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Gonstead Technique Alan Pan 1999 v.5
Crooked spines do not make people sick, subluxations make them sick
A-D-I-O Above - Down - Inside - Out
Get the big idea & all else will follow
World’s philosophy of Tylenol & Excedrin … wonder pain killer of Dz
Rem…. We treat the pax not the Dz … don’t ever treat based on the symptoms and don’t be
fooled by the signs
Gonstead concerns itself w/ the analysis of the pax & based upon this info proceeds
w/ a system of adjusting. Anyone can move a bone but you need to know
why & what will happen before you move it.
Level foundation …. Check the X-ray
IVD … we normalize the location thereby affecting function
Compensation …. May be subluxated in response to another segment
Fixation /Subluxation … primary findings wherever they may be
Listing …. PR, PL etc
Rem … chiropractic always works. When it does not seem to, question your application, but do
not question the principle
Chiropractic is the science which concerns itself w/ the relationship b/t structure, primarily the
spine & CNS
The body has recuperative powers to heal itself …. Innate intelligence
Gonstead formula . …Find the Subluxation … even if it is not where you thought
Accept it where you find it
Adjust it … ASAP … let the body heal
Leave it alone …. Let the body heal ADIO
Emphasis … fix the pax problem & dismiss them for that condition
Ie. C/o LBP … fix it …… now there is a closure => no more LBP
Signs of Subluxation … pain, swelling (inflam’n), immobilization (splinting/fix’n),
palpation tenderness, neurologic dysfunction
Tools for finding subluxations …..… instruments … BP cuff, scopes, nervoscope
Static palpation (swelling/point tenderness)
Motion palpation (fixation)
Visualization (antalgia, leaning, walking, moving)
Others … X-rays … not for finding sblx’ns
Cannot see soft tissues .. IVD
Can’t evaluate motion
Hx … 80% Dx is from history alone
PE … look for the telltale signs of sblx’n
You have a duty to be thorough b/c you are liable for the pax’s health so look @ the skin for lipoma, melanoma, inflammation or subluxation
What does an adjustment do ?
Joint cavitation (audible)
Increase active & passive ROM
Break adhesions …. Joint & ms receptor stimulation
Inhibition of pain
Relaxation of paraspinal ms
Stimulation of ANS
Gonstead adjustment classification … short lever, Pre-stressed, High velocity, Low amplitude
& sustained thrust
Gonstead adjustments . … Right place/location
Right direction
Right amount of force
Right time … AM, PM, day, month or even year
PI Ilium … findings include … tight hamstrings, C-sp syndrome, short leg or frozen sacrum
Motion palpation … you cannot find a subluxation w/o motion palpation ie. SIJ subluxation …
verified only by motion palpation
Which segment should we adjust …… the one that’s stuck
AS ilium => long leg
IN… describes an internal rotation of the ilium medially towards S 1 => toes flare out
EX … describes an external rotation away from the midline => toes flare in
Height of shadow / Width of shadow / Crest of iliumAS Ileum / Shorter / Wider / Lower
PI Ileum / Longer / Narrower / Higher
Since the pelvis is pretty much like a bowl, the pubic symphysis always goes IN
Obturator foramen / innominate bone / Sacral centre lineEX ilium / Wider / Narrower / Moves away from
IN ilium / Narrower / Wider / Moves towards
Sacral line …dot @ centre of pubic symphysis through S 2 tubercle perpendicular to
the femoral head line …. Mark the X-ray to determine IN or EX
Femoral head line …. Should be parallel to the floor or the bottom of the X-ray
Crosses over femoral heads & assumes film is parallel to floor
Ilial dimensions … from top of iliac crests to the line across the ischial tubes
