ChiroACCESS Article



Technique Summary: Gonstead Technique



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Gonstead Clinical Studies Society

  

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February 8, 2010

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History

The Gonstead Technique was originated by Clarence Selmer Gonstead (1898-1978).  Dr. Gonstead encountered chiropractic care when severe leg and foot pains, which were resistant to conventional medical care, responded to chiropractic adjustments. This event prompted Dr. Gonstead to seek a chiropractic education.

After graduating from the Palmer School of Chiropractic and Infirmary, Dr. Gonstead temporarily took over the practice of his chiropractic mentor before purchasing a practice in the now famous Mount Horeb, Wisconsin in 1923. Over the years, Dr. Gonstead developed the Gonstead technique which has been taught to thousands of students and doctors of chiropractic and also established the world famous Gonstead Clinic of Chiropractic in Mount Horeb.  In 1974, after fifty-one years of active practice, Dr. Gonstead sold his clinic and passed away four years later in 1978. It has been said that Dr. Gonstead provided care to patients in over 1.2 million office visits in days that stretched up to twenty three hours of work.

The Gonstead concept of chiropractic begins with the body’s structural foundation and the intervertebral discs. Maximum balance and stability in the spinal column may be achieved when the pelvis, vertebrae, and legs are level. Foundational unleveling, intervertebral misalignments and motion disturbances, as well as nerve dysfunction, are primary considerations in Gonstead chiropractic health care and patient management. Injury to the intervertebral disc is of paramount importance in causing spinal subluxations, and therefore, Gonstead adjustments are designed for maximum affect to the discs, while also working to restore normal alignment and motion.
Gonstead chiropractic assessment utilizes several methods of examination to analyze multiple factors, which, as effectively as possible, uncovers the primary characteristics of intervertebral disc lesions, intervertebral and full spine and pelvis alignment, as well as neurological ramifications of vertebral subluxation and full body health.

The full spine radiograph is an integral assessment tool in the Gonstead system. Other important Gonstead examination procedures include static and dynamic palpation primarily of paraspinal bone structure and soft tissue, visualization of spinal motion, posture, gait and physical signs of inflammation near the joints, instrumentation such as para-spinal skin temperature assessment and other tools, which are used to examine all facets of the patient’s neuro-muscular-skeletal characteristics.

The full spine radiograph is analyzed with measurements drawn on the film to assess relative positions of the adjacent vertebrae and the pelvis region. These measurements translate into listings that the Gonstead chiropractor utilizes, along with other known variables about the characteristics of the subluxation, to direct the specific application of adjustment forces.

Full Spine Radiographs

Full Spine Radiographs
Differential Skin Temperature Meter

Differential Skin Temperature Meter

The Gonstead system uniquely emphasizes specificity, as it applies to which levels are being targeted for adjustments, both in the way the various aspects of alignment and motion disturbances are approached, and in the selection of which levels to adjust. Rather than a “shotgun” approach to care where any or all levels of involvement are adjusted on the same visit, Gonstead adjustments are directed at specifically selected levels of involvement for maximum restoration and balance of function. The notion of ‘primary’ versus ‘secondary’ subluxations, and subluxation versus compensation were largely developed by Dr. Gonstead. For every subluxation there is compensation. Further, certain subluxations will likely be exerting more influence on the overall bodily health status than others. Focusing spinal adjustments on primary subluxations is an important part of the Gonstead system of care.

Multiple types of tables are used for positioning the patient for Gonstead adjustments. The Hi-Lo table, with special modifications made specifically for Dr. Gonstead many years ago, has long been an integral part of the technique equipment, and accommodates a wide variety of patients, including pregnant women. The knee-chest table was one of Gonstead’s uniquely emphasized tables, to facilitate the posterior to anterior corrections of subluxation and reposition the posterior displaced inter-vertebral disc and can be used for the entire spine. The knee-chest table is also an excellent table to use for pregnant women. The Cervical Chair is used for most cervical spine adjustments, although prone cervical adjustments on the Hi-Lo or Knee-Chest or other prone tables are also performed in the Gonstead system. The Cervical Chair technique is one of the most unique types of Gonstead adjustments. Dr. Gonstead developed this technique to emphasize ‘lifting’ the vertebra in the cervical spine, as hyper-extension misalignment is common in this region. He discovered this approach by watching himself adjust under fluoroscopic imaging in his own facility, and was of the opinion that this was the only way to adequately adjust for hyper-extension misalignment in the cervical spine.
 
