adj.tech.final Flashcards
What are some of the features of the bony anatomy of the lumbar vertebra?
1) Kidney shaped 2) Wider than deep 3) Increases in size from above down 4) forms a lordotic curve
Are vertebral bodies in the lumbar wide or deeper?
Wider than deep.
What are lumbar vertebra like at birth?
Concave.
When will the lordosis develop?
With walking.
When is the lordosis fully developed? ***
By 8-10 years.
What is the acceptable standard for the degrees of lumbardosis?***
NO acceptable degree (30-35 common range).
What is the typical range of the sacral base angle?
37 - 42, 35-45 degrees
What is the height of an IVD?
about 9 mm in height
What is the ratio between IVD and lumbar vertebral body?
Ratio is 1:3.
What does the increased height of the disc to body do for lumbar flexibility?
It allows for increased lumbar flexibility over thoracic spine
What is the major role of the IVD?***
not to direct movement, but in absorbing and dispersing compressive loads.
What shape are the articular facets of the lumbar vertebrae?
Slightly cupped shaped
What plane do the lumbar articular facets sit in?
Sagittal, with lumbosacral becoming more coronal
Which facet (inferior or superior) is convex and which facet is concave?
Inferior articular facets = convex, Superior articular facets = concave
What are the inferior facets of the lumbar vertebrae like? ***
Inferior facet lies inside the superior facet.
What is the function of the lumbar facets? ***
Resists rotation (less so at L5-S1).
In which facets are facetal tropism most commonly found?
In the lumbosacral facets
What percentage of the axial load do facets normally carry?
18%
What percentage of the axial load do facets carry in hyper extended postures?
Up to 33%
What provides up to 45% of the torsional strength of the lumbar spine?
The facets with their articular capsules
What is the relationship of facetal planes to palpation and adjusting vectors?
Avoidance of jamming or compressive adjusting forces
What is the physical presentation of lumbar vertebrae TP’s?
Small and run obliquely posterolateral
What are used in place of TP’s for adjustive contacts in the lumbars?
Mammillary bodies to avoid uncomfortable pressure on the TPs.
Where are Mammilary bodies found at in relation to the SPs?
Located up one interspinpous and out.
How do the lumbar SPs run in relation to the vertebral body?
Run almost directly horizontal to the vertebral body
What is the shape of lumbar SPs?
Large and hatchet shaped
What do the SPs do in terms of extension?
Provides a bony block to extension
How is the L5 SP different than the other lumbar SPs?
The L5 SP is shorter, more rounded and difficult to distinguish
What are the lumbar SPs like for palpation?***
Superficial and sensitive to firm pressure. Necessitates broad and padded adjustive contacts.
What is the GROM for extension of the lumbar spine?
30 degress of extension
What is the GROM for flexion of the lumbar spine?
90 degrees of flexion
In which direction is the GROM the greatest in the lumbar spine?
Flexion - extension motion
How many times is flexion greater than extension?
2 times as much flexion as extension
What percent of trunk flexion occurs in the lumbar spine?
75%
What is the degree of SROM for flexion-extension per segment of combined movement in the lumbar spine?
14 degrees
What is the degree of movement for flexion-extension at L1-L2 and what is the degree of movement at L5-S1?
L1-L2 = 12 degrees, L5-S1 = 17 degrees
What is the pattern of motion for flexion-extension in the lumbar spine?
Sagittal plane rotation coupled with some sagittal plane translation
How much translation in the lumbar spine for flexion-extension is clinically unstable?
> 4.5mm
When will the IVD open and approximate?
Opens posteriorly during flexion and approximates during extension.
Is there a significant shift in the nucleus during flexion-extension of the lumbar spine?
No
Which way does the disc bulge during flexion-extension of the lumbar spine?
Bulges on the concave side and retracts on the convex side
How do the articular facets glide during flexion and extension?
