gait analysis - logan class of december 2011december2011.weebly.com/uploads/2/2/5/1/2251900/b… ·...

Basic MT Stuff Combined from SC 1 of 34

NOTES FROM CLASSEvaluating the patient

1. AI = PSIS bilaterally

1. Erector Spinae = L3 and lower

1. Prominent PSIS

1. High Iliac Crest = distortion 5, 1, and advanced AI sacrum there might not bee any change.

1. Sacrosciatic Ligament (sacrotuberous & sacrospinous ligament)

Tension (same side)

1. Fifth lumbar body rotation (same side)1. Rotates on same side

1. Increased gluteal dimple (same side – Acute piriformis spasm)

1. Toeing out/ Foot flare (may be on either side) This helps to determine side of

pririformis contracture1. Knee Flex (same side) = to level out the pelvis1. Taut Hamstring MM (usually opposite side) = AS side fighting with concentric

rotation1. Short leg – functional (same side)1. Gluteal line deviation (same side) = used on babies1. moderate to severe pain (same side) = overriding indicator (not the P in HELPS)

…the side of severe pain is the side of contact Technic- adjusting move (notch)Technique - adjusting system put together (Basic) Unilateral A-I Sacral Subluxation

Hamstring Release - looking for neuromuscular junction, trigger point. You will find a slight ridge smoothly along the hamstrings

o Stand on side of contact broad thumb (both thumbs) and put it on lump and traction cephalic firmly. After you think you got it all give a slight thrust.

o Tilted forward pelvis or anterior base subluxation could cause this to be needed on both sides, however it is usually only on one side

Piriformis contact - developed by William Coggins due to lack of results with basic

o Stand on same side of contacto The sciatic nerve can pass through or underneath this muscle and is a great

example of peripheral nerve entrapment.


o Superior pole of greater trochanter go one inch superior and one inch anterior. This is the contact point. Medial posterior side of greater trochanter is where the muscle inserts

o There are 2 choices for this contact You are inserting your thumb in between muscle groups. It should

take less than a minute to release. Take inferior hand and make a fist and your thumb should be

sitting on top of the fist. Sit 90 degrees from your patient. Take the other hand and hold the other side of the patient. And then insert the thumb medial in between the muscles. Get ceiling and it should be going inferior. Once the contact is taken remove other hand and place on erectors. They should relax and so should the piriformis. Overall this contact is more powerful.

Superior hand your thumb should now point to the floor while in the fist and your other hand is holding the patient. The rest is the same as above. Overall this contact is softer

If you have weak hands you can do a calf lift to help apply pressure

Sacral un-lock - do to immobility the sacrum might go AI o Same side of contacto Superior hand - Thenar eminence on sacrum. Tighten and lean in. SI joint

should be lined up with middle of hand. o Inferior hand - goes on inferior aspect of gluteso Then ask the patient to walk - usually around 6 movement. o How do we know it worked?

Take both legs gently and take their heals to their buttock. If subluxated then both legs will not move easily

Apex Contact/Ulnar Contact/Notch Contact - o Auxiliary Contacts - performed during one of the o Abdominal Contacts - performed during one of the

Spinal & Cervical Pressures o After the application of the apex/notch/ulnar contact, the muscles of the

spine are balanced. Many small subluxations will have corrected themselves during that contact, and more with the simultaneous use of auxiliary contacts

Subluxations first go posterior then they go wherever else. SPINAL pressures after the apex

Through the disc plane in the lumbar spine contacting the mamillaries - feel it dropping out

P-A pressure and I-S in the thoracic or cervical plane - hear an audible with this fix

Where the lamina and disc come together From T-12 to T-7 have the patient walk


From T-6 up have the patient shake thier head NO

Abdominal Contacts Hollow organ spasm is what causes the pain These are done during the apex contact Abdominal piece released The stomach should feel like mush and you are looking for hard spots (this

is the muscle spasm) When you get to the right line of drive with the apex contact and you are

able to adjust the level of the spine where the nerve that is effecting the spasm is coming from, the spasm will stop

Auxiliary contacts

These contacts work well if you clear out the muscles.

Secondary SubluxationsBJ at one point said you should adjust all articulations in the body, but people got sick usually afterwards Riding the LigamentThis is when you sit on top of the sacrotuberous ligament. This could lead to the patient not being able to get up after the treatment High Pocket - near sacrum - no thrust on thisLow Pocket - near ischial tuberosity (usuallynear ischial tuberosity), can use this on distortion 9, do thrust on contact Ulnar Contact - through the ulna, straight wrist, fifth metacarpal is the drive shaft. Sometimes called the most forceful contact in basic.

Sit at 90 degrees Take a firm contact, and you will still have to generate a great deal of

power. Place other hand on pelvic piece driving the opposite way of ulnar. Can place the bottom foot under table for more support. Crank pelvic piece higher than normal

Right sacral subluxation will cause everything else to lean. - Patient has acute right AI sacrum, which way do they lean?

If the patient has this for awhile (past 48 hours) - the innominate will eccentrically rotate and then cause a primary curvature. (this is caused by the muscles trying to bring the back to the correct stature

So then a secondary curvature starts to take place in 4-6 months in a child or 2-3 years in an adult. This is where the spine gets a curve one way at the bottom and another at the top

Finally there is the tertiary stage, one to the right, one to the left, and one to the right. There is more spinal ache.


As time goes on the pelvis gets more distorted and the eccentric side becomes more eccentric and the other side now starts to turn concentric.(76% of soccer players have pain in the pubis symphysis) - Pain in the pubis symphysis

LD shows up and is caused do to the obliqueness of the pelvis

TLDL on one side and a sacral subluxation on the other side - 5th distortion High crest, do to fallen arch Hyperlordotic - posterior weight bearing (sway back)

L5 is deepest must be ant to sacral promenatoryDOUBLE NOTCH - pulls back ant. Base

Straight back

APEX contact

You must take the sacral base angle off the X-ray and minus the interspinous line angle gives you the true sacral base angle with in the persons pelvis

From the horizontal - if the ASIS is below it is a positive number, if it is above then it is negative

The ASIS is lowerIf you see a 38 degree sacral base angle and a 20 degree interspinous line angle

38 - 20 = 18 degree sacral base angle (this is a decreased angle) The ASIS is HigherIf you see a 38 degree sacral base angle and a 20 degree interspinous line angle

38 + 20 = 58 degree sacral base angle (this is an increased angle)

High pocket for illness MT MATERIAL ----------------------------------------------------------Cardinal signs14 indicatorsR AI sacrum what side of table are you on to administer the APEXKnow all contacts

Nothc sitting & standingSpinal pressuresApexSpinal to cervical pressures - switch whenWebster techPerineal contactSome hist - 1st year it was taught 1931


Know when the school was founded - 1935Know diff between hig and low pocket contactunlock, spinal cer presInterspinous line angle and why is it importantKnow table setups - hypo lordosis - which way should nakle piece go? Ab pieceKnow order to adjust in chronic AI sacrum

Ham, piriformis, unlock, apex, spinal/cervical pressures

NOTES FROM SCHOOL CENTER (SC)

Logan Basic TechniqueTerminology

A. Sacral Subluxation.1. The articulation of the sacrum and ilium is not in its normal position.2. In the weight bearing posture, the sacrum has slipped anterior and inferior

in relation to the ilium.3. Can be unilateral or bilateral.4. Can occur in several stages or degrees.

a. Primary – The first change from normalb. Secondary – subsequent changes in the SI articulation.

