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. Students will come away with a deeper appreciation for integration of chiropractic techniques. Copyright 2015 Howard Pettersson Pelvic Drop Table Technique Negative Derifield Thompson Derifield Leg Check Pelvic Drop Table Adjusting Gonstead SI Fluid Motion (Palmer Gonstead) Walking in Place for IN / EX (Gonstead Methodology Institute) Activator θy-axis Isolation Test Articular Pressure Testing 1
NEGATIVE DERIFIELD Scenario #1 Posterior Rotation of the Sacrum 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 simultaneously, 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. INITIAL DERIFIELD LEG CHECK Perform the Initial Derifield Leg Check. If Negative Derifield is presented, continue with the Negative 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. 2
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 side of the short leg in the prone extended position (left short leg). If the left short leg in the prone extended position stays short when flexed to 90 degrees, the initial leg check indicates Left Negative Derifield. Negative Derifield confirms a θy-axis misalignment of the pelvis EX Ilium, Posterior Rotation of the Sacrum, IN Ilium, or Anterior Rotation of the Sacrum. Next, perform the Left θy- Axis Segmental Dysfunction Test for the Pelvis. Thompson Educational Workshops. The thompson technique reference manual. Elgin, IL: 1984. 3
To perform the Left θy-axis Segmental Dysfunction Test for the Pelvis, instruct the patient to lock the knee on the side tested. Next, extend the lower extremity at the acetabular hip to its end range. And finally, extend the hip into resistance a few degrees to engage the sacroiliac joint on the side of involvement. Note the left short (indicator) leg in the prone extended position. Left θy-axis Segmental Dysfunction Test Left Posterior Rotation of the Sacrum If the reactive (indicator) leg stays short in the prone extended position and the leg on the side tested (left) becomes long when the legs are flexed to 90 degrees, pressure test for Left Posterior Rotation of the Sacrum and left EX Ilium. 4
Pressure test* for Posterior Rotation of the Sacrum. Apply a Posterior-to-Anterior and Medial-to Lateral Pressure. To pressure test for Left Posterior Rotation of the Sacrum, apply a posterior-toanterior and medial-tolateral pressure on the left sacral ala just lateral to the first and second sacral tubercles. *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. If the legs become even in the prone extended position and flexed position upon pressure testing, adjust for Left Posterior Rotation of the Sacrum. Correct for Left Posterior Rotation of the Sacrum. CP: #1b hook of the hamate SCP: Between S2 tubercle and PSIS Stab: Wrap around stabilization Deliver a straight P-A thrust through the sacroiliac joint space. The LOD is P-A & medial-to-lateral through the sacroiliac joint space. Copyright 1999 & 2014 Howard Pettersson 5
Post-Adjustment Leg Check: The legs should become even in the prone extended and 90 flexion positions after adjusting for Left Posterior Rotation of the Sacrum. 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. Left SI Fluid Motion The foot of the stationary leg may demonstrate moderate toe-out foot flare, which is considered a normal variant. Copyright Howard Pettersson 2014 NEGATIVE DERIFIELD FLOWCHART Left SI Fluid Motion Fixation Right or Left Negative Derifield Leg Check confirms a θy-axis misalignment of the pelvis Posterior Rotation of the Sacrum, EX Ilium, IN Ilium, or Anterior Rotation of the Sacrum. Perform the Left θy-axis Segmental Dysfunctional Test for the Pelvis. If the side tested flexed leg becomes long, Articular pressure test for P-L and Left EX Ilium. If the legs become even in the extended and flexed positions Upon articular pressure testing for P-L, adjust P-L. The legs should be even in the extended and flexed positions upon post-adjustment Derifield leg check, and post-adjustment Right SI Fluid Motion should now be freely moveable. 6