Articular facets glide apart during flexion and approximate during extension
What is the GROM for rotation of the lumbar spine?
5-18 degrees to each side
Where does the greatest degree of trunk rotation occur?
Occurs in the thoracic spine
What is the pattern of motion for rotation of the lumbar spine?
Movement occurs predominantely in the transverse plane. Rotation is coupled with lateral flexion
Is coupling stronger with primary rotation or with primary lateral flexion?
Primary lateral flexion provides a stronger coupled rotation than coupled lateral flexion that occurs with primary rotation.
What sided lateral flexion is coupled with rotation of the upper 3 segments of the lumbar spine?
Rotation in the upper three segments is coupled with opposite side lateral flexion
What sided lateral flexion is coupled with rotation of the lower segments of the lumbar spine?
Rotation in the lower is coupled with same side lateral flexion
At what point in the lumbar spine is there an increased incidence of degenerative change?
L4-L5 transition point
When will the lumbar facet joints gap with rotation?
On the side of rotation and approximate on the side opposite rotation.
Which joints act as a barrier to rotational mobility in the lumbar spine?
Facet joints
What is the GROM for Lateral flexion of the lumbar spine?
approximately 25 degrees to each side
What is the SROM for Lateral flexion of the lumbar spine?
approximately 6 dgrees per side with movement dropping to 3 degrees at L5-S1
What is the pattern of motion for lateral flexion of the lumbar spine?
Lateral flexion is coupled with opposite side rotation (SPs rotate to the concavity)
Under what spinal postions do the patterns of motion for lateral flexion occur?
Present with the spine in a neutral or extended position
During lateral flexion which side does the IVF open and which side closes?
Opens on the contralateral side and closes on ipsilateral side
During lateral flexion which side does the IVD bulge and retract?
The disc bulges on the concave side and retracts on the convex side
During lateral flexion, does the nucleus shift?
No the nucleus does not significantly shift
During lateral flexion, which side of the articular facets glide apart and which side approximates?
The contralateral facets glide apart and the ipsilateral facets approximate
What is the coupled motion like in the lumbar spine?
rotation with lateral flexion.
When will the rotation that is coupled with lateral flexion be reduced or reversed?
When the spine is flexed.
What will the spine do when laterally flexed or rotated?
Undergo slight flexion.
Name the adjustive setup that is not possible in the lumbars?
Resisted hypothenar spinous push for rotation / lateral flexion. Only done assisted.
What are the 4 elements of lumbar adjusting?
1) Reduce articular slack, 2) Stabilize adjacent spinal joints 3) Establish contact points 4) Establish Adjustive vector
How is slack reduced as a patient positioning component?
It is reduced by moving a joint toward end range
What are assisted patient positions?
Contact vertebra and vertebra above contact point are moved in the direction of adjustive thrust
What are resisted patient positions?
Vertebra above contact point are moved in the direction opposite the adjustive thrust
What is the intended mechanical effects seen with a flexion dysfunction adjustment?
Cavitation and stretching of the posterior joints, disc and posterior segmental soft tissues.
What does joint stabilization entail?
Counter tension and locking (induce points of resistance for adjustive thrusts
What are some ways to provide joint stabilization?
Tables, pillows, Doctro’s indifferent hand contacts, legs, forearms
What are contact points designed for?
Established to more specifically direct maximal adjustive force to a specific level or region
What is an assisted contact point?
Contact superior vertebr of dysfunctional joint (effect joint inferior to contact)
What is a resisted contact point?
Contact inferior vertebra of dysfunctional joint (effect joint superior to contact)
What would be malposition listing for a flexion restriction of L3-4?
Extension malposition L3.
What is adjustive vector and thrust?
Provides the force and direction critical to producing the desired movement
What is an assisted vector and thrust?
Thrust on superior vertebra in direction of joint restriction
What is an resisted vector and thrust?
Thrust on inferior vertebra in direction opposite joint restriction
What is an counter thrust?
