IVMI Flashcards
What is a restriction?
A loss of range of motion with the joint surfaces still in contact.
Is a restriction a subluxation?
No.
How can you diagnose a restriction?
Motion Palpation.
True/False: Restrictions involve only bone and cartilage.
False.
What is the paraphysiologic range?
Small space beyond the active and passive ranges of motion, but before anatomical barriers are breached.
True/False: a correct manipulation does not rely on strength, but instead relies on speed and specificity.
True.
What is HVLA?
High Velocity, Low Amplitude.
What are the three components of a listing?
- Segment/Joint
- Reference Point.
- Direction.
What are three general ways a restriction affects the body?
- Local Effects
- Compensatory Effects.
- Nervous System Effects.
Describe the process of local effects caused by a restriction:
Adhesions, cartilage degeneration, and decreased circulation –> decreased ROM –> less imbibition –> cartilage degeneration –> decreased blood flow
What is a compensatory effect of a restriction?
Hypermobility in adjacent joints.
True/False: Adhesions form within the joint after a few days of immobilization.
True
True/False: When the muscular part of the musculotendinous unit is in spasm, it aids in tendon function.
False - the tendon has to stretch more to compensate and is vulnerable to injury.
What are the four ways the nervous system is affected by restrictions?
- Increased pain
- Lack of inhibition of sympathetics and nociception
- Decreased input to the cortex
- Interference with peripheral nerve function
True/False: a restriction can cause an inflammatory environment or create mechanical stress on the nerves.
True - direct cause of pain from a restriction.
True/False: pain is inhibited by movement.
True - movement stimulates Ia afferent fibers.
What are two effects of high sympathetic tone?
- Overloads the adrenals
2. Suppresses the immune system
How are peripheral nerves affected by restrictions?
Mechanical stress, muscle tension, inflammation, changes in blood flow.
True/False: movement is necessary for a healthy cortex.
True
True/False: A restriction cannot affect peripheral nerve function.
False
How is frequency of firing affected by a restriction?
FOF is decreased. Decreased movement = decreased FOF of sensory and motor neurons.
What are the four things neurons need to be healthy?
- Oxygen
- Glucose
- Neurotropic Factors
- Frequency of Firing
Name the five components of a set-up:
- Doctor Position
- Patient Position
- Doctor Contact Point
- Patient Contact Point
- Line of Drive
True/False: the correct line of drive is in the plane of the joint.
True
What are the three commonly used doctor contact points?
- Calcaneal
- Pisiform
- V Trough
What doctor muscles do most HVLA thrusts use?
Pectorals, triceps
True/False: the best way to lower your episternal notch is to bend at the waist and round your back.
False - use a fencer’s stance or bend your knees.
True/False: long lever adjustments are safer than short lever adjustments.
False - short lever are safer because the contact point is very close to the joint being adjusted.
Is HVLA commonly used for long lever adjustments?
No - often allow the patient to make this type of adjustment.
What are the contraindications for spinal manipulation?
- Joint laxity/hypermobility.
- Neurologic signs.
- History of recent trauma/fracture.
- Severe arthritis.
There are two basic parts of the nervous system: the incoming, or __________ information, and the outgoing, or __________ information.
Incoming = sensory Outgoing = motor
What are the three types of motor neurons that carry information to the skeletal muscle?
Alpha, beta, gamma motor neurons
True/False: Alpha motor neurons go to intrafusal fibers to cause muscle action.
False. Alpha motor neurons go to extrafusal fibers to cause muscle action. Beta and gamma motor neurons go to intrafusal fibers to regulate the extrafusal fibers.
Transneuronal degeneration is part of the __________ nervous system (autonomic vs. somatic).
Autonomic
What are four signs of transneuronal degeneration?
Yawning repeatedly
Breathing heavily
Piloerection
Sweating
True/false: action potentials are graded.
False. Action potentials are not graded (they are always the same size). When enough local potentials add together, they cause an action potential.
True/False: alpha motor neurons are large and myelinated.
True
Which cranial nerves are tested with the Doll’s eye?
CN 3 - Oculomotor
CN 4 - Trochlear
CN 6 - Abducens
CN 8 - Vestibulocochlear
Which cranial nerves are tested with the blink reflex?
CN 5 - Trigeminal
CN 7 - Facial nerve
Which cranial nerves are motor and can be tested by observing muscle mass, tone, or function?
CN 3 - Oculomotor CN 4 - Trochlear CN 5 - Trigeminal CN 6 - Abducens CN 7 - Facial CN 9 - Glossopharyngeal CN 10 - Vagus CN 11 - Accessory CN 12 - Hypoglossal
Does the size of the spinal canal become larger or smaller on extension?
Smaller
T/F: the diameter of the IVF changes with position.
True - smaller with extension and larger with flexion
What are the borders of the IVF?
