|
|
Please support our Sponsors
 By Frank M. Painter, D.C. in Cervical Spine on May 27th, 2013 at 11:35 am
Specific Potentialities of the Subluxation Complex
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 7 from RC’s best-selling book:
“Basic Principles of Chiropractic Neuroscience”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 7: Specific Potentialities of the Subluxation Complex
This chapter describes the primary neurologic implications of subluxation syndromes, either as a primary factor or secondary to trauma or pathology, within the cervical spine, thoracic spine, lumbar spine, and pelvic articulations.
GENERAL CONSIDERATIONS
Studies reported by Drum, Hargrave-Wilson, Kunert, Burke, Gayral/Neuwirth, and others have shown that a subluxation complex, often leading to spondylosis, can effect a wide variety of disturbances that may appear to be disrelated on the surface. Most of the remote effects can be grouped under the general classifications of nerve root neuropathy, basilar venous congestion, cervical autonomic disturbances, CSF pressure and flow disturbances, axoplasmic flow blocks, irritation of the recurrent meningeal nerve, the Barre-Lieou syndrome, and/or the vertebral artery syndrome.
This chapter describes many causes for and effects of a spinal subluxation complex. In clinical practice, however, causes and effects are rarely found as isolated entities. Several factors will usually be involved and superimposed on each other.
Innervation of the Spinal Dura
It has long been known that the spinal dura mater has an intrinsic nerve supply. Spinal meningeal rami are derived from gray communicating rami and spinal nerves. The spinal nerves contribute sensory fibers to the meningeal rami. Several meningeal rami enter each IVF, and most are located anteriorly to the sensory ganglia within the IVF.
Bridge found that these intrinsic nerve fibers reach the anterior surface of the dura by three main courses. Here the nerves divide into ascending and usually longer descending filaments that run longitudinally and parallel on the dural surface, and a considerable amount of nerve overlaps from adjacent segments. Finer filaments penetrate the dural substance where they subdivide.
Kimmel reported that most of these fibers penetrate the dura near the midline, while others enter laterally near the exiting spinal nerve roots. At each segment level, two or three nerves enter the spinal dura mater and contain only small nerve fibers. In contrast, Edgar/Nundy could determine no definitive nerve endings, but the nerves could be traced to the posterior aspect of the spinal dura. These observations help to clarify the wide distribution of back pain that is often found following protrusion of a single IVD.
Cervical Dura Attachments
Sunderland states that the nerve sheaths in the cervical region are not firmly attached to their respective foramina. Only the C4 C6 cervical nerves have a strong attachment to the vertebral column, and this is to the gutter of the vertebral transverse process. He believes that these observations have relevance to any local lesion that may fix, deform, or otherwise affect the nerve and its roots to the point of interfering with their function, and they also may be important to traction injuries of nerve roots.
Continue reading …
By Frank M. Painter, D.C. in Bone Injury on April 15th, 2013 at 8:35 am
Sports Management:
Bone and Joint Injuries
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 15 from RC’s best-selling book:
“Chiropractic Management of Sports and Recreational Injuries”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 15: Bone and Joint Injuries
In traditional general medical practice, the musculoskeletal system is the most overlooked system in the body, yet it comprises over half the body mass. The relationship between structure and function, and the interrelationship between all body systems, cannot be denied. Muscles, bones, and connective tissues are involved in both local and systemic pathology, and in a wide assortment of functional and referred disturbances. Thus, great care must be taken in eliciting the details of a complaint when any musculoskeletal disorder is suspected. This section reviews the basis of alert management of bone and joint injuries within the health care of athletic and recreational injuries.
Bone Injuries
Correlation of the history of the present complaint with musculoskeletal dysfunction must be done in detail and with care. Maintain accurate initial and progress records with repeated monitoring. Few patients can appreciate the relationship of dysfunction in one somatic part with a distant somatic part, let alone the relationship between a somatic dysfunction and a visceral dysfunction.
Background
Musculoskeletal symptoms may be the first clues toward poor structural adaptation or stress adaptation. The most common musculoskeletal symptoms are joint stiffness, joint swelling, and joint pain. Bones, being essentially nonyielding structures, are damaged when excessive force is applied directly or indirectly. The nature of the damage depends on the direction of the applied force on the bones and the manner in which these bones are attached to other structures. The principal acute skeletal injuries are sprains, strains, subluxations, fractures, and dislocations.
Normal bone has an excellent blood supply with some exception in the metaphyseal area; but tendons, ligaments, discs, and cartilage are poorly vascularized. Yet both bone and joints challenge the host’s defensive mechanisms. The pressure of pus under hard bone blocks circulation, and emboli and thrombosis can cause additional devascularization. When circulation is deficient, local phagocytic function and nutrition are deficient, and cure is stymied.
The most accurate diagnosis can be made immediately after injury, before swelling clouds the picture. Many fracture and dislocation complications such as nerve and vessel injury occur not from the trauma itself but from poor first aid which does not provide adequate splinting prior to movement. Traumatic bone injury rarely occurs without significant soft-tissue damage. The physical examination must be gentle but thorough because soft-tissue trauma is poorly visible on roentgenograms for several days after injury. For example, a working diagnosis of stress fracture may have to be made in the absence of classic symptoms by bony tenderness alone as the fracture may not be demonstrable on x-ray films for 10-14 days or longer.
Probing the History
Symptoms of a musculoskeletal nature that cannot be linked to trauma are suspect of a chronic organic process. Unfortunately, a history of stress or strain may not be remembered. Even severe trauma is easily put out of the mind uring a game when emotions are high or forgotten once the pain and swelling have left. Whether pain is present or not, the history must be probed to determine if the dysfunction is the result of bone, the joint, or the motor apparatus involved in the joint motion.
Continue reading …
Clinical Disorders and the Sensory System
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 4 from RC’s best-selling book:
“Basic Principles of Chiropractic Neuroscience”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 8: Clinical Disorders and the Sensory System
This chapter describes those sensory mechanisms, joint signals, and abnormal sensations (eg, pain, thermal abnormalities) that have particular significance within clinical diagnosis. The basis and differentiation of pain are described, as are the related subjects of trigger points and paresthesia. The chapter concludes with a description of the neurologic basis for the evaluation of the sensory system and the sensory fibers of the cranial nerves.
