Published on January 22, 2013
Donna M. Maitlen, B.S., D.C., C.C.S.P.
Vertebral Subluxation ComplexMechanical Components *Joint Malposition and Hypo and hyper-mobilityNeurobiologic Components *Nerve Root Compression (theory) *Visceral-Somatic dysfunction (autonomic)Inflammation *Vascular and soft-tissue responses
Most of the time, we are adjusting patients based on the functional evaluation of the spine, typically using motion palpation techniques. This means, most of our adjustments will be due to hypo- mobility as detected using our motion palpation with confirmatory static palpation findings. You may also use devices that detect and measure pain and temperature to determine spinal joint dysfunction.
The facets of the cervicalspine angle upward fromP-A at 45 degrees.Contact points for adjustmentsare typically the articular pillars,the postero-lateral border ofthe spinous process, or thetransverse process.
Each joint has its own rangeRemember the segmental ranges of motion –these ranges help you define the subluxationcomplex.The occipito-atlantial joint (C0-C1) has themost flexion / extension in the upper c-spine.The atlantoaxial joint (C1-C2) has the mostrotation in the upper c-spine.
DUE WITHIN 1 WEEK FROM TODAY Find out what the actual arch angle of a “Roman Arch” is – it is specific. Compare and contrast this to the cervical lordosis of a newborn and the effect of a shallower or greater lordotic angle on the resistance to injury.
Discovering contraindications to manipulation Ruling out dangerous pathology1. Vertebral Artery Testing – integrity of the vertebral artery2. Compression Testing – integrity of foramen and body3. Distraction Testing – integrity of musculature and foramen4. Percussion Testing – integrity of bony structures5. Valsalva Maneuver – integrity of neural structures
Down’s Syndrome: possible lack of a transverse ligament Multiple risk factors of Osteoporosis Atherosclerotic Plaque – CVA History of sinus infection in conjunction with c-spine pain Remember that much of your pathology DX comes from the proper history of the patient - listen AND ask.
In Georges test, we first measure the bilateral blood pressure, pulse rates, and auscultate the subclavian and carotid arteries. The patient is next asked to rotate the head right and left, and then rotate, laterally bend and extend in the seated position (Maignes test) and in the supine position (DeKleijns test). Look for : Nystagmus and fatigue, Ask: Do you feel anything different? (do not lead patient)
Seated • Observe active ROM (measure-especially before first adjustment) • Static Palpation • Motion Palpation with end range overpressure • Flexion, extension, lateral flexion / medial glide, rotation • Instrumentation Supine • Static Palpation – is anything different? • Motion Palpation • Flexion, lateral flexion / medial glide, rotation
Indication: restriction of rotation lateral flexion or extension of C1Patient Position: relaxed, seatedDoctor Position: behind patient toward side of contactContact point: ventral surface of index finger(wrist straight as possible, forearm 90 degrees flex)Segmental Contact Point: Atlas transverse process (lateral orposterior)Indifferent hand: cradles patient’s headVector: P-A with rotation, P-A with Extension, or M-L IMORTANT CONSIDERATIONS BEFORE ADJUSTING: *is patient relaxed? *have you maintained joint tension before thrust?
Indication: Restricted rotation, lateral flexion or extensionPatient Position: Patient lies supineDoctor’s Position: Standing at head of table, 45 degrees to 90degrees to patientContact Point: Ventrolateral surface of index finger, thumb or thenarrests on patient’s cheekSegmental Contact Point: Posterior articular pillarIndifferent hand: Cradles patient’s head supporting occiput andcervical spineVector: medial to lateral and superior to inferior IMORTANT CONSIDERATIONS BEFORE ADJUSTING: *is patient relaxed? *have you maintained joint tension before thrust?
The physical health of your body directly relates to andimpacts your ability as a doctor to help people and to make aliving. TAKE CARE OF YOURSELF!!!!!! Always consider your posture and core strength
Why is the subluxation or restriction present? o Evaluate cervical spine for strength o Biomechanics of neck curvature o Posture o Evaluate nutritional status, especially minerals o Sleeping considerations – of posture and pillows
Approach the patient with your questions in mind Do your seated assessment before the patient lies down • Observation, A-ROM, Orthopedics, R/O Pathology, vascular tests Do your supine assessment • P-ROM, Vascular tests… Pleasantries: assure the patient (before and after)
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