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 By Frank M. Painter, D.C. in Diagnosis on December 3rd, 2011 at 3:27 pm
Sports Management:
Peripheral Nerve 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 17 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 17: PERIPHERAL NERVE INJURIES
Neurotherapy and Spondylotherapy
Neurotherapy refers to the inhibition of overly active nerve function or the activation of sluggish function. Spondylotherapy is the treatment by physical methods applied to the spinal region. A nerve fiber may be stimulated artificially (ie, mechanically, thermally, chemically, electrically) anywhere along its course.
Certain nerve fibers function specifically for certain sensory and motor acts and may be stimulated at either their central or peripheral ends: efferent nerves are stimulated centrally and afferent nerves peripherally. The ability of sensory nerve stimulation to produce a motor or glandular response is readily demonstrated in eliciting any tendon reflex where superficial percussion produces the characteristic jerk, the muscle-spasm reflex resulting from skin exposure to a cool wind or proprioceptive excitement from strain or sprain, or the salivary response from seeing a person eat a lemon.
Neuroinhibition. Abnormal reflexes appear to be inhibited more by pressure and cold than by any other methods. For example, a painful splinting erectormuscle spasm can be relaxed by placing the muscle in a position of functional rest and then applying mild continuous stretching or pressure. Cold is an excellent neuroinhibitor, especially with nerves which are located not too deep. Functional inhibition can be gained by stimulating a nerve whose chief function is inhibitory. Pressure may be applied digitally or with a pressor instrument at or near the paravertebral spaces. Steady pressure on the surface of the body, usually applied digitally, over the course of a nerve tends to be a restraining influence. There also appears to be a reflex influence upon vessels and glandular secretions. Certain skin areas (eg, suboccipital, paraspinal, parasacral, perianal, peripheral-meridian) are highly responsive to mild pressure from which reflexes of vasodilation and muscle relaxation can be initiated.
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on December 1st, 2011 at 2:36 pm
General Principles of Clinical Neurology
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:
“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 2: General Principles of Clinical Neurology
The nervous system and the endocrine system work as partners to provide the majority of functional control for body processes. Guyton, the renowned physiologist, describes the basic function of the nervous system to be the controlling factor for rapid activities such are necessary for muscle contraction, rapidly changing visceral events, and the rate of endocrine secretions.
The dominant action of the nervous system over the physical processes of the body is called neurarchy. In contrast to the nervous system, the endocrine system principally regulates the metabolic functions of the body and controls prolonged physiologic activities.
OVERVIEW
The demanding role of the nervous system of the human body can be appreciated by recognizing that during every minute of life the nervous system must receive thousands of signals from a countless variety of sensory organs, integrate the data, prepare necessary responses, and effect the responses via a multitude of motor and/or autonomic efferent mechanisms. Thus, a specialized network of nerve tissue permeates the body in such a manner that some parts receive and respond to stimuli from the external or internal environments, some parts transmit signals to and from integrating and coordinating centers, and some parts conduct messages from centers peripherally to muscles, vessels, or glands to effect an action.
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By Frank M. Painter, D.C. in Diagnosis on November 29th, 2011 at 1:57 pm
Clinical Disorders and the Autonomic Nervous 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 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: Clinical Disorders and the Autonomic Nervous System
This chapter is an overview of the clinical aspects of autonomic dysfunction that emphasizes the clinical aspects of sympathetic and parasympathetic disorders. Such topics as stress and the neurodystrophies, the evaluation of visceral function, and reflexology are described. A review of the section titled “The Visceral System” within Chapter 3 will be beneficial to the reader of this chapter.
Wiles has stated that “Visceromotor articles made up 14% of the ACA Journal of Chiropractic articles in 1977. They made up 8.9% in 1985. If we wanted to, this could be extrapolated out and this type of article would die out by 1992.” If this occurs, a great injustice would be done to the potential of the profession as well as the public it serves. It appears that some in the profession have lost sight of the fact that it was the successful management of visceral and systemic conditions that sustained chiropractic during its early years.
It was the opinion of James Firth, then president of Lincoln Chiropractic College, that chiropractic was a dying profession around the period of World War I. He stated, “There is no question in my mind that it was the successful results of chiropractic during the great influenza epidemic following the war that saved it. Hundreds of thousands of people were dying, and medicine had no solution to the problem. Chiropractors got results, and the word quickly spread throughout the nation. Chiropractic offices that had been nearly empty became filled, and state legislators began to take the chiropractic profession seriously in spite of the opposition of the AMA.”
OVERVIEW
Embryologically, the somatic structures appear late in development as compared to the vegetative nervous system, which serves as the chief integrating and correlating system of the visceral structures. The voluntary and vegetative nervous systems are intimately connected and brought into reflex connection so that visceral stimulation has skeletal and somatic expression and skeletal muscle messages are expressed in visceral tissues: The body is a whole.
Vegetative action is slow when compared to voluntary action. In addition, human will, at least for normal consciousness without specialized training (eg, biofeedback), has little power to direct visceral effects as one would direct a skeletal muscle because vegetative functions must be conducted whether one is awake or asleep. In certain acts, however, voluntary and vegetative nerves supplement one another such as in swallowing, breathing, defecation, urination, and seminal ejaculation.
