The three-sign test instead of X-ray: facts and pitfalls

From the functional perspective of the musculoskeletal system in manual medicine, diagnostic and therapeutic procedures were developed based on knowledge of anatomic relationships and physiologic functional processes, which thus render invasive methods unnecessary. Although once considered essential, X-ray diagnostics are also becoming less important for manual medicine treatment techniques. One example is Coenen's three-sign test, which makes X-ray examination to determine the direction of treatment for atlas therapy according to Arlen unnecessary. In this article, the practical execution of this test is described in detail. A nociceptive influence of structures innervated by the cranial nerves can falsify the test result and must be recognized and switched off. Craniomandibular dysfunction and heterophoria deserve special mention. Incorrect execution of the test, as taught in an epigonal version, renders the result unusable.