NEGATIVE DERIFIELD Scenario #2 EX Ilium Walking in Place: Instruct the patient to line the tips of their shoes on the yellow line. Next, instruct the patient to place their fingertips on the wall to stabilize themselves while they walk in place. Walking in Place: Instruct the patient to close their eyes and walk in place for 30 seconds. After 30 seconds, instruct the patient to stop. Next, observe the position of their feet. Look for relative toe-in and toeout foot flare. Also, note whether one foot is in front of the other. If one foot is in front of the other, and also has relative toe-in foot flare; this may indicate potential EX Ilium on that side. 7
EX ILIUM ANECDOTAL FINDINGS The patient may experience sciatic-like pain down the back of the thigh. Copyright Howard Pettersson 1999 EX ILIUM VISUALIZATION Observe the contour of the gluteal musculature that extends about two inches laterally from the PSIS. This strip of muscle, normally about two inches wide, appears narrow and hunched compared to the opposite side. Copyright Howard Pettersson 1999 Right Gluteal Hunching Note the right gluteal hunching and the left gluteal flattening. Gluteal hunching is a visual finding for EX Ilium. Right Left Copyright 2015 Howard Pettersson 8
EX ILIUM TRIGGER POINTS The gluteus medius trigger points may be tender upon palpation. One is located two inches, and the other four inches lateral of the PSIS, respectively. These trigger points may be present even though the problem may be an IN ilium on the opposite side. Copyright Howard Pettersson 1999 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 simultaneously, 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. INITIAL DERIFIELD LEG CHECK Perform the Initial Derifield Leg Check. If Negative Derifield is presented, continue with the Negative 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 side of the short leg in the prone extended position (left short leg). If the left short leg in the prone extended position stays short when flexed to 90 degrees, the initial leg check indicates Left Negative Derifield. Negative Derifield confirms a θy-axis misalignment of the pelvis EX Ilium, Posterior Rotation of the Sacrum, IN Ilium, or Anterior Rotation of the Sacrum. Next, perform the Right θy- Axis Segmental Dysfunction Test for the Pelvis. Thompson Educational Workshops. The thompson technique reference manual. Elgin, IL: 1984. 10
To perform the Right θy-axis Segmental Dysfunction Test for the Pelvis, instruct the patient to lock the knee on the side tested. Next, extend the lower extremity at the acetabular hip to its end range. And finally, extend the hip into resistance a few degrees to engage the sacroiliac joint on the side of involvement. Note the left short (indicator) leg in the prone extended position. Right θy-axis Segmental Dysfunction Test Right EX Ilium If the reactive (indicator) leg stays short in the prone extended position and the leg on the side tested (right) becomes long when the legs are flexed to 90 degrees, pressure test for Right EX Ilium and right posterior rotation of the sacrum. 11
Pressure test* for Right EX Ilium. Apply an arcing tissue pull, roll in from inferior-to-superior and lateral-to-medial against the lateral, inferior aspect of the PSIS to pressure test for Right EX ilium. *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. If the legs become even in the prone extended position and flexed position upon pressure testing, adjust for Right EX Ilium. Correct for Right EX Ilium. Elbow-in torque Apply a straight down P-A stabilization. Perform an arcing tissue pull, roll in from I-S, and lateral-tomedial until 10b (proximal thenar green dot) butts up against the bony ridge separating the iliac ala from the PSIS. Utilize a curvilinear thrust I-S, P-A, and lateral-to-medial. The elbow is torqueing in from lateral-to-medial up the articulation. 12
Post-Adjustment Leg Check: The legs should become even in the prone extended and 90 flexion positions after adjusting for Right EX Ilium. 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. Right SI Fluid Motion The foot of the stationary leg may demonstrate moderate toe-out foot flare, which is considered a normal variant. Copyright Howard Pettersson 2014 NEGATIVE DERIFIELD FLOWCHART Right SI Fluid Motion Fixation Right or Left Negative Derifield Leg Check confirms a θy-axis misalignment of the pelvis Posterior Rotation of the Sacrum, EX Ilium, IN Ilium, or Anterior Rotation of the Sacrum. Perform the Right θy-axis Segmental Dysfunctional Test for the Pelvis. If the side tested flexed leg becomes long, Articular pressure test for P-R and Right EX Ilium. If the legs become even in the extended and flexed positions Upon articular pressure testing for Right EX Ilium, adjust Right EX Ilium. The legs should be even in the extended and flexed positions upon post-adjustment Derifield leg check, and post-adjustment Right SI Fluid Motion should now be freely moveable. 13
