Written by Charles L. Blum, DC
Friday, 04 May 2007 13:10
The Sacral Cup Test and adjustment can be an extremely important tool for the chiropractor because of its ability to help stabilize a chronic unstable sacroiliac (SI) joint, especially if it is slow to respond to traditional category two pelvic procedures. [Figure 1] In addition, it gives the doctor a tool to determine the presence of a complication in the treatment of a moderate sprain of the SI joint which might require additional time for recovery. A reoccurring sacral cup will also alert the doctor that an SI support belt and rehabilitative exercises will be required.
In essence, the Sacral Cup, or prone leg extension, tests the strength of the muscles crossing the posterior aspect of the SI joint. When a joint is unstable the adjacent musculature will often sacrifice strength and flexibility for stability, therefore weakness will be noted on straight leg extension, which is especially evident when the SI joint is so badly sprained that the sacrum has displaced posteriorly on one (or infrequently both) side(s). DeJarnette discussed this by noting that such weakness of the muscles crossing the posterior aspect of the SI joint contributes to confusing SI joint hypermobility response to treatment.
Sacral Cup Testing
Proper leg lift: When a patient’s joint is sufficiently sprained, they will adapt by recruiting other muscles to extend their straight leg. They will accomplish this by externally rotating their leg [Figure 2] and slightly abducting their thigh as they lift. [Figure 3] In addition, they will rock toward their "non lifting" side and lift their ipsilateral hip. [Figure 4] It is appropriate that the patient be instructed prior to beginning the test to:
1) Keep their hips on the table
2) Keep their leg straight
3) Attempt to keep the leg slightly turned inward and held near the midline as they lift. [Figure 5]
Determining leg/thigh extension strength:
With a severe SI joint sprain, the patient will be unable or have difficulty in lifting his/her leg(s) off the table or one side will not go up as high as the other. Possibly both legs individually might be able to be raised but, with doctor pressure upon the legs "toward the table," the leg(s) will be obviously weaker to some degree.
Locating the Sacral Cup
Dr. DeJarnette first described the sacral cup as being located by palpation at the posterior surface of the sacrum. He divided these cups into right or left superior and inferior "cuplike" depressions. [Figure 6] Since his work, there have been studies that have found that with some adults the sacrum does not fuse completely, allowing for some slight sacral segment malposition. This necessitates greater specificity when correcting the posterior sacral segment and expands the diagnostic and treatment region beyond just a "cup" area.
Once weakness of the leg/thigh extension has been determined, the side of sacral segment or body posteriority needs to be identified. Begin by applying posterior/anterior (P/A) pressure to the superior ipsilateral region of the sacrum on the side of weakness which, 70 percent of the time, is the main area of posteriority. [Figure 7] If, upon maintaining pressure, the leg does not strengthen, then apply pressure to the ipsilateral inferior, the contralateral superior, and the inferior aspect of sacrum respectively.
Initially, it is possible that gravity alone will be sufficient to test muscle strength. Remember that this is not about muscle strength but about an SI joint injury sufficient to permit posterior displacement of the sacrum. Patients will present with varied degrees of weakness and, as they improve, they will develop greater strength. With proper P/A pressure to the sacrum in the "right place," their leg/thigh extension weakness will eventually resolve and the muscle will appear to "lock in" appropriately.
Adjusting the Correct Segment or Sacral Cup
Once the "cup" on the sacrum is identified, the joint can be treated. Dr. DeJarnette recommended a double thumb thrust or Activator gun impulse directly into the posterior cup. For greater effectiveness, have the patient lift and slowly lower their leg while applying multiple impulses at each stage of lifting and lowering. If the ligament isn’t strong enough to hold the correction (such as chronic ligamentous compromise), sometimes the thrust, alone, will not be sufficient. In those isolated cases, you will need to apply constant P/A pressure as the patient lifts their leg and slowly lowers it to the table. Pressure must be maintained during the lowering process, since this is when the sacrum will attempt to dislodge posteriorly. Two to three leg lift attempts are generally sufficient to create some degree of improvement of function.
What does a returning positive sacral cup tell you?
