Methods 4: Adjustment Set Ups & Orthos

Static & Motion Findings:

-PSIS palpates posterior, medial, and inferior on R

-Loss of extension

-Sacral base - nutated, CN restriction

Technique:

-Prone Bilateral Hypothenar Ilium Sacral Apex Push

PP: Prone-verbalize how you found the segment

DP: Square or Modified fencer stance on side opposite the dysfunction

CH: Cephalad (R) hand, hypothenar (pisiform) on L PSIS

IH: Caudal (L) hand knife-edge on side of sacral apex closest to you

LOD: CH: P-A, M-L, slight I-S

IH: P-A, slight S-I

Static & Motion Findings:

-PSIS palpates posterior, medial, and inferior on L

-Loss of extension

Technique:

-Prone Unilateral Reinforced Pisiform Ilium Push

PP: Prone- verbalize how you found the segment

DP: Square or Modified fencer stance on side opposite the dysfunction

CH: Cephalad ( R) hand, hypothenar (pisiform) on L PSIS

IH: Reinforcing CH

LOD: P-A, M-L

Static & Motion Findings:

-PSIS palpates anterior, superior, and lateral on R

-Loss of flexion

-R sacral base - CN, NR

Technique:

-Prone Bilateral Hypothenar Ischium Sacral Base Push

PP: Prone- verbalize how you found the segment

DP: Square or Modified fencer stance on side opposite the dysfunction

CH: Caudal (L) hand, hypothenar (calcaneal) contact on (L) ischial tuberosity

IH: Cephalad ( R) hand, hypothenar(pisiform) on L sacral base(just medial to the L PSIS)

LOD: CH: P - A, S -I

IH: P -A, I - S

Static & Motion Findings:

-PSIS palpates posterior, medial, and inferior on R

-Loss of extension

-Sacral base - nutated, CN restriction

Technique:

-Prone Hypothenar Ilium Push with Hip Extension

PP: Prone- verbalize how you found the segment

DP: Square or Modified fencer stance on side opposite the dysfunction

CH: Cephalad ( R) hand, hypothenar (pisiform) on L PSIS

IH: Caudal (L) hand grasps pt's distal thigh on same side as the adjustive contact (L distal thigh)

LOD: CH: P - A, M - L

IH: Reinforcing with shallow lift of the thigh contact

Static & Motion Findings:

-L sacral base palpates posterior & superior

-Loss of nutation

Technique:

-Prone Unilateral Reinforced Pisiform Sacral Base Push

PP: Prone- verbalize how you found the segment

DP: Modified fencer stance on same side of dysfunction

CH: Caudal (L) hand, hypothenar (pisiform) on superior margin of sacral base just medial to PSIS

IH: Reinforcing CH

LOD: P-A, I-S

Static & Motion Findings:

-PSIS palpates posterior, medial, and inferior on L

-Loss of extension

Technique:

-Side Posture Hypothenar Ilium Push

PP: Basic side posture position with the dysfunctional side up - verbalize how you found the segment

DP: Modified fencer stance on side of dysfunction

CH: Caudal (L) hand,hypothenar (pisiform) on RPSIS

IH: Cephalic ( R) hand slight upward traction holding the pt's up-side shoulder or overlapping hand

LOD: CH: P-A, M-L, I-S

Static & Motion Findings:

-PSIS palpates anterior, superior, and lateral on R

-Loss of flexion

Technique:

-Side Posture Hypothenar Ischium Push

PP: Basic side posture position with the dysfunctional side up - verbalize how you found the segment

DP: Modified fencer stance onside of dysfunction

CH: Caudal (L) hand, soft broad hypothenar contact R ischium

IH: Cephalic ( R) hand slight upward traction holding the pt's up-side shoulder or overlapping hand

LOD: CH: P-A, along shaft offemur to induce SIJ flexion

Static & Motion Findings:

-PSIS palpates anterior, superior, and lateral on R

-Loss of flexion

Technique:

