Gonstead Technique Study Sheet Fall 2006

Patient Position Contact Point Segmental Contact General Finger Approximate

Listing Miscellaneous
(P.P.) (C.P.) Point (S.C.P.) Position Line of Correction (L.O.C.)

Lower Cervical Adjustments (C2-C7)

P-A, R-L through pts

Right index, distal- Right posterior inferior CH - Rat hole, IH-
PR Seated opposite eye, *** along
lateral portion spinous process fingers down neck
plane line of disk

P-A, L-R through pt's

Left index, distal- Left posterior inferior CH - Rat hole, IH-
PL Seated opposite eye, *** along
lateral portion spinous process fingers down neck
plane line of disk

Left lamina of involved P-A through pt's same side

Left index, distal- CH - Rat hole, IH-
PR-La Seated segment (opposite of eye, *** along plane line of
lateral portion fingers down neck
the listing) disk
LOC must take into account facets and
disk plane. Disk planes vary from
Right lamina of involved P-A through pt's same side patient to patient so set angles are
Right index, distal- CH - Rat hole, IH-
PL-La Seated segment (opposite of eye, *** along plane line of inappropriate. The doctor must align
lateral portion fingers down neck
the listing) disk him/herself with the patient's disk and
then align slightly lower to
P-A, R-L through pts accommodate the facets.
Right index, distal- Right posterior inferior CH - Rat hole, IH-
PRS Seated opposite eye, CW torque,
lateral portion spinous process fingers down neck
*** along plane line of disk Each segment will require an I-S lift
(relative to that segment) and then the
thrust should aim along the plane of the
P-A, L-R through pt's
Left index, distal- Left posterior inferior CH - Rat hole, IH- disk (which is essentially perpendicular
PLS Seated opposite eye, CCW torque,
lateral portion spinous process fingers down neck to the patien's back at that level).
*** along plane line of disk

P-A through pt's same side

Left lamina of involved
Left index, distal- CH - Rat hole, IH- eye, De-rotate spinous with
PRI-La Seated segment (opposite of
lateral portion fingers down neck P-A, CCW torque, ***
the listing)
along plane line of disk

P-A through pt's same side

Right lamina of involved
Right index, distal- CH - Rat hole, IH- eye, De-rotate spinous with
PLI-La Seated segment (opposite of
lateral portion fingers down neck P-A, CW torque, *** along
the listing)
plane line of disk

GENERAL NOTES FOR LOWER CERVICALS:

> Cervical adjustments as presented at this level, should be performed in the Cervical Chair.
( More advanced techniques may take advantage of the knee-chest, and the Zenith Hi-Lo table)
> The line of correction should include a slight lift at the beginning of the thrust to bring the vertebra up "into the saddle" and then follow the disk plane line
> Modify the disk plane to suit the individual patient during a thrust.
> Stabilization hand should be held steady and not "whipped". Too much thenar pressure will cause a "whip" of the head
> Stabilization hand should contact the antero-lateral neck at the level below the one you are adjusting.
You should think about "catching" the vertebra you are adjusting at the MCP or distal portion of your index and middle finger of the stabilizing hand
> Extension of the neck should not bring the chin past level; only enough to cause the segment you are adjusting to just begin to move.
> Spinous contacts are at the posterior, inferior lateral aspect of the Spinous.
> The location of the lamina contact is approximately 1/8" lateral and 1/8" superior to the cervical spinous process.
> Torques: Right side contacts are clockwise, and left side contacts are counter-clockwise (we are always contacting the open wedge side).
> Remember to "squash the grape" when you thrust - it will give you speed and help with the appropriate torque.
> Keep your muscles relaxed until you actually thrust, a tight muscle has no speed. Most of the speed and depth occur within the first 1-1 1/2 inches.
> All gonstead adjustments are a thrust and HOLD for a beat - this takes advantage of ligamentous creep.

