Kotheimer Chiropractic Technique

I began my chiropractic practice in 1977 in the office of my father, William J. Kotheimer, DC, in Youngstown, Ohio.  Dad had just authored a book on his technique, Chiropractic in Distortion Analysis.  He had mentored me and would continue to do so through the coming years.  The experience in his office was mythical.  It seems like more than one lifetime ago.  Over and over I heard from patients how they could only get a good adjustment at Dad’s office.  He was truly a gifted chiropractic genius.  He imparted his expertise to me and taught seminars, wrote numerous articles for the Digest of Chiropractic Economics, and wrote a second book, Chiropractic in Subluxation Analysis, in 1995.  Dad passed away in 2009 after long illness.  His technique has been honored but it never really caught on in the profession.  I once asked him why he thought that was so.  He said, “They didn’t understand it.” 

I am not re-writing Dad’s book.  He already did that.  Dad’s writing was very exacting and technical.  But it was difficult to understand.  Because his technique is so effective, I am writing this summary to simplify the technique a bit.  My intention is to stimulate interest in the technique.  I am happy to teach the Kotheimer technique, or you may purchase Dad’s book.  I pray that Dad will forgive me for oversimplifying, and I defer to his superior genius in recommending his second book for more detailed background.  It is available from Pig Iron Press, at pigironpress@cboss.com, phone 330-747-6932.  Also his articles from “Digest of Chiropractic Economics” are available from me at kotheimerdc@gmail.com or by calling 513-831-4092.

 I am deeply grateful to Dad and to my patients, who have great faith in me and ask what they are going to do when I retire.  It is largely for them that I wish to find other chiropractors who are truly interested in doing a good job.  I thank the Divine for inspiration from within and from without.

I cannot stress enough the importance of specific chiropractic adjustments.  So many chiropractors do a cursory exam or none at all prior to the adjustment.  They do not know what is subluxated, in what direction, or how to correct it.  Successful adjustments depend upon specificity.  General manipulation does not correct subluxation except by accident, and our profession is suffering from a horrible image that the public has of us, mainly for this reason.  If you do the job right the first time the patient will get better, he won’t have to return often.  He will be much happier and refer others to you, and you will be successful.  He will return to you as needed.  I haven’t advertised since the 1980’s, when I started my practice in the Cincinnati area, and my schedule is quite full most of the time.

The Kotheimer technique is most unique in its revelation of the relationships between the cervical spine and the low back and pelvis.  There are over 20 such relationships, but the primary ones are between the atlas and sacroiliac and between the axis and the sacrum.  The other relationships are called “cervical complexes.”

After describing the atlas/axis relation to the SI/sacrum, I will describe the remainder of the technique in order of the typical examination.

The atlas/SI relationship

In almost all cases, whenever the atlas is out, the SI joint is out on the same side, either at the sacral base or the sacral apex.  If C1 palpates as anterior, the sacrum will be anterior on the same side.  Atlas is palpated, with the patient sitting, in relation to the mastoid while moving the head in flexion/extension, rotation and lateral bending.  Palpate C1 on each side at the transverse processes, and challenge it (when the patient is prone) by pressing it toward misalignment and checking for a leg length change.  After the sitting exam the patient is lying prone and the legs are marked with a line across the lower calf area.  Most often in all tests, the left leg shortens.  Also most often the right innominate flexes (PSIS going posterior) or the left innominate extends (PSIS moving anterior).  So with an anterior left atlas the sacral apex will be anterior on the left.  With an anterior right atlas the right sacral base will be anterior.  Always challenge by pressing the bone toward misalignment and checking the change in leg length (or checking for weakening of an intact muscle). 

Palpating a posterior atlas, the SI is challenged for a posterior left sacral base (atlas posterior on the left) or a posterior sacral apex on the right (atlas posterior on the right).  These are by far the most usual directions of misalignment.  Sometimes the ilium subuxates.  And if there is no leg length change, this sometimes means that the SIJ has subluxated in the opposite direction, related to a posterior left innominate or an anterior right innominate.  As in all cases, for further details check Dad’s book.

