Welcome to the Free Kiro Kids "Secrets of the Subluxation" E-Course.

My name is Dr Neil Davies, Chiropractor, from Ballarat, Australia. We have taught chiropractors for over 10 years in 18 countries to hundreds of chiropractors and have created many successful multimedia products to help teach this often challenging area. In our decision to make our chiropractic educational products available online, and particularly throughout Nth. America, we decided to simply give some away for free since it may be quite a while before we actually present courses in that part of the world. Simply, we have some exciting new techniques to offer and we want to get to know you any way we can. If I cant present a seminar to you, this is the next best way to learn what I have been teaching in other countries.

This E-course is an excerpt from the popular Adjusting the Child set of DVDs and distance learning CDs. To be honest, were not giving you all our pearls of wisdom but certainly enough to whet your appetite and get you started. Okay, let's start...

Principles of Subluxation
An Interactive Review of the Principles, Methodology of Examination and Interpretation of Findings It is essential to have complete ownership of the principles of subluxation identification before attempting to master the examination technique. The whole Kiro Kids model of subluxation in children is based on the principle that the subluxation always occurs in a predictable pattern of three essential components...
y y y

Kinesiopathology Neuropathology Biomechanical Compensation

Simply put, this means

1. Altered kinesiology, at identifiable spinal segmental levels 2. Altered neurology related to identifiable spinal levels 3. Compensation patterns at predictable spinal levels
This predictable pattern presents in all patients, regardless of age, gender or size. If examination findings in any given patient fail to conform to a predictable pattern, then it is reasonable to conclude they do not represent a true subluxation. There are many compensations... but few real subluxations. It is a widely held opinion amongst chiropractors and educators that aberrant motion findings alone identify the subluxation, the inference being that this disturbed motion impairs neurological function. The missing link has always been the failure to demonstrate altered neurology both before and after the adjustment. Various modes of instrumentation have purported to measure neurological function but time honoredtechniques of clinical neurological examination have been largely ignored. You will be revisiting your studies in anatomy, neurology and kinesiology on this journey to identify the presence of the subluxation, identify its clinical effects and demonstrate its change after the application of the chiropractic adjustment. A little tip here - Repetition Produces Comprehension. My first question to you then is this... How much evidence is needed to make a diagnosis?" Answer: As Much As Possible This is not a flippant answer - it is the truth. It is unlikely you would diagnose a family member with a single examination finding when a constellation of findings were available. Wouldnt you collect as much evidence as possible, collate it and arrive at a diagnosis that satisfies all the criteria?

Identifying the subluxation involves using the accumulated knowledge of kinesiology, neurology, posture, pain and radiology.

Due diligence and an open mind is the key! Welcome to the journey!

Our Recommended Approach

Use this presentation to revise the principles and steps involved in identifying the subluxation in the cervical spine. Use the questions to check your understanding of these principles and steps. Attempt your own answer, and then check against the answer that follows. This presentation is normally sold in a PowerPoint file where the answers only appear after the question has been posedwere giving you this free limited version with a few limitations.

Revision of Anatomical Orientation

The X-axis runs horizontally across the mid-frontal plane of the body. Which spinal movements occur about the x-axis? Flexion and extension

The Y-axis runs vertically through the long axis of the body. Which spinal movements occur about the Y-axis? Rotation

The Z-axis runs horizontally across the mid-sagittal plane of the body. Which spinal movements occur about the Z-axis? Lateral flexion

The Importance of Patient Positioning

1. Prior to commencing motion palpation, it is imperative to seat the patient in a position which does not alter the true spinal motion components. 2. Incorrect positioning will create inherent errors and all subsequent findings will contain these inherent errors.

3. The patient examining position will be one that retains an X-Y-Z neutral position.
Essentially, you should ensure three points when seating the patient for motion palpation:
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Legs are uncrossed with feet flat on the floor. Patient sits maintaining the correct lumbar lordosis. Patient does not lean back in the chair.

Creating Inherent Errors

The examiner may unintentionally create inherent errors by poor motion palpation technique. Take the time to ensure you develop the right habits early on in the development of your motion palpation skills. These are the essential items to watch for. Examiner stands or sits to one side of patient using body close against patient to prevent excessive movement. Stabilizing hand rests on apex of cranium, not frontal area where cervical extension can be unwittingly created. Infants should have mother assist to hold the lumbar lordosis erect with one hand and chest upright with the other to prevent slouching while the doctor palpates. Doctor may use pressure with pisiform area of palpating hand over vertebral prominens to prevent slouching. In essence, you may induce false findings if the normal anatomic orientation of the body is altered. No different to examining a seated patient with a wallet in his pocket! Let's move on to actual motion palpation technique.

IDENTIFYING THE SUBLUXATION

Ten Steps to Diagnostic Accuracy STEP I Identify kinesiopathology at the upper cervical complex in lateral flexion.
A loss of lateral flexion unilaterally implies a subluxation on that side. The first step in our examination process is to perform lateral flexion at the upper cervical complex.

Note that this is not a specific movement between occiput-C1 or C1-C2 but a generalized motion. The image at left shows this demonstrated on a pre-school age infant. Note the placement of the supporting hand or stabilizing hand over the cranium and not over the forehead where you could unwittingly exert cervical extension causing an inherent motion error.

The mother supports the infant in an upright position with hands on the chest and lumbar lordosis to maintain an X-Y-Z neutral posture.

Interpretation of Step 1 Which motion is lost as the common denominator in cervical spine subluxation? Lateral flexion

A loss of lateral flexion unilaterally can only imply three possible subluxation components at this stage. What are they?