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 Gonstead Technique Study Sheet Fall 2006
Patient Position Contact Point Segmental Contact General Finger Approximate
Listing Miscellaneous
(P.P.) (C.P.) Point (S.C.P.) Position Line of Correction (L.O.C.)

Atlas AS Cervical Adjustments (C1)

Thumbpad, Right
AR Seated Right Lateral TVP R-L
hand
Thumbpad, Left
AL Seated Left Lateral TVP L-R
hand
Thumbpad, Right
ASR Seated Right Lateral TVP R-L, CW torque
hand
Thumbpad, Left Contact hand is slightly cupped, thumb
ASL Seated Left Lateral TVP L-R, CCW Torque in tight, wrist in slight extension.
hand
R-L, CW torque, prestress
Thumbpad, Right A relaxed hand is much faster here.
ASRA Seated Right Lateral TVP posteriorly (nose toward
hand
contact)
Let the lateral portion of your index
L-R, CCW Torque, finger lay along the base of the
Thumbpad, Left
ASLA Seated Left Lateral TVP prestress posteriorly (nose patient's skull to monitor the tension on
hand
toward contact) the sub-occipital musculature. Raise
the patient's chin slightly until these
R-L, CW torque, prestress
Thumbpad, Right muscles relax.
ASRP Seated Right Lateral TVP anteriorly (nose away from
hand
contact)

L-R, CCW torque,

Thumbpad, Left
ASLP Seated Left Lateral TVP prestress anteriorly (nose
hand
away from contact)

Atlas AI Cervical Adjustments (C1)

Soft Pisiform of
AIR Prone Right Lateral TVP R-L, CCW torque
Right hand
Soft Pisiform of
AIL Prone Left Lateral TVP L-R, CW torque
Left hand
Soft Pisiform of Episternal notch anterior to Contact
AIRA Prone Right Lateral TVP R-L, CCW torque, A-P
Right hand Point
Soft Pisiform of Episternal notch anterior to Contact
AILA Prone Left Lateral TVP L-R, CW torque, A-P
Left hand Point
Soft Pisiform of Episternal notch Posterior to Contact
AIRP Prone Right Lateral TVP R-L, CCW torque, P-A
Right hand Point
Soft Pisiform of Episternal notch Posterior to Contact
AILP Prone Left Lateral TVP L-R, CW torque, P-A
Left hand Point

For AS listings: Pt is in the cervical chair. LOC is across the line of the shoulders, through the plane of the atlas
> Hand position, AS listings: Somewhat flat hand, thumb pulled in tight, slight wrist extension, lateral index finger along suboccipital musculature.
Line of Drive: across the plane line of the atlas (send your thrust out the opposite TVP of atlas)
For AI listings: The patient is on the knee-chest table with the side of laterality turned upward. The doctor is standing
on the side the patient's face is turned toward (i.e. AIR: Rule - RIGHT side up, RIGHT hand contact, Doc on the Pt's RIGHT)
remember: "right,right,right/left,left,left"
> "squashing the grape" under your arm as you thrust helps you produce the appropriate torque and improves your speed.
> AS listings may be performed on the knee -chest with reversed torque. AI listings may be performed in the chair with the patient's chin raised
and torque reversed; the notes in the grid above represent, however, the preferred methods

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 Gonstead Technique Study Sheet Fall 2006
Patient Position Contact Point Segmental Contact General Finger Approximate
Listing Miscellaneous
(P.P.) (C.P.) Point (S.C.P.) Position Line of Correction (L.O.C.)

Occipital Listings (C0)

Overlaid Pisiforms A-P, S-I, R-L in a scooping Preload condyles by turning chin
Right Supra-orbital
AS-RS Seated or 2nd-4th motion toward the reion of slightly down and laterally flexing head
ridge
phalanges the Dr's opposite kidney to right

Overlaid Pisiforms A-P, S-I, L-R in a scooping Preload condyles by turning chin
AS-LS Seated or 2nd-4th Left supra-orbital ridge motion toward the reion of slightly down and laterally flexing head
phalanges the Dr's opposite kidney to left

A-P, S-I, R-L in a scooping

Preload condyles by turning chin
Overlaid Pisiforms motion toward the reion of
Right Supra-orbital slightly down, laterally flexing head to
AS-RS-RP Seated or 2nd-4th the Dr's opposite kidney.
ridge right and turning nose away from
phalanges Pt's head is pre-positioned
contact
in left rotation.