A table with a drop section is essential for proper adjusting.  The SI may be adjusted prone into the drop section or in side posture.  For most all adjustments of the thoracic or lumbar spine and pelvis, I loosen the area up beforehand by rocking the bone in rhythmic fashion.  I also use SOT blocks under the pelvis if the SI is out while completing the remainder of the prone exam.

Atlas/cranial relationship

Atlas subluxation is also related to cranial vault misalignments.  An atlas subluxation found in flexion/extension (anterior or posterior atlas detected while palpating in flexion and extension) is related to a temporal bone misalignment.  Atlas subluxation found in lateral bending is related to an occipital misalignment.  Atlas subluxation found in rotation is related to a frontal bone misalignment.  I consider it beyond the scope of this book to describe these cranial relationships as I am trying to simplify the technique.  Incidentally, if the atlas is subluxated in flexion/extension, the related SI subluxation is of the ilium at the SI, not the sacrum.  I do an exam of the skull after correcting everything else anyway, using visual exam and manual palpation and the finger muscle test.

The axis/sacral relationship

C2 is palpated with the patient sitting, at the transverse processes, moving the head in flexion and extension.  Have the patient lie prone and mark the legs.  With a posterior axis, challenge the sacrum at the lumbosacral joint into flexion on the same side.  By flexion we mean forward bending.  With an anterior axis challenge the sacral base into extension at the lumbosacral joint, on the side of axis extension.  To distinguish between challenging the SI and sacrum at the lumbosacral joint, for the latter, make a wider contact on the affected side of the sacral base and carry part of the ilium with you as you press anterior, superior and somewhat lateral.  With the sacral base anterior at the SIJ, challenge without carrying the ilium with you.  The sacrum may be adjusted prone or in side posture.  For the prone adjustment of the sacrum in extension (sacral base anterior at the lumbosacral joint), raise the abdominal section of the table with the patient’s ASIS being lifted on both sides.  This adjustment is the same as for a Right-3 or Left-3 adjustment as described under the post for listings.  I normally stretch the sacrum into correction for a while prior to thrusting.
For a sacral base in flexion at the lumbosacral joint, the adjustment is made into the drop section as for a Right-4 or Left-4 listing as described in the post for listings.

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The cervical spine

My exam of the cervical spine begins with C7 and the first ribs with the patient sitting.  These are more easily palpated this way, in static palpation.  Then the atlas is examined as described above.  At this point it is good to check the atlas lamina bilaterally for resistance to motion or rigidity.  This is the beginning of the exam for the cervical complexes.  Atlas posterior ring is more easily palpated with the patient sitting than prone.  Next is motion palpation of the remainder of the cervical spine, checking the transverse processes in flexion and extension.  Note any apparent fixations and challenge them when the patient is prone, using the leg check.  Many times chiropractors adjust the cervical spine into backward extension when there is an extension subluxation, making it worse.  Palpation takes time and requires your earnest attention.  These things do not always pop right out at you.  You have to dig for them.  And listen to the patient.  He will often guide you in finding subluxations you might otherwise miss.  We are treating people, and hopefully we want to be healers.  This means we have to cooperate with our patients and attend to their feedback.

Besides testing for cervical flexion and extension the doctor tests for subluxation in relation to the vertebra above or below.  This is essentially the same as testing for, respectively, medial or lateral flexion on the side of subluxation.  If the cervical vertebra is subluxated in medial flexion the adjustment is made from the opposite side.  If subluxated in lateral flexion the cervical vertebra is adjusted from the side of subluxation.

The final check with the patient sitting is for pectoral fibers.  These are described below.