Sympathetic Distribution
The sympathetics are widespread in their distribution. Through their innervation of blood vessels, sympathetic fibers reach every tissue of the body. They control blood vessel diameter, subdermal structures, heart muscle, the sphincter system of the gut and urinary apparatus, and parts of the bladder and reproductive organs; they inhibit many structures in the head and chest; and they reach the enteral system’s muscles and glands.
While it is widely recognized that the cervical sympathetic chain communicates with the lower cranial nerves, Parkinson and associates have confirmed that the sympathetic nerve running with the carotid artery gives off a multitude of fine branches at irregular intervals as the nerve travels cephally. The largest residual component joins the cranial VI (abducens) and leaves to join the cranial V (trigeminal) nerve. Similar fibers have not been found to join the cranial III (oculomotor) or IV (trochlear) nerves.
Parasympathetic Distribution
The parasympathetics activate the intrinsic eye muscles, glands of the peripheral head, bronchi muscles and glands, entire enteral system, body of the bladder; they inhibit the heart; and they provide vasodilation in many structures (especially the head and penis).
STRESS AND THE NEURODYSTROPHIES
An autonomic efferent nerve has two major functions: (1) impulse conduction and
(2) a trophic influence on receptor organ growth, repair, immunity, and cellular alterations in disease.
While these conduction and trophic functions are of equal importance and separate actions, trophic functions have unfortunately received secondary interest by most research neurologists. Because interference with trophic function serves an important role within chiropractic concepts, several pertinent findings are described in this section.
Research on nonimpulse initiated communication between the neuron and its end structures has increased in recent years. Singer relates that despite considerable controversy modern consensus accepts the role of neurotrophic and impulse stimulation in the maintenance of muscle tissue. He feels that, experimentally, it has been difficult to report these two mechanisms for individual study because most information has been obtained in model systems.
Autoadaptation and Immunity
Guth, Gutmann, and Gurkalo/Zabezhinski show that there should be no question that the autonomic nervous system regulates directly and indirectly the functions of all organs and tissues and influences even biochemical processes at the cellular and subcellular level.
After observing more than 15,000 patients with infectious diseases and studying the host-parasitic relation in infectious disease, Sato found that the adaptation of the human body to the internal environment is maintained by an autoadaptation mechanism operating upon the biological binary digit. That is, the autoadaptation mechanism has two antagonistic systems (sympathetic and parasympathetic divisions) that are composed of many antagonistic links: (1) the two reciprocal nerves of the autonomic nervous system;
(2) two phases (rise and fall) of mitosis of the neurotrophic system in bone marrow; and
(3) two defense reactions (the cell-stimulant factor reaction and the antibody-antigen reaction).
These binary antagonistic links are interconnected into two systems that are controlled by the two antagonistically functioning nerves (sympathetic and parasympathetic) of the autonomic nervous system.
In a following study, Sato found that the autoadaptation mechanism of the human body loses its rationality and purposefulness by an imbalance of the autonomic nervous system, and the host body falls into adaptational disturbances. He reports that hosts with sympathicotonia often fall into acute adaptational disturbances in the acme to the convalescent stage by stimuli of the second-phase factors (the factors lowering mitosis of the neurotrophic system in the bone marrow), resulting sometimes in death.
Review the complete Chapter (including sketches and Tables)
at the ACAPress website |
By Frank M. Painter, D.C. in Diagnosis on November 27th, 2011 at 8:06 pm
Clinical Disorders and the Motor 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 9 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 9: Clinical Disorders and the Motor System
OVERVIEW
Such clinical features as fatigue, weakness, nervousness, pain, tenderness, paralysis, sensory loss, paresthesia, and abnormalities of muscle mass or tone are the most common signs and symptoms noted in neural disorders. Fatigue, weakness, and nervousness are frequently presented together. This triune can usually be attributed to a functional disorder or appear as a complication in organic disease.
Abnormal striated muscle function has its origin in diseases of the brain, spinal cord, peripheral nerves, or muscle tissue itself. Dysfunction occurs in a variety of symptoms and signs such as:
(1) impaired movements,
(2) spontaneous movements,
(3) coordination defects,
(4) abnormal reflexes,
(5) distortions of muscle tone, and
(6) postural and movement distortions.
Weakness, wasting, and sometimes paralysis are represented in these conditions. Common types of motor lesions are shown in Table 9.1.
Basic Neuromuscular Activities
There are two fundamental types of neuromuscular activity. One type consists of reflex postural contractions, which are the basis of posture and physical attitudes and maintain muscle tone. The other type consists of phasic contractions, which produce movement. Phasic contractions may be either reflex or volitional in origin. While reflex actions are always purposeful, predictable, and involuntary, cortical activity is not.
Neurons carrying phasic and tonic impulses have distinctive characteristics. Phasic motor neurons are large, have a rapid conduction velocity, have a high threshold of physiologic excitability, present large impulses of short duration, and are electrically silent during rest. In contrast, tonic motor neurons are smaller, have a slower conduction velocity, have a lower threshold of physiologic excitability, present smaller impulses of longer duration, and are electrically active during rest.
Muscle and Joint Correlations
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on November 20th, 2011 at 2:44 pm
Clinical Geriatrics: A Diagnostic Compendium
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 8 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 8: Clinical Geriatrics: A Diagnostic Compendium
The objective of this chapter is to focus attention on disorders witnessed in practice by those dealing with the geriatric patient. Following neurologic disorders, heart, vascular, and blood disorders are discussed. Digestive and gastroenterologic disturbances are then followed by disorders of the urinary system, skin, endocrines, and reproductive system. Next, eye, ear, and throat conditions are followed by orthopedic and respiratory considerations. The chapter concludes with information about the sexual aspects of aging, common complaints and symptoms, and other pertinent considerations.