A-P, S-I, R-L in a scooping

Overlaid Pisiforms motion toward the reion of Preload condyles by turning chin
Right Supra-orbital
AS-RS-RA Seated or 2nd-4th the Dr's opposite kidney. slightly down, laterally flexing head to
ridge
phalanges Pt's head is pre-positioned right and turning nose toward contact
in right rotation.

A-P, S-I, L-R in a scooping

Overlaid Pisiforms motion toward the reion of Preload condyles by turning chin
AS-LS-LP Seated or 2nd-4th Left supra-orbital ridge the Dr's opposite kidney. slightly down, laterally flexing head to
phalanges Pt's head is pre-positioned left and turning nose away from contact
in right rotation

A-P, S-I, L-R in a scooping

Overlaid Pisiforms motion toward the reion of Preload condyles by turning chin
AS-LS-LA Seated or 2nd-4th Left supra-orbital ridge the Dr's opposite kidney. slightly down, laterally flexing head to
phalanges Pt's head is pre-positioned left and turning nose toward contact
in left rotation.

Palmar aspect of
P-A, S-I, R-L through the Preload condyles by bringing chin
the metacarpo- Right Supra-mastoid
PS-RS Seated C0-C1 joint plane line, in a slightly up and laterally flexing head to
phalangeal joint of notch
scooping motion the right
thumb.
Palmar aspect of
P-A, S-I, L-R through the Preload condyles by bringing chin
the metacarpo- Left Supra-mastoid
PS-LS Seated C0-C1 joint plane line, in a slightly up and laterally flexing head to
phalangeal joint of notch
scooping motion the left
thumb.

P-A, S-I, R-L through the

Palmar aspect of Preload condyles by bringing chin
C0-C1 joint plane line, in a
the metacarpo- Right Supra-mastoid slightly up, laterally flexing head to the
PS-RS-RP Seated slight scooping motion.
phalangeal joint of notch right and turning nose away from the
Pt's head is prepositioned
thumb. contact
in left rotation

P-A, S-I, R-L through the

Palmar aspect of Preload condyles by bringing chin
C0-C1 joint plane line, in a
the metacarpo- Right Supra-mastoid slightly up, laterally flexing head to the
PS-RS-RA Seated slight scooping motion.
phalangeal joint of notch right and turning nose toward the
Pt's head is prepositioned
thumb. contact
in right rotation

P-A, S-I, L-R through the

Palmar aspect of Preload condyles by bringing chin
C0-C1 joint plane line, in a
the metacarpo- Left Supra-mastoid slightly up, laterally flexing head to the
PS-LS-LP Seated slight scooping motion.
phalangeal joint of notch left and turning nose away from the
Pt's head is prepositioned
thumb. contact
in right rotation

P-A, S-I, L-R through the

Palmar aspect of Preload condyles by bringing chin
C0-C1 joint plane line, in a
the metacarpo- Left Supra-mastoid slightly up, laterally flexing head to the
PS-LS-LA Seated slight scooping motion.
phalangeal joint of notch left and turning nose toward the
Pt's head is prepositioned
thumb. contact
in left rotation

> All AS listings require a cervical blocker

> To make it easier to remember which hand to use and which side to contact, think of the first and third letters of the listing. I.e. PS-RS-RA
The first letter "P" and the the third letter "R" tell you to put your "R"ight hand on the "P"osterior "R"ight side of the patient's head, and then lean the
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 Gonstead Technique Study Sheet Fall 2006
Patient Position Contact Point Segmental Contact General Finger Approximate
Listing Miscellaneous
(P.P.) (C.P.) Point (S.C.P.) Position Line of Correction (L.O.C.)

patient's head to the "P"osterior "R"ight. Then just remember to pre-load the condyle based on the very last "P" or "A" in the listing (if present).
An AS-RS-RP would be done the same way: "R"ight hand on the "A"nterior "R"ight and lean pt's head "A"nterior and "R"ight.