THE ANALYSIS OF PAIN IN THE CLINICAL SETTING
Although all pain does not have organic causes, there is no such thing as “imagined” pain. Pain that can be purely isolated as a structural, functional, or an emotional effect is rare. More likely, all three are superimposed upon and interlaced with each other in various degrees of status. This is also true for neural, vascular, lymphatic, and hormonal mechanisms.
Common Causes of Pain and Paresthesia
The common causes of pain and paresthesia are:
(1) obvious direct trauma or injury;
(2) reflex origins in musculoskeletal lesions, which deep pressure often exaggerates, such as trigger areas;
(3) peripheral nerve injury (eg, causalgia), which results in an intense burning superficial pain;
(4) the presence of nerve inflammations and degeneration of the peripheral or CNS, which frequently cause other changes indicative of such lesions;
Continue reading …
The Horizontal Neurologic Levels
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 4 from RC’s best-selling book:
“Basic Principles of Chiropractic Neuroscience”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 4: The Horizontal Neurologic Levels
and Related Clinical Concerns
This chapter describes the basic functional anatomy and clinical considerations of the horizontal aspects of the supratentorial, posterior fossa, spinal, and peripheral levels of the nervous system.
OVERVIEW
The reader should keep in mind that the various aspects of the nervous system as described in this manual (eg, longitudinal and horizontal systems) are only reference guides that are visualizations of a patient’s nervous system in the upright position. They can be likened to the lines of longitude and latitude on a globe of the earth.
Such systems do not exist physically, but they do serve as excellent mental grid-like tools (viewpoints) during localization and areas in which and from which relationships can be described. For example, although the longitudinal systems take a general vertical course within the spinal column there are numerous alterations and they actually become horizontal when decussating. While the horizontal levels are spatially placed in and extend from the CNS in a general segmental manner, they soon take a widely diffuse course as they project toward their destinations. Thus, references to longitudinal and horizontal levels are just general viewpoints.
It is helpful for study purposes to isolate the body into certain systems, as described above, organize systems into organs, organs into tissues, tissues into cells, and cells into their components. However, we should keep in mind that, physically and functionally, there is only one integrated body and it is more than the sum of its parts. And even the body cannot be thought of as truly separate from its external environment. Although we may do this for study purposes, it is a limited viewpoint.
Continue reading …
The Longitudinal Neurologic Systems
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 3 from RC’s best-selling book:
“Basic Principles of Chiropractic Neuroscience”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 3: The Longitudinal Neurologic Systems
This chapter succinctly describes the basic structure and function of the six major longitudinal systems; viz, the sensory, motor, visceral, vascular, consciousness, and cerebrospinal fluid systems.
As we begin this chapter, it might be well for the reader to subjectively grasp the significance of the motor and sensory systems as far as possible. One exercise in this is to imagine that you had become unconscious and someone has placed you in a remote dark empty cellar, far beyond any source of environmental sound. The first thing you realize is that you are a total sensory and motor paralytic from the neck caudad. You are unable to move even a fingertip because your motor system is not functioning. Because there is no feeling, you do not know whether you are recumbent or tied in a chair. Your vision is normal, but there is no light. Your hearing is normal, but there is no sound. Your taste buds are functional, but there is nothing to eat or drink. Your olfactory organs are functional, but there are no detectable odors. There is little left except thought and memory.
After a time in this predicament, thoughts undoubtedly arise such as, “I wish I had really looked at the beauty of the world when I had a chance. I wish I had listened to the music of the masters and even the birds in my backyard when I had a chance. I gulped down so many delicious meals. I had a beautiful garden, but I rarely took time to appreciate its design and fragrance. I even failed to take time to appreciate the texture of my own clothes. I was in such a hurry to go nowhere that was more important. I missed so much.”
OVERVIEW
The human nervous system is a marvel in organizing and adapting to internal and external environmental changes:
(1) The receptors and afferent neurons of the visceral and somatic input systems are necessary to detect internal and external environmental changes.
(2) The visceral efferent neurons and the muscles of the motor output system must be stimulated if action is to be taken.
(3) The integrative system serves as intermediary stations via a complex arrangement of interneurons whose synapses control impulse strength and signal direction from the sensory system to the motor system.
Continue reading …
By Frank M. Painter, D.C. in Chiropractic Care on January 6th, 2013 at 1:54 pm
Clinical Biomechanics: Mechanical Concepts and Terms
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 2 from RC’s best-selling book:
“Clinical Biomechanics:
Musculoskeletal Actions and Reactions”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 2: Mechanical Concepts and Terms
All motor activities such as walking, running, jumping, squatting, pushing, pulling, lifting, and throwing are examples of dynamic musculoskeletal mechanics. To better appreciate the sometimes simple and often complex factors involved, this chapter reviews the basic concepts and terms involved in maintaining static equilibrium. Static equilibrium is the starting point for all dynamic activities.
Energy and Mass
Biomechanics is constantly concerned with a quantity of matter (whatever occupies space, a mass) to which a force has been applied. Such a mass is often the body as a whole, a part of the body such as a limb or segment, or an object such as a load to be lifted or an exercise weight. By the same token, the word “body” refers to any mass; ie, the human body, a body part, or any object.
Energy
Energy is the power to work or to act. Body energy is that force which enables it to overcome resistance to motion, to produce a physical effect, and to accomplish work. The body’s kinetic energy, the energy level of the body due to its motion, is reflected solely in its velocity, and its potential energy is reflected solely in its position. Mathematically, kinetic energy is half the mass times the square of the velocity: m/2 X V524. In a closed system where there are no external forces being applied, the law of conservation of mechanical energy states that the sum of kinetic energy and potential energy is equal to a constant for that system.
Potential energy (PE), measured in newton meters or joules, is also stored in the body as a result of tissue displacement or deformation, like a wound spring or a stretched bowstring or tendon. It is expressed mathematically in the equation PE = mass X gravitational acceleration X height of the mass relative to a chosen reference level (eg, the earth’s surface). Thus, a 100-lb upper body balanced on L5 of a 6-ft person has a potential energy of about 300 ft-lb relative the ground.
The Center of Mass
The exact center of an object’s mass is sometimes referred to as the object’s center of gravity. When an object’s mass is evenly distributed throughout, the center of mass is located at the object’s geometric center. In the human body, however, this is infrequently true, and the center of mass is located towards the heavier, often larger, aspect. When considering the body as a whole, the center of mass in the anatomic position, for instance, is constantly shifted during activity when weight is shifted from one area to another during locomotion or when weight is added to or subtracted from the body.
