DIVERSIFIED I REVIEW

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DIVERSIFIED I REVIEW

• Photos Courtesy of
• 1 Spine, Spinal Cord and ANS
• Cramer Darby
• 2 Spinal Biomechanics and Specific Adjusting
• Otto C. Reinert, D.C, F.I.C.C.

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MANUAL CONTACTS

• Pisiform
• Hand Heel
• Pollicus/Thenar
• Lateral Index
• Distal or Flat Thumb
• Modified Pollicus (Thenar)
• Chiropractic Index

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THUMB-PISIFORM
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DOUBLE THUMB
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IDENTIFY DOCTORS MANUAL CONTACTS

• Superior Hand
• Inferior Hand
• Manual contacts

Spinal Biomechanics and Specific Adjusting Otto
Reinert, D.C.
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OSSEOUS/VERTEBRAL CONTACTS

• PELVIS (S/I jt)
• PSIS
• ASIS
• Sacral Ala
• Ischial Tuberosity

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OSSEOUS/VERTEBRAL CONTACTS

• LUMBAR SPINE
• Spinous
• Mamillary

IVD space
Mamillary
Spinous
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OSSEOUS/VERTEBRAL CONTACTS

• THORACIC SPINE
• Spinous
• Transverse Process
• Rib

Transverse
Spinous
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OSSEOUS/VERTEBRAL CONTACTS

• LOWER CERVICAL
• Articular pillar (capsule/rotation)
• Lateral aspect (Luschka trauma)

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OSSEOUS/VERTEBRAL CONTACTS

• UPPER CERVICAL
• Occiput
• Mastoid
• Atlas TP
• C2 spinous

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HVLAHIGH VELOCITY LOW AMPLITUDE

• SPEED AND SPECIFICITY
• Specific Osseous Contact Applied
• Joint is taken to maximum resistance
• Specific Line of DriveForce(s) Directed and
  Applied to the Joint
• Move Motor Unit to Voluntary End Range
• Sudden Load is Applied, Moving Joint Past its End
  Range, Creating Cavitation

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Table Position While Patient is Prone

• Foot piece elevated
• Pelvic piece at or below level of greater
  trochanters
• Abdominal piece unlocked
• Head piece level or slightly below

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SPINOUS RECOIL THRUST

• Doctors Stance
• Faces in at 90º on same side of spinous
  laterality
• Pisiform Manual Contact (L1 2 sup. L4 5 inf.)
• Spinous Osseous Contact
• Doctor instructs patient to turn head toward
• LOD
• Anterior-medial
• Execution
• Lean-in with 20-25 lbs pressure w/ flexed elbows
• Quick extension of elbows1 INCH60-65 lbs of
  pressure with immediate recoil

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LUNGE THRUST

• Doctors Stance
• Faces superiorly at 45 º (exception may face
  inferiorly)
• Any manual contact
• Osseous contact depends upon region of spine
• LOD
• Depends upon specific subluxation pattern
• Execution
• Arms fully extended taking jt to max resistance
  (55 lbs)
• Front leg flexed, back leg extended
• Transference of body weight from legs through
  extended arms, turning the shoulders and hips in
  with the thrust
• HOLD, then slowly release

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IMPULSE THRUST

• Doctors Stance
• Faces in at 45 º
• Any manual contact
• Osseous contact depends upon region of spine
• LOD
• Depends upon specific subluxation
• Execution
• Lean in with extended arms to max resistance
  (20-25 lbs)
• Flex elbows
• For thrust, quickly contract pects and triceps,
  fully extending elbows
• HOLD, then slowly release

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PELVIC ACCOMODATIONS

• STANDING
• When the patient laterally flexes the Lumbar
  Spine to the RIGHT
• PSIS- On the LEFT goes Posterior and Inferior
• PSIS- On the RIGHT goes Left and Superior
• SEATED
• Patient flexes forward
• PSISs go Posterior and Inferior
• Patient extends backward
• PSISs go Anterior and Superior

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ARTHROKINEMATIC REFLEX

• SUPINE
• Internal Rotation
• Leg Shortens
• External Rotation
• Leg Lengthens

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SEATED EVALUATION

• Internal and External Rotation with approximation
  and flaring of thighs
• Flexion-PI and Extension-SA
• Motion palpation

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SACRUM

• Integral part of pelvis- Key Stone in an
  Arch
• Increased vertical load leads to an increase in
  joint surface bonding
• Supports Vertebral Column
• Disperses weight from spine to pelvis
• Transmits forces from lower limbs upward

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SACROILIAC DYSFUNCTION

• Most often a SYMPTOM rather than a PRIMARY cause
  of distortion
• Common cause of low back ache, but not usually
  responsible for severe low back pain
• The total pelvis tips, sways and rotates in
  accommodation to eccentric weight imposition upon
  it
• Unequal weight into each S/I joint- leads to
  abnormal gait
• Pelvis consistently responds to changes in weight
  distribution

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SECTIONAL TOWERING

• Lateral movement of the spine away from open
  wedge
• BASE- where primary open wedge located
• APEX- found at the top of the sectional towering,
  open wedge on opposite side
• ANATALGIA- Leaning of body AWAY from side of open
  wedge

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ANTALGICPOSTURE

• To the patients LEFT
• Sectional tower will be to the patients LEFT
• Side of Open Wedge or BASE of the sectional
  tower will be on the patients RIGHT

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TYPICAL

• ROTATION WITH LATERAL FLEXION-
• Spinous rotates TOWARD side of open wedge
• Body rotates PI

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ATYPICAL

• ROTATION WITH LATERAL FLEXION
• Spinous rotates AWAY from side of open wedge
• Body rotates Superior Posterior

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POSTURE ANALYSISDISCOVERING SPINAL CURVATURES

• Scapula prominence
• PELVIC AND SHOULDER UNLEVELING
• RIB HUMP- SAME SIDE OF CONVEXITY

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PALPATION of VERTEBRALMALPOSITIONS

• FOR ROTATIONAL MALPOSITION
• Spinous deviation
• Mamillary prominence on the opposite side
• FOR LATERAL FLEXION MALPOSITION
• Appearance of the base of a sectional tower of
  the spine
• May or may not have deviation of spinous at the
  base if there is deviation, it may be toward or
  away from the side of open wedge
• Side of body rotation will be side of prominent
  mamillary

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DAMAGING STRESSES ON THE IVD

• 1 Flexion with axial rotation
• Flexion
• Excessive axial compression
• Degenerative changes

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PARTSPPain

• Doctors notes may reflect
• Location
• Quality
• Intensity
• Observation
• Percussion
• Provocation
• Palpation
• Visual analog scales
• Pain questionnaires

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PARTSAAsymmetry/Alignment

• Doctors notes must reflect
• Sectional or segmental level
• Observation
• Posture
• Gait
• Palpation or X-Ray evidence of
• Misalignment
• Asymmetry

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PARTSRRange of Motion Abnormality

• Doctors notes must reflect
• Decrease or Increase of
• Active, Passive or Accessory joint motion
• Verified by
• Motion palpation
• Stress X-ray

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PARTST Tissue Tone, Texture, Temp.

• Doctors notes may reflect
• Abnormal changes in
• Skin
• Fascia
• Muscle
• Ligaments
• Identified by
• Observation
• Palpation
• Instrumentation
• Length and strength

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PARTSS Special Tests

• Doctors notes may reflect
• Test specific to a technique system