A 35-year-old male magazine editor presents to the clinic with neck discomfort. He informs the doctor that the pain is usually dull; however, it can be sharp and stabbing especially when checking his blind spot as he drives. He also notifies the doctor that the problem began approximately five years ago, when he began his new job with the magazine, and began spending countless hours in front of a computer. The patient informs the doctor that he no longer exercises since he began this job, as he has no time, and often finds himself checking e-mails on his BlackBerry late into the evening. Furthermore, the patient also states that because his job forces him to be seated for a minimum of 10 hours per day, editing documents, the excessive use of the computer mouse aggravates the problem. On physical examination, the doctor notices an anterior head position on visual inspection. An SEMG instrumentation reading detects a significant change present at C2 on the left. Palpation reveals a subluxation present at C2. The doctor is proficient in Gonstead Technique, and labels the subluxation as a C2-PR listing. X-ray analysis assists in confirming the palpatory listing. All other radiological and neurological analyses are unremarkable. The doctor seats the patient in a Gonstead chair, takes specific contacts on the C2 vertebrae and proceeds to thrust perpendicular to the spine and in line with the disc plane.
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How does a chiropractor who is not trained in Gonstead interpret a spinal listing? Why is a Gonstead chair utilized in a cervical adjustment? In this edition of Technique Toolbox, I will explain these questions as we explore the Gonstead Technique.
But first, some review:
The Gonstead Technique was developed by Dr. Clarence S. Gonstead in the early 1920s. Before entering into chiropractic, Clarence had been studying engineering until his education was interrupted by the FirstWorld War. At that time, he was drafted into the military and served as an aviation technician. When he returned from service, Clarence re-entered the university setting. While a student, Gonstead became disabled from rheumatic fever. He sought the expertise of medical doctors, but medicine was unable to help him. Chiropractic care, however, enabled him to resume his studies within a month. Clarence then pursued a chiropractic education, and began practice in 1923.1 From this point onward, Dr. Gonstead was an innovator in the profession. Through his clinical research, he created the Gonstead Chiropractic Technique which has been incorporated into several chiropractic colleges since its inception. Dr. Gonstead was so successful at using his system of analysis and correction of subluxations that he had to construct an inn to lodge the abundance of patients that came to his clinic in Mt. Horeb, Wisconsin for treatment.
In the Gonstead Technique, the chiropractor conducts a thorough analysis of a patient’s spine using five criteria to detect vertebral subluxations: case history, static and motion palpation, instrumentation and full spine X-ray analysis. Following this, and due to the fact that each patient is different, a descriptive annotation or “listing” is assigned. (Listings were created and developed to denote the specific characteristics of movement associated with the subluxation and reflect each individual patient’s unique vertebral findings associated with their individual problems.) Once these vertebral subluxations are identified, and their specific direction of movements characterized, then proper correction can take place.
|Photo 1: Palpatory findings confirm a C2-PR subluxation is present.|
|Photo 2: Seated Cervical Adjustment is displayed. Note the contact is on the right lateral posterior spinous of C2.|
|Photo 3: X-ray findings confirm the palpatory C2-PR listing. Notice how the C2 spinous process has visiably rotated on the film.
For those chiropractors who have not had training in the Gonstead technique, understanding a listing is very straightforward, provided you know what the reference point for the vertebrae is. In the cervical spine, from C2-C7 as in our sample case, the reference point is the spinous process. (Note that atlas listings would have a different point of reference.) If a listing were to be labelled a C2-PR, as in our sample case, this would mean that the C2 spinous process has subluxated Posterior and to the Right. As another example, if a C2-C7 vertebrae were labelled PLS, this would denote that the affected vertebrae’s spinous process has subluxated Posterior, to the Left, and Superior. Furthermore, if additional letters are added in the listing, for example, one that reads PLS-La, the same subluxation pattern would be present as stated earlier, only the “La” denotes that a Lamina contact would be taken, rather than a spinous contact.
GONSTEAD C2-C7 CERVICAL ADJUSTMENT, ACCORDING TO THE LISTING
In our sample case, the listing was a C2-PR. This indicates that the vertebrae subluxated Posterior and to the Right, remembering that the spinous process is our reference point. Therefore, with this in mind, a Gonstead seated adjustment for C2-PR subluxation would be: (See Photos 1-3)
Doctor: Standing behind patient.
Contacts: Right DIP contact on the right lateral posterior spinous of the involved segment.
Stabilization Hand: Placed on left parietal bone, applying left lateral flexion, and left rotation until segment is in lock-out position.
LOC: P-A, aiming the thrust through the patient’s left eye, in line with the disc plane.
The P-A component will correct for the posteriority and aiming through the patient’s left eye will correct for the right deviation.
Dr. Gonstead was one of chiropractic’s true pioneers, and was in private practice for over 50 years. He intended to create a full spine system that was detailed in its analysis, and specific in its adjusting procedures. Gonstead was often quoted as saying, “Find it, Fix it and Leave it alone” as far as detecting and correcting subluxations. I think that quote is very reflective of Dr. Gonstead’s confidence in his system of analysis, adjusting practices, and his overall belief in the power of the chiropractic adjustment.
Until next time…adjust with confidence!
Cooperstein, R. Gonstead Chiropractic Technique. Journal of Chiropractic Medicine. 2003. 2(1):16-24.