior Cervical
& Move On
"-- ,..._
Same Segment �
Head Rotation To Either Side Indicates That The Assess and Correct
� Cervical Syndrome Is Pelvis First
Does Not Balance Legs
,.._
Not Present at This Time Re-Check Cervicals Afterwards
Dr. John Minardi 43

ECTIO THREE:
PRii\1 RY ARE : OCCIPUT-CERVICAL
. ·ormal
Bilateral Cervical yndrome

Cla ic Prone Adjustment
Modified Stucky Supine Adjustment
.\!odified Seated Adju tment
A!odified Toggle Board Adju tment
J!odified Supine Lift Adju tment
l.Jnilateral Occiput Syndrome

Toggle Set Adju tment
Modified Supine Adju tment
Po terior Occiput Syn drome

Modified Supine Adju tment
Exception Derefield
XD: Cer vical Syndrome
XD: Derefield Negative
XD: Bilateral Cervical Syndrome
XD: Unilateral Occiput Syndrome
XD: Posterior Occiput Syndrome
ormal, BCS, UOS, POS and X-D Leg Length Analysis Review Chart
Dr. John Minardi Copyright2006

ORMAL
o Adjustment is Required
cAS Ill••
In ome ituation the patient will be subluxation free. These instances are deemed a " ormal,
and require no adju tment that day. In order for a normal spine to be considered the following
mu t take place:
I. Patient pr ent \ ith even leg in exten ion.
2. Do tor in truct patient to turn their head to the left and to the right.
• Head rotation produce no change to the legs in the extended position.
p c:u�'•
• Therefore the legs remain even in the extended position.
3. Doctor then flexes the legs to 90 degrees, and the patient's legs remain even in the flexed
position.
4. While keeping the patient's legs in the flexed position, the doctor again instructs the patient to
turn their head to the left and to the right.
• Head rotation produces no change to the legs in the flexed position.
• Therefore, the legs remain even in the flexed position as well.
5. The patient's legs are balanced in the extended and flexed positions, and are not affected by
head rotation. This confirms the findings ofNormal. (See Figures 57&58)
6. No adju tment i required that day.
figure 57 omllll Even Legs in the Extended Po ition, Not

ffected by Head Rotauon.
Dr. John Minardi 45

BIL. T R.\L ER\1 L \. 'DRO�lE 8 )
la ic Thomp on - Prone orrection
Th Bi!Jt ral en 1 al . ndrom (BC , d pite it nam , h very little in common\\ ith
C n 1 -al � ndrome. A m ntion d earli r, the Cervical ;mdrome require that the atient
. . ..
pr . nt \\ uh a ontra ted leg. Th B , hov,e,·er, require that the patient pre�em with even leg
..... .
rn th e\tend d po 1t1on. Furthenn re, becau e the BC 1 one of everal problem that an b
d t, ·t·d ,, ith an even leg pr entation the following enario mu t be pre ent in ord r to
y
'Ln.ider th categor a a B
I. Patient mu t pr ent v,:ith E leg in e ten ion.
2. Th do tor ha th pati nt tum their head to the left which make the patient' left leg
'Ontract (pull hart). The do tor then ha the patient tum their head to the right, which mak the
pat1 nt' · right leg contract (pull hort). ( ee Figure 59-61)
If thi exact nario occur . thi pattern repre ent that the primary ublu; ation i a
BC
hani ofa B indicate that th ubltr t d anteri r- up n )

iput tra l ant ri
th on ve urf:
r, it mu t ublu. ate up n .(Figur
0
m1al B
� � l
I) IO l 6-l 8
Copyright 2006
Th e -m (Figure 64 & 5) di play an anterior dislocation of the Occiput. 0
This is an absolute contra-indication to
chir pmctic treatment. The e -ray ha e been included only a an"�1d to visualize the anterior-superior movement of the occiput
on atla . The B ubluxation will ha e a similar anterior-superior displacement, but obviously to a much lesser degree then
di pla ed in the e x-ra . Court sy ofwww.radiologyeducation.com.
4. Correction: Classic
.f...." fl.�111
T
Thompson Prone Correction: (See Figures 66&67)
Doctor: tither side of table. '"'" 1 •
Patient: Prone. Chin tucked. Mouth closed.

Table: Cervical piece in the ready position, and flexed.
Contact: Bilateral thenars on the inferior aspect of the mastoid processes.
LOC: I-S, and slightly P-A to initiate the drop piece. Thrust is a s��ping motion.
Figure 66 BCS Prone Correction. Bilateral Thenar Contacts on Figure 67 BCS Prone Correction Doctor Positioning.
Inferior A pect of Mastoid Proce ses.
It is important for the doctor to remember that in order for this adjustment to be performed
properly, four aspects must be incorporated:
• Tremendous speed must be generated.
• A well functioning drop piece must be used.
• The thrust should never be focussed into the headpiece, as this will injure the patient.
• The focus of the thrust should be concentrated ce halad, with only enough P-A pre ure
to initiate the drop piece.
Flexing the headpiece and having the patient tuck their chin allows the doctor to place the
occiput in the oppo ite direction of the subluxation pattern. This facilitates a biomechanically
ad antageou po ition prior to correction.
Dr. John Minardi 47

BIL TERAL CER\'I L YSDROME (BC )
'.\lodified tucky upine dju tment
The modtfi d uptne adJu tment wa tak n from Dr Joe tucky' Integrated Method , and
pro td an alt mati\ to adJu ting the BC . Thi modification can be ub tituted if the prone
method I unabl to b p rformed on the patient, or if the doctor imply prefer to have the
pat1 nt m th upine po ition.
I. am leg length anal i mu t be pre ent a di cu ed pre iou I .

Patient pre ent with even leg .
Tum head left - left leg pull hort, Tum head right - right leg pull hort.
ubluxation pattern i the AS Occiput a di cu ed pre iou ly.
3. Corre tion: tucky upine Adju tment: (See Figure 6 &69)

Do tor: Head of table facing caudad.
Patient: Supine.
Table: Cervical pi ce in the read po ition. c- �.
Contact l: Bilateral middle finger inferior to the occipital ridge.

Contact 2: Bilateral thumb along maxilla.
LOC: Take out lack, A-P (whip-like).
The doctor hould place the patient in a biomechanicall ad antageou po ition by in tructing
the patient to tuck their chin to their che t.
• Thi imple motion will po ition the occiput po terior, and a i t in the orre tion of the
ubluxation.
The do tor mu t al o be ure that the contact along the occipital ridge are di tra ting phalad
"J ..
to remo\'e an ti ue lack. ,. • '*" • · • �· , t ... , ......, ,, • ..r- l, • , -· o • �

f
Thi di traction will al o eparate the occiput from atla before the adju tment i
p rformed.
Furthermore, the doctor mu t en ure that the dor al a pect of hi /her hand are in ontinuo
contact with the headpiece.
Thi will en ure that the drop piece i proper! initiated with th thru t. If th doctor
f
rai e hi er hand of of the table during the di traction of the oc iput, th thru twill
not initiate the drop piece and the adju tment will b in ffecti e.
and ontinue t the ne t rea of ublu ati n.
Dr. John Min•rdi 48 Copyrlght2006

BILATERAL CER\1 1CAL S ORO fE (BC )
Modified eated Adjustment
Thi m difi ation wa de igned to r vide the doctor\.\ ith the ability t adju t for the B S when
no drop pi w r availabl . Ith' ugh thi adju tment ha the ad antage of not requiring a
drop piec to be perfi rmed, it la k a cectairi
� }egree of pecificity, a thi adju tment i primarily
a di traction of th o iput from atla . Howe er it continue to remain extremely effe tive in
orr ting for the
l. ame 1 g length anal i mu t be present a discussed pre iou ly.

• Pati nt pr ent with e en legs.
• Turn head left - left leg pulls short, Turn head right - right leg pulls short.
2. ubluxation pattern is the AS Occiput as discussed previously.

, &)' �
3. Thi adju tment requires that the occiput be adjusted one side at a time. Thereforf, the doctor
mu t perform a imple clinical analysis to determine which side to start with. E �� though it is a
BCS and the occiput is subluxated bilaterally there is always a dominating side of subluxation
and that i the ide that the doctor must start with.
Doctor standing behind a seated patient.
• In truct the patient to turn their head to the left and then to the right. 1...,.w,· .. ,
On the side to which the patient has the most range of motion (can turn the farthe t i the
position in which the doctor will start this adjustment.
• For example, if the patient can turn their head farthest to the right the doctor\ ill take
his/her contact with the patient's head turned to the right, and will be contacting the
patients left mastoid process. The doctor will then repeat this adjustment with the
patient head turning to the left, hence contacting the right mastoid.
• In our example, the doctor started with the most affected side (left occiput) a the
ubluxated occiput was the reason that the patient could not turn as far to that ide.
4. Correction: Modifi d Seated Lift: (See Figures 70&7 l )

Doctor: Standing.
Patient: Seated h ad turned to the side of most motion.
Contact: Hypothenar contact on opposite mastoid proce
Stabilization: Reinforce contact hand.
LOC: Scooping inward, and distracting superior. Repeat on oppo ite side.
M I id Proc
Dr. John Minardi 49 CopyrlghtZOof

kI nd m on to ne t area.
11 j rtant fi r the doctor to ensure that the pati nt s ja i clo ed. Thi pre ents th patient's
c th m h tt ring, or biting their tongue during the adju tment The doctor mu t al o a oid
nta t ith th T J, to pr ent ubluxating it indirectly. Furthennore, in order for thi
dj tm nt t b ffi cti , the doctor must use hi er legs to distract the occiput from atlas prior
( th thru t.
Th Bil teral Cervi al Syndrome is most often associated with:

• rpenter perfonning overhead work, which forces the occiput into an AS po ition for a
prolonged period of time.
The elderly over-extending their occiput in order to compensate for a thoracic kyphosis.
Infant that are just beginning to learn how to control their head and neck.
Other modifications to adjusting the BCS have been introduced as options that the chiropractor
an use depending on the equipment that is available, as well as doctor and patient preferences.
The following are additional options that can be used when the BCS is detected.
BILATERAL CERVICAL SYNDROME (BCS) - Modified Toggle Board Correction
Doctor: Standing behind patient.

Patient: Seated. Mouth closed. Chin tucked in.
Contact: Interlocking hands on frontal bone, toggle board placed inferior occipital ridge.
LOC: 1-S A-P scooping motion with toggle board.
BILATERAL CERVICAL SYNDROME (BCS) - Modified Supine Lift Adjustment
Doctor: Either side of table depending on clinical test (Same as seated modification earlier).
Patient: Supine. Mouth closed. Head turned to side of most motion.
Contact: Hypothenar contact on inferior mastoid process.
Stabilization: Patient's chin. Head resting across forearm.
LOC: 1-S, A-P. Repeat on opposite side.
The doctor must be aware that this adjustment is extremely powerful if no drop mechanism is
utilized and can potentially frighten the patient. When the drop piece is incorporated, the
adju tment becomes more comfortable for the patient, while continuing to be efficient and
ffective.
ample e:
A 50 year old male carpenter present to the clinic with miaraine headaches. He mentions that be has been doina
much ofhi work o erhead for the past several weeks. Following a complete examination, Thompson analysi
re cal even leg in the extended position. The doctor instructs the patient to tum his head left. which resul in
the patient left leg pullina hon. The doctor then instructs the patient to tum hi head to the ria.ht, and the
patient' right leg pull hort. The leg analy&i in thi case conftnn1 the presence of a BCS. The doctor chooses to
pcrfonn thi correction while the patient i in the upine position. The doctor' index fmscn contact inferior to
the patient' occipital ridae, and the doctor' thumb pads contact alona the maxillary bones bilaterally. The thrust
l ·P and 1- to adju t the AS occiput ubluxation. The doctor will then recheck the lep, and move on to the
•
UNILATERAL OCCIPUT SYNDROME (UOS)
Toggle-Set Adjustment
The Unilateral Occiput Syndrome is the third category that must be considered and ruled out
when a patient pre ents \! ith e en legs. As it name uggests this category signifies that the
occiput has ubluxated unilaterally, and is detected by the doctor when the patient presents with
on1 half of the typical findings of the Bilateral Cervical Syndrome. Once detected, this
ubluxation pattern indicates that the occiput has unilaterally subluxated anterior-superior with
re pect to the atla . In order for the doctor to accurately detect the Unilateral Occiput Syndrome,
the following mu t be pre ent:
I. Patient presents with only half of the normal findings for the Bilateral Cervical Syndrome,
indicating that on1y one side of the occiput has subluxated.
• For example: The patient has presented with even legs. The doctor asks the patient to
rotate their head to the left, and the patient's left leg shortens. However, when the patien t
is asked to rotate to the opposite direction, the patient's legs remain balanced.
• Thi scenario would indicate that the patient has a left Unilateral Occiput Syndrome,
imply because his/her head is turned to the left. However, it is the right occiput that has
subluxated.
• Con ersely if the patient presents with even legs, and the right leg shortens upon right
head rotation, yet any other head movement results in the patient's legs remaining
balanced, this scenario would indicate that the patient has a right Unilateral Occiput
S ndrome. (See Figures 72&73)
• It i named a right UOS simply because the patient's head is turned to the right, however,
it i the left occiput that has subluxated.
Figure 73 Right UOS. Right Head Rotation Draws the Right I.ti
Short. All Other Head Movement Re ults in Balooced Leg ·
2. Correction: Toggle Set Adjustment: (See Figures 74-76)

Patient: Prone, head rotated to the side of CO
involvement.(lesion ide up).
Doctor: On involved ide, facing patient.
ontact: Knife edge contact on the anterior
co
aspect of the mastoid process. Cl
tabilization: Pi iform in contact hand's
anatomical snuffbox.
C2
LO : S-1 and A-P toggle et. No recoil. Figure 74 U Toggle l Cont t.
Dr. John Mln•rdi 51

II' A. �I C'f th \fa,t 1d Proc S.
The do tor mu t remember to keep the headpiece level to minimize any di tortion betw een the
o 1put and atla and to maximize the patient' comfort. The doctor mu t also keep in mind that
thi i not a toggle recoil adju tment, which empha ize the recoil a pect of the corre tion. As
mentioned previou Iv, a recoil adju tment cau e the vertebrae to overcorrect \Vith the initial
thru t, followed immediately b a recoil in which the egment adjust into its nonnaJ po ition.
The o ciput toggle- et ha no recoil, and thu correct the ubluxation on the initial thrust and et
of the adju tment.
3. Recheck the leg , and continue on to the ne t area of ublu ation.
Th doctor hould note that many patient who have occipital ubluxation . v hether the be
unilateral or bilateral, tend to uffer from headache . The e ymptom are due to the ublw ated
iput' influence on the rectu capiti po terior minor. Thj ub-occipital mu le rigin te at
the occipital nuchal line, and in ert to the po terior tubercle of atla . What make the re tus
capiti po terior minor mu cle unique, i that it al o ha attachm nt to the p teri r atlant -
o cipital membrane, re ulting in a direct influence on the ner v ou tern. urrent re ear h
ugg t that a oft ti ue bridge connecting the rectu capiti po teri r minor to th p eri r
atlanto-occipital membrane wa pre ent in the majority of cada er pe imen e amined. and v a
r fle ti e of normal anatomy. 1 The re ult of thi re earch pr ide the d tor \! ith a tr ng
anatomical connection linking ubluxation in the atlanto-occipital regi n \I ith patient
h adache . Other re earch ha al o ugge ted an anatomic relati n bet\! een the re tu capiti
po terior minor and the dura mater at the atlanto-occipital junction. The re ear he tated that
ev ry pecimen examined exhibited the connection, and that the fibre were po itioned to re i t
mo ment of the dura toward the pinal cord. 2 The e tudie reinfi rce the importance of
properly a e ing and correcting occiput ubluxation . When the occiput ublu ate , it \ ill ha e
a direct influence on the rectu capiti po terior minor, \ hich will lead to di tortion of the dura
and th atlanto-occipital membrane , due to it connecti e ti ue attachment . Thi di t rtion
may lead to a ari ty of ymptom , including headache , all of which can be eliminated on e the
ubluxation i d tect d and corre ted.
Dr John Mln•rdl 52 Copyright 20CHS

IL TERAL OCCIPUT SYNDROME (UOS)
Modified tucky djustment
Thi m dificati n for c rrecting the Unilateral Occiput Syndrome was taken from Dr. Joe
tu , and adju t the unilateral anterior- uperior occiput from a upine po ition. It is equally
ffi cti and can b performed at the preference of the doctor or patient.
l. Leg length analy i and ublu ation are the same as discussed previously.
-· Correction: Modified Stucky Adjustment: (See Figures 77-79)

Patient: Supine, head rotated to the opposite side
of CO in ol ement. (lesion side up).
Doctor: On in ol ed side, facing cephalad.
Tabl : Cervical piece in the ready position.
co
(Hi-Lo Table Raised to 45 degrees) Cl
Contact: Thumb pad contact on anterior inferior
aspect of the patient's mastoid.
C2
Stabilization: Cradling patient's head across the forearm. Figure 77 UO Supine Adju tment
LOC: S-I and A-P. Contact.
Inferior A peel of Affected Ma toid.
3. Re-check the legs and move on to the next area of subluxation.

As a clinical note, the doctor must be sure to di tract the occiput uperiorly from atla to as I tin
setting the occiput to its neutral position. In order for this adjustment to be effective the doctor
must be sure to have his/her elbow cross the midline for a proper line of correction. Thi i not
adequately displayed in Figure 79, because proper positioning of the elbow compromi ed the
photo's angle to display the contact. Therefore, please en ure that the doctor s elbo\J cro e th
patient's midline (arrow). Furthermore, the doctor must also realize that any of the correction
for the BCS can be used for this category provided that the adjustment i performed unilat rall ·
Sample ase: A 20 year old male freestyle wrestler pre ent to the clinic with head and n ck pain. H m nti n
that the pain occurred immediately after a match two day ago. Foll wing a complete e amination, Thomp on
analy i re eal e en legs in the extended po iti n. The do tor in truct the patient t turn hi head 1 ft, , hi h
re ults in the p tient' left leg pulling short. The doct r then in tru t the pati nt to tum hi head t the ri ght , and
the patient' leg remain balanced. E en leg pulling hort to the left with left head r tati n c nfirms the
pr ence fa left O problem on the oppo ite ide. The do tor ill th n c nta t the patient' right o ciput. and
thru t A-P and 1- to adju t the unilateral AS cciput ublu ation. Reche k the leg and m e n to the ne t
problem.
Dr. John Minardi 53 Copyri'1't20IJI

iput ,Jdrome repre en an oc iput subluxation that occurs in the oppo ite
a BC ubluxation. Instead of the oc iput subluxating anterior-superior AS as
n , the PO ubluxate the o iput po terior-superior (P . In order for the
� or to d te t and orre t for a Po terior Occiput yndrome the follo\"\-ing mu t o cur:
I. Patient pre n with EVE leg in e tension.
-· Th do tor ha the patient tum their head to the left, which make the patient right leg
ontra t (pull hort . The doctor then ha the patient tum their head to the right which make the
patient" I ft leg contract pull hort . See Figures 80-82)
If thi exact cenario occur which is completely oppo ite to the AS Occiput de cribed
in the BC earlier thi pattern represents that the primary subluxation is a POS.
Figure I Patient Tum Head Right, Left Leg Draw hort.
3. The biomechanic of the POS indicate that the occiput ha subluxated posterior-superior (PS)
bilaterally. A the occiput begin to travel po terior on the lateral ma se of atla , it mu t al o
ubluxate uperior a it follow the concave surface. (See Figure 3& 4
onnal PO
fl ure 83 cc1p1tal ondyl p 11i ned rmally in the Lateral Figure 84 Oc 1p1tal ondyle ublu. ating P During a PO .
Dr. John Minardi Copyright 2006

4. Thi adju tment requires that occiput be adjusted one side at a time. Therefore, the doctor
must perfonn the ame clinical analy is described in the BCS Seated Adju tment to detennin
which ide to start with. As mentioned pre iou ly e en though this is a bilateral occiput
ubluxation, there is alway a dominating side of subluxation, and that i the ide that the doctor
must start with.
• Doctor tanding behind a seated patient.
In truct the patient to tum their head to the left and then to the right.
• On th ide to which the patient has the most range of motion ( can turn the farthest) i th
po ition in which the doctor will start this adjustment.
• For example if the patient can tum their head farthest to the left, the doctor will take
his/her contact with the patient's head turned to the left, and will be contacting the
patient right mastoid process. The doctor will then repeat this adjustment with the
patient's head turning to the right, hence contacting the left mastoid.
• In our example the doctor started with the most affected side (right occiput) as the
subluxated occiput was the reason that the patient could not tum as far to that side.
5. Correction: POS Supine Correction: (See Figures 85&86)

Doctor: Either side of table.
Patient: Supine. Chin tucked. Mouth closed. Head turned to the side of most rotation.
Contact: Thumb Pad posterior aspect of the mastoid process.
Stabilization: Cradling patient's head across the forearm.
LOC: P-A, S-1. Repeat on Opposite Side.
figure 85 POS orrecuon. Thumb Pad Contact on Posterior A pect

of Mastoid Proces . Repeat on Oppo ite ide.
Sample a e:
A 45 year old male construction worker present to the clinic with neck pain and headaches. H mention tha t h
has been operating a jack-hammer for the pa t everal weeks, and is con tautly facing down ard. Folio\\ ing a
complete examination, Thomp on analysi reveal even leg in the extended po ition. The d tor instru t th
patient to tum hi head left, which re ults in the patient's right leg pulling hort. The do tor th n in tru t th
patient to tum hi head to the right, and the patient' left leg pull hort. The I g analy i in thi nfinns th
pre ence of a PO . The doctor performs the seated analy i to detennine which id of th o ciput to tart with.
The patient can rotate their head farthe t to the left, which detennine that the patient' right o iput will be th
tarting point. The doctor contact po teri r to the patient' right ma t id, and thru P- and -I t adju t th P
occiput ubluxation. The d ctor then repeat thi procedure on the I ft ide. The d t r re- he k th I g and ,,111
then mo e n to the next area of prob! m.
--
Dr. John Minardi 55
E CEPTJO . DEREFIELD -D)
The Ex eption Derefield i the la t category that the doctor mu t rule out when the patient
pre ent with even leg . Hi toricall thi category ha been referred to by everal name : the
E. ption Derefield, the Cro Derefield the X-Derefield and the Hidden eurological
yndrom . All of which refer to the ame category classically labelled the Exception Derefield
by Clay Thompson. He referred to this category a the exception to the rule becau e the pine
had been o ubluxated that the only way to completely flu h out the problem was to tre the
ner\"Ou tern. The implest way to accomplish thi wa to flex the leg past 90 degrees. By
doing o, the pinal cord i tretched through its attachment via the filum terrninalae to the
o C)'X. A the leg are flexed there is an increased lumbar lordosis which increase the stretch
of the pinal cord, 3 resulting in an increased stress placed on the nervous ystem. By tretching
the pinal cord. ner v ou d sfunction is facilitated, and thus allows easier detection of the e
hidden problem . Stres ing the nervous system by flexing the legs in this category i imilar to
the way that Braggard's orthopaedic test help flush out nerve root lesions. In Braggard s test,
the ciatic ner ve i stressed by applying dorsi-flexion to the lower limb flushing out the
problem. The E ception Derefield flexes the legs in order to stress the spinal cord flushing out
the problem. In order for the doctor to properly detect and correct for an Exception Derefield the
following mu t occur:
I. Patient pre ents \ ith EVE legs in extension. When the patient is asked to rotate their head to
the left and right, the patient's legs remain e en.
2. Patient's leg are brought into flexion and a short leg appears. When a patient originally
pre ems with even legs, and a short leg appears when the legs are placed at 90 degree , thi 1s
labelled an Exception Derefield. However the doctor must now rule out v hich of the two
ubcategories within the Exception Derefield is present. In order for the doctor to differentiate
which one of the two subcategories is present the folio, ing must be adhered to:
Keeping the patient's legs in the flexed position, instruct the patient to tum their head to the left
and right.
Subcategories:
1. X-D: CS
If the patient's legs at 90 degrees become balanced with head rotation then it i labelled
an Exception Derefield-Cervical Syndrome and will be treated as any other Cervical
Syndrome previously discussed.
2. X-D: D-
lf head rotation does not balance the legs at 90 degrees, then it is labelled an E ception
Derefield-Derefield Negati e, pro ided that the doctor can elicit one of fi e tender point
that will be discussed next section.
How ever if the patient's legs are brought to 90 degrees and they remain e en then the do tor
mu t now rule out three other ubcategories of the Exception Derefield that are uncommon. To
differentiate if either of the Exception Derefield' rare ubcategorie are pre eat the following
mu t be adhered to:
Keeping the patient's leg in the flexed position in truct the patient to turn their head to the left
a nd right.
Dr. John Minardi

Copyright2006
n ommon ubcategorie :
3., -D: BC
• If the left leg dra s short ith left head turning and the right leg dra short with righ
head turning then this i labelled an Exception Derefield-Bilateral Cervical Syndrom
and treated as an other BCS pre iously di cu ed.
4. -D: OS
• If onl one of the legs draws short as the patient turns to that side hile the legs remain
balanced with all other head movement then this is labelled an Exception Derefield
Unilateral Occiput Syndrome and is treated as any other UOS pre iousl di cussed.
5. X-D: POS
• If the left leg draws short with right head turning, and the right leg draws short with left
head turning, then this is labelled an Exception Derefield-Posterior Occiput Syndrome
and treated as any other POS previously discussed.
3. Correction: X-D: CS- same as for CS correction previously described.

X-D: D- same as D- correction described next section.
X-D: BSC- same as previously described.
X-D: UOS- same as previously described.
X-D: POS- same as previously described.
4. Recheck the legs, and continue to the next area of subluxation.
The doctor must always remember that this category is very rare and usually occurs when the
spine has endured severe stress such as a motor vehicle accident or se ere trauma. When this
category does appear, most often the patient will present with the a contracted leg in the flexed
position, therefore the more common subcategories must be differentiated and corrected.
Sample Case:
A 33 year old female office worker presents to the clinic with neck and back discomfort since a motor vehicle
accident two months ago. Following a complete examination, Thomp on analy is re eals even leg in the
extended position. The doctor instructs the patient to turn her head left and to the right both of which result in the
legs remaining even. Since the patient's legs remained even with head rotation, this immediately rules out a BCS.
UOS and the POS. Now the doctor must determine if this case is Normal or an X-D. The doctor will then flex th
legs to 90 degrees, which in this case reveals a short left leg while in the flexed position. ormal is now ruled out.
due to the short leg appearing in the flexed position, leaving only the X-D. Keeping the leg in the flexed
position, the doctor will have the patient turn her head to the left, which balances the legs in the flexed po ition.
Head turning to the right produces no change to the short leg. Left head rotation balancing the legs in the fle. d
position indicates that this is an X-D:Left Cervical Syndrome. The doctor will then palpate the patient' right
lamina pedicle junction for a nodule and adjust it exactly the same as he/she would in a classic Cervical
Syndrome. The doctor will then recheck the legs and move on to the next area of problem.
Dr. John Minardi 57

p
rm I B 0 POS and X-D Leg Length Analysis Re ·e
ead Rotallon to Le Pulls Le Leg Short Correct For A Recheck Legs

ead Rotation o R ht Pulls Rig I Leg Short BCS & eOn
Head Rotation Head Rola ·on to One Side. Pulls the lpsi Leg Short Correct For A Recheck Legs
Produces Change But II Other Head Movement Produces No Change uos & �veOn
Head Rotation to Left. Pulls Right Leg Short Correct For A Recheck Legs
Head Rotation to Right. Pulls Left Leg Short POS & eon
�!- Head Rolallon
� Legs Brought Into Flexion

Produces a Short Leg
Head Rota!Jon
Produces o Change
Head Rotation
Produces No Change Do
Puns Each lpsi Leg Short

Correct X-D·BCS
Legs Brought Into Flex,on
Remain Even
Head Rotation Pulls One lpsi Leg Short
Produces Changes Correct X-0:UOS
Pulls Each Contra Leg Short

Correct -0.POS
Dr. John Minardi Copyrlght200G

58
ECTIO FOUR:
PRIMAR ARE : PEL VI
egative Derefield (D-)

la i Tlwmp 011 Two-Part Supine Adjustment
C/a i Thomp on Two-Part Prone Adju tment
Modified t11d) ' One Part Prone Adju tment
Uodified Al acral Pu h Adjustment
A-fodified tu ky Bilateral Roll (Coup de Gras) Adjustment
Po itive Derefield (D+)