-Side Posture Forearm Ischium Push

PP: Basic side posture position with the dysfunctional side up - verbalize how you found the segment

DP: Modified fencer stance on side of dysfunction -naturally becomes more of a chest drop

CH: Caudal (L) forearm, soft broad contact pull inferior and lateral over the medial, inferior margin of

IH: Cephalic ( R) hand slight upward traction holding the pt's up-side shoulder or overlapping hand

LOD: CH: Thrust P-A, along shaft of femur to induce SIJ flexion

Static & Motion Findings:

-PSIS palpates anterior, superior and lateral on R

-Loss of flexion

-Sacral base palpates posterior & superior on R

-Nutation Restriction

Technique:

-Side Posture Hypothenar (Pisiform) Sacral Base Push, Dysfunctional Side Up

PP: Basic side posture position with the dysfunctional side up-verbalize how you found the segment

DP: Modified fencer stance on side of dysfunction

CH: Caudal (L) hand, hypothenar (pisiform) on R sacral base (just medial to R PSIS)

IH: Cephalic (R) hand slight upward traction holding the pt's up-side shoulder or overlapping hand

LOD: P-A, slight I-S

Static & Motion Findings:

-PSIS palpates anterior, superior and lateral R

-Loss of flexion

-Right sacral base palpates posterior & superior

-Nutation restriction

Technique:

-Side Posture Hypothenar (Pisiform) Sacral Base Push, Dysfunctional Side Down

PP: Basic side posture position with the dysfunctional side down-verbalize how you found the segment

DP: Modified fencer stance on side opposite dysfunction

CH: Caudal (L) hand, hypothenar (pisiform) on L sacral base down side (just medial to L PSIS)

IH: Cephalic (R) hand slight upward traction holding the pt's up-side shoulder or overlapping hand

LOD: P-A

Static & Motion Findings:

-PSIS palpates posterior, medial, and inferior on L

-Loss of extension & counternutation

Technique:

-Side Posture Hypothenar (Pisiform) Sacral Apex Push, Dysfunctional Side Down

PP: Basic side posture position with the dysfunctional side down-verbalize how you found the segment

DP: Modified fencer stance on side opposite dysfunction

CH: Caudal (L) hand, hypothenar (pisiform) on up-side of the sacral apex (R lateral side of sacral apex)

IH: Cephalic (R) hand slight upward traction holding the pt's up-side shoulder or overlapping hand

LOD: P-A

Static & Motion Findings:

-PSIS palpates posterior, medial, and inferior on R

-Loss of extension & counternutation

Technique:

-Side Posture Forearm Sacral Apex Push, Dysfunctional Side Down

PP: Basic side posture position with the dysfunctional side down-verbalize how you found the segment

DP: Modified fencer stance on side opposite dysfunction

CH: Caudal (L) hand, forearm on up-side of the sacral apex (R lateral side of sacral apex)

IH: Cephalic (R) hand slight upward traction holding the pt's up-side shoulder or overlapping hand

LOD: P-A

Static & Motion Findings:

-L4 SP palpates posterior & inferior on the L

-Loss of left rotation & right lateral flexion

Technique:

Prone Hypothenar Mammillary Push

PP: Prone-verbalize how you found the segment

DP: Square stance on side of contact

CH: Cephalad (R) hand, hypothenar (pisiform) on L4 MP with fingers running parallel to the spine

IH: Reinforces in anatomical snuffbox

LOD: For rot with LF: P-A, S-I

just rotation: P-A

Static & Motion Findings:

-L3 MP palpated posterior & inferior on the L

-Loss of right rotation & right lateral flexion

Technique:

Prone Hypothenar Spinous Push

PP: Prone-verbalize how you found the segment

DP: Square stance on side of contact

CH: Cephalad (R) hand, hypthenar (pisiform) on L3 SP with fingers crossing the spine

IH: Reinforces in anatomical snuffbox

LOD: P-A, L-M, S-I

Static & Motion Findings:

