By: Wayne Henry Zemelka, DC
Positive Derifield (+D) analysis is derived from observing the Leg Length Inequality (LLI) (Fig. 1), in that the short leg in extension comes even or crosses over to become longer when placed into flexion (Fig. 2). A +D indicates that the rotation of the ilium occurs at the acetabulum, therefore pulling the leg superior. This results in the ilium rotating posteriorally in relation to the top of the ilium. This can be noted on an A to P X-ray of the patient’s pelvis. This is similar to what some Chiropractors call a PI Ilium.
With the patient in the prone position the procedure for correction of a +D involves the movement of the ilium on the side of involvement from posterior to anterior utilizing the drop of both the pelvis and lumbar sections. Set the drop tension to the weight of the patient and with a minimum of added tension to just hold up the weight of the patient at pelvic/lumbar level. The doctor’s stance is scissored, slightly inferior along the side of involvement with the segmental contact point being the medial portion of the PSIS and the contact point, on the doctor’s hand being the thenar (Fig. 3). Line of drive and line of correction must be followed, as the need is to move the joint from inferior to superior and posterior to anterior.
Stabilization is accomplished by placing the other hand over the posterior ischium on the opposite ilium (Fig. 3). Keep in mind that the primary thrust is from the contact hand and not the stabilization hand. Just holding the stabilization will in most cases result in the overall correction of any anterior pelvic subluxation on the opposite side of the PI ilium (Fig. 4).
The characteristics associated with the anteriority of the opposite ilium that may accompany a Positive Derifield should not be mistaken as the primary subluxation. The short leg is the affected side and any variation of the opposite ilium is considered as secondary response to the initial subluxation found.
In the early days of adjustment of the PI Ilium stabilization was taken by reaching around the ilium of the opposite side. With the advent of segmental drop adjusting, it was found that the posterior ischium that may occur on the opposite side was easier to correct by changing the stabilization to the posterior ischium. This was noted in the early publications authored by Dr. J Clay Thompson, the originator of the Thompson Technique.
Complications and Recommendations
A further complication to LLI is the problem of plantar fasciitis that may affect your patient’s leg length in the upright posture. Plantar fasciitis results in the decrease of the arch that will cause the body to tilt to the lower side. The weight of the patient in the standing position further complicates the situation in that the pelvis may tilt towards the weak side. This condition affects the Kinetic Chain and proprioceptive balancing systems, which may result in possible complications throughout the spine.
Another scenario may present itself in that both feet are affected by plantar fasciitis, which not only affects the basic Kinetic Chain, but also presents an increased complication for the balancing of the proprioceptive system. Symptoms from these problems can involve aching feet, burning, tenderness of the shin area, and difficulty in walking for any great distances.
If any of the above scenarios are detected you should examine the patient’s arches. The addition of Foot Levelers’ custom-made, flexible orthotics to correct the insufficiency in this patient will aid in the normalizing of the Kinetic Chain and help the patient to hold their adjustments.
About the Author
Dr. Wayne Henry Zemelka is a 1975 graduate of Palmer College of Chiropractic. He was Faculty President for six years in the 1980’s, during which time he built and operated the Media Production Department for Television and Video and was instrumental in production of classroom instruction videos and operation of the Printing Department. “Dr. Z” also taught in the Technique Department, Business Management and Continuing Education. In 1997 he was elected once more as Faculty President. He retired from Palmer in 1998.
Dr. Zemelka, who is now regarded as the Thompson Technique Specialist, worked with Dr. Thompson for years, beginning in the late Seventies. In early 1980 he convinced Dr. Thompson to make a video series showing the analysis and adjusting techniques. This turned out to be a very good idea, and thus was born a teaching concept that has brought the Thompson Technique to the forefront of Chiropractic adjusting worldwide.
Dr. Zemelka presently operates the Zemelka Family Chiropractic Clinic on Lillie Avenue in Bettendorf, IA, “next to but not in Simoniz Car Wash on Kimberly Road.” He writes for several national magazines and journals, and in 2000 finished production on a new Thompson Technique Video which can be seen in the Palmer Library. His Thompson Manual is available from the Palmer Bookstore. Dr. Zemelka is Certified in Videofluoroscopy and is presently working on a video series of instructional tapes for the Chiropractic profession.