At this point the patient is placed on the table face down.  A board is placed under the pelvis if the atlas was found in fixation, since this indicates a probable SI subluxation as well.  Mark the lower calves with even lines with a skin marking pencil.  The findings from the cervical spine exam are now tested by challenging each vertebra or related SI or sacral misalignment indicated.  Again, challenge by pressing the bone toward misalignment and re-checking the legs for length discrepancy.  If the SI is subluxated, place the SOT blocks appropriately under the pelvis.

                             

Ribs and spinal erector muscles and finger muscle testing

This is a good point to examine the ribs for fixation and to go down the spine looking for tight muscles in major spinal areas which will have to be worked out.  Ribs that are protruding can be challenged by placing the fingers of one hand over the rib and doing a finger muscle test with the other hand.  The finger muscle test is extremely helpful and saves time, in this case by allowing the doctor to test without walking to the foot of the table to test each rib.  The test is done by pressing the palmar surface of the index finger against the dorsal surface of the middle finger.  The fingers are pressed against each other.  Then the rib is challenged by holding it with the other hand.  If the rib is subluxated, the middle finger gives out and there is a very noticeable movement of the fingers as a result.  This test can be used in many ways.  It can be used to determine subluxation anywhere, to determine a weak reflex point for an organ or condition, and to replace the leg or muscle test in simply asking the body a question.  Some doctors use the squeaky box or rub the thumbnail with the index finger.  A positive test is indicated by the squeak of the box or by a hang-up in motion of the index finger on the thumbnail due to sweating in the fingertip.

The cervical complexes

These relationships between the cervical spine and pelvis/low back/cranium, are crucial to successful chiropractic treatment.  However, they are unique to the Kotheimer technique and are generally not known in the profession.  These lesions are located in the pelvic area or low back, or in the cranium, and they reflect into the cervical spine.  Their correction is very significant in relieving distortion and pain.  Generally if the pelvic component is corrected the cervical indicator automatically melts away and needs no adjustment.  Many of these lesions are pulls of the muscle involved in the pelvis.  They are not pulled muscles or mere tight muscles, but pulling muscles.  They pull the posture into distortion and the involved muscle must be adjusted!!!

Dad listed the S2/sacral base relationship under cervical complexes, but I have listed them above instead.

The pelvic/low back lesions will be found on the same side as the cervical indicators.  The cervical indicators may be checked for with the patient sitting or prone.  I check the atlas laminae with the patient sitting and the remainder of the indicators with patient lying prone.

Nuchal point/ilio-inguinal ligament/sphenobasilar

There is a knot like a trigger point at the medial end of the superior nuchal line, just lateral to the EOP.  This point indicates tension on the ilio-inguinal ligament.  If I find this indicator I wait until the patient is on his back and challenge the ilio-inguinal ligament by pressing it along the pubic bone from the lateral attachment near the ASIS, pressing medially and somewhat caudally.  It is easiest just to do a finger muscle test for confirmation.  There is often tenderness at the affected lateral attachment of this ligament.  Before adjusting, do a stretch of the ligament with both thumbs overlapping, away from its attachment.  The adjustment is a short thrust in the same direction, using the drop section.

This cervical indicator also sometimes indicates a spenobasilar misalignment, being the first of three such indicators.  In this case, challenge the skull by pressing the forehead and occiput together or pressing them apart on the side opposite the nuchal indicator.  Adjustment is made in the same direction as the challenge.  This is best done with the patient lying on the side opposite the cranial lesion.  You may use a spring cushion to enhance the adjustment.  I find for most such cranial adjustments that approximately 18 gentle thrusts are about right.
The spring cushion is useful for cranial adjustments as well as extremity adjustments, especially the knee and wrist. Below is an illustration of the inside of a spring cushion.  It is made of three pieces of hardboard or mason board, the top one being the movable one.  There are six bolt and spring units.  The cushion is approximately 14 X 19 inches, six inches in height (wide enough for the patient to rest both knees on it for knee adjustments).  The illustrated cushion is of course to be covered with upholstery.

