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. Copyright 2015 Howard Pettersson Pelvic Drop Table Technique Positive Derifield Thompson Derifield Leg Check Pelvic Drop Table Adjusting Gonstead SI Fluid Motion (Palmer Gonstead) Activator Articular Pressure Testing 1
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 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 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. 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 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. 3
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. Copyright Howard Pettersson 1999 PI ILIUM STATIC PALPATION Right superior PSIS Left inferior PSIS Copyright Howard Pettersson 2010 4
PI ILIUM STATIC PALPATION Right superior PSIS Left inferior PSIS Copyright Howard Pettersson 2010 PI ILIUM STATIC PALPATION Ischial tuberosity palpates relatively anterior to the ischial tuberosity on the opposite side. Copyright Howard Pettersson 1999 PI ILIUM STATIC PALPATION Left anterior ischial tuberosity Copyright Howard Pettersson 2010 5
PI Ilium Articular Pressure Test Articular pressure test* in the direction of correction to confirm PI ilium. Typically the sacrum is relatively anterior to the 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. Articular Pressure Test to 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. 6
Correct for Left PI Ilium SCP: CP: LOC: Stab: Medial-inferior PSIS 1b hook of the hamate I-S and P-A 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. 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 7
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 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 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. 8
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. 9
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. Copyright Howard Pettersson 1999 AS ILIUM STATIC PALPATION Right superior PSIS Left inferior PSIS Copyright Howard Pettersson 2010 10
AS ILIUM STATIC PALPATION Right superior PSIS Left inferior PSIS Copyright Howard Pettersson 2010 AS ILIUM STATIC PALPATION Ischial tuberosity palpates posterior relative to the opposite side. Copyright Howard Pettersson 1999 AS ILIUM STATIC PALPATION Right posterior ischial tuberosity Copyright Howard Pettersson 2010 11
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. Articular Pressure Test to 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. 12
Correct for Right AS Ilium Right AS Ilium 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. 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. Post-Adjustment Leg Check: The legs should become even in the prone extended and 90 degree flexion positions after adjusting for Right AS Ilium. 13
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 14