Segmental Drop Adjusting: Posteriorly Rocked Ischium

By: Wayne Henry Zemelka, DC

Analysis

Figure 1. Palpation of the gastrocnemius muscles

Figure 1. Palpation of the gastrocnemius muscles

Detecting the Rocked Ischium is accomplished by palpation of the gastrocnemius muscles of the lower legs (Fig. 1). Consideration must be made in how to go about this procedure, so as not to stand over the patient (in the event the patient reacts by bringing up the leg being examined in a reflex response). Be sure to inform the patient what you are about to do. Positive findings include pain and taut-tender fibers – or, as Dr. Thompson used to say, a “boardiness” of the muscles on the affected side. In many instances you will find the problem bilaterally, although that may not be the case in some patients.

This boardiness and pain is caused by the ischium rocking back on Pivot Point Two, and compressing the sciatic nerve that creates this problem in the lower limb (Fig. 2). This examination procedure is done after clearing out the Cervical Syndrome if it exists. The “Pivot Points” are provided in Fig. 3 for review purposes. Pivot Point One is related to the Negative Derifield, and Pivot Point Three relates to the Positive Derifield (both of which were covered in previous articles).

Figure 2. Sciatic nerve compression

Figure 2. Sciatic nerve compression

Adjustment

With the patient in a prone position and the pelvic and lumbar drops engaged, stand straight away and take a contact on the posterior ischium (Fig. 4) with the superior hand, with the inferior hand acting as stabilization. Adjust the drop mechanism, so as to be set with the weight of the patient, and maintain your stance, so that your shoulders are directly over the ischium (Fig. 5). Remember, line of drive is important, as you do not want to drive the ischium away from you—which may create an EX – Ilium. The doctor’s position and line of drive is very important when doing the adjusting on a segmental drop table.

Other Considerations

Figure 3. Pivot points

Figure 3. Pivot points

Patients who present with this problem may also have several underlying causes that contribute to this muscular problem—such as wearing of high heeled shoes or boots, and poor posture while sitting at their work stations. Excessive pronation and other problems of the feet may also contribute to the posterior ischium problem. Additionally it has been found that a posterior tibia may also contribute to the taut-tender muscle fibers of the lower leg; adjustment of the tibia may also need to be performed. It may be that you will need to recommend custom-made orthotics to correct these underlying problems, in order to stabilize the Kinetic Chain of the patient’s body.

A deeper examination of the patient may include psoas muscle testing and adjustment, as well as the consideration of the “Q Angle” this patient may display. Keep in mind the “Levels of Involvement,” which I have been lecturing on for years, take into consideration that the body interacts through muscles and nerves affecting the structural integrity throughout the entire skeletal system.

Figure 4. Contacting the posterior Ischium

Figure 4. Contacting the posterior Ischium

A recently published research project—performed at Logan College of Chiropractic and published in the peer-reviewed Journal of Manipulative and Physiological Therapeutics (JMPT)—shows that there was “immediate changes in the quadriceps femoris angle after insertion of an orthotic device.”1 The study shows that thirty-nine of forty test subjects had a reduced Q-angle, which was in the direction of correction. The conclusion states: “Insertion of full-length, flexible orthotic devices significantly improves the Q-angle in hyperpronating male subjects. If the literature accurately links an increase in the Q-angle with a predisposition for knee injury, then the possibility of long-term benefits following the use of flexible orthotics exists. More research is required to determine whether these biomechanical changes are maintained after use of these orthotics.”

Figure 5. The Ischial adjustment

Figure 5. The Ischial adjustment

The researchers and JMPT are to be commended for their extraordinary diligence and dedication to furthering research in our profession.

Reference

1. Kuhn DR, Yochum TR, Cherry AR, Rodgers SS. Immediate changes in the quadriceps femoris angle after insertion of an orthotic device. J Manip Physiol Ther 2002; 25(7):465-470.

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.