-L3 MP palpates posterior on the R

-Loss of left rotation

Technique:

Side Posture Hypothenar Mammillary Push

PP: Basic side posture position with the dysfunctional side up-verbalize how you found the segment

DP: Modified fencer stance on side of dysfunction

CH: Caudal (L) hand, hypothenar contacts dys segment MP (L3 MP) with fingers parallel to spine

IH: Cephalic (R) hand slight upward traction holding the pt's up-side shoulder or overlapping hand

LOD: P-A, slight I-S

Static & Motion Findings:

-L3 MP palpates inferior on the R

-Loss of left lateral flexion

Technique:

Side Posture Hypothenar Mammillary Push, closed-wedge side

PP: Basic side posture position with the dysfunctional side up-verbalize how you found the segment

DP: Modified fencer stance on side of dysfunction

CH: Caudal (L) hand hypothenar on L3 MP with fingers runing parallel to spine

IH: Cephalic (R) hand slight upward traction holding the pt's up-side shoulder or overlapping hand

LOD: P-A, I-S

(Place roll under patient to assist the LF motion)

Static & Motion Findings:

-L3 MP palpates inferior on L3

-Loss of right lateral flexion

Technique:

Side Posture Hypothenar Mammillary Push, open-wedge side

PP: Basic side posture position with open wedge side up-verbalize how you found the segment

DP: Modified fencer stance on side of dysfunction

CH: Caudal (L) hand hypothenar on L3 MP with fingers runing parallel to spine

IH: Cephalic (R) hand slight downward traction holding the pt's up-side shoulder to assist in production of LF

LOD: P-A, L-M, S-I

(Lower the thoracolumbar section or place pt's down arm cephalad to induce LF)

Static & Motion Findings:

-L3/L4 interspinous space is decreased

-Loss of flexion

Technique:

Side Posture Hypothenar Spinous Push

PP: Basic side posture position with either side up-verbalize how you found the segment

DP: Modified fencer stance

CH: Caudal hand hypo/calcaneous slides onto superior segment (L3) spinous with fingers angled across the spine

IH: Cephalic hand slight upward traction holding the pt's up-side shoulder or overlapping hand

LOD: P-A, I-S

(Opening interspinous space)

Static & Motion Findings:

-L3/L4 interspinous space is increased

-Loss of extension

Technique:

Side Posture Hypothenar Spinous Push

PP: Basic side posture position with either side up-verbalize how you found the segment

DP: Modified fencer stance

CH: Caudal hand hypo/calcaneous slides onto inferior segment (L4) spinous with fingers angled across the spine

IH: Cephalic hand slight upward traction holding the pt's up-side shoulder or overlapping hand

LOD: P-A, I-S

(Closing the interspinous space)

Static & Motion Findings:

-L5/S1 interspinous space is decreased

-Loss of flexion

Technique:

Side Posture Hypothenar Sacral Apex Push

PP: Basic side posture position with either side up-verbalize how you found the segment

DP: Modified fencer stance

CH: Caudal hand hypo/calcaneous slides inferiorly to contact sacral apex

IH: Cephalic hand slight upward traction holding the pt's up-side shoulder or overlapping hand

LOD: P-A, S-I

Static & Motion Findings:

-L3 MP palpates posterior on L

-Loss of right rotation

(Can be used with lateral flexion too)

Technique:

Side Posture Hypothenar Spinous Push

PP: Basic side posture with the dysfunctional side down (since spinous has deviated to R) - verbalize how you found the segment

DP: Modified fencer stance on side opposite dysfunction

CH: Caudal (L) hand hypothenar on L3 SP with fingers crossing the spine

IH: Cephalic (R) hand slight upward (downward for lateral flexion) traction holding the pt's up-side shoulder or overlapping hand

LOD: CH: P-A, L-M

Static & Motion Findings:

-L3 MP palpates posterior on R

-Loss of left rotation

Technique:

