The Development and Protocol Of The Grostic/Orthospinology Procedure - Part 1

By Kirk Eriksen, D.C.

The late John F. Grostic, D.C., developed the Grostic Procedure (on which Orthospinology is based) during the 1930s and 1940s as a complete system of upper cervical chiropractic care. The procedure employs a method of X-ray analysis which quantifies the lateral and rotational misalignments between atlas and axis as well as atlas and occiput.

The analytical procedure examines the spatial orientation of the atlas, the geometry of the articulating surfaces and the misalignment configuration to arrive at an effective correction vector. In addition to the X-ray analysis, the system contains steps for ensuring the precision of the X-ray analysis, adjusting procedures and post-adjustment re-evaluation procedures which allow the doctor to assess the effectiveness of the adjustment and, equally important, to fine-tune the adjustment to the individual patient.

The Grostic Procedure has been described as being analytical and requiring significant discipline to master. Why is there so much attention to detail? To answer this question, let us examine the history and development of the procedure.

History
John Francis Grostic was in his early twenties when he was diagnosed with Hodgkin’s disease. His medical doctor gave him a poor prognosis of only two years to live. Grostic, who worked as a manager of a men’s clothing store, decided to go to a chiropractor who had an office in the same building. The doctor adjusted him several times and then suggested that he seek care from Dr. B.J. Palmer at the research clinic in Davenport, Iowa. He followed this advice, and after a trial of upper cervical care, he made a full recovery.

This life-saving experience led Grostic to enroll at Palmer College of Chiropractic, where he graduated in 1933. He then began intensive research into the analysis and correction of the occipito-atlanto-axial subluxation. Part of his motivation was that he was not able to consistently obtain effective adjustments from field doctors utilizing the HIO (Hole-In-One) technique.

This became readily apparent after Dr. Grostic had a critical relapse while in the early years of his practice after suffering neck injury from an accident in his X-ray room. He was unable to achieve results from the adjustments of local HIO practitioners, so once again he sought the care of Dr. B.J. Palmer in order to recover. This was, in part, because Palmer's system was a qualitative, not quantitative, analysis. Palmer had mastered the HIO system, but its subtle variations were hard for other chiropractors to duplicate.

Development
The Grostic Procedure is based on concepts developed by Drs. B.J. Palmer, Al Wernsing and many other chiropractors who participated in clinical research in the 1920s and 1930s. These doctors shared their work through the Palmer Standardized Chiropractic Council (PSCC), which included about 70 chiropractors throughout the United States, Canada and England. The council’s purpose was to provide a forum to exchange research and new ideas to help standardize chiropractic procedures and methods.

As a member, Grostic presented his research and ideas at PSCC’s annual meeting, which evolved into the pre-Lyceum program. He also presented his information in the PSCC’s monthly Bulletin. Since much of the material was being presented as it was being developed, continuity was lacking. This led a group of doctors to request that he assemble his research into a "package" that could then be presented at one time.

In 1946, he made his first group presentation of the Grostic Procedure in Ann Arbor, Mich., to a group of 14 doctors. As the seminars grew, so did the reputation of Grostic’s legendary practice. He averaged seeing 96 patients per day and usually accepted only four new patients per week, with a waiting list of up to eight months.

From 1946 until his death on Oct. 31, 1964, he conducted approximately four seminars per year and presented the procedure to more than 1,000 chiropractors.

Orthospinology and Other Procedures
After Dr. John F. Grostic’s death, the group split into two factions, and the larger one was established in Atlanta, Ga., in May 1965. This group became Grostic Presentations, Inc., and presented the more traditional technique applications until 1975, when it became The Society of Chiropractic Orthospinology, Inc.

Dr. John F. Grostic’s son, Dr. John D. Grostic, was very involved in the teaching and research of the Grostic Procedure up until his death in 1995. He was the director of research at Life University and served on the Advisory Board of Orthospinology as well as many other professional activities.
In 1966, Dr. Ralph R. Gregory founded the National Upper Cervical Chiropractic Association (NUCCA). He worked with Grostic on various ideas related to what became the Grostic Procedure and also provided the researcher with appropriate upper cervical care.