Thrust applied on adjacent vertebral levels to induce movement in direction of joint restriction (one assisted, one resisted)
What are the limitation of assisted and resisted language?
ie: supine technique, solved by classifying method by which vertebra of motion segment are contacted
Whais the intended Mechanical Effects of flexion dysfunction adjustments?
Cavitation and stretching of the posterior joints, disc and posterior segmental soft tissues.
What is the movement caused by a flexion dysfunction adjustment?
Bilateral gliding separation in the sagittal plane
Which are the two adjustments that can fix a flexion dysfunction?
1) Assisted hypothenar spinous push 2) Resisted hypothenar spinous push
Describe the components of a Assisted hypothenar spinous push adjustment for flexion
1) Superior vertebral contact 2)either side up 3) P-A & I-S vector
Describe the components of a Resisted hypothenar spinous push for flexion
1) inferior vertebral contact 2) either side up 3) P-A & S-I vector
For flexion dysfunction adjustments, which contacts are preferred and why?
Assisted contacts are preferred since it is a less stressful position on the doctor’s shoulder
What is the intended mechanical effects seen with an extension dysfunction adjustment?
Gliding approximation of the posterior joints and disc. Stretching of the anterior segmental soft tissue.
What is the movement caused by a extension dysfunction adjustment?
Bilateral gliding approximation in the sagittal plane
Name a restriction listing for a flexion malposition at L3?
Extension restriction L3-4.
Which are the two adjustments that can fix an extension dysfunction?
1) Assisted hypothenar spinous push 2) Resisted hypothenar spinous push
Describe the components of a Assisted hypothenar spinous push adjustment for extension
1) superior vertebral contact 2) either side down 3) P-A & S-I vector
Describe the components of a Resisted hypothenar spinous push for extension
1) Inferior vertebral contact 2)either side up 3) P-A & I-S vector
For extension dysfunction adjustments, which contacts are preferred and why?
Resisted contacts are preferred since it is a less stressful position on the doctor’s shoulder
What is the intended mechanical effects of a rotation adjustment?
Unilateral or bilateral cavitation and stetching of the posterior joints and segmental soft tissue..
What movements are caused by a rotational dysfunction adjustment?
1) Gapping on the side of posterior restriction 2) Gliding on the side of anterior restriction
Which are the adjustments that can fix a rotational dysfunction? (7)
1) Assisted hypothenar mammillary push 2) Assisted digit spinous pull 3) Resisted hypothenar mammillary push 4) Resisted digit spinous pull 5) Spinous digit push-pull 6) Assisted hypothenar spinous push 7)Resisted hypothenar mammillary pull
Describe the components of a Assisted hypothenar mammillary push for rotation
1) Superior vertebral contact 2)side of rotational restriction down 3) P-A & I-S vector
Describe the components of a Assisted digit spinous pull for rotation
1) Superior vertebral contact 2)side of rotational restriction down 3) L-M vector
Describe the components of a Resisted hypothenar mammillary push for rotation
1) inferior vertebral contact 2) side of rotational restriction up 3) M-L with slight P-A pressure
Describe the components of a Resisted digit spinous pull for rotation
1) inferior vertebral contact 2) side of rotational restriction up 3) L-M vector
Describe the components of a Spinous digit push-pull for rotation
1) Adjacent vertebral contacts 2) Side of rotational restriction up 3) L-M pushing vector with superior arm and L-M pulling vector with inferior arm
Describe the components of a Assisted hypothenar spinous push for rotation
1)Superior vertebral contact 2) Side of rotational restriction up 3) P-A, M-L, S-I vector (typically applied to same side lateral flexion and rotational restrictions)
Describe the components of a Resisted hypothenar mammillary pull for rotation
1) Inferior vertebral contact 2) rotational restriction side up 3) M-L vector (uncommon method, most effect with lumbo sacral region)
What is the intended mechanical effects of a lateral flexion adjustment?