1. Usually opposite side.2. Can be same side.

B. Sacral Inferiority1. The sacrum is low in relation to the ilium when the body is weight-

bearing.2. Unilateral – When one side is inferior compared to the other.3. Bilateral – When both sides of the sacrum are inferior in relation to the

iliac articulations. Bilateral sacral subluxation

C. Eccentric Rotation of the Innominate Bone1. The superior portion of the innominate (ilium) rotates posterior.2. The ASIS moves superior and backward.3. The pubic bone moves anterior and superior

D. Concentric Rotation of the Innominate Bone1. Opposite that of eccentric rotation

E. Wedging1. The condition in which the vertical measurement of one side of a vertebra

is less than that of the other side.2. L-5 is the most commonly wedged vertebra.3. If bilateral, also called compression.


F. Compression of the Disc 1. The measurement of one side of an intervertebral disc (IVD) is less than

the other.2. The opposite side is called “The open wedge”3. This may indicate a disc bulge to the open wedge side.

G. Infiltration1. The condition in which calcium salts are deposited in tissues.

H. Atony1. The condition in which the muscle cells lose tonicity.

I. Atrophy1. Decrease in size of a tissue or organ that had previously reached normal

size.

J. Scoliosis 1.

K. Leg Deficiency1. One femur head is lower than the other femur head.2. This may be “functional” or “structural” or both.

a. Functional – one side is lower due to a rotation of the pelvisb. Structural – one side is lower due to a true difference in length

from the bottom of the foot to the top of the femur head.

L. Ischial Deficiency1. The condition in which the lower borders of the ischial bones are of a

different height when measured in a standing position or on an x-ray taken in the standing position.

2. The deficiency is considered to be on the side of the high ischium.

M. High Crest1. One iliac crest is higher than the other when measured in a standing

position or on an x-ray taken in the standing position.

N. Heel Lift (Shoe Lift)1. A pad, placed in a shoe to provide support under the calcaneus. It will

elevate that side of the femur height when measured from the floor.

O. Ischial Lift (Sitting Lift)1. A pad, placed under the ischial tuberosity, which holds the spine in the

same position sitting as standing.2. It prevents too great a change in the position of the pelvis when changing

from a standing to a sitting position.


P. Apex Contact1. A light pressure applied to the sacro-tuberous ligament close to its

insertion with the sacrum, with the thumb in an effort to lift the sacrum.2. The patient is in a prone position when applied.3. It is applied with the anterior-lateral 1/3rd of the end of the thumb.

Q. Notch Contact1. A light pressure applied by the thumb tip along the margin of the sacrum

through the gluteal muscles, below the inferior end of the SI joint and the insertion of the sacrotuberous ligament.

2. This is given in the area of the greater sciatic notch.

R. Ulnar Contact1. A more forceful contact applied at the same point as the apex contact with

the distal end of the fifth metacarpal of the hand, in contact with the sacrotuberous ligament.

2. It is used when the thumb cannot be used.3. It is used when a more forceful contact is needed due to an ankylosed SI

joint, due to any reason of ankylosis.

S. Piriformis Contact1. This is applied at the musculotendinous junction of the Piriformis muscle

with the tip of the thumb.2. The direction of force is toward the inferior, between the opposite greater

trochanter and the popliteus fossa.3. This contact is applied prior to the apex/ulnar/notch contact.

T. Auxiliary Contacts1. These are applied to both vertebrae as well as muscles.2. Vertebrae Contacts3. Muscle Contacts.4. These are applied during the apex/ulnar/notch contacts.

U. Abdominal Contacts.1. These are applied to hollow organ spasms.2. These are applied during the apex/ulnar/notch contacts.

V. Perineal Contact1. Applied best during the fifth month of pregnancy.2. This is applied on the pelvic floor muscles.3. This helps to return the normal tonicity of the pelvic floor muscles.4. This helps to lessen the delivery time. 5. This is given with a straight thumb, by the distal end of the thumb, L.O.D.

to the umbilicus.

W. Lumbar Pressures


1. Acute low back conditions – sprained low back conditions, disc bulge, disc herniations.

2. Given on the mamillary processes of each lumbar vertebra, one side of the body at a time.

3. Given with a reinforced pisiform of the superior adjusting hand of the doctor.

Physiology, Pathology and Biomechanics

A. Physiology of Spinal Correction1. When the spine is brought toward normal, many physiologic processes are

involved:a. Reduction of strain and relaxation of the musculature.b. Increased blood flow to those muscles. New and improved blood

flow would bring more oxygen for conversion of lactic acid to muscle glycogen and the products of metabolism would be passed to the blood and to the liver and kidneys for detoxification and elimination.

c. Now the muscles would be better able to respond to other needs, e.g. moving body parts within normal limits.

d. With elimination of these toxic chemicals may cause short-term vertigo after the first few adjustments.

e. Better balance is achieved, seen by using bilateral weight scales and the patient may notice increased overall energy.

B. Effects of Gravity on the Physiology of the Body.1. Muscles, ligaments and bones resist the effects of gravity in the erect,

upright posture.2. This requires a great amount of energy. 3. If the pelvis and spine are distorted, the energy demand is greatly

increased, the more the distortion, the greater the energy demands.

C. Center of Gravity.1. On earth, the center of gravity is the center of mass.2. The center of gravity for the human body is very close to the sacrum.3. Gravity Line.

a. In a normal spine, the gravity line runs from the tip of the mastoid process, though the front of the shoulder, greater trochanter, back of the patella and about one inch anterior to the external malleolus.

b. In a distorted spinal column or pelvis changes the center of gravity from its normal point creating an unstable condition in the body and causes a strain in part of the body requiring a greater amount of energy to keep it in its vertical state.

c. Normally, the line of weight lies posterior to the hip joints (Kippers, University of Queensland, 2000).


D. Abnormal Distribution of Weight1. Distortion of the spine always leads to an abnormal distribution of weight

on the bodies of the vertebrae, IVDs and at times, the articular facets.2. Long continued unilateral compression in the spine may cause wedging of

the disc and/or vertebrae.3. The most common wedged vertebra is L-5.

E. Muscle Strain1. Muscle strain, especially in the erector spinae group, always exists when

the spine becomes distorted.2. Retention of muscle wastes because of long standing strain leads to

fibrosis, atony and even calcification.3. Over a period of time, strained muscles fail to hold the spinal column

within a normal range and lead to greater distortion of the spine than previously observed.