C/a ic Thomp on Prone Lor er Boot Adjustment
Lower Boot Modified Leg Distraction Adjustment
Cla ic Thompson Supine Upper Boot Adjustment
Dr. John Minardi 59

upine dju tment
\ " , umtmue to det t and c rre t ubluxat1 n \.\ 1thm the pine, the next pnmary area of
uhtu,Jtion, Jre tho'> that take pla c \.\ nhm the peh i . Both erv I al and p I\ 1c area are
on,1JereJ pnmal) area� ofpr blem. there re, one d e not take pnonry O\er the other. If the
d)Ctor ·hoo ...e'>. he ...he can tart to rule ut pr blem at either th pelv1 or the ef"\, teal pme.
HO\\t!\t:r. tt ha been lai,\1call:y taught fi r the d ctor t imply check the cent al area fir t, and
orrect an) problem that are pre ent befi re mo ing on to the pelvi . Ifno clear findmg ar
pr ...ent m the cen 1cal �pin , then the d tor mu t a e and correct the pel i fir t, th n re
hecl-.. and Lorre ·t the cen I al pine afterward . The key for the doctor to remember 1 that both
the ef\ ILJI ...pme and peh, 1 are primary area , and mu t be a e ed and corrected before
m \ mg onto an} ther area in the pine. The egati e Derefield repre ent a ubluxated acrum
on...1den:d the key t ne of the pelvi . Sacral ubluxation often lead to further mi alignment
throughout the lumbar and thoracic area . The Negati e Derefield i con idered to be the mo t
ommon peh ic ublu ation detected in patient , occurring in more than 80 per cent ofca e . In
order to ac uratel dete t and correct for a egati e Derefield the following mu t occur:
1. Patient pre ent with a contracted/ hort leg in exten ion, and the ame leg continue to be
hon or balan e in flexion. For example:
The doct r detect a hort left leg in exten ion. When the leg are brought to 90 degree
of flexion. the l ft leg continue to be hort. (See Figure 7 & 8 )
2. Any time that the doctor detect the h rt to hort (or hort t balance phen m na d ribed
above, the doctor mu t then confirm that the finding i indeed a D refield gati e.
Confirmation occur by the tatic palpation of pecific tender p int a iated with the
Derefield egati e. Only one f the following tender point i required t b eli it d for
confirmation:
The proximal a pect of the medial tibia - Ip ilateral to the hort leg.
The i chial tubero ity - Ip ilateral to the hort leg.
• The P I - Ip ilateral to the hort leg.
The pubic tubercle - Ip ilateral to the hort leg.
• The thora ic TVP T2-T6 - ontralateral to the hort leg.
\ !f �n or more tender point are palpated a tende�, thi c?n�rms the_pr ence fa D-. Thi
unphe an anterior inferior (Al) acral ba e ublu ation on 1p ilateral tde of ontract d I g.
Dr. John Minardi Copyright 200G
4. ral hanjc
.Oblique
Post. Ant.
. .Respiratory
Oblique
Figure 89 Anterior and lateral vie, s representing the axises and planes of motion within the sa.crum. The
A i e are the Left Oblique, Right Oblique, Respiratory and Transverse (TA). The Planes are the Coronal
(CP) and Sagittal Plane (Involved in P-A Motion).
HH
The biomechanics of the sacrum are straight forward, however, the doctor must always
understand the sacral planes and axises of motion. Also, the doctor must realise the complex
interplay between the sacrum, ilium, and the lumbar spine; because as the sacrum subluxates
both the ilium and lumbar spine must compensate. As Figure 89 displays, the sacrum moves
along four main axis and two planes. 16
• The sacrum nutates I counter-nutates along the sagittal plane through the respiratory axis.
• Also moving within the sagittal plane, the sacrum moves anterior-inferior independently
on both left and right sides through its oblique axises. By travelling along these oblique
�is�s, tbe sacrum is able to move in its classic "figure-8" pattern during gait.
• 1
1-1<> urthe�ore, the sacrum travels along the coronal nlane, through its trans erse axis, in
,roLu,te
order for the sacrum to rotate, much like a steering wheel.
• It is im ortant
�ll,,o� 11. 1•al •>If• for the doctor to understand that the sacrum does not have a sagittal axis
e:,1p.A'1E i�i'O.t
therefore, it cannot spin like a top, causing one aspect of the sacral base to go anterior,
and the other side of the sacral base to go posterior.
• When the left or right aspect of the sacral base subluxates anterior then this is
accomplished through its oblique axis, and therefore, the only compensating component
to travel posterior will be the opposite sacral apex.
• The opposite sacral base is in its neutral position, and is sometimes labelled posterior.
However, the doctor should never forget that this posteriority is merely a relati e
statement to the opposite sacral base's anterior subluxarion. Furthermore, the relative
posteriority of the sacrum should never be corrected, as it is in its neutral position. Any
attempt to force it anterior will only subluxate the entire sacrum in a nutated po ition. and
cause further problems. The only exceptions to this are with pregnancy and infant .
To fully understand the mechanism of how these tender points indicate a Derefield egati\e,
individuals must first comprehend that with an AI Sacrum subluxation, the ilium on that
ipsilateral side must move in relation to the subluxation. The reason for this is that the ilium mu
compensate for the AI sacrum, to allow locomotion to continue.
• ln "normal" pelvic mechanics, assuming that everything is functioning optim ll., wh n

the sacral base moves AI, the ipsilateral ilium moves PI (posterior sagittal rotation) to
compensate. t':oni�r�ely, when the ilium moves AS (anterior sagittal rotation) then the
ip ilateral acral base will be posterior RELATIVE to the ipsilateral PSIS on the ilium.
• If the sacrum is subluxated AI, the ilium does not move in its normal PI formation.
Dr. John Minardi 61
Jn,t ut nt ri rl refi rr d t a an IN ilium and r tat lightly
tn r und th p teri r a p t f the a rum. Th e abn rmal p I ic
m t whi h th tender p int originate.
plain d in mu h greater d tail .
T furth r under tand the t nd r p in we mu t quick.Jy re 1e hat happen at th

J \ I f the mu cle pindle. hen any mu le i tretched the mu le pindl i al o tr tch d.
The tretch in the mu le pindle i n ed mainly by Type l a afferent fiber whi h th n a nd
to th rebellum thr ugh th v ntral and dor al pinocerebellar tract . The thalamu then
integrate infi rmati n fr m th reb llum to the en ory cortex. If the information within the
c r helium i difli r nt than the infi rmation held within carte , which i the ca e with a
ubluxation) th c rte e ecute a re p n e to the efferent gamma motor neuron . The gamma
efTer nt tra el thr ugh the de cending tract which innerv ate the mu cle and cause it to
ontract. Thi will re ult in a c ntraction of the po tural mu cle in the lower leg and pel i
(through the e tibul pinal tract). Al o, a contraction will result in response to the original
lengthening f the mu le and pindle at the sight of the subluxation.
With all thi in mind the fi e tender point are in olved as follows:
Ip ilat r l medial a pect of the tibia. Thi is the location where the semimembrano us
emitendin u and artoriu muscles in ert. Remember that the ilium is in the abnormal
flared out (TN ilium) AS position mentioned earlier. Con idering the fact that the e
mu cle riginate at the i chial tuberosity and in ert at the medial aspect of the pro imal
tibia the abnormal pel ic position lengthen tretches these muscles cau ing them to
ntract through the muscle spindle neurology . Hence causing a tender point upon
palpation.
Ip ilateral i chial tubero ity. This marks the origin of the semimembranosu and
emitendino u mu cle . The abnormal pelvic position and the muscle spindle
me hani m a mentioned above causes these muscles to be tender at their origin. Hence a
tender point i present at this location.
Ip ilateral PSIS. Remember that the PSIS is abnormally po itioned by being r tated
lightly and wrapped around the acrum po teriorly. Thu provoking pain through
palpation in thi area indicate that the PSIS i colliding with the acral ba e. Hence
imp ding normal motion and producing a tender point.
Ip ilateral pubic tubercle. Again, abnormal pelvic mechanic are to blame. Since the
ilium i in the ASfN po ition thi causes the pubic tubercle to be po itioned inferior and
lateral from it original po ition. This causes surrounding tructures to be taught,
produ ing the tender point upon palpation.
• ntralateral T2-T6 tran ver e proce se . The contralateral mu culature in thi area
c ntra t to compen ate for the original hort leg cau ed by the AI acrum. The hort leg
au e th entire body to ift to that ide, thu , the contralateral mu culature in the T-
pin mu t contract to bring the body back to a level position with re pect to gravity. The
tend r p int i pre ent due to the ten e mu culature.
82
EG TIVE DEREFIELD (D-)
la ic Thomp on upine Adju tment
This adju ttncnt wa th original t\ o-part mo e that lay Th mpson created lo adju t the
ant ri r-infcrior acral �ublu ati n. What make thi adju tment unique i that Thomp on
nta t d the ilium ancl LI d it t indirect I cl the acrum back t it neutral po ition.
h mp on utilized the p \ rful ligament that onnect the acrum and ilium, namely the
'a r tub r LI , '3 r ·pin u and p tcri r intern eL1s ligament . Thomps n rationed that
b • au" f the nat mi al placement of the e tructure , the ilium could be used to correct the
primar y antcri r inferior ublu ation within the sacrum, a well a correct for the econdary
l c mp n'ation that oc ur within the ilium.
5. rrc ti n : l acrum dju tment - Supine two-part mo e:

I t Part: ( ec Figure 90&91)
D ctor: n invol ed ide.
Patient: Fl x in olved leg so that th foot i flat on the table. Un-in ol ed leg extended.
Table: Pel i piece in the ready po ition. ( 440 Table clutch po itioned to drop cephalad).
nta t: Thcnar contact on i chial tubero ity of in olved ide.
tabilizati n: A I on in ol ed ide.
L : 1- with light A-P. Repeat 3 times.
Figure 91 0-: Supine orrection Part I Doctor Po iuonmg.
Thi fir t part \ ill dri e the entire pel ic tructure superior, and will correct for the inferiority of
the acrum.
2nd Part: ( ee Figure 92&93)

D ct r: On in ol ed ide.
Patient: lex un-in ol ed leg o that foot is flat on table. Involved leg i extended.
Table: Pel ic piece in the r ady po ition.(440 Table clutch positioned to drop cephalad).
ontact: Midp int of inguinal ligament.
tabilization: pp ite knee.
L : light A-P with hea y medial t rque. Repeat 3 time .
Thi� ec nd part will flare the ilium into an X po ition, allowing the P J to extcmall r tote.
hi will pr duce the pace nece ary for the a rum to fall po terior at the terminal p int fth
dr p piece, c rrecting it anteriority. Furthenn re, the compen ating IN ilium i al o rr cted
due to the naturl.! of the torque placed n the inguinal ligament. This t rque will dri "the ilium
rnt a correcll e • po ition, o that when the a rum fall into it neutral po iti n, th
ilium n longer need t c mpen ate.
Dr. John Min rd/ 63 CopyrlghtZOOf

nth that m rm
fr mth tend dt th fle, d

lift in mpari nt th un
bthlg,th a id
. .
n. m c m an
ultu r ,th r "ill
l th .th n IIthr Jim
nt i du t th h ni rth t i
ID\ h d withth 0-
th
thi.
NEGATIVE DEREFIELD (D-)
Classic Thompson Prone Adjustment
Thi modification was implemented by Clay Thompson as an alternative for doctors to ke ep the
patient prone for the entire two-part adjustment. Similar to the supine correction, the Cl assic
Thomp on Prone adju tment utilizes the ilium to adjust the sacrum, and corrects for the anterior
inferior ublu ated sacrum using a two-part move.
1. Leg length analy is, subluxation pattern biomechanics and neurology are all the same as
explained for the supine adjustment.
2. Correction: AI Sacrum Prone Two-Part move

1st part: (See Figures 94&95)
Doctor: On involved side.
Patient: Prone.
Table: Pelvic piece in the ready position. ( 440 Table clutch positioned to drop cephal ad).
Contact: Knife-edge contact on ischial tuberosity of involved side.
Stabilization: Anatomical Snuffbox of contact hand.
LOC: I-S and slight P-A. Repeat 3 times.
Figure 94 D-: Prone Correction - Part I. Knife-edge Contact on Figure 95 0-: Prone Correction - Part I Doctor Po itioning.
I chial Tuberosity.
Similar to the supine adjustment explained previously, the first part of the Classic prone
adjustment drives the entire pelvic structure superior, and thus corrects for the inferiority of the
sacrum.
2nd part: (See Figures 96&97)

Patient: Prone.
Table: Pelvic piece in the ready position.( 440 Table clutch positioned to drop cephalad).
Contact: Ulnar ridge of forearm on medial PSIS.
Stabilization: Anterior thigh of involved side.
LOC: M-L, P-A with thrust following contour of pelvis. Repeat 3 times.
s
It i important for the doctor to note that bending the patient's leg while supporting the pa tient'
Dr. John Minardi
. ht h \\ ill reat le train on the doctor, and be more com
1�' 1 d t of... pa·
rti ular ad
.
ustm
fonable for the patient. Toe
0 th i J ent occur in thi eco nd part as the compensating
tinut t t
· · ilium
1 d with th1 move, b owe er. the anteno n of the sacrum ometun · ·
es 1 not. The th ory
" ht n� thi move i when the pelvis hi the tenninal point of the drop. the sacrum will pop in o
However. considering that the thru t pattern is anterior and the acral sublu
Pia · ell thi i
·
omettme not correcte d .
xation i
ant n· o r as w
rt move i a beneficial altemati e that Thomp on provided for patients who

The prone two-pa
. v ing freely on the table, such a the elderly.
ha,·e d1ffi ult� turn
• tedtal Aspect of P I
3. Recheck the legs, and continue to t he next area of subluxation.
Copyright 2006
Dr. John llin 66
ardi
DEREFIELD NEGATIVE (D-)
Modified Stucky One Part Prone Adjustment
Dr. Joe tucky implemented a modification to the correction of a Derefield Negati ve in which
both the anteriorit and th inferi rity of th acrum subluxation could be corrected in one mo.
e
Thi v a a c mpli hed by onta ting the acrum directly, rather than the indirectly through th: .
ilium. U ing th obliqu axi present within the acrum biornechanics Dr. Stucky co nta ct ed th e
pp ite a ral ape of th Anterior Inferior sacral base subluxation. Furthennore, by
impl m nting a t rque within the adju tm nt thrust the transverse axis was utilized allowing
th a rum to r tat al ng it coronal plane. Combining the two results in correcting for the
ant ri r-inferior a rum in one fluid motion.
l. Patient pre nt \l ith a contracted leg in extension. This leg continues to be short or balances
in fl ion.
2. Doctor confirm the presence of a Derefield Negative by static palpation of specific tender
point mentioned pre iously. Reminder that only one of the tender points needs to be elicitedia
ord r to confirm the pre ence of a Derefield Negative. Presence of a tender point indicates that
the primary ubluxation is an anterior-inferior sacral base ipsilateral to the contracted leg.
3. acral Mechanics: The fol lowing diagram displays how the contact (grey circle) is taken on
the acral apex opposite to the side of the original Al sacral base. (See Figure 98)
• Thi contact utilizes the sacrum's oblique axis to correct for the anteriority.
• Addition of a lateral to medial torque at this contact also enables the sacrum to utilize its
tran er e axi to rotate along its coronal plane. Correcting for the inferiority.
Oblique
Obliqu
Figure 98 D-: Modified One Part Adju tment. ontacting the

acral Apex on the Oppo ite ide of the Al acrum.
4. Correction: Modified Stucky One Part Adjustment (See Figures 99&100)

Patient: Prone. Cross the short leg over the opposite leg to gap the involvedjoinL
Doctor: Opposite side of the lesion.
Table: Pelvic piece in the ready position. 440 Table clutch positioned straight).
Contact: Fle hy hypothenar on opposite sacral apex.
Stabilization: PSIS of short leg side.
LOC: P-A with torque towards in olved ide. Repeat 3 times.
It is important for the doctor to note that cro ing the affected leg over the unaffected leg
produc a gapping in the in ol ed SI joint pro iding the room nece ary to ork within the
Dr. John Minard 67 Co,,/---
J()tnl.
Th d_1u�tm nt rr t or both dire tions of the ubluxation simultaneou ly.
Th P-A thru t and drop piece component on th opposite acral ape , utilize the
bliqu axi of the acrum and thu corre t for th anteriority of th ublu ation.
• The torque that i implem nted rotate the acrum along it tran erse axi within the
oronal plane. corr ting for the inferiority.
A mentioned pre iou ly the D- ubluxation ha a direct influence on the tate of the ham tring
mu le . Th r fore, correction of the D- re ult in an equalization of the ham tring . Re earch
into the neurological effect of adju ting the acroiliac joint ha found neural re pon e that ma
b re pon ible for the reduction of mu cle tension following an adju tment. 1- Chibulka et al. 3
on entrated pecifically on the re pon e of trained ham tring mu cle to mobilization of the
a roiliac j int and di co ered increa ed peak torque in the treatment group in compari on to the
ontrol, ugge ting an a ociation between ham tring mu cle train and acroiliac d function.
ther re arch al o found ignificantly increased traight leg rai e SLR te t p t lumbo acral
joint adju ting. 1.-i Re earch ha hown that the neurological effect of the adju tment produces a
r du ti n in motor neuron acti ity, re ulting in a change in ham tring tle ibility fi ll wing a
roilia adju tment. 5 Further tudie ha e concluded that hypomobility and it adju tment are
a iated with modulation of pinal information. They state that thi cau e a reduction in the
itabilit of the mu cle pindle rendering it le en itive and re ulting in the lengthening of
th intra-fu al mu cle fibre cau ing a reduction in the T-r fle . They also hypothe i ed that the
d r a d pindle en iti ity po t acroiliac joint adju tment may explain the reduction in mu cle
tightn after and adju tment. 2•6• 7 Other research conclude that the adju tment pro ide quick
tra tion and e citation of the Golgi tendon organs located in the muscle tendon junction that may
r la mu le , known a autogenic inhibition. Finally Herzog 9) believed that the adju tment
timulate th low and high thre hold mechanoreceptor and nociceptor to generate a bur t of
matic afferent re eptor activity, thu producing a relaxation of the soft tis ue. Thi brief re iew
f literature r in for e the fact that an adju tment ha a direct effect on the nerv ou y tern,
whi h au e a rela ation in the ham tring mu cle a een in the detection and correction of th
D-.
Copyright 2001
EG Tl E DEREFIELD (0-)
Modified I acral Pu h djustment
Th M difi d Al a ral Pu h adju tment \ a er ated as an altemati e to adju ting the AI

acrum fi r th do tors r patient \ h prefer a id p ter t up but al o wi h to incorporate
th u of th drop piece .
i , bi m chani and ubluxati n pattern ar the rune a di cussed
2. Patient pre ent \ ith a D- ( hort to hort or hort to balanced leg length analysis) confinned
\ ith at l a t n p iti e tend r point.
rr ction: Modifi d AI acral Pu h Adjustment: (See Figures 101-103)

Pati nt: ide po ture with the in ol ed side down, split leg position.
D tor: ide of Table.
Table: Pel ic piece in the ready position. (440 Table clutch positioned to drop traight).
onta t: Pi iform on acral apex (approximately S4).
tabilizati n: Elbow or houlder of patient.
LO : P-A, L-M. ( W torque with left side up CW torque with right ide up).
Repeat 3 time .
The following diagram di play the po itioning of the sacrum in the side posture position.
ate how the le ion ide i down, and that the doctor's contact (grey circle) is on the oppo ite
acral ap to utilize the oblique axis.
Oblique
···.Oblique
Ill
Figure 101 D-: Split Leg Adjustment ontact.
In order for the adju tment to be executed effecti ely:
• The doctor must bring the sacrum to tension, followed by the thru t given with a bod
drop and a pu h.
• A alway patient placement will make a sub tantial difference in the e ecuti n of the
adju tment. By u ing the plit leg position, the weight of the patient' leg will rem e
mo t of the lack within the pet i and will a i t the do tor tremendou ly.
• The plit leg po ture al o as i t in gapping the SI joint pace, providing a more efficient
and e fective adjustment.
Dr. John Minardi 69 Copyrlflht JOOI

figur 102 [). \;Kral Pu�h Correction. Le i n
Con ct on Oppo II a ral pe"\.
Th P-A thru ·t and drop piece correct for the anteriority of the sacrum and the L-M torque
orr t for the inferiority.
The adju tment can be done manually without the use of drop pieces. Howe er the doctor must
alway remember that the adju tment mu t be done exactly a de cribed above.
At no time hould the doctor ever ub titute the oppo ite acral apex contact for an
oppo ite acral ba e contact.
A mentioned pre iou ly the acrum ha no agittal axi . Thu a acral ba e contact will
re ult in the doctor forcing the entire acrum into nutation creating a whole new
problem.
r pr ent to the clini with I w back pain. h that the pain i

EGA TIVE DEREFIELD (D-)
Modified Stucky Bilateral Roll (Coup de Gras) Adjustment
The Bilateral Roll adjustment i designed as a side posture two part move to correct for chronic
Derefield egati e subluxations that are not responding to traditional or modified Thomp on
adjustments. When a doctor experiences cases in which chronic D- subluxations are not
correcting properly a unique phenomena may be occurring between the sacrum and lumbar
pine. In such cases the ubluxated AI sacrum, further complicates itself by rotating along its
coronal plane, no longer forming a perpendicular angle with the lumbar spine. Due to the
chronicity of the problem as well as the patient's lack of improvement the doctor must take x
ray . Radiological analysis will verify that the sacral base is no longer at a perpendicular angle
, ith the lumbar pine. The doctor must now convert to the Bilateral Roll Adjustment in order to
correct for the original AI sacrum and the additional rotational malposition of the sacrum.
Resulting in the restoration of the perpendicular angle.
l. Leg length analysis and subluxation pattern are the same as discussed previously for the D-.
2. D- is chronic, and has not been improving with previously discussed corrections.
3. The doctor takes X-rays of the area, and finds the following on the films: (See Figures 104
&105)
Normal D- :BR
Figure 104 D- Bilateral Roll: distortion of the normal perpendicular angle

present between the sacrum and lumbar spine.
Figure 105 a rum is not Perpendicular
to the Lumbar pine.
The diagram and x-ray displays how the sacrum has rotated so that it no longer forms a perpendicular angle \\ith th
lumbar spine. Because of this rotation, two angles are formed; an acute angle, and an obtuse angle. The a ut anc l
will always be on the ipsilateral side of the short leg, and therefore is the side of the AI sacrum. The obtu e angl i
the wider angle produced by the rotational component of the sacral subluxation.
4. Correction: Modified Stucky Bilateral Roll (Coup de Gras).

Part I A
l st Part: (See Figures I 06, l 08 & 110)
Patient: Side posture with the short leg down (obh.1se angle up)
acute angle down.
Table: Lumbar and Pelvic pieces in the ready position.
ontact: Fie hy pisiform on sacral apex. figur 106 Part I· (l)ITCI:
LOC: P-A light I-S. Repeat 3 times. Ant ri nt).
Dr. John Minardi 71

dJu� tm m rr th Al acrum on the oppo ite
ide by utihzine the
'rum. It al o en to reduce the obtuse angle lightly
through th; uperior
_nd Part: ( ee Figure IO , I 09 &111 Part _
Patient: Lie on oppo ite ide acute angle up .

Doctor: ide of patient.
Table: Lumbar and Pelvic piece in the read po ition.
Coma t: Pi iform on acral apex.
LOC: L-\1. with torque. Repeat 3 time
Fi ure 10 Pan 2: Restonng th

Perpend, ular Angle.
Toe e ond part of the adju tment correct for the remaining di tortion of the obtu e angle, and
r tore the acrum' perpendicular angle with the lumbar spine.
figure IO 81lat ral Roll Correction Part I. Acute Angle

D01m. Pi 1form Contact on Oppo ite acral Apex.
Copyrlght2006
Or. John 12
Minardi
PO ITIVE DEREFIELD (D+)
Lower Boot ublu ation
The D refield P iti (D+) i the final pet i c mp n nt a ciated with the primary areas of
ublu 'ati n. The pr i u ti n fo u ed entirely with the 0-, and it implicati n on acral
ubluxati n . Thi ti n will fi u n th D+, wh ubluxati n pattern impact the ilium. It
i imp rtant fi r th d t r t n te that wh n the pel i i ubluxated, th D+ pr blem occur
nl 2 p r nt f th tim in mpari n t th D- which c ur O perc nt of the time .
Ith ugh b th th - and D+ ublu ati n cur within th pet i their ign , ymptom and
anal i are quite diffi r nt. In rd r fi r the d t r t accurately d tect and correct for a D+, the
fi 11 v ing mu t ur:
I . Patient pr ent v ith a ntra t d I g xten ion. In fl xion, however, the contracted leg
b m 1 ng r. ( Figur 1 12&113)
hi i a mpl te cro o er in length, and not a r lative change in leg length a may be
e n in ther technique . For example if the right leg i short by one inch in exten ion
h we er, in flexi n i only ho11 one-half of an inch, thi would represent a relative
lengthening. Thi i OT considered a D+, a Thompson always compare the right ide
t th left.
• Th refi r an example of a D+ in Thompson is that a patient present with a hort left leg
in exten i n f Yi inch in comparison to the right side. In flexion, the left leg completely
er and b c mes longer by one inch in comparison to the right side.
Figure 112 Patient Pre eats with a hort Left Leg in Extension.
2. The short to long leg length analysis implies a D+, which indicates that the ilium ha
ubluxated po terior-inferior (PI) on the involved side.
3. ince the sacro-iliac (SI) joint is comprised of two separate joint spac the doctor mu t
erify whether the superior joint or inferior joint is affected. Considering that the I joint i "L"
haped, or "Boot" shaped (See Figure 114), Thompson referred to this tep as verifying b tw en
an upper or lower boot subluxation. It is ess ntial to differentiate b tween the upp r and lov r
boot ubluxation , a each area will exhibit a unique subluxation pattern. A a result, the
mo ement f the ilium will vary con iderably, a will the adju tment that must b u d.
4. P l ic Mechanic and Difference Between Upper and Low r B ot Subluxation.
Dr. John Minardi 73 Copyright 2(106

Figur J 14 .. Boot- haped.. Aniculation
ofth I Joint.
Toe bO\ e diagram di pla the unique 'Boot- Shaped" SI joint. The upper boot is composed
hi ly of fibro-cartilage and ha a poor neurological supply. The ilium will only subluxate
;thin th upper boot 20% of the time, and is called a False D+.
Con\· rsely. the lower boot i a yno ial joint and has a strong neurological supply. The ilium
;u ubluxate within the lower boot 80% of the time, and is called a True D+.
\ 'hen the ubluxation occur in the lower boot the ilium rotates along that lower axi re ulting
in the P IS ubluxating PI. Altemati ely if the ilium rotates along the upper boot the
bluxation i till labelled a PI ilium, because it does go slightly PI. Howe er because the ilium
· rotating along the upper axis it predominately forces the pubic tubercle anterior which i the
primary ublu ation.
. To verify whether the PI ilium i a lower or upper boot subluxation the doctor mu t perform
an Ann Fo a Te t, which Clay Thompson incorporated from the Sacra-Occipital Technique
( OT).
Patient i upine. Doctor is tanding on the affected ide.

In tru t the patient to extend their arm to 90 degrees, palm facing caudad.
The doctor applie caudad pressure to the patient' arm, to which the patient re i t m
order to maintain hi /her arm at 90 degree .
A the doctor applie the caudad pre ure the doctor will palpate the inguinal ligament
from lateral to medial, tarting from the ASIS to the Pubic Tubercl .
A the doctor i palpating the ligament, there will be a pecific point in which the patient
will experience a "blow out" or extreme weakne .
Once thi "blow out" occur the patient wi 11 be unabl to keep their arm at 90 degree .
If the '·blow out' occur anywhere from the ASIS to th midway point of the ligament it
indi ate a lower boot ubluxation. If the ' blow out occur from the mid ay point to the
pubic tubercle, then it i an upper boot ubluxation. See Figure l l 5& 116)
If the pati nt did not ha e a D+ then no blow out would occur and the patient ould be
ab! to tain equal re i tance throughout the entire palpation of the inguinal ligam nt.
Although man y indi idual ha e que tioned the r liability of the arm fo a te t r earch ha
con i tently found thi te t to be a alid method for a e ing acroiliac j int dy fun ti n. 11•
1 12
arm fo a t t h pro d to b an e tr m ly aluable Thomp on t ol, and i n of th fi

alid t that pr p rly e the upper and lower acroiliac joint .
Dr. John Minardi 74 Copyrlght2<HHS

Inguinal Ligament
Figure 115 Inguinal Ligament. Figures 116 Areas of Blow Out.
Figurt 115 and 116 di play the inguinal ligament\ hich connects from the ASIS to the Pubic T�bercle (Pl). ot� that ifa blow-out� the arm
fossa te t oc urs in the upp r halfof the inguinal ligament, it i considered a lower boot subluxat1on. Conversely, 1fa blow-out occurs m the
IO\\er halfofthe ligament, it i on idered an upper boot subluxation. Courte y ofBartleby.com's edition of Gray's Anatomy of the Human Body.
6. Correction for the Lower Boot Subluxation of the PI ilium: (See Figures 117&118)
Patient: Prone.
Doctor: On involved side facing cephalad.
Table: Pelvic piece in the ready position. (440 Table clutch to drop down and inferior).
Contact: Medial-Inferior PSIS.
Stabilization: Opposite ischial tuberosity.
LOC: P-A, following contour of SI articulation. Repeat 3 times.
figure 117 D+: Lower Boot Correction. Thenar Contact on PSI

tabilize Opposite lschium.
In addition to the leg length analysis, there are several clinical ways that assist the doctor in the
detection of a D+.
Firstly, as the doctor lifts the patient's legs from the extended to the flexed position, the
patient' affected side will be heavier to lift in comparison to the unaffected ide.
Secondly, while in the flexed position, if the doctor releases both legs the affe ted ide
will kick back at the doctor more forcefully than the unaffected side.
La tly, as the doctor observes the patient's gluteal mu cuJature there will be an in crea ed
mu cle size on the affected side's gluteus.
If the patient wa normal or when the D+ subluxation is corrected, then all three clinical ign
would not exi t because there would be a balance between the right and left sides. The rea on
that these clinical signs are pre ent is due to the biomechanics and neurology that is involv ed
t
with the D+ subluxation. As the ilium subluxates Pl, it will cause a lengthening, then ub eq uen
ntra tion of the rectus femoris muscle, which originates at the AJIS and attaches via the
quadricep tendon to the patella. Subsequently, the antagonist hamstring muscles are inhibited.
• Thi ten ion v ithin the rectu femoris explains why the affected leg feels heavier. The
rectu femori is a leg extensor thus trying to flex the leg to a 90 degree position will go
again t the intended action of the muscle. The resultant resistance that the doctor
encounters manifests as a heavy leg.
• The 'kick back" phenomena also occurs due to the tension occurring in the rectus
femoris. As the doctor releases the legs at 90 degrees, the affected side has a build up of
tension in the leg extensor, causing the kick back to occur on the affected side.
The increase in gluteal size occurs due to the subluxation. The PI ilium forces the PSIS
po terior inferior, causing the gluteal musculature to appear larger in size.
It i important for the doctor to remember that the clinical signs that are present with a D+ are
the exact opposite as those found in a D-, described in the previous section.
POSITIVE DEREFIELD (D+)