Unilateral cavitation and stetching of the posterior joints and segmental soft tissues on the side opposite lateral flexion.
What are the motions created by a lateral flexion dysfunction adjustment?
1) Coronal plane gliding separation on the side opposite lateral flexion restriction 2) Coronal plane gliding approximation on the side of lateral flexion restriction
What are the adjustments that can correct a lateral flexion dysfunction? (3)
1) Assisted hypothenar spinous push 2) Assisted hypothenar mamillary push (distraction) 3) Resisted digit spinous pull, Push/pull and resisted hypothenar mammillary push
Describe the components of a Assisted hypothenar spinous push for a lateral flexion adjustment
1) Superior vertebral contact 2) side of lateral flexion restriction is up 3) P-A, L-M, S-I vector
Describe the components of a Assisted hypothenar mamillary push (distraction) for a lateral flexion adjustment
1) Superior vertebral contact 2) Side of lateral flexion restriction is down 3) P-A, M-L, I-S vector
Describe the components of a Resisted digit spinous pull, Push/pull and resisted hypothenar mammillary push for a lateral flexion adjustment
1) side of lateral flexion restriction is down 2) vectors same as those decribed for rotational restriction
When should lateral flexion adjustments typically be used?
Applied in circumstances where the patient cannot tolerate coupled rotation
When will the prone and knee chest lumbar adjustments be used?
Circumstances where extension is desired.
What are the adjustments that can correct a rotation with opposite sided lateral flexion dysfunction? (4)
1) Assisted hypothenar mammillary push 2) Resisted hypothenar mammillary push 3) Resisted digit spinous pull 4) Spinous digit push-pull
Describe the components of a Assisted hypothenar mammillary push for a rotation with opposite sided lateral flexion dysfunction
1) Superior vertebral contact 2) Side of rotational restriction is down 3) P-A, L-M, S-I vector
Describe the components of a Resisted hypothenar mammillary push for a rotation with opposite sided lateral flexion dysfunction
1) Inferior vertebral contact 2) side of rotational restriction is up 3) M-L, slight P-A
Describe the components of a Resisted digit spinous pull for a rotation with opposite sided lateral flexion dysfunction
1) Inferior vertebral contact 2) side of rotational restriction is up 3) L-M
Describe the components of a Spinous digit push-pull for a rotation with opposite sided lateral flexion dysfunction
1) Adjacent vertebral contacts 2) Side of rotational restriction up 3) L-M pushing vector with superior arm and L-M pulling vector with inferior arm
What are the adjustments that can correct a rotation with same sided lateral flexion dysfunction? (2)
1) Assisted hypothenar spinous push 2) Assisted hypothenar mammillary push
Describe the components of an Assisted hypothenar spinous push for a rotation with same sided lateral flexion dysfunction
1) Superior vertebral contact 2) Side of rotation restriction is up 3) P-A, L-M, S-I
Describe the components of an Assisted hypothenar mammillary push for a rotation with same sided lateral flexion dysfunction
1) Superior vertebral contact 2) side of roational restriction is down 3) P-A, M-L, I-S vector
What are the different prone and knee chest lumbar adjustments? (5)
1) Bilateral thenar mammillary 2) Crossed bilateral hypothenar mammillary 3) Hypothenar spinous push 4) Hypothenar mammillary push 5) Hypothenar spinous thenar mammillary push
For what dysfunction is there the greatest potential for application for prone & knee chest lumbar adjustments?
Extension dysfunctions
Why is a flexion dysfunction an unsuitable adjustment for knee chest tables?
Because the lumbar lordotic curve works against the vectors required in a flexion adjustment
Are lateral flexion and rotational adjustments possible in the prone or knee chest lumbar adjustment methods?
Theoretically yes, but based on the lumbar lordotic curve, patient position and P-A thrusts the potential for extension is much higher
What is the best fit for a sitting lumbar adjustment?
