Technique Toolbox: Detecting Cervical Subluxations
By John Minardi BHK DC
By John Minardi BHK DC
A 35-year-old office worker presents to the clinic with neck pain, low back pain and general fatigue.
A 35-year-old office worker presents to the clinic with neck pain, low back pain and general fatigue. He informs the doctor that he has had the same office job for the past 10 years, and finds himself in front of his computer for hours. Physical examination reveals anterior head carriage and a flexed thoracic posture. Furthermore, static and motion palpation detects subluxations present at C5 and L5 on the right. The doctor is proficient in The Complete Thompson Technique-Minardi Integrated Systems, and performs leg length analysis. The leg check shows a short right leg in the extended position, and a short right leg in the flexed position. The doctor instructs the patient to rotate his head to the left, which balances the legs in the extended position. The doctor then instructs the patient to rotate his head to the right, which keeps the legs unbalanced. Neurological and radiological examinations are unremarkable.
|Photo 1: Contacts for the Cervial Syndrome are displayed on the skeletal model.
What do these leg length findings indicate? What should be analyzed first? What needs to be corrected and how do we correct the problem? In this edition of Technique Toolbox, we will answer all of these questions and more, as we look at the classic cervical syndrome subluxation.
CERVICAL SUBLUXATION AND CORRECTION
One of the primary areas of subluxation, and one of the most powerful areas of correction, is the cervical spine. When adjusted properly, the cervical correction has tremendous effects. With this in mind, the cervical syndrome is the initial problem that a Thompson practitioner must rule in or out within the patient. The following procedures are required to detect and correct the cervical syndrome subluxation:
STEP ONE – ANALYSIS:
1. The patient must present with a contracted leg in extension.
The doctor instructs the patient to turn his/her head to the left then to the right. In order for a cervical syndrome to be diagnosed, the patient’s legs must balance upon head rotation to one or both sides. If the patient’s legs balance with head rotation, the cervical syndrome is then labelled a left or right cervical syndrome according to the side of head rotation.
|Photo 2: Contacts for the Cervical Syndrome are displayed on a patient.
As in our sample case, if the patient presents with a contracted right leg, and head turning to the right balances the patient’s legs, then this would be labelled a right cervical syndrome, simply because the patient’s head is turned to the right. However, the actual problem is located on the opposite side of head rotation. In this example, the problem would be on the patient’s left side.
The doctor must note that the patient’s legs must balance 100 per cent with head rotation in order for a cervical syndrome to be present. If the legs partially correct, but do not become completely balanced, this would not be considered a cervical syndrome, and the doctor would continue to the next area of concern prior to adjusting the cervical spine. Following correction of that area, the doctor will revisit the cervical spine by having the patient turn their head to both sides again to verify if a cervical syndrome is now present.
Palpate along the lamina-pedicle junction from C2-C7, contralateral to the side of head rotation, (right side in our example above) for a tender “pea-shaped” nodule.
This nodule is an inflamed facet capsule, which is extremely tender due to inflammatory mediators that are gathered within the capsule. It is important to locate the capsule itself, and not simply contracted musculature in the cervical region. Thus, a simple test to confirm the capsule, is the “Roll Test.”
When the doctor finds the pea-shaped nodule, he rolls the mass between his fingers up and down and side to side. If the mass is able to be rolled, then the doctor is on muscle. The facet capsule, located beneath this muscle mass, is firm and does not move. This nodule confirms the location of the cervical subluxation.
3. Biomechanics of a cervical syndrome subluxation
Figure 1 demonstrates the biomechanics involved in a cervical syndrome present anywhere from C2-C7. Note that the affected segment subluxates posterior, and rotates the spinous process away from the side of the nodule (black arrow). The subluxation pattern stretches the facet, causing inflamation to build and resulting in a palpatory nodule within the facet joint (grey arrow).
Based on these biomechanics, the doctor must correct for the both the posteriority and rotational components of the subluxation. This is accomplished by the doctor thrusting P-A, perpendicular to the facet, and parallel to the disc plane. In order for this to be achieved, the doctor’s line of correction must change throughout the cervical spine to compensate for a patient’s natural cervical lordosis. Therefore, in superior cervical segments, the line of correction will be cephalad, and will gradually become caudad with each inferior segment.
STEP TWO – ADJUSTMENT:
Classic Cervical Syndrome Correction (See Photos 1 and 2):
- Doctor: side or head of table.
- Patient: prone.
- Table: cervical piece in the readyposition.
- Contact: MCP or PIP joint on the LPJ (location of nodule).
- Stabilization: opposite side zygomatic arch or parietal bone.
- LOC – P-A, L-M perpendicular to the facet joint and in line with disc plane.
The posterior-to-anterior thrust corrects for the posteriority of the subluxation, and the unilateral contact on the lamina-pedicle junction corrects for the rotational component involved. Thus, the doctor will be thrusting into the patient’s natural cervical lordosis, restoring the affected segment back into a normal position. The doctor must note that the tenderness within the facet capsule will persist at the lamina-pedicle junction. Although this tenderness will be slightly decreased immediately following the adjustment, the body requires time to flush out the inflammation caused by the subluxation.
After correcting the cervical subluxation the legs become balanced in the extended position, but still present as a short right leg in the flexed position. What does this mean? Are there other subluxations present? We will answer these questions in our next edition as we continue on with our sample case.
Until next time… adjust with confidence.
Dr. John Minardi is a 2001 graduate of Canadian Memorial Chiropractic College. A Thompson-certified practitioner and instructor, he is the creator of the Thompson Technique Seminar Series and author of The Complete Thompson Textbook – Minardi Integrated Systems. In addition to his busy lecture schedule, Dr. Minardi operates a successful private practice in Oakville, Ontario. E-mail email@example.com, or visit www.ThompsonChiropracticTechnique.com .