Width of ilium … from sacral ala to the lateral border of the ilium
Landmarks to examine on X-ray …. PSIS, Pubic symphysis & ischial tuberosities
Femoral head line
S2 tubercle line
Aka Sacral line
Adjusting … normalize the joint Fx
SIJ … ilium & sacrum … position & Fx relative position needs to be normalized
We adjust so that the dysfunctional joint moves & looks like the functional
IN … adjust w/ affected side up and contact the inside border … push outwards
EX … adjust w/ affected side down and contact the outside border … pull inward
Pelvic listings …. Various combinations of AS/PI and IN/EX … 16 in all
Pivot point …. Superior acetabulum … AS & PI pivot about this point
Correcting AS or PI ….. PI ilium … contact above pivot point in AS direction
AS ilium … contact below pivot point in PI direction
AS ilium … DC contact …. Pisiform
Pax contact …. Gonstead tubercle .. ischial spine
X-ray findings … short innonimate & obturator but long leg
PI ilium …. Stuck posterior & inferior on the sacrum
DC contact …. Pisiform
Pax contact …. Inferior PSIS
LOD …. Anterior & inferior to re-approximate the sacrum & ilium
X-ray findings … long innonimate & obturator but short leg
EX ilium … rotated externally on sacrum away from sacral line
DC contact … palmar
Pax contact …. Lateral ilium
LOD … medial / internal to restore SIJ to normal position
X-ray findings … narrow but poached out innonimate
IN ilium … rotated internally toward sacral line
DC contact … pisiform
Pax contact … medial border of PSIS
LOD … lateral / external to restore normal position of SIJ
X-ray findings …. Fatter & elongated ilium, stretched gluteus muscles
Listing / DC contact to adjustPI-IN / Medial PSIS
PI-EX / Lateral PSIS
AS-IN / Gonstead tubercle / medial ischial spine
AS-EX / Gonstead tubercle / lateral ischial spine
On X-ray, every 5 mm defect is actually only 2 mm
Heel lifts …. help hold adjustments but they are permaneant b/c once you start, you do not stop
using them. They are to help the pax hold the adjustment not level the pelvis. Do not recommend high heels or sandals
IVD’s … this segment allows for the greatest amount of mobility of the spine
Contraindication to heel lifts scoliosis b/c it will make the scoliosis worse SP or body rotation
to side of Short leg is a No-No b/c => over-rotated vertebrae
Rule 1 .. if you have predominant AS or IN listing on the side of posterior sacrum adjust the
sacrum first b/c AS or IN crowds the sacrum in subluxation you create space first and
then reassess the AS and IN
If you find a hypermobile and a stuck ilium, which do you adjust ? the one that’s stuck and make it mobile
Movements of the sacrum …...PR or PL .. posterior on right or left
PI-R or PI-L ..posterior-inferior right or left
Base posterior
Spondylolisthesis
Rule 2 …if you have a predominant PI or EX on the side of posterior sacrum, adjust
the PI or EX first to approximate the two bones to reduce the ligamental
stretch
Ie. PI 5 EX 2 …. So adjust the PI more than the EX
ie. AS 6 IN 2 … adjust both simultaneously since they are ipsilateral
PI 2 IN 5 ….. adjust the IN b/c it predominates
PI 5 EX 2 …. Adjust the predominant PI
AS 3 EX 6 …. Adjust ilium EX component
AS 2 IN 3 … adjust IN component
61 69
33 39
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Adjust S2 or S1 ….. segment closest to problem area and push it Inferior => Superior
Youths may still have mobile S1, S2, S3 & S4 segments so be careful
if it is L4 - L5 level …. Adjust L5
Base Posterior Sacrum … purely a L5-S1 IVD problem
If it is even or swollen posteriorly => base posterior is Dx
You cannot go backwards b/c there is nothing underneath it
to compare it to.
