The Blair Toggle-Torque adjustive thrust, developed from the adjustive methods of B.J. Palmer, is a distinctive toggle mechanism without recoil on the part of the adjuster and incorporating a 180 degree torque. It is applied with the patient placed in the side posture on an adjusting table with a drop headpiece. Crucial to proper application of the Blair Toggle-Torque is the mastery of the "pisiform lead," in which the contacting surface of the adjuster's pisiform remains in firm contact with the segmental contact point throughout the adjustive thrust, rather than describing a helical pathway as in some other upper cervical techniques.
One unique feature of Blair Technique is that, for any given articular misalignment to be adjusted, the clinician has a choice of adjustments permitting either an ipsilateral or a contralateral segmental contact. Superior or inferior torque is used, depending upon the misalignment and choice of contact. (In adjusting posterior-inferior atlas listings no torque is used, and the adjustor does recoil his hands from the thrust.)
Listings of any cervical vertebra may be adjusted using the Blair method, although Dr. Blair did not adjust below C4, and some current practitioners do not adjust below C2 or even Cl. Atlas is analyzed and listed as misaligning either obliquely anterior-superior or obliquely posterior-inferior along either or both of the long axes of the atlantooccipital articulations. Adjustments of atlas require the doctor to orient along up to three angular measurements of C I or the condyles from the spinographic series, depending upon the misalignment. Ipsilateral or contralateral condylar slope, atlas plane line in the lateral view, convergence of the ipsilateral or contralateral atlanto-occipital articulation, and posterior condylar convexity measurements may be incorporated in the adjustment, depending upon the listing and choice of segmental contact. Atlas contacts are made on transverse process or posterior arch.
Axis and subjacent cervical segments are analyzed and listed as misaligning either anterior-superior or posterior-inferior at one or both apophyseal articulations. The slope of the relevant articulation is used in the adjustment, and segmental contact points may include the ipsilateral or contralateral lamina or spinous process. In cases where two segments (usually C2 and C3) have misaligned together to the same extent in relation to the subjacent segment, both segments may be contacted simultaneously in the adjustment. Where tow adjacent segments have misaligned in opposite directions, opposing contacts (using both hands) may be made on the two segments simultaneously.