Chronic sacral cup findings are commonly found with sacroiliac hypermobility syndromes (category two) presenting with a moderate to severe sprain. The patient’s recovery from this condition will not likely be rapid. Even if they have pain relief, until the posterior extensors are functioning well for one to two months, they will need to exercise caution when sitting and stressing their SI joint. The repeating positive Sacral Cup Test is indicative of two aspects of the patient’s recovery process:
(1) The need for a sacrotrochanter belt, and
(2) The need to perform leg extension rehabilitative exercises.
The SI belt can be worn in acute phases for twenty-four hours (while sleeping, compression can be reduced). As the patient’s condition improves, the belt may be needed just for sitting, lifting objects, or whenever weight-bearing stress of the joint might occur. For some patients, this might mean two weeks, for others six to eight weeks with a gradual tapering off. When the patient’s Sacral Cup Test shows up negative for one to two weeks, the need for the SI belt will decrease significantly.
SI Joint-Sacral Cup Rehabilitation
As the sacroiliac joint stabilizes in its acute phase, prone hip extension exercises are used to encourage strengthening of the joint tissues, ligament and cartilage. As our bodies age, the blood supply to the connective tissue diminishes. This "exercise" has the goal of increasing blood supply into the SI region without further traumatizing the joint tissues. Gentle lifting of the straight leg while prone is advised. If there is low back discomfort, a pillow under the stomach may help. If nothing relieves the discomfort enough to allow them to do this exercise, then they are not ready and should focus on slow walking with minimal sitting or lifting.
While lifting, the patient’s leg is maintained in a slightly adducted and internally rotated position to maximize forces into the SI joint (rather than the lateral pelvis). While lifting, the patient should attempt to keep his/her ipsilateral hip down, lifting just his/her leg, holding for a count of two, and alternating sides with each lift.
Usually a patient with a severe joint sprain will start with three sets of three, with thirty to sixty seconds of rest between each set. After a few days, if the exercise feels easy, then it is increased to three sets of five and, as that feels easier, increase it to three sets of seven. When the patient can perform three sets of ten and is pain free, they should continue at this level without further increase for three to six months. The patient should never do this exercise to any point of pain or exhaustion—it should always feel like he/she can do more but stops.
The recurring failure of a sacral cup to respond to category two pelvic block treatments, sacrotrochanter support belt, and rehabilitation indicates a problem with the patient’s recovery program. The key is that posterior segment displacement can only occur if the SI joint suffers significant compromise. Sometimes patients respond with a single treatment (without the need of a support belt) and sometimes they will be responsive during the office visit but return on successive visits exhibiting the return of the leg/thigh extension weakness.
This return of leg extension weakness necessitates reevaluation, which might just be changes in lifestyle, like making sure he/she walks frequently and avoids prolonged sitting as well as evaluating the need for nutritional support. As the patient gains strength, the need for joint support will diminish. Even so, the patient will still need to maintain sacral cup exercises for three to six months.
Once the sacral cup is negative for two weeks, you can begin the process of weaning the patient from belt use. However, if the sacral cup returns, you acted prematurely and need to reevaluate.
The sacral cup test evaluates posterior SI joint integrity and is an essential part of the category two treatments and evaluation. Examination should monitor not only for the sacral cup but also the presence of iliolumbar ligament integrity or lumbar involvement piriformis tone (anterior SI instability), and hip restriction (piriformis muscle syndrome). All these factors must be eliminated prior to leg length determination, category two-block placement, and additional treatment utilizing the SOT protocol. These procedures will be discussed in the next article.
Dr. Blum will be speaking at this year’s Chiropractic ‘07 Conference in Panama City, Panama, on "Neuromuscular Specific Diagnosis and Treatment of Severe Lumbar Herniated Discs" February 22-24, 2007. Aside from Panama City being a beautiful city at this time of the year, the warmth of everyone at the conference, and the vast array of amazing speakers make this a fabulous opportunity to come learn, share, and have fun.
Sacro Occipital Technique Organization (SOTO-USA is a chiropractic organization teaching SOT and performing research to investigate its efficacy. SOTO-USA teaches SOT as strictly developed by Dr. DeJarnette yet also continually updates the teaching of SOT based on the current research evidence base. Go to www.SOTO-USA.org for information about SOTO-USA seminars and don’t miss the 8th Annual Clinical Symposium in Nashville, Tennessee, October 25-28th, 2007.
