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DIVERSIFIED I REVIEW

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. MANUAL CONTACTS. Pisiform Hand Heel Pollicus/Thenar Lateral Index Distal or Flat Thumb Modified Pollicus (Thenar)

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DIVERSIFIED I REVIEW

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  1. 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.

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

  3. THUMB-PISIFORM

  4. DOUBLE THUMB

  5. IDENTIFY DOCTOR’S MANUAL CONTACTS • Superior Hand • Inferior Hand • Manual contacts Spinal Biomechanics and Specific Adjusting Otto Reinert, D.C.

  6. OSSEOUS/VERTEBRAL CONTACTS • PELVIS (S/I jt) • PSIS • ASIS • Sacral Ala • Ischial Tuberosity

  7. OSSEOUS/VERTEBRAL CONTACTS • LUMBAR SPINE • Spinous • Mamillary IVD space Mamillary Spinous

  8. OSSEOUS/VERTEBRAL CONTACTS • THORACIC SPINE • Spinous • Transverse Process • Rib Transverse Spinous

  9. OSSEOUS/VERTEBRAL CONTACTS • LOWER CERVICAL • Articular pillar (capsule/rotation) • Lateral aspect (Luschka trauma)

  10. OSSEOUS/VERTEBRAL CONTACTS • UPPER CERVICAL • Occiput • Mastoid • Atlas TP • C2 spinous

  11. “HVLA”HIGH VELOCITY LOW AMPLITUDE SPEED AND SPECIFICITY • Specific Osseous Contact Applied • Joint is taken to maximum resistance: • Specific Line of Drive—Force(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

  12. 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

  13. SPINOUS RECOIL THRUST • Doctor’s 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 elbows—1 INCH—60-65 lbs of pressure with immediate recoil

  14. LUNGE THRUST • Doctor’s 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

  15. IMPULSE THRUST • Doctor’s 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

  16. 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

  17. ARTHROKINEMATIC REFLEX • SUPINE • Internal Rotation • Leg Shortens • External Rotation • Leg Lengthens

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

  19. 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

  20. 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

  21. 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

  22. ANTALGICPOSTURE • To the patient’s LEFT • Sectional tower will be to the patient’s LEFT • Side of “Open Wedge” or BASE of the sectional tower will be on the patient’s RIGHT

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

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

  25. POSTURE ANALYSIS:DISCOVERING SPINAL CURVATURES • Scapula prominence • PELVIC AND SHOULDER UNLEVELING • RIB HUMP- SAME SIDE OF CONVEXITY

  26. 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

  27. DAMAGING STRESSES ON THE IVD • #1 Flexion with axial rotation • Flexion • Excessive axial compression • Degenerative changes

  28. PARTSP=Pain • Doctor’s notes may reflect: • Location • Quality • Intensity • Observation • Percussion • Provocation • Palpation • Visual analog scales • Pain questionnaires

  29. PARTSA=Asymmetry/Alignment • Doctor’s notesmustreflect: • Sectional or segmental level • Observation • Posture • Gait • Palpation or X-Ray evidence of: • Misalignment • Asymmetry

  30. PARTSR=Range of Motion Abnormality • Doctor’s notes must reflect: • Decrease or Increase of • Active, Passive or Accessory joint motion • Verified by: • Motion palpation • Stress X-ray

  31. PARTST= Tissue Tone, Texture, Temp. • Doctor’s notes may reflect: • Abnormal changes in: • Skin • Fascia • Muscle • Ligaments • Identified by: • Observation • Palpation • Instrumentation • Length and strength

  32. PARTSS= Special Tests • Doctor’s notes may reflect: • Test specific to a technique system

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