Pelvic Drop Table Technique

(1)

All materials contained in this PowerPoint Presentation are protected by copyright laws, and may not be reproduced, republished, distributed, transmitted electronically, displayed, broadcast or otherwise exploited in any manner without the express prior written permission of Howard Pettersson, DC.

Howard Pettersson, DC, either owns the intellectual property in all the information and media in this PowerPoint Presentation or has obtained permission of the owner to use the content in this presentation. You may download or print this material for your own personal and educational use only, without altering or removing any trademark, copyright or other notice from such material.

Viewing this PowerPoint Presentation constitutes explicit agreement with the terms of this copyright declaration.

Pelvic Drop Table Technique

Pelvic Drop Table Technique is a synthesis of concepts

and ideas from Thompson, Gonstead, and Activator

chiropractic techniques. Chiropractic procedures

from each of these techniques are blended together

to create a fluid, easy to learn method for analyzing

and adjusting the pelvis. Participants will come away

with a deeper appreciation for integration of

chiropractic techniques.

Pelvic Drop Table Technique

•

Positive Derifield

–Thompson

•Derifield Leg Check •Pelvic Drop Table Adjusting

–Gonstead

•SI Fluid Motion (Palmer Gonstead)

–Activator

•Articular Pressure Testing

(2)

POSITIVE DERIFIELD LEG CHECK

PI ILIUM on the Left

Left SI Fluid Motion

LEFT SI FLUID MOTION Apply a firm continuous pressure S-I, P-A, and medial-to-lateral through the joint plane into the table.

If both legs lengthen simul-taneously, then the sacroiliac joint on the side tested is fixed. This test indicates sacroiliac joint fixation for any one of the six primary pelvic listings. Copyright © 2014 Howard Pettersson

INITIAL DERIFIELD LEG CHECK

Perform the Initial Derifield Leg Check. If Positive Derifield is presented, continue with the Positive Derifield Protocol.

Initial Derifield Leg Check has been adapted from:

Fuhr AW, et al. Activator methods chiropractic technique, second edition, St. Louis: Mosby-Elsevier, 2009.

(3)

ANKLE INVERSION Typically ankle inversion is noted on the side of the short leg in the prone extended position. (Potential left short leg). If ankle inversion is on the side opposite the short leg in the prone position, it may be due to a previous ankle inversion sprain. Ask the patient about their past history.

Note the left short leg in the prone extended position.

Left Positive Derifield The left short leg in the prone extended position crossed over and became long in the flexed position indicating Left Positive Derifield.

(4)

POSITIVE DERIFIELD /

PI

ILIUM

•

Positive Derifield usually indicates

PI

ilium on the

short leg side in the prone extended position.

•

PSIS palpates relatively inferior to the PSIS on the

opposite side.

•

Ischial tuberosity palpates relatively anterior to the

ischial tuberosity on the opposite side.

PI

ILIUM STATIC PALPATION

•

PSIS palpates relatively inferior to

the PSIS on the opposite from both

the inferior and superior aspects.

PI

ILIUM STATIC PALPATION

Copyright Howard Pettersson 2010

Left inferior PSIS Right superior PSIS

(5)

PI

Copyright Howard Pettersson 2010 Right superior PSIS

Left inferior PSIS

PI

ILIUM STATIC PALPATION

•

Ischial tuberosity palpates relatively

anterior to the ischial tuberosity on

the opposite side.

PI

Left anterior ischial tuberosity

(6)

PI

Ilium Articular Pressure Test

•

Articular pressure test* in the direction of correction

to confirm

PI

ilium.

•

Typically the sacrum is relatively

PI

ilium intersegmentally.

* Haas M, Peterson D, Panzer D, Rothman E, Solomon S, Krein R, et al. Reactivity of leg alignment to articular pressure testing: evaluation of a diagnostic test using a randomized crossover clinical trial approach. J Manipulative Physiol Ther. 1993;16(4):220-7.

* Khauv KB, John C. Health-related quality of the improvements in adult patients with chronic low back pain under low-force chiropractic care: a practiced-based study, Chiropr J Aust. 2011; Dec;41(4):118-122. * Fuhr AW, et al. Activator methods chiropractic technique,second edition.

St. Louis: Mosby-Elsevier, 2009.

Confirm Left PI Ilium Apply an inferior-to-superior pressure on the PSIS with the superior hand, and a superior-to-inferior pressure on the sacral ala (S2 – S3) with the inferior hand. Apply both pressures simultaneously.

If the legs become even in the prone extended and 90 degree flexion positions upon articular pressure testing, adjust for Left PI Ilium.

(7)

Correct for

Left

PI

Ilium

SCP: Medial-inferior PSIS CP: 1b – hook of the hamate LOC: I-S and P-A

Stab: Place cupped fingers under right ASIS.

