Our time together today? - Life Chiropractic College West · 2019. 11. 5. · Subluxation “A...

Our time together today?

Clinical Concepts in the management of the Craniocervical Junction (CCJ) Vertebral Subluxation (part 3 of 4)Jeff Scholten, DC

“It is well known that the total CSF volume in the adult is approximately 130 ml, of which about 60 ml is contained within the cranial cavity, and about 70 ml is stored within the vertebral canal.”

“During the head rotation, the sub occipital muscles could draw the cervical dural sleeve by the MDB and then head movements might work like a muscle pump which drives CSF based on deformations of the dural sac.”

“ …the stroke volume during the entire cardiac cycle was increased significantly in cranial direction after the head rotations.

Thus it was speculated that head movements could be a significant contributor to CSF dynamics in the craniocervical junction, besides mentioned factors in the past, such as heartbeat and respiration.”

Homunculus

Sensory (posterior)

Motor

Cortical Blood Flow?

Where does the blood come from?

Cortical Blood Supply• Anterior Cerebral Artery (from

ICA) – Inner cortex

• Middle Cerebral Artery (from ICA) – Outer cortex

• Posterior Cerebral Artery (from VA) – Back-base of cortex

Dickholtz

Kessinger

Coupled motion

Motion about multiple axes that reduce stress in each other

Lack of appropriately coupled motion is difficult to adapt to both biomechanically and neurologically.

http://lifewest.edu/


A Method to Measure, Confirm and Localize Joint Dysfunction and its Impact on Cartilage.Authors: Ola Grimsby, PT, DMT, FFAAOMPT and David Harshfield M.D., M.S.

Slide credit David Harshfield

Instantaneous Axis of Rotation

Imaging evaluation must begin to correlate

the Static-structural findings with

the Kinematic-functional assessment

if we are ever to truly begin to understand

osteoarthritis


Osteoarthritis is inherently caused by biomechanical dysfunction in joints caused by ligamentous insufficiency induced disruption of the instantaneous axis of rotation ( IAR- motion) for each position.


Refers to two dimensional analysis

Aberrancies relate to joint degeneration

Position, Time, Nutrition, Genetics, Coping

Helical Axis of Motion (HAM)The axis of motion when three-dimensional motion occurs between objects (a screw axis of motion)

Can parameters of the helical axis be measured reliably during active cervical movements? Marco Barbero, etal. Musculoskeletal Science and Practice, Elsevier, February 2017

"Torqued subluxations" and "torqued alignments" involve THREE directions.”

“no ADJUSTMENT is ever given unless THE TORQUED VERTEBRA IS UNTORQUED; until the three-direction locked vertebra is three-directionally unlocked; with its "staying-put value" in exact ratio as the three-directional production is reversed to a three-direction reduction; as the torque is untorqued; as the lock is unlocked.”

“Abnormal ranges of motion may not show in the full range of motion studies

Abnormalities of the spine might be revealed by abnormal patterns of motion within individual segments”

Narrative Review of the In Vivo Mechanics of the Cervical Spine After Anterior Arthrodesis as Revealed by Dynamic Biplane Radiography, William Anderst, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania

Subluxation

• ?

Subluxation

“A (sub)luxation of a joint, to a Chiropractor, means pressure on nerves, abnormal functions creating a lesion in some portion of the body, either in its action, or makeup.”

Palmer DD, Palmer BJ: The Science of Chiropractic 1906

Subluxation

“Vertebral Subluxation

1. Loss of juxtaposition of a vertebra with the one above, the one below, or both.

2. Occlusion of an opening.

3. Nerve impingement.

4. Interference with the transmission of mental impulses.”

Stephenson RW: Chiropractic Text Book. Palmer School of Chiropractic. Davenport, IA, 1927

Subluxation

“A motion segment in which alignment, movement integrity, and/or physiological function are altered although contact between the joint surfaces remain intact.”

Gatterman, M: Foundations of Chiropractic Subluxation

Definitions

“Motion Segment – a functional unit made up of two adjacent articulating surfaces and the connecting tissues binding them to each other.”

“Spinal Motion Segment – two adjacent vertebrae and the connecting tissues binding them together.”


Definitions

“Manual Therapy – procedures by which the hands directly contact the body to treat the articulations or soft tissue.

Mobilization – movement applied singularly or repetitively within or at the physiologic range of joint motion, without imparting a thrust or impulse, with the goal of restoring joint mobility.”


