Exercises to Develop Adjusting Skills, Part 1

Cervical Spine Adjusting Skills

To master the Gonstead adjustments requires physical agility (flexibility and position sense), focused strength, and speed. An adjustment is an athletic event. Those who learned toggle recoil upper cervical adjustments at Palmer in the old days should remember the exercises that were required in order to develop flexibility of the hand and wrist, rotate the upper limbs for torque, sense the body position for adjusting, develop the muscle relaxation, and develop the speed and direction of force. The regular use of the “speeder board” helped one to regularly practice the adjustments. The instructors broke down the elements of the adjustment to facilitate learning the technique. An example of this concept of breaking down complex maneuvers is the movie, Karate Kid, wherein the master had his student do physical activities that were seemingly unrelated to karate as far as the student was concerned. When the master finally began showing the student the basic moves, the student connected the tasks that he had done to what was required to master the karate moves. One does not expect to show up at a pool and expect to beat Michael Phelps without developing the same skills that he had to develop. First, one needs to learn to float, hold one’s breath underwater, and then, learn the strokes. Phelps probably started with a paddleboard much like everyone else and gradually added the different and complex strokes. Along the way he developed power and efficient strokes and kicks.

Those trying to learn the Gonstead technique are told that the physical skills needed will come with experience. It eventually does for many, but too many drop out before they develop the physical skills necessary. To help those who are beginning to study the Gonstead adjustments, we have designed some exercises to help develop the physical skills needed to help one successfully master the adjustment. What follows are a few starter preadjustment exercises for the cervical spine.

BALANCE: One of the most basic skills to learn is balance. In martial arts, dance, and innumerable activities, balance is the foundation. In Japanese martial arts, there is the concept of the hara (“stomach”). This is a point an inch or two below the navel. This is the balance point in martial arts. That point stays in the same place on the body but is raised or lowered or shifted laterally by standing taller, flexing their knees, or bending sideways as the situation demands. Watch modern dancers perform. You can quickly observe that they have a center-of-gravity point in the same location as martial arts experts. They can use a shift in the their body position relative to the the hara to even show emotion or make a slight shift to show danger or ease.

Stand relaxed and feel the position of your body—shoulders, head, hips, etc. Touch a point an inch or two below your navel and focus on it. More your body a little around that point to see if it is the hara. If it doesn’t feel like the center point, move your finger on your belly, either up or downwards, and try again. It is a good way of working on your posture as well.

In cervical chair adjustments, you keep that point balanced, although you might bend forward a little, especially if you are tall. It is the immovable foundation (unlike side posture push adjustments where you shift the center forward to the point of toppling forward except for your stabilization on the patient’s hip.). The cervical adjustment requires a slight amount of initial muscular tension but no change in the center’s position.

CERVICAL SPINE STABILIZATION: Many beginners have difficulty getting their elbow up and forward to stabilize the patient’s head and neck. It requires considerable internal rotation of the shoulder joint and elevation of the shoulder. It also requires a simultaneous anterior movement of the shoulder joint that creates a “fossa” anteromedial to the glenohumeral joint.


Demo of reaching arm behind your back

Fig. 1: Reaching behind:
increasing internal rotation

CERVICAL SPINE STABILIZATION: Many beginners have difficulty getting their elbow up and forward to stabilize the patient’s head and neck. It requires considerable internal rotation of the shoulder joint and elevation of the shoulder. It also requires a simultaneous anterior movement of the shoulder joint that creates a “fossa” anteromedial to the glenohumeral joint.
One exercise is to roll your shoulder forward (posterior-to-anterior and some internal rotation) to create the “fossa” (Fig. 1).


Demo of raised shoulder rotated forward, hand by waist

Fig. 2: Creating the “fossa,” moving the shouler and elbow anterior, and elevation of the shoulder

The second rolls the shoulder forward and internally rotates the shoulder until your forearm is just past perpendicular to the floor. Rotate your shoulder in internal rotation and reach to your lateral lower torso with the back of your hand. Then elevate the shoulder and roll your shoulder forward (Fig. 2).