The topics described in this chapter are not to be considered a complete reference for all geriatric conditions seen in practice. They have been chosen as those most likely to be encountered or because they present a unique situation necessary for differentiation and/or case management.
While some described disease states may not be commonly considered within the scope of chiropractic general practice, their diagnosis is. Thus, this general knowledge will help clarify when referral should be considered, thus serving the best interests of the patient and possibly avoiding a potential accusation of professional negligence.
It is the editor’s opinion that most errors in diagnosis or judgment do not occur from a lack of clinical knowledge. They occur as the result of a hurried history and examination. A clinician must be self-disciplined to give full attention to the patient at hand, without distracting concern for those patients waiting in the reception room.
CLINICAL APPROACH
In past years, it was a frequent fault of young practitioners of all disciplines to contribute age an important etiologic factor. It is emphasized that age alone is an inadequate factor in the cause of severe illness in the elderly. Careful examination, treatment of the whole individual, and prolonged follow-up is necessary for optimal results.
Most pathologists readily admit that disease is a process, not a state, but rarely is the process defined other than to say that disease of any tissue or organ is the result of disturbed function — normal physiology gone wrong.
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on November 18th, 2011 at 1:53 pm
Endocrine Imbalance
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 13 from RC’s best-selling book:
“Clinical Chiropractic: Upper Body Complaints”
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 13: Endocrine Imbalance
CLINICAL BRIEFING
The nervous and endocrine systems work hand in hand. The nervous system is design to operate body functions when rapid response is necessary. For long-term duty, the endocrines take over and simulate neural activity. These two systems can be compared to an athlete who sprints in a 100-yard dash and another who runs a marathon. They have two different roles but are not entirely independent in either role. They are integrated, synergistic, and facilitating.
Sympathetic stimulation increases the secretion of the adrenals, pancreas (including islets), pineal gland, and thyroid and parathyroids. The parasympathetics generally have a reverse or unknown effect. See Table 16.18.
The highly integrated system of ductless glands in the body produces internal secretions (hormones) that discharge into circulating blood or lymph to affect remote tissues. Some of these glands also produce external secretions. The adrenals, isles of Langerhans of the pancreas, thyroid, parathyroid, pituitary (hypophysis) ovaries, and testes are true endocrine glands. The thymus and pineal body have not been shown to produce hormones.
CNS Endocrine Function
Research of recent years has shown that the brain and spinal cord also secrete many specific and nonspecific hormone-like substances into blood or lymph. Brain endorphins and enkephalins and spinal cord dynorphins and enkephalins are typical examples. Many other similar substances are likely to be discovered as investigation continues. The subtle functions of the nervous system are pioneer fields of study.
Normal Effects
The endocrine system acts similar to a chemical nervous system. Like the nervous system, self-contained positive and negative feedback mechanisms (essentially hypothalamic, pituitary, or peripheral) are crucial to proper operation and integration of body functions.
Among the physiologic processes influenced by hormones are resistance to disease; rate of systemic metabolism; rate of metabolism of specific substances; rate of growth, development, and repair processes; rate of development and function of the reproductive organs, primary and secondary sexual characteristics, and degree of libido; and the secretory activity of other endocrine glands. Hormonal processes also play an important role in the development and function of the CNS, personality formation, and how the body reacts to stress. Thus, hormones may have a specific effect on a specific organ or tissue or produce a wide systemic effect on the entire body.
General Causes of Endocrine Imbalance
Endocrine dysfunction may result from inadequate secretion or hypersecretion. Activity is under the control of the nervous system, certain circulating chemical influences, and other hormones. There is barely any pathologic process having a neurologic component that does not involve to some degree parts of the endocrine system. Because of the important role the endocrines have in maintaining homeostasis, the effects of disease, neoplasm, stress, and maladaptation can be widespread. The extent that the imbalance will have on body function depends on the severity and duration of the disturbance.
Review the complete Chapter (including sketches and Tables)
at the ACAPress website |
By Frank M. Painter, D.C. in Diagnosis on November 17th, 2011 at 6:27 pm
Clinical Chiropractic: The Wrist and Hand
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 9 from RC’s best-selling book:
“Clinical Chiropractic: Upper Body Complaints”
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 9: The Wrist and Hand
CLINICAL BRIEFING
Structural Considerations
Clinically, the most important articulation in the elbow is formed by the proximal ulna and the distal radius forms the most important articulation in the wrist. The carpals articulate with the ulna only during extreme wrist adduction.
The distal row of carpals forms a complex joint with the proximal row. Because they are loosely connected, the navicular and trapezium spread during wrist abduction and approximate during adduction. The proximal carpals rock and glide toward the ulna during wrist abduction and toward the radius during adduction. Adduction is slightly greater in pronation because the styloid process of the ulna restricts motion when the hand is supinated. During adduction, the styloid swings backward out of the way. As the A-P curve of the proximal carpals is more acute than the transverse curve, greater excursion is allowed in wrist flexion and extension than in lateral motion. The more delicate the patient’s bone structure, the greater the mobility.
The intricate anatomical architecture of the wrist allows flexion (80°), extension (70°), radial deviation (30°), ulnar deviation (20°), supination and pronation of the forearm.