F. Ankylosis1. Shows a wide variation in amount and distribution.2. From slight to complete fixation.3. As time goes on, fixation can progress from affecting the muscles to

affecting the length of ligaments to eventually deposition of calcium in the ligaments and adjacent muscles.

4. Ankylosis obstructs normal restoration of the spine by holding the vertebrae in their distorted position.

5. Calcium in the body is in a state of flux. It can be deposited in and withdrawn from bone, as the body requires. If the body is normalized to a point where the need for calcium in ligaments and muscles are no longer required, the body can withdraw it.

G. Toxicity1. In a distorted body, the musculature discharges metabolites into the blood

stream constantly. The metabolites in the blood in greater than normal range adversely affect the toxin sensitive hypothalamus.

a. This center can adversely affect other areas of the brain, the endocrine glands and excretory organs, including the liver, kidneys and intestines.

H. IVD Health.1. Water Imbibation by the nucleus.

a. When a significant axial force is applied to the spinal column, as during standing, the water contained within the gelatinous matrix of the nucleus escapes into the vertebral body thru microscopic pores linking the casing of the nucleus and the spongy bone underlying the vertebral plateau.


b. As this static pressure is maintained throughout the day, by night the nucleus contains less water than in the morning so that the disc is perceptibly thinner. In a healthy individual, this cumulative thinning of the discs can amount to 2 cm. (Kapandji)

c. Conversely, during the night, when one lies flat, the vertebral bodies are subject to much less axial compression, only generated by normal muscle tone. At this time, water is drawn back into the nucleus and the disc regains its original thickness. Therefore, in a normal spine, the person is taller in the morning than at night.

d. However, if a constant load is applied, as in ankylosis, mild to marked, than the loss of thickness is not linear but exponential, suggesting a dehydration process proportional to the volume of the nucleus. Therefore, the disc does not recover its initial thickness. This state is analogous to aging.

e. This progressive flattening of the disc has an effect on the joints between the articular processes. With a flattened disc, these joints are disturbed and the interspace opens out posteriorly. This articular distortion by itself will lead to osteoarthritis in the long run. (Kapandji)

I. Hip Joint Disease.1. High weight can develop on one side. Over time, this leads to

compression of he head of the femur, which may lead to ischemia. Healing occurs with the formation of a granulation tissue, which changes into bone. However, the flattened shape remains. A lift may be required to offset any leg deficiency caused by the unilateral flattening of the femur head.

J. Biomechanics of the Pelvis

1. In a normal pelvis, in the neutral state, the pubic bones meet at the symphysis, level. The sacral base is level. The iliac crests are even. The top of greater trochanters is level. The spine above is in midline with no rotation or misplacement. Normal A to P curves are present. Discs are healthy and normal in shape and dimensions.

2. As a whole, the pelvis transmits forces from the vertebral column to the lower limbs.

3. The weight is distributed equally along the alae of the sacrum and through the ischial tuberosities towards the acetabulum.

4. Part of the reaction of the ground to the body weight is transmitted to the acetabulum by the neck and head of the femur. The rest is transmitted across the horizontal ramus of the pubic bone and is counterbalanced at the symphysis pubis by a similar force from the other side.

5. These lines of force, together, form a complete ring along the pelvic brim.


6. Nutation and Counter-nutation (Classical Theory of Farabeuf)a. Nutation (“Nodding”)

1. The sacrum rotates about an axis made by the axial ligament (deep layer of the sacroiliac ligaments that runs from the PSIS and the sacrum on the anterior surface between S-1 and S-2).

2. When the sacrum rotates the promontory moves inferiorly and anteriorly while the apex of the sacrum and the tip of the coccyx move posteriorly.

3. The sacrotuberous and sacrospinous ligaments as well as the anterosuperior and anteroinferior aspects of the anterior sacroiliac ligaments limit this movement.

4. The iliac bones move togetherb. Counter-nutation

1. Exact opposite movement involved with nutation.2. The iliac bones move apart.

c. Nutation and Counter-nutation also occurs during child birth. Counternutation happens first to widen the upper portion of the birth canal, then as the child progresses downward, then nutation occurs to widen the lower portion of the birth canal.(Kippers, University of Queensland, 2000).

K. Subluxation of the Sacrum.1. Acute Unilateral Anterior-Inferiority of the Sacrum.

a. Anteriority of the sacrum on one side allows gravity to also cause inferiority on the same side.

b. The degree of unilateral anterior-inferiority of the sacrum is limited to 1/8th of an inch.

c. The sacral subluxation remains in this acute stage as long as the muscles and ligaments of he articulation retain sufficient tone to hold it there.

d. Usually occurs as a result of trauma, occupational position, or excessive stress upon the sacroiliac articulation.

e. Most of the time it is self correcting. f. This is the primary direction of sacral subluxation.g. The sacrum cannot subluxate superior and posteriorly in any

body that is capable of standing.h. SI joint dysfunction (subluxation) has been implicated as a

common cause of back pain in more than 30% of children (Mierau,DR, JMPT 1984).

2. Chronic or Advanced Unilateral Anterior-Inferiority of the Sacrum.a. The end product of the above.b. Perhaps the most common ordinary or usual sacral subluxation

seen in your office.


c. There is a degree of atony in the sacroiliac muscles and ligaments accompanying this subluxation of the sacrum, which allows the innominate bone to rotate in a counterclockwise direction (eccentric rotation), in which the PSIS of the ilium moves to the posterior. The ilium on the opposite side of the sacral subluxation, will also rotate, but the opposite way, called concentric rotation.

d. The ilium rotation will temporarily reduce the inferior “effect” on the spine.

e. As time continues, if the sacral subluxation is not corrected either by self-correction or by intervention, the sacrum will continue to move more and more anterior and inferior, having an effect on the rest of the pelvis and the spine. “As the sacrum goes, so goes the spine.”

3. Complete Anteriority of the Sacrum.a. The entire sacrum moves anterior and inferior.b. A chronic stage of sacral subluxation.

4. The sacrum is subluxated to the anterior or inferior or a combination of both, on the right side, in over 85% of all cases.

5. Due to self correction in many cases, when a patient presents in your office with sacral subluxation, correction will have to be performed on the right side in 60% of all cases.

6. Rotational Subluxation and Distortion of the Spine.a. “The body of the lowest freely moveable vertebra will rotate to

the side of least support, usually indicated by the low side of the sacrum.”

b. “The body of the lowest freely moveable vertebra will rotated to the side of high crest, when such crest is high as a result of sacral subluxation.”

c. The progression of distortion in the spine due to different types of sacral subluxation produces nine distinct spinal distortions. A tenth is produced by wedging of the fifth lumbar vertebra.

7. Anteriority of the Apex of the Sacrum.a. Provides for the apex of the sacrum to move forward from its

normal position.b. The sacral base angle is reduced.c. If not corrected, can cause vertical wedging of the lumbar bodies.

8. Anteriority of the Sacral Basea. The base of the upper portion of the sacrum moves anterior and

slightly inferior to the same degree in relation to both innominates.

b. The sacral base angle is increased.


