Chiropractic listings are the designation of specific findings relating to the vertebral subluxation and other joint dysfunctions found through the chiropractor’s examination and analysis of the patient. Listings provide the doctor with the specifics of the misalignment, the contact point, and the line of drive used for correction. Specific listings are important because they give precision to our adjustments and help prevent us from adjusting into the wrong angle or in the wrong direction.
Because there are numerous chiropractic techniques and analytical methodologies, listings are largely technique specific. However, some have traversed multiple techniques and are commonly used by many DCs. Below I describe some of those techniques and listing examples.
The Palmer Specific Upper Cervical Analysis Listings, developed by B.J. Palmer in the 1930s, which designates the subluxations of Cl (atlas) and C2 (axis), is probably the oldest and most widely used.
The Palmer Listings for Atlas, also used in Gonstead Technique, are ASRA, ASRP, ASLA, ASLP “A” is for atlas, “S” is for superior (there could be an “I” for inferior, but this is very rarely found). “R” is for right laterality, “L” for left laterality. The final “A” or “P” designate anterior or posterior vertebral rotation on the side of laterality.
Palmer Axis Listings, 2CPR or 2CPL (sometimes seen as axis PR or axis PL) simply designate spinous posterior with left or right rotation.
Gonstead Technique and Analysis, like Palmer Specific Upper Cervical, is based on a series of X-rays and precise measurements of the individual vertebrae and pelvic misalignments. The listings derived from this analysis provide the DC with the direction of misalignment of the individual vertebrae, the contact point, and the line of drive for correction.
Gonstead Listings PRS (posterior, right superior) or PLS (posterior, left superior) can apply to segments 2C through 5L, and indicate “P” for posteriority, “R” or “L” for spinous rotation right or left, and “S” for superior tilt of the vertebra.
These listings assist the doctor in making specific and precise adjustments. The PRS or PLS listings indicate that the doctor’s contact point and line of drive are into the convexity of the scoliotic curve. The contact point is the spinous process, and the line of drive is posterior to anterior and superior to inferior.
If the listings are designated PRI or PLI (posterior, right or left inferior), the “I” indicates an inferior tilt of the vertebrae on the side of spinous rotation. These listings can also be applied to segments 2C through 5L.
In the case of an inferior tilt, the proper adjusting protocol is a bit more complex. To follow the rule of adjusting into the convexity of the scoliotic curve, an alternative contact to the spinous is required. The contact point will depend upon the region of the spine to be adjusted.
The contact point for all inferior listings is on the side opposite spinous rotation. The proper adjustment listings, which include the contact point, will vary depending on the region of the spine to be adjusted.
For the cervicals, the contact point is on the lamina, and the line of drive is P to A and S to I. For example, 2C PLI-L (posterior, left, inferior, lamina contact point on the right side).
...“Gonstead Technique and Analysis, like Palmer Specific Upper Cervical, is based on a series of X-rays and precise measurements of the individual vertebrae and pelvic misalignments.”...
For thoracic adjustments, the contact point is the transverse process on the side opposite the inferior spinous rotation, and the line of drive is P to A and S to I. For example, T7 PLI-T (posterior, left, inferior, transverse process contact on the right side).
For the lumbars, the contact point is the mamillary process on the side opposite the inferior spinous rotation, and the line of drive is P to A and S to I. For example, L3 PRI-M (Posterior, right, inferior, mamillary process point on the left side). For that example, the adjustment could be done with the patient in a side posture, left side up, contacting the left mamillar process of L3 with a line of drive P to A, I to S, and L to R.
Gonstead also lists the right and left ilea. Misalignments of the right and left ilea are based upon the X-ray projections of the superior to inferior measurement of one versus the other. In a P-to-A X-ray, the side with a projected longer dimension is the AS (anterior/superior) side, and the side with the shorter projected dimension is the PI (posterior/inferior) side. The PI side would correspond to the short leg side.
Each ileum is also designated as either internal or external based on the projected width of the bone at its widest point. The side with an internal rotation appears wider (at the widest part), while the side of external rotation appears narrower. This would be listed as PIEX (posterior, inferior, external rotation) or a PUN (posterior inferior internal rotation). Other possibilities are an ASIN or ASEX (anterior, superior, internal, or external rotation). If one side is PUN, you can accurately assume that the other side is the opposite listing, in this case, an ASEX.
This is best addressed as a side adjustment, with the contact point at the posterior iliac spine. In Gonstead Technique, the preferred adjusting sequence is to first address the PI on the side of lumbar body rotation.
The Pettibon Spinal Biomechanics Technique is based on a highly precise set of three cervical X-rays — lateral, vertex, and nasium views — and two lumbopelvic views — A to P and lateral.
Pettibon analysis of the cervical views measures the cervical subluxation complex and will show one of three possible configurations: against the angles, into the angles, and head subluxation. These configurations indicate the possible misalignments between skull and atlas, C2 to C5, C6 to Tl.
Pettibon lumbopelvic analysis measures the angular relationship between the lumbar spine, L2 through L5, relative to the sacral base. Designation is by the acute angle side as measured on the A-to-P view. The acute angle side (less than 90 degrees) would be equivalent to the Gonstead AS side. The obtuse angle (greater than 90 degrees) in Gonstead terminology would be equivalent to the PI side.
Grostic Practitioners utilize a similar analytical approach to that of Pettibon practitioners, but it is exclusively upper cervical.
Chiropractic BioPhysics (CBP) analysis is similar to Pettibon cervical and full-spine analysis, with some variations in the details of analysis and corrective procedures.
Both Pettibon and Chiropractic BioPhysics evolved from the original work of Dr. John Grostic over 70 years ago.
Sacro-Occipital Technique (SOT) has a unique analytical and corrective approach. The SOT examination calls for the DC to compile a series of physical tests and indicators that direct them to a specific lumbopelvic subluxation category.
Category 1 indicates a craniosacral subluxation, causing excess right or left dural tension. This is detected by excess right or left Achilles tendon tension. It is listed as CAT 1 PLSS (pelvic left short side) or PRSS (pelvic right short side).
Category 2 indicates a sacroiliac slippage and separation or sacroiliac ligament sprain. This is a unilateral pelvic weight-bearing fault that must be corrected before other categories are addressed. It is designated as CAT 2 PLSS or PRSS.
Category 3 is the category of lumbosacral disc syndromes. It usually includes a genuine sciatic neuralgia, neuropathy, or radiculopathy.
In conclusion, I hope this explanation of listings, with an overview of the listing systems of several popular chiropractic techniques, has conveyed the importance of using listings, whichever techniques you employ. Specific chiropractic analysis and listings allow the DC to qualify and quantify the details of complex joint dysfunction.
If you don’t understand how something works, you can’t begin to fix it, nor can you solve a problem you can’t define in detail. Chiropractic is nothing if it is not specific. Nonspecific adjusting is not adjusting at all. It is manipulative therapy, not chiropractic.
Dr. William H. Koch is a 1967 Cum Laude graduate of Palmer College of Chiropractic in Davenport, Iowa. He practiced in the Hamptons of Eastern Long Island, New York for 30 years and in the Bahamas for 15 years aboard his motor yacht, The Coastal Chiropractor. He is licensed to practice in New York, Florida and The Bahamas and currently splits his time between Abaco in The Bahamas and his newest practice in Mount Dora, Florida. Now, wanting to give back to the profession he loves, he offers courses on "The Koch Protocols for Integrated, Advanced, Chiropractic Techniques." Simple, Effective, No Nonsense and Hands On. He may be reached on DrWilliamHKoch.com or by email [email protected].
