diversified i review
DESCRIPTION
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. Pisiform Hand Heel Pollicus/Thenar Lateral Index Distal or Flat Thumb Modified Pollicus (Thenar) - PowerPoint PPT PresentationTRANSCRIPT
DIVERSIFIED I REVIEW
Photos Courtesy of:1 “Spine, Spinal Cord and ANS”
Cramer & Darby2 “Spinal Biomechanics and Specific Adjusting”
Otto C. Reinert, D.C, F.I.C.C.
MANUAL CONTACTS• 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 Spinal Biomechanics and Specific AdjustingSpecific AdjustingOtto Reinert, D.C.Otto Reinert, D.C.
OSSEOUS/VERTEBRAL CONTACTS
• PELVIS (S/I jt)– PSIS– ASIS– Sacral Ala– Ischial Tuberosity
OSSEOUS/VERTEBRAL CONTACTS
• LUMBAR SPINE– Spinous– Mamillary
MamillaryMamillary
SpinousSpinous
IVD spaceIVD space
OSSEOUS/VERTEBRAL CONTACTS
• THORACIC SPINE– Spinous– Transverse Process– Rib
SpinousSpinous
TransverseTransverse
OSSEOUS/VERTEBRAL CONTACTS
• LOWER CERVICAL– Articular pillar
(capsule/rotation)– Lateral aspect
(Luschka trauma)
OSSEOUS/VERTEBRAL CONTACTS
• UPPER CERVICAL– Occiput – Mastoid– Atlas TP– C2 spinous
“HVLA”HIGH VELOCITY
LOW AMPLITUDESPEED 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 Range3. 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 it1.Unequal weight into each S/I joint- leads to
abnormal gait2.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
ANTALGICPOSTURE
• 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 VERTEBRALMALPOSITIONS
• 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
PARTSP=Pain
• Doctor’s notes may reflect:– Location– Quality– Intensity
• Observation• Percussion• Provocation• Palpation• Visual analog scales• Pain questionnaires
PARTSA=Asymmetry/Alignment
• Doctor’s notes must reflect:– Sectional or segmental level– Observation
• Posture• Gait
– Palpation or X-Ray evidence of:• Misalignment• Asymmetry
PARTSR=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
PARTST= Tissue Tone, Texture, Temp.
• Doctor’s notes may reflect:– Abnormal changes in:
• Skin• Fascia• Muscle• Ligaments
– Identified by:• Observation• Palpation• Instrumentation• Length and strength
PARTSS= Special Tests
• Doctor’s notes may reflect:– Test specific to a technique system