 

                                               

Mastoid/gluteal/temporosphenoid

The indicator for this complex is in the SCM muscle near its attachment to the mastoid process, felt as a taut fiber that extends about ½ inch from the mastoid.  The pelvic lesion is a pulling gluteal muscle felt just lateral and superior to the homolateral PSIS.  Challenge is made with therapy localization to the taut muscle.  The adjustment is into the tight spot floorward with the drop section.

The cranial association is with the contralateral suture between the sphenoid and temporal bone.  Challenge is made by therapy localization (TL) of that suture, then if positive, by rotating the sphenoid clockwise or counterclockwise in relation to the temporal (twist the bones that way with thumb and index finger).  Adjustment is made in the direction of the challenge.

Atlas lamina/latissimus

The cervical complexes with indicators at the laminae of C1 through C4 are very common.  Correction brings tremendous relief to your patients over the course of your career.  Ignorance of these means your patients miss out.  The indicator for the first one is a resistance to motion of the atlas lamina.  This is best palpated with the patient sitting, so I always check for this along with the cervical exam.  It doesn’t take much motion of the head to detect as the atlas lamina will be quite prominent.  The pelvic lesion is at the lateral aspect of the latissimus attachment to the ilium.  Find this by pressing the low back muscle at its most lateral location one half to one inch above the ilium.  Challenge is by TL at that point.  Adjustment is made into the muscle attachment, first pulling the muscle outward with a lateral torque.  Thrust is made into the muscle attachment in a lateral, floorward and outward rotational direction, with the drop section.  The adjustment may also be made in side posture with the lumbar flexion technique and a contact at the outer muscle attachment.  This elicits quite an audible release and relieves a great deal of tension.  The lesion is very often bilateral.  Some patients do well with side posture adjusting.  You will know these patients because they don’t feel well enough with a prone adjustment.  But most low back adjustments are best done prone with the drop, which is very effective without being harmful to the discs and other structures.

C2 lamina/TFL/ethmoid

There is a resistance palpated at C2 lamina.  The pelvic lesion is at the homolateral tensor fascia lata.  Test by stretching the muscle firmly.  The adjustment is made by sliding the knee off the table with the patient prone, then contacting the muscle and driving it toward the knee, using the table drop.

C2 lamina may also indicate a misalignment of the ethmoid bone on the side opposite the C2 lamina.  Test by pressing into the ethmoid bone just medial to the inner canthus of the eye.  Use a finger muscle test (rather than walking to the patient's feet for a leg check).  If positive, test the ethmoid in rotation clockwise and counter clockwise.  The adjustment is made when the patient is prone, in the direction of testing, with a rotational sliding adjustment.  I use a towel under the contacting thumb.

C3 lamina/anterior hip

There is a C3 lamina resistance.  The homolateral hip joint is rotated externally.  The test is done with the patient prone, bending the knee and sliding it out to the side and lifting up on the knee (frog leg position).  Hold it there for a few seconds and replace it to neutral position.  Measure for a change in leg length.  Adjustment is made with the patient supine.  Before adjusting the hip, the pelvis is stabilized to the table using a strap around the pelvis and down around the table.  Hold the lower leg with the foot turned in all the way and pull the leg toward you as you stand at the foot of the table.  Hold for a few seconds, then pull firmly.  I normally make three repetitions on this adjustment.  I normally make a couple thrusts for most of my adjustments except the cervical manual adjustments.  Straps can be found very inexpensively at strapworks.com.

C4 lamina/hamstring

Resistance is found at C4 lamina and is related to a pull of the homolateral hamstring attachment at the ischium.  Test by stretching the muscle attachment then the leg check.  The adjustment is on the muscle attachment with a line of drive into the drop section and footward.

