Download for lateral flexion malposition

DIVERSIFIED I REVIEW
Photos Courtesy of:
1 “Spine, Spinal Cord and ANS”
Cramer & Darby
2 “Spinal Biomechanics and Specific Adjusting”
Otto C. Reinert, D.C, F.I.C.C.
MANUAL CONTACTS
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Pisiform
Hand Heel
Pollicus/Thenar
Lateral Index
Distal or Flat Thumb
Modified Pollicus
(Thenar)
• Chiropractic Index
THUMB-PISIFORM
DOUBLE THUMB
IDENTIFY DOCTOR’S
MANUAL CONTACTS
• Superior Hand
• Inferior Hand
• Manual contacts
Spinal Biomechanics and
Specific Adjusting
Otto Reinert, D.C.
OSSEOUS/VERTEBRAL
CONTACTS
• PELVIS (S/I jt)
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PSIS
ASIS
Sacral Ala
Ischial Tuberosity
OSSEOUS/VERTEBRAL
CONTACTS
• LUMBAR SPINE
– Spinous
– Mamillary
IVD space
Mamillary
Spinous
OSSEOUS/VERTEBRAL
CONTACTS
• THORACIC SPINE
– Spinous
– Transverse Process
– Rib
Transverse
Spinous
OSSEOUS/VERTEBRAL
CONTACTS
• LOWER CERVICAL
– Articular pillar
(capsule/rotation)
– Lateral aspect
(Luschka trauma)
OSSEOUS/VERTEBRAL
CONTACTS
• UPPER CERVICAL
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–
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Occiput
Mastoid
Atlas TP
C2 spinous
“HVLA”
HIGH VELOCITY
LOW AMPLITUDE
SPEED AND SPECIFICITY
1. Specific Osseous Contact Applied
2. Joint is taken to maximum resistance:
1. Specific Line of Drive—Force(s) Directed and
Applied to the Joint
2. Move Motor Unit to Voluntary End Range
3. Sudden Load is Applied, Moving Joint Past
its End Range, Creating Cavitation
Table Position While Patient is Prone
• Foot piece elevated
• Pelvic piece at or below level of
greater trochanters
• Abdominal piece unlocked
• Head piece level or slightly below
SPINOUS RECOIL THRUST
• Doctor’s Stance
– Faces in at 90º on same side of spinous laterality
– Pisiform Manual Contact (L1 & 2 sup. L4 & 5 inf.)
– Spinous Osseous Contact
– Doctor instructs patient to turn head toward
• LOD
– Anterior-medial
• Execution
– Lean-in with 20-25 lbs pressure w/ flexed elbows
– Quick extension of elbows—1 INCH—60-65 lbs of
pressure with immediate recoil
LUNGE THRUST
• Doctor’s Stance
– Faces superiorly at 45 º (exception may face
inferiorly)
– Any manual contact
– Osseous contact depends upon region of spine
• LOD
– Depends upon specific subluxation pattern
• Execution
– Arms fully extended taking jt to max resistance
(55 lbs)
– Front leg flexed, back leg extended
– Transference of body weight from legs through
extended arms, turning the shoulders and hips in
with the thrust
– HOLD, then slowly release
IMPULSE THRUST
• Doctor’s Stance
– Faces in at 45 º
– Any manual contact
– Osseous contact depends upon region of spine
• LOD
– Depends upon specific subluxation
• Execution
– Lean in with extended arms to max resistance (20-25
lbs)
– Flex elbows
– For thrust, quickly contract pects and triceps, fully
extending elbows
– HOLD, then slowly release
PELVIC ACCOMODATIONS
• STANDING
– When the patient laterally flexes the
Lumbar Spine to the RIGHT:
• PSIS- On the LEFT goes Posterior and Inferior
• PSIS- On the RIGHT goes Left and Superior
• SEATED
– Patient flexes forward
• PSISs go Posterior and Inferior
– Patient extends backward
• PSISs go Anterior and Superior
ARTHROKINEMATIC REFLEX
• SUPINE
– Internal Rotation
• Leg Shortens
– External Rotation
• Leg Lengthens
SEATED EVALUATION
• Internal and External
Rotation with
approximation and
flaring of thighs
• Flexion-PI and
Extension-SA
• Motion palpation
SACRUM
• Integral part of pelvis“Key Stone in an Arch”
– Increased vertical load leads
to an increase in joint
surface bonding
• Supports Vertebral Column
– Disperses weight from spine
to pelvis
– Transmits forces from lower
limbs upward
SACROILIAC DYSFUNCTION
• Most often a SYMPTOM rather than a
PRIMARY cause of distortion
• Common cause of low back “ache”, but not
usually responsible for severe low back pain
• The total pelvis tips, sways and rotates in
accommodation to eccentric weight
imposition upon it
1. Unequal weight into each S/I joint- leads to
abnormal gait
2. Pelvis consistently responds to changes in weight
distribution
SECTIONAL TOWERING
• Lateral movement of
the spine away from
open wedge
• BASE- where primary
open wedge located
• APEX- found at the top
of the sectional
towering, open wedge
on opposite side
• ANATALGIA- Leaning
of body AWAY from
side of open wedge
ANTALGIC
POSTURE
• To the patient’s
LEFT
• Sectional tower will
be to the patient’s
LEFT
• Side of “Open
Wedge” or BASE of
the sectional tower
will be on the
patient’s RIGHT
TYPICAL
• ROTATION
WITH LATERAL
FLEXION– Spinous
rotates
TOWARD side
of open wedge
– Body rotates
PI
ATYPICAL
• ROTATION WITH
LATERAL FLEXION
–Spinous
rotates AWAY
from side of
open wedge
–Body rotates
Superior
Posterior
POSTURE ANALYSIS:
DISCOVERING SPINAL
CURVATURES
• Scapula prominence
• PELVIC AND SHOULDER
UNLEVELING
• RIB HUMP- SAME SIDE OF CONVEXITY
PALPATION of VERTEBRAL
MALPOSITIONS
• FOR ROTATIONAL MALPOSITION:
– Spinous deviation
– Mamillary prominence on the opposite side
• FOR LATERAL FLEXION MALPOSITION:
– Appearance of the base of a sectional tower of
the spine
– May or may not have deviation of spinous at the
base; if there is deviation, it may be toward or
away from the side of “open wedge”
– Side of body rotation will be side of prominent
mamillary
DAMAGING STRESSES
ON THE IVD
• #1 Flexion with
axial rotation
• Flexion
• Excessive axial
compression
• Degenerative
changes
PARTS
P=Pain
• Doctor’s notes may reflect:
– Location
– Quality
– Intensity
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Observation
Percussion
Provocation
Palpation
Visual analog scales
Pain questionnaires
PARTS
A=Asymmetry/Alignment
• Doctor’s notes must
reflect:
– Sectional or segmental level
– Observation
• Posture
• Gait
– Palpation or X-Ray evidence of:
• Misalignment
• Asymmetry
PARTS
R=Range of Motion Abnormality
• Doctor’s notes must reflect:
– Decrease or Increase of
• Active, Passive or Accessory joint motion
– Verified by:
• Motion palpation
• Stress X-ray
PARTS
T= Tissue Tone, Texture, Temp.
• Doctor’s notes may reflect:
– Abnormal changes in:
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Skin
Fascia
Muscle
Ligaments
– Identified by:
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•
•
Observation
Palpation
Instrumentation
Length and strength
PARTS
S= Special Tests
• Doctor’s notes may reflect:
– Test specific to a technique system