Cor Tech Lab Midterm Patient Presentations

A 19 year old athlete has low back pain on the right. He stands with the right leg externally rotated and has a right short leg in the prone leg check. The right SI joint is very fixated.
Show an appropriate adjustment.
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A 19 year old athlete has low back pain on the right. He stands with the right leg externally rotated and has a right short leg in the prone leg check. The right SI joint is very fixated.
Show an appropriate adjustment.
Regular PI Ilium - Side Posture
An athlete has low back pain on the right. Analysis shows a right PI, and a fixated right SI joint.

Your first two efforts to adjust him with a PSIS contact fail.

Show an appropriate alternative adjustment.
1) Left Side Posture: Sacral Apex

2) Drop Table - PSIS Contact with Sacral Apex

• One hand on PSIS = Inferior Hand
• One hand on Sacral Apex = Superior Hand


3) Left Side Posture: Sacral Base
20 year old male has episodic low back pain. X-ray shows retrolisthesis of L5


Show an appropriate adjustment, one emphasized in this course.
1) P- A on L5

2) Sacral Apex contact
• P - A body drop
• To tension the P.L.L
A 36 year old female presents with excruciating pain at the sacrococcygeal area following a fall while roller blading. X-ray and palpation indicate anterior coccyx.
Show an appropriate adjustment, emphasized in this course.
1) Pettibon Move Sacral Apex
• Patient in maximal flexion
• Have patient HOLD BREATH
• Contact Sacral Apex


2) Thumb Contact thrust on side of deviation

3) Thumb Contact modulation 3 x 30 seconds each time
48 year old female has chronic lumbosacral area pain following an awkward lift several years ago. X-ray shows stable, Grade I (Meyerding scale) L4 spondylolisthesis.

Show an appropriate adjustment, emphasized in this course
1) Sacral Apex contact
• P - A. hyperflex joint
• Tension the P.L.L

2) Drop Table S-I Sacral Base
Patient has left PI ilium, very fixated. Doctor has injury to right shoulder

Demonstrate an appropriate thrusting adjustment.
1) Pettibon Body Drop Left Side Up PI

If unable to use right shoulder:

2) Pettibon Body Drop Right Side Up Sacral Apex Contact

3) Pettibon Body drop Right Side Up Sacral Base Contact
A 20 year old female indicates pain at L5/S1 area. Her lumbopelvic spine is carried in a right PI ilium distortion pattern, and she is hyperextended at the lumbosacral joint, with pain on extension

Demonstrate an appropriate adjustment.
1) Modified Pettibon Right Side Up PI
Flexion position with Body Drop

If this does not work:

2) Modified Pettibon Left Side Up Sacral Apex
Flexion position with Body Drop

3) Modified Pettibon Left Side Up Sacral Base
Flexion position with Body Drop
Demonstrate a method for determining if there is sacral base rotation; ie, if there is a subluxation of the sacral base.
1. Palpation while pt prone
• Palpate medial to the PSIS for depth of Sacral Ala on each side

2. Active Sacral Leg Check
Put hand on left or right PSIS and sacrum. "I want you to use only modest effort to lift your leg" or something like it. Ask them which side felt harder to lift (they usually agree with your findings). Harder to raise PI side. Look at thighs, not feet

3. Passive Sacral Leg Check:
Dr. lifts leg (hands above the knee) themselves. Should get same results
A 20 year old male has episodic low back pain. X-ray shows anterolisthesis of L5, no pars defect.

Show appropriate contact adjustment, emphasized in this course.
Sacral Apex Contact
• P to A Body Drop
Motion and static palpation indicate left lateral flexion restriction of the L4-L5 articulation in a lumbar spine that has left lateral curvature

Show an indicated side-posture setup.
1) LEFT SIDE UP Side Posture Push L4 Simple L-M thrust