IVD usually wider anteriorly and narrow posteriorly but if
it swells up, you will find the reverse happening =>
"hockey puck" appearance of the IVD
The disc bulges w/ fluid to protect itself from stresses =>
1. symptomatic …. 94% trauma related
2. transient swelling will leave the IVD
Adjusting the base posterior …….. before adjusting, verify that there is no PARS
Fracture on X-ray
Lateral L5-S1 film should look normal
Usually, it is not difficult to adjust L5 when there is
an existing base posterority
Pt position ….. side lying on either side
DC contact … pisiform
Pax contact …. S2 tubercle
LOD …. PA from Superior-Inferior w/ a "swoop"
Finding the "major" subluxations ……... from C2 - L5, vertebrae move posteriorly
SP's rotate Rt or Lt
Disk spaces => wedge Ant/Post
Wedge … open side of the vertebra b/t 2 segments that are misaligned
Gonstead adjusts "over the rainbow" from the side of the open wedge or the
convexity of the scoliosis
Spondylolisthesis … aka. Anteriolisthesis … anterior slippage of a bone from it
Base …. Use Meyerding's grading technique … I - IV
Grade V is a spondyloptosis
L3 & L4 may not move anterior w/ L5
90 - 95 % all cases are asymptomatic
usually caused by pathology … pars fracture or elongation
Gonstead listings of L5 …. Separately b/c sacrum need not be level
P = posteriority
RT or LT = Verterbral rotation of SP to either Right or Left
S … Superior if the body rotation is on the side of the open wedge
I … Inferior if the body rotation is on the side if approximated TP's
L5 …. PRS-SP Normal PRS PRI
Functional motor unit ..aka trijoint complex .. 2 VB & assoc. IVD & all articulat'ns
In Gonstead, you move the whole unit
IVD is the biggest joint so Gonstead concerns itself w/ the
Disc … which we can normalize … stabilize the unstable
thus restoring proper function
Goal as a DC ….. restoration of Function
What happens if a joint is fixated …. No nutrition => degeneration => will happen before
sense of pain that's what you need a DC wellness to
prevent S/S before the pain
Between C2 - L5 … vertebral bodies move posteriorly before anything else b/c of the angle of
the facets
SP's & pedicles …. Check for rotation of the individual segment not relative to the one above
& below it
Rotation …. On X-ray …. Shortest distance b/t SP & TP is toward the side of rotat'n
Longest distance b/t SP & TP is away from the rotation
Gonstead contact points ….... SP's except C1
M…. Mamillary bodies (L-sp)
TP's (T-sp)
La ….. Lamina (C-sp)
Always try to contact the SP unless it is across from you
Use the Mamillary bodies next, then the LA and lastly, use the TP's
What do you do when there is a scoliosis ? You must always adjust from the side of the
convexity so as not to hurt the ligaments that are
already stretched adjust to close the wedge and use
a torque to help.
IVD is not seen on an X-ray …. Only an MRI can see it
AP X-ray PRI Lateral X-ray PI
Whether we take an SP or M contact, we are driving through the VB to rotate the TP
Making the adjustment …. Explore the passive end range of motion
Take the segment into tension @ end-range
Thrust into the paraphysiological joint space to restore Fx
L5 has more degrees of freedom of motion vs all other L-sp. Only @ L5 b/c sacrum
Conventional listings …. Occurs if the open wedge & scoliosis are in synch
PRS-SP PLS-SP PLI-M PRI-M
Always contact the SP's unless the SP is across from you and you are force to switch to M, La or TP
Gonstead always adjusts over the rainbow or from the of the convexity of a scoliosis
DC makes the contact w/ torque to close the wedge
Unconventional listings … if wedge & L-sp scoliosis are not in synch
PRS-M PLS-M PLI-SP PRI-SP
DC makes the contact on the M and torque it to close the wedge on the opposite side
Keys to Gonstead adjusting .…… Determine the convexity of scoliosis
Analyze the listing of L5
Decide the lever to use …. SP or M
Determine the direction of torque
X-rays …. Why …. Well, we get paid for them and you can find ……
Pathology …. Body is a whole unit & the effects can be global
Function …. DJD
Anomalies …. Tumours
Structure …. Affects the function
As you develop X-rays, evaluate …. Fractures, Dz, pathology or normal variants
Labelling X-rays …… label each vertebral body on the Full Spine X-ray
C-sp 1 – 7, T-sp 1 – 12 and L-sp 1 -5
Marking X-rays … keep the convention alive
All marks are to be inside the VB not along the perimeter
Mark the inside tops of femoral heads
Mark L5 inferior aspects where it joins the sacrum
Mark the top of the iliac crests
Mark the pubic symphysis
Mark the sacral ala, PSIS & ASIS
Mark the S2 tubercle
Now draw some lines …. Gridlines help you see if you are level to the floor / bottom of the film
which is supposed to be parallel to the floor
Femoral head line is parallel to the floor … measure any differences
Calculate using the 5:2 ratio to correct any distortion before recommending heel lifts to