CARDINAL SIGNS (HELPS)

This system of diagnosis is called by Dr. Logan as the Cardinal Signs. Dr. Hutti put them in a list known as the acronym – HELPS. These are

H – High Crest - Usually on the same side as sacral subluxation

E – Erector Spinae Tension – Usually on same side as sacral subluxation. Palpated at the L-4 level, up to 1 ½ inches lateral to the spinous process.

L – Lowest Freely Movable Vertebra – After finding which is the lowest freely movable, determine side of vertebral body rotation.

P – Pain - May or may not be present. If acute condition, may be the overriding sign and/or indicator of side of contact for that adjusting session.

S – Sacrotuberous Ligament Tension. – May be hard to determine.

GAIT ANALYSIS


A. Four parts to a gait1. Heel Strike2. Mid-Stance3. Push Off4. Mid-Swing

B. Body Movements during Walking1. Watch for:

a. One arm swinging freely or even excessively while the other arm barely moves.

b. “Irish Dancers’” Gait – no arm movementc. Arms moving during walking, but excessively.d. One arm moves freely but close to the body while the other

moves freely but away from the body.e. One sacroiliac joint not moving and the other moves excessively.f. Toeing-out or Foot flare.

C. Body Positions to watch for:1. Head tilted to one side or the other2. Head forward on one side (dominant eye syndrome)3. Shoulder dropped on one side4. Shoulder moved forward on one side5. Shoulder height raised in response to carrying a heavy purse or handbag.

Logan Basic Technique


Full Spine X-ray Procedures

The taking and interpretation of Full Spine X-ray films is a part of the analysis of a patient in Logan Basic Technique. Care in positioning the patient is important to get the best possible x-ray film with the least amount of unnecessary time spent in interpretation.

The patient should be gowned with all metal removed. On the initial x-ray exam, the patient should also have his/her shoes on. The average patient is then measured for thickness at the level of greatest thickness. The tube to film distance is 72 inches. The film used is 14x36 inches. Rare earth screens and capable film should be used to limit exposure time to the patient.

Full Spine AP Procedure

The patient should be placed with his/her back to the bucky. Care should be taken to place his/her second sacral tubercle in direct line with the centerline of the bucky. The patient’s feet should be level with each other and approximately as far apart as the patient’s shoulders. Both knees should be locked. When x-raying older patients and children, the x-ray operator should have those patients hold onto the sides of the bucky for stability (so they don’t inadverantly sway or move).

The patient should be told to look straight ahead. Then the patient should open his/her mouth fully. Then the patient should be told to take a deep breath, exhale completely and then take half of that breath and hold it. The patient should be told not to move. Then the doctor should take the exposure.

In following the above procedure, the doctor, using exposure settings provided by the technique chart in the x-ray room, should get the best possible film in which to begin analyzing the results with the minimum of corrections.

Some points to take into consideration:1. Proper collimation will reduce unnecessary areas to exposure. Care should be

taken to not expose the lens of the eyes. The amount of femur exposed should also be limited as much as possible and still view the bottom of the Ischial tuberosities.

2. On patients with marked scoliosis noted on the physical and chiropractic exams, the amount of lateral collimation should also allow the viewing of the entire spine. Care should be taken not to “cut-out” the portions of the spine at the apices of the curvatures by too severe of collimation.

3. On patients that have considerable girth around the middle, the doctor should use a “compression band” to spread the excess tissue to the sides. This compression band is attached to the bucky and is wrapped from one side to the other side.

4. People with full dentures should be asked to take them out at the same time they remove their jewelry.


5. When taking films of the elderly, reset the technique settings by reducing the Kvp by 16% and doubling the mAs. In doing so, spines with osteoporosis will still be seen well on Full Spine films.

Full Spine Lateral Procedure

The patient should be placed so that his/her left side is against the bucky. The patient should bend his/her elbows and grasp a handle on a rod that stands on the floor and the height of the handle can be changed and measured. The elbows should be bent at a 90 degree angle and the height of the handle should be recorded in the patient’s file. The collimator light should illuminate the patient from just below the ears down to about 3 inches below the top of the greater trochanter.

Appropriate filtration should be used with the taking of all films!

Follow-up X-ray Examination Protocol(Adapted from the “Scoliosis Care and Treatment Guidelines presented by the Committee

for Chiropractic Standards and Care in Scoliosis”, March 1987)

Four follow-up (evaluation) films should be taken in a twelve month period when curve progression is suspected. High risk patients under treatment require a minimum of four x-ray examinations per year. X-rays may be taken P to A to minimize exposure in female patients.


Tips to Improve Your Results withLogan Basic Technique

# 4

This is the fourth article in a series on How to Improve Your Results with Logan Basic Technique.

“To see is to know, not to see is to quess, and we will not guess concerning your health!”- James Parker, D.C.

These words about x-raying a patient, by the late Dr. Jimmy Parker, founder of Parker Chiropractic College, couldn’t be more true in the application of Logan Basic Technique. After your initial physical, orthopedic, in-office Neurologic and chiropractic examination, a practitioner of Logan Basic Technique now takes Full Spine X-rays on his/her patient.

The analysis of the Full Spine AP (FSAP) x-ray using the detailed marking system of Logan Basic Technique can take a long time to perform. However, a 1949 graduate of Logan College invented a measuring device that markedly speeds up the process. Dr. Jack Pry, who became the Chairman of the Board of Trustees of Logan College from 1961 to 1979, invented an ingenious device, called the Pry Off-Center Scale, or Pry Rule for short.

The Pry Rule

Analyzing the FSAP in Basic Technique is essential in determining True Sacral Anteriority, True Leg Length and significant Vertebral Rotation Subluxations. Dr. Pry realized, however, if a new student or busy practitioner had to spend a great deal of time to do this indepth analysis, he/she might be tempted to skip it, to the detriment of his/her patient’s care. Therefore, he designed a L-shaped clear plastic measuring device that has two main parts to it.

The long part of the Pry Rule has millimeter markings on it. It is also long enough to help a doctor find the central ray of the film. Place the device sideways across the film using the long part. The third red line on each side should be in line with the sides of the film. Where the “0” mark is located, is where the center of the film is. If your film does not have the central ray line burned into it, mark this spot with your film marker. Raise the device higher and repeat. Now, turn the device and “connect the dots”. This is the center of your film. You will need to have this marked in order to find any significant “off-centering” of the bony parts of the patient’s spine and pelvis.

Using the description of where the marking dots should be placed on the bony landmarks is covered in Chapter 18 of the Textbook of Logan Basic Methods, 3 rd ed. By Dr. Lawrence Hutti. After these have been done. Find the center of the pelvis by using the Pry Rule. Place the Rule from the two lateral pelvic dots and move it back and forth until the same number appears on each side of the center of the long end of the Rule. Where


the “0” is found is the center of the pelvis. Place a dot there. Now, place the long end of the Rule up and down and place the central red line of the Rule over the central ray line. The short end of the Rule is to be lined up so that the pelvic center dot is on the line labeled PELVIS. The number that corresponds to where the pelvic center dot is placed is the Off-Centering Number to be used to correct the P.A. Also on that line on the short end of the Rule will show a “+”. This is to remind you to ADD the number found to the measurement of the pelvis on the same side as the pelvis is off-centered.