Lower Boot Subluxation - Modified Leg Distraction Correction
The modified leg distraction adjustment for the D+ was created for usage on a drop table other
than the Thompson 440 table. When working on the Thompson table, the table's pelvic piece is
set to drop down and inferior to provide a caudal distraction of the ilium as the doctor thrusts
through the PSIS. As most other drop piece tables do not have this option this modification
provides the doctor with the caudad distraction necessary for an effective adjustment.
1. Patient presents with a short leg in extension. In flexion, the contracted leg appears longer.
2. Leg length analysis represents a D+, indicating a PI ilium subluxation on the in ol ed side.
3. Doctor must verify whether the D+ is an upper or lower boot subluxation by performing an
Arm Fossa Test.
4. The Arm Fossa Test displays a blow out in the upper half of the inguinal ligament (from ASIS
to Midway point), confirming a lower boot subluxation of the ilium.
5. Lower Boot Subluxation Biomecharucs. (See Figure 119) The ilium rotates along it lower axis
(solid grey dot), forcing the PSIS to subluxate PI (grey ilium).
Fleure 119 Pl lhwn ubluxaung Along

it Lower Axi .
o,. John Minardi 78 Copyrtght2ooa
6. Correction: Modified Distracted Leg Adjustment: See Figure 120
Patient: Prone.
Doctor: On either side, facing cephalad
Table: Pel ic piece in the ready position.
ontact I-Medial-Inferior PSIS.
Contact 2-Hand grasping the anterior portion of patient's thigh.
LO : ontact I : P- following contour of sacral articulation.
ontact 2: Distracting patient' thigh caudad. Repeat 3 times.
7. Re-check the leg and mo e on to the next area of subluxation.
Figure 120 O+: Modified Lower Boot Correction Doctor Position.
It i important for the doctor to realize that the D+ lower boot subluxation can be corrected with a
ide po ture manual adjustment as the biomechanics of the subluxation are the same. If the doctor
doe not ha e access to a drop table, place the patient side posture, lesion side up. The doctor
contacts the affected PSIS and will thrust through the contact, performing the manual adjustment.
Howe er, the side posture adjustment cannot be performed on the upper boot subluxation and
will be explained further in the next section.
Intere ting research studying the effects of sacroiliac manipulation on quadriceps muscle trength
demon trated that adjusting the ilium resulted in statistically significant strength impro ement in
the quadriceps muscles. 13 Other research has shown a decrease in quadriceps inhibition following
acroiliac joint manipulation in patients with anterior knee pain. 14 Furthermore Suter et al.(15)
found that sacroiliac joint manipulation resulted in a significant reduction of knee-exten or
muscle inhibition. These studies reinforce the fact that the sacroiliac joints have a direct effe t on
the integrity of the quadriceps muscles. Therefore, proper detection and correction of pel ic
subluxations such as the D+, will reinstate balance to these structures.
Sample ase: A 32 year old female soccer player presents to the clinic with low back pain. he mention that th
pain i incrca cd when kicking a occer ball. Following a complete examination, Thomp n Anal i rev al a
hort right leg in exten ion, and a long right leg in flexion. The doctor first a e se if a ervical yndrom i
pre ent, and corrects it if neces ary. The hort to long leg length analy i indicate a Derefield P itiv . Th d tor
perfi rms an Arm Fossa Test to determine if it an upper or a I wer b ot ubluxati n. In thi ca e, th pati nt b
bl w ut n the upper ection of the inguinal ligament, indicating a lower b t ublu ati n. The doct r will con13ct
the P IS and tabilize the anterior thigh of the affected ide. The doct r di tract th thigh caudad, and thrusts P·
t c rrect the ilium subluxation. The doctor then re-check the leg foll wing the adju tm nt and mo on toth
next ubluxation.
Dr. John Minardi 77

PO ITIVE DEREFIELD (D+)
Upper Boot ublu atioo
for de ade chiropractor a urned that any po terior subluxation occurring within the ilium
ould be adequateI) corrected by contacting the PSIS and thru ting P-A. ln eighty percent of the
ase . that a- umption \\ ould hold ome merit. as the subluxated ilium would displace along the
lo,\erboot (a\i-). and could indeed be corrected with such an adjustment. However, in twenty
per ent of the ca e . where the ubluxated ilium displaces in the upper boot(axis), the po teriority
of th e iltum i light. and i only present because of the anterior displacement of the pubic
ruber le. In the e ca e . not only will a P-A adju tment not be effective, it will do further damage.
Therefore. it i critical for the doctor to be able to distinguish when a D+ upper boot ubluxation
ha o urred. In order to accurately detect and correct for an upper boot subluxation the
following must occur:
I. Patient pre em- with a contracted leg extension. In flexion, the contracted leg become longer.
-· Leg length anal� i repre ent a D+, indicating a PI ilium subluxation on the involved ide.
3. Doctor mu t \'erify whether the O+ i an upper or lower boot subluxation by performing an

Ann Fo a Te t.
. The Arm Fo a Te t di play a blow out in the lower half of the inguinal ligament from the
midway point to the pubic tubercle), indicating an upper boot ubluxarion of the ilium.
-. pper Boot Subluxation Biomechanic . ( ee Figure I 21) The ilium rotate along it upper axi
( olid grey dot). forcing the pubic tubercle to ublu ate anterior and only ligbtl subluxating the
P IS po terior (grey ilium).
Figur 121 Pl )hum ublu aung

Along its pper i .
5. Correction: Supine Upper Boot Adju tment: (See Figure 122&123
Patient: Supine.
Doctor: On invol ed ide.
Table: Pelvic piece in the ready po irion. 440 Table clut h to drop down and upenor .
Contact: Gentle knife-edge on area of blow out.
Stabilization: Anatomical nuffbo of contact band.
LOC: S-l predominantly, light A-P to initiate the drop piece. Repeat 3 time .
6. Recheck the leg and move on to the ne t area of ubluxation.
....
If a male doctor is working on a female patient, the contact should be modified. Have the patient
place her hand on the pubic tubercle, and the doctor will take his contact over the patient's han d.
Thi modification will provide more comfort to the patient, and eliminate any potential confusion.
The doctor mu t note that the D+ upper boot subluxation cannot be corrected in the manual side
po ture position described in the D+ lower boot section. Since the ilium is subluxating in the
upper boot, the axis of rotation is primarily forcing the pubic tubercle anterior. Therefore, if the
ide po ture adjustment was performed, it would cause the entire ilium to subluxate into an
Externally Rotated (EX) malposition. Therefore, the D+ upper boot subluxation must be corrected
with the drop piece, as described previously.
Over time, many individuals have questioned how it is possible that the D+ leg
length analysis becomes longer in the flexed position. The answer to this question
i quite imp le. The leg appears long in knee flexion because of the muscle spindle
reflex loop involved in the ipsilateral rectus femoris. The rectus femoris originates
at the AIIS and attaches via the quadriceps tendon to the patella. (See Figure 124)
As the rectus femoris lengthens because of the subluxated PI ilium, the reflex loop
mentioned earlier is activated causing the muscle to contract. It is this muscle
contraction that causes an increased muscle bulk in the ipsilateral rectus femoris, in
relation to the contralateral side. Thus, in knee flexion, the increase in muscle bulk
appear as the "long leg" in flexion, in comparison to the contralateral leg.
Furthermore, it is the contraction of the quadriceps that also makes the leg appear
shorter in the extended position. Figure 124 R rus
Femori.
Rec1us Femons Image Copynght 2003-2004 niversity of Washington. All rights reserved including all photographs and images. o re-use. re-
d1;tnbution or commercial use without prior written permission of the authors and the University of Washington.
Sample Case:
A 45 year old female jogger presents to the clinic with low back pain and pain near her pubic bone. She mentions
that the pain is increased when performing activity. Following a complete examination, Thompson Analy is
reveal a short right leg in extension, and a long right leg in flexion. The doctor first assesses if a Cervical
Syndrome is present, and corrects it if necessary. The short to long leg length analysis indicates a Derefield
Po itive. The doctor performs an Arm Fossa Test to determine if it an upper or a lower boot subluxation. In thi
case, the patient has a blow out on the lower section of the inguinal ligament, indicating an upper boot ublLLxati on.
The doctor will place the patient supine, and have her place her hand on the affected pubic bone. The doctor will
contact over the patient's hand, and thrust P-A to correct the ilium subluxation. The doctor rechecks the leg
following the adjustment and moves on to the next area of subluxation.
Dr. John Minardi 79

E TIO. Fl\'£:T
ECOXD. RY AREA:
Le. IBAR
�pin
LU mbar
c.1. ,1 Thomp 011 el red Adju tment
\loJi 't .I pl r-Lea Adju rment
\fo,/, it I Prone Adju rment
H,· -p racti\ e P oas

Cf 1-,:iL Tlwmp on upine Adju rment
L5- I Distraction Adjustment (Acute Low Back)

\fod(fied Prone Adju trnent
pondylolisthesis
Cla si Thompson upine Adju tment
.\lo f(ti d In ritutional Adju tment
It:, 80
Copyright 2006
LUMBAR SPINE (LS)
Classic Thompson Seated Adjustment
In pre ious ections the primary area of subluxation cervical and pelvic were discussed in
detail. After the doctor has corrected the primary areas of subluxation three scenarios can occur.
• The fir t i that the patient could now have balanced legs in extension and flexion tha t
are not affected by head turning. In this case the patient is balanced thus, the doctor
would not continue adju ting the remaining areas of the spine (with exception of clean up
mo e di cu sed later).
• The second scenario that can occur, is that the patient continues to have a short leg
following corr ction of the cervical and pelvic areas. This scenario would indicate that
th pati nt has other subluxations that must be corrected. Therefore, the doctor must now
proc d to the econdary areas of problem (lumbar spine).
• The third cenario that can occur, is that a lumbar subluxation exists, that is independent
of the pel is. For example, the doctor corrects for a cervical subluxation. The patient's
1 g continues to pull short, so the doctor continues to the pelvis. No pelvic subluxations
are present, however, the lumbar spine is subluxated. This scenario is the most
uncommon of the three occurrences, as a lumbar misalignment is predominately due to an
original pelvic misalignment.
• In the second and third situations, the doctor will then proceed to the secondary areas of
the pine.
1. The leg length analysis for the lumbar subluxation is extremely similar to that of a D-.
• The patient will present with a contracted leg in extension. In flexion, the contracted leg
balances or stays short.
• Greater than 90% of the time, a lumbar subluxation is secondary to an original D- which
is the reason that the leg length analysis is identical. When this is the case, the doctor
would initially correct for the subluxated D-, as discussed previously then continue to
correct the lumbar subluxation.
2. The only exception to the statement above is if the lumbar subluxation occurred, or remained
independent of a D-. When this is the case, the doctor will encounter the short to short leg length
phenomena described previously, however, no tender points will be present.
• Lack of tender points rules out a D- sacrum subluxation, and points to a lumbar
subluxation. In this case, the doctor would not adjust the sacrum, but would rather move
directly to the lumbar spine.
3. Static palpation reveals spinous deviation ipsilateral to the AI sacrum (original short leg side).
• Palpation will also reveal erector spinae tonicity, aberrant lumbar interspinous spacing a
well as localized edema in chronic cases.
4. Motion palpation of the lumber spine reveals a lack of proper joint movement, further
confirming the presence of the lumbar subluxation.
5. Lumbar Spine Biomechanics. (See Figure 125) Leg length analysis, static and motion
palpation all confirm that L5 has subluxated posterior and rotates spinous toward the side of the
original AI sacrum/contracted leg.
• L5 subluxates posterior due to the coronal orientation of the facet joints betw een L5 and
SI. Due to the fact that the L5 facets are positioned posterior to the S 1 facets, the o nly
direction that the lumbar spine can move initially is posterior.
• The only two exceptions to this rule are facet tropism or a spondylolisthesis. These allow
Dr. John Minardi 81
.- 1 rr n I te merior. however, the e are unique cases and will be di d in more
d "t ii I t r on.
Folio\\ mg the po teriority, L5 then rotate pinou toward the ide of the original D-. A
th · rum -ubluxate AI, it will cau e the lumbar spine to rotate with it due to the
n om1 al po ition of L5 on S 1.
Post. Ant.
LS
Sacrum
Figure 125 L5-SI Coronally Orientated Facet Joints. ote that the L5
facet 1s po tenor to SI (arrow).
Figure 125 displays the coronally orientated L5-S 1 facets (black arrow). The positioning of these articulations forces
L5 to subluxate posterior initially, followed by spinous rotation toward the ipsilateral side of the original Derefield
Negative. or contracted leg.
5. Correction: Lumbar Seated Adjustment: (See Figures 126&127)

Patient: Seated with legs secured. Arms crossed. Involved side arm on top of
opposite arm. Head turned away from involved side.
Doctor: Standing or seated behind the patient.
Contact: Contralateral mamillary process.
Stabilization: Patient's involved side elbow.
LOC: P-A.
To make this adjustment easier for both the doctor and the patient, a certain procedure can be
followed before the adjustment is performed, to ensure that the patient s positioning is optimal.
Have the patient sit straight at the edge of the table, with legs grasping the table.
Instruct the patient to protrude their stomach out.
• This will assist in the restoration of the lumbar lordosis.
Instruct the patient to tum shoulders toward the side of the original short leg.
• This will assist in establishing the torque needed for the adjustment. and to
decrease any slack within the tissues.
Inst ruct the patient to rotate head to look over their shoulder of the affected side.
• This will remove any remaining tissue slack.
As the patient is turning their shoulders and head. the doctor must follow the patient
around as he/she is turning.
•
• This will maintain a proper contact and line of drive for the thrust.
Thrust quickly, using legs and hips behind the thrust to add any force that is needed.
6. R heck the legs and continue on to the next area of subluxation.
Although thi adjustment does not use a drop piece, Clay Thompson used it regularly and
effecti ely by empha izing proper doctor and patient positioning. Due to Clay Thompson's small
tature, he demonstrated that size has very little influence on the effectiveness of this adjustment.
• The doctor must note that in the seated lumbar adjustment, proper positioning and speed
of thru t are the key components to an optimal correction.
The P-A thru t corrects for the posteriority, and the unilateral contact will correct for the
rotation.
The doctor should note that if a patient presents with a Derefield Positive (short to long) rather
than a Derefield Negative (short to short), then the biomechanics of the lumbar spine will be
altered. In the case of a D+, the doctor will perform an Arm Fossa Test, and proceed to correct
for the subluxated PI ilium. If the patient's leg continues to pull short following the adjustment,
the doctor will again continue to the lumbar spine. However, the subluxation pattern for the
lumbar spine will differ:
• In this situation, L5 will continue to subluxate posterior, however, spinous rotation will
be away from the contracted leg. (Remember that when a patient began with a D-, the L5
spinous rotation was toward the contracted leg side)
• The PI ilium subluxates the lumbar vertebrae via the ilio-lumbar ligament, which attache
from the iliac crest to the anterior aspect of the lumbar TVP. Therefore, as the ilium shift
PI, its attachments to the ilio-lumbar ligament forces L5 to shift posterior and rotate.
• The doctor must remember that this situation occurs in the minority of cases wherea
lumbar subluxations due to an AI sacrum is the majority.
Sample Case:
A 25 year old engineer presents to the clinjc with low back pain and stiffness. He mentions that sitting for long
periods of time aggravates the problem. Following a complete examination, Thompson Analysis re eal a hort
left leg in extension and a short left leg in flexion. The doctor will assess if a Cervical Syndrome is present and
correct it if neces ary. The short to short leg length analysis points to a D-, o the doctor checks if pecific tender
points are pre ent. In trus case, the patient had a tender point, and therefore, the D- subluxation wa corrected.
Howe er, the patient's left leg continue to pull short following the correction of the primary areas of
ubluxation. Now the doctor moves to the lumbar pine. The patient's LS ha subluxated po terior with pinou
rotation to the hort leg side(Jeft). The doctor places the patient in a seated po ition, contacts the right LS
mammary proce s thru ting P-A. The doctor recheck the leg and moves on.
Dr. John Minardi 83 Copyright JOO'

L JBAR P (L
plit-Leg Correction
lb !urn ar pin plit-Leg odification djustment was created as an alternative for doctors or
ri n that prefer the ide po ture adjusting po ition. However, the e indi idual aJ o prefer to
- the drop pie me hanisrn to their ad antage.
I. Th le'"' length analy i for the lumbar subluxation is extremely imilar to that of a D-.
The patient \\ ·11 present with a contracted leg in e ten ion. In flexion, the contracted leg
balan e or tay hort.
Greater than 90% of the time a lumbar ubluxation is econdary to an original D- which
i th reason that the leg length analy is is identical. When thi is the ca e the do tor
would initiall correct for the ubluxated D- a discussed pre iously then continue to
correct the lumbar ubluxation.
. The on1 exception to the tatement abo e i if the lumbar subluxation occurred, or remained
independent of a D-. When thi i the ca e the doctor will encounter the short to short leg length
pbenom na de cribed pre iou ly howe er no tender points will be present.
La k of tender point rule out a D- acrurn subluxation and points to a lumbar
ubluxation. In thi ca e the doctor would not adjust the sacrum, but would rather mo e
dire tly to the lumbar pine.
3. Static palpation re eal pinou de iation ip iJateral to the AI acrurn original short leg side .
Palpation will al o re eal erector pinae tonicity aberrant lumbar interspinous spacing as
well as localized edema in chronic ca e .
4. Motion palpation of the lumber pine re eal a lack of proper joint mo ernent further
confirming the pre ence of the lumbar ubluxation.
-. Biomechanics and subluxation pattern are the ame as de cribed pre ·ousl .
6. Correction: Lumbar Split Leg Adju tment: See Figure 12 & 129
Patient: Side posture with the in ol ed ide down. Top leg traigbt and draping
off of the table.
Table: Lumbar piece in the ready po ition.
Contact: Pisifonn or Finger Tip on the mamillary proc
Stabilization: Elbow of patient.
LOC: P-A. Repeat 3 time .
. Recheck the leg and mo e on.
For the adju tment to be mo t effecti e the doctor mu t thru t through the contact u ing a light
body drop to initiate the drop piece mechani m.
The P-A thru t correct for the po teriority and the unilateral contact will correct for the
rotation.
Both of the e are aided by the drop piece which will increase the peed of the
adju tment.
Dr. Joh n Minardi IU Copyright 2008

Figure 128 Lumbar Split Leg Correction. Finger Pad Contact on the
Contralateral Mamillary Process.
If the doctor does not have access to a drop table, then he/she should perform the seated
adjustment described earlier.
It is important for the doctor to note that a side posture "lumbar pull" adjustment will only
correct for the rotational component of the subluxation, not for the posteriority. Therefore a
"lumbar pull" should not be performed for this subluxation.
If a side posture manual adjustment is preferred over the seated adjustment then the
doctor must use a "lumbar push" adjustment, contacting the mamillary process
contralateral to spinous deviation.
• This will correct for the rotation and posteriority of the subluxation.
Sample Case:
A 25 year old engineer presents to the clinic with low back pain and stiffness. He mentions that sitting for long
periods of time aggravates the problem. Following a complete examination Thompson Analysis re eats a hort
left leg in extension and a short left leg in flexion. The doctor will assess if a Cervical Syndrome is present and
correct it if necessary. The short to short leg length analysis points to a D- so the doctor checks if specific tender
points are present. In this case, no tender points are present. Therefore, the sacrum is not subluxated and the
doctor must now move to the lumbar spine. The patient's L5 has subluxated posterior with spinous rotation to th
short leg side(left). The doctor places the patient in a side posture split leg position, lesion side down. The doctor
contacts the L5 contralateral marnillary process and thrusts P-A. The doctor rechecks the leg and moves on to th
Dr. John Minardi 85

Ll'!\18 R Pl�E (L. )
Prone Correction
Th Prone '-orr "ltlOn 1s one of the mo t imple and effecti\ e adjustments for the lumbar pme
Ho, \er. there i · no manual altemati, e to this exact adju tment, a drop table mu t be u ed.
I Leg length anal) i . palpatory finding , and biomechanic are the ame a di cu ed
pr , 1ou I) m the Seated and Split Leg Lumbar Adjustment
-· orr tion: Prone Adju tment: ( ee Figure 130& 131)

Doctor: ide of table, contralateral ide of pmou rotation.
P tient: Prone.
Table: Lumbar piece in the ready po 1t1on.
Contact: Pisiform contact on lateral a pect of SP on involved side.
tabilization: Reinforce contact hand
LOC: L-M, P-A to initiate the drop.
The doctor mu t be certain to time the thru t and body drop simultaneously in order to execute a
cri p and effe ti, e adju tment. The thru t will correct for the rotational component. and the P-A
direction of the drop piece'> ill correct for the po teriority of the ubluxation.
ri nt 130 Lumb.lr Prone (orrcu1on P1 1fonn lloo!...mg on Lateral

l\�tof�p nou Pr .:, on the lmolH:d u.Je
3. Re heck the leg and continue on to the ne t area f ublu ·ati n.
Dr John Minardi 86 Copyrlght2006

LUMBAR SPINE (LS)
H peractive Psoas
In ertain ituations a lumbar ubluxation may be due to cause other than a pelvic subluxation.
In some in tance a hyperacti e p oas mu cle can cause the ertebra to subluxate. However, in
thi in tance the primary concern is not the mi placed vertebra but rather the caus e of this
mi placem nt· the hyperacti e p oa . In the past this technique has been referred to as an
adju tment to the p oa muscle. Howe er as the description will demonstrate the corrective
for e i impl a quick tretch into the musculature and not an adjustment.
1. Patient present with short leg in extension and remains short or balances in flexion .
. Either the original AI sacrum has been cleared and a short leg persists, or no tender points
ere elicited.
3. At this point the doctor may consider a Hyperactive Psoas as the possible cause of the lumbar
ubluxation. Howe er the doctor must always remember that a lumbar subluxation usually
occurs due to an original AI sacrum (D-), which must always be ruled out first.
4. Once the sacral origin is ruled out, the doctor can consider a hyperactive psoas, provided that
the following clinical signs are present.
• Toeing out of the patient's foot ipsilateral to the short leg.
• Patient complains of groin pain ipsilateral to the short leg.
Leg length analysis is consistent with a lumbar subluxation (short leg in extension which
continues to stay short in flexion).
The doctor will detect a reflex point at the medial aspect of the great toe ipsilateral to the
short leg.
5. Anatomy and Biomechanics of the Psoas.
Figure 132 displays how the Psoas muscle

originates at the posterior aspect of the
lesser trochanter, and attaches to the T l2-L5
TVPs and vertebral bodies. Therefore, contraction
of this muscle results in external rotation of
the leg (toeing out).
lliopsoas image i Copyright 2003-2004 University of Washington. All rights re erv d including all
photographs and images. o re-use. re-distribution or commercial use without prior wrinen permi ion
of th author and the niversity of Washington.
6. Correction: Hyperactive Psoas Correction. (See Figures 133& 134) Figure 132 (hop
Mus le.
Patient: Supine.
Doctor: On affected side facing cephalad.
Contact: Knife-edge in Psoas muscle belly.
Stabilization: Anatomical snuff box of contact hand.
LOC: A-P. Repeat 3 times.
Dr. John Minardi 87

Fig ure 133 Hyperactive Psoas Correction. Knife-Edge Contact On
p50a Muscle.
lmmediately following the correction, the doctor must re-place the patient in the prone position
and recheck the leg lengths.
If the patient's legs are in balance, then the psoas is indeed the proble� and the doctor
must implement a stretching or soft tissue program for the patient.
This correction is not a permanent solution, but rather a confirmation of the problem.
It is clinically important for the doctor to note that many of the clinical findings found in the
hyperactive psoas are similar to those found with an IN ilium ( explained in a later section).
This reinforces the importance of the doctor confirming that all clinical findings
associated with the hyperactive psoas are present. Furthermore it stresses the importance
of having both clinical and x-ray findings to diagnose an IN ilium.
The doctor must always remember that all findings must be incorporated to ensure that
the appropriate problem has been detected and corrected.
Sample Case:
A 32 year old female sprinter present to the clinic with low back pain and groin stiffness. Following a complete
examination, Thompson Analysis reveals a short right leg in extension and a short right leg in flexion. The doctor
also observes that the patient toes out on her right side. The doctor will assess if a Cervical Syndrome i present
and correct it if necessary. The short to short leg length analysis point to a D- so the doctor checks if pecific
tender points are present. In this case, no tender points are present. Therefore, the sacrum is not subluxated and
the doctor must now move to the lumbar spine. Due to the patient s presenting symptoms the doctor mu t rule
out if a hyperactive psoas is involved. The doctor then palpates for a reflex tender point on the medial a pect of
the patient's right great toe. In this case the great toe refle point is tender, confirming the pre en e of a
hyperactive psoas. The doctor contacts the psoas muscle belly and thrust P-A. sending a quick tretch into the
muscle. The patient is re-placed in the prone position, and the leg lengths are re-checked immediately. The
correction has balanced the legs, confirming that a hyperacti e p oas \ as indeed the problem. The doctor will
de elop a soft tissue and stretching program for the patient's hyperacti e psoas. The doctor will re- heck the legs
and mo es on to the next area of problem.
Dr. John Min

ardi 88 Copyright 2006
LUMBAR SPINE (L )
Acute Low Back- LS SI Distraction Adjustment
The L5-S l Distraction adjustment was created to correct for a completely differen t ubluxation
pattern that occurs in the lumbar spine. In this situation the lumbar spine no longer subluxate
posteriorly with rotation as discussed previously. In this situation L5 subluxates poste rior and
inferior causing a jamming of the articular facets of L5 and S1. In order for the doctor to detect
this problem, the following must take place:
1. The patient presents to the office with an antalgic gait, more specifically, the patien t's gait
be flexed forward, and has no tendency to favour one side or the other. The pain is centr ally
located and is easily reproduced with extension of the lower back (straightening his/her posture).
2. Both static and motion palpation of the lumbosacral area reproduces the pain. The only
position that offers any relief to the patient is the antalgic flexed position.
3. Leg length analysis is often unable to be performed on patients with this subluxation, as
flexion of the legs increases the patient's pain. In less acute patients, the leg length analysis will
demonstrate the typical short to short, or short to balanced phenomena found in lumbar
subluxations discussed previously. However, because the majority of these cases will be acute,
the doctor must rely on palpation findings and the clinical appearance of the patient.
4. Biomechanics of the subluxation. Figure 135 demonstrates that L5 has subluxated posterior
and inferior (arrow), causing the sacrum to nutate as a compensation. This position results inan
increased lumbar lordosis, which in turn causes an increased irritation of the coronally orientated
L5-S1 facets. The orientation of these facets explains why flexing the legs causes an increase in
the patient's pain. As the doctor flexes the patient's legs, the lumbar lordosis will increase
thereby exacerbating the problem.
Post. Ant.
L5
PI Sacrum
Figure 135 L5 subluxating PI, jamming the facets and causing intense
pain.
5. Correction: L5 SI Distraction Adjustment: (See Figures 136 &137) ..

