Biomechanics Flashcards
Historical Emergence of Chiropractic
D.D. Palmer in 1895, stated that a subluxation is a vertebra that is out of its normal anatomical relationship with an adjacent vertebra, subluxation effects nerve and transmission, causes disease, body can heal itself
Divergence of Chiropractic
Vitalism; biological activity is controlled by a vital force of life principles that cannot be tested, the innate intelligence
this Innate intelligence is responsible for restoring health, subluxations can impinge these nerve roots
Mechanism; biological activity can be explained by physical and chemical laws and principles
inquiry of subluxations impact of body, sublux cause nerve impingement creating abnormal reflexes
Emergence of Difference in Chiropractic
Straight - focus on spine excluding ancillary therapies
Mixers - treatment of spine and extremities with full use of ancillary techniques
Technique Systems
step by step protocol for diagnosing and treatment - originate from the practice experience, is not easily testable b/c they are based on unquestionable principles
Prominent Named techniques - Activator, Gonsted, Thompson, CBP, Logan Basic, NUUCA, Applied Kinesiology, SOT
Biomechanical Model of Chiropractic
Biomechanics; the science concerned with the internal and external forces acting on a human body and the effects produced by these forces
Kinesiology; the science of human movement
- principles can be used to explain joint dysfunction, function of joint can be formulated and tested, provides framework of understanding spinal function and can be linked with information from other fields
Biomechanical Approaches to Joint assement
Static and Dynamic
Static Model
structural emphasis
hypothesis: alterations in position of adjacent bones create changes in mechanical function of a joint and neurological functions
diagnostic entities: subluxation-chiro anatomic disrelationship and orthopedic is a partial or incomplete dislocation, misalignment, malposition
diagnostic tools: static palpation, X-ray, posture evaluation
basis: straight spine is healthy spine, structure determines function
limitations: anomalies to bones, vertebral segments are correctly aligned even though there are signs of dysfunction, vertebral segments are compensating for biomechanical faults, posture, hand dominance and other biomechanical factors
advantages: used in acute conditions, limited motion exists, easily understood by patients
Dynamic Model
functional emphasis
hypothesis: alterations in motion, b/w adjacent bones result in altered mechanical and neurological function, muscles and ligaments contribute
diagnostic entities: jt. dysfunction, jt. restriction, jt. fixation
diagnostic tools: global range of motion, motion palpation, joint and end play, motion X-rays, posture and gait analysis
basis: mobile spine is a healthy spine, function is more significant than structure
limitations: less help for acute, relationship b.w areas in spine can be overlooked, postural and static stresses often overlooked, less helpful in areas with limited motion, limited motions due to coexisting diseases, lock of consistent interexaminer reliability
advantages: theory and concept consistent with current knowledge in other related health care disciplines, accounts for more components of the joint that become dysfunctional such as relationship b/w soft tissue changes and jt. dysfunction
UWS Approach
- Integrated biomechanical approach to the physical examination of the Neuro Musculo Skeletal system incorporating both structural and functional analysis
- Integration of ancillary therapies such as diet, exercise, physiotherapy and psychological support in overall assessment and treatment of the patient
Classical Components of Physical Exam
observation, palpation, percussion, auscultation
Components of the physical exam of NMS system
observation, range of motion, palpation, muscle testing, orthopaedic testing,neurological testing, percussion and auscultation
Pathomechanical Diagnosis and Definitions
Subluxation, Subluxation Syndrome, Joint Dysfunction, Joint Fixation, Joint Restiction
Subluxation
medical - a partial or complete dislocation
chiro - alteration of the normal dynamic, anatomic, and physiological relationships of contiguous articular structures
Subluxation Syndrome
a complex clinical syndrome with potential mechanical inflammatory vascular and neurobiologic pathological effects
Joint Dysfunction
joint mechanics showing disturbances of function without structural or positional change
3 types: joint hypomobility (restriction), joint hypermobility, clinical joint instability
Joint Fixation
articulation has become temporarily immobilized in a position (malposition), the immobilization of an articulation in a position of movement when the joint is at rest, or in a position of rest when the joint is in movement
Joint Restriction
sometimes called a subluxation
limitation of movement, describes the direction of limited movement in dysfunctional joints
PARTS
Pain - location, quality and intensity
Assymetry - section or segmental
Range of Motion abnormality - increase or decrease of movement, assessed by motion palpation
Tone, Texture and Temperature - of the soft tissue
Special Tests - lab procedures, specific technique systems
Clinical Presentation of Joint Dysfunction/Subluxation
Causes are: Macrotrauma - single traumatic event
Microtrauma - repeated minor cumulative events
Posture - anterior head carriage
Diagnosis of Clinical Conditions
Joint Dysfunction - presence of joint pathomechanics without further pathophysiologic process
Joint dysfunction and disease - a causal relationship exists b/w the joint pathomechanics and other conditions thru somatoautonomic reflexes (Somatosomatic reflex, Somatoviceral reflex, viceralsomatic reflex)
Joint dysfunction and disease - Both existing independently, no apparent causal relationship exists
Physical Assessment of Joint Dysfunction and Subluxation
Inspection/Observation
Global Range of Motion
Static Palpation
Motion Palpation
Inspection/Observation
Superficial, Posture Gait
Global Range of Motion
The evaluation of a joint or spinal regional movement in all its ranges of movement comparing to standards of goniometry and Inclinometry
Static Palpation
The act of feeling with the hands. The application of variable pressure through the surface of the body for the purpose for determining the shape, size, consistency, position, mobility and health of the tissues beneath. Includes static palpation of soft tissue (Dermal and sub dermal layers), bone and cartilage
Motion Palpation
Palpatory diagnosis of passive and active segments joint range of motion. There are 3 parts to it:
- Objectives
- The range of joint motion
- Interpretation of Joint Motion
Objectives of Motion palpation
are to find quantity of the joint movement, quality of the movement thru motion, joint play against resistance, end feel and pain symptoms during the motion of that joint
Range of Joint Motion
is a known continuum that can show each range of the joint movement. Parts include Joint play, active ROM, passive ROM, Physiological barrier, End play, Elastic barrier Paraphysiological space, and anatomical limit
Interpretation of Joint Motion
- End play; each joint has a characteristic end feel, can be palpated in normal or abnormal conditions, palpated in abnormal only
- Painful arc; pain during normal arc of joint
- Capsular pattern; injuries to joint capsule that lead to predictable patterns of end play (Cyriax)
- Noncapsular pattern; Injuries to only one part of the joint capsule lead to predictable patterns of end play restrictions
- Hypermobility - joints that move too much
Palpation of joint in normal and abnormal condition
Capsular - firm but giving; resistance builds with lengthening, like stretching a piece of leather
Ligamentous - like capsular but may have a slightly firmer quality
Soft Tissue approximation -Giving, squeezing quality; results from the approximation of the soft tissues
Bony - Hard, nongiving abrupt stop
Muscular - Firm but giving, build elongation; not as stiff as capsular or ligamentous
Palpation of joint in abnormal condition only
Muscle spasm - guarded, resisted by muscle contraction. The end feel cannot be assessed b/c of pain and/or guarding
Interarticular - bouncy, springy quality
Empty - Normal end feel resistance is missing; end feel is not encountered at normal point, and/or the joint dysfunction demonstrates unusual give and deformation
Muscle Testing
- clinical assessment of strength of a muscle to evaluate the integrity of the muscle tissue and its nerve supply
- not muscle testing in the AK sense
- has a grading system
- Clinical significance shows signs of strong and painful, weak and painful, and weak and painless