For vectors that do not incorporate extension.
Will sitting adjustments be assisted or resisted?
Assisted.
What are the sitting lumbar adjustments that are possible?
1) Assisted hypothenar mammillary push 2) Assisted hypothenar spinous push
How can pre-tension be maximized to one side of the spine when treating rotational restrictions?
By laterally flexing the patient away from that side.
What are the 3 possible diagnostics with back pain (Diagnostic triage)?
- Serious spinal pathology. 2. Nerve root pain; radiculopathy secondary to orthopedic encroachment. 3. Mechanical back pain.
What are some motion segment causes of mechanical back pain?
1) Subluxation syndrome, joint dysfunction, posterior joint or facet syndrome 2) Joint (articular) strain/sprain 3) Internal disc derangement
What are some non segmental causes of mechanical back pain?
1) Muscle Strain 2) Myofascial trigger point syndrome 3) Postural syndrome
Of the 3 possible diagnostics what % will have mechanical back pain?
90-95%.
What % of patients fear they have a serious pathology?
40%.
What % of patients have a serious pathology?
Less than 1%.
What % of patients will have a radiculopathy?
Less than 5%.
What ages bring up red flags?
less than 20 and over 55.
What kind of trauma brings up a red flag?
Violent.
What kind of pain would be a red flag?
Constant, progressive, non-mechanical.
What type of previous history brings up red flags?
Carcinoma, systemic steriods, drug abuse, HIV.
What type of systemic problems bring up red flags?
Systemically unwell, weight loss.
What type of neuro symptoms are red flags?
Widespread neuro symptoms (like cauda equina syndrome).
Can serious pathology be ruled out by a normal exam?
No.
What are some Red Flag Findings?
1) Widespread neuro symptoms or signs (sensory, motor & reflex testing, palpate bladder, upper motor neuro signs) 2) persisting severe restiction of lumbar flexion (serious path, disc prolapse and infection can cause this) 3)structural deformity (does not change with position)
Radiographs in absence of red flags catch how many problems?
1/12500 patients.
When will ESR’s have a high false positive?
In absence of red flags.
What do normal ESR and radiographs in presence of red flags typically mean?
Decrease probability of serious pathology, but does not rule out presence of serious pathology
With Nerve root problems what will hurt more than the back pain?
Unilateral leg pain.
Where will pain from nerve root problems travel to?
Often below the knee.
How is the leg pain associated with nerve roots different than other leg pain?
It is often sharper and more localized than sclerogenic referral
Is most leg pain radicular?
No
Does numbness or paresthesia occur with nerve root problems?
Yes it is in the same distribution as the pain
How can you test for nerve root irritation?
Nerve traction signs (SLR, Bragard’s, Bowstring)
How can you test for nerve root compression?
Motor, sensory, or reflex changes.
What is the typical age range of mechanical back pain?
20-50
Where does pain refer to with mechanical back pain?
lumbosacral, buttocks and thigh
How does Mechanical back pain vary?
With activity, position and time.
What is a subjective and objective exam?
Subjective- history. Objective- Physical exam.
What is the most common complaint with a subluxation/dysfunction syndromes?
Pain by far the most common complaint
What is pain like with subluxation/ dysfunction syndromes?
Poorly localized, deep achy quality, midline to unilateral.
Will absence of pain rule out dysfunction?
No joint pain at one level may be the product of painless dysfunction at another level.
What causes pain joint hyper- or hypo- mobility?
Both.
Subluxation/dysfunction syndrome pain is often associated with what?
referred pain and allodynia.
What is the referred pain like with subluxation/ dysfunction syndromes?
sclerogenic, ill defined, deep and achy.
Where might pain be worse at source or referred area for subluxation/dysfunction syndromes?
Sites of referred pain may be more painful to palpation and of greater intensity than the source or disorder.
What will aggravate subluxation/ dysfunction syndrome pain?
