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Gonstead Quote.

"First, spend all the time necessary to precisely find and correct a patient's problem. Do not be in a hurry. Check and recheck your x-ray, your palpation, instrumentation and visualization. Second, remember that Chiropractic always works. When it does not seem to examine you application, but do not question the principle. Third, be prepared when demand for chiropractic care increases. Study the spinal column and the nervous system every chance you get. Our future will be our results."


Name the 5 parts of the Gonstead system

1. Visualization
2. Instrumentation
3. Palpation
4. X-ray
5. Patient symptoms


Name the 11 aspects of visualization.

1. Foot Flare
2. Antalgic Position
3. Dishing
4. Loss of a smooth lateral curve
5. Head tilt or rotation
6. Pelvic tilt
7. Buttocks/gluteals
8. Rib humping
9. High shoulder
10. Shoulder drop
11. Scoliosis


What can unilateral "toe out" foot flare be caused by?

1. IN ilium
2. PEX tibia


What can bilateral "toe out" foot flare be caused by?

1. Base posterior sacrum
2. Knee problems


What can unilateral "toe in" foot flare be caused by?

1. EX ilium
2. Anterior talus (an inversion sprain)
3. Paralysis of the extensor muscles


What would you check for if a patient has antalgic position?

You would first check the lumbar region. If the patient is unable to stand up straight, they may have a base posterior sacrum.


What is dishing?

Flatness in the thoracics is a compensation do to a posterior vertebra below


How can you check for a loss of a smooth lateral thoracic arc?

Laterally flex or bend the patient slowly and look for the loss of a smooth arc


What is typically the cause of a bilateral loss of the lateral thoracic arc?

A segment of the spine is fixed or stacking is present; usually posteriority is the major part of the listing


What is typically the cause of a unilateral loss of the lateral thoracic arc?

The wedge would be the major part of the listing and will be suspected on the side of unilateral loss


How does scoliosis effect the loss of the lateral thoracic arc?

When a scoliosis is present it will make the lateral wedging more difficult to observe.


Which is more common; head tilt or rotation?

Head tilt


Why is rotation less common than head tilt?

Rotation may be caused by overall spinal rotation or by upper cervical rotation.


What happens to the head when there is a posterior rotated atlas?

It causes the head to be raised on that side, due to the shape of the superior articular facets, which results in a higher mastoid on that side.


What happens to a child with an AS occiput?

They might walk on their toes or they might bang their heads in effort to decrease the pressure that is caused by the AS occiput. These children also have a flattened forehead due to banging their heads.


Explain what the PSIS, gluten folds, and the iliac crests look like in a patient with pelvic tilt.

If there is a lower PSIS, there is a lower fluteal fold and a higher iliac crest.

If there is a higher PSIS and glutenl fold, there is a lower iliac crest.


What could cause a lower PSIS, lower fluteal fold and a higher iliac crest on that side?

A PI ilium, an anatomically short leg, or a fallen arch in the foot.


What could cause a higher PSIS, higher fluteal fold, and a lower iliac crest?

May be caused by an AS ilium.


What does a flat buttocks indicate?

May be caused by an IN ilium or a posterior rotated sacrum.


What does a narrow peaked buttocks indicate?

May be caused by an EX ilium or the sacrum may be rotated posterior on the opposite side.


What is rib humping?

Ribs on the patient are more prominent posterior on one side.


What causes a high shoulder?

1. Open wedge in the mid thoracic spine on the side of the high shoulder
2. PS shoulder
3. Scapula that is fixed superiorly
4. Sternoclavicular or acromioclavicular subluxation


What could shoulder drop be caused by?

May be caused by paralysis of the trapezius.


How do you determine if scoliosis is structural or non-structural?

Use Adam's test: have the patient bend at the waist and note if the scoliosis disappears or stays the same


What does it mean if the scoliotic curve disappears?

The curve is mild to moderate or less than 25 degrees


Do moderate scoliotic curves have more of a structural or functional component?

They have more of a functional component and are amendable to conservative management


What muscle changes does rotary scoliosis have?

A rotary scoliosis has a more prominent muscle bundle on the side of the high transverse. Raised muscles may also be evident on the side of handedness.


Should you take a different x-ray if the visualization changes on the patient?

Yes because we now have a different patient.


What are the 7 skin changes to look for when visualizing?

1. Skin color
2. Varicosities
3. Pete Chia
4. Brown or white patches
5. Blemishes
6. Scarring
7. Hair changes