Diagnosis

UPDATE: Texas Judge Finally Rules on Diagnosis Issue

By Frank M. Painter|September 17, 2010|Diagnosis, News|

UPDATE: Texas Judge Finally Rules on Diagnosis Issue

SOURCE: 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.” (more…)

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Clinical Biomechanics: Basic Factors of Biodynamics and Joint Stability

By Frank M. Painter|July 30, 2010|Diagnosis, Education|

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. (more…)

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Clinical Biomechanics: The Cervical Spine

By Frank M. Painter|July 28, 2010|Cervical Spine, Diagnosis, Education|

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

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Applied Physiotherapy: Rehabilitation Methodology

By Frank M. Painter|July 27, 2010|Diagnosis, Education, Rehabilitation|

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. (more…)

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Clinical Biomechanics: The Upper Extremity

By Frank M. Painter|June 29, 2010|Diagnosis, Education|

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. (more…)

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Commonly Used Meridian Points

By Frank M. Painter|June 20, 2010|Acupuncture, Diagnosis, Education, Meridian Points|

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]

(more…)

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