Veterbral Subluxation Complex

Question 1

Who was the first person to describe the vertebral subluxation complex?

Answer 1

Faye. Later published and developed by Dishman and then Lantz

Question 2

What are the five components in Faye’s model?

Answer 2

Biomechanical.
Neurological.
Muscular.
Inflammatory.
Stress response.

Question 3

What does vertebral subluxation complex describe?

Answer 3

The misalignment as well as connective tissues associated with joint.

Question 4

What does subluxation complex contain?

Answer 4

Kinesiopathology.
Neuropathophysiology.
Myopathology.
Histopathology.
Vascular dysfunction.
Biochemical changes.

Question 5

Kinesiopathology

Answer 5

Diseased motion such as hypo mobility, and hyper mobility and instability.
Includes degenerative changes.

Question 6

Neuropathophysiology.

Answer 6

Reflex or compression based neural irritation that can potentially cause visceral, endocrine, and immune system changes.

Question 7

Gillet Fixation Theory

Answer 7

Based on work of Henri Gillet who developed motion palpation and technique.
Categorizes fixations (restrictions) into types that are either partial (muscular and ligamentous) or total (bone)

Question 8

Sustained stress on muscle fibers leads to:

Answer 8

Hypertonicity/spasm.
Joint restriction.
Ligamentous and soft tissue shortening.
Articular adhesions/fibrosis.
Impaired function and joint degeneration

Question 9

Mennell Joint Dysfunction Theory

Answer 9

Developed by John Mennell MD manual therapist.
Developed series of concepts related to joint dysfunction, especially in peripheral joints.

Question 10

According to Mennell, what is joint dysfunction?

Answer 10

The loss of joint play movement that cannot be recovered by action of voluntary muscles.

Question 11

Northeast and MPI use what as basis for extremity joint technique?

Answer 11

Mennell Joint Dysfunction Theory

Question 12

Articular acute motion segment blockage theory

Answer 12

Meniscoid bodies.
Loose bodies
Articular surface irregularities.
Synovial fluid changes.
Periarticular adhesions.

Question 13

Acute motion segment blockage theory of discs?

Answer 13

Displaced disc fragment.

Question 14

What is a loose body?

Answer 14

Foreign material within the joint such as a piece of articular cartilage, bone chip, piece of meniscus.

Question 15

What are articular surface irregularities?

Answer 15

Roughened surfaces glide past and lock, probably most common in SI joint.

Question 16

What are capsular/periarticular adhesions?

Answer 16

The result of long standing joint restriction. Manipulation. Tears adhesions.

Question 17

Acute motion segment blockage theories cause?

Answer 17

Synovial tissue hyperplasia after injury and inflammation, decreased synovial fluid (often seen overlapping with osteoarthritis in older populations)

Question 18

Disc herniation/intradiscal block?

Answer 18

Annular fiber disruption with nuclear migration into the tear (THINK SARAH’S JELLY DONUT THEORY)

Question 19

Mechanical effects of manipulation?

Answer 19

Reversing mechanical dysfunction such as hypo mobility, misalignment, compensators.
Reversing or limiting soft tissue pathology such as fibrosis, adaptational shortening, and loss of flexibility/elasticity.

Question 20

Early stages of manipulation?

Answer 20

Goal is to decrease pain and inflammation, prevent further injury, and promoting flexible healing and good alignment

Question 21

Later stages of manipulation?

Answer 21

More aggressive treatment. Break up scar tissue formation and restore normal function within kinematic chain.

Question 22

What do you need to make an adjustment?

Answer 22

Palpation of misalignment along with at least 1-2 other findings such as stiffness on a joint scan or localized tenderness

Question 23

What are the most significant restrictions?

Answer 23

Demonstrable in more than one postural position.
Detected in more than one direction.
Qualitatively presents as hardest endfeel compared to other restrictions.
Pain exists during end feel analysis.

Question 24

Reasons for hyper mobility?

Answer 24

Secondary adaptive compensations (lumbar cage).
Post macro trauma (shoulder dislocation).
Repetitive motions or repeated micro trauma (tendinitis).
Congenital (collagen weakness) such as marfan’s syndrome, Down’s syndrome, Ehlers Danlos syndrome.