Segmental Drop Adjusting Protocol - DrZemelka.com
The Thompson
Technique on a Segmental Drop Table
A Short
Historical Perspective
Hippocrates and Articulations
The development of
Adjusting dates literally to the time of Hippocrates as noted in his
writings of “On the Articulations” that dates to 400 B.C.E
and his attempts at detailing the procedures of restoring motion to
the various articulations through what he referred to as
“Reduction.” Practically as old as time itself, Adjusting
the Spine is chronicled in the writings of Hippocrates.
References may
be found on the Internet at: http://www.mala.bc.ca/~mcneil/hippo1.htm
There are 87
separate descriptions on Articulations written back in 400 B.C.E. and
translated by Francis Adams. When visiting this site be sure to
review both the Articulations and Reduction sections of the web site.
Isaac
Newton and
the “Law of Inertia”
Also referred
to as Newton’s Law in previous writings of Dr. Thompson
Another portion of
history that plays an important part in the evolution of
“Segmental Drop Adjusting” is the references used by Dr. J.
Clay Thompson when presenting his work before the Hearing Committee
of the U.S. Patent office. His written testimony was examined and
when Dr. Clay attempted to verbalize the basis of Newton’s Laws
he was reminded by the Chairman that the committee was well aware of
Newton’s Law. Little did he and his attorney know at that time
that a few weeks later he would receive a “Process Patent”
on the drop system of Chiropractic Adjusting. A happy day indeed.
Here’s how
Newton plays in the equation:
Newton’s Law
states that when two particles interact in such a way that they are
accelerated, they are said to exert forces on each other.
Mass “M”
experiences acceleration “A”, creating vector
“MA”, the force acting on the body resulting in the formula
of F=MA. Whenever a body exerts a force
on
another body, the latter exerts a force
of equal magnitude and opposite direction on the former. This
is known as the weak
law of action and reaction.
For every action force, there is a corresponding reaction force which
is equal in magnitude and opposite in direction. Furthermore, the
forces are central
forces,
i.e., they act along the line joining the particles. This is
referred to as the Strong Law of Action and Reaction.
Law of Inertia:
-
A body at rest
remains at rest and a body in motion continues to move at a constant
velocity unless acted upon by an external force.
-
A force acting on
a body gives it an acceleration a
which is in the direction of the force and has magnitude inversely
proportional to the mass m
of the body: F=ma
-
Whenever a body
exerts a force on another body, the latter exerts a force of equal
magnitude and opposite direction on the former. This is known as the weak
law of action and reaction.
Let us put
into the equation the following:
The
“Thrust” is the acceleration applied along with the
“Drop Piece”, and you have created the basic function of
Newton’s Law of Inertia. The table drop piece is set to the
patient’s weight and cocked. Then the doctor places the contact
hand on the segment to be adjusted. The thrust is then applied and
this sets the body into motion that then activates the drop table
into motion as the two forces interact on one another. Then the drop
stops and the force is translated into the joint, and/or the soft
tissue of the body, producing the desired change in the joint or the
afferent b fibers of the musculature.
I don’t mean
to over simplify what has taken place over the years, but it is. The
addition of the drop has improved the way articulations may be
adjusted for the benefit of the patient and with less effort and
reaction to the patient and into the Doctor of Chiropractic’s
body, especially the wrist, arms and shoulders. This results in a
more precise directed force into the area to be affected.
Dr. B.J. Palmer
recognized the importance of the drop system and incorporated this
concept into adjusting procedures that utilized for the
“HIO” toggle adjustment accomplished in the B.J. Palmer
Clinic in the 1950s.
You will find
extensive documentation about Isaac Newton at Yahoo.com,
Search: “Isaac Newton”
The Thompson
Technique has evolved over the years to a System of Analysis and a
means of Chiropractic Adjusting that serves as a basis of Patient
Care for the Chiropractor. Dr. Clay remarked many times that he had
developed a means of adapting the Derifield Leg Analysis and
adjusting techniques to the drop table. With his discovery of the
drop headpiece and subsequently the development of the drop-adjusting
table he revolutionized the utilization of Chiropractic Adjusting
within the profession.
The basis of the
Analysis System is the Derifield Leg check built around the
disclosure of the Five Basic Categories. The neurological basis is
rooted in the Inhibitory/Facilitory System of the brain found in the
Reticular Formation that affects the balance needed to maintain the
body in relationship to earth’s gravity.
Leg Length
Analysis Procedure
The
Derifield-Thompson Leg Check Analysis serves as a method to gain data
used in analyzing the patient to determine what articulation or area
may need to be adjusted. This information is part of the
“Data” gathered by the Doctor of Chiropractic to develop a
decision as to what area to adjust. Data may also include history,
physical examination, x-rays, ortho-neuro examination and laboratory results.