Patient: Prone. Raise the lumbar & pelvic pieces to assume a passive antalgic pos1bon.
Contact I : Knife-edge on the inferior aspect of LS spinous process.
nta t 2 : Palmar contact on 3.
onta t I: P-A ( light and I- S. Repeat 3 time
Contact 2: P-A. Repeat 3 times.
Figure 136 L -- I Di traction Correction. Knife-edge Contact on

Inferior Aspect of L5 Spinous Proces . Palmar Contact on 53.
Figure 137 L5-S I Distraction Correction Doctor Po irion. 'ote

How Both Lumbar and Pel\-ic Pieces are Ele,-ated to
Antalgic Po ition Prior to Setting the Drop Mechani m.
Clinically the doctor should note that any manual side posture adjusting is not recommended
with these patients initially.
• However, if manual adjusting is the doctor's only option then a ide posture lumbar
push adjustment must be performed bilaterally on the mamillary processe of L5
followed by a counter-nutation adjustment on the sacrum.
• The bilateral lumbar push will correct for the PI lumbar segment and the counter
nutation adjustment will correct for the compensating nutated sacrum.
Sample Case:
A 37 year old male magazine editor presents to the clinic with an antalgic gait and severe low back pain. He
mentions that the pain started after sleeping on a "pull out" bed in " hich the upport bar protruded into hi Jo
back for the majority of the night. The patient cannot stand straight, and need as i tance to mo e fr m r om to
room. Following a complete examination, Thompson Anal si reveal a hort right leg in e ten ion. and a hort
leg inflexion. However flexing the leg cannot be performed fully, becau e it aggra ate the patient' pain to the
point where he cream out loud. Leg length analy is combined with the patient' ymptoms point to an L5- I
exten ion ubluxation. The doctor po ition the table to a ume the antalgic p sture, and take a knife- dge
contact inferior to the pinou of L5, and a palmer contact at S3. Tb d ctor thru t P-A and I- at L5 to c rrect
for the po terior-inferior L5 ubluxation, and P-A on the acrum to corre t th ompen ating count r-nutation.
The doctor rechecks the leg and mo e on.
90 Copyrlght2006
LUMBAR PINE (L ) - POND OLI THE I
Classic Correction
\J ntinu t r al ublu ation patt rn within the lumbar spine there are certain
nditi n th t i t in \ hi h ancillary mo ha e also been incorporated into the technique fi
or
th itu ti n . The are n t ubluxation patterns per se but rather pre-existing
nditi n that ar pr nt \J ithin th pati nt. One such ituation i a per on suffering from pain
iat d ith a p nd loli th i . pondyloli thesi i defined as a displac ement of a
rt bral b d u u 11 ant rior in r lation to the segment immediately inferior. 1 This is usually
iat d , ith a d ti t at th pars interarticularis of the involved segment. According to
ilt I th r ar fi cla ification to which the spondylolisthesis may originate from:
T I: Di pla tic - a congenital abnormality allowing displacement to occur.
T II: I tluni a a tre fracture at the pars b) elongation of the pars, c) acute fracture of the
par .
T III: Degen rati e - u ually secondary due to long standing degenerative arthritis.
Typ IV: Traumatic - a fracture along the neural arch other than the pars.
Typ : Pathological - associated with bone disease - metastasis, Paget's, etc...
Mey rding has graded the degree of spondylolisthesis by dividing the sacral base into
four qual quadrant and determining which of the quadrants the posterior aspect of the
displaced ertebrae ends up. For example, a grade 1 spondylolisthesis represents that the
po terior a pect of the displaced vertebral body rests between the posterior aspect of the sacrum
and the first of the four divisions. If it is a grade 2, it will rest in the second of the four divisions
etc ... 1 In order for the doctor to treat a spondylolisthesis the following must occur:
1. Clinical Analysis: The presence of a lumbar subluxation with symptomology of belt-like pain
around the flanks. On occasion, this problem will also present with tingling or numbness down
both legs.
2. X-ray Analysis and Myerding scale: (See Figures 138&139) A-P lateral and oblique lumbar
radiographs will show an interruption of the Pars Interarticularis resulting in anterior slippage of
the vertebrae.
p A
<P@]�
Sacrum
Figure 138 Grade 2 Spondyloli thesi
The diagram and x-ray in Figure 138 and 139 demon trate a Grade 2 Spondyloli the i of L5.
the ertebral body fall in cond quarter of the sacral ba e.
Dr. John Minardi 91

ham
Th r ar rt tn alteration in the biome hani that may predi p e a ertebra to
. and n th lippage ur , further biom chani al change may develop due to the
of th tnJUI). urrent r ear h indicate that indi idua1 ho have bilateral gittal
ri nt d fa t JOtnt angle ar twenty-ti e time more likel to ha e a degenerative
ndyloh the 1 .� rudi al o demon trate that a maller Jumbo acral d. c angle and an
d ral kypho i are ignificantl a ociated with an in rea ed lippage. 3· ..s. On e
lip a ur , the biome hanical alteration in the egment cau e an incre ed lumbar
I rdo i , a de r a ed lumbar range of motion and e ere pathologic alterations within the
bilizi ng mu cularure. · · 1 The e biomechanical change cau e se eral of the ymptoms
ri n d b patient with a pond Ioli the i . The increa ed lumbar lordo i and abnormal
ori ntation of the articular facet cau e an increa ed tre on tho e tructure re ulting in
inflammation, irritation and localized pain. Furthermore lumbar teno i e ondary to disc
d n ration often r ult . being re pon ible for the patient' ymptorns of intermittent
n urogeni laudication. Thu , thi complex can account for the low back pain and po terior leg
par th ia e perienced b patients v ith a pondyloU the i . 9• Furthermore the tabilizing and
10
po tural mu le are ultimate! o er- trained leading to pain, tiffne s and overall fatigue.
3. Th re are two criteria that mu t be met before the doctor correct for a spondylolisthe i .
The patient mu t be yrnptomatic.
The pond Ioli the i mu t be either a Grade l or Grade 2 nothing higher.
4. There are man contraindication to performing thi adju tment and if an of the follo\1 ing
are pre ent. the doctor hould not perform thi correction.
Grade 3, 4, or 5 pondylolisthe i on the Me erding cale.
Abdominal aortic aneuri m.
Pregnanc .
Meta tatic carcinoma.
Asymptomatic patient.
In many case , a spondyloli thesi i an incidental finding di covered on -ra and i not the
cause of the patient's problem. The research currently sugge t that an anter Ii the i of 3mm or
more in the lower lumbar spine i relati ely common among elderl \ men. but is not correlated
with pain or impaired function. 15 Therefore, it i e ential that both x-ra and clinical symptoms
are pre ent before performing thi adju tment.
5. Correction: Classic Thomp on Spondyloli the i Adju tment: See Figure 140&141)
Patient: Supine. Leg can be bent to 90 degre or remain in the extended position.
Doctor: Either ide of the table. Epi-Sternal n tch i at the patient' midline.
Table: Lumbar and Pel ic piece are et to ready position. 440 table: attach sacral
blocker).
Contact: Bilateral thenar pads at the level of in ol ement on the abdomen.
LOC: Small impulse A-P. NOT a deep thrust! Repeat 3 times.
A a clinical notation be sure that the patient's bladder is empty before e ecuting this
ad ju tmeat.
Th e literature support and encourages chiropractic care in the treatment of a patient with a
spondyloli thesi , howe er most of this research focuses on stretches and e ercise that the
patient can perform. 16,
11
•
The e method are beneficial however can be more effecti e if done following an
adju tment which restores the proper neurology and biomechanics of the affected
Dr. John Mln1rdl
92 Copyright 2006
tructure.
• The Thomp on clas ic spondylolisthesis adjustment provides this necessary restoration.
allowing optimal healing to take place.
• It is e ential for the doctor to note that a deep thrust is not given to the abdomen.
Altemati ely, the doctor hould gradually increase pre sure on the abdomen and provide
a small impuls to initiate the drop piece.
Figure 140 pondyloli thesis Classic Correction. Bilateral Thenar Figure 141 Spondylolisthe is Classic Correction Doctor Po ition
Contacts on Abdomen at Affected Level. ote how the Doctor's Sternum is MidJine.
6. Following the adjustments, the patient is then re-placed in the prone position and the leg
lengths are re-checked for a balanced or even state.
LUMBAR SPINE (LS) - SPONDYLOLISTHESIS

Modified Institutional Method
The Modified Institutional Adjustment was created as an alternati e to the classic

spondylolisthesis adjustment. It is important for the doctor to note that although this method
increases the amount of distraction throughout the lumbar spine during the adjustment, it also
compromises a certain degree of specificity in the process.
1. Clinical analysis, X-ray analysis, Criteria and Contra-indications are the same as previous
described.
2. Correction: Modified Institutional Method Adjustment: (See Figure 142)

Patient: Supine with both hips and knees flexed over the abdomen.
Doctor: Either side, Epi-stemal notch is at the patient's midline.
Table: Lumbar and Pelvic pieces are set to ready position. (440 table: attach sacral
blocker)
Contact: Both hands cupping legs inferior to the patella.
LOC: A-P,1hrough the involved vertebra. Repeat 3 times.
The doctor must flex the patient's knees over the abdomen until either a point of tension is
reached, or when the patient's ischial tuberosities begin to lose contact with the table pad. To
ensure a stable and effective adjustment, always maintain complete contact of the patient s peh 1
on the table pad.
Dr. John Minardi 93

. Rh the I g and mo\ e on.
Sample Case
An O year old female presented to the clinic, ith lo\ back pain and numbness down the po terior aspe t of both
legs. The numbnes , a so evere, that the patient could not walk for more than three minute without topping to
it and re t. Once she began \J alking again, the pain and di comfort returned. Following a thorough Hi tory and
Physical Examination, Thompson leg length analysis demon trated a contracted ( hort) right leg in e ten ion,
followed by a hort right leg in the flexed position. Spinal x-rays \ ere taken to rule out pathology, and
demonstrated a grade 2 degenerati e pondyloli thesis at L3 and L4. 1n our case, the patient met the indi arion
required, and did not fall within any of the contraindications mentioned therefore the Thompson
spondyloli thesi adjustment is required and encouraged. The doctor must alway remember that the lumbar pine
denote a econdary area of problem, and henceforth, the primary areas of the pine must b che ked and cleared
of any subluxation before the lumbar area is dealt with. A mentioned pre iou 1 . the pati nt pre nted \J ith a
short right leg in exten ion and a hort right leg in fle ion. ln thi particular ca e. our patient had a right cervical
syndrome which wa corrected first. The short to hort leg length anaJy i usuall indi ate that the problem is a
Negative Derefield (D-), However, one of fi e trigger points mu t be elicited to confirm the D-. ln thi situation,
no trigger point were elicited, which hift our attention to the lumbar pine. Symptoms and x-ra anaJy i
confirm a pondylolisthe is at L3 and L4. The doctor perform the Thomp on pond Ioli the i adjustment by
having a bilateral thenar contact on the anterior a pect of the abdomen, at the level of the le ion. The doctor then
provide a mall A-P impul e to initiate the drop piece. The doctor then rechecks the legs and mo es on.
Dr. John Minardi

Copyright2006
ECT10 IX:
TERTIARY AREA: THORACIC
Thoracic Spine
Pottinger s Saucer
Clas ic Supine Adjustment
Modified Prone Adju tment
Lateral Listhesis
Cla ic Thompson Prone Adjustment
Dorso-Cervical Thumb Pull

Dorso-Cervical Thumb Push

Modified Cross Bilateral

Leg Length Analysis in the Flexed Position Review Chart
Dr. John Minardi

9S
THORACIC Pl E (T )
Pottinger' Saucer - upine Correction
The thora 1 pine is the tertiary area of subluxation, and will only be addres ed if the patient
ntinue to have unbalanced legs following the correction of all primary and ecoodary
bluxation . If the patient has balanced legs following correction of the primary and secondary
areas. then the practitioner will not adjust the thoracic area regardless of the area of pain.
For example, if a patient complains of mid back pain, and throughout your examination
)OU find ubluxation in the primary areas of problem which are then corrected and
balance the patient' leg , then no further adjustments will be given.

Even though the doctor did not adjust the area of complain the patient's legs were in a
balanced tate, indicating that thi area wa not the root cause of the problem.
In order for the doctor to accurately detect and correct for subluxations in the thoracic spine the
following mu t occur:
I. The patient's hort leg per i t following correction of primary and econdary ubluxation
areas.
-· The doctor now mo e on to the thoracic spine analysis.
3. Doctor palpate the dor al pinou proce e and detects a concavity within the intra- pinous
pace . Directly inferior the concavity, further palpation re eal that t\J o pinous proce e are
approximated ( pinous kis ing). The conca ity that i palpated is referred to as a Pottinger·
Saucer, and i created by a po terior-inferior ubluxation of a thoracic egment. ee Figure 143
figure 143 Pottinger' au er.
Figure 143 demon rrate how the affe ted thoracic egment has ubluxated p teri r and inferior (thick bla k arr w).
\\hicb au e a onca ity referred to as a P ttinger' aucer (gre y arrow ). The ublu ation al o produce spinous
kis ing dire tly inferior to the oncavity (thin black arro ).
4. orrection: upine r eated Correction: ee Figure 144& 145

Patient: eated or upine with arm ro ed and hand on h ulder .
Do tor: ither ide.
Table: Dor al, Lumbar, or Both are et to ready po ition depending on affected area.
ontact: D r al bl cker or Thenar contact i placed inferior to affected pinou proce
ta ilization: Do tor' ann reache ar und patient, or aero patient's folded arm .
L : P-A while tracti ning down on elbow to implement a much flex.ion a po ible.

5. R he k th leg and mo on to the next subluxation.
Th thru t ill corr t the inferiority of the subluxation, and the drop will correct for th
p teriority.
Th d tor mu t note that clinically this adjustment can be performed as a manual ant rior
thoracic adju tment taught at most chiropractic colleges.
Hm e er, if the doctor choo es to perform the manual anterior adju tment he/ he mu t
be ure to induce a great deal of flexion within the patient by flexing the patient knee ,
a w 11 a flexing the head and neck.
If in ufficient flexion is induced then the doctor will keep the thoracic pine in an
xtended po ition, which will aggra ate the existing condition.
THORACIC SPINE (TS)

Pottinger's Saucer - Modified Prone Adjustment
Thi modification a de eloped as an alternative to the pre iou adju tment for a Pottinger's
auc r. The ad antage to thi modification i that the doctor can keep the patient in the prone
po ition, whjle continuing to be biomechanically sound in the execution of the adju trnent.
I. The ubluxation analysi and biomechanjcs of the subluxation are the ame a de cribed
pre iou ly.
2. The doctor prefers to preform the Pottinger's Saucer correction with the pa6 nt in a prone
po ition.
3. orrection: Modified Prone Adju tment: (See Figures 146& 147)

Patient: Prone.
Doctor: ither ide of table.
Table: Dor al, Lumbar or Both are et to ready po ition dep nding n affe t d area.
ontact: Knife-edge inferior to ffected spinous pro e
LO : P-A I- .
Dr. John Minardi 97 Copyrlght20IJI

nd -omm e to n xt - blu at1on.
Th thrust will correct the inferiority of the subluxation, and the drop \\-ill correct for the
po eriority.
It i more effective to induce the flexion required to preform this adjustment when the do tor
use the knife-edge contact. \Vhen performing tbi modification the doctor must remember to:
Alway take up tissue slack from t\ o segment below the affe ted area. Thi \\-ill make
the contact more comfortable for the patient. and ensure that the conta t i inferior to the
prnous proce of the ub luxated segment.
Roll the knife-edge contact into the affected egment imilar to rolling into the onta t of
the C -Tl Extension Adjustment, explained in the c rvical e ti n. Thi- \\ill ensur a
firm contact and significantly reduce the chan e of lippage.
Dr. John Minardi 98 CooYJiabl 200li

THORACIC SPINE (TS)
Lateral Listhesis
The Lateral Li thesis adju tment i preformed when the doctor discovers that an entire thoracic
egment ha sublu ated laterally. Palpation alone cannot fully differentiate whether the segment
ha ubluxat d laterally r simply in rotation. Therefore, the doctor must utilize both palpatory
and x-ray findings to d tect and ultimately correct the thoracic Lateral Listhesis subluxation. As
with all ublu ation within the thoracic spine, this would only be detected and corrected if the
pati nt leg ontinued to pull short following corrections in the primary and secondary ar eas. To
accurately detect and correct for a Lateral Listhesis subluxation, the following must occur:
1. Short leg p r i t following correction of primary and secondary subluxation areas.
2. Doctor nov moves on to thoracic spine analysis.
3. Doctor palpation along the thoracic spinous processes reveals noticeable lateral deviation of a
thoracic egment. This deviation could indicate a rotational subluxation or a lateral listhesis.
4. To assist in the differentiation between a rotational subluxlation and a lateral listhesis, the
doctor mu t correlate clinical symptoms and x-ray findings associated with the lateral listhesis.
Clinically, the doctor will palpate painful and taut musculature contralateral to the spinous
deviation. Also, the doctor will palpate a muscle bulge ipsilateral to the spinous deviation,
howe er, the muscle bulge is not painful. (See Figure 148)
5. X-ray analysis will demonstrate a break in the spinous process line, as well as a break in the
vertebral body lines, verifying the lateral listhesis. (See Figure 148)
Lateral Listhesis
Figure 148 displays the clinical and x-ray findings

associated with a lateral listhesis. Note the tense mu cles
contralateral to the deviation (solid grey lines), and the
bulking of muscle ipsilateral to the deviation ( curv ed
grey lines). Also note how both spinous lines and
vertebral body lines are broken on x-ray analysis
(deviation from all three vertical dashed lines).
Figure 148 TS LateraJ Listhesis.

Superior Vi w
6. Once both clinical and x-ray findings confirm the lateral listhesis,
the doctor must realize that the subluxated vertebra has actually shifted
in two directions. It has subluxated laterally and due to the orientation
of the thoracic facets, the segment must also ubluxate posterior.
See Figure 149 black arrow ).
le.
Figure 149 TS Facet Ang
Dr. John Minardi 99

·t1 n at ·ral L1 th 1 Pull: ( Figur 151
P t1 nt: Pr n
D ·t r: ontral t ral t pin de\iation.
T bl : D r I. Lumbar. r 8 th ar et to ready po ition depending on affe ted area.
C n t: Pi 1form on I teral p t of pinou pr
tabilizauon: Int rl k tinge ofcontact hand
LOC: Lat rally into ide ft ndeme and lightly P- to initiate the dr p p1 ce .
. R h k Le.... - and ontinu to ne t ublu ation.
The lateral thru t will correct for the laterality and the drop will corre t for the po teriority of
the ubluxation.
E ential ote :
It i important for the doctor to take a large ti ue pull into the affe ted egm nt prior to
making the contact. Thi will pro ide more comfort to the p ti nt.
The thru t mu t be performed quickly and ne d to follow th nt urs ofthe patient
rib-cage to prevent accidental injury.
the prob! m.
on.

THORACIC SPINE (TS)
Dorso-Cervical Thumb Pull
The Dorsal-Cerv ical Thumb Pull was created to correct for rotational subluxations occurring
within the thoracic spine primarily from T l -T4. For rotational subluxations occurring fromT5-
Tl2 it is recommended that the doctor utilize the Modified Cross Bilateral Thoracic adjustment
de cribed later in this section. As mentioned previously, all primary and secondary areas of
subluxation must be corrected prior to the thoracic area. To accurately detect and correct forthi
thoracic subluxation, the following must occur:
l. Leg length analysis demonstrates that a short leg persists following correction of primary and
secondary areas of subluxation.
2. Doctor continues to the thoracic spine for palpatory analysis.
3. Static and motion palpation reveals a spinous deviation of the upper thoracic segments.
4. The doctor must confirm the presence of a rotational subluxation and rule out a Lateral
Listhesis subluxation. (See Figures 152 & 153)
• Rotational subluxation: The doctor will palpate muscle tension bilateral to the deviated
spinous process. Also, no muscle bulking will be present.
• Reminder: Lateral Listhesis only has muscle tension opposite to the side of spinous
deviation, in addition to non painful muscle bulking ipsilateral to the deviation.
• In x-ray analysis, a rotational subluxation demonstrates a break only in the spinous line,
whereas, a Lateral Listhesis disrupts the spinous line as well as the vertebral body lines in
the A-P view.
Nonna) Rotated Segment T I-T4

I I I I I
I I I
I
I I I I I
I I I
I I I I
I I I I
Figure 152 Nonna! TS Findings. Figure 153 TS Rotational Subluxatioo F�.
Figures 152 and 153 display the clinical and x-ray findings associated with a rotational subluxation. Note the tcme
muscles bilateral to the deviation (solid grey lines), and the absence of muscle bulking. Also note bow only the
spinous line is disrupted on x-ray analysis (deviation of central dashed line).
5. The doctor must always be mindful that if Tl is the vertebrae involved, an Over coiopemated
Cervical Syndrome (explained in detail in the cervical section) must also be ruled out.
n, _ lnhn lllnJ>rnl
rr c11on: D o-Cen i al Thumb Pull Adju tment: See Figure
154_ 156
t,.
n .
Pat1ent: P ro
of the table.
O ror: H ad . .
o al and en·1cal piece LD the ready po ition.
Table: D
pad o high tran erse
Canta t: Th umb _ � proces .
tabilize: O ppo ne panetal bone or zygo matic arch.
LOC: P-A.
The diagram in Figure 154 represents a rotated thoracic

segment from Tl-T4 (black arrow). The figure displays
the contact for the dorsal-cervical thumb pull. Note how
the thumb pad contact is on the contralateral TVP of the
rotated segment. (dashed grey arrow).
Rotation
Figure 154 Dorsal Cervical Thumb Pull
ContaCL
The unilateral contact, and the P-A line of drive corrects for the rotational subluxation. The
doctor must take a large tissue pull from three or four segments below the desired segment to
reduce the probability of slipping off of the contact. When perfonned correctly this a very
comfortable adjustment for upper thoracic area.
Finr, I SS Dorsal
CMcal Thumb Pull Correction. Thumb Pad Figure I 56 DorsaJ-Cervical Thumb Pull Doctor P
Coiiract 00 High Transverse Proc
102
THORACIC PINE (TS)
Dor o-Cenical Thumb Push
The Dorsal-Cervical Thumb Pu h \ a created to correct for rotational subluxations occurring

within the thoracic pine, primarily from T 1-T4 as a modification to the dorsal-cervical thumb
pull adju tment de crib d pre iou l . For rotational subluxations occurring from T5-Tl2 it is
recommended that the doctor utilize the Modified Cross Bilateral Thoracic adjustment de cribed
later in thi ection. A mentioned pre iously, all primary and secondary areas of ubluxation
mu t be corre ted prior to the thoracic area. To accurately detect and correct for this thoracic
ubluxation the following must occur:
1. Leg length analy is demonstrates that a short leg persists following correction of primary and
econdary areas of subluxation.
2. Doctor continues to the thoracic spine for palpatory analysis.
3. Static and motion palpation reveals a spinous deviation of the upper thoracic segments.
4. The doctor must confirm the presence of a rotational subluxation and rule out a Lateral
Listhesi ubluxation. (See Figures 157 & 158)
• Rotational subluxation: the doctor will palpate muscle tension bilateral to the deviated
spinous process Also, no muscle bulking will be present.
• Reminder: Lateral Listhesis only has muscle tension opposite to the side of spinous
deviation, in addition to non painful muscle bulking ipsilateral to the deviation.
• In x-ray analysis, a rotational subluxation demonstrates a break only in the spinous line,
whereas, a Lateral Listhesis disrupts the spinous line as well as the ertebral body lines in
the A-P view.
Normal Rotated S gm nt T 1-T4

I
I I I I
I I
I I I I
I
I I
Figure 157 TS ormal Finding . Figure 158 TS Rotational ublwcation Findings.
Figures 157 and 158 display the clinical and x-ray findings as ociated with a rotational ubluxation. ote the tens
muscles bilateral to the deviation (solid grey line ), and the ab ence of mu cle bulking. Al o not how only th
spinous line is disrupted on x-ray analysis (deviation of central dashed line).
5. The doctor must alway be mindful that if Tl is the ertebrae involved, an Over Compen ated
Cerv ical Syndrome (OCCS) must al o be ruled out. (Explained in detail in the cervical ection).
Dr. John Minardi 103

ti ,11 l)l,r l -( t.:J"\ 1 humb Pu h Adju tment: ee Figure 159-161
PJtl nt Prone.
·wr He d f the tab I .
T ble. Dor I and el"\ i al piece in the ready po it ion.
ont t: Th umb pad on lateral a pect of the rotated pinou proce .
tabilize: ppo ite parietal bone or zygomatic arch.
L : Lateral with light P- from the tabilization hand to initiate the drop piece.
The diagram in Figure 159 represents a rotated thoracic egment

from T 1-T 4 (black arrow). The figure displays the contact for
the dor al-cervical thumb pu h. Note the thumb pad contact is on
the ip ilateral a pect of the rotated segment's spinous process.
(da hed grey arrow).
Rotation
Figur 1-9 Dorsal Cen I al Thumb
Pull Canta t.
The unilateral contact and the P-A line of dri e corrects for the rotational subluxation. The
do tor mu t note that lateral flexion and rotation of the cervical spine is required to lock out the
affected joint in the upper thoracic spine. Ju t a in the thumb pull adjustment the lateral flexion
and rotation i toward the contact ide. Howe er with the thumb pu h adjustment the doctor
will be thru ting lateral with the drop wherea the thumb pull will be P-A with the drop.
ample Cas e:
A 30 year old female ecretary pre ent to the clinic with back pain and o ca ional beada he . She mentions that ining in
front of the computer for long periods of time aggra ate the problem. Following a complete examination, Thomp on Analy i
re\ a hon left I g in e ten ion and a hort left leg in flexion. Tb doctor will a e if a Cervical Syndrom i pre ent and
correct it if nece sary. The hon to hort leg length analy i points to a D- so the doctor cbe k if pecilic t nder poinrs are
pr nt. In thi c , no tender point are pre ent. Therefore, th sacrum i not ubluxat d and the doctor mu t now mo e to the
lumbar pine. Th patient' L5 has ubluxated po terior with pinou rotation to�
ard the hort leg id pinou left . Th
doctor correc thi econd.ary area and finds that the patient' left leg continue 10 pull hon during leg length anal i . The
doctor now se e the thoracic pine and palpate a lateral spinou proce de iation at T2. lini al and -ray criteria rule
out the pr nc of a lat ral Ii the i , indicating that a rotational problem i pres nt. The doctor then onta tS th lat ral a pe t
ofth T2 spinous pr e and perform a dorsal-cervical thumb push to orre t for the rotated egm nt. The do tor re heck
I lengths nd move on.
Or. John lin1ral 104 Copyrlght2006

THO Pl
1
Th Bilat ral Th rr t or rotation I

lower than T4. For
do tor utilize ither th
m ntion d arli r, 11
pine. To
ur:
d m that a h rt I g per i t folio\! ing orre tion of primary and
ntinu t th thora 1c pm for palpatory anal
and moti n palpation re\' al a pmou d iation within th T -T 12 gm nt of th

pm .
4. The d tor mu t onfinn the pre ence of a rotational ubluxation and ru1 out a Lat ral
Li th ubluxation. ee Figure 162 & 163
• Rotational ubluxation: the doctor will palpate mu cle ten ion bilateral to th de iat d
pinous pro Al o no muscle bulking will be pre nt.
• Remind r: Lateral Li the i only ha mu cle ten ion oppo ite to th id of pinou
de iation, in addition to non painful mu cle bulking ip ilat ral to th d \ iation.
In -ray analy i , a rotational ubluxation demon trat a br ak onl in th pinou lin .
wherea , a Lateral Li the i di rupt th pinou lin a 11 a th rtebral body !in in
the A-P i w.
ormal R tat d bm nt TS-TL

I I I
I
I I
,
., ,,,:,,, I
�, I I I
I I I I
I I I
Figure 162 T ormal Finding . igur 163 T R 1at1 nal ublu at11Jn FinJmgs
I
l 62 and l 3 di play the linical and -ray finding a iated with a r tati nal ublu: atio n. ' t th
th
mu le bilat ral to the d iation ( olid grey lin ) , and th ab en f mu l bulking. I n t ho " only
pinou !in i di rupted on -ray analy i (d iation f entral d h d lin .

thlf' \ 1 J, ti ,J rn . BilJt r I Thor . dju tm nt:( eeFigure 164 16:
n
P.tt nt Pr,l '
r t ,r . ,J, f th bl . ntr I teral to pin u de\·i tion.
T hi, D ,r. I p1 � m th re dy po iuon.
tlOl �t Pi. 1fonn n p uenf T\·p of ublux ted \ rtebra.
t b1h · Contr I ter I T\"P of the egment ab , e the affe t d vertebr .
LOt P-
Figure 164 repre ent a rotated thoracic egment from T5-T 1 �

(black arrow). The diagram di play the contact for the
modified cro bilateral thoracic adju tment. ote the pi ifi nn
contact i on the contralateral TVP of the deviated pmou
proce . ( da hed grey arrow).
Rotation
figur l(H T · \lod1fied Cr � Bilat'ral
nl,1"1.
The unilateral ontact. and the P-A line of dri e correct for the rotational ubluxation.
Thi adju tment an be perforn1ed manually if the doctor prefer . However the modified de ign
of the adju tment allow for the drop of the table to correct the ublu.xation. making it le
forceful and more comfortable for the patient.
Or. John Minardi 10G Copyrlgh t20De

Leg Length Analysis in the Fie ed Position
Recheck Legs
Produce Balance
Tender Points Correct For
Eh cited 0-
Recheck legs:
Leg Sllll Pul s Short
Original Short Leg
Remains Short or Balanced Tender Points lumbar
Not Elicited Sub luxation
Check And Correct

Hyperactive Psoas
If Criteria Present
Bnnging Legs To Original Short Leg

The Flexed Position Becomes Longer
Blow Out Occurs:

Perform Arm
ASIS to Midline = Lower Boot
Fossa Test
Midline to Pubic Tub = Upper Boot
Recheck Legs: Assess and Correct

Leg Still Pulls Short Lumbars ·ne
Recheck Legs
Produce Balance
Correct For
D+ Check Clean Up o es Assess and Correa
And Finished Thoraoc Spuie
Check Clean Up
And Fll1IShed
Recheck Legs· Chee Clean Up Moves

Produce Balance And Finished
Dr. John Minardi

107
E Tio.· E\'E.·:
LE P JO\I
Cl an Cp Adju tment
Rotated acrum
Cla ic Thompson Prone Adjustment
Posterior Rocked Ischium

Cla ic Thomp on Prone Adjustment
Posterior Sacral Apex

.\fodtfied Prone Adjustment
Anterior Coccyx
.\!odified Prone Adjustment
I� Ilium
Cla sic Thompson Supine Adjustment
Vodified Prone Adjustment
EX Ilium
Classic Thompson Supine Adjustment
Elevated Rib Cage

Classic Thompson Supine Adju tment
Rotated Rib
Modified Supine Adjustment
Or. John Minardi 108 Copyright 2006

ROT TED R
wi 11 d t
I. T b he k d and rr t d after all categorie ha e been cl ared .
. The d t r will p rfom1 a Rotated Sa rum L g E ten ion Test:

• Pati nt pr ne.
Do tor tabilize th patient s acral base with the palm of hi r hand.
D tor in truct the patient to keep leg straight and lift extend each leg off of the table,
one at a time.
onnal = both leg hould raise off of the table equally and will exhibit none of the
follo\J ing in #3:
3. The doctor analy is of the patient s leg raise will denote a problem on the in ol ed ide if
one or more of the following are present:
One leg will not rai e off of the table as high a the other.
One leg will way off to one side before going back to centre.
One leg will xhibit cog-wheeling in which the in ol ed leg will rai e lightly top
rai e slightly more then stop again etc...
One leg will ha e pain and clicking as ociated with the leg exten ion.
If the patient doe not exhibit an of the abo e, then the patient is normal and do not h a e a
rotated acrum. Therefore thi adjustment is not required.
Howe er if one or more of the symptoms are present a rotated sacrum ublu ation i confinned
and mu t be corrected. Thi mi alignment indicates that the sacral ba e ha rotat d in it coronal
plane toward the affected side subluxating the sacro-iUac joint cau ing the aforementioned
ymptom . (See Figures 166 & 167)
nt rior Vi w Lat ral \V
Post. Ant.
Figure 166 Rotated acrum Anterior ie . Figure 167 R rated a rum L t rat i ,,.
Figures 166 and 167 di play how the r tat d I ng th rum' r nal plan (Ant rior Vi w-black arro\\ •
Lateral i w-black Im , using i tran er -gre ir I , Lat ral i -grey da h d lin .

-
R tat d a rum Adjustment: eeFigure 16 &169)
Patt nt: Prone'"' ith the in\olv d ide leg cro ing the oppo ite leg.
D tor: Either id of tab I .
Tabl : P )\ i pie e in the ready po ition.
Conta t 1- Knifi - dg cont.a t on apex of sacrum on unin olved side.
Conta t _: Knife-edge contact lateral to S2 tubercle on involved side.
LO : P-A with rotation in oppo ite direction of subluxation. Repeat 3 time .
Cro ing the patient' affected leg over the unaffected ide create space within the involved
a ro-iliac joint. Thi pro ide the doctor with the room nece ary to perform the adju tment.
Due to the awkward orientation of the acrum between the ilia See Figure l O the do tor must
initiall pu h P-A on the acrum in order for rotation to occur. Similar to opening a pill bottle
with a child-proof top· one mu t fir t pu h down then rotate. The drop piece me bani m a i t
with the P-A movement and the thru t rotate the acrum back into it neutral p i6on. After the
adju tment i completed, the doctor mu t re-perform th acral leg ten ion te t. If th
adju tment i done correctly both leg will be equal and pain fr e. If the ymptoms till persi t
re-perform the adju tment with two more thru t and re he k again.
Thi figure demon trat th a k\ ard orientation of the sacrum

with re pect to the ilium. Thi al o reinforce why it i necessary
to thru t P-A befor r tating the acrum can be accomplished.