Vertebral Facets Vertebral Bodies Vertebral Pedicles Ligamentum Flavum Disk
What are the structures within the IVF?
Fat CSF Ligaments Blood Vessels Lymphatics Dorsal Root Ganglion Spinal Nerve Recurrent Meningeal Nerve Dura
Which motion decreases the diameter of the spinal canal and the IVF?
Extension
What are three reasons that walking a horse with the head elevated changes the gait, even in normal horses?
- Extending the neck causes a decrease in the diameter of the spinal canal/IVF
- Affects visual inputs
- Affects vestibular input/balance
Extrafusal/Intrafusal fibers are the part that contracts to create muscle action.
Extrafusal
True/False: alpha motor neurons are large and myelinated, making them fast and able to carry a lot of information.
True - as many as 10,000 axons converge on each motor neuron to regulate muscle action.
Which motor neurons are larger, alpha or gamma?
Alpha
Which motor neurons go to the extrafusal fibers?
Alpha
Muscle spindles monitor _____________.
Muscle stretch
Which type of motor neuron innervates the muscle spindle cell?
Gamma
True/False: spinal manipulation is designed to stimulate golgi tendon organs.
True. The golgi tendon organs are proprioceptors noted at the musculotendinous junction, which are stimulated when a muscle contracts. GTO stimulation will cause muscle relaxation.
True/False: Golgi Tendon Organs (GTOs) monitor tension/contraction and stimulate relaxation.
True.
Interneurons are usually _______________ (excitatory/inhibitory).
Inhibitory. GTO receptor –> spinal cord via 1b neuron –> interneuron –> alpha motor neuron of same muscle
Which mechanoreceptors inhibit the muscle they are in?
a. Muscle Spindles
b. Golgi Tendon Organs
b. Golgi Tendon Organs
Why do we need to bring the joint to tension before the HVLA?
To stimulate the GTOs
One GTO monitors tension/contraction of:
a. All the extrafusal fibers
b. Approximately half of the extrafusal fibers
c. Approximately 30% of the extrafusal fibers
d. Approximately 10-20 extrafusal fibers
d. Approximately 10-20 extrafusal fibers
What do GTOs monitor?
a. Gamma neurons
b. stretch
c. 1b neurons
d. Tension/contraction
d. tension/contraction
What are the three parts of the muscle spindle?
Receptor
1a sensory neuron
Gamma motor neuron
True/False: The muscle spindle relaxes synergistic muscles and contracts antagonistic muscles.
False - contracts synergistic muscles and relaxes antagonistic muscles; stimulates gamma motor neurons back to the same muscle spindle
What are the four jobs of the 1a fibers from muscle spindles?
- contract self-muscle
- contract synergistic muscle
- relax antagonistic muscle
- stimulate gamma motor neurons
Where are the muscle spindles located?
In the muscle belly
What do muscle spindles monitor?
a. Gamma neurons
b. stretch
c. 1a neurons
d. Tension/contraction
b. stretch
How many neurons are in between the 1a afferent neuron and the alpha motor neuron?
a. 0
b. 1
c. 2
d. 3
a. 0
The 1a afferent neuron goes to (choose all that apply):
a. The same muscle
b. synergistic muscles
c. antagonistic muscles
d. gamma motor neurons
a, b, c, d
True/False: the gamma motor neuron keeps intrafusal fibers taut and regulates muscle spindle sensitivity.
True
The sensitivity of the muscle spindle is called __________.
Gamma gain
(High/Low) gamma gain is desirable.
High
Gamma motor neurons regulate:
a. Contraction of extrafusal fibers
b. MS size
c. Muscle mass
d. MS sensitivity
d. MS sensitivity
It is desireable to have (high/low) gamma gain
High
Why is it important to keep the intrafusal fibers taut?
a. To improve blood flow
b. So it is sensitive to all muscle lengths
c. To stimulate the 1b fibers
d. So that it takes more stretch to stimulate the MS
b. So it is sensitive to all muscle lengths
A fit athlete:
a. should have clear muscle definition
b. should have muscles with smooth contours
c. should have tight, tense muscles
b. should have muscles with smooth contours
What are the four functions of muscle tone/gamma gain?
- to keep us upright against gravity
- to keep the center of gravity within the base of support
- to store energy
- to allow for smooth movement
True/False: tense muscles put more strain on the tendons
True
To compensate for poor muscle tone:
a. strength is used
b. movement is slower
c. tension is used
d. less energy is expended
c. tension is used
Tense muscles make movement (more/less) accurate.
Less
Tense muscles can lead to tendon injury:
a. with intense work
b. with slow work
c. within the normal range of motion
d. outside the normal range of motion
c. within the normal range of motion
Low gamma gain can lead to tendon injury:
a. with intense work
b. with slow work
c. within the normal range of motion
d. outside of the normal range of motion
d. outside of the normal range of motion
What is the contact point for manipulations of C3-C7?