Movement, position, activities of daily living.
What are the steps used to evaluate joint and soft tissues?
PARTS. (pain, asymmetry, range of motion, tone, texture, temperture, special tests)
What is the diagnosis of joint subluxation/ dysfunction syndrome based on?***
A collection of signs and symptoms and any one abnormality is usually insufficient to establish this clinical diagnosis.
What are some NMS outcome measures?
1) Pain (pain drawings, palpation, joint challenge, end play) 2) Function (Regional mobility measures, physical capacity questionanaires, physical capacity tests: muscle strength and endurance)
When should we not take X-rays?
Patients under 50 with no red flags during the first 4 weeks of acute back pain.
What is the chiropractic rational for taking x-rays?
1) Aid in establishing biomechanical diagnosis 2) Identify anomalies that would contraindicate manipulation 3) Screen for contraindications: check for safety of manipulation 4) Monitor degenerative process
What are the limitations to a static x-ray evaluation for segmental alignment ?
1) Anatomic asymmetry 2) Radiographic magnification/distortion 3) Radiographic malpositioning 4) Static analysis of dynamic motion segments 5) Marking errors
How is the reliability of static x-ray evaluation for segmental alignment ?
incomplete and inconclusive where marking procedures are reliable but have not been tested through all steps
How is the validity of static x-ray evaluation for segmental alignment ?
Untested
What can be seen in a static AP lumbar x-ray film?
1) Horizontal plane lines (lateral flexion malpositions) 2) spinous body margin: rotational malpositions 3) laterallisthesis
What can be seen in a lateral lumbar x-ray film?
1) A-P plane lines (flex-ext malpositions) 2) George’s line (antero & retrolisthesis) 3) Gravitational line (determination of ant or post weight bearing 4) Lumbar curve angle (lumbar lordosis: 50-60 degrees = average) 5) Sacral base angle: (average = 41 degrees range of 26 -56 degrees (+/-7))
What are some conclusions to the use of static x-ray evalutions?
1) static xrays not indicated for uncomplicated acute back pain 2)not needed as screening tools for safety 3) biomechanical findings must correlate with clinical findings
Are X-rays needed as a screening tool for safety?
Only in airports, and not in DC offices.
What are the 3 different dynamic x-ray evaluations?
1) Lateral bending 2) Flexion/Extension 3) Compression/distraction
Are lateral bending x-rays commonly applied in practice?
No
What is measured in a lateral bending x-ray?
Meaure rotation, lateral flexion and observe for translation in neutral and right and left lateral flexion views
How many types of mechanical categories and abnormal movements are there?
4
What does a type I mechanical category mean?
normal bending and coupling
What does a type II mechanical category mean?
normal bending with reversed coupled rotation
What does a type III mechanical category mean?
limited or absent bending with normal coupled rotation
What does a type IV mechanical category mean?
limited, aberrant or absent bending and coupled rotation
What are flexion/extension studies a standard for assessing?
Setandard for lumbar instability assessment
What does an anterior element of a flexion/extension study consist of?
Lateral translation
What does an posterior element of a flexion/extension study consist of?
Abnormal coupled rotation
How is the reliability for dynamic x-ray evaluations?
L1-L4 good segmental assessment and categorization but L5 is not so good
How is the validity of dynamic x-ray evaluation?
Mixed, preponderance (with quanitity) shows poor correlation to back pain
What is the compression/distraction method?
Standing loaded (20kg) lateral lumbosacral spot, measure sagittal plane translation (> 5 mm abnormal)
What is the Clinical application of the compression/distraction method?
Strictly for instability assessment
What is the flexion extension method?
Comparing neutral, flexed and extension views in a standing or side lying lateral lumbar to measure for segmental translation and degree of angulation
What is a normal translation for the flexion extension method?
4 mm
What is the Clinical application of the flexion extension method?
