Clinical/Technique Terms

  • “High side of the rainbow”: The “high side of the rainbow” is the convex side of a scoliotic curvature. When a vertebra is determined to be subluxated and a scoliotic curvature is present in that region, the segmental contact point is on the convex side. The object in mind is to prevent increasing the angle of the scoliotic curvature, as well as, to reduce lateral wedging that might be present at the level of subluxation.
  • Disc Wedging: This refers to the comparative distances between like points on opposing vertebral body surfaces across the disc space as viewed on radiographs and is a very important consideration in the Gonstead analysis and adjustment of the spine. If lines drawn through and parallel to opposing vertebral body surfaces diverge, this is considered an “open wedge.” If the lines converge, this is called “closed wedge.” On the AP film, wedging would denote lateral flexion or Z-axis rotation misalignment and is called lateral wedging. (Herbst RW p.69) On the lateral film. X-axis or flexion/extension misalignment would be indicated.
  • “Through the plane line of the disc”: The purpose of the adjustment is to “fit” the vertebra onto the subadjacent disc. For this reason, the “plane line of the disc,” or a virtual line parallel to the posterior-to-anterior horizontal plane of the disc and is considered the primary vector in the line-of correction of an adjustment. It is used to reduce the posterior misalignment component (–Z) of a subluxation for the purpose of re-centering the nucleus pulposus.
  • “Lifting the vertebra onto the disc”: The line-of-correction during the entire adjustment, particularly in the cervical and lumbosacral spine, is not entirely parallel to or “through the plane line of the disc.” In the presence of posterior-inferior component of vertebral misalignment of a subluxation, the initial phase of 10the adjustment (C2 to sacrum) involves a primarily inferior to superior (I-S) line of drive to reduce inferior (–θX) misalignment component before the thrust is re-vectored posterior to anterior (P-A) and parallel the disc plane line, i.e., the I-S vector force initiates the P-A vector force through the “plane line of the disc.” This is somewhat akin to an airplane climbing up to altitude before leveling off.
  • “Closing down the wedge”: If the subluxated vertebra on the A-P film shows an “open wedge”  (lateral flexion) misalignment on the lateral aspect of the disc. A component of the adjustment is to reduce the “open wedge” by applying “torque.” This is usually done by contacting a segmental contact point on the open wedge side; exceptions are the special L5 listings where the contact points are on the “closed” wedge side or side of lateral flexion malposition.
  • Torque: Torque is a rotary movement over the segmental contact point that is applied at the end of the thrust perpendicular to the primary vector or around the long axis of the thrust. There are two reasons for applying torque: 1) increase the speed and effectiveness of a thrust much like the “rifling” in a gun that fires bullets; and 2) reduce the appropriate direction of misalignment of a vertebra. From C2 to L5, the θZ torque is used to reduce lateral wedging (θZ) of the disc. At the atlas, it is used to reduce the anterior-superior (extension, –θX) or anterior-inferior (flexion, +θX) misalignment. In the ilium adjustment, it is used to reduce the flexion/AS (+θX) or extension/PI (–θX) and rotational (In and Ex, θY) misalignments.
  • Posteriority: Dr. Gonstead stated that the initial and primary direction of misalignment of a vertebra, from C2 to L5, is posteriorward (–Z). In the cervical and lumbar spine, it is usually accompanied by some degree of inferiority (–θX) while the thoracic spine may show signs of superiority (+θX). He also cautioned against determining a subluxation based upon the degree of posterior or posterior-inferior misalignment observed on the lateral x-ray film. Often the most posterior-appearing or otherwise excessively misaligned-appearing vertebra is in the area of compensation.
  • “Taking out the slack”: Prior to delivering the adjustment, the Gonstead doctor reduces the elasticity in the soft tissues and joints. A misnomer is that the adjustment is delivered at the “point of tension” or at the physiological limits of joint motion of a fixated segment. The latter point is taking the joint beyond the point of “taking out the slack.” The adjustment goes through the “point of tension.”
  • Tissue Pull: The purpose of tissue pull is to take the slack out of the skin, subcutaneous tissues, and underlying muscle up to the segmental contact point prior to making your contact. This makes the contact with the segmental ontact point more stable (your contact point is not sliding around), and if done in the right direction, it pre-stresses the tissue in the direction of correction.
