All contact points are optional at some time. Thus, the choice of selecting a transverse process, a spinous process or a lamina contact is a matter of clinical judgment. A mobilizing force directed against any of these structures will induce articular separation, tissue stretching, and the effected segmental motion, although one contact may be more efficient and less painful to the patient than another, depending on the situation at hand. Most classic adjustive technics apply contact on the spinous process or transverse process for greater leverage. Whenever possible, a laminal contact would allow the force to be directed against the strongest aspect of the posterior portion of the vertebra.
Some leverage is lost with a laminal contact, but added safety is gained.
Unless cautiously applied, a transverse process contact holds the inherent danger of the contact slipping laterally, which can easily result in rib injury. A transverse or laminal contact is less painful to the patient than a spinous contact because of the padding afforded by the intervening soft tissues. Securing the Contact Hand Precautions should always be taken when applying an adjustment to avoid slipping and pounding, as both can bruise the patient, induce unnecessary pain, and result in an inefficient correction attempt. The patient's skin should be drawn taut in the direction of drive. Slipping results from not having the contact point properly anchored or perspiration from the patient's skin has not been removed.