Basic Wrist and Finger Biomechanics
The muscles of the wrist course obliquely to the parts to be moved. This requires coordination with other muscles whenever the wrist is moved. Wrist strength in flexion is nearly double that in extension, and the power of extension is greatly lessened when the wrist is fully flexed. During extreme flexion of the wrist, it is impossible to strongly curl the fingers in full flexion because the flexor tendons are slack. When the wrist is hyperextended, the extensors relax and the fingers cannot hyperextend fully. These are two important considerations during examination.
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on November 15th, 2011 at 5:29 pm
Clinical Chiropractic: The Shoulder and Arm
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:
“Clinical Chiropractic: Upper Body Complaints”
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: THE SHOULDER AND ARM
CLINICAL BRIEFING
Shoulder Pain
Shoulder pain can be deceiving. As in so many musculoskeletal disorders, consideration of pain in the shoulder should not give priority to sudden trauma whether it be of intrinsic or extrinsic origin. Thorough investigation of the history may reveal that trauma did not initiate the first attack or that an injury was just a precipitating event that revealed an underlying degenerative disorder. Besides trauma, 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. See Table 7.1.
The Complexities in Treating Shoulder Complaints
Many practitioners would be happy if another patient with a shoulder complaint did not enter their offices. There are five major reasons for this:
- The shallow shoulder joint is highly unstable. Its stability is provided by muscles rather than the strong ligament straps provided in most other joints. This makes recurring disorders common. The answer is therapeutic exercise, but many patients soon get bored with such regimens and the prescribed exercises are stopped long before adequate strength is acquired. Thus thorough counseling and monitoring are required.
- The shoulder area is unique in its wide extremes in range of motion. There is abduction, adduction, downward rotation, upward rotation, and depression in the shoulder girdle. The shoulder (glenohumeral joint) 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.
- Cases presenting with what initially appears to be the result of minor trauma are often misdiagnosed. The shoulder and arm are common sites of referred pain from the cervical spine, lungs, heart, mediastinum, diaphragm, liver, and gallbladder. Sometimes a lesion in the wrist or elbow will refer pain to the shoulder. As tenderness also can be referred, a thorough diagnostic workup is required in almost all cases of shoulder pain, tenderness, paresthesia, and weakness. This must incorporate a thorough knowledge of
referred pain patterns and reflexology.
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on November 14th, 2011 at 6:39 pm
Clinical Chiropractic: The Elbow and Forearm
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 8 from RC’s best-selling book:
“Clinical Chiropractic: Upper Body Complaints”
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: The Elbow and Forearm
CLINICAL BRIEFING
Functional Considerations
The arm and forearm are joined by a joint that serves as both a hinge and a pivot. The semilunar notch of the ulna is hinged with the hyperboloid trochlea of the humerus. The proximal head of the radius pivots with the spherical capitulum of the humerus and glides against both the proximal and distal ends of the ulna.
The distal end of the humerus can be viewed as two columns: a larger one medially that articulates with the semilunar notch of the ulna, and a smaller one laterally that articulates with the head of the radius. The pulley-like trochlea apparatus has:
(1) a depression at the front that lodges the coronoid process of the ulna and
(2) a depression at the rear that holds the olecranon process of the ulna when the elbow is extended.
The olecranon process restricts hyperextension of the elbow and protects the ulnohumeral articulation posteriorly. The concave head of the radius glides against the spherical capitulum of the humerus. The capitulum and trochlea are separated by a bony crest that fits into the opening between the proximal ulna and the radius and serves as a fixed rudder to guide elbow motion. The elbow flexors originate from the medial epicondyle, and the extensors originate from the lateral epicondyle. This structural arrangement should be visualized during examination to discriminate normal from abnormal articular motion.
The basic range of elbow joint motion involves elbow flexion (135°) and extension (0°), and forearm supination (90°) and pronation (90°). If a motion block is found in active motion, passive motion should be checked and the type of restriction and its degree noted.
Clinical Analysis
The elbow joint was not made to be used as an organic battering ram, but it often is: purposefully in sports; by accident in falls. For this reason, the vast majority of elbow disorders has trauma as their origin or precipitating factor.
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on November 13th, 2011 at 9:31 pm
General Factors Involved in Vitamin and Mineral Deficiencies
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 the Appendix from RC’s best-selling book:
“Symptomatology and Differential Diagnosis”
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.
General Factors Involved in Vitamin and Mineral Deficiencies
Several general factors are involved in vitamin and mineral deficiencies. For example, abnormal loss and utilization or subnormal absorption, intake, storage, or transport, singularly or in combination, may readily lead to symptoms of nutritional deficiency.
See Table A.1.
You may also find value reviewing the:
Nutrient–Drug Depletion Charts
Agents Contributing to Vitamin, Mineral, and Other Nutrient Deficiency Symptoms
Drugs and nutrients often have adverse interactions. Drugs usually interfere with normal cellular nutrition by:
(1) depressing the central appetite center,
(2) decreasing normal blood levels (eg, excessive excretion),
(3) interfering with the nutrient’s storage or metabolism,
(4) developing a chemical antagonism (eg, inactivate),
(5) increasing the action of ingested antivitamins or antiminerals, or
(6) destroying intestinal bacteria necessary to synthesize the nutrient.
See Tables A.2, A.3, and A.4.