Cervical Chair Adjustment

Cervical Chair Adjustment
Lumbar or Pelvic Table Adjustment

Lumbar or Pelvic Table Adjustment

Hydraulic Hi-Lo Table

Hydraulic Hi-Lo Table
Knee-Chest Table

Knee-Chest Table

Gonstead adjustments can best be described as short lever, high velocity and low amplitude, with long lever assist force application. The short lever is the specific contact on the vertebra near or on the vertebral midline. The high velocity is the quick application of force. The low amplitude is the force depth being controlled at a shallow level, just enough to effect the disc and joint sufficiently. The long lever assist applies to the stabilization of the region above and/or below the contact area being adjusted, usually employing the chiropractor’s hand or thigh, not thrusting, but holding.

Another unique aspect of the Gonstead adjustment is the specificity of the contact point on the chiropractor’s hand. For the cervical chair adjustment, the distal-lateral-anterior tip of the index finger is most often used for C2 down to the upper thoracic vertebrae, as well as the analogous portion of the thumb for cervical chair Atlas contacts. Most other manual techniques utilize the broader areas of the metacarpal-phalangeal or inter-phalangeal joints for similar hand to vertebral contact points. The specific emphasis on the contact point for the Gonstead cervical adjustment enhances the specificity of the thrust in the line of correction, consistent with the goal of specific force application.

One Cervical adjustment contact point

One Cervical adjustment contact point

Although this technique was originated and clinically applied during an unprecedented and not since comparably repeated professional life by Dr. Gonstead, the Gonstead Clinical Studies Society (GCSS) continues the work. The GCSS conducts examinations for Diplomate status for qualified Gonstead practitioners. Qualifications include attending a sufficient number of seminars or other training hours in the technique, as well as Gonstead chiropractors receiving credit for teaching, publishing and other works related to the Gonstead technique. The examination consists of demonstration of detailed knowledge of the technique in both written and practical form, under the supervision of multiple Gonstead Diplomates.

While Gonstead practitioners have a strong base in the established chiropractic principles of the past, they also have a great interest in improving the abilities of future doctors of chiropractic. To that end, they embrace and support research that furthers the improvement of chiropractic care. The GCSS is a truly non-profit organization, with mostly volunteer efforts and a few paid positions contributing to the efforts of the group. Research and education are primary concerns with GCSS and every dollar that goes to GCSS is used to facilitate and support research and education in chiropractic.  Further information concerning the Gonstead Clinical Studies Society may be found at their web site: www.gonstead.com.


Reference Source for the Gonstead Technique

The following is a reference text, which expands on the basic fundamentals of the original Gonstead technique chapters that describe the Gonstead technique approach:

Plaugher G, Lopes M (eds). Texbook of Clinical Chiropractic, A Specific Biomechanical Approach. Baltimore: Williams & Wilkins, 1993.

The Gonstead Technique Chapters were the original resource of written material describing the Gonstead technique and are still available through the Gonstead Foundation at gonstead@mhtc.net:

Herbst RW. The Art and Science of Chiropractic. Sci-Chi Publications

There is also a Pediatrics textbook that uses the Gonstead technique as it primary approach to chiropractic care for children:
 
Anrig C, Plaugher G (eds). Pediatric Chiropractic. Baltimore: Williams & Wilkins. 1997.


Following is a listing of some of the articles related to the Gonstead system of chiropractic care, which have appeared in the peer reviewed literature. More studies are being conducted by GCSS and two additional studies on x-ray projection are being readied for submission to peer review.

2007

Menke JM, Plaugher G, Carrari CA, Coleman RR, Vannetiello  L, Bachman TR. Likelihood-evidential support and Bayesian re-analysis on a prospective cohort of children and adolescents with mild  scoliosis under chiropractic management. Journal of the Arizona-Nevada Academy of Science 2007; 39:99-111

2002

Plaugher G, Long CR, Alcantara J, Silveus AD, Wood H, Lotun K, Menke M, Meeker WC, Rowe SH. Practice-based randomized controlled-comparison clinical trial of chiropractic adjustments and brief massage treatment at sites of subluxation in subjects with essential hypertension: pilot study. J Manipulative Physiol Ther 2002;25:221-39

2000

Coleman R, Harrison D, Fischer T, Harrison SO. Correlation and quantification of relative 2-dimensional projected vertebral endplate z-axis rotations with 3-dimensional y-axis vertebral rotations and focal spot elevations. J Manipulative Physiol Ther 2000;23:414-9.