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 Gonstead Technique Study Sheet Fall 2006
Patient Position Contact Point Segmental Contact General Finger Approximate
Listing Miscellaneous
(P.P.) (C.P.) Point (S.C.P.) Position Line of Correction (L.O.C.)

Thoracic Adjustments

Right posterior spinous 45, across the

Prone with doctor on P-A, R-L, *** along plane
PR Pisiform process, as high on the spine (hand
right line of disk
shaft as possible relaxed)

Left posterior spinous 45, across the

Prone with doctor on P-A, L-R, *** along plane
PL Pisiform process, as high on the spine (hand
left line of disk
shaft as possible relaxed)

Left Transverse
Parallel to the
Prone with doctor on Process of involved P-A, *** along plane line of
PR-T Pisiform Spine (not crossing
left segment (opposite of disk LOC must take into account facets and
the spine)
the listing) disk plane. Disk planes vary from
Right Transverse patient to patient so set angles are
Parallel to the
Prone with doctor on Process of involved P-A, *** along plane line of inappropriate. The doctor must align
PL-T Pisiform Spine (not crossing him/herself with the patient's disk and
right segment (opposite of disk
the spine) then align slightly lower to
the listing)
accommodate the facets.
Right posterior spinous 45, across the
Prone with doctor on P-A, R-L, CW torque, *** Each segment will require an I-S lift
PRS Pisiform process, as high on the spine (hand
right along plane line of disk (relative to that segment) and then the
shaft as possible relaxed)
thrust should aim along the plane of the
disk (which is essentially perpendicular
Left posterior spinous 45, across the
Prone with doctor on P-A, L-R, CCW torque, *** to the patien's back at that level).
PLS Pisiform process, as high on the spine (hand
left along plane line of disk
shaft as possible relaxed)

Left Transverse
Parallel to the P-A, De-rotate spinous with
Prone with doctor on Process of involved
PRI-T Pisiform Spine (not crossing P-A, *** along plane line of
left segment (opposite of
the spine) disk with a CCW torque
the listing)
Right Transverse
Parallel to the P-A, De-rotate spinous with
Prone with doctor on Process of involved
PLI-T Pisiform Spine (not crossing P-A, CW torque, *** along
right segment (opposite of
the spine) plane line of disk with a
the listing)

GENERAL NOTES FOR THORACICS:

> Thoracic adjustments should be performed on the knee-chest, or the Zenith Hi-Lo table (with abdominal piece unlocked)
> Dr stands on the side of CONTACT, angled toward the patient's head slightly.
> Modify the disk plane to suit the individual patient during a thrust.
> For the T1-T3 use your inferior hand for the primary contact, your support hand will produce the necessary S-I thrust
> We do not reach across the spine for the transverse-process contacts in the thoracic spine.
> Keep your muscles relaxed until you actually thrust, a tight muscle has no speed.
> All gonstead adjustments are a thrust and HOLD for a beat - this takes advantage of ligamentous creep.

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 Gonstead Technique Study Sheet Fall 2006
Patient Position Contact Point Segmental Contact General Finger Approximate
Listing Miscellaneous
(P.P.) (C.P.) Point (S.C.P.) Position Line of Correction (L.O.C.)