Dr. Roy Sweat was a founding member of Grostic Presentations, Inc., and, like Gregory, he assisted Dr. John F. Grostic with some aspects of the classes. In 1980, Sweat formed Atlas Orthogonality with an interest in pursuing research and development of instrument adjusting.
NUCCA and AO have modified various aspects of the original Grostic work. The NUCCA group utilizes exclusive manual upper cervical adjusting by hand, while AO doctors only utilize a table-mounted percussion instrument. All three groups are in the same "family" of orthogonally-based techniques and are represented with other upper cervical methods by the Academy of Upper Cervical Chiropractic Organizations.

X-Ray Analysis
Grostic/Orthospinology X-ray analysis is the real core of the procedure and is the one area that has remained the most constant over the past 55 years. Because the radiological assessment is so important, Grostic felt that chiropractors should always lead the way in X-ray quality and patient safety. He was the first in the profession to advocate and teach doctors the use of aligned X-ray equipment. He collaborated with Travis Utterback to help develop self-centering head clamps, the X-ray turn-table chair and "L-Frame" apparatus. Many doctors who utilize this upper cervical procedure handle the issue of X-ray safety through utilization of lead filters, high film/screen combinations, shielding and high kVp technique.

The lateral, nasium and vertex views are the initial cervical X-rays taken for this analysis. Standard protocol for pathology assessment is first utilized when studying the lateral cervical. An S-line is then constructed to measure the sagittal plane of the atlas to determine the angle of the central ray necessary to project the appropriate image of the atlas posterior arch on the nasium film.

The nasium (AP) X-ray is then analyzed to measure atlas laterality. A perpendicular bisector of the skull is measured by utilizing template analysis. Determining the vertical central skull line is essential, as the other misalignments will be measured in relation to this reference. The atlas plane line is drawn through the inferior intersections of the atlas posterior arch and the lateral margins of the atlas lateral masses. Atlas laterality with respect to the skull is measured on the side of the acute angle and is quantified as the amount the angle varies from 90°. The rotational misalignment of the atlas with respect to the occiput is measured on the vertex view. The angle is formed by the intersection of the atlas plane line (drawn through the center of the transverse foramina) and the central skull line. The determination of anterior or posterior rotation is dependent on the side of atlas laterality (see Figure 1).

Furthermore, the relationship of the atlas to the axis is also measured by drawing a line from the center of the axis through the center of the 7th cervical vertebra on the nasium X-ray. The angle formed by the intersection of this line with the atlas plane line is known as the "lower angle." Although the entire cervical spine is included in the analysis, this measurement indicates the lateral misalignment between the atlas and axis. Rotation between atlas and axis is determined by measuring the deviation of the tip of the axis spinous process from the mid-line. The X-ray analysis has been further advanced with the development of computer aided digitization (CAD). CAD systems not only make the analysis more objective, but they also speed up the process.

In addition to the misalignment factors, the radii of curvature for the condylar and axial articular surfaces are also measured. These are the surfaces over which the atlas must slide during the adjustment. The ratio of these slopes is factored into the correction formula. The height component of the correction vector is also affected by how high or low the atlas plane line is measured on the nasium view. The spatial orientation of the atlas and the magnitude of the lower angle are the final two components of the height factor (see Figure 2). By using all of this information, the goal is to compute a correction vector that will reduce all of the misalignment factors proportionally. In essence, the Orthospinology Procedure enables the doctor to provide a "tailor-made" adjustment.

About the authors: Kirk Eriksen, D.C., a 1991 Life Chiropractic College graduate, is president of the Society of Chiropractic Orthospinology. He is a member of the Life University postgraduate faculty and the editorial review board for the Chiropractic Research Journal. He helped develop the curriculum for the Upper Cervical Diplomate postgraduate program of the College of the Upper Cervical Spine. In 1997, the Alabama Chiropractic Council named him "Chiropractor of the Year. " A lecturer and author, he manages a private practice in Dothan, Alabama. For more information, call (334) 793-7992; e-mail to drkeriksen@ala.net; or access Web site www.orthospinology.org.

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