Continue reading …
By Frank M. Painter, D.C. in Cervical Spine on November 12th, 2011 at 12:00 pm
The Posterior Neck and Cervical 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:
“Symptomatology and Differential Diagnosis”
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 Posterior Neck and Cervical Spine
Introduction
With the important exception of neurologic and vertebral artery syndromes, most of the disorders witnessed in the posterior aspect of the neck are musculoskeletal conditions. Of particular significance are the symptom complexes of cervical arthritis, deformities, disorders of muscle tone, IVD syndromes, spondylosis, vertebral subluxation, tumors, and the effects of trauma. It is helpful to keep in mind that tumors of the cervical spine are usually secondary and that chronic degenerative disc disease and congenital anomalies may be asymptomatic for many years.
Functional Considerations
Nowhere in the spine is the relationship between the osseous structures and the surrounding neurologic and vascular beds as intimate or subject to disturbance as it is in the neck. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the brachial plexus and cervical spine.
The gross mechanical function of the neck is determined by analysis of joint motion and muscle strength.
EVALUATING JOINT MOTION OF THE NECK
Gross joint motion is roughly screened by inspection during active motions. When a record is helpful, it is usually measured by goniometry. The prime movers and accessories responsible for voluntary joint motion in the cervical region are shown in Table 5.1.
EVALUATING MUSCLE STRENGTH OF THE NECK
Muscle strength is recorded as from 5 to 0 or in a percentage and compared bilaterally whenever possible. The major muscles of the neck, their primary function, and their innervation are listed in Table 5.2.
Structural and Neurologic Considerations
The healthy posterior neck provides stability and support for the cranium, a flexible and protective spine for movement, balance adaptation, and housing for the spinal cord and vertebral artery. From a biomechanical viewpoint, primary cervical subluxation syndromes may reflect themselves in the total habitus; from a neurologic viewpoint, insults may manifest throughout the motor, sensory, and autonomic nervous systems. Unlike the lumbar region, cervical disc herniations are not frequently associated with severe trauma; however, traumatic nerve root or cord compression has a high incidence in this area.
A general classification of musculoskeletal disorders of the neck is shown in Tables 5.3, and the function of the nerves of the cervical plexus and the brachial plexus is shown in Tables 5.4 and 5.5.
Anomalies and Deformities
Gross anomalies are rarely seen in chiropractic practice unless well adapted to the individual’s life-style. Those cases that have biomechanical significance vary in severity from minor to severe and occur multiply or singly. The cause is purely genetic transmission in about 35% of cases, and the remainder is due to environmental factors or a mixture of genetic and environmental factors.
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on June 19th, 2011 at 10:37 am
Musculoskeletal Development and Sports Injuries in Pediatric Patients
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Deborah Pate, DC, DACBR
Physical activity is extremely important for everyone, but especially for children. A well-designed exercise program enhances the physical and intellectual development of a child. Competitive sports are often a child’s first introduction to programmed exercise.
In the past decade, there has been an increase in the number of children participating in team and solo sports. Younger children are allowed to participate in sports for enjoyment, health and personal development. However, this changes as competitive elements become more dominant and young athletes train harder and longer, and may practice a sport throughout the whole year. Consequently, sports-related injuries in children have significantly increased.
To understand pediatric injuries that can occur during sports performance, it’s important to be aware of the peculiarities of the growing musculoskeletal system. Children’s tendons and ligaments are relatively stronger than the epiphyseal plate; therefore, with severe trauma the epiphyseal plate will give way before the ligament. However, children’s bones and muscles are more elastic and heal faster. At the peak period of adolescent linear growth, the musculoskeletal system is most vulnerable because of imbalances in strength and flexibility and changes in the biomechanical properties of bone.
Physiological loading is beneficial for bones, but excessive strains may produce serious injuries to joints. Low-intensity training can stimulate bone growth, but high-intensity training can inhibit it. Growth plate disturbances resulting from sports injuries can result in limb-length discrepancy, angular deformity or altered joint mechanics, possibly causing permanent disabilities. Sports involving contact and jumping have the highest injury levels.
Pediatric Musculoskeletal Growth
Chiropractors have been uniquely trained to understand the musculoskeletal system, making them excellent resources for the management of sports-injuries. We need only to make certain we are aware of the peculiarities of the pediatric musculoskeletal system when pursuing appropriate evaluation and case management.
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on June 14th, 2011 at 7:16 pm
Introduction to the Dynamic Chiropractic Paradigm
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.
The following is Chapter 1 from RC’s best-selling:
“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 1: INTRODUCTION TO THE DYNAMIC CHIROPRACTIC PARADIGM
Overview of the Dynamic Chiropractic Approach
This chapter presents an overview of the background and basic concepts of Dynamic Chiropractic. The normal motions of spinal and related articulations, general considerations of spinal fixations, the different types of fixations, the significant physiologic mechanisms associated, a comparison of traditional and modern definitions of the vertebral subluxation complex, and other basic concepts are summarized.
In 1936, a small group of Belgium chiropractors began what was to be a long research project. Its aim was to study what chiropractors refer to as a subluxation, which is traditionally defined as an incomplete dislocation, a displacement in which the articular surfaces have not lost contact, or a partially reduced (spontaneously) dislocation.
Outstanding within the Belgium group were Drs. H. Gillet and M. Liekens. These investigators, who have been involved in this study for more than half a century, soon found that the clinical phenomenon of subluxation was a great deal more complicated than the effects of the oversimplified picture of “a bone out of place” that has been commonly proposed since the turn of the century. Their findings reported in the Belgium Research Notes are a testimony to their skillful observations. Although the theory of “a displaced vertebra” contained enough truth within it to constitute a basic therapeutic approach that could be justified by large numbers of positive benefits witnessed empirically, it was not sufficient to serve as a scientific hypothesis.
