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Objective: to determine whether a correlation exists between abnormal pronation and functional
leg-length discrepancies.
Method: Visual assessment and a pelvic thrust maneuver were used to identify the functionally
short leg The Foot Posture Index was used with a modified stance position to identify the more
pronated foot. The posterosuperior iliac spines were used to identify the "relative" position of the
innominate bones.
Results: A significant positive correlation was found between abnormal pronation and hip
position and between hip position and functional leg-length discrepancy.
Conclusion: These results are consistent with a theoretical ascending dysfunctional pelvic model:
Abnormal pronation pulls the innominate bones anteriorly (forward); anterior rotation of the
innominate bones shift the acetabula posteriorly and cephalad (backward and upward); and this
shift in the acetabula hyperextends the knees and shortens the legs, with the shortest leg
corresponding to the most pronated foot.
Friction-reduced table
www.lafayetteinstrument.com
Chiroslide
Allis (Galeazzi) test
The short leg observed in the legs-flexed position may result from
guarding responses instigated by stretch reflexes involving
asymmetry of quadriceps tone associated with pelvic
asymmetry.
J Manipulative Physiol Ther. 2003 Nov-Dec;26(9):557-66. Validity of
compressive leg checking in measuring artificial leg-length
inequality.
Cooperstein R, Morschhauser E, Lisi A, Nick TG.
Department of Technique, Palmer College of Chiropractic West
OBJECTIVE: To determine the accuracy of instrumented prone
compressive leg checking. DESIGN: Repeated measures (n = 26) on
single subjects (n = 3).
METHODS: A pair of surgical boots were modified to permit continuous
measurement of leg-length inequality (LLI). Multiple prone leg-check
observations of a blinded examiner on 3 subjects were tested against
artificial LLI that was created by randomly inserting 0 to 6 1.6-mm
shims in either boot.
CONCLUSION: Compressive leg checking seems highly
accurate, detecting artificial changes in leg length +/-1.87 mm, and
thus possesses concurrent validity assessed against artificial LLI. Pre-
leg-check and post-leg-check differences should exceed 3.74 mm to be
confident a real change has occurred.
J Manipulative Physiol Ther. 2000 May;23(4):258-75. Are chiropractic
tests for the lumbo-pelvic spine reliable and valid? A systematic
critical literature review.
Hestbaek L, Leboeuf-Yde C.
Nordic Institute for Chiropractic and Clinical Biomechanics, Odense,
Denmark.
Only tests for palpation for pain had consistently acceptable results.
Motion palpation of the lumbar spine might be valid but showed poor
reliability, whereas motion palpation of the sacroiliac joints seemed to be
slightly reliable but was not shown to be valid. Measures of leg-length
inequality seemed to correlate with radiographic measurements but
consensus on method and interpretation is lacking. CONCLUSION:
The detection of the manipulative lesion in the lumbo-pelvic spine
depends on valid and reliable tests. Because such tests have not been
established, the presence of the manipulative lesion remains hypothetical.
Great effort is needed to develop, establish, and enforce valid and
reliable test procedures.
J Manipulative Physiol Ther 1988 Oct;11(5):396-9
Reliability of the Derifield-Thompson test for leg length inequality,
and use of the test to demonstrate cervical adjusting efficacy.
Shambaugh P, Sclafani L, Fanselow D.
New York Chiropractic College Research Division, Glen Head 11545.
An inter- and intra-examiner reliability study was performed to validate a prone leg length-
differential test. Naive students (n = 40) were called, in random order, into three adjacent
examining rooms where three experienced chiropractic clinicians measured differential leg
lengths. Using standard placement a tape measure was read to the nearest mm to detect
inequalities at the shoe-sole interface. The leg length differences were recorded, for both the
straight and flexed legs prone positions, twice by each of the three clinicians. Intraclass
correlations were significant for the two independent readings for all three examiners, indicating
high reliability of the test. Good agreement among examiners was indicated as well by significant
intraclass correlation in two of the three possible examiner combinations. These results argue
strongly for the reality of the leg length inequality phenomenon and also that it can
be reliably measured.
J Manipulative Physiol Ther. 1987 Oct;10(5):232-8. Short leg
correction: a clinical trial of radiographic vs. non-radiographic
procedures.
Aspegren DD, Cox JM, Trier KK.
Low Back Pain Clinic, Fort Wayne, Indiana.
Prone Patient
Look for trigger point on side opposite head turn (side of body
rotation). If no trigger point, think Atlas
Cervical
Cervical Syndrome Rotation
SCP- LPJ
SSP- Zygomatic Arch
LOC- L-M, P-A, I-S
Rotate the head
completely before
adjusting.
Maintain contact
during rotation
Chin is 1” above the
bottom of the head piece
This adjustment can also be done from the head of the table, with
more of an S-I line of drive for the lower cervicals, to follow the
plane line of the disc and stay perpendicular to the facets.
Cervical Syndrome ATLAS
Legs balance on
head rotation to one
side only
Legs balance
on head
rotation to
both sides
Cervical
Rotation
Cervical
Rotation
Xception Derifield Cervical Syndrome
If right cervical rotation, with the legs flexed, creates balanced legs,
you have a RXDCS.
If left cervical rotation, with the legs flexed, creates balanced legs,
you have a LXDCS.
X-Derifield Cervical Syndrome
vs.
X-Derifield Negative Derifield
Cervical
Rotation = XD CS
Cervical
Rotation = XD -D
Overcompensated Cervical Syndrome (OCCS)
•Suspected w. chronic C2
subluxation
•decreasing spinous laterality
Cervical down to C7,
Rotation • very tight trapezius muscle
opposite side of axis spinous
laterality.
•Often seen in torticollis.
•Left spinous Right
rotation
C2
Trapezius •Often found when the sacro
Spasm iliac joint is in severe need of
•Left
overcompensated
correction.
cervical syndrome Left Overcompensated
C7 Cervical Syndrome (LOCS)
C2
Side of Trapezius
Spasm
C7
Bilateral Cervical
Syndrome Rt. Cerv.
Rotation
NOT Lt. Cerv.
automatically a Rotation
double PS or AS
Occiput
-D
Left OR
Think: Pro
Wrestling
SCP PSIS
SSP Ishial tuberosity
LOC P-A, I-S, M-L.
Thrusts 3-5
Note: Pelvic piece drops toward feet
to allow ASIS to drop inferiorly
Supine Positive
Derifield
SUPERIOR
ON LEFT
INFERIOR
ON RIGHT
SACRAL
APEX LEFT
Testing for Sacral Rotation
Pt.
Prone
This
exacerbates a
LEFT sacral
apex.
“Bend the right
knee and lock the
left knee into
extension” SAR
This accentuates
a right sacral
apex.
Sacral Base Rotation
(for any coronal plane sacral rotation affecting either
S-I joint or L5 disc)
Thompson Indicator:
tenderness
or at
gastrocnemius. Looks
like AS on film.
Stabilize