By Sagi Hebron & Austin Bergquist
Sagi Hebron
Austin Bergquist
Exploring Sagi Hebron’s analysis techniques may leave you embracing his “tracksuit-wearing” ways. Can you walk me through your system to asses a patient for subluxations?
First, I would have the patient sit in the cervical chair. I would just kind of palpate their upper thoracics, my hands are on their shoulders, letting them know I am here, and gathering information with my hands on their back. This helps to put the patient at ease. Then I begin with the cervicals. I start at the top of the spine and I work my way down. The same with my adjustments. Top down. I know a lot of doctors say to start at the pelvis, because it’s the base, but I like the system of having the patient first sit in the chair to check their neck, then they go on a table face down and I check their thoracics and their pelvis, and I adjust. It’s just the system that I like. In practice, you are not going to do a full scan, write listings, get signed off, and then deliver adjustments. You’re going to find your listing and adjust right away and then move the patient to the next position. So [in practice] I am going to adjust their neck as I feel it during the analysis.
When I palpate the neck, I stand on the side of the patient and I’ll have a knife edge contact on the top of their forehead. Very minimal contact. I don’t want to touch makeup or hair. I barely want to touch their head [with the stabilization hand]. I want them to be comfortable. I palpate with my thumb and middle finger, the chiropractic index finger. I go right off the mastoids to the [transvers processes; TPs] and check lateral motion, and move down each segment and feed [posterior to anterior; P-A] in neutral [head] position. Then I palpate [each segment] in rotation [Sagi uses the same hand to check left and right rotation]. As I palpate in rotation, I’m palpating the pillars, checking for differences in muscle tone and texture and I’m also looking for limited rotation of the neck. I’m really paying attention to how far they can look, and feeling if the segment I’m contacting is restricted. Often the rotation restriction is upper cervical, but sometimes it comes from one or two segments in the lower cervicals. Once I have decided that a segment should be adjusted, I make my contact, tuck the chin always, laterally flex toward and rotate away from my contact and “boom”.
I concentrate on being as soft as I can be, so that it doesn’t feel like a “setup” and so it is comfortable for the patient. I plan to adjust all my patients in the cervical chair, but some patients are nervous and have even had past trauma from other chiropractors. In those cases, I usually adjust them supine first, because [for some people] its more comfortable and they can relax. Also, some people can be adjusted regularly in the cervical chair, but some days they don’t want or can’t seem to relax. I’ll use distractors… “drop your shoulder, look to the right, wiggle your toes…”. I’ll use everything, but nothing works, so I’ll adjust them supine as well.
After cervicals, I ask [the patient] to go facedown [on the adjusting table]. To start, I just put my hands on their back to feel for spinous posteriority, muscle tonicity, and I’m feeling for things that are not expected. I also move the pelvis around a bit to help relax the patient. Then I use a cross-pisi position for my main assessment. That’s the position that I adjust in, and that’s the position that I palpate in. I’m thinking about practice. I palpate in that position, the second I find it, “boom”. What’s great about cross-pisi is that I can palpate the spinous, I can palpate the TPs, and I can palpate ribs. I usually start T8 and move up, then I go to T12 and up to T8, then I check the pelvis and move up the lumbars. I assess in sections because there’s a lot of space and it’s easy to get lost. When I adjust the thoracics, I don’t usually give breathing instructions, because I can see and feel when they are breathing. Often, breathing instructions will lead them to brace for the adjustment, instead of relaxing, and I don’t want that.
When I assess the sacroiliac joints, I first feel their location, whether one is higher or lower [superior or inferior], then I do [general] P-A compression on left and right to feel for restriction. I’ll also compress [specifically] in the direction of a potential listing [e.g. restriction S-I, L-M for anterior-superior ilium]. Then I move to the sacrum and place my thumbs in the sacral alas to sense for any rotation. I don’t use leg checks because there are number of factors that can throw it off. After sacrum, I roll off the sacrum onto L5 and check for posteriority and lateral movement, and move up from there. That’s it. That’s all I do.
Do you adjust everything you find?
It’s challenging because, as the patient, you want to feel like you are getting your moneys worth, but often less is more. I don’t adjust everything I find. I have areas that I will focus on. Sacrum and L5 adjustments can change someone’s life. I adjust sacrum over ilium every time, if I find it. If I find a [sacroiliac joint; SIs] and an upper lumbar, I will adjust both, but I won’t adjust SIs and lower lumbars. If I find four restricted segments in thoracics, I’ll adjust one or two, focusing on transitional segments. I’ve found that correcting posteriority is the most important, over rotation. Hitting the high points down. If you correct posteriority, you’re going to help a lot of people.
Let’s say you find 3 segments to adjust in the neck, how do you decide which to address?
I usually will not adjust the same side twice. Unless there are no findings on the other side, and the segments are far apart. I normally would not adjust C2 and C4 that are both on the right, I would just adjust C4. Sometimes my decision will have a lot to do with range of motion. If their range of motion is pretty low, I might choose to adjust both segments. No more than 2 cervical adjustments. If there is something else, I’ll let them know that we will get that next visit. When I find a few segments together that are all stuck [e.g. C3-5], I’ll choose to adjust the lowest segment. I find this can often release all of the segments.