Side Posture Digital Spinous Kick Pull

PP: Basic side posture position with the dysfunctional side up (since spinous has deviated to L) - verbalize how you found the segment

DP: Square stance on side of dysfunction & contact their knee with you knee/distal tibia

CH: Fingertips (digital contacts) of 2nd, 3rd, 4th digits of caudal (L) hand hooks the down side of the L3 SP

IH: Cephalic hand slight upward traction holding the pt's up-side shoulder or overlapping hand

LOD: L-M pulling movement to induce axial rotation with quick extension (kick) of contact leg

Static & Motion Findings:

-L3 MP palpates posterior on L

-L4 MP palpates posterior on R

-Loss of right rotation

-Loss of left rotation

Technique:

Side Posture Bilateral Digital Spinous Push, Pull

PP: Basic side posture position with the superior dysfunctional side down (since spinous has deviated to R) - verbalize how you found the segment

DP: Square stance on side of dysfunction & contact their knee with your knee/distal tibia

CH: Fingertips (digital contacts) of 3rd & 4th digits of cephalic (R) hand reach under the pt's up-side arm to contact lateral surface of L3

IH: Fingertips of caudal (L) hand hook the downside of the L4 SP

LOD: Cephalic hand-pushes L-M

Caudal - pulls L-M with quick extension of contact leg

Static & Motion Findings:

-L pubis palpates more superior than R

-L pubis loss of inferior glide

Technique:

Hypothenar/Thigh

PP: Supine off center of table to side of involvement & corresponding leg hangs off table

DP: Modified fencer stance on involved side facing caudal

CH: Palmar contact of caudal (L) hand to distal femur of leg on involved side

IH: Cephalad (R) hand palmar contact over the opposite ASIS to stabilize the pelvis

LOD: CH applies A-P stress on pt's thigh. Ask pt to raise thigh against resistance & after 4-5 seconds deliver a slight & shallow impulse thrust S-I down the thigh

Static & Motion Findings:

-R pubis palpates more anterior than L

-R pubis loss of posterior glide

Technique:

Hypothenar/Pubis

PP: Supine-uninvolved knee & hip flexed with foot flat on table

DP: Modified fencer/square stance on uninvolved side facing caudal

CH: Hypothenar contact of cephalad (R) hand on anterior aspect of the involved pubis (barrier over pubis)

IH: Caudal (L) hand reinforces CH or establishes a palmar contact over the involved distal thigh

LOD: A-P

Static & Motion Findings:

-R pubis palpates more inferior than L

-R pubis loss of superior glide

Technique:

Hypothenar/Ilium, Palmar/Ischium

PP: Supine-involved knee & hip flexed with foot flat on table

DP: Square stance on uninvolved side leaning over pt with your upper body contacting the anterior aspect of pt's tibia

CH: Caudal (L) hand palmar contact of ischium

IH: Cephalic (R) hand reaches over and to place hypothenar on ASIS of the involved side

LOD: CH: P-A, I-S

IH: A-P

Static & Motion Findings:

-Diffuse pain with palpation

-Diffuse pain with provocation

Technique:

Pubic Distraction

PP: Supine-flex both knees & hips with feet flat on table pt's shoulder width apart

DP: Standing at foot of table facing the patient

CH: Palmar contacts of both hands to medial aspects of knees

IH: Palmar contacts of both hands to medial aspects of knees

LOD: Instruct pt to squeeze knees together until adductor mm fatigue occurs. Then deliver a shallow M-L impulse thurst to both knees

Static & Motion Findings:

-Coccyx palpates anteriorly

-Loss of posterior glide

Technique:

Thumb/External Coccyx Push

PP: Prone-with Dutchman roll placed under ASIS. Verbalize how you found the segment

DP: Modified fencer stance facing cephalad

CH: Cephalad thumb contact to base of coccyx

IH: Caudal pisiform/hypothenar contact reinforced over contact thumbnail

LOD: I-S, slight P-A