K.F. Wells, second
edition of Kinesiology, refers to the short leg as the
“contractured leg”, which is descriptive of a
neuro-pathological relationship seen in many patients. The term
“contractured leg" emphasizes the origin of the
neurological imbalance, which appears as an innervation spasticity.
This occurs when various muscles are over stimulated.
This overstimulation results in a leg length differential that is
visually evident and is measurable.
The “Key”
to the short leg analysis system is understanding the biomechanical
function that takes place in the Ilium, when the patient is in the
prone position. The three points that act as a fulcrum are: the
sacroiliac level; the mid portion of the mass of the Ilium; and the
acetabular level.
The Fulcrum Concept
The change in the
length of the leg is not due to a physical length change of the limb;
on the contrary it is caused by the Ilium rotating around a fulcrum.
The “See Saw” effect is exhibited in the variation of the
limb length, when an imbalance is caused by a change in the neuronal
component from the reticular formation. This neuronal change affects
the muscular state of the affected limb, causing the “short leg”.
Contraindications
Contraindications
to application of Leg Analysis to a patient may involve a congenital
short leg, history of broken, poorly mended limb, implanted
prosthesis in the hip or knee and degeneration of the acetabular
cavity, all of which should be found on your initial examination of
the patient.
Analysis System
There are five
basic categories we will deal with in the Derifield-Thompson Analysis
System. They are:
-
Negative Derifield
-
Positive Derifield
-
Cervical Syndrome
-
X-Derifield
-
Bilateral
Cervical Syndrome
Refer
to graphic representation of the Leg Analysis System (at
bottom of page)
Patient
Placement: Prone
It is important
that you do not shake the legs or place excessive pressure into the
acetabular cavities of the femur and to carefully lift the legs
slightly off the leg rest. By lifting the legs off the footrest you
will reduce the friction allowing the legs to move more freely.
When conducting
the Leg Check it is recommended having the shoes on the patient, so
as to have a common reference point of the seam where the heel and
shoe are joined.
When performing
the Leg Check be sure to keep the patient’s feet slightly apart,
about ¼ to ½ inch, and sight through the area where the
heel attaches to the shoe. Take out the eversion and inversion being
careful not to dorsi flex or plantar flex the feet. Place the thumbs
in front of the heel and wrap the fingers around the feet. Depending
on the size of your hands and the patient’s feet, you may have
to alter this slightly. By keeping the thumbs under the heel you will
prevent the shoe from lifting away from the feet, giving you a more
precise measurement of the leg length.
The Doctor’s
stance is very important in order to obtain dependable information
from your examination. The Doctor’s feet should be shoulder
width apart with the knees bent and close enough to the base of the
table to lift the legs into flexion without shifting position. If you
have a Lloyd 900HS elevation table as shown in the example, raise the
patient, bend the knees, and tilt your pelvis and arch your lumbars
to reduce stress on your own spine. Sight up between the
patient’s feet across the gluteal fold and to the EOP.
A
Note on Cervical Analysis
When having your
patient turn their head for the Cervical Analysis have the patient
place their head in a resting position and not hold the head off the
table. The pictures show the correct method of turning the head on a
level headpiece. The headpiece is tilted down 10 to 15 degrees when
the adjustment is performed.
Protocol for
the Thompson Technique
The basis of an
analysis system is the ability to derive information that can be used
to assist in the decision making process. The decision to adjust a
specific area and the probable outcome to expect, is an important
consideration when working with the Derifield-Thompson System of Analysis.
The gathering of
information is accomplished by the incorporation of clinical tests
spanning orthopedic and neurological exams administered by the doctor
or an assistant. The Derifield-Thompson Analysis System is used to
focus on the specific area to be adjusted through the use of the
“Leg Analysis”, coupled with the other data gathered on the
patient through the entire clinical examination. This may also
include X-ray, Video Motion X-ray, (VMX), Thermal scan, SEMG, and
Laboratory findings.
Once you have
chronicled your patient data and recorded it on your examination
forms you proceed to the “Leg Analysis” to aid you in
making your decision. This is referred to as the “Triage
Method” to sort, sift and select from the information derived on
the patient. By clustering information, you will be capable of coming
to a conclusion on what care to render to the patient. Clustering
gives the doctor the ability to prioritize groups of information in
order to address the problems in order of importance.
There are three
categories under which a doctor may find that a patient may be presented:
-
Emergent –
care is needed at once
-
Urgent –
care can wait a few hours
-
Non-Urgent – no hurry at all
Algorithm:
a rule or procedure for solving a problem that frequently involves
repetition of an operation - Merriam-Webster Dictionary
With the addition
of an “Algorithm” format you take the results of one test
or piece of information and apply it to your list in order to
eliminate large portions of the overall structure. This then directs
you to follow only one path. The aim is to formalize the diagnostic process.