ATLAS LINE-OF-CORRECTION: A common error for those learning the atlas cervical chair adjustment is that when they set up, their contact hand wrist is palmarflexed. The thrust becomes uncontrolled with a questionable line-of-drive. There should be a straight line from your elbow out to the tip of your thumb. Force and line-of-correction is in a single vector.


Demo of arm stretched in front shoulder height

Fig. 3: Note the straight line from the shoulder to the thumb

Raise your arm straight in front of you at shoulder height as if you are going to shoot a pistol. The palm faces inwards with the thumb up. The fingers are slightly flexed as a unit and the thumb is against the proximal 3rd phalanges of the index finger. You should have a straight line from your shoulder to the end of your thumb (a very slight volarflexion of the wrist).


Demo of arm held straight across chest

Fig. 4: Flex the elbow but maintain the straight line from the elbow to the thumb

Your arm must be relaxed with only enough tension to maintain the position. Once you are comfortable with the position, flex your elbow 90° so that your forearm crosses you at shoulder height. You should have maintained the straight line from the elbow to the thumb. Once you are certain you have maintained the straight line, drop your arm down until it rests against your upper abdomen.


Arm held straight across waist

Fig. 5: Lower the arm to the adjustment position

Check to see if you have maintained the straight line from the elbow to the thumb — many people palmarflex the wrist during this last procedure. Do this facing a mirror or have someone watch you. As you learn the adjustment, regularly practice this exercise until you can automatically set up your contact arm and maintain the straight line. Your arm muscle should remain relatively relaxed during the entire procedure (Fig. 3-5).


OVER THE “TOP OF THE WORLD” LINE-OF-DRIVE: CERVICAL LINE-OF-CORRECTION: Technically, the cervical adjustment (C2-C7) line-of-drive is posterior-to-anterior, inferior to superior, and lateral to medial. These three vectors translate into a smooth arc motion. The motion is similar to running the back of your hand over the top of a basketball/volleyball.


Hands in cervical adjusting position on top of a large ball

Fig. 6: Hand in adjusting position is midline and behind the upper part of the ball

Using a ball about the size of a basketball/volleyball or even a large gym ball, have your hand, palm up and in ulnar deviation, in the cervical adjusting position and place it just posterior to the top of the ball.


Back of fingers sliding over top surface of large ball

Fig. 7: Hand traces an arc that arcs back to the midline

Slide your hand over the top of the ball, like the “great circle arc” that airliners use to cross large expanses. Your hand should describe an arc that is posterior to anterior, inferior to superior, and towards the centerline. Once you practice that movement, add supination and radial deviation. Of course, in the actual adjustment, your hand does not travel that distance, but the proper thrust does follow that movement. The “wrist flick” exercise that follows executes this arcing motion that is exaggerated in this exercise. This exercise is to help you picture the motion (Fig.6-7).


Hand in ulnar deviation resting against abdomen

Fig. 8: Forearm against the abdomen. Wrist in ulnar flexion.

CERVICAL ADJUSTMENT “WRIST FLICK”: The speed and much of the thrust of the cervical adjustment (C2 to T2) comes from the wrist. Initially, and for upper thoracic adjustments, the shoulder is often used as it has power, but it does not have the speed of the wrist motion. For speed, you need to use the “wrist flick.”

Rest your forearm against your abdomen with your hand and fingers in the adjusting position. The forearm and wrist muscle have relaxed tone. Your wrist is in ulnar deviation.


Fig. 9: Foream remains against the abdomen. Wrist goes into radial deviation and supination

Fig. 9: Foream remains against the abdomen. Wrist goes into radial deviation and supination

Without moving your forearm away from the abdomen, slowly go through the motion of the thrust: supination and radial deviation — what you worked on in the “over the top of the world” exercise. As you get comfortable with the movement, go faster. The thrust is an explosive version of this motion. (Fig. 8-9)