The Lamina-Pedicle Junction
Which cervical vertebra has long, delicate transverse processes?
C3
True/False: as we move caudally in the neck, the transverse processes of the cervical vertebrae become shorter and thicker.
True - they become more robust to accommodate large muscle attachment.
Which parts of the vertebra surround the spinal canal?
Lamina - roof
Pedicles - walls
Vertebral body - floor
The dorsal plate of the spinal cord carries mostly (motor/sensory) information.
Sensory
The ventral plate of the spinal cord carries mostly (motor/sensory) information.
Motor
True/False: the spinal canal is much larger in diameter than the cord so that the cord is not restricted with flexion and extension.
True
True/False: the dorsal root ganglion is outside the IVF.
False
The dorsal root ganglion contains cell bodies of (motor/sensory) neurons.
Sensory
The denticulate ligaments run from:
a. caudal facet to cranial facet
b. mixed spinal nerve to DRG
c. the pia mater to the dura
d. the dorsal ligament to the dura
c. the pia matter to the dura
How can vertebral restrictions change the tension on the dura?
a. through its attachment at the IVF
b. through the ligamentum flavum
c. through the transverse process
d. through the vertebral body
a. through its attachment at the IVF
The dorsal root ganglion is:
a. made up of motor neuron cell bodies located in the ventral plate
b. made of both sensory and motor neuron cell bodies in the IVF
c. made up of sensory neuron cell bodies in the dorsal plate
d. made up of sensory neuron cell bodies in the IVF
d. made up of sensory neuron cell bodies in the IVF
How can inflammation of the ligamentum flavum affect the spinal nerve?
Strain of the ligamentum flavum can cause swelling and inflammation that can diffuse into the IVF.
The contents of the IVF can be affected by (choose all that apply):
a. Arthritis or DJD of the facets
b. Restrictions
c. Spondylitis
d. Synovitis of the facet joint
a. Arthritis/DJD of the facets
b. Restrictions
d. Synovitis of the facet joint
True/False: restrictions involve the motion unit and have no effect on the IVF.
False
Name 9 things that lie within the IVF.
Dorsal Root Ganglion The Spinal Nerve Recurrent Meningeal Nerve CSF Dura Blood Vessels Lymphatics Ligaments Fat
Can cervical restrictions have an effect on distal limb lameness?
Yes - affects motor function and blood flow
What are the four main ligaments in the neck?
Ventral Longitudinal Ligament
Dorsal Longitudinal Ligament
Ligamentum Flavum
Nuchal Ligament
Which of these ligaments runs within the spinal canal?
a. Supraspinous
b. Dorsal Longitudinal
c. Ventral Longitudinal
d. Lamina-pedicle ligament
b. dorsal longitudinal
Why is there no ventral longitudinal ligament in the lower cervical region?
a. to allow for more lateral bend
b. to allow for greater extension
c. to allow for greater flexion
b. to allow for greater extension
Injury or inflammation of which ligament can affect the cord?
a. ventral longitudinal
b. dorsal longitudinal
c. ligamentum flavum
d. nuchal ligament
b. dorsal longitudinal
Injury or inflammation of which ligament can affect the contents of the IVF?
a. ventral longitudinal
b. dorsal longitudinal
c. ligamentum flavum
d. nuchal ligament
c. ligamentum flavum
The TMJ is a (simple/complex) joint.
Complex. A complex joint has two articular surfaces and a disc.
What are the two compartments of the TMJ?
Dorsal
Ventral
The (dorsal/ventral) TMJ compartment is responsible for open and close motion, while the (dorsal/ventral) TMJ compartment is responsible for lateral excursion.
Ventral compartment = open/close
Dorsal compartment = lateral excursion
True/False: restrictions of the TMJ can affect the hyoid.
True.
Name the four bones of the hyoid apparatus:
Stylohyoid
Ceratohyoid
Epihyoid
Basihyoid
The hyoid apparatus has muscular connections to the:
a. First Rib
b. Humerus
c. C5
d. Sternum
d. Sternum
Which cranial nerve innervates the temporalis muscle?
CN5
Name three muscles that attach to the basihyoid.
Omohyoideus
Stylohyoideus
Sternothyrohyoideus
What are two muscles that close the mouth?
Masseter
Temporalis
What are three possible presenting signs of a hyoid restriction?
Lack of lateral bend
Short stride in front end
Protrusion of tongue when riding
True/False: the atlanto-occipital joint moves only in flexion and extension.
False. A large portion is flexion/extension, but there is some lateral movement as a result of translation.
The capitis muscle is located:
a. over the dorsal arch of the atlas
b. over the nuchal crest
c. ventral to the occipital condyles
d. on the rostral aspect of the skull
a. over the dorsal arch of the atlas
Which foramina of the atlas carries blood vessels and where is it located?