The term weight is not synonymous with the word mass. Body weight refers to the pull of gravity on body mass. Mass is the quotient obtained by dividing the weight of a body by the acceleration due to gravity (32 ft/sec524). Each of these terms has a different unit of measurement. Weight is measured in pounds or kilograms, while mass is measured by a body’s weight divided by the gravitational constant. The potential energy of gravity can be simply visualized as an invisible spring attached between the body’s center of mass and the center of the earth. The pull is always straight downward so that more work is required to move the body upward than horizontally (Fig. 2.1).
Newton’s Laws of Mechanics
Continue reading …
By Frank M. Painter, D.C. in Chiropractic Care on November 15th, 2012 at 9:31 pm
Orthopedic and Neurologic Procedures in Chiropractic
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 3 from RC’s best-selling book:
“Basic Chiropractic Procedural Manual”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 3: Orthopedic and Neurologic Procedures in Chiropractic
This chapter presents the general diagnostic methods currently used in differential diagnosis of selected orthopedic and neurologic conditions.
SELECTED NEUROLOGIC PROBLEMS
Overview
The typical patient presents the challenge of differential diagnosis of a number of neurologic conditions. These range from a variety of peripheral neuritides that may be completely reversible to serious degenerations of the central nervous system.
The tendency of the geriatric patient to develop neurologic problems is often related to the aging process: loss of tissue elasticity, particularly that of the musculoskeletal system. This is manifested by greater rigidity of the spinal column with the appearance of fixation subluxations. These, together with dehydration and subsequent thinning of the intervertebral discs, predispose to radiculitis, neuritis, and vasomotor disturbances and metabolic effects on the cord and brain. The neurologic disturbances can be superimposed on already degenerating arteriosclerotic vessels and alter metabolism of the gastrointestinal and other systems, which may cause serious problems unless recognized early and prompt corrective measures are administered.
Types of Neuritides
Peripheral Neuritis
Peripheral neuritis is a general peripheral neuritis such as that which may be present in such disorders as diabetes, anemia, and vitamin deficiency. Diminution of all sensation will be noted, with proprioception affected most. A stocking distribution with an ill-defined border is commonly witnessed. Glove distribution may appear later, along with paresthesias in the distal areas of sensory distribution. The clinical picture does not conform to either dermatome or nerve patterns of distribution. The cause for this is unknown.
Local Neuritis
Continue reading …
By Frank M. Painter, D.C. in Chiropractic Care on November 10th, 2012 at 12:03 pm
Introduction to Chiropractic Physiologic Therapeutics
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 10 from RC’s best-selling book:
“Basic Chiropractic Procedural Manual”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 10: Introduction to Chiropractic Physiologic Therapeutics
The use of physiotherapy and physical therapy to enhance the effects of the chiropractic adjustment in treatment can be significant in many cases. Superficial heat, diathermy, cold, microwaves, ultrasound, ultraviolet rays, galvanic and sinusoidal currents, traction, hydrotherapy, or therapeutic massage and exercise are among the therapies that may benefit the patient when properly applied. These procedures may help to reduce stiffness in joints, relieve tension, relax muscle spasm, and offer many other physiologic benefits.
Special precautions, however, must be observed when treating patients of advanced age. Special consideration must also be given to indications and contraindications, patient sensitivity, intensity, and duration of treatment.
Special caution must be used with patients that have heart and blood pressure problems, renal failure, diminished sensation or circulation, or an inability to tolerate heat or cold. For example, patients with Raynaud’s disease do not tolerate cold. Patients with other circulatory problems do not tolerate thermotherapy because they have less ability to dissipate the heat. Patients with a distinct loss of sensation will not realize if an area is being overheated or even being burned.
A patient’s tolerance cannot be the only guide to intensities and duration of treatment. Frequent checking, both visually for redness and by palpation to determine over heating, must be done during the treatment period. Reasonable examination, monitoring, and care by the doctor can avoid problems in most instances.
INTRODUCTION
Physiotherapy techniques are frequently used preparatory to the chiropractic adjustment to improve function, relieve spasm, minimize pain, and enhance circulation and drainage. They are often used before primary care to relax the patient and condition tissues, and posttherapy to relive pain and prevent deformities resulting from trauma or disease and to maintain what has been gained in treatment. There are also times when it may be considered primary therapy. Rehabilitation objectives are shown in Table 10.1.
Continue reading …
By Frank M. Painter, D.C. in Chiropractic Care on September 17th, 2012 at 12:46 pm
Diagnosis and Management of Piriformis Syndrome
The Chiro.Org Blog
SOURCE: J Am Osteopath Assoc. 2008 (Nov); 108 (11): 657-664 ~ FULL TEXT
Lori A. Boyajian-O’Neill, DO, Rance L. McClain, DO, Michele K. Coleman, DO, Pamela P. Thomas, PhD
Department of Family Medicine, Kansas City University of Medicine, Biosciences College of Osteopathic Medicine, 1750 Independence Ave, SEP 358, Kansas City, MO 64106-145, USA.
Piriformis syndrome is a neuromuscular condition characterized by hip and buttock pain. This syndrome is often overlooked in clinical settings because its presentation may be similar to that of lumbar radiculopathy, primary sacral dysfunction, or innominate dysfunction. The ability to recognize piriformis syndrome requires an understanding of the structure and function of the piriformis muscle and its relationship to the sciatic nerve. The authors review the anatomic and clinical features of this condition, summarizing the osteopathic medical approach to diagnosis and management. A holistic approach to diagnosis requires a thorough neurologic history and physical assessment of the patient based on the pathologic characteristics of piriformis syndrome. The authors note that several nonpharmacologic therapies, including osteopathic manipulative treatment, can be used alone or in conjunction with pharmacotherapeutic options in the management of piriformis syndrome.
From the Full-Text Article:
Epidemiologic Considerations
Piriformis syndrome occurs most frequently during the fourth and fifth decades of life and affects individuals of all occupations and activity levels. [7-12] Reported incidence rates for piriformis syndrome among patients with low back pain vary widely, from 5% to 36%. [3, 4, 11] Piriformis syndrome is more common in women than men, possibly because of biomechanics associated with the wider quadriceps femoris muscle angle (ie, “Q angle”) in the os coxae (pelvis) of women. [3]
You may also want to review
Post-isometric Relaxation (PIR) of the Psoas
Difficulties arise in accurately determining the true prevalence of piriformis syndrome because it is frequently confused with other conditions.