Written by Tedd Koren, D.C.
Friday, 04 May 2007 13:07
Head banging has been reported in 3.3 to 15.2 percent of "normal" children,2 but is more common in children with cerebral palsy, mental retardation, schizophrenia, autism, otitis media, teething, decreased visual acuity and certain genetic syndromes.3
The medical approach
The medical profession considers head banging a relatively harmless way of releasing tension: "If the sound of your baby’s head banging bothers you, try moving the crib away from the wall. Also be sure to tighten the screws and bolts on his crib regularly."4 A helmet is sometimes recommended.5
What causes head banging?
Medically, the etiology of head banging is unknown. The psychoanalytic school believes that head banging is a manifestation of poor ego identity6 and even maternal deprivation.7 The latter appears related to the discredited "refrigerator mother" school of autism etiology.
From a structural perspective, head banging, head rolling, thumb sucking and other repetitive behaviors may be indicative of cranial subluxations either causing or resulting from meningeal stress. These subluxations/meningeal stresses are often the result of neurological damage caused by pre-natal or birth trauma, accidents, vaccinations, chemical stress and/or emotional stress.
Anger and other extreme emotions tighten the meningeal system and increase brain pressure; consequently, head banging is sometimes associated with tantrums.8 Repetitive rocking appears to be an attempt to release pressure on the brain and nervous system.
How could the cranial bones subluxate? Aren’t they fused?
Do cranial bones fuse?
Italian anatomists always considered the cranial bones to remain non-fused, while the German and British anatomists believe the bones to be fused. Americans learned their anatomy from German and British texts.
Recent research reveals the Italians are correct—the skull bones do not fuse, but remain movable throughout life.
Studies of live monkeys and sections of living human skulls sutures between the ages of seven and fifty-seven demonstrated objectively that the cranium moves in a rhythmical manner and that the sutures, rather than being fused and filled with calcified tissue, contain myelinated and non-myelinated nerve fibers, nerve receptor endings, connective tissue and blood vessels.9-12
Accommodation to pressure
Cranial movement appears to help the body adapt to changes in air pressure. If the bones of the skull are subluxated, proper accommodation cannot occur and meningeal stress on the brain and nervous system cause pain and discomfort. That’s why children become hypersensitive when a storm is on the way.
According to an osteopathic source, "Head banging is often an indicator of stresses within the head, and not simply a sign of frustration."13
In Congressional testimony, John E. Upledger, DO, developer of CranioSacral Therapy, reported: Many autistic children are known to bang their heads, chew on their wrists and/or the bases of their thumbs until deep tissue (tendon sheath) is visible, and/or they may suck on their thumbs so vigorously that the front upper teeth begin to displace forward. Actually, these thumb-sucking children are pressing on the roof of the mouth as hard as they can. We have observed that, when specific corrections of the craniosacral system are successfully carried out, these behaviors spontaneously cease. It is my opinion that the head-banging child is trying to release a compressive force in the head that is quite painful. When we release this compression, head banging stops.14
It may be no coincidence that head banging in some children occurs when walking begins15 since, at that stage, the lower back or lordotic curve forms which adds length to the spinal cord and may increase meningeal tension.
What needs to be done?
Head bangers are often trying to relieve cranial/meningeal pain. When meningeal/structural stresses are relieved, head bangers have often responded favorably:
• "Alex was given osteopathic treatment…after the second treatment his chronic head banging stopped."16
• A 3½ year-old autistic female compulsive head banger had a "50 percent reduction in head banging" under chiropractic spinal care.17 Had the child additionally received cranial adjustments, the improvement would have, no doubt, been greater.
• "In over twenty years of practice with thousands of brain-injured children, we have found brain tension due to severe cranial sacral pressure, due to the temporal bones and sphenoid basilar junction being ‘stuck’ in addition to intense myofascial strain. After Koren Specific Technique was added to our protocol, we have seen even more rapid progress in creating good cranial rhythm, reducing fascia strain and elimination of head banging symptoms." Matt Newell, Director of Family Hope Center, Blue Bell, PA18
What to check for
All cranial bones may subluxate; however, using KST analysis procedures, we have found the following subluxations to be the most common:
1. left and right side of sphenoids anterior (sometimes inferior/superior)
2. occipital bone inferior (sometimes lateral)
3. hard palate inferior
4. left or right parietals inferior (indicative of head trauma)
5. one or both temporal bones anterior.
