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