Anatomic Characteristics
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on August 6th, 2012 at 12:08 pm
Multiple Myeloma Presenting as Sacroiliac Joint Pain: A Case Report
The Chiro.Org Blog
SOURCE: J Can Chiropr Assoc. 2012 (Jun); 56 (2):94-101
Danielle Southerst, BScH, DC, John Dufton, DC, MSc, MD, Paula Stern, BSc, DC, FCCS(C)
Canadian Memorial Chiropractic College, Division of Graduate Studies, 6100 Leslie Street, Toronto, ON, M2H 3J1, (416) 482-2344 x 287; dsoutherst@cmcc.ca.
Multiple Myeloma (MM) is the most common primary cancer of bone in adults. The clinical presentation of MM is varied and depends on the sites and extent of involvement. Most importantly for chiropractors, the leading clinical symptoms of MM are related to bone neoplasm and may mimic pain of musculoskeletal origin. The following is the case of a 56 year old male chiropractic patient presenting with a 6 month history of sacroiliac joint pain previously diagnosed and managed unsuccessfully as a hematoma by multiple providers. Physical examination, imaging, and laboratory investigations confirmed a diagnosis of MM. The case report describes relevant pathophysiology, clinical presentation, imaging, and management for MM, while illustrating key issues in patient management as they relate to chiropractic practice and the recognition of pathology in the context of musculoskeletal pain.
From the FULL TEXT Article
Introduction:
Multiple Myeloma (MM) is a primary malignancy of bone marrow characterized by clonal proliferation of plasma cells and production of monoclonal immunoglobulin. It is the most common primary bone cancer in adults [1,2] contributing to 1.3% of new cancer cases in Canada and 1.9% of cancer deaths. [3] In 2008, an estimated 6000 Canadians were living with the disease, including 2100 newly diagnosed. [3] Myeloma is slightly more prevalent in males [4-6] and blacks. [4,5,7] The median age at diagnosis is 66, with the majority diagnosed over the age of 60; [8,9] however in a review of 1027 patients diagnosed with MM, 30% were under the age of 60 and the age of diagnosis ranged from 20–92. [8] The most common symptoms reported are those related to bone neoplasm including unexplained backache that is often severe and precipitated by movement. [8,11] These symptoms may motivate a patient to seek conservative care for what is assumed to be a complaint of musculoskeletal origin. This case emphasizes key components of patient management as they relate to chiropractic practice and the recognition of pathology in the context of a patient presenting with pain of presumed musculoskeletal origin.
Discussion:
Pathophysiology
Continue reading …
A Practical Guide to Avoiding Drug-Induced Nutrient Depletion
The Chiro.Org Blog
SOURCE: Nutrition Review ~ October 2011
By Hyla Cass, MD
A little known, but potentially life-saving fact is that common medications deplete your body of a host of vital nutrients essential to your health. This practical guide will show you how to avoid drug-induced nutrient depletion and discuss options for replacing nutrient-robbing medications with natural supplements.
America has been called a pill-popping society, and the statistics bear this out. Nearly 50 percent of all American adults regularly take at least one prescription drug, and 20 percent take three or more. [1] Our increasing reliance on prescription medications has contributed to the growing problem with nutrient depletion. The truth is that every medication, including over-the-counter drugs, depletes your body of specific, vital nutrients. This is especially concerning when you consider that most Americans are already suffering from nutrient depletion. Additionally, many of the conditions physicians see in their everyday practice may actually be related to nutrient depletion. The good news is that, armed with information and the right supplements, you can avoid the side effects of nutrient depletion, and even better, you may be able to control and prevent chronic diseases, such as diabetes, cardiovascular disease and osteoporosis.
There is more info like this at our:
Nutrient Depletion Page
A Common Scenario
Continue reading …
By Frank M. Painter, D.C. in Announcement on June 14th, 2012 at 10:16 pm
The Subluxation Complex Saves Diagnosis for Texas Chiropractors
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By James Edwards, DC
On April 5, 2012, the Third Court of Appeals of Texas issued a 58-page opinion in Cause No. 03-10-673-CV – the Texas Board of Chiropractic Examiners (TBCE) and the Texas Chiropractic Association (TCA) vs. the Texas Medical Association (TMA), the Texas Medical Board (TMB) and the State of Texas.
According to an April 6, 2012 communication by the Texas Chiropractic Association [1], the case presented three questions for the court:
1) Are the two TBCE rules that allow chiropractors to make certain “diagnoses” valid?
2) Can chiropractors perform MUA?
3) Can chiropractors perform needle EMG?
Here’s what the Court of Appeals had to say in the matter:
Diagnosis
On the two most important issues presented by the TCA, the Court of Appeals upheld the validity of TBCE’s Rules 75.17(d)(1)(A) and (B) (“the scope of practice rules”). The first rule, 75.17(d)(1)(A), permits chiropractors to render diagnoses “regarding the biomechanical condition of the spine and musculoskeletal system,” and lists six typical diagnostic areas as examples of what is within the scope of practice. At the district court level, Judge Yelenosky had struck down that rule, stating that it created an unlimited authorization to diagnose any disease or condition, which, he said, exceeded chiropractors’ scope of practice.
The Court of Appeals disagreed and reversed Judge Yelenosky’s decision. The court found that the TBCE rule does not exceed the scope of practice because the rule limits chiropractors to making diagnoses of the biomechanical condition of the spine and musculoskeletal system.
The second rule, 75.17(d)(1)(B), permits chiropractors to diagnose subluxation complexes of the spine or musculoskeletal system, and lists three examples of what is within the scope of practice. The Texas Medical Association and Texas Medical Board had challenged that rule, claiming that the rule allowed chiropractors to diagnose neurological conditions, and pathological and neurophysiological consequences that affect the spine and musculoskeletal system. At the district court level, Judge Yelenosky agreed and struck down the rule because he found that it expanded the scope of chiropractic beyond what was allowed in the Chiropractic Act.
Again, the Court of Appeals disagreed with District Court Judge Yelenosky. The appeals court acknowledged that a subluxation complex could have functional or pathological consequences that affect essentially every part of the body. But the court found that the rule itself only allowed chiropractors to render a diagnosis regarding a subluxation complex of the spine or musculoskeletal system. That authority, the appeals court held, was consistent with the Chiropractic Act.