C5 lamina/quadratus lumborum

Resistance is found at C5 lamina and is related to a pull of the quadratus lumborum muscle on the same side.  The muscle is tested by stretching the muscle belly then the leg check.  Adjustment is into the muscle belly from medial to lateral, into the drop section.  The opposite ilium may be held for opposing support, with the doctor standing on that opposite side.

C6 lamina/adductors

Resistance is found at C6 lamina and is related to thigh adductors on the same side.  Test by stretching the muscle then the leg check.  My correction for this muscle pull is to do a firm deep muscle stretch of the muscle.

C7 lamina/obturator

Resistance is found at the C7 lamina, and it feels like a tight muscle at that point.  This is related to the obturator muscle on the same side, located between the greater trochanter and the ischium.  It is tested by stretching the muscle then the leg check.  Adjustment is made into the muscle belly with a torque laterally, into the drop section.

C2 spinous/symphysis pubis/sphenobasilar

A C2 spinous resistant to left or right rotation is related to a symphysis subluxation at the pubic joint.  The test is with the patient prone.  Bend the knees at 90 degrees and press the legs outward gently as far as they will go.  Hold the legs in this position a few seconds, replace the legs on the table for the leg check.  I find most often that the pubic bone is subluxated inferior on the affected side, but the opposite side needs to be adjusted inferiorly.  However, the doctor may test further and check by observing the comparative ASIS heights.  To adjust the superior pubic bone, place the patient supine.  Have him bend the opposite knee and support that leg in a frog-leg postion.  Place a towel over the subluxated pubic bone.  Take the slack out of the legs and thrust the pubic bone into the drop section and inferiorly.

C2 spinous may also be related to the sphenobasilar joint.  Test for cranial misalignment by holding the frontal and occipital areas in the two hands, then rotate the hands in opposite directions.  Adjust the cranium into the direction of the positive test.  You are adjusting the spenobasilar joint in a clockwise or counterclockwise direction axially.

C3 spinous/posterior hip joint/spenobasilar

C3 spinous restriction to right or left rotation is related to a posterior hip joint.  Test on the side of C3 restritction by bending the knee to 90 degrees then press the foot outward, then holding it a few seconds as far as it will go.  Replace the leg straight on the table and check for leg length change.  The adjustment is made with the patient on the back.  Apply a strap around the pelvis.  Grasp the lower leg above the ankle and turn the leg into external rotation.  Hold a few seconds, then make two or three traction pulls to correct.

C3 spinous restriction is sometimes related to spenobasilar misalignment on the side opposite C3 restriction.  Testing is done by bending the head into a banana shape into concavity and convexity on the affected side.  Adjust into the direction of a positive test.

C4 spinous/psoas

C4 spinous restriction is related to the psoas muscle on the same side.  With the patient on the back, test by stretching the muscle, followed by muscle test of the patient or finger muscle test.  Correction may be done with deep muscle stretching, or using a strap around the pelvis.  With the patient stabilized with a strap, hold the affected leg just above the ankle, carry it into abduction and internal rotation and extension at the hip toward the floor.  Hold a few seconds the apply a traction pull two or three times.

C5 spinous/sartorius

C5 spinous restriction is related to a sartorius pulling.  Test with the patient on the back by stretching the muscle then test a strong muscle or do a finger muscle test.  Correction is done first by stretching the sartorius at the attachment to the ASIS, then with an adjustive thrust at the attachment into the drop section, with a line of drive away from the ASIS.

C6 spinous/pectineus

C6 spinous restriction is related to a pectineus pulling on the affected side.  Test with the patient on the back and stretch the pectineus, followed by a muscle test.  Adjustment is made by first stretching the pectineus then making a thrust into it from lateral to medial, into the drop section.

C7 spinous/quadratus femoris

C7 spinous resistance to rotation is related to the quadratus femoris on the same side as the restriction.  This muscle runs from the lateral sacrum to the ischium.  Testing is done by stretching the muscle and checking for a weak muscle or leg check.  Correction is done by first stretching the muscle, then with a thrust into the muscle with the drop section, with torque.

