Today's Chiropractic/January-February 1983 (pages 24-28 and 53-54)
Technique Review

The Authors: James E. McAlpine, D.C. is a 1949 graduate of Lincoln Chiropractic College, and has practiced in Chesaning, Michigan, for over 33 years. Dr. McAlpine attended his first Grostic Seminar in 1952, and has been active in the Grostic procedure ever since. He was invited by Dr. Grostic to assist with his seminars in 1962, and has been instructing in the Grostic procedure since that time. Dr. McAlpine was a member of the board of Grostic Chiropractic Presentations, Inc., serving as President for one term. He is presently President of the Society of Chiropractic Orthospinology. James K. Humber, D.C. is a 1949 graduate of Palmer College of Chiropractic, and has practiced in the greater Atlanta, Georgia, area for 32 years. Dr. Humber attended his first Grostic Seminar in 1954 and has, since that time, been active in the Grostic procedure, both in practice and as an instructor. He was also invited by Dr. Grostic to Assist in his seminars in 1962 and, since that time, has been instructing in the Grostic Procedure. He served many years as Secretary of Grostic Chiropractic Presentations, Inc. and, at present, is Secretary of the Society of Chiropractic Orthospinology. Dr. Humber has been active in I.C.A. for many years, serving as Chairman of the Representative Assembly two terms in the early 1960's.

Introduction

"Research is the delving for facts and principles. Any fact or principle laid down by one researcher which can and has been applied by others can be applied by all, providing all elements are understood and utilized with accuracy."(1)

This paper is a brief introduction to the procedure used to analyze and correct the misalignment factors of the occipito-atlanto-axial subluxation. Vertebral misalignment factors are measurable. They can be re-aligned back to the normal model by hand or instrument. The objective functional leg length check and paraspinal skin temperature graphs are dependable objective tests for monitoring the presence of apparent neurological involvement. The nerve insult mechanism is hypothesized as a traction on the central nervous system via the supporting system of ligaments, especially the first denticulate projection at the foramen magnum, when the occipito-atlanto-axial segment are out of alignment.

If you attempt to adjust the cervical spine in your practice, we hope you will find the procedures taught by the Society of Chiropractic of Orthospinology of great interest.

An Overview of Chiropractic Orthospinology

Orthospinology is based on the research of Dr. B. J. Palmer and Dr. John F. Grostic. Dr. B. J., after many years or research and teaching, informed the world that the only true subluxation (vertebral misalignment with nerve interference) occurred in the upper cervical spine. The only adjustment given in his famous clinic was in the occipito-atlanto-axial area.

Dr. John F. Grostic, a graduate of Palmer College in the early 1930's and a student of B. J. Palmer, researched and developed the Grostic procedure which he began teaching in 1946 and continued to teach until his death in 1964. In 1965, Grostic Chiropractic Presentations, Inc. was incorporated in Georgia by the Grostic family and several chiropractors who had assisted Dr. Grostic with his classes. Seminars were held in Atlanta, Georgia and Ann Arbor, Michigan, from 1965 until Grostic Chiropractic Presentations, Inc. dissolved in 1976. In 1977, the Society of Chiropractic Orthospinology was organized by some of the former directors of Grostic Chiropractic Presentations, Inc., continuing the upper cervical research and seminars to improve the quality and efficiency of the chiropractic service.

The term Orthospinology is derived from the Greek root orthos (straight), spine (spinal column) and ology (a science or special branch of study). Orthospinology continues to teach the basic chiropractic procedures taught by Dr. Grostic, using his model of normal cervical alignment and procedures for x-raying, analyzing and adjusting the occipito-atlanto-axial subluxation. One major change, however, has been the introduction of instrument adjusting. Instrument adjusting is now being taught in addition to hand adjusting. The Grostic procedure attempts to be as precise as possible, and it requires some basic equipment and procedures.

Basic equipment necessary is: An x-ray generator, bucky or grid cabinet containing a 14" x 17", 40 inch linear focused grid, with a 12:1 ratio. All x-rays are taken at a 42" focal film distance. Central beam alignment with the imaging system is a critical requirement and must be maintained throughout the tubes full range of motion. The tube of the x-ray should be able to be raised to at least 84" from the floor. Ceiling height in the x-ray room should be at least 8' or preferably 8-1/2'. This will allow sufficient tube height to obtain a vertex radiographic prosection. Self centering head clamps are necessary and must be installed in alignment with the central ray and bucky with an alignment rod centered on the head clamps. A positioning chair mounted on a turntable is necessary for proper positioning of the patient, relative to the central ray and bucky.

