A 30-year-old male office worker presents to the clinic with neck stiffness. He informs the doctor that the problem started approximately three years ago when he began his current job. The patient states that he sits in front of a computer for eight hours a day, and rarely moves from this position. He also mentions that he has been falling asleep on the couch recently, and wakes up in the middle of the night with a “kink” in his neck. Postural exam reveals that the patient’s head deviates to the left, and he has a high right shoulder. Static palpation reveals a subluxation present at C5 on the right. However, knowing that each segment can move in six different directions, the doctor, who is trained by the Motion Palpation Institute, elects to utilize Motion Palpation technique to dynamically analyze how the vertebra has subluxated. The doctor begins with a “Quick Scan” of the cervical spine, which confirms the C5 subluxation by its hard “end feel” and lack of joint play. Following the Quick Scan, the doctor analyzes the affected segment through its dynamic motion, and concludes that the subluxation has a lateral flexion fixation. Since neurological and X-ray examinations are unremarkable, the doctor adjusts the subluxation to correct for the proper biomechanical deviation.
Would you be confident doing this in your clinic? Could you find a subluxation through static palpation, then, confirm which functional direction the vertebra has subluxated in? In this edition of Technique Toolbox, I will review exactly that, as we look at the Motion Palpation technique.
The Motion Palpation Institute (MPI) was founded in 1981 by Dr. Leonard Faye and Dr. Donald Peterson. The core principles of MPI are based on the teachings of Dr. Henri Gillet, as well as the work of researchers Cyriax and Mennell, who created models for “joint play” and “end feels.”1 Gillet also developed the fixation theory that differentiated classes of fixation and their characteristics. This provided chiropractors with an alternative means of finding subluxations as well as evaluating the effectiveness of their adjustments.1 Faye incorporated the teachings of these pioneers to develop three core principles that established the foundations of MPI: (1) a change from static to dynamic concepts; (2) a shift from reductionist to holistic principles; and (3) a scientific practice rationale over anti-science and dogma. These MPI principles were established over 25 years ago, and remain relevant today.1
So, how can we utilize an MPI cervical spine analysis and adjustment protocol for a patient similar to our sample case?
|Photo 1: MPI Quick Scan is displayed.
||Photo 2: MPI Flexion is displayed.
|Photo 3: MPI Exension is displayed.
||Photo 4: MPI Rotation is displayed.
|Photo 5: MPI Lateral Flexion is displayed.
||Photo 6: MPI Seated Lateral Cervical Adjustment is displayed.
Step 1: The MPI Quick Scan – Cervical Spine:2 (See Photo 1)
The Quick Scan is a generalized method for finding cervical subluxations. Once a restriction is found with this method, more detailed testing of the affected vertebra will follow.
- Patient: Seated.
- Doctor: Standing on either side of the patient.
- Contact: Thumb pad and index finger on the bilateral facets of the same segment (starting at C7 and progressively moving superior to the base of the occiput).
- Stabilization: Opposite hand on the patient’s forehead.
- Doctor applies a gentle P-A pressure from C7 to the base of the occiput.
- It is important to push completely through to the end-range of motion, so that the doctor can properly assess for a lack of joint play.
- Normally, each segment should exhibit a smooth and fluid motion, with a spongy joint play at the end range of motion.
- When a subluxation is present, a hard end feel and lack of joint play is found at the affected segment (C5, in our sample case) .
- Once this hard end feel is discovered, the doctor will move on to step two. This next step will provide a more thorough analysis to help determine which direction of motion is most affected.
Step 2: Cervical Spine Motion Palpation Analysis:2 (See Photos 2-5)
Once the affected segment is located by determining the Quick Scan’s lack of joint play (C5, in our case), the doctor will now assess flexion, extension, rotation and lateral flexion, of the affected segment.
- Flexion: Doctor flexes the patient’s head, while simultaneously palpating the C5 spinous process. Normally, the spinous process will move superior-posterior, which occurs in our case.
- Extension: Doctor extends the patient’s head, while simultaneously palpating the C5 spinous process. Normally, the spinous process will move inferior-anterior, which occurs in our case.
- Rotation: Doctor rotates the patient’s head to the left, while simultaneously palpating the C5 right facet. Normally, the facet will move anterior-superior, which occurs in our case. Repeat opposite side, which also produces normal findings in this case.
- Lateral Flexion: Doctor laterally flexes the patient’s head to the left, while simultaneously palpating the C5 left transverse process. Normally, the transverse process will move medial and retains its soft end feel, which occurs in our case. However, when the doctor laterally flexes the patient’s head to the right, while simultaneously palpating the C5 right transverse process, the segment does not move medial; instead, it has a hard and abrupt end feel. (This, too, occurs in our sample case).
Step 3: Correction – Seated Lateral Cervical Adjustment: (See Photo 6)
- Patient: Seated.
- Doctor: Standing, on same side as affected segment.
- Contact: PIP contact on the right C5 transverse process. Palm facing the ceiling.
- Stabilization Hand: Opposite parietal bone. Laterally flex the head to the right until the C5 segment has achieved a locked out position.
- LOC: Lateral to medial.
Until next time . . . adjust with confidence! •
- Schaefer R. Motion Palpation and Chiropractic Technique. 1989. Huntington Beach, CA. The Motion Palpation Institute.
- MPI Seminar Notes. 2001. Toronto.