1. A M C T
Dr Seungmo Yoo

2. A Brief History of Activator Methods
The ACTIVATOR METHOD of chiropractic analysis and low- force spinal adjusting technique originated in Redwood Falls, Minnesota in 1965 Warren C. Lee,D.C. (graduate of Northwestern College of Chiropractic, 1941) Arlan W. Fuhr, D.C. (Logan Basic college of Chiropractic, 1961). Since then, the procedure has become a major chiropractic clinical methodology, and is now used to some extent by approximately 21,000 doctors of chiropractic throughout the world

3. AAI-II( Activator Adjusting Instrument II )

4. Terms Used in Activator Methods Chiropractic Technique
Activator Adjusting Instrument: A chiropractic adjusting instr ument which provides a manually manipulatable instrument c apable of providing a dynamic thrust which includes a control led force of adjustment at a precise and specific line of drive a t a high speed.

5. Terms Used in Activator Methods Chiropractic Technique
Facilitated Segment: A spinal segment which responds to vari ous stimuli in a more intense and prolonged manner than is n ormal.
Isolation Test: A specific active movement on the part of the patient to assist in locating and evaluating the subluxation or facilitated motion segments of the spine in small, incremental steps.

6. Terms Used in Activator Methods Chiropractic Technique
Line of Drive: The angle at which the Activator adjusting inst rument contacts the vertebra to correct subluxations or misalignments.

7. Terms Used in Activator Methods Chiropractic Technique
Pelvic Deficiency (P.D.) or Functional Short Leg: A leg th at appears “short” due to a posterior inferior rotation of the ilium on the same side and observed when a patient is in a prone, non weight-bearing position. Another possible cau se is a contraction of the supra pelvic muscles and should not be confused with an anatomical short leg.

8. Terms Used in Activator Methods Chiropractic Technique
Pressure Test: A light pressure applied into the direction of correction.
Stress Test: A light pressure applied into the direction of the subluxation.

9. Terms Used in Activator Methods Chiropractic Technique
Subluxation: Just what a subluxation is still has not been pro ven, but, on the other hand, dis-qualification of the hypothesi s of a subluxation has neither been proven. Activator Methods Chiropractic Technique accepts the definition of a subluxation along with its etiology and effects as reported in Basic Chirop ractic Procedural Manual published by the American Chiropr actic Association.
There are two major causes of subluxation: 1) inequality in muscular balance, and 2) abnormal structural support. The subluxation then causes local effects on tissue as well as mechanical and neurological effects.

10. AMCT 기본사항 관련
The No.1 position (prone) leg check discloses the presence of a subluxated or facilitated motion segment.
The NO.2 position (legs 90 degrees) discloses whether the subluxation or facilitation is located on the P.D. side or the side opposite P.D.
When the legs become level in the NO. 1 position upon initial re-examination at levels previously subluxated or facilitated, DO NOT STOP AT THIS POINT but continue to bring the legs to the 90 degrees NO.2 position. A minor degree of subluxation or facilitation may still exist, and although not detected in the NO.1 position will be disclosed by the use of the 90 degress NO. 2 position.

11. LONG-SHORT RULE
The Short-Long Rule applies when performing the various is olation tests from L through occiput (includes pubes)
If the P.D leg LENGHENS at 90 degrees (Position No.2), this indicates subluxation or facilitation ON the P.D. SIDE.
If the P.D leg SOORTENS at 90 degrees (Position No.2), this indicates subluxation or facilitation ON the SIDE OPPOSITE P.D.

12. Leg Testing 족지 분석은 AMCT 기법의 핵심요소이다.
정확하고 세심한 족지 분석은 치료의 필요성을 판정할 수 있도록 한다.
초기 단족 검사는 subluxation이 존재 하느냐 아니면 다른 신체 부위에서의 facillitation 이냐를 판정하는 주된 방법이다.

13. 단족 변화에 대한 명확한 관찰과 해석은 ?
Isolate subluxation of the axial skeleton by vertebral level
Determine direction of msialignment in vertebral subluxations
Identify or confirm subluxations of extremity articulations

14. 초기 족지 분석에서 4가지 필수 과정
Patient palcement – preserving postural distortions
Visual observation – noting leg length discrepancy
Position #1 procedure – identifying the PD leg
Position #2 procedure – specifically identifying subluxation malposition

15. Patient Placement
환자를 방문시마다 테이블에 제대로 위치시키는 것 이 검사의 정확성에 결정적인 역할을 할 수 있다. 부 적절한 환자 배치는 단족 차이 감소, 다리의 장단족 의 역전, 단족 분석의 불명확화를 초래할 수 있다.