PO TERJOR ROCKED I CHIUM (PRI)
Clean-up Move
1. To be performed after all categorie have been cleared.
2. Short leg per i ts after the primary secondary and tertiary areas have been corrected.
3. Palpate along the calf of the short leg. A PRI is confirmed by an extremely tender point
located within the gastrocnemius and soleus muscles on the involved side. (See Figure 171
4. Static palpation of an ip ilateral fixated ischial tuberosity assists in confirming that the
i chi um has ubluxated posteriorly ( extension).
Figure 171 demonstrates the biomechanics of the PRI. A

the ischium subluxates posteriorly, it causes the ilium to
rock into extension (white arrow). Extension of the ilium
produces a stretch and subsequent neurological
PRI contraction of the hamstrings (grey line). The ham tring
originate at the ischial tuberosity and insert into the
proximal aspect of the tibia and the fibular head. A the e
muscles cross the knee joint line the fascia} attachment
that exist within the hamstring muscle ga trocnemius
soleus and inter-osseous membrane produce ten ion
within the gastrocnemius and soleu mu cle cau ing the
tender point (black dot).
Figure 171 PR! Biomechanics lnvol ed in Causing

the Tender Point Located within the Soleus Muscle.
5. Correction. Prone PRI Adjustment: (See Figure 172-174)

Patient: Prone.
Table: Pelvic piece in ready position.
Contact: Hypothenar contact on involved i chial tubero ity.
Stabilization: Anatomical snuffbox of contact hand or oppo ite ide PSIS.
LOC: P-A and slight S-1. Repeat 3 time .
Po terior
Ant nor
Figur 172 PRI orrecti n. H
Tubero ity.

tment. the doctor must rule out thrombophlebiti in high ri k individuals.
Pri r to t:h AdJu
Figure 174 PR! Correcuon 2 Doctor Posnion.. ·01 Contact on

lschial Tuberosity \\bile Stabilizing the Conta Hand
Following the adju tment, the doctor will note that the oleus tender point should decrea e
immediately.
• The pain will not be completely gone, but substantially decreased.
The doctor ma also find that tension/tenderness also exi ts \) ithin the patient ham tring
musculature, in addition to the calf tendeme . It i important for the doctor to remember that the
gastrocnemius/soleus tender point is what Clay Thompson originally found with thi problem,
howe er, hamstring tenderness may also be pre ent.
The hamstring tension helps to explain why thi subluxation is commonly a ociated \vith
a 0- . In many instances, the doctor will correct for a D- initial! , then continue on to
detect and correct for a PRJ, as both subluxation patterns in ol e aberrant ten ion within
the leg flexors.
As a clinical note, the doctor should be aware that the PRI i commonly a ociated \vith runners
who perform a tremendous amount of training on hilled terrain.
Sample Case:
A 30 year old male marathon runner pre ent to the clinic ith back pain and tiffne within the legs. He
mentions that he has been training in ten ely for an upcoming race, and has been doing much of hi training in the
mountain . Following a complete examination, Thompson Analysi re eals a short left leg in extension and a
short left leg in flexion. The doctor will a ses if a Cervical Syndrome i pre ent and correct it if nece ary. The
short to bort leg length analysi points to a D-, so the doctor checks if specifi tender point are pre nt. In thi
case a tender point wa present at the PSIS, confirming the D-. The doctor correct the acrum ublu ation,
howe er, the hort leg persists. The doctor mu t now mo e to the lumbar pine. The patient' L5 ha ublu: ated
posterior with spinou rotation to the short leg ide ( pinou left). The doctor corrects thi e ondary area, and
finds that the patient continues to pull hort during leg length analy i . The do tor no a e e the th ra ic pine
3:"d palpate a lateral pinou proce de iation at T2. Clinical and -ra criteria rule out the pre ence of a lateral
It� i , indicating that a rotational problem is present. The doctor then contact the lateral a p ct of the T2
5Ptnous proce and performs a doral-cervical thumb pu h to correct for the rotated egment. The leg ontinue to
pull hon, now the doctor move on to clean up mo es. Gi en the patient' hi tory a a runner, the d tor
Palpate the gastrocnemiu and oleus of the affected side, , hich cau e the patient to jolt in pain. Thi confirms
the pre nee of a PRl, thu , the doctor contacts the left i chial tuberosit and thru t P-A. The doctor will che k if
any other clean up mo e are required. The patient i fini hed treatment for that day.
Or. John Mlnirdl 112 Copyright 2006

PO TERIOR . RAL APE
Clean-
1. T b h ked fi r and orr t d nly after all primary, econdary and t rtiary categorie have
b n l ared.
-· The d tor will b er ve through Clinical nalysi that the patient exhibit the following igns:
• Prone leg exten ion rai e ( ame a rotated sacrum leg raise te t) analy i hov limi tat ion
on both side . Therefore, the patient's leg only extend off of the table a few inche
bilaterall .
• The patient ha hyperlordosis of the lumbar spine.
• The doctor will notice that the patient exhibits toeing out of the feet which i often
a ociated with a bilateral IN Ilium (explained in detail in a later section).
If the patient displays these signs, these clinically confirm the presence of a Po terior Sacral
Apex. Thi indicate that the sacrum has nutated along its respiratory axis, resulting in the acral
apex to subluxate posterior. (See Figures 175&176)
p t
I
t
A LS Sacrum
Figure 175 Posterior Sacral Apex. Figure 176 Posterior Sacral pe, .
The above figures display the Posterior Sacral Apex sublu ation. ln Figure 176 note ho the sacrum has nutat cl, forcing the
sacral apex posterior (solid arrow). Correction is via a P-A thru t through the a ral ape dashed arrow). Figure l 5
demonstrates how a posterior sacral apex appears on x-ray, which will re ult in a hyperlordosi of the lumbar pine.
3. Correction: Prone Sacral Apex Adjustment: (See Figures 177&178)

Patient: Prone.
Table: Pelvic piece in the ready position.
Contact: Palmar contact on S4 sacral tubercle, in the midline.
Stabilization: Bilateral tibia with patient's legs bent past 90 degrees.
LOC: P-A and slight S-I. Repeat 3 times.
Flexing the legs past 90 degrees assists in remo ing the remainder of ten ion within the p lvi ,
thereby promoting an optimal adjustment. The P-A thrust combined with the drop piece
mechanism sends the sacrum into counter-nutation, allowing the sacrum to return into it neutral
position.

Following the adju rment, the doctor must re-visit the clinical signs formally displayed b the
patient, and en ure that they have been corrected with the treatment.
If the doctor prefers to perform this correction by way of a side po ture manual adju trnent. the
biomechanic are till correct, provided that the doctor contact the sacral apex and not the
acral ba e.
Sample Case:
A SO year old male con truction worker pre ents to the clinic with chronic Jo-. ba k pain, and lately has been
having difficulty standing from a seated po ition. Due to the chronic nature of th problem. the d tor de id to
take x-rays of the lumbar spine, which reveal the pre ence of a hyperlordo i . Following a ompl t e amination.
Thompson Analysis reveals a short right leg in exten ion and a hort right I g in flexion. Th d tor al o notices
that the patient's feet toe out bilaterally. The doctor will as e if a ervical yndrome i pre nt and correct it if
necessary. The short to short leg length analy is points to a D-, o the do tor he k if pe ifi tend r point are
present. In this case, no tender point are pre ent. Therefore, the acrum i not ublu; ated and the doctor mu t
now move to the lumbar spine. The patient's LS ha ubluxated po t rior \ ith pinou rotation to the hort leg
side( pinous right). Thi correction produce balanced leg , th refore there i no need to ontinu into th
thoracic pine. The doctor now move on to check for lean up mo e . The d ctor p rforrns the prone leg rai
test and find that both of the patient' leg rai e only a fe,; inc he off the table. Thi ombin d \ ith the bilateral
toeing out and hyperlordo i that the patient pre ent with confirms the pre enc of a po terior a ral apex. The
doctor contacts the sacral apex while imultaneou ly bending the patient leg pa t O d gr e to remo any
pelvic tension. The doctor then thru t P-A to c rrect the p terior acral apex. Th do tor che k if an oth r
clean up moves are required. The patient i fini hed treatment for that day.

TERIORCO
lean-up love
I. To b h ked fi r and rre t d nl aft r all primary, ndary and t rtiary cat gori ha\e
b n 1 ared.
.... Th d tor will ob r ve thr ugh clini al anal i that the patient exhibit the following 1gn :
Th patient omplain of pain that i pecifically located o er th cocc .

• Th patient indi ate that they ha e e perienced a r cent fa]l onto th buttock .(Typical!
u d b kiing, ic kating or tripping backward down the tair
tatic palpation on the apex of the coccyx re-produce the pain.
If the patient di play the e sign these clinically confirm the pre ence of an anterior coccyx, in
which the apex of the occyx ha subluxated anteriorly.
3. ubluxation Diagram and Biomechanics. (See Figure 179) The following diagram di pla
how the apex of the coccyx has subluxated anteriorly (solid arrow). Al o di played i the
posterior acro-coccygeal ligament, attaching the posterior aspects of the acrum and coccyx
(gre line). Correction will utilize this ligament to adjust the coccyx back into it normal po ition
(da hed arrow).
4. The doctor must take x-rays due to the history of a fall. X-ray analysi confirm the anterior
occyx and rules out fracture. (See Figure 180) If any fracture of the coccyx is pre ent. thi
would be a contra-indication to adjusting.
A Sacrum Coccyx
Figure 179 Anterior Coccyx Biomechanic
5. Correction: Anterior Coccyx Adjustment: (See Figure 1-1 3)

Patient: Prone.
Doctor: Either side, facing cephalad.
Table: Pelvic and lumbar pieces are elevated then et to a ready po ition.
Contact: Thumb pad on posterior acrococcygeal ligament at Cx 1.
Stabilization: Opposite hand pisiform on initial contact for r infor ement.
LO : I-S, with slight P-A to initiate the drop piece. Repeat 3 time .
Both lumbar and pelvic piece of the table mu t be ele at d t pla the coccy in an op timal
po ition for adjusting.

Thi adju tment u e the po teri r acr -c cc geal lioarn nt t ull th
ne u
. tral po ttlo
'°
· · n 1a the ligament' attachm nt . Th dju tment pr vid
mvas1. ve altemat1 · .
en Ure that e to any coccy adju tm nt that mu t r th anal verg tor mu t
the patient i ympt mati but that n fr ture i pre ent within th
Copyrlght2006
116
IN ILJ 1 - Classic Supine Correction
Clean Up Move
An IN Ilium refer to an internally rotated ilium. The point of reference is the PSIS there fore an
IN Ilium indicate that the patient's PSIS ha de iated closer to midline. This is usually found as
a econdary compen ation to an original Al acrum subluxation (D-) that was not completely
corrected. An IN Ilium ubluxation can also occur independently without the influence of a D-.
1n either ca e, the doctor mu t detect and correct for the IN Ilium in the following manner:
l. To be checked for and corrected only after all primary, secondary and tertiary categories have
been cleared.
2. In order for the doctor to accurately assess that the patient has an IN Ilium, the patient must
present with both clinical and x-ray findings. The clinical signs that are present with an IN IJium
are:
• Toeing out of the foot on the affected side.
• Flattening of gluteal musculature on the affected side.
3. The doctor' x-ray analysis reveals the following signs: (See Figure 184-186)
• The ize of the iliac crest is increased.

• There is a decrease in the distance from the PSIS to midline.
• The obturator foramen appears small and lit-like
• The pubic tubercle shifts away from midline.
EX IN
l 1
Figure 184 The four x-ray signs involved with an IN Ilium.
The doctor must have both X-ray and Clinical findings in order to accurately label the
subluxation as an IN Ilium. Both findings must be present because other categories may have
similar clinical symptoms, but will not have the x-ray findings to correlate.
ote that both x-ray and clinical findings for the IN Ilium are the exact oppo ite of the EX Ilium
explained later.

Figure 186 (', !hum on the Right
Th x-ra� d1 pla� the differen ·e bet\\ en a :"\ormal Peh is and an [;\ Ilium. ;\Ote the � !hum demon!>trate· the
b3ra ten 11 fearur _ noted earlier.
4. When both lini al and x-ray finding are pre ent. it confirms an I� Ilium ubluxation.
whereb) th ilium ha ubluxated into internal rotation with re pect to the acrum.
-. Corr tion: Cla ic upine Adju tment: ( ee Figure l & I

Patient: upin with im·olwd ide leg flexed at the knee and hip.
Do tor: On im·ol\'ed ide.
Table: Pel\'i piece in the ready po ition.
Conta t: Th nar contact on lat ral a pe t of
tabilization: Po ition the invoh d I g pa t midline.
LOC: L-M, into the table through th -I joint. Repeat 3 time-.
The doctor bould note that the patient' kn hould b tak n a ro the midlin toward the
oppo ite hip to induce the de ired EX corrective pla em nt f th ilium prior to the thru t. The
thrust hould be ombined with a mall bod drop to a i t the movement.
!he doctor may al o be required to increa the ten ion in th dr p pi t mpen ate for the
m rea ed weight added by lifting the leg.
Or. Jo,,
nM n a
r d/
118 Copyright2006
I ILIUM - Modified Prone djustment
Clean-up Move
Thi m difi ati n wa r ated a an alternati e to the rN Ilium upine adju tment, and i
intend d for m n wh uffi r from an incr a ed amount of articular damage within the Sl
joint. The pron method pro ide le articular and os eou tre s to the patient, by eliminating
ry m ment a the pati nt i already ituated in the proper po ition to be adjusted.
1. To be heck d for and corrected after all other categories have been cleared.
2. In ord r for the d ctor to accurately asses that the patient has an fN Ilium, the patient must
pr ent with both clinical and x-ray finding described previously.
3. Clinical and X-ra finding confirm that the subluxation is an fN Ilium.
4. Correction: Modified Prone Adjustment: (See Figure 189& 190)

Patient: Prone.
Doctor: Opposite side of involvement.
Contact: Superior or Inferior Hand Knife-edge on medial aspect of the ischia1 tuberosity.
Stabilize: Contact hand.
LOC: Medial to lateral, slight P-A. Repeat 3 times.
The doctor has the choice to alternately contact the medial aspect of the PSIS as the
Figure 189 IN Ilium Prone Correction. Knife-edge on Medial Figure 190 [N Ilium Prone Correction Doctor Position.
Aspect of lschial Tuberosity. the Doctor Stabilizes the Contact Hand.
biomechanics would be the same. However, it is easier for the doctor to contact the medial
aspect of the ischial tuberosity. The doctor also has the choice of using a superior or inferior
hand contact, as Figures 189 and 190 display. The doctor should note that IN Ilium subluxation
are common! seen in atient's with hi com laints.
Sample Case: A 50 year old male accountant presents to the clinic with chronic low back pain. Following a complete examination, Thompson
Analysis re eals a hort right leg in extension, and a short right leg in flexion. The doctor al o notices that the patient toe out on the right
ide. The doctor first as esses if a Cervical yndrome is present, and corrects it if nece ary. ince the short to hort leg length analy i· pom
towards a Derefield egative, the doctor palpates for the specific tender points on the hort leg ide. In thi case, the patient omplains of
tenderness upon palpation of the ischial tuberosity, which erifies the D- subluxation. The doctor will then correct the Al rum ublu: ation.
Correciing the primary areas have balanced the patient's legs, therefore the econdary and teniary areas will not be as d. Ho"e' r, lhe
patient continue to have toeing out and a flat buttock on the right side. Becau e the patient i toeing out, the do tor must rule out a
hypera tive psoas, and an I Ilium. The criteria of groin pain and refle tender point on the great t e are not pre ent for a hypera ti\ p •
which rules it out. The doctor take x-rays as the clinical findings of a flat buttock and toeing out for an Ilium mu t be ,erified b) A-ray. In
th1 case, x-ray confirm the clinical findings that an f ilium i present. The doctor adjusts the IN ilium nod ch clcs if any oth r I an up
move are required. The patiem's treatment is finished for the day.

EX ILIU 1 - Cla ic opine djustment
Clean op Move
Th EX Ilium. quite -imply, i the exact opposite problem as the IN Ilium. An EX Ilium refers to
an xtemall) rotated ilium. Preci ely a in the fN Ilium, the EX ilium point of reference is the
p I . Therefore. an EX Ilium indicate that the patient' PSIS has deviated further away from
midline. The do tor mu t detect and correct for this subluxation in the following manner:
I. To b hecked for and corrected after all primary secondary and tertiary categories have been
l ared.
_. In order for the doctor to accurately a es that the patient has an EX Ilium, the patient mu t
pr ent with both clinical and x-ray finding . The clinical sign that are pre ent with an EX Ilium
are:
Toeing in of the foot on the affected ide.
lncrea ed ize of gluteal mu culature is pre ent on the affected side.
3. The doctor' x-ray analy i reveal the following signs: (See Figures 191-193)
The ize of the iliac ere t i decrea ed.

There i a increa e in the di tance from the PSIS to midline.
Th obturator foramen appear large and round.
The pubic tubercle hift toward and ometimes pa se the midline.
EX IN
1
imilar to the IN Ilium, th E ilium al r qutr th d ctor t ha b th -ra and lini al

finding in order to a urately lab I th ublu ation a an E Ilium.
The combinati n of -ray and clini al ign will nfirm th pr en fan Ilium and rul
out any other cat g rie th t may h e imilar lini al ympt m , but la k th x-ra finding t
correlate .
Or. Joti Mi
n nardi 1,n Cnnvdnht ,11n1:
Figure 193 EX Ilium on the Right.
The e -ra dt pla the difference between a ormal Pelvis and an EX Ilium. ote the EX Ilium demon trat
feature noted earlier.
4. When both clinical and x-ray findings are present, the EX Ilium subluxation is confirmed.
Therefore, the ilium has subluxated into external rotation with respect to the sacrum.
5. Correction: EX Ilium Supine Adjustment. (See Figures 194& 195)

Patient: Supine with invol ed side leg flexed in the figure 4 po ition
Doctor: Opposite the invol ed side facing cephalad.
Contact: Thenar on medial aspect of involved ASIS.
LOC: Medial to lateral and P-A. Repeat 3 times.
Figure 194 EX Ilium upine Correction Thenar on Medial A pect of

Al
lt i important for the doctor to learn that hi torically this adju tment wa p ro rmed by
contacting the patient's knee on the affect d side. on idering th potential damag that th
original contact posed on the knee and hip joint the contact wa lat r modifi d to conta t the
ASIS to reduce any potential damage.

EX ILIUl\1 - l\1odified Prone Adjustment
Clean-up Move
imilar to the Modified Prone adjustment for the TN Ilium, the Modified Prone adju tment for
the EX Ilium was developed for an elderly patient, or a patient who suffers from an increased
amount of articular damage within the SI joint. The prone method provides less articular and
O eou stre s to the patient, and eliminates excessive movement, as the patient is already in the
proper position to be adjusted.
I. To be checked for and corrected after all primary, secondary and tertiary categories have been
I eared.
2. In order for the doctor to accurately assess that the patient has an EX Ilium, the patient must
present with both clinical and x-ray findings described previously.
3. Clinical and X-ray findings confirm that the subluxation is an EX Ilium.
4. Correction: Modified Prone Adjustment: (See Figure 196& 197)

Patient: Prone.
Doctor: Ipsilateral side of involvement.
Contact: Superior or Inferior Hand Pisiform on lateral aspect of the PSIS.
Stabilize: Contact hand.
LOC: Lateral to medial, slight P-A. Repeat 3 times.
It is important for the doctor to note clinically that the EX Ilium is commonly associated with
patients who suffer with knee ailments.
F'agure 196 EX llium Prone orrcction. Pisiforrn Contact on Lateral Figure 197 EX Ilium Prone Correction Doctor P iuon
Aspect of P I . uperior or Inferior Hand can be Uti I ized. Superior or Inferior Hand ontact can be tillzl'd
ample Case: A 35 year old female pre ents to the clinic complaining that be� ears out the inside le of h r left
also mentions that she experiences neck pain occa ionally. Following a complet e amination, Thomp on anal) 1 re, al a
Mion right leg. The doctor also notices that the patient toes in on the left. The doctor in tru.cts the pallent to tum her head t
the right, which produce no change to the leg lengths. The doctor then in tructs the patient to tum her head t the I ft. \\ht h
re ults JO balanced leg length . Left head turning producing balanced leg indic t s a Left erv ical ymlrom , but the
problem i on the opposite ide. The doctor will then palpate along the lamina p dtcl juncuon on the patient' nght id .
tender nodule i pre eat at 5. The doctor will talce his/her contact at the ite f the n dul and 1hru t P- tn hoe v.1th th d1.
and perpendicular to the facet. In thi ca e, adju ting the ervical yndrome resul in balanc d leg1. in b th ext ndcd and
fleited po itions. Therefore, further as e sment of the se ondary and tertiary area I not n ce r) . The J ctor mO\ nt
clean up mo e . Because the patient toe in and has protruding gluteal muscul ture on the I ft, -ray re taken to , n if an
X lhum 1s pre enl In thi case, -ray confirm the E llium i pr eat, therefore, the d tor c rr ct it a cording) The
doctor then checks if any other clean up mo es are required. The patient 1s fini hed the treatment for that day
_-...._,John llln ,,.., 121 Convriaht 2006

ELE A TED RIB CAGE (ERC)
Clean up Move
The Ele ated Rib Cage adjustment was created for patients who suffer from asthma-type'
ymptoms. These patients, ho er do not have a thma but rather a subluxation within the rib-
cage that places torque on the pericardium and myocardium. Excessive torque on these structures
produce the re piratory symptoms involved in an ele ated rib cage and is detected in the
following manner:
1. To be checked for and corrected after all categories have been cleared.
2. The doctor will observe that the patient presents with a high shoulder, and flexion throughout
the thorax. Following the correction of all other categories the high shoulder and flexed thoracic
posture continues to be present.
3. In addition to the postural deviations, the patient will exhibit respiratory symptoms, such as
coughing and wheezing.
4. Once postural and respiratory signs and symptoms are established, the doctor must confirm
that the subluxation is indeed an elevated rib cage, by eliciting a specific tender point. To locate
this tender point, the doctor will do the following:
Patient is supine.
Doctor stands on affected side (high shoulder side).
• Doctor will palpate along the mid-clavicular line, in the second
intercostal space. (See Figure 198)
If a tender point is elicited in this location when postural and
clinical symptoms are present, it confirms the Elevated Rib
Cage Subluxation. Figure 198 ERC Tender Point
Pectoralis Minor lmage Copyright 2003-2004 University of Washington. All rights reserved including all photographs and Location_
images. o re-use, re-distribution or commercial use without prior written permission of the authors and the University of
Washington.
In normal situations, the second intercostal space along the mid-clavicular line would produce no
tenderness. When tenderness is easily produced, this represents tension located within the
pectoralis minor muscle, which originates at the coracoid process and inserts along the first,
second and third ribs. The combination of postural and clinical symptoms in addition to the
presence of pectoralis minor tenderness confirms that the subluxation pattern is an elevated rib
cage, in which the entire rib cage has shifted superior and slightly anterior. (See Figure 199)
Figure 199 displays how the entire rib cage has

subluxated superior and slightly anterior, which causes
the abnormal high shoulder and flexed thorax posture.
The subluxation also causes torque on the pericardium
and mediastinum which results in the respiratory
symptoms that are present. Note the tender point present
at the second intercostal space (black dot) along th e
mid-clavicular line (grey dashed line).
Figure 199 Elevated Rib Cage.

·. C rre non: Elevated Rib Cage dju tment: (See Figure 200&20 I)
Patient: Supine.
Doctor: On either side.
Table: Dor al piece in the ready position.
Contact I: Knife-edge contact on tender point of high shoulder ide.
Contact 2: Web contact on lower angle of rib cage on oppo ite ide.
LOC: P-A with scissor-like fashion. Repeat 3 times.
The ci oring motion will correct for the superior rib cage, and the drop mechani m will correct
for the light anteriority.
F'igure 200 Elevated Rib Cage Correction. Knife-edge Contact on Figure 201 Elevated Rib Cage Correction Doctor Po ition. ote How
Tender Poiot of High Shoulder Side. Web Contact on Lower Angle of the Doctor is Positioned Over th Pati nt's Midhne to ist the
Rib Cage on Oppo ite Side. Scissor-Type Thru t.
When a male doctor is working on a female patient, the doctor must modify the contacts. In this
situation, the female patient should place her hands over the contact points, and then the doctor
can place his contact over the patient's hands. This simple modification allows the doctor to
avoid any confusion with the patient.
The doctor should note clinically that an elevated rib cage is usually associated with AI sacrum
(D-), in which the high shoulder and the short leg will be on same side. This is due to the contra
lateral overcompensation of the thoracic musculature (tender point on contralateral thoracic
TVPs T2-T4) involved in the D-.
Sample Case:
A 25 year old machinist pre ents to the clinic with headaches, back pain and a per i tent cough. F llo\ ing a comp! te
examination, Thomp on Analy i reveal a short left leg in e tension and a hort left leg in fle ion. Postural analy i r veal
anterior head carriage a high left houlder and thoracic flexion The doctor, ill a se ifa Cervi al yndr m i pr nt and
correct it ifnece ary. The hort to hort leg length analy i point to a D-, so the doctor che ks if p cifi tender point are
pre eat. In thi case, the patient had a tender point, and therefore, the D- ubluxation was correct d. Howe er, the patient'
left leg continue to be hort following the correction of the primary area of ubluxation. Now the d tor m e t th
lumbar spine. The patient' LS ha ubluxated posterior with pinou rotation t th hort leg id pinous left). The d tor
correct the lumbar ubluxation, and the patient' leg be ome balanced. Therefore, th thoracic pine i n t a e d or
corrected. Because ofthe patient' re piratory ymptom and p tural pre entation, th d tor mu t be k f, r the el at d rib
cag clean up mo e. The doctor palpate the econd intercostal space along the mid-cla i ular lin n th high h ulder id .
The patient complain that it i tender, which in combination with the patient' ympt m onfinn the pre�enc fan
elev ated rib cage. The doctor contact the sup rior a pect of the left rig cage, and the inf, rior a pe t of the right rib age and
thru t P-A. in a ci r-type fa hion. The doctor then che k ifany other clean up m are required. The pati nt i fini hed
the treatment for th day.
__..Q,.._,_r John llln�r,41 124 Copyrlght2006

ROTATED RIB
Clean-up Mo e
l . T b ch ked for and corre ted after all categorie ha e been cleared.
2. The pati nt present vvith sharp and tabbing pain in the chest which is aggravated by
inhalation. uall wh n a pain is produced or aggra ated by inspiration, the rib is somehow
invol ed. The doctor mu t now detennine how the rib has subluxated.
3. Th doctor will palpate along the anterior and posterior aspect of the rib cage. Palpation
r veal a , idened intercostal space inferiorly on the posterior aspect of the patient and
up riorly on the anterior aspect (See Figure 202). Motion palpation confirms the static palpation
findings and re eals a subluxation of the costotransverse joint and corresponding costostemal
joint of the affected rib.
4. Subluxation Mechanics and Diagram:
p A
Figure 202 Rotated Rib Subluxation.
The diagram in Figure 202 displays that the affected rib (grey) has subluxated in a rotational mann r. ote how the anterior
aspect of the rib has misaligned inferiorly, as the posterior aspect has misaligned superiorly creating a widening of the
inter o tal spaces (black arrows).
5. Correction: Rotated Rib Adjustment: (See Figure 203)

Patient: Supine.
Table: Dorsal piece in the ready position.
Contact I: Thenar contact on tubercle of rib (posterior).
Contact 2: Pisiforrn or knife-edge on costochondra1 junction of rib (anterior).
LOC: Contact I: S-1.
Contact 2: I-S with slight A-P to initiate the drop table.
• This adju tment can be done with the table slightly raised to ea e the doctor's back.
Ju t a in the Elevated Rib Cage, if a male doctor is working on a female patient the docto r mu t
modify hi contacts.
• The female patient should place her hand over the anterior contact point, and then th
doctor can take his contact on top of the patient' hand.

