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) Chiropractic Index

THUMB-PISIFORM

DOUBLE THUMB

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

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

OSSEOUS/VERTEBRAL CONTACTS LUMBAR SPINE –Spinous –Mamillary Mamillary Spinous IVD space

OSSEOUS/VERTEBRAL CONTACTS THORACIC SPINE –Spinous –Transverse Process –Rib Spinous Transverse

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

OSSEOUS/VERTEBRAL CONTACTS UPPER CERVICAL –Occiput –Mastoid –Atlas TP –C2 spinous

“HVLA” HIGH VELOCITY LOW AMPLITUDE SPEED AND SPECIFICITY 1.Specific Osseous Contact Applied 2.Joint is taken to maximum resistance: 1.Specific Line of Drive—Force(s) Directed and Applied to the Joint 2.Move Motor Unit to Voluntary End Range 3.Sudden Load is Applied, Moving Joint Past its End Range, Creating Cavitation

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

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 lbs pressure w/ flexed elbows –Quick extension of elbows—1 INCH—60-65 lbs of pressure with immediate recoil

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

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

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

ARTHROKINEMATIC REFLEX SUPINE –Internal Rotation Leg Shortens –External Rotation Leg Lengthens

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

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

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 1.Unequal weight into each S/I joint- leads to abnormal gait 2.Pelvis consistently responds to changes in weight distribution

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

ANTALGIC POSTURE 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

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

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

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

PALPATION of VERTEBRAL MALPOSITIONS 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

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

P ARTS P=Pain Doctor’s notes may reflect: –Location –Quality –Intensity Observation Percussion Provocation Palpation Visual analog scales Pain questionnaires

P A RTS A=Asymmetry/Alignment Doctor’s notes must reflect: –Sectional or segmental level –Observation Posture Gait –Palpation or X-Ray evidence of: Misalignment Asymmetry

PA R TS R=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

PAR T S T= Tissue Tone, Texture, Temp. Doctor’s notes may reflect: –Abnormal changes in: Skin Fascia Muscle Ligaments –Identified by: Observation Palpation Instrumentation Length and strength

PART S S= Special Tests Doctor’s notes may reflect: –Test specific to a technique system