Continue reading …
Forearm and Wrist Trauma
The Chiro.Org Blog
Clinical Monograph 18
By R. C. Schafer, DC, PhD, FICC
As with most parts of the body, traumatic effects in the forearm or wrist may occur abruptly (eg, fracture, strain, sprain) or be the result of long-term microtrauma (eg, tunnel syndromes, arthritis, entrapment by scar tissue).
BACKGROUND
Screening injuries of the forearm and wrist
Joint Motion Restriction
Restriction in pronation suggests a disorder at the elbow, radioulnar articulation of the wrist, or within the forearm. Restriction in supination is associated with a disorder of the elbow or radioulnar articulation of the wrist. Thickened tissues may cause compression symptoms. A palpable nontender ganglion may be found on either the dorsal or volar aspect of the wrist, perceived as a pea-size or slightly larger jelly-like cyst.
Significance of Tenderness
Tenderness over the medial collateral ligament, which rises from the medial epicondyle, is a sign of valgus sprain. Muscle tenderness in the wrist flexor-extensor group is characteristic of flexor-pronator strain (eg, tennis, screwdriving motions). Tender, possibly taut, wrist extensors on the lateral aspect are often associated with tennis elbow. Tenderness in the first tunnel on the radial side is a common site for stenosing tenosynovitis associated with a positive Finkelstein’s sign.
Continue reading …
Arm and Elbow Trauma
The Chiro.Org Blog
Clinical Monograph 17
By R. C. Schafer, DC, PhD, FICC
The shoulder girdle is a multiaxial intricately synchronized joint complex that has considerable power and an extreme range of motion. The anterior, superior, and posterior shoulder muscles provide the great power, and the collateral ligaments do not appreciably limit motion in any plane. Thus, stability must be provided by muscles: essentially the rotator cuff and subscapularis muscles of the arm, which are aided slightly by the glenohumeral ligaments.
BACKGROUND
The proximal ulna forms the most important articulation in the elbow area, while the distal radius forms the most important articulation in the wrist.
Elbow area injuries are commonly the result of direct blows or falls. Avulsion-type injuries of the elbow are often seen as a result of acute or chronic strain at a site of tendon or ligament attachment. As in all traumatic injuries, the sooner the patient is examined after injury, the more accurate the diagnosis. Swelling, spasm, tenderness, and motion limitations rapidly cloud the picture. A list of common elbow injury syndromes is shown in Table 1.
Table 1. Common Elbow Injuries
There are more materials like this @ our:
Shoulder Girdle Page
Continue reading …
Upper Back and Thoracic Spine Trauma
The Chiro.Org Blog
Clinical Monograph 23
By R. C. Schafer, DC, PhD, FICC
Upper-thoracic spasms and trigger points are common within the milder complaints heard in a chiropractic office. Typical posttraumatic injuries of the posterior thorax involve the large posterior musculature, thoracic spine, spinocostal joints, and tissues supporting and mobilizing the scapula (especially the rhomboids). Upper right abdominal quadrant ailments (eg, gallbladder, liver) commonly refer pain and sometimes tenderness to the right scapular area.
BACKGROUND
Severe biomechanical lesions of the thoracic spine are seen less frequently than those of the cervical or lumbar spine. But when they occur, they may be serious if related to disc protrusion or a dynamic facet defect. Shoulder girdle, rib cage, spinal cord, cerebrospinal fluid flow, and autonomic visceral problems originating in the thoracic spine are far from being scarce. Common biomechanical concerns are the prevention of thoracic hyperkyphosis, flattening, or twisting, as each can be suspected to contribute to both local and distal, acute and chronic possibly health-threatening manifestations.
Thoracic Fixations
The study of the thoracic spine is often perplexing. It was Gillet’s opinion that many fixations found in the thoracic spine were secondary (compensatory) to focal lesions in either the upper cervical spine or the sacroiliac joints. Thus, a maze of potential variables exists. Empiric evidence has suggested that many thoracic problems have their origin in its base, the lumbar spine or lower, while others are reflections of cervical reflexes. Also, a thoracic lesion may manifest symptoms in either the cervical or the lumbar spine. Foremost in an examiner’s thoughts should be the recognition that the thoracic spine is the structural support and sympathetic source for the esophagus, heart, bronchi, lungs, diaphragm, stomach, liver, gallbladder, pancreas, spleen, kidneys, and much of the pelvic contents. Referred pain and tenderness from these organs to the spine are common.
Screening Thoracic Vertebral Fractures
Continue reading …
A Basic Rehabilitative Template
The Chiro.Org Blog
Clinical Monograph 1
By R. C. Schafer, DC, PhD, FICC
INTRODUCTION
Injuries can be classified into 13 types: abrasions, contusions, strains, ruptures, sprains, subluxations, dislocations, fractures, incisions, lacerations, penetrations, perforations, and punctures. This paper will not detail the management of burns or injuries requiring referral for operative correction, suturing, or restricted chemotherapy.
Objectives
Except for the most minor injuries, traumatized neuromusculoskeletal tissues are benefited by alert restorative procedures. The more serious the injury, the more prolonged is and the greater the need for professionally guided rehabilitation. The first step in rehabilitation is to explain to the patient that rehabilitation is just as important as the initial care of the injury. The goal is not only to restore the injured part to normal activity or as near normal as possible in the shortest possible time but also to prevent posttraumatic deterioration. It is an individualized process that requires patient dedication. The author recognizes that it is easier to write about comprehensive planning than to motivate some patients to follow prescriptions after pain has subsided.
You may also enjoy our page on:
Chiropractic Rehabilitation
Most authorities would agree with Harrelson when he lists the goals of rehabilitation as:
- decreased pain;
- decreased inflammatory response to trauma;
- return of full pain-free active joint ROM;
- decreased effusion;
- return of muscle strength, power, and endurance; and
- regain of full asymptomatic functional activities at the preinjury level (or better).
Continue reading …
Joint Trauma:
Perspectives of a Chiropractic Family Physician
The Chiro.Org Blog
Clinical Monograph 8
By R. C. Schafer, DC, PhD, FICC
INTRODUCTION
The general stability of synovial joints is established by action of surrounding muscles. Excessive joint stress results in strained muscles and tendons and sprained or ruptured ligaments and capsules. When stress is chronic, degenerative changes occur.