NEGATIVE DERIFIELD Scenario #3 IN Ilium IN ILIUM ANECDOTAL FINDINGS The patient may experience inguinal area/groin pain. If the pain is severe it may radiate a short distance into the anterior-medial thigh. In some cases testicular pain may also be present. Copyright Howard Pettersson 1999 Walking in Place: Instruct the patient to line the tips of their shoes on the yellow line. Next, instruct the patient to place their fingertips on the wall to stabilize themselves while they walk in place. 14
Walking in Place: Instruct the patient to close their eyes and walk in place for 30 seconds. After 30 seconds, instruct the patient to stop. Next, observe the position of their feet. Look for relative toe-out and toein foot flare. Also, note whether one foot is behind the other. If one foot is behind the other, and also has relative toe-out foot flare; this may indicate potential IN Ilium on that side. IN ILIUM VISUALIZATION Observe the contour of the gluteal musculature that extends about two inches laterally from the PSIS. This strip of muscle, normally about two inches wide, appears flattened compared to the opposite side. Copyright Howard Pettersson 1999 Left Gluteal Flattening Note the right gluteal hunching and the left gluteal flattening. Gluteal flattening is a visual finding for IN Ilium. Right Left Copyright 2015 Howard Pettersson 15
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 simultaneously, 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. INITIAL DERIFIELD LEG CHECK Perform the Initial Derifield Leg Check. If Negative Derifield is presented, continue with the Negative 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. 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. 16
Note the side of the short leg in the prone extended position (left short leg). If the left short leg in the prone extended position stays short when flexed to 90 degrees, the initial leg check indicates Left Negative Derifield. Negative Derifield confirms a θy-axis misalignment of the pelvis EX Ilium, Posterior Rotation of the Sacrum, IN Ilium, or Anterior Rotation of the Sacrum. Next, perform the Left θy- Axis Segmental Dysfunction Test for the Pelvis. Thompson Educational Workshops. The thompson technique reference manual. Elgin, IL: 1984. To perform the Left θy-axis Segmental Dysfunction Test for the Pelvis, instruct the patient to lock the knee on the side tested. Next, extend the lower extremity at the acetabular hip to its end range. And finally, extend the hip into resistance a few degrees to engage the sacroiliac joint on the side of involvement. 17
Note the left short (indicator) leg in the prone extended position. Left θy-axis Segmental Dysfunction Test Left IN Ilium If the reactive (indicator) leg stays short in the prone extended position and the leg on the side tested (left) becomes short when the legs are flexed to 90 degrees, pressure test for Left IN Ilium and left anterior rotation of the sacrum. Pressure test* for IN Ilium. Apply an arcing tissue pull, roll in from superior-toinferior and medial-tolateral against the medial PSIS to pressure test for Left IN ilium. *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. 18
If the legs become even in the prone extended position and flexed position upon pressure testing, adjust for Left IN Ilium. Elbow-out torque Left IN Ilium Perform an arcing tissue pull, roll in from S-I and medial-tolateral until 1b (hook of the hamate green dot) butts up against the medial aspect of the left PSIS. Utilize a medial-to-lateral and slight P-A line of correction. The elbow is torqueing out from medial-to-lateral down the articulation. Post-Adjustment Leg Check: The legs should become even in the prone extended and 90 flexion positions after adjusting for Left IN Ilium. 19