1) LEFT SIDE UP Side Posture Push L5 Mammilary Contact M-L thrust

3) LEFT SIDE UP Side Posture Pull L5 M-L thrust

4) LEFT SIDE UP Side Posture Pull L4 Spinous Push L-M thrust
You are attempting to *adjust the SI joint on a very large patient on a bench table* (not a drop table) which is relatively high for you. The listing is *right PI ilium*. Show a setup that might work.1. *The Big Ugly* Right Side Up • Knee up on table • Pettibon body drop 2. *Pettibon Body Drop* Right Side Up if these do not work: 3. *Pettibon Body Drop Sacral Apex* Left Side Up 4. *Pettibon Body Drop Sacral Base * Left Side UpA patient has a *congenital disease that produces joint hypermobility*. She has been to see several orthopedists for *persistent right sided inguinal and groin pain*. Demonstrate a palpatory procedure that addresses these complaints, and show a test thrust for the most likely diagnosis.PALPATION -------------------- *Palpate the Pubic Symphysis* • Feeling for which side has gone Anterior ADJUSTMENT --------------------- 1) *Muscle Energy Technique* - Resisted Muscle Cavitation - have patient resist abduction (have patient adduct and resist them) - quick HVLA thrust through their resistance with crossed hands (can do it without crossed hands as well) 2) *Toggle Recoil* • Pisiform contact on Anterior Pubic bone • Toggle adjustment with a drop (with or without recoil)A patient comes in with *excruciating low back pain following a heavy lift*. He has no trouble sitting, and straight leg raising is negative. He points to the *right SI joint as the most painful spot*. Palpation shows the *right sacral base to feel relatively posterior*, the *left sacral base anterior*. Show an appropriate adjustment.1) LEFT SIDE UP *Sacral Base contact* - *Involved side down* 2) RIGHT SIDE UP *Sacral Base contact* - *Involved side up* if does not work: 3) RIGHT SIDE UP *Sacral Base Apex* - *Involved Base side up* 4) LEFT SIDE UP *PI Ilium contact* - *Involved side Base down* IF NONE OF THESE WORK: 5) LEFT SIDE UP *Sacral Base contact Kick Pull* - contacting Anterior Sacral BaseA pregnant patient presenting with *pelvic torsion*, is in too much pain to be adjusted using an *HVLA approach*. The *left PSIS is elevated* in the sitting position compared with the right. A) Show how padded wedges can be used to derive a lumbopelvic adjustive strategy b) show a corrective procedureA ------------------- Ask how patient is feeling? • Palpate SI Jt. • Then palpate prone L5 - L1 (in each block position as shown in image) B -------------------- *Supine Blocking* Pregnant patient is a HYPERMOBILE patient, thus needs STABILIZATION [so opposite of prone blocking which is the image] • *Left AS*= Block is at Trochanter • *Right PI* = Block is at Iliac CrestA *heavy set male* comes in complaining of moderate to *severe low back pain*. In the seated position, his *left PSIS is inferior to the right PSIS*. He is too large to manipulate in side posture for you, and your drop table is broken. show the appropriate adjustive procedures1. *PI Drop Table* - LOD = P to A, I so S, M to L --------------------------------------- a. *Unilateral PI, single hand contact* • One hand on Medial, Inferior PSIS • Other hand reinforces b. *Unilateral PI, Bilateral contact* • One hand on Medial, Inferior PSIS • Other hand on Ischium on other side 2. *S.O.T. Blocking protocol for PI Ilium* ------------------------------------------- • Left Block is at the *TROCHANTER*= to correct *Left PI* • Right Block is at the *ASIS* = to correct the *Right AS*Patient has *left PI ilium*, refuses any side posture adjustment. You believe he has adhesions in the *left SI joint* Show an alternative setup.*PI - Drop Table* • One hand contacts Medial, Inferior PSIS • Other hand either reinforces or contacts ischium on other sideThe patient has an *L5 spondy*, and declines to be manipulated in side-posture because of a previous bad experience.*Spondylolisthesis = Do Double AS move with a BLOCK* • Place 1" thick book under the Sacral Base (use SOT Pelvic Board) • THEORY: Lumbar spine will drop a greater distance if the PELVIS is blocked up!!After *failing on two attempts to correct a right AS ilium in side posture*, you remain committed to the listing of a severely fixed SI joint. show an alternative maneuver1. *Unilateral AS Ilium*- SUPINE • Hand on ASIS • Stabilize Knee • Thrust with Drop Piece (mostly at the ASIS) • Have the patient place their own hand on their ASIS and thrust through patient's hand if they are ticklish! 2. *Unilateral AS Ilium* - PRONE • Contact Ischial Tuberosity • Stand CEPHALAD and face CAUDAL • This is to "pivot" the Ischium at the Pubic Symphysis!!!The patient is a male with *lumbosacral pain*. His pelvis is tipped very posteriorly (*B/L PI Ilium* - HYPOLORDOTIC). Show an appropriate adjustment.1. *Bilateral PI Adjustment* - Drop maneuver • One hand on each PSIS • Not crossed 2. *Bilateral Low Blocks* - PRONE at level of TROCHANTERS (Horizontal blocks) 3. *Double PI Side Posture adjustments*.A 25 year old *male* comes in after a *repetitive lifting injury* at work. Low back x-ray shows *normal lumbopelvic alignment* except for *left internal/right external ilia*. The *right SI joint is found to be fixated* (RIGHT EX). Show an appropriate *drop table adjustment for the left internal**Prone thrust on Drop Table* • Stand on Contralateral side of IN Ilium • Contacting Medial PSIS • Thrust is M - L.A 25 year old *male* comes in after a *repetitive lifting injury* at work. Low back x-ray shows *normal lumbopelvic alignment* except for *left internal/right external ilia*. Show an appropriate *drop table adjustment for the right external ilium**Prone thrust on Drop Table* • Stand on Ipsilateral side of EX Ilium • Contacting Lateral PSIS • Thrust is L - MA patient has a *left lateral spinal curvature (left convexity), apex at L1* Show an indicated move, emphasized in this course for the lumbothoracic junctional area.*Rule of Lefts* ---------------------- • Left Lateral Flexion • Left Rotation • Legs to Left • Stand on the Left * Then do an *Anterior Thoracolumbar adjustment in this position*A patient has a *right lateral flexion restriction, centered around L1* Show an indicated move, emphasized in this course for the lumbothoracic junctional area.*Rule of Rights* ---------------------- • Right Lateral Flexion • Right Rotation • Legs to Right • Stand on the Right * Then do an *Anterior Thoracolumbar adjustment in this position**Demonstrate the Mackenzie procedure* for identifying directional preference1) Have patient lay *prone*; put their body in a *curved position*; have them *turn their head to the side* 2) Ask patient if *radiating leg pain go more distal (peripheral) or does it go more central (or stop radiating at all)* 3) If the pain radiates more distal, curve body in other direction 4) In curved position to the side that *centralizes the radiating leg pain, have the patient come up on their elbows* 5) McKenzie says: Ignore back pain; it will go away when leg pain is centralized 6) Have them go into this position *3x/day at home (for 3 minutes)*