Technique Toolbox: Analysis and adjustment of the lumbar spine

A 30-year-old male computer programmer presents to the clinic with low back pain. He informs the doctor that the pain is usually dull, but can be sharp with certain movements. He also notifies the doctor that the problem began approximately four years ago, when he began lifting heavier weights in his exercise regime and felt a sharp pain while performing squats.

Photo 1: Contact for a L4-PLS Listings is displayed on a skeletal model. Notice how a finger tip or pisiform contact can be placed at the left lateral posterior spinous process of L4.

Sample Case:
A 30-year-old male computer programmer presents to the clinic with low back pain. He informs the doctor that the pain is usually dull, but can be sharp with certain movements. He also notifies the doctor that the problem began approximately four years ago, when he began lifting heavier weights in his exercise regime and felt a sharp pain while performing squats. The pain eventually decreased, and he began exercising again; however, the problem would come and go from that point onward. Furthermore, the patient also states that because his job forces him to be seated for a minimum of 10 hours per day, the excessive sitting aggravates the problem. On physical examination, the doctor notices a lack of lumbar lordosis on visual inspection. Neurocalometer instrumentation reading registers a deviation at L4 on the left. Palpation reveals a subluxation present at L4. The doctor is proficient in Gonstead Technique, and labels the subluxation as an L4-PLS listing. X-ray analysis assists in confirming the palpatory listing. All other radiological and neurological analyses are unremarkable. The doctor lays the patient in side posture, takes specific contacts on the L4 vertebrae, and proceeds to place his or her own leg within the crook of the knee of the patient’s flexed leg. As the chiropractor performs the adjustment, a “kicking” move is utilized by the doctor, in order to assist the specific thrust to the spine.

How does a chiropractor who is not trained in Gonstead interpret a spinal listing? What is a Gonstead “kick” and how does it assist with a lumbar subluxation correction? In this edition of Technique Toolbox, I will explain these questions as we explore the Gonstead Technique.

BUT FIRST, SOME HISTORY
The Gonstead Technique was developed by Dr. Clarence S. Gonstead in the early 1920s. Before entering into chiropractic, Clarence had been studying engineering until his education was interrupted by the First World War. At that time, he was drafted into the military and served as an aviation technician. When he returned from service, Gonstead re-entered the university setting. While a student, he became disabled from rheumatic fever. He sought the expertise of medical doctors, but medicine was unable to help him. Chiropractic care, however, enabled him to resume his studies within a month. He then pursued a chiropractic education, and began practice in 1923.1 From this point onward, Dr. Gonstead was an innovator in the profession. Through his clinical research, he created the Gonstead Chiropractic Technique, which has been incorporated into
several chiropractic colleges since its inception. Dr. Gonstead was so successful at using his system of analysis and correction of subluxations that he had to construct an inn to lodge the abundance of patients who came to his clinic in Mt. Horeb, Wisconsin, for treatment.

Photo 2:“Kick” positioning is displayed on the patient. Notice how the doctor places his/her own leg into the patient’s flexed leg.

In the Gonstead Technique, the chiropractor conducts a thorough analysis of a patient’s spine using five criteria to detect vertebral subluxations: case history, static and motion palpation, instrumentation, and full spine X-ray analysis. Following this, and due to the fact that each patient is different, a descriptive annotation or “listing” is assigned. (Listings were created and developed to denote the specific characteristics of movement associated with the subluxation and reflect each patient’s unique vertebral findings associated with his or her individual problems.) Once these vertebral subluxations are identified, and their specific direction of movements characterized, then proper correction can take place.

HOW DOES ONE INTERPRET A SPINAL LISTING?
For those chiropractors who have not had training in the Gonstead technique, understanding a listing is very straight-forward, provided you know what the reference point for the vertebrae is. Although a full description of the listing annotation system is not within the scope of this article, we can look at our sample case as an example of how the system works. If we are dealing with the lumbar spine, as we are in our sample case, the reference point is the spinous process.

If a listing were to be labelled a PRI, this would represent that the spinous process has subluxated Posterior, to the Right, and Inferior. Furthermore, if an additional letter is added in the listing (for example, one that reads PRI-M), the same subluxation pattern would be present as stated earlier, only the “M” denotes that a Mamillary contact would be taken, rather than a spinous contact.

HOW DO WE PERFORM THE ADJUSTMENT ACCORDING TO THE LISTING?
In our sample case, the listing was an L4-PLS. This indicates that the vertebrae subluxated: Posterior, Left, and Superior, remembering that the spinous process is our reference point. Therefore, with this in mind, a Gonstead Technique Lumbar Pull Adjustment for L4-PLS subluxation would be (see photos 1-3):

• Patient: On their left side (spinous rotation side down).
• Doctor: Side of the table. Left leg and knee bent, placed within the patient’s flexed leg.
• Contacts: Fingertip or pisiform contact on the left lateral posterior spinous of the involved segment.
• Stabilization hand: Placed on patient’s arm or shoulder to stabilize the upper torso when the thrust is applied.
• LOC: 

• Hand contact: P-A, left to right with a counter-clockwise torque. This thrust will be in line with the disc plane.
• Leg contact: Simultaneously with the thrust, the leg will produce a kicking motion to the patient’s flexed leg. This will assist the thrust during the correction.

Photo 3: Gonstead Technique Lumbar Pull Adjustment for L4-PLS subluxation is displayed on the patient. Note that the kicking motion would be performed simultaneously with the thrust, in order to assist the adjustment.

The P-A component will correct for the posteriority, the left to right will correct for the left spinous deviation, and the counter-clockwise torque will correct for the superiority involved with the subluxation pattern. Please note that the kicking motion is performed similar to kicking a soccer ball, not similar to kick-starting a Harley Davidson motorcycle. Always remember, the kick is introduced simply to assist the thrust, it is not meant to replace it.

Dr. Gonstead was one of chiropractic’s true pioneers. He intended to create a full spine system that was detailed in its analysis, and specific in its adjusting procedures. As many students of Gonstead like to say, “Give the right adjustment at the right place at the right time.” I think that quote is very reflective of Dr. Gonstead’s consciousness when developing his technique.

As usual, I have only scratched the surface of this technique. If you would like to learn more, please go to www.gonstead.com. If you have any questions, please e-mail me at johnminardi@hotmail.com.

Until next time . . .  Adjust with Confidence! •

REFERENCES

1. Cooperstein, R. Gonstead Chiropractic Technique. Journal of Chiropractic Medicine. 2003. 2(1):16-24.