The lining of synovial joints is slightly phagocytic, is regenerative if damaged, and secretes synovial fluid that is a nutritive lubricant having bacteriostatic and anticoagulant characteristics. This anticoagulant effect may result in poor callus formation in intra-articular fractures where the fracture line is exposed to synovial fluid. Synovial versus mechanical causes of joint pain are shown in Table 1.
Table 1. Synovial vs Mechanical Causes of Joint Pain
| Feature |
Synovitic
Lesions |
Mechanical
Lesions |
| Onset |
Symptoms fairly consistent, during use and at rest. |
Symptoms arise chiefly during use |
| Location |
Any joint may be involved. |
Primarily involves weight-bearing joints. |
| Course |
Usually fluctuates. Episodic flares are common. |
Persistently worsening progression. No acute exacerbations. |
| Stiffness |
Prolonged in the morning. |
Little morning stiffness. |
| Anti-inflammatory effect |
Aided by cold and other anti-inflammatory therapies. |
Anti-inflammatory therapy of only minimum value. |
| Major pathologic features |
Negative radiographic signs or diffuse cartilage loss, marginal bony erosions, but no osteophytes. |
Radiographic signs of cartilage loss and osteophyte developments |
Periarticular Lesions
Continue reading …
Posttraumatic Subluxation-Fixation Implications
Etiology, Effects, and Common Coincidental Factors
The Chiro.Org Blog
Clinical Monograph 5
By R. C. Schafer, DC, PhD, FICC
INTRODUCTION
The kinetic aspects of spinal biomechanics are an important consideration in traumatology since the totality of function is essentially the sum of its individual components. However, although reminders are frequently given, the multitude of causes and effects of an articular subluxation complex (spinal or extraspinal) will not be detailed here that is primarily directed to chiropractic clinicians and advanced students who are well acquainted with standard hypotheses. For a detailed description, the reader is referred to:
Basic Principles of Chiropractic:
The Neuroscience Foundation of Clinical Practice
Arlington, Virginia, American Chiropractic Association, 1990.
Basic Implications
The biomechanical efficiency of any one of the 25 vertebral motor units, from atlas to sacrum, can be described as that condition (individually and collectively) in which each gravitationally dependent segment above is free to seek its normal resting position in relation to its supporting structure below, is free to move efficiently through its normal ranges of motion, and is free to return to its normal resting position after movement. The degree of fixed derangement (subluxation-fixation) of a bony segment within its articular bed and normal range of motion may be an effect in the range of microtrauma to macroscopic damage. Regardless, it is always attended by some degree of mobility dysfunction; neurologic insult; and overstress of the muscles, tendons, and ligaments involved and their respective mechanoreceptors.
You may also enjoy our page on:
What is The Chiropractic Subluxation?
Once produced, the lesion becomes a focus of sustained pathologic irritation in which a barrage of impulses streams into the spinal cord where internuncial neurons receive and relay them to motor pathways. The contraction that provoked the subluxation initially is thereby reinforced, thus perpetuating both the subluxation and the pathologic process engendered. Sensory reflex phenomena can also be involved, and they frequently are. The nerve impulse creates a multitude of cellular reactions and responses besides those of even the most intricate, subtle, and variable sensations and motor activities. Once this is appreciated, we must add the complexities of trophic effects, neuroendocrine interrelations, biochemical affinities, proprioceptive buildup, summation increments, facilitation patterns, the input of the ascending and descending reticular activating mechanisms, genetic neurologic diatheses, synaptic overlaps, demoralization and disintegration of synaptic thresholds, the neurologic spread and buildup, reflex instability, predisposition to sensorial aberrations, undue cerebrovisceral or viscerocerebral interactions, psychosomatic overtones, and those many phenomena that science is only beginning to understand or are beyond our present understanding. This underscores that the quality and sometimes quantity of nerve function relates directly or indirectly to practically every bodily function and contributes significantly to the beginning of physiologic dysfunction and the development of pathologic processes.
Structural Imbalance
Continue reading …
Shoulder Girdle Trauma
The Chiro.Org Blog
Clinical Monograph 16
By R. C. Schafer, DC, PhD, FICC
The articulations of the scapula, clavicle, and the humerus function as a biomechanical unit. Only when certain multiple segments are completely fixed can these parts possibly function independently in mechanical roles. Forces generated from or on one of the three segments influence the other two segments. Thus, they will be described here as a functional unit. Please underscore this point in your mind as you read this paper.
BACKGROUND
Shoulder pain can arise from either local or systemic causes. Jaquet points out that about 95% of all shoulder disorders are due to four conditions:
- adhesive capsulitis
- simple tendinitis,
- tendinous perforation and rupture, and
- hyperalgesic calcareous tendinitis.
Note that three of these four conditions are tendinous in origin, but tendon inflammation is not as common in the shoulder as it is in the elbow and wrist. However, because all tendons are relatively avascular, all are subject to chronic trauma, microtears, slow repair, and aging degeneration.
As in so many musculoskeletal disorders, thorough investigation of the history of shoulder pain may reveal that trauma did not initiate the first attack or an injury was just a precipitating event that revealed an underlying degenerative disorder. Besides direct injury, shoulder pain may have an inflammatory, a neurologic, a psychologic, a vascular, a metabolic, a neoplastic, a degenerative, a congenital, an autoimmune, or a toxic origin.
You may also enjoy our page on:
The Shoulder Girdle and also
Chiropractic Rehabilitation
Deciphering Shoulder Complaints
Shoulder pain has a high incidence. Cailliet says that it ranks third to low-back and neck pain. Despite its prevalence, posttraumatic shoulder pain can be deceiving. Accurate diagnosis is not an easy task. For example, there may be unavoidable occupational stress in the clinical picture that is aggravating the condition and delaying healing. How should the patient react when a doctor says “avoid overhead work” and the patient makes his living as a painter or pipe fitter of ceiling sprinkler systems? Temporary rest can be provided but not permanent relief from such occupational stress. It may have taken the patient many years of effort to reach his present status. This is not easily put aside. Counsel the patient thoroughly — from his or her viewpoint.
Normal mobility is extensive. The glenohumeral joint alone expresses abduction, adduction, elevation, extension, external rotation, flexion, horizontal abduction, horizontal adduction, and internal rotation. Thus, a thorough knowledge of shoulder kinematics, neurology, angiology, myology, and kinesiology is required for proper treatment to be applied.