Please keep in mind that every skull is different. Birth trauma may subluxate a part of the skull that is not anatomically "supposed" to be subluxated. That is especially true if there are bumps, ridges, indentations and other unusual landmarks on the child’s skull.
The upper cervical spine should also be checked for subluxations. We find the following cervical subluxations to be the most common:
1. atlas/C1 right posterior arch lateral and posterior,
2. C2/C3 disc right
3. C5 posterior
Correcting cranials using KST
Koren Specific Technique was developed to easily and quickly analyze and correct or adjust the entire structural system, including the cranial bones.
In addition to being able to locate and correct subluxations to a high degree of specificity with low force on patients, KST practitioners can analyze and adjust themselves!
For information on Koren Specific Technique (KST), go to www.teddkorenseminars.com or call 800-537-3001.
1. Vinson RP, Gelina-Sorell D. Head banging in young children. American Family Physician. 1991;43(5):1625-1628.
2. Delissovoy V. Head banging in early childhood: a study of incidence. J Pediatr. 1961;58:803-5.
3. Hyman SL, Fisher W, Mercugliano M, Cataldo MF. Children with self-injurious behavior. Pediatrics. 1990;85(3 Pt 2):437-441.
4. http://www.babycenter.com/refcap/baby/babysleep/7556.html by the Baby Center editorial staff.
5. Dawson-Butterworth K. Head banging in young children. Practitioner. 1979;222:676-679.
6. Baumeister AA. Origins and control of stereotyped movements. Monogr Am Assoc Ment Defic. 1978;3:353-384.
7. Brody S. Self rocking in infancy. J Am Psychoanal Assoc. 1960;8:464-491.
8. Berkson G. Early development of stereotyped and self-injurious behaviors: II. Age trends. Am J on Mental Retardation. 2002;107(6):468-477.
9. Retzlaff EW et al. Nerve fibers and endings in cranial sutures research report. J Amer Osteopathic Assn. 1978;77:474-475.
10. Retzlaff E, Mitchell F, Upledger J, Biggert T. Aging of cranial sutures. Anat Rec. 1978;190:520.
11. Retzlaff E, Mitchell F, Upledger J, Biggert T, Vredevoogd J. Temporalis muscle action in parietotemporal suture compression. Presented at 22nd Annual Research Convention of American Osteopathic Association, Chicago, 1978.
12. Retzlaff EW, Michael D, Roppel R, Mitchell F. The structures of cranial bone sutures. J Amer Osteopathic Assn. 1976;75(6):607-608.
13. Sutherland Cranial College http://www.scc-osteopathy.co.uk/learning.php
14. Testimony of John Upledger, April 6, 2000. Gov’t Reform Committee of the U.S. House of Representatives, 106th Congress (1999-2000). http://www.upledger.com/Clinic/autism.htm
15. Silberstein RM, Blackman S, Mandell W. Autoerotic head banging: a reflection on the opportunism of infants. J Am Acad Child Psychiatry. 1966;5(2):235-242.
16. Centers S. Autism. http://www.osteopathiccenter.org/autism.html
17. Warner SP and Warner TM. Case report: autism and chronic otitis media. Today’s Chiropractic. May/June 1999.
18. Matt Newell, Director of Family Hope Center, Blue Bell, PA. Personal correspondence to author, February 6, 2006.
Written by Tedd Koren, D.C.
Wednesday, 04 April 2007 11:55
I discovered Koren Specific Technique (KST) in the best tradition of empirical healthcare: by accident. D.D. Palmer had Harvey Lillard. I had a seven-foot-high piece of heavy laminated furniture. I was blindsided as it crashed down on me, almost cutting off most of three fingers. Luckily, my head was in the way or I would have lost my index, ring and middle right hand fingers. I still have the scars.
After sleeping off the concussion, I was left with chronic hand, arm and shoulder pain and burning. I couldn’t use scissors. I couldn’t pick up my ten-month-old son. My neck didn’t feel right; I heard noises from it all the time. That wasn’t even my only problem; I had been suffering from intermittent hip, leg and sciatica pain for the prior twenty years.
Here’s the kicker: I had been getting adjusted all that time.