Figure 203 Rotated Rib Correction Doctor Position.
Anterior and Posterior Aspects of the Affected Rib.
Sample Case:
A 20 year old male hockey player presents to the clinic with neck pain, back pain and stiffness foJJov ing a rough
game last night. He also mentions that he experiences a sharp pain in the back when he breaths in. X-rays are
taken and are absent of fractures or abnormalities. Following a complete examination, Thompson Analysis
reveals a short left leg in extension and a long left leg in flexion. The doctor will assess if a Cervical Syndrome is
present and correct it if necessary. The short to long leg length analysis points to a D+ so the doctor will perform
an arm fossa test and correct for either an upper or a lower boot subluxation. In this case, the patient continues to
pull short following correction of these primary areas. Now the doctor moves to the lumbar pine. The patient's
LS has subluxated posterior with spinous rotation away from the short leg side(spinous right). The doctor corrects
this secondary area, and finds that the patient continues to pull short during leg length analy is. The doctor now
assesses the thoracic spine and palpates a lateral spinous process deviation at T5. Clinical and x-ray criteria rule
out the presence of a lateral listhesis, indicating that a rotational problem is present. The doctor then corrects the
rotated segment, which balances the legs. Considering that the patient experience a sharp pain with inspiration,
the doctor will check for a rotated rib clean up move. In this case, the doctor palpates a large intercostal space
inferiorly at the posterior aspect of the fifth rib. The doctor also palpates a large intercostal space superiorly at the
anterior aspect of the fifth rib. Palpation findings and clinical symptoms onfi.rm the presence of a rotated rib. The
doctor contacts the subluxated segment both anteriorly and posteriorly and adjusts it accordingly. The doctor then
checks if any other clean up moves are required. The patient is fini bed the treatment for that day.
Copyrlght2006
126
. John Mln1rdl
If SbyUNEVEN arter tr.. tlng Prlm8ry .. Secondary CLEAN-UP move:
! Rotlllod 1acrUT1
areas:
··> TliCRACIC SANE Posurlcr lb:kod bclii.m
Pattver S.<Dr ( Pl ltua::lc lllrwl IN & EX 11 UT> (prono "4)1rn)
Knlfo·Edge Ele.latecl rlb cage
i.n1u_,
Tlul'lbil:7..C,,',ja,1 pJ!ap.,-.(T1-T4) Rocatod rib
T Slint-i:J1T5·T12 POiiterlcr sacr ol epCK
1� corrected by•
R.QB.L hmd rotatlon 100% corrected by a
RAW L heed rotet Ion
IIR'oor s In
t'lll!d rotatlon flexlon
Noduesat Nodue
atC7 R becane SI-ORT
dlffenn w th R mod rotatlon
eiel with/<U 8
rcdooon anl vlc&-versa
lpsl/cortra
side
EXCEPllON DEREFIELD
acs
2d tlllseJ: R told • R 51ut &

1. Painshnlng L hood• nocl....-go
in slnJldEI' (vlc&-versa)
• Cenrical pein& 2. In tte Sl4J
k:115 d trd051s emrlscapw
3. Pain In 1. lpsl proximal Tlb A-ClmslcToggtesct EXCEPTION DEREFIELD
flel<lon & ext. 2. lpsl PSIS B· Modlrle:I Stu:ky
uos
1. Ccrtr acta:I Ilg dne:k 3. lpsllsctial nb. C· L.Hlateral seated
2. OlronlcC2 4. lpsl PwlcTLba'clo
3. 1st Coitttrara9'sejolrl 5. Cortra TsplnoT2·T6
fl xatJon (ssre side dC2
alurlm: nxlue) R bocorm SI-ClRT with R
Pat kn llrn tis road R and L
1. Clrvlcal l'IXIUe Is pr- 4. T tn!fr !pOl lti!nslcnd DEREFI aD ·(!).) road rOIDt ion anl
2. Side dl'DlhJe • nulCI.W' tnpezha dtheq>pmite (Al IIIF'
,al base) k mr<M!fl test Vic&-1/0'SII
mawlty sidedC2rmue (112 514>· lrgunai lg• b.Yer
3. At'fectllj -tllbr • Im a boot ct 112 at • t«ier) 100II cerrectcd � lllll
BILATERAi.CERViCAL SO
tpncull!Mlllcn_.d byaRallt'lll!d corrected by
(Occl p.t AS)
nal!Uellde rotation road r Ollltl m
Lunb.- Spl reSU>x Pmt
(ll)lroia tqAI sacrun)
t •• A· Clll!lslc Ttanp,rn prcn,
?
'
···
.; ..��" �
' ,• Cl•c Th""1, Solt
lpltleg caractbn
lo.ler boot B- Modlrled stu:ky "4)111!
C· Modlflccl _.
EX(IP11QN
4) per !lbx llfj.J.
"'.:"��I..,...csJ.�
Stu:kyActJ Fhrecar1Cti:J1 EXCEPllON lml'l!LD

boot Modi llod Ilg D Moditied Toggb Board Olll!FIILD DNeglllWe
� Sp>llljlc, clll-c Tpm,w
SI.DC• distraction C<rrectlon cs l•-aftlal
Stu:ky Stack �b: li>d. l.. tu:i:J1,.,
mot!ul E· Modlned q,lr11 llrtaqf. trtpr ...
SECTION EIGHT:
EXTREMITIES
omplex
§boulder C
ea01erus
Glenohumeral Jomt
Anterior Humerus
Modified Seated Adjustment
Posterior Humerus
Clavicle
Sternoclavicular Joint
Acromioclavicular Joint
Scapula
Medial Inferior Scapula
Hip
Modified Externally Rotated Hip Adjustment
Modified Internally Rotated Hip Adjustment
Patella
Superior Lateral Patella
Tibia
Inter nally Rotated Tibia
F ib u l a
Anterior Fibula
Ternporom
andibular Joint (TMJ)
Modified Stucky Two Part Supine Adjustment
128
Extremities
Any instance in which a patient presents with a extremity complaint, following a complete
examination of the affected area the doctor must also check the patient's spine to rule out if any
subluxations are present. Due to the fact that many extremity complaints are originally cause d by
pinal subluxations extremity adjusting must be performed after all spinal subluxations are
corrected. If the extremity complaint is addressed without proper correction of spinal
subluxations it is possible that the extremity problem will reoccur as the root cause of the
problem ha not been corrected. All extremity corrections are based on the combination of the
doctor's observ ation palpation, instrumentation and x-ray findings.
Shoulder Joint
The shoulder complex is a complicated assemblage of structures, that provide substantial range
of motion, at the expense of stability. The anatomy of the shoulder complex contains seven
articulating sites:
1) Glenohumeral(capsular).
2) Suprahumeral.
3) Acromioclavicular(capsular).
4) Scapulocostal.
5) Sternoclavicular(capsular).
6) Costostemal (described in the rotated rib subluxation).
7) Costovertebral (described in the rotated rib subluxation, and the OCCS).
Glenohumeral (GB) Joint
1. The doctor must ensure that all primary, secondary and tertiary subluxations of the spine have
been assessed and corrected.
2. Patient presents with shoulder pain between 60-120 degrees of abduction, further aggravated
by medial and lateral rotation.
• The doctor must comprehend that the pain is exacerbated in the 60-120 degree arc,
because as the humerus subluxates, the greater tubercle of the humerus collides with the
acromial hood.
• This collision results in the compression of two structures; the supraspinatus tendon and
the subacromial bursa.
3. Biomechanics of the GH Joint.

• Three movements take place within the glenohumeral joint.
• Rotation (Picture a tire spinning in the mud)
• Rolling (Picture a tire moving normally across the pavement)
• Translation. (Picture a tire braking on ice. The tire stays stationary, but slides)
The humerus must be able to perform all three of these motions during abduction to provide the
greater tubercle proper clearance from the acromion process.
• If one or more of the three motions are impeded, the result will lead to impingement of
the supraspinatus tendon and the subacromial bursa.
The doctor must be aware that if the shoulder pain is due to contact injury, then an x-ray is
required to rule out fracture, instability or dislocation. No adjusting should be perfonned until
this is completed.

p
GLE OHUMERAL (GH) JOINT

Anterior Humerus-Supine Correction
Th tor must ensure that all primary, secondary and tertiary subluxations of the spine have
b n a e sed and corrected. To accurately detect and correct an anterior humerus subluxation
th doctor will observ e the follm ing:
1. The patient pre ents with anterior shoulder pain, a lo s of strength abducting the involved arm
and cannot circurnduct the affected arm fully during physical examination.
. The patient re eals that he/she tried to pull open something that was unknowingly locked or
e ured.
• For example a typical clinical scenario may be that the patient had attempted to pull
open an icy car door which did not give way, resulting in an immediate pain in the
anterior aspect of the shoulder.
3. To confirm that the patient indeed has an anterior humerus subluxation, the doctor must
perform an Anterior Deltoid muscle test:
Patient: Supine arms at 90 degrees, palms facing caudad.
Doctor: At the head of the table.
Procedure: Doctor applies caudad pressure to the patient's extended arms, and will
instruct the patient to resist, keeping their arms at 90 degrees.
Normal: If an anterior humerus subluxation is not present, the patient will be able to
resist the doctors pressure, and keep the arms at 90 degrees.
Subluxation: If the patient is unable to resist the doctor's caudad pressure and breaks the
90 degree position of the arms, this confirms that the humerus has subluxated anteriorly.
4. Anterior Deltoid muscle testing confirms that the subluxation is an anterior humerus whereby
the humeral head has translated in an anterior position. (See Figures 204&205)
Normal A.Humerus
p A
Figure 204 Normal GlenohumeraJ Figure 205 Anterior Humeral Translation.
aniculation.
5. Correction: Supine Anterior Humerus Adjustment: (See Figures 206&207)

Patient: Supine, affected shoulder and elbow flexed to 90 degrees.
Table: Dorsal piece or toggle board under the affected shoulder in the ready position.
Contact: Palmer contact on affected side elbow.
Stabilization: Humeral Head.
LOC: A-P. Repeat 1-3 times.
The doctor should be aware that if the patient cannot flex the shoulder and ann the doctor can
alternatively have the patient's affected ann straight, contact the humeraJ neck, distract the
Or. John lllnardl 130 Copyrtght2006

affi t d arm with the tabilization hand, then th.ru t P-A with the contact hand.
Figure 207 Anterior Humerus Correction Doctor P ·ition.

the Patient's Hand is Clear From the Face to \Oid Collision.
ANTERIOR HUMERUS -Modified Seated Correction
The seated anterior humerus adjustment was created as an alternative for the doctor to use if no
drop pieces were available.
1. Patient presentation, clinical scenario, muscle testing and subluxation pattern are the same as
pre iously discussed.
2. No drop-pieces are available.
3. Correction: Anterior Humerus Modified Seated Adjustment. (See Figure 208

Patient: Seated. Flex affected shoulder and elbow.
Doctor: Standing behind patient.
Contact: Interlocking fingers cupping elbow.
LOC: A-P.
The doctor must take careful note of the patient's hand placement. When the doctor flexes the
patient's elbow to take his/her contact, the patient's hand may approximate the patient's face
and result in a collision when the thrust is performed. Thus the doctor mu t take precaution in
having the patient's hand and arm positioned away from the patients face.
Figure 208 Anterior Humerus Seated Correction Doctor Po ition.
Dr. John Minardi 131 copyrightZOof

GLE OHUMERAL (GH) JOINT
Posterior Humerus-Prone Correction
Th d tor must ensure that all primary secondary and tertiary subluxations of the spine have
n e sed and corrected. To accurately detect and correct a posterior humerus subluxation,
the do tor\ ill observe the following:
1. The patient presents with posterior shoulder pain, a loss of strength with adduction and
external rotation and cannot circurnduct the affected arm fully. Physical examination also
reveals pain and posterior capsular swelling upon palpation.
2. The patient notifies the doctor that he/she fell forward onto an outstretched arm.
For example a typical clinical scenario may be that the patient had been carrying her
child in one arm, lost her balance, and fell forward onto an outstretched arm in an attempt
to dampen the fall. The fall resulted in immediate pain in the posterior aspect of the
shoulder.
A typical sports scenario may be that a football player was tackled and landed on the
point of his bent elbow, immediately causing posterior shoulder pain.
3. To confirm that the patient indeed has a posterior humerus subluxation, the doctor must
perform a Teres Minor muscle test:
Patient: Supine affected arm in the "Chicken Wing" position (affected arm and elbow
bent at 90 degrees, hand tucked under the patient's pelvis).
Doctor: On affected side.
Procedure: Doctor grasps patient's elbow, applies P-A pressure, and will instruct the
patient to resist, maintaining their arm in this position. (Patient resistance, while in the
Chicken Wing position, applies external rotation and adduction to the affected arm. The
only muscle that performs both of those functions is Teres Minor).
Normal: If a posterior humerus subluxation is not present, the patient will be able to resist
the doctor's pressure, and keep the arm in the same position.
Subluxation: If the patient is unable to resist the doctor's P-A pressure, and is unable to
maintain the arm position; this confirms that the humerus has subluxated posteriorly.
4. Teres minor muscle testing confirms that the subluxation is a posterior humerus whereby the
humeral head has translated in a posterior position. (See Figures 209&2 l 0)
Normal
p A
F"igure 209 omial Glenohumeral Articulation. Figure 210 Po terior Humeral Translation.
Dr. John IIJn 132 Copyrlght2006

5. Correction: Posterior Humerus Prone Adjustment: (See Figures 211 &212)
Patient: Prone, in olved arm straight and extended 45 degrees.
Doctor: On affected side, facing cephalad.
Table: Dorsal piece in the ready position, or toggle board under the affected area.
Contact I: Knife edge of medial hand on posterior surgical neck of the humerus.
Contact 2: Lateral hand grasping wr ist of invol ed arm.
LOC: Contact I: P-A.
Contact 2: Long axis distraction.
The doctor must be aware that if the shoulder problem is due to repetitive throwing motion,
biceps tendon involvement must be ruled out as well.
Figure 211 Posterior Humeru.s Correction. Knife-Edge Contact on Figure 212 Posterior Humerus Correction Doctor Position.
Surgical eek of Humerus. with Simultaneous Distraction of the
Affected Arrn.
Sample Case:
A 20 year old varsity football player presents to the clinic with headaches, back pain and posterior right shoulder
pain since his football game last night. The patient explains that he was running for a touch down when he was
suddenly tackled from behind, and landed on the tip of his elbow. Shoulder range of motion re eals tenderness
during adduction and external rotation. Palpation of the shoulder also re eals welling posteriorly. Following a
complete examination, Thompson Analysis reveal a short left leg in extension and a short left leg in flex.ion. The
doctor will assess if a Cerv ical Syndrome is present and correct it if necessary. The hort to short leg length
analysis points to a 0-, so the doctor checks if specific tender point are present. In this case the patient bad a
tender point, and therefore, the D- subluxation was corrected. Howe er, the patient's left leg continues to be short
following the correction of the primary areas of subluxation. Now the doctor move to the lumbar spine. The
patient's L5 has subluxated po terior with spinous rotation to the hart leg side(spinous left). The doctor correct
the lumbar subluxation, and the patient's legs become balanced. Therefore, the thoracic spine is not assessed or
corrected. The doctor quickly checks if any clean up moves are required. None are required in this case. Due to
the mechanism of injury, the doctor takes x-rays of the right shoulder, which show no igns of fracture or
instability. Because of the patient's clinical scenario and examination findings the doctor suspects a po terior
humeru subluxation, and performs a Teres Minor muscle test to confirm. The patient is unable to pro ide
resistance during the Teres Minor muscle test, which con.firms a posterior humerus ubluxation. The do tor
contacts the posterior surgical neck of the humerus, while simultaneously distracting the right arm caudad. The
doctor thrusts P-A, correcting the posterior humerus subluxation. The patient i finished the treatment for the day.

STERNOCLA VICULAR (SC) JOINT
Toe doctor must initially ensure that all primary, secondary and tertiary subluxations of the spine
ha\·e been a sessed and corrected. To accurately detect and correct a subluxation of the proximal
cla icle within the sternoclavicular joint, the doctor will observe the following:
1. Patient presents with anterior shoulder pain, which is aggravated by abducting the ann past 90
degre e .
2. The patient reveals that he/she has sustained a lateral impact in contact sports. Typically
pre ented as being tackled in football, or checked from the side in hockey. The doctor must note
clinically that these lateral impact injuries can separate the stemoclavicular joint, and tear the
fibres of sharpy located within. Thus, the doctor must rule out any possibility of separation prior
to adjusting, as this would be a direct contra-indication.
3. Since the injury is most commonly due to impact, the doctor must x-ray the affected area to
rule out the possibility of fracture or dislocation. A height difference of 5mm or more found on
x-ray indicates a stemoclavicular separation, and cannot be adjusted (See Figure 213). As with
any fracture, dislocation or separation, the patient must be referred out. If no separation exists,
the doctor will continue in the treatment of this injury.
4. The doctor must be aware of the biomechanical movements that occur within the
stemoclavicular joint. Movement occurs through:
l) Protraction and Retraction.
2) Elevation and Depression.
3) Rotation.
Subluxation of the sternoclavicular joint results in a negative influence on the normal scapulo
humeral rhythm. The scapulo-humeral rhythm is normally a l :2 ratio, indicating that for e ery
one degree of scapular movement, the humerus must move two degrees to maintain optimal
function. However, the scapulo-humeral ratio is highly dependent on an optimally functioning
clavicle. When the clavicle functions without subluxation, the first 90 degrees of ann abduction
requires the clavicle to elevate 30 degrees. After this point, the clavicle rotates anterior for 45
degrees. This clavicular rotation permits the scapula to rotate, and allows rotation to occur
through the acromio-clavicular joint. Furthermore, the last 30 degrees of arm abduction would
not be possible without the crankshaft rotation of the clavicle. When a ubluxation exists, this
natural rhythm is disrupted, which limits arm abduction to 90 degree .
5. Due to the mechanism of injury, the proximal clavicle will sublux.ate within the
stemoclavicular joint in protraction and elevation. (See Figures 213 & 214)
------c::::1
A-P and Superior View
•• 5111111 i:p.
r
...... N
Diagram display the
��--- --�
Superior and Protracted
proximal cla i al
ublux.ation within the
,----- .........
joint (arrows). A differenc
of 5mrn or greater repre ent
separation of th - joint
and must be referred.
Flga,e 213 A-P View. Proximal Clavicle Figure 214 Superior View. Proximal la icle
Subluxation. uperior Aspect Di played. Subluxation. Protraction Aspect Di played.
---��
°'·.IOhnIll 134 Copyright 2006
6. Correction: SC Adjustment: (See Figure 215-217
Patient: Supine.
Do tor: Opposite ide facing patient.
Table: Dorsal piece in the ready po ition.
Contact: Pi iform on head of the proximal clavicle.
Stabilize: Conta t hand.
LOC: S-1, A-P.
Figure 215 SC Adjustment Contact: Head ofClavical (arrow).

Coun ) ofBanleby.com·s edition of Gray's Anatomy of the Human Body.
The inferior direction of the thrust corrects the superior component of the subluxation. The
posterior direction of the thrust and the drop piece mechanism corrects for the protraction
component of the subluxation.
Figure 216 Stemoclavicular Joint Correction. Pisiforrn Contact on

Head of Proximal Clavicle.
If a male doctor is treating a female patient, have the patient place her hand on the contact
initially, then the doctor can take a contact over her hand. This simple modification will
eliminate any potential confusion.
Essential ote: It is important for the doctor to recall that the sternocleidomastoid muscle has
tendonis attachments from the mastoid process to the sternum, clavicle and sternoclavicular
meniscoid. When a lateral impact is not involved with a sternocla icular subluxation, a potential
cau e may be a Unilateral Occiput Syndrome (described earlier) due to the occiput's connection
, ith the sternocleidomastoid. If this is the case the UOS must be corrected initially, followed by
the sternocla icular correction.
Dr. John Minardi 135 Copyright ZOO'

ACROMIOCL VICULAR (AC) JOINT
Th tor mu t initially ensure that all primary, secondary and tertiary subluxations of the spine
h re been a e sed and corrected. To accurately detect and correct a subluxation of the dj tal
laYi Je within the acrornioclavicular joint, the doctor will observe the following:
l. p tient pre ent with anterior shoulder pain, wruch is aggravated at 120 degrees of arm
v
abdu tion. Doctor's obser ation will detect a horizon sign present at the distal aspect of the
lavicle. A horizon sign is quite simply a lump that is produced when the acromioclavicular joint
j- damaged resulting in the cla icle lifting away from the acrornion process, producing the
protuberance. (See Figures 218-219)
-· The patient re eals that he/she has sustained a lateral impact in contact sports, or has fallen
laterally on an outstretched arm. The doctor must note clinically that these lateral impact injuries
can separate the acrornioclavicular joint. Thus, the doctor must rule out any possibility of
eparation prior to adjusting as this would be a direct contra-indication.
3. Since the injury is most commonly due to an impact injury, the doctor must x-ray the affected
area to rule out the possibility of fracture or dislocation. If a fracture or separation exists the
patient must be referred out. If neither are present, the doctor will continue in the treatment of
this injury.
s •�.--•--......··�----··...· ----�·· Horizon Sign
•
I
I
I
Figure 218 Subluxated Distal Clavicle.
Figure 219 Lump Produced By ubhucated
Di ta! Clavicle.
The Diagrams demonstrate the subluxated distal clavicle affecting the A-C joint (Figure 218 black arrow) and the resultant
horizon ign that is produced (Figure 219 grey arrow). Correction is S-I through the distal cla icle (Figure 218 dashed grey
arrow).
4. lfno signs of fracture or instability exist, the doctor must distinguish which Grade of A-C
strain is present.
Grade 1: Has no horizon sign present, indicating that the majority of the tendons,
Hgaments and supporting structures are stable and firmly attached.
Grade 2: Has a horizon sign present, however some tendons, ligaments and supporting
structures are still attached.
Grade 3: Has a horizon sign present, however the vast majority of tendons, ligaments and
supporting structures are unattached.
In order for the doctor to clinically differentiate which Grade of A-C strain exists, the doctor will
perfonn a Coracobrachialis muscle test:
• Patient: Supine. Shoulders flexed 30 degrees. Elbows flexed to 90 degrees.
• Doctor: Head of table.
Procedure: Doctor places palms on the patient's biceps and applies caudad pressure. The
0,, "°"'1 Ill 6 Coemght 2006
patient is instructed to resist the doctor' caudad pressure.
• ormaJ: If no A-C strain or clavicular subluxation existed this muscle test would be
performed pain-free and the muscle test would re ult in the distal clavicle moving
lightl inferior.
Howe er, when a ubluxation of the distal cla icle is present subsequently causing an A-C
train, the mu cle test produces the following signs:
• Grade l : Mu cle test produces pain at the A-C joint however patient is able to apply a
significant amount of resistance to the caudal pressure. Horizon sign continues not to be
present and the di tal cla icle moves slightly inferior during muscle testing.
Grade 2: Muscle test produces significant pain at the A-C joint and the patient can apply
limited resistance to the caudal pressure. Horizon sign continues to be present however
distal clavicle moves slightly inferior during muscle testing.
Grade 3: Muscle test does not produce significant pain, however, the patient cannot
provide resistance to the caudal pressure. Horizon sign persists, and the distal clavicle
remains superior during muscle testing.
The significance of this muscle testing to differentiate between the Grades of A-C strain is
because the doctor will be able to treat a Grade 1 or Grade 2 A-C strain but not a Grade 3. If a
patient demonstrates signs associated with a Grade 3 A-C strain, the patient must be referred as
it would be a direct contraindication for adjustment.
5. Subluxation affecting the A-C joint indicates that the distal clavicle has subluxated superior.
6. Correction: A-C Adjustment: (See Figures 220&22 l)

Patient: Supine.
Doctor: On affected side. Head of table. Facing caudad.
Contact: Web contact on the superior aspect of the distal clavicle.
Stabilize: Abducting involved arm to 120 degrees.
LOC: S-I, A-P.
The doctor must note that if the injury has been present for greater than a three month period
fibrosis may have occurred and could have created a permanent misalignment. If this is revealed
on x-ray, adjusting the area is contraindicated.
Dr. John Minardi 137 Copyright ZOOG

l
MEDIAL-INFERIOR SCAPULA
The doctor must initially ensure that all primary, secondary and tertiary subluxations of the spine
have been asse sed and corrected. To accurately detect and correct a subluxation of the capula,
the do tor will obser e the following:
v
1. Patient presents with posterior shoulder pain which is aggravated with arm abduction past 90
degree .
2. The doctor will clinically obser ve that the involved scapula is slightly winged, and is located
on the ipsilateral side of a postural low shoulder. Physical examination will further reveal that
tati and motion palpation of the scapula produces pain, especially when assessing rotation.
3. The doctor will detect tension and tenderness located in the Rhomboids Major muscle on the
in ol ed side.
4. If the injury is caused by trauma, the doctor must x-ray to rule out the possibility of fracture or
instability. The doctor must be aware that when comparing the inferior scapular poles, a height
difference of l 5mm or more indicates instability, therefore, adjustments would be
contraindicated.
5. If no instability is present, the doctor can continue with the treatment of the subluxated
scapula. The subluxation indicates that the inferior pole of scapula has misaligned medial and
inferior, with slight protraction. (See Figure 222)
Figure 222 Medial Inferior Scapula ubluxation.
Figure 222 depicts the Medial Inferior Scapula. Note how the subluxation i ipsilateral to the low houlder (gr y arro ). , 11
as the tension within the Rhomboids Major (solid grey lines). Also note the I 5mm height difference thnt mu t be n e d to rut
out instability (dashed grey lines).
6. The biomechanics of the scapula has been described differently by a ariety of re ear her .
The movements are the same, but the descriptive terms sometime ary. The capula ha the
following basic movements:
• Elevation and Depression also referred to as Superior and Inferior.
•
Abduction and Adduction also referred to as Protraction and Retra ti n.
Upward Rotation and Downward Rotation also referred to a Lateral Rotation and
Medial Rotation (Note that the reference point for rotation is the inferior pol of th
scapula).
--�°"I.!!!' )ftlfJ_lllrwtll,--�--------� -""'=-- Copyrlght2006

. Corre tion: Prone M-1 Scapula Adjustment: See Figures 223&2_4
Patient: Prone. Affe ted arm in ··chicken Wing'· po ition.
Doctor: On affi cted ide. Facing patient.
Contact I: Web contact medial to the inferior pole of the capula.
Contact 2: Web contact on the lateral-superior aspect of the scapula.
LOC: Contact l : Lateral and Superior.
Conta t 2: Medial and Superior.
Figure 213 Medial Lnferior Scapula Correcrion. Web Contacts on the Figure 224 Medial Lnferior Scapula Correction Doctor Position. 'ote
Lnferior Pole. and Lateral Superior Aspect of the Scapula. the Patient's Affected ide in the �chicken Wing- Position.
The rotational component of the thrust will correct for the scapular rotation whereas the drop
piece will assist in the protraction of the scapula.
It is important for the doctor to be aware that this type of sublu ation can sometimes cau e a
condition called Cervico-Brachial Traction Syndrome.
• As the scapula subluxates medial and inferior, it produces traction on certain nerves
arising from the brachia( plexus, specifically the suprascapular nerve and the axillary
nerve.
• The suprascapular nerve passes through the supra capular notch of the scapula, and the
axillary nerve passes through the quadrangular space. Therefore both nerves are directly
irritated by the scapular subluxation, and will produce symptoms associated with the
function of these nerves.
The doctor must also take into consideration the slight winging of the scapula associated with
this subluxation. Therefore, the doctor must rule out any problem with the long thoracic nerve
which innervates the serratus anterior, and produces a winging scapula when compromised. The
problem with the long thoracic nerve may be associated with an original cervical syndrome thus
the doctor must correct for this primary problem before any extremity adjustment is perfonned.
Finally, the doctor should be aware that this subluxation is usually present on the same side as
the contralateral t-spine compensation of the D- (Opposite side of the original short leg).
Dr. John Minardi 139 -

HIP JOl T
1b do tor mu t initially en ure that all primary, secondary and tertiary subluxation of the pine
have been a e ed and corrected. To accurately detect and correct a subluxation of the hip, th
d tor\ ill ob er e the following:
v
I. The doctor must first be aware that most hip joint problems are usually secondary to an initial
c D- D+ IN or EX Ilium, so it is imperative that the doctor rule these out first. In many
iruations where a patient complains of hip pain, most often they are referring to their pelvi and
not the actual hip joint.
2. When the hip joint is indeed involved, the patient will present with the following clinical
ign:
Slight limp on the affected side, with a dull ache in hip socket area.
The patient complains of early muscle fatigue in the involved leg.
The patient's foot will display toeing-in or toeing-out on the affected side.
Following these clinical signs, the doctor must rule out other categories that may produce the
same signs and symptoms.
When the patient displays toeing-out, the doctor must rule out the possibility of:
Hyperactive Psoas
IN Ilium.
When the patient displays toeing-in, the doctor must rule out the possibility of:
• EX Ilium.
All three have been described in detail in previous sections.
The doctor must re-visit clinical and x-ray findings associated with these categories prior to
confirming the presence of a hip subluxation.
3. Hip Anatomy: Figure 225 displays how the head of the femur has a hallow arti ulation within
the acetabular fossa. The only structures that provide depth to the hip joint are the acetabular
labrums and the supportive ligaments surrounding the femur. The e labrum can tear or form
adhesions to which chiropractic care can be beneficial. However more re ear b on thi topic i
required.'
�whul:ir L bnim ·
Figure 225 The Hip Joint. Acetabular Labrums(gre ) pro iJ depth to

the structure.
Or. "°"" "'"-"'' 140 Copyright�

4. Correction: Internal or External Femur Adju tment: (See Figures 226-228
Patient: Supine In ol ed leg bent to 90 degrees or point of re i tance.
Table: Pel ic piece in the ready po ition.
Contact: Palmer contact on greater trochanter of femur.
Stabilize: Cradling flexed knee in internal or external rotation.
LOC: A-P.
The doctor must note that depending on whether the patient is toeing in or out the stabilizatio
hand mu t be positioned accordingly. As Figures 227 and 228 show, if the patient is toeing ou�
then the stabilization hand will be applying internal rotation into the hip joint prior to the thrust.
Conversely, if the patient is toeing in, then the stabilization hand will be applying external
rotation into the hip joint prior to the thrust.
It is important for the doctor to note that athletes over the age of 35 often developed some hip
socket adhesions along the acetabular labmms, which may limit range of motion. Thrusting
through the axis of the femur with the adjustment will serve to release those adhesions.
Figure 226 Hip Correction. Palmar Contact on Greater Trochanter of the

Femur. Cradle Flexed Knee in Internal or External Rotation.
Figure 227 Externally Rotated Hip (Toeing Out) Docto p · ote

ote the tab.1. . Hand is Under the Calf and on
1 1zat1on
r o 1·t·ion. ?
Figure 228 Internally Rotated Hip (Toeing In) Doctor p 1'tion.
et of
the LaIeral the S ta bilization Hand is Un der th e alf and n the Medial
Aspect of the Patient' Thigh. Applying Internal Rotati pe
on. the Patient's Thigh. Applying External Rotation.
Dr. John Minardi

141
SUPERIOR-LATERAL PATELLA
The do tor must initially ensure that all primary secondary and tertiary subluxations of the spine
have been a sessed and corrected. To accurately detect and correct a subluxation of the patella
the do tor will observe the following:
l. Patient presents with knee pain, which increases in intensity during stair or hill climbing.
Runners that perform a great deal of training on uneven terrain are especially susceptible to this
type of subluxation.
2. The doctor can easily reproduce the pain through palpation of the lateral aspect of the patella
and quadriceps tendon. The pain can also be reproduced through quadriceps resistance testing
during the physical examination. Muscle resistance within the quadriceps also reveals a
weakness in the Vastus Medialis.
3. If the injury is caused by impact or trauma, the doctor must take an x-ray to rule out the
possibility of fracture or dislocation. As in all cases of fracture or instability, it will be a
contraindication to adjustment and must be referred out. For clinical interest the doctor should
be aware that this subluxation pattern is often associated with Osgoode Schlatters, and will be
detected on x-ray analysis. If x-ray analysis indicates no sign of fracture or instability, the doctor
can continue to treat this subluxation pattern.
4. The patella has subluxated superior and laterally. (See Figure 229)
5. The doctor must note that spinally, this condition is usually associated with an original D+.
This has been described in great detail previously, and as the doctor is aware, the D+ subluxation
pattern indicates a PI ilium. The PI ilium causes an excessive lengthening and subsequent
neurological contraction on the quadriceps muscles, especially the rectus femoris. When there is
a weakness in the Vastus Medialis, this excessive pull subluxates the patella superior and lateral.
Normal Subluxation
Figure 229 SL
Patella.
The diagrams in Figure 229 depict how a wealcne s in the Va tus Medialis muscle (curv ed grey lines) cau es the patella to
subluxatc superior and lateral (grey arrow). The Vastus Medialis (thick black arrow) originates at the pro imal femoral shaft and
attaches to the medial aspect of the patella. Weaknes in thi muscle allows the remaining quadricep to dominate forcing the
patella lateral and superior. Vastus Mcdialis image Copyright 2003-2004 Uni c:rsity of Washington. All rights rc:ser.c:d including II ph tographs and m1:1g
No�-. �bution or commc:rcial use without prior written pc:nni ion of the authors and the: Uni\ rsiry of Wa hington

6. Correction: Superior Lateral Patella Adjustment: See Figures 230&23 l)
Patient: Supine. Affected knee placed in the cerv ical headpiece.
Doctor: On affected ide. Facing caudad.
Table: Cerv ical piece in the ready position or toggJe board under affected knee.
Contact: Web contact on uperior a pect of patella.
tabilize: Contact hand.
LOC: S-I and L-M.
Figure 230 uperior Lateral Patella Correction. Web Contact on the Figure 231 Superior Lateral Patella Correction Doctor Position.
Superior Lateral A pect of Patella. the Cervical Piece is Flexed to Relax the Quadriceps Tendon.
The doctor must note that the superior lateral patella subluxation is often associated with a
condition called Excessive Lateral Pressure Syndrome.
This syndrome causes knee pain due to lateral tracking of the patella.
When the patella tracts laterally, it results in the lateral facet of the patella grinding
excessively against the lateral femoral condyle.
This results in the destruction of the hyaline cartilage and roughening of the joint space.
The doctor must always be meticulous in detecting and adjusting the D+ prior to any correction
of the patella. After these have been corrected, an exercise program for the Vastus Medialis
should be implemented to eliminate future recurrence of this problem.
An interesting study from Montreal explored the Vastus Medialis muscle in great detail through
dissection and electromyography. 2 The researchers found that three separate groups of fibres
existed within the Vastus Medialis; proximal fibres, medial fibres and distal fibres. The study
stated that the proximal and medial fibres were inserted on a tendon common to the Rectus
Femoris, whereas the distal fibres were attached directly to the medial aspect of the patella.
Furthermore, the proximal fibres were significantly more active than the distal fibres during
maximum knee extensions. 2 The study concludes by stating that the role of the proximal fibres
is one of assisting the Rectus Femoris in knee extension, whereas the sole purpose of the distal
fibres is to track the patella medially. 2 Therefore, when patients present with a superior lateral
patella due to a weak Vastus Medialis, the rehabilitation program for the Vastus Medialis should
focus on strengthening the distal fibres.