Pelvis Push Moves

Straight up the
PI ISU Pisiform Posterior Inferior PSIS P-A, I-S
spine

Straight up the P-A, S-I (Along line of Fingers may be turned toward the
AS ISU Pisiform Gonstead Fossa *
spine femur) Doctor to accomodate S-I line of drive

Pull move recommended for this

Ex ISU Pisiform Lateral PSIS Down to the table P-A, L-M adjustment (in other words PULL THIS
ONE)
In ISU Pisiform Medial PSIS Point to Doctor P-A, M-L

45 degrees down - P-A, I-S, L-M, Torque

Posterior inferior Unless Ex component is very small
PIEx ISU Pisiform to opposite iliac pisiform medially (R - CW,
Lateral PSIS compared to PI, pull this one
crest L - CCW)

45 degrees up - P-A, I-S, M-L, Torque

Posterior inferior medial
PIIn ISU Pisiform toward same side pisiform laterally (R -
PSIS
iliac crest CCW, L - CW)

Generally, this one pulls much better

P-A,S-I, L-M, Torque
than it pushes, so a pull is preferred.
ASEx ISU Pisiform Gonstead Fossa* 45 degrees down pisiform medially (R - CW,
Especially pull this one if Ex component
L - CCW)
is greater than AS.

P-A, S-I, M-L, Torque

ASIn ISU Pisiform Gonstead Fossa* 45 degrees up pisiform laterally (R -
CCW, L - CW)

Pelvis Pull Moves ALL PULLS HAVE A "KICK"

In ISU "High C" Medial PSIS P-A, M-L
Reach around patient, and tissue pull
Ex ISD Pisiform Lateral PSIS P-A, L-M
medially to the PSIS
P-A, I-S, M-L, Torque
Posterior inferior medial
PIIn ISU "High C" fingers laterally (R - CCW,
PSIS
L - CW)

Reach around patient, and tissue pull

P-A, I-S, L-M, Torque medially to the PSIS. You should be
Posterior inferior
PIEx ISD Pisiform pisiform medially (R - CW, leaning toward the patient's head. If PI
Lateral PSIS
L - CCW) component is greater than Ex, consider
pushing this one.

Begin by reaching around patient, and

tissue pulling with the pisiform medially
toward PSIS, then inferiorward toward
P-A,S-I, L-M, Torque
the Gonstead Eminence. You should
ASEx ISD Pisiform Gonstead Fossa* pisiform medially (R - CW,
be leaning toward the patient's feet,
L - CCW)
and as you move to this position, your
SCP should swing down to the correct
point near the Gonstead Eminence.

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 Gonstead Technique Study Sheet Fall 2006
Patient Position Contact Point Segmental Contact General Finger Approximate
Listing Miscellaneous
(P.P.) (C.P.) Point (S.C.P.) Position Line of Correction (L.O.C.)

Sacrum Moves
Between S2 tubercle
P-R/P-L Straight down to
ISU Pisiform and PSIS on involved P-A
Push table
side
Between S2 tubercle
P-R/P-L
ISD Pisiform and PSIS on involved 45 - 45- 45* P-A
Push
side
Between S2 tubercle
P-R/P-L Pull ISU "High C" and PSIS on involved P-A All Pull moves have a "kick"
side
Base
Either Pisiform S1 Tubercle Down to Table P-A
Posterior
L5
Only adjust if symptomatic and grade 1
Spondylolist Either Pisiform S1 Tubercle Down to Table S-I, then P-A
or 2
hesis
* Patient rotated to 45, contact hand at 45 away from midline, and thenar lifted 45 degrees off the patient's body for specificity.
Coccyx

Thumb-tip of
cephalad hand with Coccyx (tissue pull from
Prone (Dr. on either Caudad forearm
A pisiform of caudad low on coccyx straight I-S ONLY Only adjust if symptomatic
side) parallel to ground
hand on contact up midline)
thumb nail

Thumb-tip of
Coccyx (tissue pull from
cephalad hand with Only adjust if symptomatic - Dr. may
Prone (Dr. on either low on open wedge side Caudad forearm
A-R/A-L pisiform of caudad I-S ONLY have slight advantage by standing on
side) of coccyx straight up parallel to ground
hand on contact side of open wedge
midline)
thumb nail

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 Gonstead Technique Study Sheet Fall 2006
Patient Position Contact Point Segmental Contact General Finger Approximate
Listing Miscellaneous
(P.P.) (C.P.) Point (S.C.P.) Position Line of Correction (L.O.C.)