The self centering head clamp will support the patient's head in the center of the bucky. The positioning chair allows rotary, lateral, anterior and posterior positioning of the patient in order to align the patient with the imaging system and, at the same time, maintain the patient's normal posture, while aligning the patient. The positioning objective, in an attempt to eliminate radiographic image distortion, is to keep all bilateral parts x-rayed, as parallel to the film as possible. The entire radiographic procedure must permit a reasonable degree of accuracy in duplication of patient positioning to provide comparable x-ray views obtained before and after the chiropractic adjustment.

The adjusting table recommended has a headpiece designed to support the mastoid process. A graphing instrument that records skin temperature differentials is also recommended. The instrument measures what is hypothesized to be a by-product of nerve interference, namely paravertebral skin temperature differentials and the dermatomal correlation with specific spinal nerve levels. The clinical application of thermography has been utilized by chiropractors for over 50 years. Thermography is presently being extensively utilized by the medical profession and has gained the attention of the scientific community, relative to it's diagnostic potential.

The practice of Orthospinology consists of many procedures. First, the patient must exhibit evidence of nerve interference to become a chiropractic case. Symptoms alone aren't sufficient reason to begin manipulating the spine. Some people with symptoms are not out of adjustment, and they only need a little time for innate intelligence to restore order again.

We recommend two tests to determine if a patient has nerve interference. The (a) thermoscribe reading and (b) leg check. The thermoscribe reading should allow at least a two point break, and the leg check should show at least a 1/4 inch difference. A recent survey of 120 seventh and eighth graders showed that only 33 percent had a full 1/4 inch leg imbalance, 33 percent had a deficiency of less that 1/4 inch, and the rest checked even. The survey was correlated to a health index form they filled out, and it indicated the children with a leg length difference visible in the supine position had a definite poorer health picture than those who checked even. The vast majority of leg length differences is not anatomical, but an imbalance of muscle tone due to nerve interference at the level of the foramen magnum. It has been clinically proven over the past 36 years in hundreds of offices that the leg length imbalance can be restored to normal by reducing the misalignment factors of the occipito-atlanto-axial subluxation.

The nerve insult mechanism at the foramen magnum level appears to be due to the misalignment factors, causing an excursion of the brain stem from the center of the foramen magnum and resulting in a traction on the brain stem by the first centare ligament projection at that level. The first projection is attached to the pia meter and fixed to the dura mater and periosteum of the rim of the foramen magnum.

If the patient exhibits evidence of nerve interference, a minimum of three cervical x-rays are needed for upper cervical analysis. A lateral view showing seven cervical vertebrae, a nasium view of the atlas with the central x-ray high enough to project the atlas posterior ring above the posterior ring attachments to the lateral masses of the atlas. The skull and lower cervicals must also be visible. The third view is a vertex of the atlas.

Orthospinology teaches the analysis as presented by Dr. John F. Grostic, with the exception of going slightly higher on opposite angles of 6 degrees or more. We use a clear plastic template to find the vertical central skull line, using the average center between the lower angles of the parietal bones above the highest tempero parietal suture. We also measure the relationship of the axis center and spinous to the atlas, the plan of atlas, the condylar and axial circles, the atlas odontoid relationship, and the upper and lower cervical angles to determine the height factor of the adjustment.

The vertex view is analyzed to determine the rotation factor of the atlas on the condyles. The x-ray analysis arrives at the height factor and a rotation factor and a final resultant line of force that will best correct the rotation ad laterality of atlas as well as misalignment of the spinous of axis and the lower cervicals. The adjustment, if properly given, will reduce the misalignment to the hypothetical normal completely or to some degree.

When analyzing cervical x-ray film, abnormalities of bone structure must always be considered. Some of the common abnormalities are unilateral short condyle on occiput; malformed adontoid which is often accompanied by a malformed spinous.

The outer edges of the articulations of lateral masses vary considerably. The condyles vary in the position on the occiput and their relationships to the foramen magnum. The foramen is not always in the center of the floor of the skull or the attachments of the posterior arch to the lateral masses are not always bilaterally symmetrical. However, the inferior attachments have proven to be dependable points for establishing the plane line of the atlas. The plane of the atlas (the vertical central skull line between the lower angles of the parietal bones and the center of the neural canal of the lower cervicals) has withstood the test of 36 years and more of clinical experience on thousands of patients.