Algorithms say:
given this, do that; being more directive in seeking a diagnosis,
algorithms do not require mathematical computations and are a great
help to the clinician in formalizing the thinking process to arrive
at a decision as to care to be rendered.
An example of this
style of patient care is best demonstrated utilizing the
“Decision Tree” process found in the Thompson Manual
authored by yours truly. This decision path concept leads you to
narrow the problem list and focus on what you determine to be the
major problem.
The decision path
method is similar to the diagnostic path method except it deals with
only one branch and screens the information to a more narrow focus.
This enhances the decision process in that items not directly related
to the problem are eliminated. Once the decision has been made to
proceed with conservative chiropractic care, the information clusters
are reviewed and care is based on this information.
Multiple Thrust Adjusting
The concept of
multiple thrust low force adjustment of joints is enhanced with the
addition of drop sections on the segmental adjusting table. The
reasoning is based on Newton’s Second Principle, in that when
two objects fall through space the energy generated in object number
one is transferred to the second object and is enhanced at the moment
of contact as the drop piece enters the equation. The force induced
by the chiropractor’s thrust into the joint space is enhanced
with the addition of the drop mechanism. Three or four quick thrusts
overcome the body’s inherent capacity of the “Fight or
Flight Mechanism, giving rise to the concept that the patient will
relax more readily as the Doctor of Chiropractic performs the
adjustment process. In the event you feel the segment move on the
first or second adjustment then cease adjustment of the segment.
The Decision
Tree Concept and its Application to the DERIFIELD-THOMPSON Analysis System
Visualize the
function of the Central Facilitory and Inhibitory mechanisms.
Normally the Facilitory mechanism increases the normal spinal stretch
reflex, while the inhibitory mechanism decreases the reflex.
These systems
constantly react to proprioceptive input to the cerebral cortex,
cerebellum, and brain stem to maintain postural balance. The cortex
stores normal values of body function, while the actual state of the
body is monitored and compared to the cortical data by the cerebellum
and hypothalamus.
Structural
imbalance (whether a subluxation or fixed joint) is displayed in the
cerebellar/cortical system as increased input from the ascending
cerebellar efferent fibers. The inhibitory influences are prevented
from modifying the facilitory influences, which now unopposed, result
in innervational overload, exaggerated spinal reflex, and a
contractured leg.
Depending on the
nature of the misalignment (cervical, pelvic, etc.), the contractured
leg displays different characteristics, identified by both objective
and subjective findings. Thompson Technique categorizes these
findings as either Positive Derifield, Negative Derifield, Cervical
Syndrome, Bilateral Cervical Syndrome, or the X-Derifield readings in
the leg length displayed.
Graphic
Representation of the Leg Analysis System
Five
Categories consist of:
.......EXTENSION................ .............FLEXION
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NEGATIVE DERIFIELD
One leg is short in extension and when brought into flexion the short leg stays short. Additionally, the Negative Derifield will also display trigger points at the pubic tubercle, medial knee, PSIS, and the posterior ischium.
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POSITIVE DERIFIELD
One leg is short in extension, and when placed in flexion the short leg becomes longer than the other. Remember the short leg in extension is the involved leg. Muscular tension is evident when moving legs into flexion.
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CERVICAL SYNDROME
Rotation of the head to the left or right will cause the short leg to come even or cross over and become longer. If the head is turned to the right and the short leg becomes longer, a nodular mass will be found on the left side of the cervicals at the lamina pedicle junction of the involved vertebrae.
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X-DERIFIELD
Legs appear level in extension. Upon flexion, one leg will shorten. With legs in flexion, have patient rotate head to left and to right. If short leg comes even or crosses over it is a Cervical Syndrome. If no change in head rotation, it will be a Negative Derifield. Check for trigger points... if no trigger points, look to L-5 lumbar rotation.
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BILATERAL CERVICAL SYNDROME
Legs are level in extension and flexion. With the legs in extension, have the patient rotate the head, turning head to the right causes the right leg to shorten. Rotation of the head to the left results in the left leg shortening. A nodular mass may be found at the base of the occiput bilaterally. In reality the BCS is an occipital problem likened to an "AS" Occiput. |
References
Wells, Katherine
F. Kinesiology; The anatomic and Mechanical Fundamentals of Human
Motion illustrated. 2d ed. Philadelphia: Saunders, 1955.
Guyton, Arthur C.
Textbook of Medical Physiology, 7th
ed. Philadelphia: Saunders, 1986
Travell, Janet G.,
et al. Myofacial Pain & Dysfunction: The Trigger Point Manual,
Baltimore: Williams & Wilkens, 1983
Zemelka, Wayne
Henry , The Thompson Technique; With a special section on Gonstead
and Diversified Adjusting on the Segmental Drop Table: Multiple
Interest Services Corporation; Victoria Press, 1992
Check
the dates