Post-Adjustment Leg Check: The legs should become even in the prone extended and 90 degree flexion positions after adjusting for Left PI ilium.

LEFT SI FLUID MOTION Post Ajustment: The leg on the side tested should now lengthen while the leg on the opposite side remains stationary indicating that the sacroiliac joint on the side tested is now freely moveable.

The foot of the stationary leg may demonstrate moderate toe-out foot flare, which is considered a normal variant.

(8)

POSITIVE DERIFIELD LEG CHECK

AS ILIUM on the Right

Right SI Fluid Motion

RIGHT SI FLUID MOTION Apply a firm continuous pressure S-I, P-A, and medial-to-lateral through the joint plane into the table.

If both legs lengthen simul-taneously, then the sacroiliac joint on the side-tested is fixed. This test indicates sacroiliac joint fixation for any one of the six primary pelvic listings. Copyright © 2014 Howard Pettersson

INITIAL DERIFIELD LEG CHECK

Perform the Initial Derifield Leg Check. If Positive Derifield is presented, continue with the Positive Derifield Protocol.

Initial Derifield Leg Check has been adapted from:

Fuhr AW, et al. Activator methods chiropractic technique, second edition, St. Louis: Mosby-Elsevier, 2009.

(9)

ANKLE INVERSION Typically ankle inversion is noted on the side of the short leg in the prone extended position. (Potential left short leg). If ankle inversion is on the side opposite the short leg in the prone position, it may be due to a previous ankle inversion sprain. Ask the patient about their past history.

Note the left short leg in the prone extended position.

Left Positive Derifield The left short leg in the prone extended position crossed over and became long in the flexed position indicating Left Positive Derifield.

(10)

POSITIVE DERIFIELD /

AS

ILIUM

•

Positive Derifield usually indicates

AS

ilium on the

long leg side in the prone extended position.

•

PSIS palpates relatively superior to the PSIS on the

opposite side.

•

Ischial tuberosity palpates relatively posterior to the

ischial tuberosity on the opposite side.

AS

ILIUM STATIC PALPATION

•

PSIS palpates relatively superior to

the PSIS on the opposite side from

both the inferior and superior

aspects.

AS

Left inferior PSIS Right superior PSIS

(11)

AS

Left inferior PSIS

AS

ILIUM STATIC PALPATION

•

Ischial tuberosity palpates posterior

relative to the opposite side.

AS

Right posterior ischial tuberosity

(12)

AS

Ilium Articular Pressure Test

•

Articular pressure test* in the direction of correction

to confirm

AS

ilium.

•

Typically the sacrum is relatively

posterior

to the

AS

ilium intersegmentally.

* Haas M, Peterson D, Panzer D, Rothman E, Solomon S, Krein R, et al. Reactivity of leg alignment to articular pressure testing: evaluation of a diagnostic test using a randomized crossover clinical trial approach. J Manipulative Physiol Ther. 1993;16(4):220-7.

* Khauv KB, John C. Health-related quality of the improvements in adult patients with chronic low back pain under low-force chiropractic care: a practiced-based study, Chiropr J Aust. 2011; Dec;41(4):118-122. * Fuhr AW, et al. Activator methods chiropractic technique,second edition.

St. Louis: Mosby-Elsevier, 2009.

Confirm Right AS Ilium Apply a superior-to-inferior pressure on the upper part of the ischial tuberosity with the superior hand, and an inferior-to-superior pressure on the sacral ala (S1 – S2) with the inferior hand. Apply both pressures simultaneously.

If the legs become even in the prone extended and 90 degree flexion positions upon articular pressure testing, adjust for Right AS Ilium.

(13)

Correct for Right

AS

Ilium

Right

AS

Ilium

CP:Dual: Superior contact hand use CP #11 (heel of the hand), and inferior contact hand use CP #10 a & b (Thenar). SCP: Dual: Superior contact hand on the ischial tuberosity, and inferior thenar on the right sacral ala at the level of S1-S2. Stab: Not applicable.

LOC: Superior contact hand S-I & P-A, and inferior contact hand I-S & P-A. Proc:Find the proper tension setting on the table for the patient. Place contact hands on their respective points. Three short quick thrusts are given in accordance with the LOC with the lumbar and pelvic pieces being cocked before each thrust. PP: The anterior superior iliac spines are placed

just above the superior edge of the pelvic piece. DS: Straight away on the same of involvement.

Post-Adjustment Leg Check: The legs should become even in the prone extended and 90 degree flexion positions after adjusting for Right AS Ilium.

(14)

RIGHT SI FLUID MOTION Post Ajustment: The leg on the side tested should now lengthen while the leg on the opposite side remains stationary indicating that the sacroiliac joint on the side tested is now freely moveable.

The foot of the stationary leg may demonstrate moderate toe-out foot flare, which is considered a normal variant.