INTERNALLY ROTATED TIBIA ORT)
Th d tor mu t initiall ensure that all primary, secondary and tertiary ubluxations of the spine
h ,e been a e ed and corrected. To accurately detect and correct a ubluxation of the tibia, the
tor \\ill ob erve the following:
l. Patient pre ent with knee and shin pain. The doctor will also palpate swelling and tendemes
al ng the medial inferior a pect of the knee joint and anterior aspect of the tibia. Thjs condition
j· mmonly connected with long distance runners, and can mimic the pain associated with srun
plints or anterior compartment syndrome.
2. The doctor -v ill take x-rays of the lower limb to rule out
any possibility of stress fractures. Upon radiological
examination the patient will have an increased Q-angle
on the affected side. The Q-angle also known as the
quadriceps angle is measured by drawing one line from
the ASIS to the centre of the patella. The doctor then
draws a second line from the tibial tuberosity up through
the centre of patella. The Q-angle is described as the angle
ofpull of the quadriceps. Normally, thls angle should be
between 15-20 degrees. (See Figure 232)
Increased tension in the quadriceps results in a decreased
Q-angle. Con ersely, decreased tension (laxity) in the
quadriceps results in an increased Q-angle.
Figure 232 Q-Angle.
3. To fully understand the mechanism of this injury, the doctor must take into consideration the
unique anatomy of the tibial plateau as well as the complex biomecharuc that occur between
the tibial plateau and the femoral condyles. The lateral aspect of the tibial plateau i round in
s hape has a shallow depth and is in direct alignment with the shaft of the femur. Howe er the
medial aspect of the tibial plateau is oval in shape, has greater depth, and i not in direct
alignment with shaft of femur. Furthermore, the doctor must also be aware of the ··Track Bound
Rotation" phenomena that occurs. Tract Bound Rotation indicates that in the fir t 30 degree of
knee flexion, the femur internally rotates, while the tibia externally rotates simultaneou ly. The
doctor should also recall that at 90 degrees of flexion, the knee is in closed pack po ition.
4. The subluxation pattern is that the tibia has internally rotated.
S. The doctor hould know that spinally, this problem is usually secondary to an original D- n
the affected side. The D- bas been described in great detail in pre iou e tion . A a brief
summary, the D- indicates an anterior inferior sacrum subluxation and c mpen ating IN
ilium. This subluxation pattern causes a lengthening and subsequent neur logi al ontra ti n f
the semirnembranosus and semitendino u muscles and inhibit the quadricep mu cl . Th
contracti on of the semimembranosus and semitendinosu muscle , a w 11 a anatomj al
Dr. John IIIIWdl Copyrlght2006

po itioning of the medial tibial plateau cause the tibia to rotate internally. The inhibition of the
quadriceps causes the increase in Q-angle observ ed with this subluxation pattern.
6a. Correction: Prone Internally Rotated Tibia Adjustment: (See Figure 233&234)
Patient: Prone with affected knee placed in the Cervical piece.
Table: Cervical piece in the ready position, or toggle board under affected knee
Contact: Palmer contact grasping proximal tibia.
Stabilize: Distal Femur with opposite hand.
LOC: P-A with External Rotation of the tibia.
Figure 233 LRT Prone Correction. Palmer Contacts Grasping Figure 234 LRT Prone Correction Doctor Po ition.
Proximal Tibia and Distal Femur. Cervical Piece Flexed to Open the Knee Joint.
6b. Correction: Modified Supine Internal Tibia Adjustment: (See Figure 235&236)
Patient: Supine, with affected knee in the Cervical piece.
Doctor: Head of table. Affected shin tucked into the doctor's thighs applying traction.
Table: Cervical piece in the ready position, or toggle board under affected knee.
Contact: Bilateral Palmer contacts grasping proximal tibia.
LOC: P-A with External Rotation of the tibia.
Figure 235 IRT Supine Correction. Bilateral Palmar Figure 236 fRT Supine Correction Doctor Po ition. ote
Contacts Grasping Proximal Tibia.
Doctor's Legs Applying Traction to the Affected Leg.
In both corrections, the doctor must ensure that the drop piece is positioned so that flexion of the
knee is implemented. By flexing the knee, the doctor takes advantage of tract bound rotation and
releases the knee from its closed pack position, optimizing the adjustment.
The doctor should also be aware that the semimembranosus has attachments to the posterior
aspect of the medial meniscus. Therefore, a D- may also be associated with recurrent meniscal
problems in addition to the internal rotation of the tibia.

TERIOR FIBUL
The doctor mu t initially ensure that all primary econdary and tertiary ubluxations of th iru
hare been a ses ed and corrected. To accurately detect and correct a ublu ation of the fibula.
v
the doctor,, ill obser e the following:
1. Patient pre ents with pain in the posterior aspect of the leg, within the area of the
gastro nenu us.
2. The patient u ually describes the mechanism of injury as a strike to the back of the leg .
ually a slash from a hockey tick).
3. Upon palpation, the doctor will disco er a lack of motion and anterior misalignm nt of the
fibular head. The doctor mu t be aware that the fibula has the ability to mo e anterior and
posterior superior and inferior as well as rotation.
4. Due to the fact that the mechanism of injury is caused by a direct impact the do tor must
ray to rule out fracture or instability. If fracture or instability exists the patient mu t be referred.
lf no sign of fracture or instability exists, the doctor can continue to treat thi ubluxati n
pattern.
5. The subluxation involved in this situation is that the fibular head has subluxated anterior,
caused primarily by the mechanism of injury. (See Figures 237&_38
Normal Subluxation
Figure 237 Lateral ie\ of ormal Figure 238 L t rat \'i , f n

Fibula. Fibul tblad, rro,, ).
6. Correction: Anterior Fibula Adjustment: (See Figure 23 _40)

Patient: Supine or Seated. Affected leg placed in th c ni al pie
Doctor: On affected ide.
Table: Cervical piece in the ready po ition or t ggl b rd und r a.ff t d are .
Contact: Thumb Pad or Thenar ontact on the anteri r a p t f th fibul� r h ct.
Stabilize: Pro imal Tibia with oppo ite hand.
LOC: A-P.
Or. John llln 1,6

Figure 239 Anterior Fibula Correction. Thumb Pad Figure 240 Anterior Fibula Correction Doctor Position. ote that a Thenar
Contact on Anterior Aspect of Fibular Head. Contact can Replace the Thumb Pad if the Doctor Prefers.
The doctor should be aware that this subluxation pattern has the ability to mimic signs of a D-, or
PRl, due to the fibular head's attachments to the Biceps Femoris.
As the fibular head subluxates anteriorly, it lengthens the Biceps femoris and causes a
subsequent neurological contraction.
Therefore, the leg may continue to pull short after proper corrections of the D- and PRI
have been performed.
If the doctor should ever run into this problem, re-visit the history to examine if this
mechanism may be involved. If the fibula has subluxated anterior! as well the leg
lengths will balance after a proper adjustment has been implemented.
Sample Case:
A 22 year old hockey player presents to the clinic with back pain and left po terior knee and calf pain folio\ ing
his hockey game two nights ago. The patient explains that he wa about to core a goal when a he \ as slashed in
the back of the leg from a player on the opposing team. The patient mentions that he ti II to the ice immediately,
but was able to continue playing after a short rest. Palpation of the area re eal t nsion in th ga trocoemius, as
well as an anterior fibula subluxation. Due to the mechani m of injury the d tor takes x-rays of the area which
show no signs of fracture or instability. Following a complete examination, Thompson Analysis re eats a short
left leg in extension and a short left leg in flexion. The doctor wi II as ess if a Cervical Syndrome is present and
correct it if necessary. The short to short leg length analysis points to a D-, so the doctor checks if specific tender
points are present. In this case, the patient had a tender point, and therefore the D- subluxation \ as corrected.
However, the patient s left leg continues to be short following the correction of the primary areas of subluxation.
Now the doctor moves to the lumbar spine. The patient's LS has subluxated posterior with spinous rotation to the
short leg side(spinous left). The doctor corrects the lumbar subluxation, howe er the patient's left leg still pulls
short. The doctor moves on to the thoracic spine, but no abnormalities are present. The doctor quickly checks if
any clean up mo es are required. A tender point is immediately located in the left soleu and gastrocnemius,
indicating the presence of a PRl. The doctor corrects the PRl, but notices that the patient's left leg continue to
pull hort. The doctor checks if any other clean up moves are required but no abnormalities are found. Because
of the patient's mechanism of injury and examination finding the doctor corrects for the left anterior fibula
subluxation. The doctor rechecks the leg lengths, which are now balanced. The patient is finished the treatment
for the day.

TEl\IPORO-MA DIBULAR JOINT (TMJ)
1. Patient pre ents with jaw pain. May also complain of ear pain or tinnitus.
2. Mechanism of injury may be direct blow to jaw, but most commonly due to recent dental
work.
3. If trauma was invol ed, the doctor must x-ray to rule out fracture or dislocation. Once these
have been ruled out the doctor can continue with the treatment.
4. The doctor will clinically observe that the patient is unable to place three fingers in their
mouth. Furthermore observ ation will also reveal that the patient's mandible will deviate to one
side upon opening of the mouth.
5. The doctor must be aware that during opening of the mouth, normal biomechanics through the
TMJ occur as follows:
• The first motion to occur is rotation (head of the mandible rotates on the meniscoid
tissue).
• The second motion to occur is translation (the meniscoid tissue translates on the articular
eminence).
6. A subluxation of the TMJ indicates that a problem exists with both sides of the jaw, howe er,
the subluxation patterns are different from one side to the other.
• For example, if a patient exhibits right deviation with opening of the mouth, this indicates
that the right TMJ is able to rotate, but has subluxated in translation. Furthermore the left
TMJ is able to translate, however has subluxated in rotation.
7. Correction: Stucky 2-Part Adjustment.

Part l: (See Figures 241 & 242)
Patient: Supine. Deviation side up.
Contact: Thumb pad on mandibular ramus.
Stabilize: Cradling head.
LOC: S-1, in line with ramus of the mandible.
148
The fir t part of this adjustment decreases the compression involved in the TMJ, and allows
translation to resume.
Part 2: (See Figures 243 & 244)

Patient: Supine. Deviation side down.
Contact: Thumb pad on mandibular condyle.
Stabilize: Opposite thumb reinforce the contact.
LOC: I-S pull.
Figure 243 TMJ Correction Part 2. Thumb Pad Contact on Mandibular Figure 244 TMJ Correction Pan 2 Doctor Position. ote How the
Condyle. Cervical Piece is Level when Adjusting the TMJ.
The second part of this adjustment will reduce the translation and allow rotation to resume.
Following the adjustment, the patient should be able to place three fingers into the mouth, and
the deviation should be significantly reduced.
Similar to all extremities, the TMJ must be assessed and corrected after the spine has been
checked and all necessary subluxations have been adjusted. Ancantara et al (3) discusses a
patient who suffered from bilateral ear pain, tinnitus, vertigo and headaches. The patient's
complaints were attributed to a diagnosis of TMJ syndrome and wa treated unsuccessfully. An
atlas subluxation was detected and corrected in the patient which resol ed the persistent
symptoms in nine visits. 3 The primary subluxation in this case was the atlas which assimilated
TMJ symptoms. This case reinforces the principle that the spine must be assessed and corrected
prior to extremity adjusting. Other research has found that the majority of indi iduals who suffer
from a TMJ disorder will also suffer from at least one otologic complaint. 4 Otalgia, tinnitus,
vertigo, and hearing loss were reported most frequently in patients suffering with TMJ disorder,
whereas individuals lacking TMJ disorder had much less incidence of these symptoms.4
Therefore, if a patient presents with otologic symptoms, the doctor must be sure to rule out any
potential problems with the TMJ, and correct them as necessary.

COD.vri.aht2DIM
E TION NIN
P DI TRI
\\eb ter' In Utero on traint Technique

Clo i Two Part Adju tm nt
Pediatric
Ca e History
Protocol for Adjusting an Infant
As e ment of the Infant
Infant eurological Reflexes and Spinal Asses ment
Pediatric Cranial Assessment and Correction

Web fer' Coronal Suture Adju tment
Pediatric Atlas Assessment and Correction

Modified Infant Toggle Board Adjustment
Pediatric A e sment and Correction of C2-C7

Modified Infant Toggle Board Adjustment
Modified Su fained ontact Adju tment
Pediatric As essment and Correction of the Sacrum

Modified Sacral Ba e Adju tment
Modified Sacral Apex Adju tment
Pediatric Assessment and Correction of the Ilium

Modified Leg Di traction Adju tment
Pediatric Assessment and Correction of the Lumbar Spine

Pediatric Assessment and Correction of the Thoracic Spine

Or. JOhn Minardi 150

Copyrlght2006
eb ter s In-Utero Constraint Technique
eb t r Techniqu i not pecific to Thompson I thought it would be

ial to includ it b fore e begin ith P diatric Adjusting. Treatment of the pregnant
pati nt i riti al to h r own pinal health a weJI a the fetu . Therefore i it fitting to begin
b ter' T chnique.
Th eb ter In-Utero onstraint Technique specifically detects and correct for
ubluxation that o cur in the pregnant mother pelvis. This technique erve to relax the pelvic
upporting tructure providing the physiological environment necessary for normal fetal
po itioning. If the subluxation complex is allowed to persist the resultant oft ti sue tension in
the pel is may produce uterine constrain. This constraint may prevent the baby from comfortably
a urning the vertex position. In addition to the increased incidence of labour and neonatal
complication associated with positions other than vertex, uterine constraint throughout the
pregnancy may lead to asymmetrical forces on the developing fetus. The longer the e
asymmetrical forces affect the fetus, the greater the potential for aberrant growth and damaging
effects.
The late Dr. Larry Webster, founder of the International Chiropractic Pediatric
Association developed this technique as a safe means to restore proper pelvic functioning in
pregnant patients. In expectant mothers presenting with uterine constraint there bas been a 75-
95% success rate of the baby turning to the normal vertex position.
Step l
Place patient in the prone position.

Flex each leg toward the patient's buttocks and locate the side of most resistence.
The side of most resistence indicates an ipsilateral posterior sacral base.
• The doctor will adjust the subluxated sacral base:
• Patient: Prone, with pregnancy pillows under stomach.
• Table: Pelvic piece set to ready position.
• Contact: Thumb pad on sacral base medial to PSIS.
Stabilization: On contact hand.
LOC: P-A, use a light thrust due to lax pelvic ligament .
There are two possibilities of what will occur after the adju tment:
A. The most resistant leg will release to equal the lea t r i tant leg (occur 80% of the time).
B. The least resistant leg will tense to equal the most re i tant leg (occurs 20% of the time).
The doctor is seeking an equalization of re i tence during leg flexion. This equalization should
take place before continuing to Step 2. As mentioned in previous section , the acral ba e cannot
ipsilaterally ubluxate posterior, with the exception of pr gnancy and newborn . During
pregnancy, there i an increa ed amount of relaxin hormone relea ed in the mother. Thi re ults
in an ex pan ion of the pelvis allowing the baby to grow, and al o pro iding the room nece ary
for the ipsilateral sacral ba e to ubluxate po terior.
Step 2
• Place the patient in a upine po 1tton.

• On the ide opposite to the acraJ adju tment draw a line 45 degree lateral and inferior

fr m the umbilicu .
Draw another line fr m the I inferior and medial 45 degree .
Where the l\\. line bi eel hold an T- c ntact with your thumb ( - unc · f pre, urc).
Rotate thumb contact from the bi ect p int 15 degree in either dire ti n until mu ·clc
ten ion i palpable.
Hold the thumb c ntact for 1-1.5 minute .
The do t r will feel the mu cle ten ion ub ide under the ntact.
top at thi point. Do not adju t another segment that day.
It i re mnmended that the patient be adju ted e ery 2-3 day for 2 , eek . The baby,h uld tum.
If during the econd or third i it there i equal leg re i tence. the doctor h uld n t pcrfi m1 thi
adju tm nt on the patient. I n thi ca e, the patient can be adju ted el e\ here al ng the ·pine
where appropriate.
PEDIATRJCS
The doctor mu t under tand that the neurological underpinning of a child is e �entinll th amc
for the adult. However, certain developmental realitie must be incorporated with the pcdi 11ri
patient and in certain in tance , the doctor will u e pa i e mo ement to elicit neur I gi nl
re pon . What make the pediatric application of thi technique unique, i the pre cncc f
infant reflexe which mu t be taken into con ideration. [t i recommended that all a c mcnt be
performed ,. ith the patient in diapers only, and to pull the diaper down when it i ncce ary t
reveal the acrum. For the child's comfort, use of a cu hion cradle is recommended during
a e ments and correction where applicable.
Ca e History
A patient's ca e hi tory i an e ential tool at any age, howe er, a pediatric patient' hi tory mu t
include que tioning that is more pecific to their situation. In the pediatric patient, the doctor
must include the following question , hile being aware of key element :
I) Was there in-utero constraint? Get the details.

Babies that experienced a trans erse lie will often suffer from an AS occiput ubluxati n.
Babies that experienced plegocephalgia - a right corkscrew exit instead of a left
corkscrew exit will often result in a rotation subluxation of CO C 1, and C2.
Babies that experienced C-Section deliveries are prone to upper thoracic ubluxarion .
2) What wa the mechani m of the injury?

• Falls on the buttocks tend to affect S2 and S3 in young children.
Without trauma upper cervical subluxation are common becau e of di pr p rtionat
head weight and immaturity of the supporting ti ue .
3) Child abu e - always remember that it exi t and know \ hat to lo k for.
More common if the child is in fo ter care.
Be aware of uncommon relation hip between parent and child.
For example, if a relation hip is too cold or too cozy should peek a do t r' intere t.
4) The doctor mu t a k about behaviours that predi po n child t ublu.xati n.

•
Stomach Jeeping predi po e the child to upp r cervical ublu ·ati n du t th
rotation of the head and neck.
It is recommended that children p on th ir bnck fr m d y one, with n pill w for the
152 Copyright 200t

fi t r thi p int a thin pillow hould be introduced.
Protocol for Pediatric djusting
I. r \Jith th child her th child i mo t at ea .

• For ampl if th child ha th mo t c mfort and ecurity in the mother' arms, then
k p th m in thi p ition.
2. D n t ru h th pr <lure.
• B ffi nt but thorough. Rushing will lead to anxiety in both the child and parent.
3. r r mo the child from the parent. The doctor's eye contact and all communication
bould be directed to the child however the parents will "listen in' and feel incorporated into
the pr dur .
• It i important to establish a rapport with the child and trust from the parents early on.
4. Ne er hold a child down or force a child into position.

• Work cooperatively with the child and parent, or the doctor will lose trust from both.
5. Don t e er have the adjustment cause the baby to cry.

Adjusting too forcefully will cause pain. Gentle adjustments are essential with a child.
6. Do not let symptoms dictate your care for the child. Perform a proper assessment and accept
the subluxations where the Thompson analysis indicates.
7. Know that the babies I children respond very quickly and at times very dramatically.
• It is common for the baby to have a bowel movement body temperature shifts or
suddenly falling asleep when sleeping has been a problem.
8. Do not adjust heavily. All adjustments should be 2 oz to 6 oz of pressure.

• The doctor must remember that the child's bones and soft tissues are immature and
cannot accept a heavy thrust.
• The child's nervous system has many survival reflexes which renders it more sensitive.
• The doctor may invoke what Webster termed a' Rebound Phenomenon", wherein
dennathermagraph readings actually worsened when high force was used. This occurred
even when the proper location and the proper vector was utilized.
9. Be Specific. The doctor must learn to adjust with the finger tips.
• Toggle adjusting works well especially when using the infant toggle headpiece.
• The doctor should only perform one or two adjustments per visit.
10. Be Patient.
• It may take months or years for the child to overcome not only the illnes , but the effect
of the medication as well.
11. The frequency for well-children check-ups is recommended to be once e ery two weeks.
• This is ba ed on research conducted by Tapio Videman (1).

Vi ualization
Man childr en ma b unable t adapt to the d t r' need during a hir pra tic s , mcnt.
Th r fore, i ualizati n ma be me ne f th primary meth d r
analy i . h ll in Ii t
d ri be fa ariet f b er ati n that can be d t ted, which m, p t nli lly indic t th·
pr en e fa ublu ati n c mple :
Head tilt:
• The ide of the rai ed ma toid can indicate either an iput r tin
n that ide.
Head and neck exten ion or flexion:

• May indicate an AS or PS occiput.
Rotation: The patient will have difficulty r tating tm ard the ide fin
• U ually related to an upper cervical or occiput ublu , ti n.
Foot flare during tanding:

• May indicate a pelvic rotation.
Bilateral toeing inward during tanding:

• May indicate a Base Posterior Sacrum or X-Ilium.
Gluteal fold
• Lower or d eper fold can indicate a po terior inti rior ilium n th t ide.
Leg rigid in exten ion:

• May indjcate increased intra cranial pre ur .
• May present a an inability of the parent to diaper the baby.
Dr. John lllnardl 154 Copyrlght2006

INFANT NEUROLOGICAL REFLEXES AND SPINAL ASSESSME T
Test How to Perform the Test Normal Response
Frontal - Facial - 5 -
Webster s Coronal Measure each Hemi-cranium. Hemi-crania are equal and
Suture Correlate large Hemi- canthi are level.
cranium with low medial
can thus.
Rooting Reflex Examiner gently strokes The infant immediately
(0-4 mos.) above the ramus of the responds with a definitive
mandible towards the mouth, movement towards the finger.
bilaterally. Assesses CNS function.
Sucking Reflex Examiner inserts a clean The examiner should feel an
(0-4 mos) finger into infant's mouth enthusiastic sucking
and lightly strokes the hard response. Also assesses CNS
palate. function.
Blink Reflex - Light and A bright light is shone into Shutting the eyes in response
Sound the eyes & sharp noise to light and sound.
(0-4 mos) produced.
Neck Righting Reflex Infant supine, the examiner The infant should rotate
(4-lO mos) rotates the infant's head to his/her trunk toward the
one side, then to the other. ipsilateral side of rotation.
Thoracic - 2 -
Symmetry of Soft Tissues Observe any differences Even folds under arms,
between the left and right nipples even, umbilicus
sides. central.
Abdominal Palpation Gentle A-P pressure with No hard or irregularly shaped
finger pads. masses should be present.
n·IPS- 2 -
Symmetry of Soft Tissues Observe any differences Symmetry from left to right.
between the left and right
sides.
Ortolani's Test Bilaterally, simultaneously No slippage or clunking
flex hips to 90 degrees. sounds.
Abduct thighs and lift greater
trochanters forward. Look for
slipping feeling in the
acetabulum or a "clunk".

In the pro css of turning th baby o, r, th follo\\ing four t II b p form d:
[re t I Ho\\ to P rforrn th
Pia ing Re p � ammer hold, th in nt 111 Th· tnf'rnl ,h uld fl· th

(0- \\,).. ) an upnght p ill n.
upp rtmg ar und the t �
ightl rub the d rmm f
t n the unde ide fa
1or R fl r tartle ammer upp n the mfant lmt1�1ll) th· ml:mt �h, ul
R flc'\ e urel in a upin p iti n )111ffi"tn ·all · I nu nJ
(0-t m \\ith b th hand undeme th. full bdu t th" 1m1,
aminer then "dr p "the bil.t' • II
infant qui kl d '"nward t
alter the p it1 n f the
infant' b d by 1-- in he .
te: ··or pping Pr e "

im Ive the d t r e urel
upp ning the child, and nly I th •
m \ ing the hild tw in he
di tan e. t no time h uld
u,.
P ra hutt= R fl The infant h uld ten l th

(4m -1)-T) h nc.1,
Im r I n st ra p the hild' thighs.

n ure th t the cont t are
ure. then gentl) lift the
h.ild up id down nd
b erve.
15,1
Te t How to Perform the Test NormaJ Response
Dorsal - Cervical - 2-
Sub-Occipital Tension Scan musculature with Should be uniform. If not
pinkie. may indicates underlying
meningeal stress.
Palpation C2-C7 Motion palpation with pinkie Should be no subluxations
applying pressure P-A. present posteriorly. A
protuberance or hard end feel
indicates a posterior vertebral
subluxation.
Dorsal - Thoracic-2-
Gallant' s test Infant in prone position. Infant should extend and
(0-8 wks) Unilaterally stroke the laterally flex the head and
paraspinal musculature from trunk towards the ipsilateral
the cervical region to the iliac side of the stimulus.
crest. Test both sides.
Palpation T2-L5 Motion palpation with pinkie Should be no subluxations
applying pressure P-A. present posteriorly. A
protuberance or hard end feel
indicates a posterior vertebral
subluxation.
Dorsal - Pelvic- 3-
Sacral Squeeze Test L-M pressure is applied Normal = Crease stays
bilaterally on the infant's midline.
bare buttocks- results in fold Deviation of the crease to the
forming at L5 that travels right or left = Ipsilateral AI
straight and cephalad. Sacrum.
Lateral Folds Test Observe. Normal = Right and Left
symmetry. A lower and
deeper fold indicates an
ipsilateral PI Ilium.
Heel to Buttock Test Child prone. Lift the child s Nonnal = Both legs have
heel to buttock one side at a equal resistance. Unilateral
time. resistance indicates ipsilateral
posterior sacrum.

PED( TRIC CRANI LA M NT ND ORR
Webster'
y
Thi rn thod wa de eloped by Dr. Larr Web ter a an a e ment nd rr ti n mtr -
rani al pre ure. The pediatric cciput repre nt a prime ry "rea f u lu oti n.
I. ing a oft mea uring tape, the doctor mea ures the hemi- r, nium fr m th nl n r
fi ntan Ile to the e ·ternal occipital protuberance. Thi i perfi rm d bilate c lly .
•. Th doctor will ob erve the presence of a low medial canthu ide .
. Wh n a low medial canthus and an enlarged hemi-cranium ar ral, thi th

d fun tion i pre ent at the coronal/squamosal uture. Th or na quam I utur i an
irr guJarly haped uture located between the frontal and parietal b n . It i the irr gul rity
th uture that allow it to subluxate in an elevated position re uJting in an nlarg d
ma urement of that hemi-cranium.
4. Correction: Webster's Coronal Suture Adjustment: (See Figure 245&24

Patient: Supine.
Doctor: Standing on either side.
Contact: Pinkie tips along the suture's border.
LOC: Gentle scissor motion. Repeat 3-4 times.
Tb doctor hould note that within two minutes the previously ob erv ed abn nn liti " ill b
markedly decrea ed.
n r
nu ub-
Dr."°"" 158
PEDIATRIC ATLAS ASSESSMENT AND CORRECTION
Just as in the adults the pediatric cervical spine denotes a primary area of subluxation.
l . The doctor will palpate the TVPs of atlas bilaterally to ensure symmetry. Under normal
circumstances, motion palpation of the inter-transverse spaces between CO Cl and C2 should
demonstrate a 1-2-3 sequence.
• A 1-2-3 sequence indicates that the inter-transverse space increases on the side opposite
of lateral flexion between CO-C1 and then C1-C2.
• For example; In left lateral flexion, the space between the occiput_ and Cl TVPs,
followed by the space between the CI and C2 TVPs will increase on the right. When this
phenomenon does not occur, it usually indicates that the atlas has subluxated.
The subluxation finding will reveal a prominence on one side indicating that the segment is
positioned lateral, superior and slightly posterior.
2. An Inversion Test is performed to confirm palpatory findings of an atlas subluxation.

• Patient: Supine.
• Doctor: Either side of table.
• Procedure: Securely grasp the infant's thighs and slowly invert the child so that the
child's head is 1-2 inches off of the table. Observe the positioning of the child's head,
and slowly return the child to the supine position.
• In normal conditions, the inversion test would reveal an infant positioned straight with no
tendency to rotate the head in either direction.
• When the atlas is subluxated, the inversion test will demonstrate that the baby s head will
rotate away from the side of the subluxated atlas.
• Prior to the doctor inverting the child, always inform the parent of the procedure.
• Have the parent assist in this manoeuver, particularly in returning the child back to a
supine position. This benefits the doctor, and encourages parental involvement.
As a clinical note, the doctor should not invert a baby who is less than l O days old (a precaution
incorporated from the Sacro-Occipital Technique). Also, do not invert a baby who is nervous or
who's parents are nervous (ask the parents to perform the test, and the doctor can still observe).
3. Palpation findings and the Inversion Test confirms that the atlas is subluxated lateral, superior
and slightly posterior.
4. Leg length analysis will demonstrate a contracted (short) leg in extension which balances with
right or left head turning, indicating that a Cervical Syndrome is present. The doctor palpates for
a nodule at the LPJ on the opposite side of head rotation. However, no nodule is present,
implicating atlas as the subluxation. Assessment and detection of an Atlas Cervical Syndrome
for a child is identical to that of an adult, explained in detail previously. However, the child must
be ambulatory for the leg check analysis to be accurate. Prior to weight bearing, assessment is
highly dependent on the inversion test and palpatory findings.
5. Correction: Infant toggle board: (See Figures 247&248)

Patient: Side posture, lesion side up. Toggle board under infant's head in ready position.
Doctor: Standing.
Contact:. Pinkie contact on lateral tip of C l TVP.
L OC: L-M, S-I. 2-6oz of pressure.