Laterality of Occiput Laterality of Atlas Laterality of Axis

The segmental level of subluxation is not revealed at this stage. Laterality simply defines the level of subluxation. The following steps will tighten up the listing using other motion vectors.

IDENTIFYING THE SUBLUXATION

Ten Steps to Diagnostic Accuracy STEP II Examine long axis condylar movement in both flexion and extension.When flexion is lost, an anterior-superior (AS) occiput is implied. When extension is lost, a posterior-superior (PS) occiput is implied.
Note movement of the occiput into the right posterior quadrant. Loss of extension into this right quadrant implies a right posterior occiput listing. Movements are performed at 45 degrees to the coronal and sagittal planes.

The mother holds the infant in an X-Y-Z neutral position. The occiput is brought back into the right quadrant feeling for fixation into long axis condylar extension with palpating fingers just under the nuchal rim. The combination of loss of right lateral flexion and right long axis extension creates the Gonstead listing of PS-RS occiput (post sup - right sup). Note movement of the occiput into the left anterior quadrant. Loss of flexion into this left quadrant implies a right anterior occiput listing. Movements are performed at 45 degrees to the coronal and sagittal planes.

The mother holds the infant in an X-Y-Z neutral position. The occiput is brought forwards into the left quadrant feeling for

fixation into long axis condylar flexion with palpating fingers just under the nuchal rim. The combination of loss of right lateral flexion and left long axis flexion creates the Gonstead listing of AS-RS occiput (ant sup - right sup).

Interpretation of Step II Combined planes of movement are known as coupled movements. At some spinal articulations, the dominant movement is not always in the X, Y or Z axis, but is a coupled combination of two of these. What is the dominant motion found at the atlanto-occipital junction (C0-C1)?

Long Axis Condylar Movements

This is represented by combined flexion/lateral flexion to the contralateral anterior quadrant followed by extension/lateral flexion to the ipsilateral posterior quadrant. It represents the movements of the occipital condyles on the lateral masses of the atlas as they move anteriorly, superiorly and medially, then posteriorly, superiorly and laterally. This can be conceptually awkward for some people and may be visualised as follows. Visualize the superior surface of the right lateral mass of atlas. It is a concave surface upon which the occipital condyle glides in three directions. The top left corner A represents the anterior, superior medial aspect. The right bottom corner B represents the posterior, superior lateral aspect.

If the condyle moves towards position A, how is the occipital motion best described? Answer: Long Axis Extension

Visualize the right condyle of the occiput as it glides anteriorly, medially and superiorly over the right lateral mass of the atlas. As it does so, the occiput describes right posterior extension as the head rocks backwards and look up to the left side. This is sometimes hard to conceptualize. If the condyle moves towards position B, how is the occipital motion best described? Answer: Long axis flexion. Visualize the right condyle of the occiput as it glides posteriorly, laterally and superiorly over the right lateral mass of the atlas. As it does so, the occiput describes right anterior flexion as the head rocks forwards and look downwards to the left side.

Forming Occipital Listings

If the right condyle fixates at Position A, the occiput has reduced ability toperform which movement? Answer: Long axis flexion. It is therefore listed an as anterior occiput. If the right condyle fixates at Position B, the occiput has reduced ability to perform which movement? Answer: Long axis extension. It is therefore listed as a posterior occiput. As the occipital condyle lies in a superior position when subluxating at either end of the concave lateral mass of atlas, it is deemed to be subluxated superiorly together with its anterior/posterior component. Hence, it becomes termed either an AS or PS occiput.

Step 1 yields the side of laterality, RS or LS. Step 2 yields the anteriority or posteriority, AS or PS
The information is then combined as a listing. Gonstead convention lists the Step 2 findings before Step 1. Eg. PS-RS occiput or AS-LS occiput. Combining steps 1 & 2, what listings can be derived from the following examination findings? Q. Loss of right lateral flexion & right long axis extension A. PS-RS occiput Q. Loss of left lateral flexion & left long axis flexion A. AS-LS occiput Q. Loss of right lateral flexion & left long axis flexion A. AS-RS occiput

Q. Loss of left lateral flexion & left long axis extension A. PS-LS occiput A little repetition and using the diagrams above lead you to these simple four listings. Understanding what is meant my long axis condylar movements is imperative in generating occipital listings. While most all other vertebral listings are conceptualised in an X-Y-Z axis, this upper cervical complex is a little different. Since the dominant vector of occipital motion takes place in the long axis condyle, you must know how to discern lack of motion in these axes.

Summary of Part I
y y y y y

Lateral flexion loss is the common denominator in cervical spine subluxation. Lateral flexion loss identifies either laterality of occiput, laterality of atlas or laterality (an open wedge) at C2-3. Long axis condylar movementsin flexion & extension determine occipital motion loss. If there is no motion loss in condylar movements, the subluxation cannot be occipital and must be at C1 or C2-3. The next steps in Part II will determine if these levels are involved.

Practice tips Practice these steps on all patients over and over just to determine if a loss of lateral flexion exists on one side or even both sides (more about this later!) Practice palpation of condylar movement in flexion and extension. The more youuse these axes of motion, you more you will feel.
We know that motion palpation is a practiced skill that often eludes students and even experienced practitioners. We have found that a step-by-step approach encourages a good method, reproducibility and reduces errors of judgment. This e-course series will demystify motion palpation and introduce intelligent thinking, rationale and neurological concepts that support the technique and give you the right foundation and confidence to determine subluxations. Our path has been a long one and our technique has evolved to the point that we are now able to determine and successfully correct spinal, pelvic, cranial, extremity, front of body and muscular subluxations. We welcome you to our journey of learning and to the world of Kiro Kids.