16. Visual inspection – Observe leg length discrepancy
환자의 발에 접촉하기 전에 대칭되는 발의 비교 포 인트를 이용해 단족 차이를 검사한다.
비대칭적 내반이 있는 지 확인 한다.

17. 족지분석 과정

18. Take out supination and Plantar flexion in Position #1

19. 순서
1. Take out supination and plantar flexion in position #1

20. 2. Keep index fingers on metatarsal – Phalangeal junction

21. 3. Keep Elbows tucked in

22. 4. Shift thumbs onto balls of feet while elevating to position #2.

23. 5. Ensure that soles of shoes are level in position #2

24. 6. Form a “V” in position #2 with heels about ½ inch apart and toes flared

25. Three Possibility
Possibility One : Position #1에서 짧았던 다리가 Position #2에서 길어지는 현상을 말한다.
Possibility Two : Position #1에서 짧았던 다리가 Position #2에도 짧은 경우
Possibility Three : Position #1에서 even 했던 다리가 Position #2에서도 even한 경우

26. Pressure-Stress Testing
Pressure Testing
1. The P.D. leg is short in position #1.
2. Apply a light pressure into the direction of correction.
3. If the legs become even in position #1, adjust into the direction of correction.
Example : Left P.D.

27. Pressure-Stress Testing
1. The leg are even in position #1.
2. Apply a light pressure into the direction of subluxation.
3. If P.D. leg shortens in position #1, adjust into the direction of correction.
Example : Left P.D.

28. Routine Procedure
Testing Step One : P.D. leg lengthens in Position #2
Knees and Feet : Medial Knee & Talus / Lateral Knee & Cuboid
2. 6 point pelvic Pattern : AS Ilium/ PI Ilium
3. Pubic bone isolation test : superior pubic bone/ inferior pubic bone
4. Lumbar isolation test : L5-L4/ L2
5. Lower Thoracic Isolation Tests : T12 / T8
6. Upper Thoracic Isolation Tests : T6 / T4 / T1
7. Shoulders : Medial Scapula / Lateral Scapula
8. Lower Cervical Isolation Tests : C7 / C5
9. Upper Cervical Isolation Tests : C2 / C1
10. Occipital Isolation Test : Occiput

29. Routine Procedure 4. L5-L4 Lumbar Isolation Test
Testing Step Two : P.D. leg Shortens in Position #2
4. L5-L4 Lumbar Isolation Test
5. Continue with testing steps 5 through 10

30. Knee And Feet
Medial Knee : P.D. 측 내방 슬관절 subluxation이 있는지 pressure test를 실시한다.
Medial Knee : Medial, Superior로 subluxation  교정의 방향은 Lateral, Inferior
Talus : Medial, Anterior, Inferior로 subluxation  교정의 방향은 Lateral, Posterior, Superior로

31. Knee And Feet
Lateral Knee : P.D. 측 외방 슬관절 subluxation이 있는지 pressure test를 실시한다.
Lateral Knee : Lateral, Superior로 subluxation  교정의 방향은 Medial, Inferior
Cuboid : Lateral, Anterior, Inferior로 subluxation  교정의 방향은 Medial, Posterior, Posterior

32. Medial Knees and Talus 교정

33. Lateral Knee And Cuboid 교정

34. 6 Point Pelvic Pattern AS Ilium PI Ilium
Pressure Test : PD 반대측 장골능에 접촉하여 천장 관절면과 평행되게 장골능에 부드럽게 하방 내측방 압력을 가한다.
PI Ilium
AS 교정후나 AS pressure test 음성으로 나온 경우 PD측의 ilium 후하방 subluxation을 고려한다.

35. Pelvic Point Right side PD Crest of Ilium Iliac Fossa
Posterior Base of Sacrum
Under Sacrotuberous Ligment
Toward SI Joint
Spine of Ischium
Ischial Tuberosity

36. Pelvic Point Left side PD Crest of Ilium Iliac Fossa
Posterior Base of Sacrum
Under Sacrotuberous Ligment
Toward SI Joint
Ischial Tuberosity
Spine of Ischium

39. AS ilium
AS Ilium Pressure Test : PD 반대측 장골능에 접촉하여 천장 관절면과 평행 되게 장골능에 부드럽게 하방 내측방 압력을 가한다.

40. AS Ilium AS Ilium Adjustment
PD 반대측 제1천골 결절 외측 약1/2인치 천골 기저부에 접촉한다. LOD=Ant, Inf.
PD 반대측 PSIS 상방 약 1인치 장골능에 접촉 LOD=Inf, Med
PD 반대측 좌골 조면의 상부에 접촉
LOD=Ant, Inf.