1996

Plaugher G, Alcantara J, Doble RW. Missed sacral fracture prior to chiropractic adjustment: a case report. J Manipulative Physiol Ther 1996;19:480-3

Plaugher G, Alcanatara J, Hart CR. Management of the patient with a Chance fracture of the lumbar spine and concomitant subluxation. J Manipulative Physiol Ther 1996;19:539-51

1995

Herzog W. Mechanical and physiological responses to spinal manipulative treatments. J Neuromusculoskel Syst 1995; 3:1-9.

Julianna M. Gal, W. Herzog, G. Kawchuk, PJ Conway, YT Zhang. Forces and relative vertebral movements during SMT to unembalmed post-rigor human cadavers: Peculiarities associated with joint cavitation. J Manipulative Physiol Ther 1995; 18:1; 4-9.

1994

Ebrall PS, Iggo A, Hobson P, Farrant G. Preliminary report: the thermal characteristics of spinal levels identified as having differential temperature by contact thermocouple measurement (Nervo Scope). Chiro J Australia 1994; 24:139-146.

1993

Plaugher G, Bachman TR. Chiropractic management of a hypertensive patient. J Manipulative Physiol Ther 1993; 16:544-549.

Plaugher G, Haas M, Doble RW, Lopes MA, Cremata EE, Lantz C. The interexaminer reliability of a galvanic skin response instrument. J Manipulative Physiol Ther 1993; 16:453-459.

Plaugher G, Hendricks AH, Doble RW, Bachman TR, Araghi HJ, Hoffart VM. The reliability of patient positioning for evaluating static radiological parameters of the human pelvis. J Manipulative Physiol Ther 1993; 16:517-522.

Kawchuk GN, Herzog W. Biomechanical characterization (fingerprinting) of five novel methods of cervical spinal manipulation. J Manipulative Physiol Ther 1993; 16:573-577.

Herzog W, Kawchuk GN, Conway PJ. Relationship between pre-load and peak forces during spinal manipulative treatments. J Neuromusculoskel syst 1993; 1:52-58.

Herzog W, Conway PJ, Kawchuk GN, Zhang Y, Hasler EM, Forces exerted during spinal manipulative therapy. Spine 1993; 18: 1206-12

Lee M, Svensson NL. Effect of loading frequency on response of the spine to lumbar posteroanterior forces. J Manipulative Physiol Ther 1993; 16:439-446

1992

Plaugher G. Skin temperature assessment for neuromusculoskeletal abnormalities of the spinal column.  J Manipulative Physiol Ther 1992; 15:365-381.

Nansel D, Peneff A, Quitoriano J. Effectiveness of upper versus lower cervical adjustments with respect to the amelioration of passive rotational versus lateral-flexion end-range asymmetries in otherwise asymptomatic subjects. J Manipulative Physiol Ther 1992; 15:99-105.

Lee R, Evans J. Load-displacement-time characteristics of the spine under posteroanterior mobilization. Aust J Physiother 1992; 38:115-123.

Plaugher G. The role of plain film radiography in chiropractic clinical practice. Chiropractic Journal of Australia 1992;22:153-61

1991

Plaugher G, Lopes MA, Melch PE, Cremata EE. The inter- and intraexaminer reliability of a paraspinal skin temperature differential instrument. J Manipulative Physiol Ther 1991; 14:361-367.

Plaugher G, Cremata EE, Phillips RB. Letter to the editor; In Reply
J Manipulative Physiol Ther 1991; 14:335-336.

Plaugher G, Cremata EE, Phillips RB. Letter to the editor; In Reply
J Manipulative Physiol Ther 1991; 14:539.

Plaugher G, Hendricks AH. The inter and intraexaminer reliability of the Gonstead pelvic marking system. J Manipulative Physiol Ther 1991; 14:503-508.

Cremata EE, Plaugher G, Cox WA. Technique system application: the Gonstead approach. Chiropractic Technique 1991; 3:19-25.

Specht DL, DeBoer KF. Anatomical leg length inequality, scoliosis, and lordotic curve in unselected clinic patients. J Manipulative Physiol Ther 1991; 14:368-375. 

Bartol KM. A model for the categorization of chiropractic treatment procedures. Chiropractic Technique 1991; 3:78-80.

Haas M. Interexaminer Reliability for Multiple Diagnostic Test Regimens. J Manipulative Physiol Ther 1991; 14:95-103.