  • Push Move: The push move is a P-A (posterior to anterior) lumbar or pelvic adjustment utilizing a pisiform contact adjustment with the patient in the side posture position. There is a solid hip-to-hip stabilization between the doctor and patient (the exception is the AS, In, or ASIn ilum adjustment where the stabilization is present but somewhat looser to allow the proper line of correction to occur but sufficient to prevent torsion of the patient’s torso.).
  • Pull Move: The pull move is another form of lumbar or pelvic, side posture adjustment. Depending upon the segment being adjusted, the contact is a 2-3 fingertip or pisiform contact with a “kick” stabilization. An effective P-A thrust is likened to a “push” move but using the finger contact (the doctor is on the opposite side of laterality in the “pull” move). The chest rather than back muscles are used to facilitate the “push.” A properly done “kick” stabilization minimizes torso long axis rotation (θY) by producing a momentary stabilization of the patient’s hip, unlike the “lumbar roll” which involves using the knee to significantly rotate or twist the patient’s torso. In cervical spine adjusting, there is a “pull” move as well. It is used when a spinous listing cannot be adjusted from the side of laterality or when the conventional cervical adjustment does not reduce the inferiority enough. The adjusting finger on the contralateral side to spinous laterality is used. The finger contacts the side of laterality and wraps or hooks underneath the spinous. The thrust is P-A. Hooking the finger in this manner helps to “lift” the spinous to reduce inferiority. In cervical torticollis, sometimes the patient won’t allow you to adjust them on the side of spinous laterality due to the pain and muscle spasms. In these cases, the cervical “pull” move can be used until the patient can accept an adjustment from the side of spinous laterality.
  • “Accept it where you find it”: A saying in chiropractic states: “Find the subluxation. Fix it. Leave it alone.” Gonstead added the sentence: “Accept it where you find it.” A subluxation anywhere can cause problems in areas not usually associated with the subluxated vertebra through compensation or the extensive neural network – Manual Medicine: Diagnostics by Dvorak and Dvorak illustrate the extensive and unique muscular changes caused by intersegmental lesions that is different with each vertebral level lesion, and that is merely the muscular component.
  • “The right adjustment at the right place at the right time”: When all conditions are right, you can correct the subluxation with one adjustment. One needs to find the appropriate table, the right vertebra, the right line-ofcorrection, the right speed and depth of thrust, the right phase of correction or little or no damage or degeneration, and above all, done when the patient’s body is prepared for a correction. (Cox, Firczak, Butler)
  • “Leaving it alone”: Dr. Gonstead was very adamant about backing off from adjusting a vertebra once changes have begun to occur, symptomatically and/or objectively. He did not believe in maintenance chiropractic care as the temptation to adjust once too often is a risk – too many doctors feel obligated to adjust a patient on each and every visit whether adequate signs of subluxation are present or not. This tradition was continued by Drs. Cox. He stated that once the subluxation was sufficiently corrected, the chiropractor must leave that vertebra alone until such time that it may become re-injured. His concern was that overadjusting the segment could create a new problem. As is well-known, damaged soft tissue repairs with scar tissue, therefore, re-injury is a distinct probability, and many patients must return at later time for care of new injuries to the same region or vertebra.
  • “Adjusting too hard, too often, and in too many places”: Dr. Gonstead regularly stated that too many chiropractors adjusted “too hard, too often, and in too many places.”
  • “Chasing” or adjusting symptoms: The Gonstead chiropractic accepts the subluxation wherever it is found (‘accept it where it is”) and does not rely heavily upon the location of obvious symptoms, in particular, pain. The purpose of the Gonstead spinal analysis protocol is to find the subluxation regardless of its location. Pain is a symptom but so is anesthesia. In chronic subluxations, anesthesia may be present rather than pain. On the other hand, in spite of the presence of some objective factors of subluxation, if pain or other symptoms have abated considerably over the course of care, Gonstead chiropractors consider leaving that segment alone for awhile. It is true that Dr. Gonstead and most Gonstead chiropractors have the Meric System (i.e., each vertebral level is associated with particular organs or conditions) in mind when searching for a subluxation in a patient with presentations suggesting visceral or visceral-like symptoms and check those segments carefully. One related question is: Is a patient not presenting with pain truly “asymptomatic?”
  • “Right Hand Orthogonal Coordinate System”: This is the common language of biomechanists to describe the position and/or the movement of a object in much the manner we use listings to give us the three-dimensional misalignment of a vertebra. The name denotes that the agreed upon reference point is the right side of the body.