41. PI Ilium
PI Ilium Pressure Test : PD side 천골 결절 인대의 하부에 무지로 가볍게 접촉한다.

42. PI Ilium PI Ilium Adjustment PD side 좌골극 접촉
LOD = posterior, superior, lateral
Contact under sacro –tuberous lig. In sciatic notch on side of PD
LOD = posterior, superior, lateral
Contact lateral aspect of ilium
LOD = anterior, superior

43. Symphysis Pubis
발 무릎, AS Ilium, PI ilium에의 테스트와 교정 후에 Position 1 이나 Position 2에서 보통 다리 길이가 균형 을 이룰 수 있다.
Isolation Test를 시행한다.
Isolation Test : 환자의 양 무릎을 바짝 붙이도록 한다. #2에서 PD leg가 짧아졌다면, PD 반대측 치골의 하방 subluxation을 의미한다.

44. Pubic bone isolation Test
Instruct the patient to squeeze the knees together

45. Pubic bone Adjustment Supeior Pubic bone adjust LOD = Inferior
Inferior Pubic Bone adjust
LOD = Superior

46. Lumbar Isolation Test
L5 Isolation Test : Patient to place the forearm on the side of PD on the low back . After completing the 5th lumbar isolation test, ask the patient to return the forearm th the side of the body
Left PD
반대편 4th Lumabr
5th Lumabr
No Involvement

47. L5 Adjustment
Contact Point : the mammillary process on the side indicated by the short-long rule
LOC = anterior, superior, through the plane line of the facet

48. Lumbar Isolation Test
4th Lumbar Isolation Test : Patient to place the forearm on the side opposite of PD over the lumbar vertebrae. After completing the 4th lumbar isolation test, ask the patient to return the forearm to the side of the body
Left PD
Possibility
One
Two
Three

49. L4 Adjustment
Contact Point : the mammillary process on the side indicated by the short-long rule
LOC = anterior, superior, through the plane line of the facet

50. Lumbar Isolation Test
2th Lumbar Isolation Test : Patient to place both forearms on the lumbar vertebrae. After completing the 2th lumbar isolation test, ask the patient to return the forearm to the side of the body
Left PD
Possibility
One
Two
Three

51. L2 Adjustment
Contact Point : the mammillary process on the side indicated by the short-long rule
LOC = anterior, superior, through the plane line of the facet

52. Lower Thoracic Isolation Test
12th Thoracic Isolation Test : patient to place the forearm on the PD side next to the head. After completing the 12th Thoracic isolation test, ask the patient to return the forearm to the side of the body.
Left PD
Possibility
One
Two
Three

53. T12 Adjustment
Contact Point : Transverse process on the side indicated by the short-long rule
LOC = anterior, superior, and slightly medial, through the 60° plane line of the facet
Contact Point : Body of the rib about 1/2inch lateral to the transverse process on the side of rib involvement.
LOC = lateral and inferior at a 45° angle

54. Lower Thoracic Isolation Test
8th Thoracic Isolation Test : patient to place the forearm next to the head. After completing the 8th Thoracic isolation test, ask the patient to return the forearm to the side of the body.
Left PD
Possibility
One
Two
Three

55. T8 Adjustment
Contact Point : Transverse process on the side indicated by the short-long rule
LOC = anterior, superior, and slightly medial, through the plane line of the facet
Contact Point : Body of the rib about ½ inch lateral to the transverse process on the side of rib involvement.
LOC = lateral and inferior at a 45° angle

56. Upper Thoracic Isolation Test
6th Thoracic Isolation Test : The patient to turn the face to the PD side. After completing the 6th Thoracic isolation test, ask the patient to return the head to the neutral position.
Left PD
Possibility
One
Two
Three

57. T6 Adjustment
Contact Point : Transverse process on the side indicated by the short-long rule
LOC = anterior, superior, and slightly medial, through the plane line of the facet
Contact Point : Body of the rib about 1/2inch lateral to the transverse process on the side of rib involvement.
LOC = lateral and inferior at a 30° angle

