Download Fixation Complexes

Unusual Situations in
Muscle Testing
Subclinical Weakness
The Indirect Muscle Test
Subclinical Weakness
The “51%-er”
“51%-er”
Facilitation
Inhibition

Tests WEAK
50%
Tests STRONG
“51%-er”
Associated muscle
But NOT all the time!
How it shows up in the clinic
“Should be weak”
Within the 5 Factors
Test for Subclinically Weak
Muscle
Not really a TEST
Run the “5 Factors” checklist
TL each factor
If Involved - Strong or Weak?
CORRECTION = 5 Factor Correction
Indirect Muscle Test
Subclavius - Cannot Test Directly
Subclavius
Indirect Muscle Test
Levator Ani - Probably Do Not Want to
Test Directly
Levator Ani
Levator Ani - Muscle Test
Levator Ani - Muscle Test
Can I TL a muscle that is
inhibited?
NO, a “weak” muscle does
NOT TL!
However, we CAN TL the
weakness!
How do you TL muscle
weakness?
TL tells you WHERE the problem is
LOCATED
Where is the problem of an inhibited
muscle located?
Subclavius - Indirect Mus.
Test - Step 1 (any muscle)
Subclavius - Indirect Mus.
Test - Step 1 (TL suspect
mus.)
If the muscle is “WEAK”?
If the muscle is “STRONG”?
“Activate the Muscle” Step 2
Patient contracts the Subclavius muscle
Weakness is now “transferred” to
LOCATION of the Subclavius
Subclavius - Indirect Mus.
Test - Step 3 (Re-test
indicator)
If the muscle is “WEAK”?
If the muscle is “STRONG”?
How do you TL muscle
weakness?
Find an INDICATOR muscle
Normal muscle?
TL suspected weak muscle
Check indicator
Strong?
Weak?
Contract suspected weak muscle
Test indicator
Strong?
Weak?
Fixation Complexes
What are they?
Why do I Care?
How do I Find them?
Fixation Complexes Are:
NOT Subluxations
Misalignment
Aberrant motion
NO Motion
May have normal alignment
Why Do I Care?
Some joints never seem to “go”
Whole sections of the spine palpate
fixated
Chronic problems but can’t find anything
And…
Fixation Complexes
HIDE
Subluxations!!!
Fixations Hide
Subluxations
Subluxations Within Locked Areas
Subluxations Distant to Locked Areas
Also, they will hide OTHER Fixation
Complexes
Characteristics of Fixation
Complexes
Subluxation
MAY show on x-ray
TL’s to Indicator m.
TL’s to Associated m.
Challenges with a
single point contact
Adjusts with a single
point contact
Fixation Complex
NOT show on x-ray
NO TL to Indicator m.
TL’s to Associated m.
Challenges with a
TWO point contact
Adjusts with a TWO
point contact
Muscle Weakness
Subluxation
Any muscle related to
the subluxation can be
weak
Example:
C5 subluxation could
affect any C4, C5, C6
innervated muscle
Maybe even C3 & C7
Fixation Complex
Only ONE muscle
(usually bilateral) is
related to EACH
fixation complex
Fixation Complex Muscle
Relationships
Fixation:
Occiput
Upper Cervical
Lower Cervical
Cervicothoracic
Thoracic
Thoracolumbar
Lumbar
Muscle
Weakness:
(B)
(B)
(B)
(B)
(B)
(B)
(B)
Psoas
Gluteus Maximus
Popliteus
Middle Deltoid
Teres Major
Lower Trapezius
Neck Extensors
Unusual Relationships
Lumbar Fixation
Neck Extensors
“Tested Together”
Bilaterally Weak
Sacroiliac Fixation
Sacrum Fixation
Neck Extensors
“Tested Individually”
 Unilaterally Weak
Neck Extensors
“Tested Individually”
 Bilaterally Weak
Why this relationship?
Normal Inhibitory Pattern
Demonstration
NOT normal when patient is being tested
How Do I Find Them?
BILATERAL Muscle Weakness
Usually
Of ONLY the 7 Muscles
Is a bilateral weakness of these 7 muscles
ALWAYS a fixation complex?
MUST VERIFY with TL or Challenge!
Fixation Complex Scan
Neck Extensors - Tested Together
Neck Extensors - Tested Individually
One side then the other (2 tests)
Middle Deltoid
Teres Major
Lower Trapezius
Popliteus
Gluteus Maximus
Psoas
Neck Extensors 1. Tested Together
2. Tested Individually (B)
Middle Deltoid - Supine
Teres Major
Lower Trapezius
Note:
There are 7 muscles to test but 9 tests
We only have to test one side if they are
strong
Cannot be bilaterally weak if one side is
strong!
If muscle tests weak THEN test the other
side
Remember:
Fixation:
Muscle
Occiput
Upper Cervical
Lower Cervical
Cervicothoracic
Thoracic
Thoracolumbar
Lumbar
(B)
(B)
(B)
(B)
(B)
(B)
(B)
Weakness:
Psoas
Gluteus Maximus
Popliteus
Middle Deltoid
Teres Major
Lower Trapezius
Neck Extensors
Unusual Relationships
Lumbar Fixation
Neck Extensors
“Tested Together”
Bilaterally Weak
Sacroiliac Fixation
Sacrum Fixation
Neck Extensors
“Tested Individually”
 Unilaterally Weak
Neck Extensors
“Tested Individually”
 Bilaterally Weak
Fixation Complex Analysis
Step 1: Find bilateral weakness
Step 2: TL appropriate area of the spine
If (B) muscles are Strong?
Fixation Complex
If (B) muscles are STILL weak?
(B) Weak Muscles
Fixation Complex Analysis
Step 1: ID Top and Bottom of the Stack
Adjacent SP’s Opposite Directions Laterally
Step 2: ID the Anterior and Posterior Side
Top SP Left and Right
Step 3: ID the Primary Side
Facet Joints P-A
Adjusting Rule
If it is a “Posterior Fixation,” adjust:
the TOP vertebra and the one below.
If it is an “Anterior Fixation,” adjust:
the BOTTOM vertebra and the one above.
Sacral Fixation Analysis
Step 1: ID Top and Bottom of the Stack
Already KNOW top and bottom of sacrum
Step 2: ID the Anterior and Posterior Side
S2 tubercle Left and Right
Step 3: ID the Primary Side
Sacral ala P-A
Unusual Corrections
Occipital Fixation Complex
Palpate for tender nodule at Inferior Nuchal
Line
LOC from nodule to glabella
SI Fixation Complex
Simply open up the joint
Posterior Sacral Fixation Complex
Adjust P-A & M-L at Sacral Ala
Right Posterior Sacral
Fixation Complex
Left Anterior Sacral
Fixation Complex
Unusual Corrections Anterior Sacral Fixation
Complex
Side lying - involved side UP
Stabilize POSTERIOR side of sacrum
Contact shoulder and PUSH
NOT THRUST!
Torques spine to move anterior sacrum
posteriorly
Fixation Complex Analysis
“Easy Method”
Step 1: Find bilateral weakness
Step 2: TL appropriate area of the spine
If (B) muscles are Strong?
Fixation Complex
If (B) muscles are STILL weak?
(B) Weak Muscles
Then:
Just Challenge!
The proper two bones will challenge
To the associated muscle
To an indicator muscle
Two different bones
Opposite sides of the spine