You will repeat this procedure for the sacrum and every vertebra. However, for the sacrum, you will use the line on the short end labeled “SACRUM” and it has a “ – “ to remind you to SUBTRACT the number found from the same side as the sacrum is off-centered. For each vertebra, you will use the line on the short end labeled “VERTEBRA” and it also has a “ – “ to remind you to SUBTRACT the number from the same side as the vertebra is off-centered to.

The Pry Rule has been re-introduced to the core curriculum of Logan Basic Technique to help all students speed up their analysis and thereby be more accurate in the care and management of their patients.

Our thanks must go to Mrs. Polly Pry, the widow of Dr. Jack Pry in allowing us to reproduce the Rule, to Dr. George Goodman who sponsored the effort to bring this device back into the instruction of Logan Basic Technique, and to Mary Jane Palmer, the manager of the Matthews/Logan College Bookstore for tracking down the original manufacturer of the Pry Rule and carrying it in the store for use by our students.


LOGAN BASIC TECHNIQUEADJUSTIVE PROCEDURES

FLOW CHART

UNILATERAL A-I SACRAL SUBLUXATION

1. Hamstring Release

2. Piriformis Contact

3. Sacral Un-lock

4. Apex Contact/Ulnar Contact/Notch Contact

a. Auxiliary Contacts – performed during one of the aboveb. Abdominal Contacts – performed during one of the above

5. Spinal Pressures

6. Cervical Pressures

SPECIAL PROCEDURES

1. Acute Low Back/Disc Derangementa. Apex Contact – Bilaterally applied, initial on side of severe pain.b. Lumbar Pressures – Bilaterally applied, initial on side of severe pain.

2. Pregnancya. Perineal Contactb. Webster Technique

BILATERAL ANTERIOR SACRAL BASE SUBLUXATION

1. Double Notch


Logan Basic TechniqueHamstring Release

After the doctor has determined that the patient requires the application of the adjusting procedures of Logan Basic Technique, and has determined the side of the sacral subluxation and has correctly positioned the patient on the adjusting table, the first procedure performed is usually the Hamstring Release.

When a patient’s sacrum subluxates on one side, the sacrum moves anteriorly and then with the force of gravity, it moves inferiorly. As time progresses, the innominate bone on that side rotates eccentrically. As more time progresses, the innominate bone on the opposite side rotates concentrically. When that occurs, tension is placed on the hamstring muscles on the side of concentric rotation. In other words, the hamstring muscles become tight on the opposite side of the sacral subluxation.

In order to reduce all forces acting on the pelvis, the doctor must release the tension on those hamstring muscles. The doctor gently palpates down the back of the thigh from the top to the bottom. What the doctor is trying to find is the tightess place in the muscle bundle. It is usually found approximately 1/3 to 1/2 the way down the muscle group. This is the trigger point or the neuromuscular junction. The doctor should place both his/her thumbs across this point. The pads of the thumbs are pressed firmly into the tight area and tractions it slowly cephalad until he/she feels the muscle is stretched and the thumbs come to a stop and then quickly thrusts with both thumbs cephalad. The doctor should re-palpate to make sure that the muscle bundle has relaxed. If necessary, the doctor should repeat this maneuver.

Sometimes the doctor will find this tight area in the midline of the thigh. Other times it may be more to one side or the other, but still in the hamstrings.

Occasionally, the doctor may find this tightness on the same side as the sacral subluxation, but not usually.

Now the doctor is ready to go on to the next procedure in Logan Basic Technique.


Logan Basic TechniquePiriformis Contact

When a person suffers an acute unilateral sacral subluxation, the muscles of the spine, gluteal region and lower extremity contract. This response many times corrects the subluxation without the need of a chiropractic intervention. One of the muscles that participate in this action is the Piriformis muscle. In the acute phase, the ipsilateral Piriformis contracts to close the SI joint in the attempt to re-align the sacrum and re-establish the normal juxtaposition of the sacrum and ilium.

The involvement of the Piriformis can be seen by the doctor in several ways. One is the dimpling of the mid-gluteal region on that side of the patient. In Sacral-Occipital Technique, this is called the Dollar Sign. Another way the doctor can see the unilateral contraction of the Piriformis muscle is the flaring of the foot on that side. This is known in LBT as toeing out or foot flare. Sometimes this is best observed by having the patient walk down the office hallway while the doctor stands behind the patient observing the feet and comparing how much of the forefoot is revealed. The side that shows the more of the forefoot is the side of the Piriformis contraction, as one of the actions of the Piriformis muscle is as an external rotator of the leg.

If the sacral subluxation is not reduced by the action of the muscles or by a chiropractic intervention, the Piriformis muscle fatigues. The apex of the sacrum continues to move further away from the side of sacral subluxation. What then occurs is the Piriformis muscle on the opposite side shortens as it no longer needs to be its original length.

In either case, a shorter Piriformis or a contracted Piriformis may irritate the sciatic nerve on that side. This may lead to neuritis that the patient feels as a pain that can extend from the buttock all the way to the end of the sciatic nerve pathway. This is then called The Piriformis Syndrome.

When the Piriformis muscle is involved, direct treatment on the muscle is necessary. This is usually performed after the Hamstring Release and before the Apex/Notch/Ulnar Contact is applied. Direct pressure is required on the muscle. To be able to perform this maneuver, called The Piriformis Contact.

To find the spot on the patient to apply this contact, the patient is prone. The doctor sits on the same side that the contact will be applied. The doctor locates the greater trochanter and palpates the superior pole. He/she then moves cephalad one human inch and then from that point, one human inch anterior. The doctor should be able to palpate the superior edge of the Piriformis muscle.

The contact is given with the doctor’s thumb. The contact hand is closed in a fist with the thumb extruded. There are two ways of giving the contact, either the superior hand or inferior hand of the doctor.


If the inferior hand is used, the thumb nail side is up. The end of the thumb is inserted under the Piriformis muscle. The other hand supports the other side of the patient so that the contact can be given without the patient’s body moving away from the contact. The doctor then directs the force of the contact posteriorward (ceiling) and slightly inferiorward. The doctor may also reinforce his/her hand by resting his/her fist on the knee and then perform a calf lift. This combination gives a very firm and steady pressure on the Piriformis muscle. The muscle responds by relaxing and stretching as the doctor is putting direct pressure on the muscle as well as stretching the muscle between its origin and its insertion.

If the superior hand is used, the thumb nail side is down. The insertion of the thumb tip is given at the same place as just described. The doctor may decide to use this contact instead of the other if a gentler force is necessary due to tenderness of the Piriformis muscle.

The Line of Drive (LOD) is begun almost straight across the patient and is gradually changed to direct it towards the opposite popliteal space. During this contact, the other hand moves to palpate the lower lumbar erector spinae muscles. The doctor can tell if the contact is successful by feeling the Piriformis muscle relax and the lower erector spinae muscles relax slightly as well.