I immediately got adjusted but the pain worsened. I had X-rays taken that revealed loss of cervical curve, degeneration at C5, C6 and C7 and disc thinning.
"How could that be?" I wondered.
Bleeding on Patients
The daytime pain was bad enough but the hand burning would awaken me nightly. I couldn’t close my hands to make a fist and the skin began cracking and bleeding. Sometimes, I’d accidentally bleed on my patients. Some days the sciatica pain was so intense, I couldn’t walk more than ten feet at a time before having to sit down. I remember looking at a photo of three old uncles, each of whom had had back or hip surgery. In spite of all my chiropractic care, was this to be my fate also?
As my problems worsened, I started seeing DC’s with expertise in various techniques. I traveled throughout the US and Canada and even to England for adjustments. My suffering continued.
I started seeing craniosacral therapists, cranial osteopaths, homeopaths, even a physical therapist.
I continued to suffer for another two years. I felt, deep down, there was a reason for my suffering. It was this: I discovered Koren Specific Technique.
Koren Specific Technique
Koren Specific Technique is based on two wonderful chiropractic techniques: Directional Non-Force Technique (DNFT), developed by Richard Van Rumpt, DC, and Spinal Column Stressology, developed by Lowell Ward, DC. When combined with a hand-held adjusting instrument and a few modifications, the results are amazing.
The Most Difficult Patients in the World
After discovering KST, I decided to approach the most difficult chiropractic patients in the world, to see if it would work:
At my regular lectures on chiropractic science, philosophy, vaccination and humor, I’d announce before the break, "Anyone who has been adjusted multiple times with many different techniques and still has a problem, please see me at the break."
To my surprise, a long line would form.
"Some days, I am in more pain than my patients," doctors would tell me. It wasn’t just hand, arm, back, neck, disc, arm, leg and other musculoskeletal complaints. The doctors presented with irritable bowels, anxiety, depression, heart conditions, low immune function, weakness, "hump" patterns, migraines; sinus, vision, vocal, hearing, dizziness, insomnia, and menstrual problems; "brain fog," post-traumatic disorders, postural problems and many other conditions and disorders.
It may sound too good to be true but, after one adjustment, there was a dramatic improvement or a complete resolution in almost everyone. They were shocked and amazed! And so was I.
Doctor after doctor said, "This is the best adjustment I’ve ever had in my life."
But, just as amazing, I discovered that I could specifically adjust myself.
Suddenly, I took a long, fulfilling deep breath, as years of subluxation pressure released. My lungs seemed to open up. My vision sharpened, my neck and shoulders shifted in relation to gravity and old muscle tension released. I felt relaxed, balanced, stronger—and wonderful!
"This is what an adjustment is supposed to feel like," I thought to myself.
My hand, wrist and shoulder problem resolved within a few days. My twenty-five-year lumbo-sacral disc problem and sciatica disappeared in about six weeks. (It probably would have taken less time, but then I didn’t know exactly what I was doing.) Additionally, my wife’s eleven years of chronic migraines ceased after one adjustment.
This was revolutionary. I have to show others how to do it. Chiropractors no longer have to live with chronic problems—nor do their patients.
Koren Specific Technique is a quick, easy and gentle way to locate and correct subluxations anywhere in the body. For information on taking a KST seminar, go to www.teddkorenseminars.com or call 1-800-537-3001. Dr. Tedd Koren can be reached at
Written by Tim Maggs, D.C.
Wednesday, 04 April 2007 11:50
When I graduated from chiro-practic college in 1978, I elected to come back to my home state of New York to practice. At the time, the law didn’t allow for chiropractors to X-ray below L2. Chiropractors couldn’t order X-rays below L2. We were reduced to hoping there were no pathologies or contraindications. Since that time, I’ve come across a couple abdominal aortic aneurysms, several bowel issues and several bone cancers. Fortunately, I had the good sense to X-ray the patient prior to treatment.
As a new graduate, I was thrust into the cold realities of practicing on the front lines in comparison to the womb-like comforts of being a student. It was a moral, ethical, clinical and legal tennis match in the mind of every practicing chiropractor in New York.
