|Photo 1: In BCS presentation part 1, patient presents with even legs in the extended position.
|Photo 2: In BCS presentation part 2, patient rotates head to the right, resulting in the right leg pulling short.|
|Photo 3: In BCS presentation part 3, patient rotates head to the left, resulting in the left leg pulling short.|
|Photo 4: BCS contacts are displayed. Bilateral thenar contacts are placed inferior to bilateral mastoid processes.|
Doctor and patient positioning for a BCS are displayed. Note that the
doctor is in a fencer stance to focus the thrust in the cephalad
A 40-year-old carpenter presents to the clinic with headaches and low back pain. He informs the doctor that his occupation requires him to work overhead for most of the day, which aggravates his symptoms. The physical exam reveals a decreased range of motion in cervical flexion and in lumbar extension, both of which produce pain at end range. Static and motion palpation reveal subluxations present bilaterally at the occiput, and in the right sacro-iliac joint. The doctor, who is proficient in The Complete Thompson Technique-Minardi Integrated Systems, decides to perform leg length analysis to elaborate on his palpation findings. The doctor finds that the patient presents with even legs in the extended position and even legs in the flexed position. However, when the doctor asks the patient to rotate his head to the right side, the doctor observes that the patient’s right leg pulls short in the extended position. Furthermore, when the doctor asks the patient to rotate his head to the left, the patient’s left leg pulls short. Both radiological and neurological analyses are unremarkable.
What does this leg length analysis indicate and how do we correct this problem? In this first instalment of a two-part edition of Technique Toolbox, I will answer these questions and others, as we take a look at the Thompson Technique’s Bilateral Cervical Syndrome (BCS) category.
The Thompson Technique was originally created by J. Clay Thompson in the early 1950s. The technique was created in an attempt to decrease the force being applied to both the patient and the doctor with each adjustment. To achieve this goal, Clay drew from his engineering background and applied Newton’s laws of physics to create the drop-piece table. The drop-piece allowed less torque to be applied to the patient, hence, decreasing the force that the doctor absorbed as well. Paramount to the Thompson technique is the use of leg length analysis, which is originally credited to Dr. Romer Derefield. Leg length analysis provided a consistent reference tool to be utilized throughout the adjusting procedure. Due to the scientific limitations of his era, Clay could not scientifically explain why the technique worked, even though clinical trials were validating the technique. Beginning in the late 1990s, and to the present day, the author has focused on establishing the neurological and biomechanical rationale underlying the technique and filling in any gaps that existed within the technique to create a more scientifically solid system for assessment and adjustment.
Figure 1: The convex occipital condyles sit within the concave lateral masses of atlas.
Figure 2: As the occiput subluxates anterior, it must also travel superior, following the concave surface of atlas.
The Bilateral Cervical Syndrome (BCS), despite its name, has very little to do with the cervical spine. When a BCS is present, this represents an occiput subluxation, and more specifically indicates that the occiput has subluxated anterior-superior (AS) bilaterally. Always remember, as the occiput travels anterior on the lateral masses of atlas, it must also travel superior as it follows the concave surface of the lateral masses of atlas. We must always be mindful that anytime the occiput subluxates anterior or posterior, it must also subluxate superior due to this concave surface. (See Figures 1 and 2.)
So, how do we find a BCS?
As our sample case described, a patient presents to the clinic with even legs in the extended position. However, because the BCS is only one of several problems that can be detected with an even-legs presentation, the following scenario must be present in order to consider the problem a BCS.
Step 1: Analysis
Patient presents with even legs in extension. This indicates that the patient is either subluxation free, or has subluxations present bilaterally, neurologically producing the even legs presentation.
The doctor has the patient rotate their head to the left, which makes the patient’s left leg contract (pull short). The doctor then has the patient rotate their head to the right, which makes the patient’s right leg contract (pull short). (See Photos 1 to 3.)
If this exact analysis occurs, this confirms that the primary subluxation is a BCS, indicating that the occiput has subluxated AS bilaterally.
Because the legs pull short with head rotation, this rules out the possibility that the patient is subluxation free. If no subluxations existed, then head rotation would have made no change to the even-legs presentation.
Step 2: Correction – Classic Thompson Prone Adjustment (See Photos 4-5)
There are several ways of correcting this subluxation. The following is the Classic Thompson Adjustment.
- Doctor: Either side of table.
- Patient: Prone. Chin tucked. Mouth closed.
- Table: Cervical piece in the ready position, and flexed.
- Contact: Bilateral thenars on the inferior aspect of the mastoid processes.
- LOC: I-S, and slightly P-A to initiate the drop piece. Thrust is a sweeping motion.
- tremendous speed must be generated;
- a well-functioning drop piece must be used;
- the thrust should never be focused into the headpiece, as this will injure the patient;
- the focus of the thrust should be concentrated cephalad, with only enough P-A pressure to initiate the drop piece.
Following the adjustment, the doctor rechecks the patient’s leg lengths and notices that the patient is no longer presenting with even legs. At this point the patient has a contracted (short) right leg in the extended position, and when the doctor lifts the patient’s legs to 90 degrees, he notices that right leg continues to pull short.
What does this new leg length analysis indicate? Did the doctor do something wrong with the occiput adjustment? Are there other subluxations that now need to be addressed and corrected? I will answer these questions and more in our next issue of Technique Toolbox. In the meantime, if you would like to learn more about this technique, please go to www.thompsonchiropractictechnique.com.
Until next time . . . adjust with confidence.