Logan Basic TechniqueNotch Contact

This contact is used in cases of severe anteriority of one side of the sacrum. This is taken at the border of the sacrum at the level of the greater sciatic notch. The notch contact is given with the tip of the thumb, under the border of the sacrum. This is on the anterior side of the sacrum. This is superior to the insertion of the sacrotuberous ligament and inferior to the PIIS (bottom of the SI joint). The line of drive is: 1. Ceiling; 2. Superior without crossing the midline of the body. Some laterality is used as well, as much as possible to affect the spinal balance.The patient is prone. Usually, the doctor sits or stands on the same side of contact, although variations of this can be used effectively. These variations are due primarily to differences in adjusting table heights and doctor build. The doctor’s adjusting hand is a fist with the thumb tip protruding. The thumb tip should be facing up. The doctor’s other hand at first stabilizes the patient’s pelvis as the adjusting hand is applied to the side of the sacrum, then it can be moved to apply auxiliary contacts.

Women’s sacrums are wider than men’s and therefore the contact will be farther away from the midline of the body.

If the doctor chooses to use the notch contact while standing, the contact side of the patient corresponds to the contact hand of the doctor. In other words, right hand – right side, left hand – left side. The doctor positions himself/herself considerably inferior to the contact site. The doctor uses the “fencer” stance, keeping his/her back as straight as possible. With this position, it is difficult to use auxiliary contacts.

If the doctor chooses to use the sitting position, either the inferior or superior hand of the doctor can be used. If the inferior hand is used, the line of drive can be much more superior than if the superior hand is used. Auxiliary contacts can be made with this position.


Logan Basic TechniqueFor Pregnant Women

Perineal Contact

The Perineal Contact was devised for women to help ease the different phases of labor. It is ideally used starting in the fifth month of pregnancy. It is to be used from then on until the day of delivery.

The contact is given while the woman is on her side. The side is to be determined preferably earlier in her gestational period. It is given on the side of A-I sacrum. It is usually given immediately after the Logan Apex Contact. Given while the expectant mother is on her side is usually more comfortable for both her and her chiropractor. The Logan Apex Contact may be given to her on her side as well, if an appropriate adjusting table is not available.

As the fetus grows, the expectant mother’s perineum begins to tighten. This starts to be noticeable in the second trimester of pregnancy. When the woman is ready to deliver, the perineal muscles are too tight to relax completely upon command and the baby’s head will be pushing against a “closed door”. The delays delivery, sometimes for hours and increases the woman’s discomfort.

The contact is given to restore the perineal muscles back to its previously normal relaxation level. The contact is given with a straight thumb. It is applied with the tip of the thumb, immediately lateral to the side of the external anal sphincter muscle. Pressure is applied by the end of the thumb, directly toward the woman’s umbilicus. The first time it is applied, gentle pressure is used, just enough to depress the perineal muscular floor. This will cause the floor to relax. When that is felt, the contact is discontinued for that visit. The next time it is applied, the doctor will notice that he/she can depress the tissues a little deeper. Each time after that the contact is applied, the doctor will notice a deeper depression is possible, until, ideally, by the time of delivery, there is no tightness found, except for normal tone and the doctor’s hand may be depressed to the point that the palm of the hand rests against the buttock tissue. The doorway is ready!Now when the Ob/Gyn or midwife tells the woman in labor to relax and then push, she can and the baby will be delivered much quicker than if the perineal floor muscles were resisting. Many women will not even notice that they are in the first phase of labor and that the second phase of labor will pass extremely fast. The woman should notice that the third phase of labor is less painful.

Normally, if the pregnant woman is receiving chiropractic care during her pregnancy, then the frequency of application of the perineal contact is usually twice a month during the second trimester and once a week during the third trimester.


Logan Basic TechniqueUlnar Contact

This contact is used instead of the Apex Contact for special conditions. First, if the doctor cannot use his/her thumb. The thumb may be injured or missing. Secondly, if the doctor needs to use more force than can be generated by the Apex Contact. This may be due to ankylosis of the patient’s SI joint, ranging from slight fixation to severe DJD.

The doctor sits on the opposite side of contact (AI sacral subluxation). The doctor’s wrist is straight and the hand is inline with his/her ulna. The patient is prone, in the same position as if he/she was to receive the Apex Contact. In some cases, the pelvic piece may need to be raised further. The contact site on the patient is the same place as for the Apex Contact. The doctor sits facing the front of the table, his/her pelvis is in line with the patient’s pelvis.

The Ulnar Contact is given with the end of the fifth metacarpal. The direction of force is: 1. Ceiling, 2. Lateral, as much as capable with this contact, to cephalad.

In special cases of the necessary use of more force, the doctor should change his/her position. In this case, the doctor should sit facing the patient. His/her superior hand should be placed on the superior aspect of the pelvic piece. Then the inferior hand is used to give the Ulnar Contact. As pressure is applied by the adjusting hand, the forces generated back to the doctor are transferred thru the doctor’s hand, up the arm, across the chest, down the opposite arm and into the top of the pelvic piece by that hand. In this manner, the doctor does not place his/her own spine in danger of injury. When this position is used, a great deal of pressure can be applied to the ankylosed SI joint.


APEX CONTACT Proper placement of the adjusting hand is critical to assure good results with the apex contact. The apex contact is used to correct a unilateral A-I sacrum. The doctor is sitting on the opposite side of the adjusting table from the side of patient contact. For example, the patient’s sacrum is subluxated on the right, therefore the doctor sits on the left side. The adjusting or contact hand is held in a relaxed position resembling holding a softball or a large peach. The area of contact on the hand is at the anterior-lateral one-third of the thumb. The area of contact on the patient is on the anterior side of the sacrotuberous ligament close to, if not at the connection of the sacrotuberous ligament with the lateral side of the patient’s sacrum. This is a natural potential cavity of the body is known in Logan Basic Technique as “the pocket”. It is called that because when the thumb is in the right place, it will feel as if the thumb is hooked in the pocket of the doctor’s pants.

During the contact time, to assure the best possible results, the doctor must concentrate on the amount of force given as well as the direction of the “Line of Correction”. The amount of the force is extremely light. The maximum used is the same as the doctor can stand comfortably on his/her eyeball. The proper Line of Correction is of utmost importance in the use of the Apex Contact. There are two. The first is posteriorward. This is posteriorward in respect to the patient. In most literature written on Logan Basic Technique, this direction is also called “ceiling”. This means that the direction is toward the ceiling of the adjusting room. Since the primary direction of subluxation of the sacrum is anterior, the direction of the Line of Correction towards the ceiling must be maintained throughout the duration of the contact. The second component of the Line of Correction is lateralwards. The degree of the lateralward from the midline of the body varies. Most Basic Practitioners start at almost 90 degrees from the midline, straight away from the doctor. As the patient’s back responds to the Apex Contact, the doctor starts slowly to move the lateral component of the Line of Correction more and more cephalic, until the direction is almost 0 degrees off the midline, or straight towards the patient’s head. The Line of Correction never crosses the midline, however.