Lumbar Push Adjustments

Posterior inferior 45, across the P-A, *** along plane line of
P Side Posture Pisiform
spinous spine disk
Right lateral posterior
Left Side Posture 45, across the P-A, R-L, *** along plane
PR Pisiform inferior spinous of
(spinous rotation up) spine line of disk
involved segment
Left lateral posterior
Right Side Posture 45, across the P-A, L-R, *** along plane
PL Pisiform inferior spinous of
(spinous rotation up) spine line of disk
involved segment
Right Side Posture Left Mammillary P-A, De-rotate spinous with LOC must take into account facets and
Straight up the
PR-M (Spinous rotation Pisiform (opposite spinous P-A, *** along plane line of disk plane. Disk planes vary from
spine patient to patient so set angles are
DOWN) rotation) disk
Left Side Posture Right Mammillary P-A, De-rotate spinous with inappropriate. The doctor must align
Straight up the
PL-M (spinous rotation Pisiform (opposite spinous P-A, *** along plane line of him/herself with the patient's disk and
spine then align slightly lower to
DOWN) rotation) disk
accommodate the facets.
Right lateral posterior P-A, R-L, *** along plane
Left Side Posture 45, across the
PRS Pisiform inferior spinous of line of disk, with a CW Each segment will require an I-S lift
(spinous rotation up) spine
involved segment Torque (relative to that segment) and then the
Left lateral posterior P-A, L-R, *** along plane thrust should aim along the plane of the
Right Side Posture 45, across the
PLS Pisiform inferior spinous of line of disk, with a CCW disk (which is essentially perpendicular
(spinous rotation up) spine
involved segment torque to the patien's back at that level).

Right Side Posture Left Mammillary P-A, De-rotate spinous with

Straight up the
PRI-M (Spinous rotation Pisiform (opposite spinous P-A, *** along plane line of
spine
DOWN) rotation) disk, with a CCW torque

Left Side Posture Right Mammillary P-A, De-rotate spinous with

Straight up the
PLI-M (spinous rotation Pisiform (opposite spinous P-A, *** along plane line of
spine
DOWN) rotation) disk, with a CW torque

L5 Special Listings

Right lateral posterior P-A, R-L, S-I along plane

Left Side Posture 45, across the Knee Chest - Use caudal hand,
PRI-Sp Pisiform inferior spinous of line of disk, with a CCW
(spinous rotation up) spine Torque UP the spine
involved segment Torque

Left lateral posterior P-A, L-R, S-I along plane

Right Side Posture 45, across the Knee Chest - Use caudal hand,
PLI-Sp Pisiform inferior spinous of line of disk, with a CW
(spinous rotation up) spine Torque UP the spine
involved segment torque

Right Side Posture Left Mammillary P-A, De-rotate spinous with Knee Chest - Use caudal hand,
Straight up the
PRS-M (Spinous rotation Pisiform (opposite spinous P-A, S-I along plane line of fingers 90 degrees away from Dr.
spine
DOWN) rotation) disk, with a CW torque Torque UP the spine

Left Side Posture Right Mammillary P-A, De-rotate spinous with Knee Chest - Use caudal hand,
Straight up the
PLS-M (spinous rotation Pisiform (opposite spinous P-A, S-I along plane line of fingers 90 degrees away from Dr.
spine
DOWN) rotation) disk, with a CCW torque Torque UP the spine

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 Gonstead Technique Study Sheet Fall 2006
Patient Position Contact Point Segmental Contact General Finger Approximate
Listing Miscellaneous
(P.P.) (C.P.) Point (S.C.P.) Position Line of Correction (L.O.C.)