Definitions

“Manipulation – a manual procedure that involves a directed thrust to move a joint past the physiologic range of motion without exceeding the anatomical limit.”


Definitions

“Adjustment – any chiropractic therapeutic procedure that uses controlled force, leverage, direction, amplitude and velocity directed at specific joints of anatomic regions. Chiropractors commonly use such procedures to influence joint and neurophysiologic function.”


Definitions

“Subluxation Complex – a theoretical model of motion segment dysfunction (subluxation) that incorporates the complex interaction of pathologic changes in nerve, muscle, ligamentous, vascular and connective tissues.”




Definitions

“Subluxation Syndrome – an aggregate of signs and symptoms that relate to pathophysiology or dysfunction of spinal and pelvic motion segments or to peripheral joints.”




Definitions

“Manipulable Subluxation – a subluxation in which altered alignment, movement, or function can be improved by manual thrust procedures.”


Role of Collagen:Solving the energy dilemma

Muscles and collagen are supporting tension

Collagen can provide a substitution mechanism for muscles to save energy by

allowing the animal to keep its posture without using muscles all the time

Muscles are energy guzzlers


Maximum 50 Kg

Muscle IAPClick


Click

The Crowbar

Less More

Fascia

Muscles

(Compression) (Compression)

Shut down muscles to minimize stress


Muscle

Fascia

20%

80%

For a200 kg lift


Muscle

Immature

fascia

Moves like a LPB

subject

People with LBP have a significant increase in muscle

activity

ClickSlide credit David Harshfield

Trunk flexion

MomentL4/5

0 15 30 45 60

Fascia

Muscle

Coordination spine/pelvis



IAP high

Big tummy benefit

Fascia is POWER( Note the flexed spine )


IAP high

Extension

IAP low

Flexion

IAP controls fascia


Visco-elasticity

take over the load

This is why continuous

postural changes are

necessary

while alternate structureswith time and need to restLoaded structures deform


3Dlordosis control

With multifidus

Control of Lordosis

Psoas

Psoas

Multifidus

Click


4 layers • Deepest layer contains multifidus (rotator(s) brevis,

longus, & semispinalis)

3 K • 25-100 per day

L,T,C regions• Language – Capital T, second toe, fifth toe

• Practice

Muscular Reactivation



Functional Disabilities

Discussion How patients tend to respond to short periods of reduced pain

How to plan to help patients avoid these issues



0 15 30 45 60

Moment at L4/5

Fascia

MuscleTrunkflexion

Trunk flexion affects the

distribution of loads between

muscles andfascia

Coordination spine/pelvis




Fascia is more than being part of a

force transmission system

Fascia is necessary for the stability and

survivability of the spinal column under

load

A subject with a damaged fascia may

not be rehabilitated

Conclusion




Viscoelasticity (Viscosity & Elasticity)

Consider loaded deformation over time

Requires rest by allowing other structures to take over

Necessitates continuous postural changes



Viscoelasticity

The conservation of energy with motion

Dynamic Stability



Do you care about Posture?How do you measure it?

Static vs Dynamic

Dynamic is easier – sway speed, deviation considerations

Static is never truly static – so how can you measure it?



Least Potential Energy position

Do we stand on our bones?

Increased Moments of Force

• Average weight of the human head 12 lbs (8-16 lbs)• increased vs decreased cervical & lumbar lordosis• increased vs decreased thoracic kyphosis

• Increased lordosis in cervical spine as a function of T1 anteroflexion(thoracic kyphosis)

• Increased lordosis in lumbar spine as a function of sacral base angle

• Reduced cervical lordosis, increases moment of force on VP

• Influence on lumbar spinal stress• FHP• Breast size• Abdominal fat

Soft tissue deformation - Creep, Hysteresis

• Creep – soft tissue elongation over time under load

• Hysteresis – the amount of elongation the tissue will maintain

• A muscle held under slight tension for 20-40 minutes will take 24-48 hours to return to its previous length

• Elastic vs contractile elements of muscle

Moving away cost more…

Less

More MoreEnergy

Wall

Energy

Wall

Material will deform

Collagen will stretch

Whiplash Considerations

Radiologists tend to opine on pathological processes where as we consider biomechanical aberrancies

Coupled motion disturbances



Our time together today? - Life Chiropractic College West · 2019. 11. 5. · Subluxation “A...

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