Nansel D, Jansen R, Cremata E, Dhami MSI, Holley D. Effects of cervical adjustments on lateral-flexion passive end-range asymmetry and on blood pressure, heart rate and plasma catecholamine levels. J Manipulative Physiol Ther 1991; 14:450-456.

1990

Shaffer WO, Spratt KF, Weinstein DO, Lehmann TR, Goel V. The consistency and accuracy of roentgenograms for measuring sagital translation in the lumbar vertebral motion segment: an experimental model. Spine 1990;15:741-50

Plaugher G, Cremata EE, Phillips RB. A retrospective consecutive case analysis of pre-treatment and comparative static radiological parameters following chiropractic adjustments. J Manipulative Physiol Ther 1990; 13:498-506.

Burk JM, Thomas RR, Ratliff CR. Inter- and intra-examiner agreement of the Gonstead line marking method. Am J Chiro Med 1990; 3:114-116.

Nansel D, Peneff A, Cremata E, Carlson J. Time course considerations for the effects on unilateral lower cervical adjustments with respect to the amelioration of cervical lateral flexion passive end-range asymmetry. J Manipulative Physiol Ther 1990; 13:297-304.

Plaugher G, Lopes MA. The knee chest table: indications and contra-indications. Chiropractic Technique 1990; 2:163-167.

Keating JC, Bergmann TF, Jacobs GE, Finer BA, Larson K. Interexaminer reliability of eight evaluative dimensions of lumbar segmental abnormality. J Manipulative Physiol Ther 1990; 13:463-470.

1989

Nansel D, Cremata E, Carlson J, Szlazak M. Effect of unilateral spinal adjustments on goniometrically-assessed cervical lateral-flexion end-range asymmetries in otherwise asymptomatic subjects. J Manipulative Physiol Ther 1989; 12:419-427. (Authors' abstract)

1988
Zengel F, Davis B. Biomechanical analysis by chiropractic radiography; Part I. A simple method for determining x-ray projectional distortion. J Manipulative Physiol Ther 1988; 11:273-280.

Zengel F, Davis B. Biomechanical analysis by chiropractic radiography; Part II. Effects of x-ray projectional distortion on apparent vertebral rotation. J Manipulative Physiol Ther 1988; 11:380-389.

Zengel F, Davis B. Biomechanical analysis by chiropractic radiography; Part III. Lack of effect of projectional distortion on Gonstead vertebral end plate lines. J Manipulative Physiol Ther 1988; 11:469-473.

Nansel DD, Jansen RD. Concordance between galvanic skin response and spinal palpation findings in pain-free males. J Manipulative Physiol Ther 1988; 11:267-272.

Jansen RD, Nansel DD. Diagnostic illusions: the reliability of random chance. J Manipulative Physiol Ther 1988; 11:355-265.

Wagnon RJ, Sandefur RM, Ratliff CR. Serum aldosterone changes after specific chiropractic manipulation. Am J Chiro Med 1988; 1:66-70.

McKnight ME, De Boer KF. Preliminary study of blood pressure changes in normotensive subjects undergoing chiropractic care. J Manipulative Physiol Ther 1988; 11:261-266.

1987

Harris W, Wagnon RJ. The effects of chiropractic adjustments on distal skin temperature. J Manipulative Physiol Ther 1987; 10:57-60.

Kaminski M, Boal R, Gillette RG, Peterson DH, Villnave TJ. A model for the evaluation of chiropractic methods. J Manipulative Physiol Ther 1987; 10:61-64.

1986

Crawford JP, Hickson GS, Wiles MR. The management of hypertensive disease: a review of spinal manipulation and the efficacy of conservative therapies. J Manipulative Physiol Ther 1986; 9:27-32.

Waagen GN, Haldeman S, Cook G, Lopez D, DeBoer KF. Short term trial of chiropractic adjustments for the relief of chronic low back pain. Manual Medicine 1986; 2:63-67.

1985

Rupert RL, Ezzeldin MT. Chiropractic adjustments: results of a controlled clinical trial in Egypt. Int Rev Chiropractic 1985; Winter: 58-60.

1984

Wood J, Adams AA. Comparison of forces used in selected adjustments of the low back by experienced chiropractors and chiropractic students with no clinical experience: a preliminary study. PCC Research Forum 1984; Autumn: 16-23.

1972

Trott PH, Maitland GD, Gerrard B. The neurocalometer: a survey to assess its value as a diagnostic instrument. Med Journal Australia 1972; 1:464-467.
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