Lumbar Pull Adjustments ALL PULLS HAVE A "KICK"

Right Side Posture Right lateral posterior
P-A, R-L, *** along plane
PR (Spinous rotation "High C" inferior spinous of
line of disk
DOWN) involved segment
Left Side Posture Left lateral posterior
P-A, L-R, *** along plane
PL (spinous rotation "High C" inferior spinous of
line of disk
DOWN) involved segment
Right Side Posture Left Mammillary P-A, De-rotate spinous with
PR-M (Spinous rotation "High C" (opposite spinous P-A, *** along plane line of LOC must take into account facets and
DOWN) rotation) disk disk plane. Disk planes vary from
Left Side Posture Right Mammillary P-A, De-rotate spinous with patient to patient so set angles are
PL-M (spinous rotation "High C" (opposite spinous P-A, *** along plane line of inappropriate. The doctor must align
DOWN) rotation) disk him/herself with the patient's disk and
then align slightly lower to
Right Side Posture Right lateral posterior
P-A, R-L, CW Torque, *** accommodate the facets.
PRS (Spinous rotation "High C" inferior spinous of
along plane line of disk
DOWN) involved segment
Each segment will require an I-S lift
Left Side Posture Left lateral posterior
P-A, L-R, CCW torque, *** (relative to that segment) and then the
PLS (spinous rotation "High C" inferior spinous of
along plane line of disk thrust should aim along the plane of the
DOWN) involved segment disk (which is essentially perpendicular
to the patien's back at that level).
Right Side Posture Left Mammillary P-A, De-rotate spinous with
PRI-M (Spinous rotation "High C" (opposite spinous P-A, CCW torque, ***
DOWN) rotation) along plane line of disk

Left Side Posture Right Mammillary P-A, De-rotate spinous with

PLI-M (spinous rotation "High C" (opposite spinous P-A, CW torque, *** along
DOWN) rotation) plane line of disk

L5 Special Listings
Right Side Posture Right lateral posterior
P-A, R-L, CCW Torque, S-I
PRI-Sp (Spinous rotation "High C" inferior spinous of
along plane line of disk
DOWN) involved segment

Left Side Posture Left lateral posterior

P-A, L-R, CW torque, S-I
PLI-Sp (spinous rotation "High C" inferior spinous of
along plane line of disk
DOWN) involved segment

Right Side Posture Left Mammillary P-A, De-rotate spinous with

PRS-M (Spinous rotation "High C" (opposite spinous P-A, CW torque, S-I along
DOWN) rotation) plane line of disk

Left Side Posture Right Mammillary P-A, De-rotate spinous with

PLS-M (spinous rotation "High C" (opposite spinous P-A, CCW torque, S-I
DOWN) rotation) along plane line of disk

Notes:
* The Gonstead point is 2" lateral and 3" inferior to the PSIS
*** See the note concerning disk planes under "Miscellaneous"
General Notes:
> Motion for the "Kick" in pulls is like kicking a soccer ball under the table - Try not to induce excess rotation in the Lumbar/Thoracic spine
> L5 special listings are identical to other listings as far as setup. You must take care that your LOC's are correct, particularly that the torque is the right direction.
> In all push adjustments, the Dr. is stabilizing the patient's pelvis or thigh into the table with a light "gluteal flex"
> Left Side Posture means the patient's left side is down, Right Side Posture means the patient's right side is down
> The word "PULL" is a misnomer... it is really a FINGER PUSH and the contact point is the figer tip.
> For -M listings, the mammillary you are contacting will be up
> For Side-posture work (pull or push), the spinous will be down to the table. EXCEPTION: spinous push move.
> Directions of fingers is incidental to the line between your elbow and your pisiform... This is where the LOC really occurs
> The disk planes listed are generic for purposes of drill. Modify the disk plane to suit the individual patient during a thrust.

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 Gonstead Technique Study Sheet Fall 2006
Patient Position Contact Point Segmental Contact General Finger Approximate
Listing Miscellaneous
(P.P.) (C.P.) Point (S.C.P.) Position Line of Correction (L.O.C.)