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By Frank M. Painter, D.C. in Diagnosis on November 20th, 2010 at 12:02 pm
Alteration of Motion Segment Integrity
The Chiro.Org Blog
Dynamic Chiropractic
By Jeffrey Cronk, DC, CICE
Sometimes the internal discourse that is common in our profession seems to get in the way of our acceptance of real help so that we can expand our profession and better serve our patients. Alteration of motion segment integrity (AOMSI) is a significant gift from the AMA that allows us to methodically locate, substantiate and objectively prove the severity of the spinal subluxation. Of course, it comes as a gift only as long as we handle it with a high level of responsibility.
Alteration of motion segment integrity is determined by exact mensuration procedure published in the AMA Guides to the Evaluation of Permanent Impairment. It is a spinal subluxation that can be objectively identified with a high degree of accuracy, especially when one acknowledges the advancements that have occurred in assessment of stress imaging (X-ray, DMX).
Please remember that some of the most significant advancements in functional radiology assessment came from information gained from our profession’s very first federal research grant, awarded in the mid 1970s. It was University of Colorado scientist Chung Ha Suh, PhD, who secured the first chiropractic funding from the National Institutes of Health (NS 12226 01A1). Suh’s main areas of research focused on the development of computerized, kinematic models of the spine and three-dimensional, distortion-free X-ray analysis. This research improved our ability to more accurately measure articular deformations such as AOMSI.
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By Frank M. Painter, D.C. in Diagnosis on September 17th, 2010 at 5:39 pm
UPDATE: Texas Judge Finally Rules on Diagnosis Issue
The Chiro.Org Blog
Dynamic Chiropractic ~ 9-17-2010
Put yourself in the position of a practicing doctor of chiropractic in Texas right about now (if you are one, this is easy). With the Texas Medical Board and Texas Medical Association breathing down your neck, threatening to take away your right to diagnose (or even use the word diagnosis in your scope-of-practice act, claiming that by medical definition, the word is reserved for medical doctors and doctors of osteopathy), a Texas judge has ruled in your favor – depending on your perspective.
While Judge Stephen Yelenosky rejected the TMB/TMA reasoning that diagnosis does not apply to non-MD/DO providers, he did render the chiropractic scope-of-practice act null and void as currently written. By all accounts, any rewrite will need to update the current language in the act, which does not include the word diagnosis (but according to the Texas Chiropractic Association and others, clearly implies it by stating that DCs can “analyze, examine and evaluate”). It is unclear whether the revised scope will need to satisfy Judge Yelenosky’s prior suggestion that chiropractic diagnosis should be limited to “the biomechanical condition of the spine and the musculoskeletal system.”
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By Frank M. Painter, D.C. in Diagnosis on July 30th, 2010 at 3:30 pm
Clinical Biomechanics: Basic Factors of Biodynamics and Joint Stability
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.
The following is Chapter 3 from RC’s best-selling:
“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 3: Basic Factors of Biodynamics and Joint Stability
The techniques used for analyzing static positions of the body are only approximate inasmuch as forces accompanying movement incorporate such dynamic factors as acceleration, momentum, friction, the changing positions of rotational axes, and the resistance and support offered by tissues other than muscles. This chapter discusses the basic concepts and terms of biodynamics, biomechanical stress, and the biomechanical aspects of articular cartilage pertinent to the clinical setting.
Structural Motion
The study of dynamics is concerned with loads and the motions of bodies (kinematics) and the action of forces in producing or changing their motion (kinetics). Kinematics lets us describe the characteristics of motion position, acceleration, and velocity such as in gait or scoliotic displacements. Here we are concerned with the position of the center of mass of the body and its segments, the segmental range of motion, and the velocity and direction of their movements. In kinetics, we become concerned with the forces that cause or restrict motion such as muscle contraction, gravity, and friction. A complete biomechanical analysis of human motion or motion of a part would include both kinematic and kinetic data.
Motion can be defined as an object’s relative change of place or position in space within a time frame and with respect to some other object in space. Thus, motion may be determined and illustrated by knowing and showing its position before and after an interval of time. While linear motion is readily demonstrated in the body as a whole as it moves in a straight line, most joint motions are combinations of translatory and angular movements that are more often than not diagonal rather than parallel to the cardinal planes. In addition to muscle force, joint motion is governed by factors of movement freedom, axes of movement, and range of motion.
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By Frank M. Painter, D.C. in Cervical Spine on July 28th, 2010 at 11:37 pm
Clinical Biomechanics: The Cervical 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 7 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 7: CLINICAL BIOMECHANICS OF THE CERVICAL SPINE
This chapter considers those factors that are of biomechanical and related clinical interest imperative to the satisfactory evaluation of common or not infrequent cervical syndromes. The discussion assumes that the physician is skilled in taking a thorough clinical history and performing the basic physical, orthopedic, neurologic, and roentgenographic examination procedures. The kinesiology and kinematics of the neck, the effects and mechanisms of cervical trauma, and a number of clinical problems are discussed that are pertinent to the diagnosis and management of musculoskeletal cervical disorders.