It matiw rrect1on: ( ee Figure 24 )
· Patient: eat d.
D t r: eated. pp ite id fle i n. T ggl board ar und d t r' n k.
nta t: Pinkie c ntact n I teral tip f I TVP.
: L-M, -1. .... - z ofpr ure.
Th d t r mu t note that the pinki c ntact hould be lightly p teri r, b au a traight

I t ral nta t and thru t may produce di comfort. Th lightly p terior contact ill al a i t
in rre ting the po terior component ofthe atla ubluxation.
T ha e the infant become familiar with the ight and sound of the toggle board, the do tor
sh uld open and clo e the apparatus se era! times in front of the infant. Thi will en ur that th
hild i accu tomed to the de ise.
As a clinical note the doctor should not use toggle board adju tm nt , ith a bild wh i
suffering from an acute ear infection simply because the noi e ofthe dr p pi e m hani m ·will
further irritate the child. When an infant has an atla ublu ation during an a ut enr in.fi ti n,
the doctor should implement the sustained contact alternati
6. Sustained Contact Alternative:
Locate the subluxated atlas as explained previou ly.

Contact the lateral and posterior aspect of the atla TVP, and r - n.fi r th nt t with
opposite pinkie finger.
Hold a sustained contact of 2-6 ounce of pr ure in ur tin f
The contact should be maintained for appro imat ly J ... -15 nd b n
moves.
The movement from thi contact will be more fa amt glid • th r th, n an u
mo vement.
Or. John Minard 160 Copyrlght2006

PED IA TRJC AS E ME CORREC JO O 2- 7
Just as in the adults the pediatric cervical pine denote a primary area o ubluxation.
1. Static palpation of the infant cervical spine is best performed with the infant in a relaxed
po ition against the chest of the parent, who may be eated or recumbent. eonate con ist ntly
exhibit a definjte preference of either the prone or supine position. Therefore, it i advised that
the doctor initiate the spinal examination in the position least favoured and complete it in the
position mo t fa oured.
2. Motion palpation. In the cervical spine, the parent should assist in stabilizing the infant by
firmly but gently supporting the baby's chest. When passive rotation or lateral flexion are
introduced into the head and neck, there is a propensity for the infant to roll or move in the
direction of rotation. Tbj rolling phenomenon occurs due to the neck righting reflex and
therefore parental assistance is critical.
Prior to the age of 10, the subluxations that occur in a child's cervical spine subluxate
posteriorly and ha e very little rotational component. This is due to the rapid de elopmental
change occurring within the patient's spine and articulations. Therefore, adjustments performed
in the cervical spine of a child will focus on the posteriority.
3. Leg length analysis will demonstrate a contracted (short) leg in extension which balances with
right or left head turning, indicating that a Cervical Syndrome is present. A nodule is then
palpated at the LPJ on the opposite side of head rotation. Assessment and detection of a Cervical
Syndrome for a child is identical to that of an adult explained in detail previously. Howe er the
child must be ambulatory for the leg check analysis to be accurate. Prior to v eight bearing
assessment is highly dependent on palpatory findings.
4. Correction: Prone P-A Adjustment: (See Figures 250&251)

Patient: Prone. (Can also be prone on the parent che t
Table: Cervical piece or infant toggle board in the read po ition.
Contact: Pinkie finger on the spinous process.
Stabilize: Contact with opposite pinkie finger.
LOC: P-A. 2-602 of pressure.
onta t on pinous Proce
Dr. John Minardi 161 Copyright�

2- 7 lternate u tained ontact dju tm nt:
If the doctor i ha ·ing great difficult u ing the cer v ical dr p pie e rt ggle rd fi r n child,
th do t r can utilize a u tained nt t Adju tment.( ee igure 251 b)
Patient: Pr ne. ( an al be pr n n the p rent' he t

Doct r: ither id f table.
ontact: Pinkie finger n the pin u pr c
tabilize: ntact with oppo ite pinkie ting r.
LOC: P- . 2-602 f u tained pre ure.
The do tor will hold the pinou contact in the line of corre ti n fi r ppr t ly 12-1
nd or until the doctor feel the ertebra return to it neutral p iti ment r m
thi contact will be more of a eamle glide rather than an m an b d nc
with th patient in irtually any position.
Copyright2008
PEDIATRIC SESSME T AND CORRECTION OF THE SACRUM (D-)
Tb p diatric patient pelvi i a primary area of suhluxation just as in the adult. However, the
main diffi r nc betw en ubluxation that occur in the child and tho e of the adult lies within the
acrum. In an adult. the acral ba e can only ubluxate in an anterior inferior fa hion
ip ilaterally, due to it anatomical position and articulation with the ilium. Since the child s
crum i not completely fu ed and it articulation with the ilium are not fully e tablished the
p diatric pati nt a rum can ipsilaterally ubluxate in either the anterior or posterior direction.
ote that in both adult and child the sacral base can subluxate po terior and anterior if it does
o bilat rally uch a in nutation or counter-nutation. However, ipsilaterally the sacral base of
th adult i limited to an anterior and inferior subluxation pattern). Therefore in a child the
do tor must differentiate betw n an anterior or posterior subluxated sacrum.
1. Doctor will perfom1 a ' Heel to Buttocks' test to determine if the sacral base has subluxated
po terior.
• Pati nt: Prone (within pediatric cushion or mother is supine and infant lies prone on
mother s chest and tomach).
• Doctor: Either ide of patient.
• Flex one of the patient s leg until the heel meets the buttocks then repeat for the other
leg.
• Normally the patient' heels will meet the buttocks pain free and with equal resistance.
• If one heel was not able to touch the buttock produced an increased resistance in
comparison to the opposite side, or produced pain during the test this would indicate that
the sacral base ha subluxated po terior.
2. Doctor will perform a "Sacral Squeeze' test to determine if the sacrum has subluxated
anterior inferior.
• Patient: Prone (within pediatric cushion or mother is upine and infant lies prone on
mother's chest and stomach).
• Doctor: Either side of patient.
• Squeeze the gluteal muscle together and ob erve the crease that form midline cephalad
to the buttocks.
• If the sacrum i articulating norrnaJly, the crea e formed hould point straight cephalad.
• If the crea e deviates to the left or right side this will indicate that the sacrum has
ubluxated anterior and infi rior, to the ipsilateral ide of th deviation.
3. When the pediatric patient is ambulatory, the doctor will xecute a leg length check. Leg
length analysis will indicate a short leg in exten ion which remain hort or balances in flexion.
Static palpation produces pain at one of the five trigger point tated previously which confirms
an AI Sacrum (D-) on the hort leg side.
It is important for the doctor to differentially diagno e and categorize as h I he performs these
te t.
• For example, if the pediatric patient re eals a negati e h el to buttocks test ruling out a
po terior acrum and a negative sacral squeeze te t or lack of trigger point in the leg
length analy i , then the acrum i not subluxated. Ther fore the doctor would then
move on to the lumbar pine ju t a in the adult.
4. The doctor will perform both static and motion palpation to confirm both clinical tests (and
leg length analy is when child is ambulatory).
Dr. John Minardi 163 Copyrlght200G

Sa. p0 terior a rum 'orr�ction: ( 'ec ·igurc� 25... •253)
Patient: Prone.
Do tor: 'amc side a� I 'sion.
Table: Pelvic piece or ll)gglc b ard 111 the ready positi m.
ntact: Pinkie on tact on lateral a peel<.. f the. a rat base on the affected 1d •.
: P- . 2-602 of pre �ur".
onta t on t he Figure 253 Pediatric Post nor 'acrol 13tl!>c Correction [)(x.1or Po"t• n
otc the Remfon:cd Pml..1e ontuct that the Doctor ll C\
Sb. AI acrum orrection: Su tained ontact: (See Figure 254)

Patient: Pr ne.
Doctor: ame ide a le ion.
ontact: Pink-y finger under ipsilateral sacrotuberou ligament.
LO : L-M, 1-S u tained contact. 2-6oz of pres ure. Hold contact until ten ion ub ide .
In thi correction, the doctor is u ing the acro-tuberou ligament a an anchor to et the a rum
back to it neutral po ition. Thi is the preferred adjustment for infant , due to patient c mfort.
Dr. John Mlnvdl

Copyrlght2006
PEDIATRIC E ME T ND CORRECTION OF THE ILIUM (D+)
Ju t a in th adult, the pediatri ilium denote a primary area of ubluxation.
l. Ob ervation during p dfatric e amination reveals a low gluteal fold on the involved side.
. tatic palpation of a po terior inferior (Pl) ilium is present on the low gluteal fold side.
3. Leg length anal i indicate a short leg in extension and crosses over to be long inflexion. As
tated pre iou 1 the accurac of the leg check is increased significantly when child is in weight
bearing ear . Until that time observation and palpatory analysis will be the primary detection
tool for the PI ilium in the child.
4. Ob erv ation palpation and leg length analysis indicates a D+ on original short leg side.
5. Correction: Infant D+ Adjustment: (See Figures 255&256)

Patient: Prone.
Table: Pelvic piece or toggle board in the ready position.
Contact: Pinkie Contact on the affected PSIS.
Stabilize: Applying caudal traction to involved side thigh, or stabilizing contact.
LOC: P-A. 2-6oz of pressure.
ote how the doctor's stabilization hand implements the distraction necessary for an effecti e
adjustment.
Figure 255 Pediatric Ilium Correction. Pinkie Contacts on Affected

PSI . ote that Stabilization Hand Can Reinforce the Contact, or
Distract the Thigh of the Involved Side.
It is important for the doctor to note that in a pediatric patient there i no need to perform an
Arm Fossa Test to differentiate between an upper and lower boot ubluxation a \: a nece ary
for an adult.
• In a child, the upper, more fibrous boot i not fully formed. Therefore all children with a
D+ posterior inferior ilium subluxation, will be a lower boot ubluxation. (PSIS ha gone
Pl).

PEDIATRIC A ES !VIENT AND CORRE TIO OF TH L MB R Pl
Ju ta in the adult , the pediatric lumbar pine den tes a econdary area of ubluxation.
I. The leg anal i fi r the lumbar ubluxation i extremely imilar to that of a 0-.
The patient will present with a contracted leg in exten ion. In flexion the contracted leg
balan e or tay hort.
Greater than 90% of the time, a lumbar ubluxation is econdary to an original 0- which
i the r a on that the leg length analysis is identical. When thi i the ca e, the doctor
would initiall correct for the subluxated D- a di cu ed pre iou ly then continue to
c01Tect the lumbar sublu ation.
2. The only e ception to the tatement above i if the lumbar ubluxation occurre� or remained
independent of a D-. When this is the ca e, the doctor will encounter the hort to hort leg length
phenomena de cribed pre iously however no tender point v ill be pre ent.
Lack of tender points rules out a D- sacrum subluxation, and point to a lumbar
ublu ation. In thi ca e the doctor would not adjust the acrum but would rather mo e
directly to the lumbar pine.
3. Static palpation will reveal a posterior spinou de iation. Motion palpation i a hie ed u ing a
preci e finger contact o er the interspinous space while flexion/exten ion motion i pr formed.
Thi re ea! a lack of proper joint movement and hard end feel confirming a lumbar
ubluxation.
It i important for the doctor to under tand that unlike adult an infant lumbar pme
will ubluxate posterior but will ha e no rotational component.
If the pediatric patient i non-ambulatory tatic and motion palpation would be the primary tool
to detect the lumbar ubluxation. Leg length analy i would lack accuracy before \i alking
begin .
4. Correction: P-A Lumbar Adju anent: (See Figures 257&25 )

Patient: Prone.
Doctor: Either ide of table.
Table: Lumbar piece or toggle board in the ready po ition.
ontact: Pinkie finger conta t n affected pinou proc
Stabilize: Contact with oppo ite pinkie finger.
LOC: P-A. 2-602 of pre ure.

PEDIATRlC E ME T D CORRECTIO OF THE THORACIC SPINE
Ju t a in the adult the thoracic pine r pre ent a tertiary area of ubluxation and is as e ed
and orr ted onl after the primary and econdary area of ubluxations ha e been cleared. Due
to th angl of th facet the p diatric thoracic pine subluxates posterior.
I. The doctor will begin tatic palpation of the thoracic spinous processe with the child in the
pr n po ition. If the pediatric patient is an infant having the mother supine on the table
followed by the infant prone on the mother' chest will be more comforting for the infant. This
doe not compromi e the qua lit of the examination, and ensures that the infant will cooperate
throughout th balance of the pinal e aluation. During static palpation, the doctor is as es ing
, hether an thoracic spinous proces es have subluxated posteriorly often identified as a
protuberance or hard end feel when compared to the remaining spinous processes.
-· The doctor will motion palpate the thoracic region, emphasizing posterior to anterior
mo ement. Th do tor an ha e the parent a sist by holding the chjld providing stabilization.
Motion palpation should be performed with the pinkie finger and a essing for a lack of motion
or a hard end feel.
3. Leg length anal i ould indicate that a short leg persists after primary and secondary areas
ha e been cleared. As mentioned previou ly the cruld must be ambulatory to pro ide an
accurate leg check. If the child is an infant, and non-ambulatory palpation finding will be the
primary as e ment tool. If the child is ambulatory leg length analy is will be the primary
a e ment with static and motion palpation confirming leg check findings.
4. Correction: Prone P-A Adjustment: (See Figures 259&260)

Patient: Prone (laying on top of mother if patient is an infant).
Doctor: Either ide of patient.
Table: Toggle board placed under affected area or dorsal piece in the ready position.
Contact: Pinkie finger on the affected spinous process.
LOC: P-A. 2-602 of pressure.

REFEREN E
History, Neurology & Leg Length In equality ection :
mp n Technique: a 1 \ fi rce, high ity ppr a h. T d y' hir pra t r.
-· Cooperstein, R. Thomp on Technique. hir pra tic te hnique. I 5; 7(2):6 -
3. Ja k on. R. Thomp on terminal point technique. (Sour e unknown 73-74.
.i. Guyton. Medical Phy iology Textbook 91h Ed. Chapter 54 and 56.
5. Berne R & Levy, M. Physiology 3ro Ed. Chapter 12 and 13. Mosby Year Bo k. t. Loui . I 92 .
. Thompson J.C. Thompson technique reference manual. Elgin Illinois: Thomp on educati nal
workshops Williams Manufacturing Co. 1987.
. Lebeouf C. et al. The SOT: the so-called arm fossa test. Intraexaminer agreement and p t treatment
changes. J. Aust. Chiro. Assoc. 1988. 18:67-68.
8. Hyman R.C. Table assisted adjusting: An exposition ofthe Thompson technique. Dalla .
Enchantment Publishing 1995.
9. Yochum, T. & Barry, M. Examination and treatment of the short leg. ACA Journal of Chiropractic.
1994· 29-32.
10. Aspergen� D. Short leg correction: a clinical trial ofradiographic vs. non radiographic procedures.
JMPT. 1987; 10(5):232-237.
11. Shambaugh P. et al. Reliability ofthe Thompson-Derefeild test for leg length inequality, and use of
the test to demonstrate cervical adjusting efficacy. JMPT. 1988; 11(5):65-67.
12. DeBeor K. et al. Inter and intra-examiner reliability ofleg length differential measurement: a
preliminary study. JMPT. 1983; 6(2):61-66.
13. Rhodes, W. et al. Comparison ofleg length inequality measurement methods as estimators ofthe
femur head heights differences on standing x-ray. JMPT. 1995· 18(7):448-491.
14. Rhodes, W. et al. The validity ofthe prone leg check as an estimate ofstanding leg length inequality
measured by x-ray. JMPT. 1995; 18(6): 343-346.
15. Nguyen, H. Inter-examiner reliability of activator methods' relative leg length evaluation in the prone
extended position. JMPT. 1999; 22(9): 565-569.
16. Knutson, G. Tonic neck reflexes, leg length inequality and atlanto-occipital fat pad impingement: an
atlas subluxation complex hypothesis. CRJ. 1997; 4(2).
17. Ten Brink, A. Is leg length discrepancy associated with the side ofradiating pain in patient with a
lumbar herniated disc. Spine. 1999; 24(7): 684-686.
Cervical Syndrome Sections:

I. Assendelft, WJ. et al. Effectiveness of chiropractic and phy iotherapy in the treatment of low back
pain: A critical discussion ofthe British randomized clinical trial. JMPT. 1991 · 14(5): 281-286.
Dr. John lllnanl 1U Copyright 200f

r wn aillancourt BS. Ca Rep rt: upper cervical adju ting for kne pain. RJ. 1993; 2(3):
-1
. H \\k, C. et al. hiropractic care fi r women with chronic pelvic pain: A pro pective ingle group
int rvention tudy. JMPT. 1997· 20 2): 73-77.
4. Hoiri KT. Case Report: management ofpo t-surgical chronic back pain with upper cervical
adju tments. CRJ. 19 9· 1(3): 37-42.
5. Ke t n B. Multiple ca e study offi e patients with pelvic unleveling. CRJ 1991; 2(1 : 51-56.
6. Kummel B. Nonorganic signs of significance in low back pain. Spine 1996; 21(9): 1077-1081.
7. Knut on GA. Case tudies ofupper cervical adjusting errors: the possibility ofchiropractic
iatrogenisis. CRJ. 1996· 3(3): 20-24.
8. Koes BW. et al. A randomized clinical trial ofmanual therapy and physiotherapy for persistent back
and neck complaints: subgroup analysis and relationship between outcome measures. JMPT. 1993; 16(4):
211-216.
9. Lew PC. et al. Relationship between cervical component ofthe slump test and changes in hamstring
muscle tension. Manual Medicine 1997; 2(2): 98-105.
I 0. Nansel, DD. et al. Effects ofcervical spinal adjustments on lumbar paraspinal muscle tone: evidence
for facilitation ofintersegmental tonic neck reflexes. JMPT. 1993; 16(3): 91-95.
11. Oliverio, A. Review ofthe literature: adjusting only the cervical spine and its effect on low back
pain. CRJ. 1994; 3(1): 3-6.
12. Pollard, H. & Ward, G. The effects ofupper cervical or sacroiliac manipulation on hip flexion range
ofmotion. JMPT. 1998; 21(9):611-616.
13. Pollard, H.& Ward, G. A study oftwo stretching techniques for improving hip flexion range of
motion. JMPT. 1997; 20(7): 443-447.
14. Robinson , S. Patients with chronic low back pain managed with specific upper cervical adjustments.
CRJ. 1993; 2(4): 10-23.
15. Rogers, RG. The effects of spinal manipulation on cervical kinaesthesia in patients with chronic neck
pain: a pilot study. JMPT. 1997; 20(2): 80-85.
16.. Schofferman, J. Successful treatment oflow back pain and neck pain after a motor vehicle accident
despite litigation. Spine 1994; 19(9): I 007-1010.
17. Vaillancourt, PJ. Case report: management of post-surgical low back pain syndrome with upper
cervical adjustments. CRJ. 1993; 2(3): 1-15.
18. Williams, SE. et al. A progress report ofchiropractic efficacy in the treatment oflow back pain neck
pain, headaches and related peripheral conditions. CRJ. 1989; l (3): 11-21.
19. McAviney, J. Determining the relationship between cervical lordosis and neck complaints. JMPT.
2005. 28(3):187-93.

Bilateral Cervical Syndrome, Unilateral Occiput Syndrome, Po terior Occiput yndrome
& Exception Derefield Sections:
I. Hart\vell. S. et al. Soft ti ue connection betv een rectus capitu po terior minor and the po terior
atlanto-occipital membrane: a cada eric tudy. Journal of hiropracti ducation. 20 ; 2 (I).
2. Hack, G. et al. Anatomic relation between the rectu capitu po terior minor muscle and the dura mater.
Spine. 1995. 20(23):24 4-2486.
3. Lew P. et al. The effect of neck and leg flexion and their equence on the lumbar pinal cord. Spine.
1994· 19(21): 2421-2425.
Derefield Negative and Derefield Positive Sections:
I. Gomes A. et al. Effects on hamstring stretching compared to hamstring tretching and acroiliac joint
manipulation. Clin Chiropr. 2006.9(1):21-32.
2. Charbonneau M. et al. Segmental modulation ofT and H reflexes and M wave following a chiropractic
adjustment: a pilot study. In: Proceedings ofthe International Conference ofSpinal Manipulation FCER:
Arlington VA' 393-8.
3. Cibulka, M. et al. Hamstring muscle strain treated by mobilizing the sacroiliac joint. Phys Therap.
1996.76(6):836-49.
4. Hoehler, F. et al. Low back pain and is treatment by spinal manipulation: measures of flexibility and
asymmetry. Rheumatol Rehabil. 1982. 21(1): 21-26.
5. Murphy B. et al. Sacroiliac joint manipulation decreases the H-reflex. Electromyogr Clin
Neurophysiol. 1995. 35:87-94.
6. Perrin D. et al. Comparison ofnon-ballistic active knee extension in neural slump po irion and static
techniques on hamstring flexiblity. J Orthop Sports Phys Therap. 1997. 26(1):7-13.
7. Herzog, W. et al. Electromyographic responses ofback and limb muscles associated with spinal
manipulative therapy. J Orthop Sports Phys Therap. 1993. 4: 172-176.
8. Bergman, T. et al. Chiropractic Technique Principles and Practice. Churchill Livingstone, New York·
1993.
9. Herzog, W. et al. Biomechanical studies ofspinal manipulative therapy. J Can Chirop Assoc. 1991.
35(3):156.
10. Hestbaek, L. Are chiropractic tests for the lumbo-pelvic spine reliable and valid? A y tematic critical
literature review. JMPT. 2001. 23(4):258-75.
l l. LeBoeuf, C. Sacro-occipital technique: the so-called arm fossa test. Intra-examiner agreement and
post treatment changes. J Aust Chiro Assoc. 1988.
12. LeBoeuf, C. The sensitivity and specificity ofseven lwnbo-pelvic orthopedic te t and th arm fos
test. JMPT. 1990.
13. Gomes, A. et al. A pilot study comparing the effects ofspinal manipulative therapy with tho e of
extra-spinal manipulative therapy on quadriceps muscle strength. JMPT. 2006.29(2):145-149.
14. Herzog, W. et al. Decrease in quadriceps inhibition after sacroiliac joint manipulation in patients with
knee pain. JMPT. 1999. 22(3):149-153.
15. Suter, E. et aJ. onservative low back treatment reduce inhibition in knee-extensor mu cles: a
randomized controlled trial. JMPT. 2000. 23 2 :76- 0.
16. Montgomery D. Palpable unilateral sacral prominence a a clinical sign of lower limb anisomelia: a
pilot tud . JMPT. 1995. l 6): 353-355.
Spondylolisthesis Section:
l . 'x ochum TR. & Rowe LJ. Natural History of Spondylolysis and Spondylolisthesis. ln Es ential of
Skeletal Radiology. 200 Ed. 1996. Williams and Wilkins. Baltimore, Maryland.
2. Boden SD. et al. Orientation of the Lumbar Facet Joints: Association with Degenerative Di c Disease.
Journal of Bone and Joint Surgery. 1996. 78A(3): 403-41 l .
3 . Bull, P. e t al. The Effects of Spondylolisthesis on the Lumbar Spine: A Cross-Sectional Radiological
Survey. Chiropractic Journal of Australia. 2000. 30(1):5-12.
4. Antoniades, SB. et al. Sagittal Plane Configuration of the Sacrum in Spondylolisthesis. Spine. 2000
25(9): I 085-1091.
5. Nagaosa Y. Pathoanatomic Mechanisms of Degenerative Spondylolisthesis. A Radiographic Study.

Spine. 1998. 23(13): 1447-1451.
6. Berlemann U. et al. The Role of Lumbar Lordosis, Vertebral End Plate Inclination Disc Height, and
Facet Orientation in Degenerative Spondylolisthesis. Journal of Spinal Disorders. 1999. 12(1): 68-73.
7. McGregor, AH. et al. Global Spinal Motion is Subjects with Lumbar Spondylolysis and
Spondylolistbesis. Spine. 200 I. 26(3): 282-286.
8. Ramsbacher, J. et aJ. Ultra structural Changes in Paravertebral Muscles Associated with Degenerati e
Spondylolisthesis. Spine. 200 I. 26(20): 2180-2185.
9. Moller, H. et al. Symptoms Signs and Functional Disability in Adult Spond lolisthesis. Spine. 2000.
25( 6): 683-689.
I 0. Harbaugh, K. et al. Lower Back Pain and Thigh Paresthesia in a Patient with Spondylolisthesis.
Journal of the Neuromusculoskeletal System. 1999. 7(2): 78-82.
11. Roberts, S. et al. Mechanoreceptors in intervertebral discs. Morphology distribution and

neuropeptides. Spine 1995; 20:2645-265 l .
12. McLain, RF. Mechanoreceptor endings in human cervical facet joints. Spine 1994· 495- 501.
13. Guyton. Medical Physiology Textbook, 9m Ed. 1992. Chapters 54 and 56.
14. Berne, R. & Levy, M. Physiology, 3n1 Ed. Chapters 12 and 13. 1992. Mosby Year Book.. St. Loui .
15. Vogt MT. et al. Lumbar Olisthsis and Lower Back Symptoms in Elderly White Women. The Stud
of Osteoporotic Fractures. Spine. 1998. 23(23): 2640-2647.
16. Massari, MA. Spondylolisthesis Evaluation, Management, and Long-Term Progno is. Journal of the
American Chiropractic As ociation. 1997. 34(9): 41-46.
17. Rouse, J. Spondylolisthesis: Re ponse to Chiropractic Rehabilitative Care. Journal of Sport

Chiropractic & Rehabilitation. 1996. 10(1): 41-43.

18. Al-Khav a hki, H. et al. ombined Dy plastic and lsthmic pondyloli thcsi : Po iblc ·tiology. pin
2001. 26(23): E542-546.
Extremity Sections:
I. Schemerl, M. et al. Labra I injuries of he hip: a review of diagnosis and manngmcnt. JMPT. 2004.
3(8):632-638.
2. Lefeb re, R. et al. Vastus medialis: anatomical and functional considerations and implications based
upon human and cadaveric studies. JMPT. 2006. 29(2): 139-144.
3. Alcantara, J. et al. Chiropractic care of a patient with temporomandibular disorder and atlas
subluxation. JMPT. 2002. 25( 1 ):63-70.
4. Tuz, H. et al. Prevalance of otologic complaints in patients with temporomandibular disorder. Am J

Orthod Dentofacial Orthop. 2003. 123(6): 620-623.
Pediatric Section:
I. Videman, T. Journal of Clinical Biomechanics. 1987.

The Complete Thomson Book Minardi Integrated Systems 1nbsped 0978148800 Compress

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

The Complete Thomson Book Minardi Integrated Systems 1nbsped 0978148800 Compress

Uploaded by

Copyright:

Available Formats

The Complete Thompson Textbook

Minardi Integrated Systems

Dr. John Minardi BHK, DC.

Copyright © 2006 to Present:

This book is copyrighted. All rights are reserved. Under the

ISBN: ISBN 0-9781488-0-0

Title: The Complete Thompson Textbook-Minardi Integrated Systems

Publisher I Author: Dr. John Minardi

Dr. John Minardi BHI(, DC.

Ant rior O ciput Di location X-ray i courte y of www.radiologyedu ation.com

James V. Thompson BA, DC

SECTION TWO: Primary Area - Cervical

Cervical Syndrome Review Chart 43

SECTION THREE: Primary Area - Occiput Cervical

Bilateral Cervical Syndrome 46

SECTION FOUR: Primary Area - Pelvis

Negative Derefield (D-) 60

SECTION FIVE: Secondary Area - Lumbar

SECTION SIX: Tertiary Area - Thoracic

Leg Length Analysis in the Flexed Position Review Chart 107

SECTION SEVEN: Clean Up Moves

Rotated Sacrum 109

Shoulder Complex 129

SECTION NINE: Pediatrics

Webster's In Utero Constraint Technique 151

Leg Length Analysis VaUdity

Patient Set Up on a 440 Drop Table

Patient Set Up on a Non-440 Drop Table

Weighing a Patient on a 440 Drop Table

Weighing the Patient on a Non-440 Drop Table

Proper Leg Check Procedure

Prioritization of the Spine

Using the Drop Piece Mechanism to Assist the Adjustment

Dr. John Minardi 2 Copyrlght2006

Terminal Point in Adjusting

As in all manual adjustive therapy, any contra-indications must be observed. It is

As mentioned previously, Thompson technique gives a chiropractor a systematic

Dr. John Minardi

Caitracfonofthe extrafusal f EXTRAFUSAL FIBERS:

h the f a:et capsue.

( Subluxation Alters These 4 Structures

Dr. John Minardi 7

Dr. John Minard I

8. Place the patient's arms on the arm rests.

PATIENT SET UP ON ANY DROP TABLE (without a Hi-Lo function)

4. Have patient's arms resting on the armrests.

5. Ensure that the patient's nose is centred in the headpiece.

Or. John Minardi 9

J . Set the select

I. Set the select knob to "L"

Thoracic and Lumbar Pieces Simultaneously

I. Set the select knob to "DL"

Dr. John lllrwdl 10

1. Set the select knob to "P".

Lumbar and Pelvic Pieces Simultaneously

1. Set the select knob to "LP"

WEIGHING THE PATIENT ON A NON-440 DROP TABLE

Dr. John Minardi 11

4) Be sure that the thumb applies

9) Make a mental note of which leg is contracted (short) if any.

Checking the Patient's Legs while in the Extended Position

Dr. John Minardi 13 eopyriQ/ltzaol

Using the Drop Piece Mechanism to Assist the Adjustment

Dr. John Minardi 14 Copyright2006