The first cervical view is a lateral view, with the central ray through the tips of the ear lobes and at 90 degrees to the film. We recommend a 10 x 12 film for this exposure. As you are collimated to 10 x 12 you must keep the tube height to the level of the tips of the ears. But you must angle to central ray to the center of the film to fully expose the seven cervical vertebrae and about four inches of skull.

The lateral film gives all the usual bone structure information, but also allows us to measure the plane of the atlas and determine the angle of the central ray necessary on the nasium view to project the image of the posterior ring slightly above the inferior attachments. It is critical to the analysis that the inferior attachment of the posterior ring to the outer edge of the lateral masses in visible on the nasium film. The central ray must be high enough to show the inferior attachments of the posterior ring to the outer edges of the lateral masses.

The nasium film must be free of head rotation with the lower cervicals visible, about 2 inches of the lower angle of the parietal bone above the squamous sutures visible, condylar and axial circle; spinous and inferior attachments of the posterior ring to the outer edge of the lateral masses of the atlas also visible.

The vertex view is taken to determine the presence of absence of rotation of the atlas in relation to a central skull line. This view must also be centered with the bilateral structures parallel with the film. The glabella or frontal groove must be centered, and the tips of the ears must be level with the film to eliminate distortion to the minimum. The central ray is directed at 90 degrees to the floor of the skull and about one-half inch behind the ear. The view will adequately project the atlas visible on the x-ray between the mandible and the posterior skull. The atlas is bisected using the centers of the transversarium foramen as constants for the horizontal bisecting line.

The center skull line is constructed by a line drawn from average center of the nasal cavity through the normal center of the axis vertebra, allowing for movement of the axis center in its subluxated or corrected position. As the center of the axis in its normal position should be directly under the center of the foramen magnum and atlas neural canal, it is a visible landmark that can represent the center of the foramen magnum. The angle formed by the bisecting atlas line and the floor of skull line is measurable in degrees showing the anterior or posterior rotation of the vertebra in its subluxated position or normal position.

There are four factors used in determining the height factor in the final resultant of force. The first is the atlas horizontal plane line. The inferior posterior ring attachments at the outer edge of the lateral masses of the atlas. This point is near the nucleus of growth of the lateral mass and posterior ring, and it has proven to be the most dependable constant for transverse plane line of atlas. After this line is constructed, a horizontal line is constructed across the film at the point the transverse plane line of the atlas crosses the outer edge of the mandible on the side opposite the side of atlas laterality. The distance between the transverse line and horizontal line at the outer edge of the ramus of the mandible is measured in 1/16th of an inch. If the plane line is higher than horizontal on the side of laterality, 1 inch is added for ever 3/16 inch higher. If it is lower than horizontal on the side of laterality, _ inch is subtracted from the height of every 3/16 inch lower.

After the transverse plane line of the atlas is drawn, it is necessary to construct a vertical central skull line and measure the acute angle as the side and degree of laterality. Observing the skull, we find many objects visible, but few bilaterally symmetrical with any dependability. Dr. Grostic found the most dependable to be the lower angles of the parietal bones above the squamous sutures. Bones structure below these sutures has little bilateral symmetry. The cervical analysis instrument is designed to find the vertical center of this structure to construct a vertical central skull line.

The second factor in determining the height of the resultant is the condylar and axial circles. The atlas subluxates around the condyles as around a circle. The size of the arc of the condyles are measured as the diameter of a circle. Outlining the outer 1/3 of the condylar surfaces and superimposing the arcs of circles of different diameter on the outlined portion of the condyles, you will find the circle that fits best and, in most instances, is a 3 inch circle; sometimes a 4 inch circle, and seldom a 5 inch circle or more. Occasionally, a condylar circle will appear that is less than 3 inch diameter for measurement purposes. If the circle appears to be 3-1/2 or 4-1/2 inches, we reduce it to a 3 or 4 inches, or to the smaller size.

In determining the size of the axial circle, we put four dots on the axis vertebra. One is placed on each articulating surface at the extreme outer edge, and one on each side of the extreme inner surface 1-1/2/16 inches lower at 90 degrees to the articulating surface.

The circle that fits these four dots best in the axial circle. Although this circle usually is from 5 to 8 inches in diameter, sometimes it is as large as 12 inches and as small as 3 inches. If the axial circle is 7-1/2 inches, we run this to 8 inches, or the large diameter. For every inch greater in diameter the axial circle is larger than the condylar circle, we add 1/2 inch to the resultant -- condylar of 3 inches and axial of 6 inches (3/6) would be plus 1-1/2 inches. For every inch in diameter smaller the axial circle is than the condylar, we subtract 1/2 inch, Condylar of 4 inches and axial of 3 inches, 4/3 axial circle measures would be minus 1/2 inch.

