The Segmental Drop (Thompson) Adjusting Protocol

By: Wayne Henry Zemelka, DC

The Thompson Technique:

  • Is a low force, hands-on adjusting technique
  • Transfers less reflective force into the joints of the doctor’s arms and shoulders
  • Is a great way to adjust children and adults
  • Is one of the top Chiropractic adjusting techniques in the world
  • Is a Chiropractic adjusting technique that follows a well-developed protocol
  • Takes into consideration structural and soft tissue adjusting (such as the psoas and piriformis)
  • Is a great way for extremity adjusting

The development of the Five Categories (Negative Derifield, Positive Derifield, Cervical Syndrome, X-Derifield, Bilateral Cervical Syndrome) is best explained by describing each one as the analysis and also the proper approach to making the adjustment. The Leg Analysis is based on the work of Dr. R.

Figure. 1. Pivot points

Figure. 1. Pivot points

Derifield of Detroit, Michigan who originated the process and was responsible for the initial protocol in the evaluation procedure.

The Negative Derifield results from the pivot point taking place at the 5th lumbar and sacrum that causes the short leg to stay short upon flexing to the mid-point of the arch (Fig. 1, #1). The Positive Derifield relates to the pivot point at the acetabular cavity where the short leg becomes even or crosses over to become longer (Fig. 1, #2). This relates to the Positive Derifield.

The number 2 shown on Figure 1 is where the pivot point creates a positive ischium that is part of the analysis procedure with the Thompson Technique in addition to the Basic Five Categories. The Cervical Syndrome is where the cervical syndrome “masks” the other categories, in that the Cervical Syndrome must be adjusted first when found. The Bilateral Cervical Syndrome occurs due to an occipital condyle problem and causes the legs to change length when the head is turned to the right and left.

And, of course, there’s the X-Derifield that can be a Cervical Syndrome or Negative Derifield. The leg analysis (Fig. 2) can aid in finding the variations that are connected to the Leg Analysis System. This provides the basic information that can aid you in the finding of those subluxations that need to be corrected.

Figure. 2. Leg analysis

Figure. 2. Leg analysis

Protocol Priority

I would like to speak to the need for the Protocol (Fig. 3) and details in your record keeping as you take care of your patients. Make plans to take a seminar on how to develop your written records and/or consider buying a computerized version that will cut your time in a busy practice.

It is indeed important to get things done within the parameters of the adjusting process that will provide similar results each time the problem is addressed. This is what we call the Thompson Protocol that has been formulated through Dr. Thompson’s work. It is important to have a protocol, in order to defend our care program that we formulate for each patient. The reason is quite simple: we have to show where we started with the care of the patient, and what the expectation is as we carry out the adjusting process.

For the group that does not get paid by insurance companies, you have a responsibility to keep accurate records as well. Let’s say that a person you have been treating for several years all of a sudden sues you. You receive the subpoena requesting all your records on that specific person. You have little in the file, except some scribbled notes and an 8X10 index form with a number of squares and picture forms to be checked and a few written items describing the type of pain or appearance of the patient’s spine.

Figure. 3. Segmental Drop Adjusting Protocol

Figure. 3. Segmental Drop Adjusting Protocol

I’m here to tell you that this happens quite often and needs to be addressed by the profession. Record keeping is being driven by the insurance industry, and it’s the thing for here and now and into the immediate future. Don’t take chances with your future and your Chiropractic services. Document your care for all your patients by writing it down, and follow the basic protocol you have been trained in—whether it’s Thompson or another technique.

In closing, I want to assure you that proper record keeping will serve a very good purpose for you and your patients. Couple this with following a proven protocol and you have a winning combination that will serve you well, in the event you get audited.