It is in the actual degree of laterality of the Line of Correction that determines the level of the spine that responds to the Apex Contact. Each degree of change in the direction changes the level of the spine that reacts. For example, a 90 degree of laterality from the midline direction of force typically affects the pelvic musculature. Between 90 and 85 degrees, the lower lumbar area, L-5 and L-4 paravertebral muscles are responding. For every degree or two more cephalic, higher and higher vertebral paraspinal musculature respond. It is with the other hand that the doctor palpates which level of spine is the apex contact is influencing.

The goal of this methodical procedure is to balance the muscles of the spine side to side the entire length from pelvis to the suboccipital region. This balancing of muscular pull will correct the spinal subluxations occurring superior to the sacral subluxation, during and subsequent to, the actual adjustment of the sacrum by the doctor. This is one of the primary goals in Logan Basic Technique. This is a full spine chiropractic technique. In concentrating on what the palpating hand is feeling and slight


changes in the direction of the apex contact, the doctor will enhance and improve his/her results with Logan Basic Technique. Try this and see!

Logan Basic TechniqueProtocol for Acute Disc Derangement

Lumbar Pressures

When presented with a patient who has an acute low back condition, especially a disc derangement or a lumbosacral strain/sprain, the doctor knowledgeable in Logan Basic Technique will decide to treat this patient using the Acute Disc Derangement Protocol which uses Lumbar Pressures.

After an assessment has been performed on the patient, using the 14 Indicators of the Logan Basic Analysis, frank, severe pain is the overriding Indicator. The first apex contact is given on the side of the sharp, severe pain. The patient is lowered on the Zenith Hy-lo chiropractic adjusting table. The pelvic piece is raised slightly before lowering the patient. The patient’s ASIS’s are supported by the top of the pelvic piece and the abdominal piece is released. As soon as the table is completely lowered, the ankle rest is raised to at least the second position. This takes the pull off the sciatic nerves.

The doctor applies the apex contact on the side of the greatest pain. After using many auxiliary contacts, both osseous as well as muscular, the doctor moves to the other side and applies an apex contact to the opposite side of the first contact. The first contact routinely takes over 5 minutes to perform. This could be as much as 8 minutes to get the desired effect. During the first contact, most muscles of the spine will relax and return to their original state of tone. However, the region over the disc bulge will remain fairly spastic, although not as much as before the contact was taken. The opposite side lower lumbar erector spinae muscles might also remain somewhat hypertonic. With the use of the second contact, the rest of the hypertonicity of the side opposite the disc derangement will relax to the normal resting tone. The doctor then washes his/her hands and returns to the patient.

Now it is time to apply the Lumbar Pressures. The pelvic piece is lowered slightly to take some of the traction off the lumbar spine. The doctor stands on the opposite side of the original pain. Using his/her superior hand, the doctor places his/her pisiform on the mamillary of L-5 on the opposite side of where he/she is standing. The doctor reinforces this contact with the opposite hand at the wrist. The patient is instructed to take a deep breath and as the patient lets it out, the doctor applies increasing pressure on the mamillary, to patient tolerance. The Line of Correction is thru the disc plane. At the end of exhalation, the doctor slowly removes the pressure and applies the next contact to L-4 on the same side that L-5 was contacted immediately prior. The doctor repeats the instructions to the patient and repeats the procedure to L-4. This is repeated then at L-3, then L-2 and then L-1. Then the doctor moves to the other side of the patient and now applies Lumbar Pressures to that side, the opposite side of the original pain. Again, the


doctor starts with his/her superior hand contacting the mamillary and the other reinforcing it. The doctor starts at L-5, then moves to L-4, then L-3, then L-2 and then L-1.

The doctor is finished adjusting the patient. After raising the patient back to the upright position, most patients need a sacroiliac brace to be placed on the injured lumbosacral junction. “Two Week Standard”Correction of this type of condition takes usually two weeks. The patient is told not to participate in any vigorous physical activity for two weeks. This includes housework, mowing the lawn, washing the car, etc.Frequency of care:

1. Three consequetive days.2. Fourth day – no adjustment3. Fifth day – same adjustment4. Then every other day for a week.

The use of any belt should be limited in use. The first two days, the patient will definitely benefit from the use of it. Starting the third or fourth day, the doctor should instruct the patient to start using it in the morning, then take it off for the afternoon and replace it again for the evening. On the sixth day, the patient should start the day with it off and put it on for a few hours in the afternoon, then take it off again. By the eighth day, the patient should not need it. No belt should be worn at night during sleep.

There are several exercises that can and should be incorporated with this patient’s care. These will be discussed in a different lecture.


Logan Basic TechniqueSpinal & Cervical

Pressures

After the application of the Apex/Notch/Ulnar contact, the muscles of the spine are balanced. Many small subluxations will have corrected themselves during that contact, and more with the simultaneous use of auxiliary contacts.

However, there will be times that the doctor will find that the patient needs to have more spinal adjustments made during that office visit. This is when Spinal and Cervical Pressures are used.

These pressures will be used after the apex/notch/ulnar contact is finished and the doctor washes his/her hands and returns to the patient.

The abdominal piece should be unlocked prior to the application of these pressures. On some patients, the pelvic piece may need to be lowered to a neutral position, to the same height as the abdominal piece.

The doctor stands to one side of the table, which ever the doctor is most comfortable. Throughout the spine, the pressures are made at the same vertebra with the right hand as the left hand. Equal pressure is given on each side.

In the lumbar spine, Spinal Pressures are given, starting at L-5 with the right thumb on the right mamillary of L-5 and the left thumb on the left mamillary of L-5. The doctor’s episternal notch is directly over the midline of the patient. Firm, constant bilateral pressure is used, to the comfort level of the patient. The Line of Drive for Spinal Pressures in the lumbar spine is thru the disc plane. The patient is asked to contraction his/her erector spinae muscles as if they were walking. Three contractions of each side of the patient’s erector spinae muscles are necessary. After three contractions are accomplished, ask the patient to stop moving, the doctor moves up one vertebra, contacts both mamillaries as before and asks the patient to move again. After three contractions on each side, the patient stops and the doctor again moves cephalic one vertebra. After all the lumbar vertebrae are contacted, the doctor now moves to T-12. This time, the thumb contacts are given at the junction of the lamina and the transverse process. This is right behind the facet joint. The Line of Direct for the thoracic vertebrae is P-A and I to S in reference to the motion segment being affected. The patient is again asked to “walk”. The doctor allows for three contractions of the muscle group on each side and then asks the patient to stop. The doctor than moves his/her thumbs superiorward to the next


motion segment and repeats the above procedure. About the level of T-4, the doctor will notice that the force of the erector spinae muscles used to “walk” will feel greatly diminished and therefore much less effective.