58. Upper Thoracic Isolation Test
4th Thoracic Isolation Test : The patient to keep the face turned to the PD side; then instruct the patient to lift the shoulder on the PD side toward the ceiling and then relax. After completing the 4th Thoracic isolation test, ask the patient to return the head to the neutral position.
Left PD
Possibility
One
Two
Three

59. T4 Adjustment
Contact Point : Transverse process on the side indicated by the short-long rule
LOC = anterior, superior, and slightly medial, through the plane line of the facet
Contact Point : Body of the rib about 1/2inch lateral to the transverse process on the side of rib involvement.
LOC = lateral and inferior at a 20° angle

60. Upper Thoracic Isolation Test
1th Thoracic Isolation Test : The patient to keep the face turned to the PD side; then instruct the patient to shrug the shoulder toward the ears and then relax. After completing the 1th Thoracic isolation test, ask the patient to return the head to the neutral position.
Left PD
Possibility
One
Two
Three

61. T1 Adjustment
Contact Point : Transverse process on the side indicated by the short-long rule
LOC = anterior and slightly medial, through the plane line of the facet
Contact Point : Body of the rib about 1/2inch lateral to the transverse process on the side of rib involvement.
LOC = lateral and inferior

62. Shoulder Involvement Lateral subluxation of the Scapula
Medial subluxation of the Scapula
Medial ala of the scapula
Inferior humerus
Posterior-superior radius
Anterior Lunate
Lateral subluxation of the Scapula
Lateral ala of the scapula
Superior humerus
Inferior-Medial ulna
Posterior Carpals

63. Shoulder Isolation Test
환자의 얼굴을 PD side로 돌리게 하고 두 팔을 양측 테이블위에 놓게한다.
PD side 먼저 검사하고 반대편 PD side를 검사한다.
PD side 팔꿈치를 몸통에 붙였다 떼도록 한다.
그런 후 Position #2를 시행한다.
검사 시행하는 쪽 견갑골의 inferior angle은 #2에서 장측 다리 방향으로 subluxation 된다.
이 test 결과로 medial scapula 인지 lateral scapula 인지를 결정한다.

64. Shoulder Isolation Test

65. Medial Scapula Pattern

66. Medial Scapula Pattern adjust
LOD = Lateral
(Medial Scapula)
LOD = Superior
(inferior humerus)

67. Medial Scapula Pattern adjust
LOD = Anterior-Inferior
(Proximal radius)
LOD = Posterior
(anterior lunate)

68. Lateral Scapula Pattern

69. Lateral Scapula Pattern adjust
LOD = Medial
(Lateral Scapula)
LOD = Inferior
(superior humerus)

70. Lateral Scapula Pattern adjust
LOD = Lateral-superior
(proximal head of ulna)
LOD = anterior
(posterior carpals)

71. Lower Cervical Isolation Test
7th Cervical Isolation Test : After completing the upper extremity isolation procedur, ask the patient to keep the face turned to the PD side; then instruct the patient to return the head to the neutral face down position.
Left PD
Possibility
One
Two
Three

72. C7 Adjustment
Contact Point : Pedicle – lamina junction on the side of involvement
LOC = anterior, superior and slightly medial, through the plane line of the facet

73. Lower Cervical Isolation Test
5th Cervical Isolation Test : Instruct the patient to lift the head off the table ½ inch (slight extension) and then return the head to the neutral face down position.
Left PD
Possibility
One
Two
Three

74. C5 Adjustment
Contact Point : Pedicle – lamina junction on the side of involvement
LOC = anterior, superior and slightly medial, through the plane line of the facet

75. Upper Cervical Isolation Test
Atlas-Axis Isolation Test : Instruct the patient to tucking the chin toward the chest(slight flexion) then return the head to the neutral face down position.
Left PD
Atlas
Axis
No Involvement

76. C1 Adjustment
Contact Point : lateral most aspect of the Transverse Process
LOC = slightly medial

77. C2 Adjustment
Contact Point : Pedicle – lamina junction on the side opposite PD
LOC = anterior, superior and slightly medial, through the plane line of the facet

78. Posterior Occiput
Posterior Occiput isolation test : Following isolation and adjustment of the C2-C1 segments, the patient’s head will be in the neutral, face-down position. Instruct the patient to gently push the face into the table which stresses the atlanto-occipital region
Left PD
Possibility
One
Two
Three

79. Posterior Occiput Adjustment
Contact Point : posterior aspect of the occiput at the inferior nuchal line
LOC = straight anterior