Continue reading …
By Frank M. Painter, D.C. in Chiropractic Care on March 15th, 2012 at 11:13 am
Clinical Decision-making to Facilitate Appropriate Patient Management in Chiropractic Practice: ‘The 3-questions Model’
The Chiro.Org Blog
Chiropractic & Manual Therapies 2012 (Mar 14); 20: 6
Lyndon G Amorin-Woods and Gregory F Parkin-Smith
Murdoch University, School of Chiropractic and Sports Science, South Street, Murdoch, 6150 Perth, Western Australia. L.Woods@murdoch.edu.au.
Background: A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis.
Discussion: This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called ’3-Questions Model’;
Summary: Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.
From the FULL TEXT Article:
Development of the 3-questions Model
The chiropractic profession, particularly in Western countries, finds itself in a rapidly evolving healthcare landscape, with ‘modernisation’ being a consequence of escalating costs, an aging population, and an ever-diminishing relative resource base [9]. With a view to rationalising resources health system decision-makers are increasingly vigilant about the delivery of safe, evidence-based, cost-effective care, summarised as “the right care at the right time in the right place” [10, 11]. With this imperative in mind, the authors propose three straightforward questions that frame clinical decision-making within the context of diagnostic uncertainty.
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on January 1st, 2012 at 11:18 am
Chiropractic Management of Post-concussion Headache and Neck Pain In a Young Athlete and Implications For Return-To-Play
The Chiro.Org Blog
Topics in Integrative Health Care 2011 (Oct 7); 2 (3)
By: Mark T. Pfefer, RN, MS, DC, Stephen R. Cooper, DC, Angela M. Boyazis
Professor, Director of Research, Cleveland Chiropractic College, KS, USA
Objective: Each year there are an estimated 1.6 to 3.8 million sports-related brain injuries; 136,000 of which occur in young athletes in the course of high school sports. The purpose of this article is to discuss the management and outcome of a post-concussive headache and neck pain in a young athlete and implications for return to play.
Clinical Features: A 16-year-old male athlete presented to a chiropractic clinic complaining of neck pain and daily headaches from a concussion while playing football 5 weeks previously.
Intervention and Outcome: A short course of diversified-type cervical and thoracic manipulation was applied with significant relief after the second treatment and resolution of symptoms after 5 visits performed over 2 weeks. The athlete was able to participate in a graduated return to play. Three months post-SRC the athlete was able to return to full game play symptom free.
Conclusion: Chiropractors who see athletes in their practices should be aware of SRC and return to play guidelines.
Introduction
Recently attention has been focused on sports-related concussions (SRC), in part due to the untimely concussion-related deaths of high school athletes, cognitive problems in professional football players, and head injuries sidelining professional hockey players for extended periods of time. Understanding the signs and symptoms of SRC and appropriate return-to-play recommendations is imperative to the safety of all athletes and young athletes in particular.
Each year in the United States, there are an estimated 1.6 to 3.8 million sports-related brain injuries; [1] 136,000 of which occur in young athletes in the course of high school sports. [2] However, these statistics may be grossly underestimated. McCrea and colleagues [3] found over half of a sample of high school football players did not report a head injury, even though it had occurred. One of the reasons for this is a failure of athletes to recognize their injury as significant. Delany and coworkers [4, 5] found that only 18.8% to 23.4% of concussed players in the Canadian Football League, and Canadian university football and soccer players realized they had sustained a concussion. Another factor in the underestimation of SRCs is the reporting of head injuries to untrained personnel, such as coaches or parents, who in turn may fail to recognize a concussion. [3, 6, 7]
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on December 12th, 2011 at 10:04 pm
Motion Palpation of the Pelvis
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 6 from RC’s best-selling book:
“Motion Palpation”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 6: Motion Palpation of the Pelvis
Differentiating Sacroiliac from Lumbar Fixations
To differentiate sacroiliac from lumbar fixations, Faye offers the following comments for consideration.
With the patient sitting and their hands placed behind their head, rotate the patient’s trunk first to the right and then to the left. Special care should be taken not to lift the patient’s pelvis. Motion restriction of the patient’s left lumbar facets or left sacroiliac joint will reduce rotation to the left (positive theta Y). Motion restriction of the patient’s right lumbar facets or right sacroiliac joint will inhibit rotation of the patient’s trunk to the right (negative theta Y).
To discern between a lumbosacral or sacroiliac lesion, the patient is allowed to relax against the doctor (patient’s hands are still behind their head). In this position, the lumbosacral joint is relatively stress free. Next, twist the patient’s trunk into posterior rotation on the right until the patient’s left ischial tuberosity lifts slightly (buttocks remaining on palpation stool). In this position, there is a marked posterior torsion strain on the right sacroiliac joint. If pain arises in the right sacroiliac that can be relieved by pushing the left ilium posteriorly, then the pain can be assumed to arise from the right sacroiliac joint. Reverse the doctor-patient positions to differentiate fixations on the left. This is Mennell’s modified Kemp’s test for the lumbosacral area.
Here are some helpful clues: The patient suffering from sacroiliac dysfunction gets up in the morning with stiffness that improves with activity. The patient suffering with facet inflammation and/or an IVD lesion arises improved, but the condition worsens as the day goes on. Fixation produces a sharp pain on certain movements that is relieved when the site is not stressed. Other points characteristic of a sacroiliac lesion are:
1. There is usually unilateral pain in the sacroiliac joint.
2. The patient may describe an onset involving a lifting or twisting maneuver upon which a “catch” in the back is felt.
3. The patient has difficulty rising from bed, and the disability is worse in the morning, improving with activity.
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on December 11th, 2011 at 3:57 pm
Motion Palpation of the Lumbar Spine
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 5 from RC’s best-selling book:
“Motion Palpation”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 5: The Lumbar Spine
This chapter describes the dynamic chiropractic approach to the correction of fixations of the lumbar spine and related tissues. Emphasis is on biomechanical, fixation, and therapeutic considerations. Some significant points in differential diagnosis are also described.
According to Faye, the three most common types of low back pain are:
(1) the lumbar facet syndrome,
(2) the sacroiliac syndrome, and
(3) the lumbar radicular syndrome, which may be discogenic or biomechanical in origin.