This is when the doctor moves to the head of the adjusting table and faces the prone patient. The doctor switches the contact starting with the next motion segment. He/she places the end of the chiropractic index finger on each hand to the juncture of the laminae with the transverse process, one on each side. The doctor’s palms should be facing each other. The Line of Correction should still be P-A and I-S. Now, the doctor asks the patient to turns his/her head back and forth as if saying “no”, with out the patient lifting his/her head up (posteriorward). This is called Cervical Pressures and is repeated for each motion segment from that point superiorward all the way to and including the atlas.

Now the patient has “adjusted him/herself” with the doctor guiding the vertebrae into normal juxtaposition. All without a thrust to an individual vertebra.


Webster TechniqueFor Pregnant Women

An Adjunct to Logan Basic Technique

Close to the middle of the third trimester of pregnancy, a woman may be told by her OB/Gyn that her baby has a “transverse lie” and/or that there may be a danger of a breech birth. This may also lead to the suggestion of having a “C-Section” delivery.

Dr. Larry Webster found a relation to the pelvic function and the incidence of the above scenario. On the opposite side of the pelvis from an A-I sacral subluxation, he found what he called a “posterior sacrum”. We at Logan College call that finding a “fixated SI joint”. There is no movement of the sacrum on that side, the opposite side of A-I sacrum. Dr. Webster also found a contracted round ligament on the opposite side of the “posterior sacrum”. In other words, on the same side of A-I sacrum.

These twin conditions lead to a torsion in the uterus, constricting fetal movement, and interfering with the baby’s ability to turn into a head down position, favorable for normal vaginal birth.

In helping to determine if the patient’s pelvis is in this condition, flex both knees gently, guiding the heels of her feet toward the ipsilateral buttock of each corresponding foot. If there is a fixation in the SI joint, on that side, the doctor will feel a resistance near the end of motion and that foot will not travel as far as the opposite foot. If performed with the patient on her side, the doctor will get the same observation, taking into consideration the resistance of bottom leg against the table.

To perform the Webster Technique, the first step is to free the fixated SI joint. Remember, in the Webster Method, this is called the posterior sacrum. With using Logan Basic Technique, the doctor uses the Sacral Un-lock procedure. The doctor’s superior hand is placed straddling the locked SI joint. The thenar eminence is on the sacral ala, the “Life Line” of the doctor’s hand follows the joint and the hypothenar eminence is on the iliac bone. The doctor’s inferior hand is placed at the bottom of the opposite buttock. Its purpose is to block pelvic movement on that side as much as possible. The doctor then tightens his/her thenar eminence on the superior hand, places more weight thru it with a locked elbow, the doctor’s episternal notch centered over the patient and the patient is than asked to “walk”. During this procedure of “walking”, the patient alternates contraction of the lumbar erector spinae muscles, thereby moving her hips superiorward then inferiorward. After 4 to 6 alternating contractions, the doctor should recheck for continued fixation or correction. There are other ways of correcting the fixation, but this method works well.


Then the patient is asked to turn on her back. The second step of performing the Webster Method is to relax the round ligament. The round ligament as some contractile tissues and it is imperitive to relax it. The round ligament to be worked is on the opposite side of the formerly fixated SI joint. To find it easily, the doctor should find two anatomical landmarks. The Umbilicus and the ASIS. The doctor should find the round ligament at the junction of two lines. The first is drawn from the Umbilicus inferiorly and laterally at a 45 degree angle from the midline. The second line is drawn from the ASIS inferiorly and medially, again at a 45 degree angle. Where these two lines cross should be the location of the round ligament. This ligament now is approximately the same diameter as the woman’s index finger and is easily palpated thru the skin. A contact should be given with the doctor’s thumb on the inferior hand. The hand formation should resemble the hand formed as if to give the Apex Contact. The thumb “hooks” under the tight round ligament and the direction of correction is superiorward and toward the opposite shoulder. After a minute to three minutes, the doctor should feel the round ligament relaxing and possibly rolling under his/her thumb.

The procedure is finished. Any other chiropractic care can be incorporated at this time.

Frequency of follow-up depends on the urgency of enough time to allow the baby to turn on its own. Sometimes frequency is daily, sometimes every other day, sometimes only a couple of visits are necessary. It is up to the doctor. Remember, you are not “turning the baby”. That is practicing obstetrics. You are adjusting the mother to allow her body to regulate the progression of the pregnancy naturally.

Clinical Case #1You have marked a FSAP using the Logan X-ray Marking System. You have found the following. A P.A. on the right of 8. The sacral measurements on the film are 40 on the right and 50 on the left. The L.D. is four on the right. The vertebral measurements on the L-5 are 15 on the right and 18 on the left; L-4 measurements are 20 on the right and 15 on the left; L-3 measurements are 17 on the right and 17 on the left. T-12 measurements are 12 on the right and 15 on the left. T-11 measurements are 15 on the right and 11 on the left. Using these findings, please answer the following questions.

The S.A is:The T.S.A. is:The T.L.D. is: The difference in the body rotation of L-4 compared to L-5 is:The difference in the body rotation of L-3 compared to L-4 is:The difference in the body rotation of T-11 compared to T-12 is:

Clinical Case #2An individual is examined in your office. You have sent out the patient to have an x-ray examination. The patient returns with their FSAP. You begin the measurements on the x-ray film and find to your dismay that the patient is off-centered. The center of the pelvis is to the right of 12 mm. The center of the sacrum is to the right of 6 mm. All the


vertebrae are off-centered by 8 mm. The other measurements are the same as above. Answer the same questions to see the difference in the results.

Hint: There is no scoliotic curve, therefore no differences reflected into the measurements of the vertebrae.

Logan Basic Technique IIIWeek 13

Logan System of Body Mechanics&

Logan Basic Technique

A. Review of Anatomy Associated with Logan Basic Technique1. Osseous Anatomy of Pelvis, Spine and Lower Extremity2. Muscular Anatomy of Pelvis, Spine, Lower and Upper Extremity, Skull

B. Review of Biomechanics of Pelvis and Spine1. Normal Gait2. Pelvic Movement3. Vertebral Movement

C. Review of Pathobiomechanics of Subluxation of the Pelvis1. Pelvic Distortions2. Spinal Distortions3. Muscular Deviations4. Extremity Deviations and Conditions

D. Reasons of Intervention by a Chiropractor1. Primary Subluxations2. Secondary Subluxations.3. Importance of Consultation4. Importance of Examination Procedures

a. Physical Examb. X-ray Exam

5. Compilation of Findings6. Arrival of Diagnosis7. Treatment Plan8. Consent to Treatment Plan by Patient9. Management of Patient

a. Visit by Visitb. Re-evaluation Date to Re-evaluation Date

1. Re-examination of Physical Findings2. Re-X-ray – Evaluation of Findings

10. MMI


E. Review of Adjusting Technique – Logan Basic Technique1. Rationale of Flow Chart for A-I Sacrum2. Rationale of Heel/Ischial Lift Procedures3. Consideration of Biochemical/Visceral Re-actions to Pelvic and Spinal

Distortions.

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