General Aspects of Cervical Trauma
Blows to the head or neck may result in unconsciousness, but most blows do not. Rather, the effect is a “subconcussive” or “punch drunk” effect for a few moments. This state may be the effect of a severe blow to the head or the cumulative effects of many blows. It is assumed that the reader is well acquainted with the proper emergency procedures involved in head and neck trauma.
The anterior and lateral aspects of the neck contain a wide variety of vital structures that have no bony protection. Partial protection is provided by the cervical muscles, the mandible, and the shoulder girdle. After spinal injury, a careful neurologic evaluation must be conducted. Note any signs of impaired consciousness, inequality of pupils, or nystagmus. Do outstretched arms drift unilaterally when the eyes are closed? Standard coordination tests such as finger-to-nose, heel-to-toe, heel-to-knee, and for Romberg’s sign should be conducted, along with superficial and tendon reflex tests. For reference, the segmental functions of the cervical nerves are listed in Table 7.3.
Cervical spine injuries can be classified as being: (1) mild (eg, contusions, strains);
(2) moderate (eg, subluxations, sprains, occult fractures, nerve contusions, neurapraxias);
(3) severe (eg, axonotmesis, dislocation, stable fracture without neurologic deficit); and
(4) dangerous (eg, unstable fracturedislocation, spinal cord or nerve root injury).
Soft-Tissue Injuries of the Posterolateral Neck
CERVICAL CONTUSIONS
Contusions in the neck are similar to those of other areas. They often occur in the cervical muscles or spinous processes. Painful bruising and tender swelling will be found without difficulty, especially if the neck is flexed. They present little biomechanic significance unless severe scarring occurs.
DIRECT NERVE TRAUMA
Nerve trauma occurs from contusion, crushing, or laceration.
Neurapraxia.
Recovery of nerve contusion usually occurs within 6 weeks. Nerve contusion may be the result of either a single blow or through persistent compression. Fractures and blunt trauma are often associated with nerve contusion and crush. Peripheral nerve contusions exhibit early symptoms when produced by falls or blows. Late symptoms arise from pressure by callus, scars, or supports. Mild cases produce pain, tingling, and numbness, with some degree of paresthesia. Moderate cases manifest these same symptoms with some degree of motor and/or sensory paralysis and atrophy.
Axonotmesis. After nerve crush, recovery rate is about an inch per month between the site of trauma and the next innervated muscle. If innervation is delayed from this schedule or if the distance is more than a few inches, surgical exploration should be considered.
Neurotmesis. Laceration from sharp or penetrating wounds is less frequently seen than tears from a fractured bone’s fragments. Surgery is usually required. Stretching injury typically features several sites of laceration along the nerve and is usually limited to the brachial plexus.
Review the complete Chapter (including sketches and Tables)
at the ACAPress website |
By Frank M. Painter, D.C. in Diagnosis on July 27th, 2010 at 4:11 pm
Applied Physiotherapy: Rehabilitation Methodology
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 13 from RC’s best-selling book:
“Applied Physiotherapy in Chiropractic”
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 13: Rehabilitation Methodology
The topics of this chapter have been adapted from Volume 1, Chiropractic Rehabilitation, by K. D. Christensen, DC, © 1990, and used here with permission.
INTRODUCTION
Strengthening exercises for the muscular system play an essential role in the chiropractic management of various neuromusculoskeletal disorders. Knowledge of various training methods and exercise techniques are thus among the most important requirements for effective treatment. [1] Properly conducted individual exercise programs help prevent many injuries and serve to shorten the recovery period necessary to restore the patient back to health. [2] Exercise programs can be designed to increase strength, aid weight loss, increase cardiorespiratory efficiency, or simply improve overall musculoskeletal performance.
All exercise programs should have specific goals in mind. The cornerstone of exercise is Davis’ Law, or the (SAID) principle that states that the body makes specific adaptation to imposed demands. [3] The more specific the exercise, the more specific the adaptation. Exercise, therefore, should be as specific as possible to the individual’s goals and needs.
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By Frank M. Painter, D.C. in Diagnosis on June 29th, 2010 at 6:15 pm
Clinical Biomechanics: The Upper Extremity
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:
“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 10: THE UPPER EXTREMITY
This chapter considers forces acting within and upon the shoulder girdle, arm, forearm, and hand, and their related clinical problems, with emphasis on the related musculoskeletal disorders. Therapy can be directed efficiently when the mechanisms of injury are appreciated and correction is applied in harmony with proven biomechanical principles.
The Shoulder Girdle and Arm
The structure of the upper extremity is composed of the shoulder girdle and the upper limb. The shoulder girdle consists of the scapula and clavicle, and the upper limb is composed of the arm, forearm, wrist, hand, and fingers. However, a kinematic chain extends from the cervical and upper thoracic spine to the fingertips. Only when certain multiple segments are completely fixed can these parts possibly function independently in mechanical roles.
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By Frank M. Painter, D.C. in Acupuncture on June 20th, 2010 at 6:08 pm
Commonly Used Meridian Points
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:
“Applied Physiotherapy in Chiropractic”
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: Commonly Used Meridian Points
This chapter delineates a few of the many theories attempting to explain the mechanisms of acupuncture point (acupoint) stimulation and meridian therapy. Stimulation of specific points on the body as a mechanism for pain control has achieved great interest in this country in recent years. The majority of studies center on stimulating endorphin production in the body. See Table 3.1. Antidotal and clinical evidence as well as patient records from Oriental cultures point to numerous cases where specific point stimulation has affected visceral and functional disease processes. In the context of physiologic therapeutics, the location, primary indications, and precautions associated with the major points (ie, those most commonly used) are reviewed.
