The vectored force direction during the hand Adjustment is determined by establishing a point in three-dimensional space for its initiation with the conclusion at the atlas transverse process. This is effectively accomplished by ensuring that the steps before the delivery of the Adjustment have been completed with due diligence and precision. A coordinate is established using the Rotational factor (RF) and Height factor (HF) as measured and calculated from the X-ray analysis relative to which the doctor will align his/her body and deliver the corrective vectored hand Adjustment. The location of the resultant point is accomplished using a measuring tape or Resultant angle ruler (see Fig. 14-5). After the Table placement is completed, the doctor should quantify the RF that was determined from the Vertex X-ray analysis. This is first done by measuring anterior or posterior in inches along the horizontal plane established by an imaginary line from the transverse process to the tip of the nose. From that point, use the Height factor, moving cephalic for a “high” and caudally for a “low” HF, Perpendicular to the horizontal plane (Fig. 13-1). The hand-adjusting table alignment bar or a paper marker should be positioned to indicate the resulting point.

A remeasurement of the resultant point may be done by first measuring the HF component upward from the atlas transverse process. The measurement is the number of inches calculated from the X-ray analysis and is made Perpendicular to the horizontal plane. For example, in the instance of a high 4 inches, a measurement is made from the atlas transverse process toward the top of the head 4 inches. The measurement typically passes
directly over the external auditory meatus. From that ending point, measure anterior or posterior the direction and magnitude in inches of the RF, parallel to the horizontal plane (Fig. 13-2).

The horizontal plane is established by constructing an imaginary line from the atlas transverse process to the inferior tip of the patient’s nose. However, it is critical that the patient’s head is placed on the headpiece with the hard palette in a neutral position. The coordinate is measured relative to the horizontal plane instead of the S-line. This eliminates either a variable or source of measurement error that result from multiple S-lines. It also improves inter- and Intraexaminer Reliability, and Works well empirically with the conversion of degrees of Atlas rotation on the vertex to the RF using 1 inch per 1°. The purpose of the RF conversion is not to line the doctor up with the rotation of the atlas but to ensure the doctor is lined up outside and near the rotation of the atlas. This creates a moment arm or Leverage to change the C1 rotation in the direction of neutral. It is a significant error to align the vectored force exactly parallel to the rotation of atlas using a 1° per 1° conversion. One inch of RF is equivalent to 2.04° to 2.87° of Atlas rotation for a taller doctor (28-inch episternal notch/pisiform distance) versus a shorter one (20-inch episternal notch/pisiform distance) with an average of 2.4° per inch to achieve this purpose.

The Orthospinology hand Adjustment is based on the manual Adjustment as developed by John F. Grostic, DC.¹ A successful hand Adjustment begins with proficient X-ray placement, X-ray analysis and Table placement. The skillful delivery of the adjusting force is achieved by mastering the foundation phase, the Adjustment, and the follow-through. The foundation phase consists of the appropriate standing position, the Settle back, turn/arc in, contact, building of the arches, seven-step Hand set, turn/arc out, and pelvic stabilization. A thorough knowledge of the applicable biomechanics of the upper cervical spine for the individual patient (see Chapter 16) and the controlled force delivered by proper triceps contraction are all necessary to achieve the most optimal correction.

The Adjustment is accomplished by contraction of the long head of the triceps that will straighten the arms, resulting in a controlled, directional force with minimal depth. The follow-through is accomplished after the adjusting force is delivered. While the triceps are relaxing, the elbows begin to bend, and the body of the adjustor loosens, resulting in a very slight downward motion along the adjusting vector as the hands withdraw from the patient. This motion is likened to the follow-through of a golf swing in the sense that The Work of the Adjustment has been accomplished but the mental process is converted to the muscular completion of the motion.

Different patterns of upper cervical misalignments require different magnitudes and durations of forces. For example, an “into-the-kink” pattern will require a lighter, quicker force; whereas “opposite angles” requires a longer, larger force. However, the adjustor does not vary the Adjustment phase, muscular contraction of the triceps, resultant force, or depth. Changing the preload before the Adjustment will vary the depth, speed, and force of the Adjustment from the perspective of the atlas, but the Adjustment itself remains unchanged. If a misalignment
pattern requires a shorter, lighter force, a lighter contact is made at approximately 1 pound before the Adjustment delivery. The Adjustment itself is not varied, but as the compression of the Adjustment begins, from the perspective of the atlas, The Work is accomplished at the bottom of the Thrust so the force is sharp, light, and quick. First establish an average contact, about 2 to 3 pounds or the weight of the hand, and then lighten the contact for an “into the kink.” Should a larger, longer force be required, a slightly heavier contact is made before the Adjustment. With a heavier preload as the compression begins, The Work against the atlas begins much earlier during the Thrust, and from the perspective of the atlas, the force is slower, longer, and larger. Use a digital scale to learn the difference between 1 to 3 pounds of preload.