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. Left SI Fluid Motion The foot of the stationary leg may demonstrate moderate toe-out foot flare, which is considered a normal variant. Copyright Howard Pettersson 2014 NEGATIVE DERIFIELD FLOWCHART Left SI Fluid Motion Fixation Right or Left Negative Derifield Leg Check confirms a θy-axis misalignment of the pelvis Posterior Rotation of the Sacrum, EX Ilium, IN Ilium, or Anterior Rotation of the Sacrum. Perform the Left θy-axis Segmental Dysfunctional Test for the Pelvis. If the side tested flexed leg becomes short, Articular pressure test for A-L and Left IN Ilium. If the legs become even in the extended and flexed positions Upon articular pressure testing for Left IN Ilium, adjust Left IN Ilium. The legs should be even in the extended and flexed positions upon post-adjustment Derifield leg check, and post-adjustment Right SI Fluid Motion should now be freely moveable. NEGATIVE DERIFIELD Scenario #4 Anterior Rotation of the Sacrum 20
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 simultaneously, 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. INITIAL DERIFIELD LEG CHECK Perform the Initial Derifield Leg Check. If Negative Derifield is presented, continue with the Negative 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. 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. 21
Note the side of the short leg in the prone extended position (left short leg). If the left short leg in the prone extended position stays short when flexed to 90 degrees, the initial leg check indicates Left Negative Derifield. Negative Derifield confirms a θy-axis misalignment of the pelvis EX Ilium, Posterior Rotation of the Sacrum, IN Ilium, or Anterior Rotation of the Sacrum. Next, perform the Right θy- Axis Segmental Dysfunction Test for the Pelvis. Thompson Educational Workshops. The thompson technique reference manual. Elgin, IL: 1984. To perform the Right θy-axis Segmental Dysfunction Test for the Pelvis, instruct the patient to lock the knee on the side tested. Next, extend the lower extremity at the acetabular hip to its end range. And finally, extend the hip into resistance a few degrees to engage the sacroiliac joint on the side of involvement. 22
Note the left short (indicator) leg in the prone extended position. Right θy-axis Segmental Dysfunction Test Right Anterior Rotation of the Sacrum If the left reactive (indicator) leg stays short in the prone extended position and the leg on the side-tested (right) becomes short when the legs are flexed to 90 degrees, pressure test for Right Anterior rotation of the sacrum and right IN Ilium. Pressure test* for Right Anterior Rotation of the Sacrum. Apply a straight lateral-tomedial tissue up against the mid-lateral aspect of the inguinal ligament. *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. 23
If the legs become even in the prone extended position and flexed position upon pressure testing, adjust for Right Anterior Rotation of the Sacrum. Elbow-in torque Correct for Right Anterior Rotation of the Sacrum The thrust is a lateral-tomedial (elbow-in) torquing thrust. Do not apply an intentional anterior-toposterior component to this thrust. Post-Adjustment Leg Check: The legs should become even in the prone extended and 90 flexion positions after adjusting for Right Anterior Rotation of the Sacrum. 24
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. Right SI Fluid Motion The foot of the stationary leg may demonstrate moderate toe-out foot flare, which is considered a normal variant. Copyright Howard Pettersson 2014 NEGATIVE DERIFIELD FLOWCHART Right SI Fluid Motion Fixation Right or Left Negative Derifield Leg Check confirms a θy-axis misalignment of the pelvis Posterior Rotation of the Sacrum, EX Ilium, IN Ilium, or Anterior Rotation of the Sacrum. Perform the Right θy-axis Segmental Dysfunctional Test for the Pelvis. If the side tested flexed leg becomes short, Articular pressure test for A-R and Right IN Ilium. If the legs become even in the extended and flexed positions Upon articular pressure testing for A-R, adjust A-R. The legs should be even in the extended and flexed positions upon post-adjustment Derifield leg check, and post-adjustment Right SI Fluid Motion should now be freely moveable. 25