Both Western and Eastern cultures developed systems for treating specific points on the body. It is hoped that future generations will be able to integrate the best of traditional Western and Oriental medicine into a single health-care delivery system for all people. [ 1]
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By Frank M. Painter, D.C. in Diagnosis on May 16th, 2010 at 8:00 pm
General Causes and Potential Effects 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 6 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 6: General Causes and Potential Effects of the Subluxation Complex
This chapter reviews the concepts underlying chiropractic articular therapy, with emphasis placed on neurologic implications. General etiology, manifestations, terminology, pertinent anatomical features, and applications are described.
SPINAL SUBLUXATION: CAUSES AND EFFECTS
Until the last 2 decades, most evidence about the success of chiropractic adjustments on the correction of vertebral subluxations and their related functional disturbances was empiric. The gap between controlled research documentation and frequent clinical observation still exists, but it has greatly narrowed in recent years.
The greatest concern today is not is it effective but why is it effective and why is it effective in some cases but not in others that appear almost identical? Added to these can be the questions: what causes the positive effects in a specific body area that result from spinal adjustments that cannot be explained on an anatomical basis and what causes the indirect, far-reaching, diverse improvement in function so often witnessed?
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By Frank M. Painter, D.C. in Diagnosis on February 24th, 2010 at 3:48 pm
Evaluating Soft-Tissue Neck Trauma
The Chiro.Org Blog
After neck injury, a careful neurologic evaluation must be conducted, and every examination should begin with a thorough case history. (See Table 1). Note any signs of impaired consciousness, inequality of pupils, or nystagmus. Do outstretched arms drift unilaterally when the eyes are closed? Standard coordination tests such as finger-to-nose, heel-to-toe, heel-to-knee, and for Romberg s sign should be conducted, along with superficial and tendon reflex tests.
Continue reading …
Headache: The Management of Pain and Disability
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:
“Clinical Chiropractic: The Management of
Pain and Disability: Upper Body Complaints”
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: HEADACHE
CLINICAL BRIEFING
Headache is one of the most common complaints presented in a chiropractic office. It is not unusual for a few adjustments to correct a problem for which the patient has suffered for years and sought relief from a score of allopaths in vain. Nevertheless, headache is not a simple problem. Its origin may be traumatic, inflammatory, neurologic, psychologic, vascular, endocrine, metabolic, neoplastic, degenerative, deficiency, congenital, allergic, autoimmune, or toxic.
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By Frank M. Painter, D.C. in Diagnosis on October 21st, 2009 at 11:41 am
Symptomatology: The Lumbar and Sacral Areas
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 12 from RC’s best-selling book:
“Symptomatology and Differential Diagnosis”
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 12: THE LUMBAR AND SACRAL AREAS
Low Back Pain
Low back pain has been the second most frequent health complaint in the United States for many years, second only to headaches. More lost working hours are attributed to this affliction than any other factor, and the vast majority of these complaints find their cause in biomechanical failures. These failures are often complex, accumulative, and subtly hidden by the body’s marvelous adaptive mechanisms –a diagnostic challenge when pain is solely referred.
BASIC INVESTIGATIVE APPROACH
Because of its prevalence, backache requires a meticulous consideration of all possibilities, a comprehensive case history, and a systematic examination associated with necessary laboratory data and x-ray findings. In addition, emotional factors must be considered. In eliciting the case history, the manner of onset, location and nature of pain and spasm, aggravating and relieving factors, and a thorough systems review are almost mandatory if professional justice to the patient is to be achieved.
The Lumbar Nociceptive Receptor System. The lumbar ligaments and fascia are richly innervated by nociceptive receptors. When the lumbar spine is in a relaxed neutral position, its nociceptive receptor system is relatively inactive. However, any mechanical force that will stress or deform receptors, with or without overt damage, or any irritating chemical of sufficient concentration will depolarize unmyelinated fibers and enhance afferent activity. Thus, the pain experienced after either intrinsic or extrinsic trauma can be the result of mechanical factors, chemical factors, or both.
Mechanical Pain. Normal mechanical force applied to normal tissue does not produce pain. However, abnormal mechanical deformation occurs whenever:
(1) abnormal stress is applied to normal tissues (eg, postural pain),
(2) abnormal stress is applied to abnormal tissues, or
(3) normal stress is applied to abnormal tissues (eg, soft-tissue shortening).
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By Frank M. Painter, D.C. in Diagnosis on October 20th, 2009 at 1:01 am
Basic Musculoskeletal Considerations
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 bestfselling book:
“Chiropractic Physical and Spinal Diagnosis”
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: BASIC MUSCULOSKELETAL CONSIDERATIONS
The skeletal system provides the body framework, shape, articulations, supports, it protects the vital organs, and it furnishes a place for muscle attachment. It provides protection for the internal organs, provides movement when acted upon by muscles, manufactures blood cells, and stores mineral salts. The muscular system moves and propels the body. In order for the skeletal and muscular systems to function properly, the nervous system gives the body awareness of its environment, enables it to react to stimuli from the environment, and allows the body to work as a unit by coordinating its activities.
Inspection, palpation, and mensuration are the three most common techniques used in examination of the musculoskeletal system. As with all systems, a knowledge of anatomy and the pathophysiology involved is essential to make the examination significant.
The Functional Skeleton
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