The third factor in determining the height of the resultant is the atlas-odontoid relationship. This relationship is determined by the lower angle, so it is advisable to first construct the lower angle line. This line is drawn from a point halfway between the superior tip of the spinous and the center of the axis, which is usually the center of the base of the odontoid (in case of a malformed odontoid, the center of the axis can be determined by placing a point halfway between the outer edges of the axial articulations. The lower cervical line is drawn from a point halfway between the spinous and normal odontoid down to a point in the middle of the 7th C vertebra. The line extends to the atlas transverse plane line. It is measured with a protractor as more or less than 90 degrees. If the subluxation of atlas is to be right and the acute lower cervical angle is to be opposite side 4 degrees to 6 degrees or more, you would suspect to find the odontoid 1 degree more to the right than the atlas. If the opposite angle is 6 degrees to 9 degrees or more to the opposite side, you would suspect it would be even more than 1 degree, perhaps even 2 degrees greater than the atlas. For each degree greater the odontoid is than the atlas, we add 1 inch. If the lower angle kink is on the same side as the laterality of the atlas and is 3 degrees to 6 degrees or more, we suspect the odontoid will be 1 degree less than the atlas laterality. If it is a 6 degree to 9 degree kink, we would suspect it could be even two degrees less than the axis. For each degree less than the atlas, we subtract 1/4 inch from the height.

The cervical analysis instrument has rectangular brackets with horizontally spaced increments equal to the space of degrees at the perimeter of 3, 4, 5, and 7-inch circles. This allows the atlas to be centered in the rectangular bracket and the atlas odontoid relationship measured in linear increments equal to the degrees in the perimeter of the condylar circle.

The fourth factor in determining the height of the resultant is the upper and lower acute angles. If the upper acute angle is smaller than the opposite lower acute angle, we add 1\4 inch for each degree difference. If the upper acute angle is greater than the lower acute angle on the same side, we add 1/4 inch for each degree difference. If the upper acute angle is greater than the opposite lower angle, we add 1/4 inch for each degree difference. If the upper acute angle is smaller than the lower acute angle on the same side, we subtract 1/4 inch for each degree difference.

The four height factors should be listed. Example:
Plane line plus 3/16 ----------------+1"
C/A Circles 3/6 ---------------------+1-1/2"
Atlas/Odontoid (at. 1 od. 2) -------+1"
Angles --------------------------------+1"
-----------------------------------------+4-1/2"

The resultant is a vector for a combination of downward and horizontal forces necessary to correct both the laterals and rotational course the atlas has taken in its misalignment on the occipital condyles. The adjusting force down this resultant will also reduce the plane line, spinous and lower cervical kink to normal or toward normal.

The final step before the adjustment is table placement, which has equal importance to the adjustment. The patient is placed on his or her side with a mastoid support under the tip of the mastoid. The mastoid support must be set at the proper height so the misaligned vertebrae meet with the least resistance in their return to normal.

Hand adjusting is an art that requires knowledge of the mechanics of the spine, study of post x-rays for guidance, and practice in physically using the hands, triceps and parallel forces of your body to direct the necessary force down the pre-determined resultant.

Instrument adjusting also directs a force down the planned resultant and also requires 100 percent understanding of all the procedures preparatory to the adjustment. A booklet has been printed through the efforts of Cecil Laney, D.C. and his son, David Laney, B.S., M.S.. It compiles the resultant angles used in the various combinations of high or low, anterior and posterior as determined by the Grostic analysis procedure. The knowledge of the resultant angle allows the instrument adjuster to properly aim the instrument force.

Some of the work in Orthospinology is academic, involving some knowledge of physics, anatomy, physiology, mathematics, mechanics and allied subjects. Much of the work is practical application in the presence of instructors who are experienced in the procedures and can recognize and correct the mistakes of the student. Orthospinology is fortunate to have a qualified staff of instructors with over 100 years of combined practical and teaching experience. If you are interested in learning more about our seminars, please contact: Society of Chiropractic Orthospinology, 2620-F Cobb Parkway, South Smyrna, Georgia 30080.

References 1. Grostic, John F., The Chiropractors Field Research Manual, Ann Arbor, Michigan, 1946.

2. McAlpine, James E., A discussion of the Dentate Ligament Neural Traction Mechanism. I.C.A. Review, October-December 1980.

3. Grostic Chiropractic Presentation, Inc. Table of Resulting Angles (RA) From Grostic Analysis for Instrument Adjusting. Atlanta, Georgia 1970.