Sacroiliac catches and ligament pulls

There are what can be termed partial subluxations or catches of the SI joint as taught by Dr. Paul Markey a number of years ago.  Also there are small muscles that occasionally pull to either side of the SI joints.

After testing the SI joints and sacrum, with the patient still lying prone, do a springing palpation of the sacrum on each side at the levels of the S1 segment (termed S1 restriction) and at the S4 (termed S2 restriction) segment.  If there is a restriction of motion at either of these four areas, the area needs to be adjusted.  This adjustment is made by first raising the abdominal piece several inches to support the ASIS bilaterally.  The patient usually has to slide up on the table several inches.  Adjustment is made with the abdominal drop section as shown below.

 

             Adjustment for S1 restriction                                         Adjustment for S2restriction

                                                                                                                     (S4 level)

The doctor makes these adjustments standing on the side opposite the restriction.

The ligament pulls should always be checked for.  These are found just laterally to the SI joints.  They are easily palpated by digging into the tissue at that location approximately at the levels of S2 and S4.  This ligament can cause a lot of pain.  Treat by working the ligament out then adjusting it floor ward with the drop section.

Pectoral, trapezius and occipital fibers

In SOT the occipital fibers are very important indicators of problems elsewhere.  The occipital fibers, line three, are located along the occipital ridge between the base of the mastoid and the EOP.  They are numbered from 1-7 from lateral to medial.  The fibers of this line relate to specific vertebral levels and their related organs.  An active fiber is felt as a knot along the occipital ridge.  The following lists each fiber with the related spinal level and related organ:

                     Fiber No.                  Vertebral Level                               Organ Reflex

                            1                                    T1                                              Coronary

                            1                                    T2                                              Pericardial

                            1                                    T10                                            Small 

                                                                                                                        intestine

                            2                                    T3                                              Respiratory 

                                                                                                                       tract

                            2                                    T11                                            Kidney or circu-

                                                                                                                       lation, lower

                                                                                                                       body

                            2                                    T12                                            Kidney

                            3                                    T4                                              Gall bladder

                            3                                    T5                                              Stomach

                            3                                    L1                                              Ileocecal

                            4                                    T6                                             Pancreas

                            4                                    L2                                             Colon, left

                            5                                    T7                                             Spleen

                            5                                    L3                                             Ovary, testicle

                            6                                    T8                                            Liver

                            6                                    L4                                            Colon, right

                            7                                   T9                                             Adrenal

                            7                                   L5                                             Prostate, uterus,

                                                                                                                     bladder

There are also fibers in the trapezius from along the top of the scapula to a spot just lateral to T1.  These “trapezius fibers” are also numbered from 1-7 from lateral to medial, the same as the occipital fibers.  These fibers, as well as the occipital fibers, are evenly spaced, so that fiber #4 is right in the center of the space between the spot just inside the acromion in the trap muscle, and the spot just aside the spinous of T1. The trap fibers can be used to confirm which occipital fiber is active (see below).

In the Kotheimer technique we also use pectoral fibers.  These are also numbered from 1-7, and each pectoral fiber has the same significance as the same numbered occipital fiber.  For example, a pectoral fiber #3 and an occipital fiber #3 both relate to T4, T5 or L1 and the related organs.  The pectoral fibers are located just under the clavicle and are numbered in the reverse direction to the occipital fibers.  So pectoral fiber #1 is located inferior to the clavicle in the portion of the pectoral muscle mass closest to the sternum.  Pectoral fiber #7 is located inferior to the clavicle in the pectoral muscle mass closest to the humeral head.  These fibers are just beneath the clavicle and are evenly spaced as are the occipital and trap fibers.  They are almost always found on the left side.  Most occipital fibers are found on the right side of the skull, and most trapezius fibers are found across the right middle trapezius.