The only precedent I was able to use to assist in my decision was the memory of chiropractors in jail for defending what they believed in. I had just graduated from National College, where I had instructors such as Terry Yochum, Joseph Howe and Reed Phillips. I believed I was more trained in radiology than any other practitioner in my county. The decision to go ahead and X-ray below L2 was an easy one for me.
Today’s X-Ray Crisis
I sit here today, almost twenty-nine years later, and see our profession faced with another X-ray challenge: how to use X-ray in a chiropractic practice. To begin with, regardless of any of our individual beliefs, our differences on this point is a critical contributor to the weakness of our profession. The public is confused about us. In medicine, an X-ray is taken and interpreted, and for the most part, all interpretations are distinctly similar. In chiropractic, we’re everything but similar.
First of all, our profession has suc-cumbed to the ranks of treating people with symptoms. Despite knowing that getting adjusted on a regular basis is a good thing, we’ve not figured out how to convey this message to the masses. So, when a patient with low back pain comes into our office, all of us use different protocols. Some take X-rays; some don’t. Some order X-rays from an X-ray facility, and rely fully on their medical reports. Of those who take their own X-rays, many will only rule out pathology, and then begin a palliative approach using chiropractic adjustments as the primary modality. And, then, there are some who use some biomechanical measurements; however, due to the restraints of insurance coverage and the pre-conceived perception by the public as to what chiropractic does, the treatment only addresses the elimination of symptoms. Rarely, will a doctor utilize quality biomechanical information as seen on X-rays, interpret and communicate it effectively to the patient, and use the biomechanical defects as the objectives for care, recommending more than just the elimination of symptoms. This approach, although rare, not only improves symptoms, but changes the future of that patient and elevates the perception and quality of chiropractic.
Structural Management™ X-Ray Protocol
Based on the premise that human beings are architectural structures influenced by gravity and many other daily stresses, combined with the fact that all of us are continually aging and many of us have suffered with multiple neuro-musculo-skeletal injuries, it makes sense to use the status of a patient’s structure before recommendations can be made. Secondly, every other valued asset a person owns is critically managed, such as their car, their house, their finances, etc. The thought that the human structure is only considered during a time of crisis is illogical. Using symptomatic elimination as our treatment goal ignores the very laws of nature with regard to preservation and health. If members of society knew they could preserve and slow down the degenerative changes of their structures, as well as maintain a higher level of function over the course of their lifetime, most would anxiously ask "Where do I need to go and what will it cost?"
Therein lies the need for Structural Management™.
A person’s structural status is based on age, prior injuries, genetics, conditioning, job, shoes worn, mattress used, diet, height, weight and many more contributing factors. Regardless of the symptomatic picture that exists, a standard X-ray series is performed on each patient. The three reasons for X-raying each patient is to 1) rule out pathology, 2) determine biomechanical defects, and 3) to show the patient for improved communication and understanding. If additional X-rays are required, it is up to the practitioner to make that decision.
The Structural Fingerprint™ Exam (X-Ray Component)
A four-view series is taken on every patient to determine the status and biomechanical imbalances from which all people suffer. These views consist of an A-P open mouth view, a lateral cervical view, an A-P L-S view and a lateral L-S view. All are performed in the standing position with shoes off. If the patient is in a distorted postural position due to spasms or any other condition, then only the area of involvement is X-rayed, with further X-rays taken at a later, more appropriate date.
A-P Open Mouth
Biomechanical measurements and interpretation:
1) Alignment of odontoid process with sp of C2
2) Equal atlanto-axial joint spaces
3) Equal atlanto-odontoid spaces
4) Balance of occiput with the spine
The abnormal views show imbalances in the atlanto-odontoid spaces, the relationship between the occiput and the spine and the rotation of the axis relative to the atlas. Any of these findings predictably produce an elevated irritation of the spinal column at the highest level. This finding is impossible to quantify, but as chiropractors, we’ll all agree that the "normal" X-ray is preferred over the "abnormal" X-ray, and the health of the individual with the "normal" X-ray is predictably better (all other factors being equal). The goal in this case should be an improved occipital-atlanto-axial relationship.
Biomechanical measurements and interpretation;
1) A lordotic curve for shock absorp-tion
2) The center of gravity (cervical gravity line) bisecting each bone so each bone can share in the distribution of the weight of the cranium (approx. 10% of body weight).
