Segmental Drop Adjusting: The Sacrum

Figure 1. Initial positioning for exam.By: Wayne Henry Zemelka, DC

Sacral Analysis

Patient—Prone

Examination—Doctor’s superior hand on the patient’s sacrum, with fingers pointing towards the feet (Fig. 1).

With the patient in the prone position have him/her lock the knee and raise each leg one at a time, as high as possible, without raising the pelvis off the table, while you press lightly down on the sacrum as noted in Fig. 2. Observe the height to which the patient is capable of raising the legs and note any difference (Fig. 3).

An observable difference is sufficient reason to adjust the sacrum. The involved leg is the one that is restricted and raised the least (Fig. 3). A chart placed on the wall will make a good reference point in observing the height of the legs. If you use your arm be sure that you do not move your outstretched arm down as the patient lowers their leg. With some practice this can also serve you well as a means of referencing.

Figure 2. Leg raise/sacral press.Once the affected rotation has been detected, stand on the side of apex rotation and contact the apex with the inferior hand and place the superior hand at the PSIS of the same side (Fig. 4).

Cross the involved leg over the other leg to open the joint spaces on the involved side before making the thrust for the adjustment (Fig. 5).

This is a more horizontal line of drive (LOD) than P to A and with slight torque applied at time to adjustment (Fig. 6).

Rationale

Interestingly enough the sacrum, treated as a single entity in this demonstration, is also involved with subluxations of the ilium in the –D and +D to some degree.

A Base Posterior Sacrum will also affect the leg raiser test, in that the patient cannot raise both legs off the relaxor bar more than a few inches. When this occurs consideration should be given to the possibility of the base posterior, but also to the fact that there more than likely is a lumbar involvement as well.

Figure 3. Comparison of raised legs.If no apex deviation is observed (in other words, the legs are raised evenly with difficulty), then adjust the BP sacrum by raising the pelvic piece 1—2 inches and perform an adjustment with equal pressure on both sides of the sacrum from S to I and P to A (Fig. 7). This base posterior problem will more than likely need to be adjusted several times to note an increase in raising the legs. Exercises are also recommended to maintain the muscular integrity of the pelvic region to maintain normal function.

Thompson always referred to the Apex Deviation rather than the base as some others do. When the involved leg is lifted up with the knee locked it will be lower than the opposite leg. The apex moves toward the leg that comes up highest, therefore indicating that the apex has rotated toward that side. We always adjust the apex towards the involved leg, which does not come up as high. Any amount of variation in the height of the raised legs is indicative of a problem with the sacral rotation.

Figure 4. Doctor's hand placement.If during the course of the leg raiser examination you note a bending of the knee, the possibly of a lumbar subluxation is likely. The bent knee is in response to a possible sciatic nerve involvement. After adjusting the sacrum proceed to palpate and locate the lumbar subluxation and adjust where necessary, and then do a post leg raiser examination. If the legs can be raised higher or with less effort than the initial examination, it shows that you have handled the problem in a proper manner.

Another anomaly that can rear its ugly head is that the coccyx or the sacral tuberous ligament may need to be adjusted to clear the problem completely. There are situations where these two problems manifest themselves in a pudendal nerve problem that results in pain anterior to the anus. This problem does not occur frequently, but when it does the adjustment in the sacral area will most likely provide relief for the patient where pills, powders, and potions have failed.

Figure 5. Position of patient's legs.It should be noted that at times after the adjustment of the lateral apex the post leg check will result in both legs being raised evenly and overall height is a little less. This is a result of the correction of the rotated apex, and the patient will feel an easier time of lifting both legs.

Walking Feet

There is another situation that appears on occasion when you are checking the leg length inequality (LLI), in that the feet are moving slightly up and down in reference to the patient lying prone. When you observe this phenomenon it is indicative of a sacral problem and can be corrected by using the base posterior method of correction.

As with any problem in the pelvic region it should always be a part of the examination to check the feet and leg length inequality to assure a stable support base for the body. In just about every case where the sacrum has become unstable orthotics have been shown to be necessary to alleviate the pelvic/sacral problem.

Figure 6. Horizontal LOD with slight torque.About the Author

Dr. Wayne Henry Zemelka was 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 was 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.

Figure 7. BP sacrum adjustment.Dr. Zemelka operated the Zemelka Family Chiropractic Clinic on Lillie Avenue in Bettendorf, IA, “next to, but not in Simoniz Car Wash on Kimberly Road.” He wrote for several national magazines and journals. Dr. Zemelka was certified in Videofluoroscopy.