Lumbar Knee-Chest Adjustments

Standard Knee-Chest Posterior inferior 45, across the P-A, *** along plane line of
P Pisiform
Position spinous spine disk

Standard Knee-Chest Right lateral posterior

45, across the P-A, R-L, *** along plane
PR Position with doctor Pisiform inferior spinous of
spine line of disk
on right involved segment

Standard Knee-Chest Left lateral posterior

45, across the P-A, L-R, *** along plane
PL Position with doctor Pisiform inferior spinous of
spine line of disk
on left involved segment

Standard Knee-Chest Left Mammillary Perpendicular to P-A, De-rotate spinous with

LOC must take into account facets and
PR-M Position with doctor Pisiform (opposite spinous spine (90 degrees P-A, *** along plane line of
disk plane. Disk planes vary from
on right rotation) to spine) disk
patient to patient so set angles are
inappropriate. The doctor must align
Standard Knee-Chest Right Mammillary Perpendicular to P-A, De-rotate spinous with him/herself with the patient's disk and
PL-M Position with doctor Pisiform (opposite spinous spine (90 degrees P-A, *** along plane line of then align slightly lower to
on left rotation) to spine) disk accommodate the facets.

Standard Knee-Chest Right lateral posterior P-A, R-L, *** along plane Each segment will require an I-S lift
45, across the
PRS Position with doctor Pisiform inferior spinous of line of disk, with a CW (relative to that segment) and then the
spine thrust should aim along the plane of the
on right involved segment Torque
disk (which is essentially perpendicular
Standard Knee-Chest Left lateral posterior P-A, L-R, *** along plane to the patien's back at that level).
45, across the
PLS Position with doctor Pisiform inferior spinous of line of disk, with a CCW
spine
on left involved segment torque

Standard Knee-Chest Left Mammillary Perpendicular to P-A, De-rotate spinous with

PRI-M Position with doctor Pisiform (opposite spinous spine (90 degrees P-A, *** along plane line of
on right rotation) to spine) disk, with a CCW torque

Standard Knee-Chest Right Mammillary Perpendicular to P-A, De-rotate spinous with

PLI-M Position with doctor Pisiform (opposite spinous spine (90 degrees P-A, *** along plane line of
on left rotation) to spine) disk, with a CW torque

L5 Special Listings on the Knee Chest

Standard Knee-Chest Right lateral posterior P-A, R-L, S-I along plane
45, across the Knee Chest - Use caudal hand,
PRI-Sp Position with doctor Pisiform inferior spinous of line of disk, with a CCW
spine Torque UP the spine
on right involved segment Torque

Standard Knee-Chest Left lateral posterior P-A, L-R, S-I along plane
45, across the Knee Chest - Use caudal hand,
PLI-Sp Position with doctor Pisiform inferior spinous of line of disk, with a CW
spine Torque UP the spine
on left involved segment torque

Standard Knee-Chest Left Mammillary Perpendicular to P-A, De-rotate spinous with Knee Chest - Use caudal hand,
PRS-M Position with doctor Pisiform (opposite spinous spine (90 degrees P-A, S-I along plane line of fingers 90 degrees away from Dr.
on right rotation) to spine) disk, with a CW torque Torque UP the spine

Standard Knee-Chest Right Mammillary Perpendicular to P-A, De-rotate spinous with Knee Chest - Use caudal hand,
PLS-M Position with doctor Pisiform (opposite spinous spine (90 degrees P-A, S-I along plane line of fingers 90 degrees away from Dr.
on left rotation) to spine) disk, with a CCW torque Torque UP the spine

> Notes For the Knee-Chest table -

-The doctor stands on the side of spinous rotation
- The doctor reaches across the spine for mammillary contacts and pulls the patient into himself/herself
- The doctor's fingers are pointed 90 degrees away from the spine for mammillary contacts,
45 degrees across the spine for spinous contacts
> At L5, it may be necessary to turn the fingers slightly headward on the patient to keep the thrust off of the iliac crest.
> Modify the disk plane to suit the individual patient during a thrust.

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