3) Healthy disc integrity
The abnormal views show a disruption (reversal) in the curvature of the neck, with the weight-bearing line falling anterior to the spine. This biomechanical imbalance predictably increases the stresses of the C5/6 and C6/7 joint space over time, encouraging increased demands and premature degenerative changes at those levels. There is also anterior bone growth with this type of biomechanical finding, which is a reflection of Wolff’s Law in action.
Biomechanical measurements and interpretation;
1) Level iliac crests
2) Alignment between spine and symphysis pubes
3) Equal obturator foramen shape
4) Alignment of the spine
The abnormal views show an imbalance in crest heights, an unequal size of the obturator foramen, a misalignment between the spine and the symphysis pubes as well as a mass in the lower bowels potentially being a pathology.
Normal Abnormal Abnormal
Biomechanical measurements and interpretation:
1) Sacral Base Angle between 36°-42°
2) Ferguson’s Gravity Line—the center of L3 bisecting the anterior 1/3 of the sacral base (center of gravity from the side)
3) Healthy disc integrity
The abnormal views show a decrease in the sacral base angle, a posterior Ferguson’s Gravity Line and a degeneration of L4, predictably an indication of an injury with inadequate rehabilitation rather than premature wear and tear which typically causes degeneration of L5 first.
If the chiropractic profession would standardize this biomechanical approach, beginning with the use of X-rays in a discreet and professional manner, we would benefit in a variety of ways;
1) The public would know what to expect when they come to us as we work to standardize not only our protocols, but our identity.
2) The chiropractic profession would address a serious need in our society today, that of Structural Management™. We, as a profession, would no longer be competing with all other providers out there who only work to alleviate symptoms.
3) As a profession, we would further reduce the incidence of malpractice claims, as a more thorough evaluation will have been done on all patients before any inappropriate care might be given.
4) The profession would begin the previously unsuccessful attempt to unify, at which time chiropractic would begin to receive the long overdue recognition we deserve.
Most importantly, many people can have biomechanical lumbar distortion patterns without symptoms. Many can have cervical distortion patterns without symptoms. If we don’t examine and identify these biomechanical faults sooner rather than later, then correction becomes an impossibility. The medical model of care, authored by the medical industry, wins, and the biggest losers are all members of society. Since we have but one life to live, shouldn’t we take part in the effort to make all people’s lives more active and less painful, more joyous and less costly? The answer is to pay now or pay later and if, presented properly, most people would gladly pay now, as the value of preserving the human structure is worth more than most of us realize.
For more information on The Structural Management™ Program, contact Dr. Maggs at 1-518-393-6566 or email him at
Written by Tedd Koren, D.C.
Sunday, 04 March 2007 10:46
Since finding myself in the world of teaching a new adjusting protocol/technique/system (Koren Specific Technique or KST), I’ve asked many of the doctors coming to our seminars why they took the plunge to learn a new way of caring for patients. The most common reasons given may surprise you:
1. The doctor is physically damaged from years of adjusting and needs something less traumatic to his/her body.
2. The doctor has health issues and is looking for something that can help him/her.
3. The doctor is bored or dissatisfied with his/her present system.
4. The doctor wants better results with corresponding practice growth.
5. The doctor likes learning and growing.
Of course, the most powerful motivator is pain. Whether it’s physical or emotional pain, we are in some ways like amoebas: we avoid pain and seek pleasure. That is why the first three reasons on the list are in the avoidance of pain category. I’m not writing from some high horse either; it is why I was searching for something new myself. Actually, I was in all five categories, and perhaps you see yourself in a few of them as well.
Is having a pain-free, satisfying, even pleasurable, practice important?
You bet it is! Years ago an epidemiological study on the causes of death listed unhappiness at work as the number one predictor of an early death.
"Technique doesn’t matter"
There are those in our profession who say it doesn’t matter what technique is used, as long as the doctor has the correct attitude. I do not agree. Not all techniques are created equal and not all techniques work equally well. Imagine if MD’s were to say, "It doesn’t matter what drug I give people, as long as my attitude is correct?" It’s just as silly as chiropractors saying it.
I discovered KST when, after traveling the country and being adjusted by lots of people with wonderful attitudes using all kinds of different chiropractic techniques, I still had health problems. With KST I was able to adjust myself back to wellness.