The pectoral fibers are palpated with the patient sitting, so after the exam of the cervical spine, the doctor checks the pectoral fibers.  This is the last thing done before getting the patient on the table, face down.  So then with the patient lying face down,  I test to confirm my findings in the cervical spine and the related problems in the low back, pelvis and cranium.  Next, I check the ribs and spinal muscles and check for catches and ligament tension in the SI area.  At this point I check for the cervical complexes (see below) and then I check the occipital fibers.  After checking these I confirm which fibers I have found, both pectoral and occipital, by using the trapezius fibers.  I do this by testing for the occipital fiber by pressing on the related trapezius fiber with the palmar surface of my middle finger.  I do a finger muscle test with the other hand to test this trap fiber.  Then I test the trap fiber related to the pectoral fiber I had found with the patient sitting, using the dorsal aspect of my middle finger on the trap fiber and finger muscle testing with the other hand.

Dad placed utmost emphasis on these fibers.  He insisted that they indicated the major subluxation(s) in the spine and the related organs.  I find that this proves to be the case often enough that I always check these fibers.  However, I also check the full spine with springing palpation (see below).  And because I use other techniques (especially Total Body Modification, or TBM) to find problems with the organs, I do not restrict my analysis of organ function to fiber analysis.  However, Dad had great success in finding the major subluxation and organ weakness using these fibers.

I use a hand mode for organ involvement by placing the hand over the active trapezius fiber and holding that hand in organ dysfunction mode.  This is called the Viscera mode in CPK (Chiropractic plus Kinesiology), a technique taught by Dr. Milton Dowty.  It is described as: tips of the middle finger and pinkie into the palmar depression with ring finger extended and thumb pad against the distal pad of index finger.

                                                            Visceral Mode

I use the finger muscle test with the other hand while holding the hand in viscera mode over the trap fiber related to both the active pectoral and occipital fibers. Theoretically this tells me if there is in fact an organ involvement.  However, I use TBM analysis later to find organ problems.  And if I do suspect an organ involvement, I will not adjust the spine until I have checked the organ reflexes with the patient lying on the back.  The reason for this is that, if the spine is adjusted, an organ dysfunction may not show on testing after the adjustment.  I also use the viscera mode over all thoracic and lumbar vertebrae found to be subluxated, after examining those areas of the spine.

                             

Thoracic and lumbar spine

Springing palpation with a unique listing of subluxations is a distinct part of this technique.  After the cervical spine and pelvis are tested, I examine the thoracic and lumbar spine.  The patient is prone.  Standing on the left side of the patient, use the right hand for palpation, sometimes with the support of the fingers of the left hand over the right.  This springing palpation is a motion palpation of the spinous processes, first checking the motion from right to left (and downward to the left), down the thoracic spine.  Any restriction of motion is noted.  I use the marking pencil at the levels found to be restricted.  Then use the left hand to check for motion of the spinouses again from right to left (and upward to the left).  Restrictions are noted and marked.  For each fixation, note whether the vertebra appears to be in flexion (protruding) or extension (indented).  It is very helpful to run the fingers down the spine to note any misalignments that were missed in the motion palpation.  Often an anterior dorsal or extension subluxation of a thoracic or lumbar vertebra is found this way.   I always count the vertebrae so that the correct level is recorded and because each level is related most commonly to a particular organ.  In counting the vertebrae I often find one that is misaligned that I missed in the motion palpation. 

Now do the springing palpation in the lumbar spine.  Next go to the patient’s right side and do the springing palpation exam of thoracic and lumbar vertebrae.  After marking all the areas noted I challenge each vertebral fixation that I found, using the leg check.  I then use the viscera hand mode over each subluxated vertebra to determine the presence of a problem with the organ related to that vertebra.  If this test is positive for any level, or if I suspect organ involvement, I will have the patient on the back and check the organ reflexes before adjusting the spine.

Drawings for vertebral listings are in the next two blog entries.