Each of these types can be acute or chronic, traumatic or nontraumatic, and have varying degrees of concomitant pathomechanics. The syndromes are named according to the level of inflammation or pain-producing structures and more than likely not the area in need of adjustments. Their typical cause may be due to:
sprain/strain,
overuse,
poor posture,
disuse,
joint dysfunction (fixation/hypermobility),
development abnormality,
degenerative changes,
or various combinations of these origins.
In addition, the possibility of viscerosomatic and somatosomatic reflexes should not be overlooked.
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on December 7th, 2011 at 5:26 pm
Sports Management:
Lumbar Spine, Pelvic, and Hip Injuries
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 26 from RC’s best-selling book:
“Chiropractic Management of Sports and Recreational Injuries”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 26: LUMBAR SPINE, PELVIC, AND HIP INJURIES
Facet Syndromes
The subluxation of lumbar facet structures, states Howe, is a part of all lumbar dyskinesias and must be present if a motor unit is deranged. In a three-point articular arrangement, such as at each vertebral motor unit, no disrelationship can exist that does not derange two of the three articulations. Thus, determination of the integrity or subluxation of the facets in any given motor unit is important in assessing that unit’s status.
ROENTGENOLOGIC CONSIDERATIONS
Any method of spinographic interpretation which utilizes millimetric measurements from any set of preselected points is most likely to be faulty because structural asymmetry and minor anomaly is universal in all vertebrae. However, the estimation of the integrity of facet joints is a reliable method of assessing the presence of intervertebral subluxation. An evaluation of the alignment of the articular processes comprising a facet joint may be difficult from the A-P or P-A view alone when the plane of the facet facing is other than sagittal or semisaggital. In this case, oblique views of the lumbosacral area are of great value in determining facet alignment since the joint plane and articular surfaces can nearly always be visualized.
When one cannot visually identify disrelationships of the facet articular structures, Howe suggests use of Hadley’s S curve. This is made by tracing a line along the undersurface of the transverse process at the superior and bringing it down the inferior articular surface. This line is joined by a line drawn upward from the base of the superior articular process of the inferior vertebrae of the lower edge of its articular surface. These lines should join to form a smooth S. If the S is broken, subluxation is present. This A-P procedure can be used on an oblique view.
DIFFERENTIATION
To help differentiate the low back and sciatic neuralgia of a facet syndrome to that of a disc that is protruding:
l. With the patient standing with feet moderately apart, the doctor from behind the patient firmly wraps his arms around the patient’s pelvis and firms his lateral thigh against the back of the patients’ pelvis. The patient is asked to bend forward. If it is a facet involvement, the patient will feel relief. If it is a disc that is stressed, symptoms will be aggravated.
2. In facet involvement, the patient seeks to find relief by sitting with feet elevated and resting upon a stool, chair, or desk. In disc involvement, the patient keeps knees flexed and sits sideways in his chair and moves first to one side and then to the other for relief. If lumbosacral and sacroiliac pain migrates from one to the other side, it is suspected to be associated with arthritic changes.
Lumbosacral Instability
Lumbosacral instability is a mechanical aberration of the spine which renders it more susceptible to fatigue and/or subsequent trauma by reason of the variance from the optimal structural weight-bearing capabilities. Hariman states that between 50% and 80% of the general population exhibit some degree of the factors which predispose to instability whether by reason of anomalous development of articular relationships or altered relationships due to trauma or disease consequences. It is the most common finding of lumbosacral roentgenography and often brought to light after an athletic strain.
Continue reading …
By Frank M. Painter, D.C. in Cervical Spine on December 5th, 2011 at 5:10 pm
Sports Management:
Neck and Cervical Spine Injuries
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 22 from RC’s best-selling book:
“Chiropractic Management of Sports and Recreational Injuries”
Second Edition ~ Wiliams & Wilkins
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 22: NECK AND CERVICAL SPINE INJURIES
Soft-Tissue Injuries of the Posterior Neck
Cervical Contusions, Strains, and Sprains
Contusions in the neck are similar to those of other areas. They often occur to the cervical muscles or spinous processes. Painful bruising and tender swelling will be found without difficulty, especially if the neck is flexed. Phillips points out the necessity of normally lax ligaments at the atlanto-axial joints to allow for normal articular glidding, thus making tonic muscle action the only means by which head stability is obtained.
Strains (Grades 1–3) or indirect muscle injuries are common, frequently involving the erectors. Flexion and extension cervical sprains are also common in sports (Grades 1–3), and usually involve the anterior or posterior longitudinal ligaments, but the capsular ligaments may be involved. In the neck especially, strain and sprain may coexist. Severity varies considerably from mild to dangerous. Anterior injuries are more common to the head and chest as they project further anteriorly, but a blunt blow from the front to the head or chest may result in an indirect extension or flexion injury of the cervical spine. Many cervical strains heal spontaneously but may leave a degree of fibrous thickening or trigger points within the injured muscle tissue. Residual joint restriction following acute care is more common in traditional medical care than under mobilizing chiropractic supervision.
Cervical sprain and disc rupture are associated with severe pain and muscle spasm and are more common in adults because of the reduced elasticity of supporting tissues. Pain is often referred when the brachial plexus is involved. Cervical stiffness, muscle spasm, spinous process tenderness, and restricted motion are common. When pain is present, it is often poorly localized and referred to the occiput, shoulder, between the scapulae, arm or forearm (lower cervical lesion), and may be accompanied by paresthesias. Radicular symptoms are rarely present unless a herniation is present.
Diagnosis and treatment are similar to that of any muscle strain-sprain, but concern must be given to induced subluxations during the initial overstress. Palpation will reveal tenderness and spasm of specific muscles. In acute scalene strain, tenderness and swelling will usually be found. When the longissimus capitis or the trapezius are strained, they stand out like stiff bands.
Extension Injuries. When the head is violently thrown backwards (eg, whiplash), the damage may vary from minor to severe tearing of the anterior and posterior ligaments. Severe cord damage can occur which is usually attributed to momentary pressure from the ligamentum flavum and lamina posteriorly, even without roentgenographic evidence. A facial injury usually suggests an accompanying extension injury of the cervical spine as the head is forced backward. Management of minor injuries requires reduction of subluxations, traction, physiotherapeutic remedial aid, a supporting collar for as long as postural muscles are inadequate for structural support, followed by graduated therapeutic exercises.
Continue reading …
www.chirowebs.net
|
If you use this box to shop,
we receive a small commission.
Support Chiro.Org when you shop!
|
Stories Feed
Recent Comments