Transverse foramen, located on the caudal wing of the atlas.
Note: the alar and lateral foramina carry nerves.
True/False: the atlanto-occipital joint is shallow and appears very close to the nuchal crest on radiographs.
False
What behavior problems can be associated with restrictions at C0-1?
Spookiness
Fear
Aggression
Depression
Other signs: lack of lateral bend or flexion, hard mouth, head tilt.
Which joint is responsible for most of the rotation of the neck?
C1-C2. Accounts for 73% of the rotation of the neck.
Some horses will rotate their poll when asked for even a slight lateral bend; what can this mean?
Indicates restrictions elsewhere in the neck. A horse should be able to laterally bend to the axilla without rotation.
In the cervical vertebrae, what foramen is mainly used for blood vessels?
a. jugular
b. lateral
c. transverse
d. lamellar
c. transverse
The angle of the facets at C2-3 are __________.
45 degrees
What is the contact point for C3 through C7?
Lamina-pedicle junction
Name two ways that C7 differs from the other cervical vertebrae.
Demi-facets on the caudal aspect to articulate with the first rib. (8 articular surfaces vs. 6)
Lacks a transverse foramen.
What are two ways a lower cervical restriction can affect the distal limb?
- Directly affects the brachial plexus (comes from nerve roots of C5-T2)
- Diminished blood flow
Muscle tension lines in the lower cervical region often come from the _______ muscle.
Serratus ventralis cervicus
What are the attachment sites for the serratus ventralis cervicus?
Transverse processes of C4-7 to medial scapula
Development of the __________ muscle should not be confused with a muscle tension line in the cervical region.
Splenius
What are the attachment sites for the splenius muscle?
Skull, atlas, and nuchal ligament to the transverse processes of C3-5 and dorsal spinous processes of T3-5.
What two muscles help flatten the lower cervical curve (i.e. lift the base of the neck)?
Serratus ventralis cervicus
Scalenes
What are the attachment sites of the scalenes?
Transverse processes of C4-7 to the first rib.
When the horse lifts the base of his neck, what is the action of the splenius muscle?
Support the head
What are the attachment sites for the obliquus capitis caudalis?
Temporal bone and nuchal crest to the wing of the atlas.
Changes in the obliquus capitis caudalis are felt when palpating:
a. the atlas
b. the axis
c. the occiput
d. C7
a. atlas
What are the attachment sites of the subclavius muscle?
Ventral sternum to supraspinatus muscle.
What are the attachment sites of the trapezius muscle?
Nuchal ligament to spine of the scapula.
Clearing restrictions and relaxing what three muscles will increase ROM of the front limb?
Subclavius
Brachiocephalic
Rhomboideus
True/False: to motion palpate C7 we need to be medial to the subclavius and near the attachment of the rhomboideus muscle.
False
What are the attachments of the brachiocephalic muscle?
Skull and transverse processes of C1-4 to the deltoid tuberosity of the humerus.
Name one pro and one con for an arched, flexible thoracolumbar spine.
Pro: allows for quick turns/speed
Con: Requires a great amount of muscular effort and energy to keep the back stable
What are three adaptations of the modern horse for running over relatively flat open terrain?
- Stiff thoracolumbar spine (little lateral bend/rotation)
- Small joint capsules in lumbar region with broad, horizontal transverse processes
- Fused radius/ulna to prevent supination
- Long cannon bones and one toe
Intentionally stiffening a joint that has a large range of motion is accomplished by:
a. ligaments
b. arthritis
c. tendons
d. muscular efford
D. Muscular Effort
How many curves are there in the horse’s cervical region?
Two - primary kyphotic and secondary lordotic
Which cervical curve develops after birth?
Secondary lordotic
Which cervical joint has the most rotation?
C1-2; 73% of total rotation
What three muscles commonly create muscle tension lines in the neck?
Splenius
Brachiocephalic
Serratus ventralis cervicus
A horse that rotates prematurely when asked for lateral bend may have (choose all that apply):
a. Restrictions
b. Cervical facet DJD
c. Hip Pain
d. Cervical Muscle Soreness
e. An Injection Site Reaction
f. Exceptionally Good ROM at C1-C2
a - restrictions
b - cervical faced DJD
d - cervical muscle soreness
e - injection site reaction
Normal musculature should:
a. have clear definition
b. feel very hard
c. have smooth contour
d. feel very soft and relaxed
c. have smooth contour
True/False: Movement of the vertebrae affects the spinal canal and IVF.
True
Neck (flexion/extension) decreases the diameter of both the spinal canal and the IVF.
Extension
When movement in one plane is always accompanied by movement in a second plane, we term it ____________.
Coupled motion
The diameter of the spinal canal and IVF decreases with:
a. flexion
b. extension
c. lateral bend
d. rotation
b. extension