1) Primarily for stability assessment 2) standard of care for instability assessment 3) consider compression/ distraction if movement is significantly limited 4) UWS protocol: do both with strong suspicion of instability to see which performs better
What is the absolute contraindication to Lumbar adjusting?
CAUDA EQUINA
Name 3 other contraindication to lumbar adjusting?
AAA, Ankylosing spondylitis (inflammatory/ autoimmune expression in lumbar), Disc herniation.
What will cauda equina cause?
Bowel or bladder dsyfunction, saddle anesthesia.
What are the neurological symptoms of cauda equina?
Widespread neuro symptoms. (> than one level, progressive motor weakness, gait disturbances, multiple sensory levels effected, paraparesis)
What should you do with cauda equina patients?
Immediate referral with bladder retention or rapidly deteriorating neuro deficits same day if recent onset.
Should referals be made for those experiencing cauda equina syndrome?
YES, immediate referral with bladder retention or rapidly deteriorating neuro deficits
At what diameter indicates an abdominal aneurysm?
Above 3 cm
When will an AAA be an absolute contraindiction for lumbar adjusting?
Until determined otherwise.
What is the mortality rate with a ruptured AAA?
90%.
How are AAA identified on X-ray?
50-75% calcified.
At around what age is the incidence of AAA most cmmon?
over 60
Which signs that accompany a suspicion of AAA acute back pain would need an emergent referral?
1) sudden change or increase in symptoms 2) pulsating mass 3) dropping blood pressure 3) dizziness, disorientation, 4) nausea/vomiting 5) AAA 7 or > cm
Which signs that accompany a suspicion of AAA acute back pain would need an urgent (same day) referral?
AAA >6cm, actue back pain but no additional signs
Which signs that accompany a suspicion of AAA acute back pain would need an immediate (within 48 hours) referral?
AAA>3.5 cm but < 6cm with acute back pain with no additional symptoms
What is the gold standard for identifying an AAA?
Ultra sound.
What is a symptom of inflammatory arthritis (Ankylosing spondilitis, Reiter’s)?
Marked morning stiffness, persistent decrease in ROM in all direction, family history.
At what age does inflammatory arthritis typcially occur?
Gradual onset, before 40
What is more critical with disc herniations?
Motor weakness more critical than sensory deficits.
Is conservative treatment indicated for disc herniations with progressive motor weakness?
Conservative treatment and watchful waiting are appropriate but advised to consult with conservative neurosurgeon or orthopedist
When would a disc herniation be indicated for chiropractic care?
Disc herniation without marked neuro deficit.
When should HVLA thrust not be delivered to a patient with disc herniation without marked neuro deficits?
With increased leg symptoms.
What % of patients have serious complications from lumbar adjustments?
Very low.
How often will a serious complication from lumbar adjusting happen in a year?
On average less than one serious case per year. 1 per 100 million manipulations.
What are some reported complications associated with lumbar adjustments?
1) Disc related complications 2) diagnostic error, vascular complications from thrombosis, 3) fracture (osteoporosis), 4) manipulation in patient on anti-coagulant therapy, 5) rib fracture, 6) inguinal and abdominal hernia
What will account for the greatest % of malpractice claims filed?
Disc problems.
IVD is protected from rotational injury by what?
Facets.
What type of force must be applied with rotation to injure the disc?
Marked, and movement must be beyond normal range of motion.
How would a healthy disc be injured by manipulation?
An unskilled and very forceful manipulation is what would need to be applied
What motion will the disc be most vulnerable in?
Flexion and rotation positions.
What motion should be avoided with rotational adjustments?
Excessive flexion
When should rotational manipulation be contraindicated upon lumbar motion evaluation?
If lumbar movements increase the patient’s leg pain
Has a compression fracture even been confirmed to be a result of spinal manipulation?
No independently confirmed & documented case because SP manipulation is unlikely to produce the compression forces necessary to cause compression fractures.
