Diagnosis

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. (more…)

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. (more…)

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. (more…)

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. (more…)

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. (more…)