"Was it really this good?" I wondered. I started making announcements at my regular philosophy/research/vaccination seminars: "Anyone with a health issue that you still have after years of chiropractic care, see me. I’ve developed a new technique that may help you."
I expected to see one or two people—instead the line went out the door. They would then get more dramatic results from one KST adjustment than they’d had from years of regular chiropractic care. Don’t tell me that that technique doesn’t matter; it matters big-time.
Which technique is right for you?
Deciding which technique to use is like deciding which school is right for you.
Is there a good fit? What should you look for? First and foremost, is it philosophically vitalistic or mechanistic? In other words, does it treat the body like a dumb machine or a vital, living, intelligent organism that is constantly changing, adapting and adjusting to its environment?
Is it specific? Do you know exactly what needs to be corrected or are you just introducing forces?
Do you know if the subluxation/dysfunction was corrected? Just because you get an audible doesn’t mean the subluxation is fixed.
Do you get results? If so, are they long lasting? Are subluxations really corrected or do they keep coming back? Will this technique become a bore after a while or does it permit you to explore, learn and grow?
These are all important questions to ask.
What about the cost?
On one hand, I understand when a doctor complains about the costs of learning a new technique. Indeed, some techniques are very expensive to learn and implement because of investment in machinery and staff training. On the other hand, when it comes to money, it all boils down to one thing: cost/benefit.
Will the investment pay off?
Let’s say you go to a seminar and get a load of new patients as a result. How much is one new patient worth? The figure can vary, but I’ve heard estimates from $1,400 to $5,000. How many patients do you need to make it worthwhile?
If you spend $1,000 on a seminar and get one hundred new patients the first year as a result, then it’s a helluva investment. But there’s another benefit.
How much are you enjoying yourself?
This cannot be overlooked. If you learn a new technique and enjoy it, if you’re not bored anymore, and if you’re excited, you’ll be happier. Your staff and patients will feel it; your practice will grow naturally.
Burnt out? Variety is the spice, well, you know.
Too many doctors are burnt out with doing the same thing all the time. Sometimes just doing something different can turn on your staff and practice.
Addicted to crack?
While I am refraining from commenting on specific techniques, I must comment on so-called "diversified" adjusting. It is among the worst techniques ever used. Actually, a lot of it is old, discarded osteopathic moves. That this racking and cracking is even taught at many chiropractic colleges is an embarrassment.
However, a lot of doctors like it because it is easy, quick and can get dramatic results as old stress patterns are suddenly shifted and released. The problem is that, after the first few adjustments, there is rarely, if ever, a dramatic improvement in the patient. In fact, you can "crack" a patient’s back three times a week for life—their subluxations never seem to go away. Is that healing? Is that chiropractic? The short answer is, "No."
The cracking sound that doctors (and patients) often expect doesn’t even mean the subluxation was even corrected. Sometimes doctors will use a little more force just to get the sound and that can be dangerous.
In my seminars, I ask doctors how many of them were hurt in chiropractic school from these diversified adjustments. Most of the attendees’ hands go up. Further, I know of four DC’s in my area who have had surgery after years of high-force techniques.
Yes, some doctors and patients are addicted to "crack." I’m sure there’s even a release of endorphins associated with some stress release. But it is a crude, primitive form of care that is more akin to ancient tribal health practices than modern subluxation correction.
Finally, I don’t know about you, but I’m pretty tired of all the cracking jokes of which chiropractic has been the butt. It’s time we moved on to specific, scientific procedures.
Let your practice be as sophisticated as your philosophy and science
Chiropractic, with its wonderful philosophy and science based on empirical (vitalistic) principles, deserves techniques consistent with that philosophy and science.
Are you seeing miracles?
Chiropractic was founded on medical failures. We’d take people whom medicine had given up on and give them their lives back. Are you seeing miracles in your practice? If you’re not, change your technique.
Koren Specific Technique, developed by Tedd Koren, D.C., is a quick and easy way to locate and correct subluxations anywhere in the body. It is a gentle, low-force technique. Patients hold their adjustments longer. It’s easy on the doctor, too. With KST, practitioners can specifically analyze and adjust themselves. For seminar information, go to www.teddkorenseminars.com or call 800-537-3001. Write to Dr. Koren at
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