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Biomech test 1 & 2

Tri 2

Occipital-Atlanto-Axial Complex the most complex joints of the axial skeleton, basis fo BJ's approach 8
Cervical Motion Studies occiput functions as a cervical 8
Werne, Studies in Spontaneous Atlas Dislocation, 1957 most detailed study of Cervicals 8
C0-C1 Flexion and Extension Combined =25 degrees or 12.5 each way 8
C0-C1 Axial Rotation one side rotation =5 degrees, not restricted by atlantooccipital membrane, has a cup like sagittal and frontal plane allowing a rocking motion instead of a rotation. one side lateral flexion=5 degrees also 8
Limiting Structures of C0-C1 Flexion is limited by the impingement of the anterior foramen magnum on the DENS. There is said to be a bursa apicis dentis here also. (Remember that flexion and extension both equal 25 degrees) Extension is limited by the Tectorial Membrane. 8
Limiting Structures of C0-C1 Rotation is limited by the CONTRALATERAL Alar ligament, allowing only 5 degrees of rotation in the cup like joint. Lateral Flexion is also limited by the contra lateral Alar ligament with only 5 degrees of rotation 8
C0-C1 IAR X axis: through the center of the mastoid process Z axis: 2-3 cm above the dens
C1-C2 Axial Rotation There is one side rotation (y) that is 40 degrees. The lateral masses convex and the mobile atlantooccipital membrane. This accounts for 60% of the TOTAL cervial spine rotation 8
Vertebral Artery Kinks Contralateral at 30 degrees, Ipsilateral at 45 degrees 8
Georges Test and DeKleyns Test Used to test Vertebral Artery, both rotate and extend, you are looking for Pt to become nauseated, vertigo etc. 8
What is VBAI? Vertebrobasilar Artery Insufficiency 8
Cervical Adjustment and STROKE White and Panjabi perpetuate myth, actually the have only been 367 reported cases of stroke related to cervical manipulation in the last 98 yrs. There are 130 VBAI strokes per 100,000 cases of all strokes. Of that only 31 % are from cervical manipulatio 8
VBAI Strokes 40 VBAI strokes per 100,000 strokes..therefore it would be the most of 280 out of 700,000 strokes 8
C1-C2 Flexion Extension Combined is 20 degrees, One side lateral flexion is 5 degrees 8
Cervical Flexion/Extension 135 degrees total, Flexion =60 degrees and extension=75 degrees 8
C1-C2 Limiting Structures The tectorial membrane limits flexion and extension after C0-C1 makes it taut. Rotation is limited by the contralateral alar ligaments and lateral flexion is limited by the ipsilateral alar ligaments 8
Atlantodental Interval In adults this is constant in full flexion and extension (max=2.5 mm) In adults some subluxation in full flexion (max=4.5 mm) Normal C1-C2 is 2-3 mm. If there is a translation of 4mm you should consider a torn transverse lig. or trisomy 21 8
C1-C2 Lateral translation controversial, only apparent motion due to axial rotation 8
Coupling Characteristics C0-C1 Insignificant, C1-C2 Strong coupling pattern, some sagittal sections convex and others concave 8
C1-C2 Coupling Rotation produces axial translation, even when the bony configuration is concave, cartilage makes the joint convex. On rotation, a point in the center arch rises on a steep slope, plateaus then gradually descends 8
C1-C2 IAR X axis: the middle third of the DENS, Y axis: central DENS 8
Middle and Lower Cervial Spine Middle=C2-C5 (increases from top to bottom) Lower= C6-T1( decreases from top to bottom) Therefore the greatest ROM is at C4/C5 and C5/C6, also increasing spondylosis 8
Cervical coupling With lateral flexion, SP go to the convexity(opposite side), clinically this means that you should not see an apparent lateral flexion with rotation, if you do there is Arthrodesis, Fixed subluxation at C1/2 etc. 8
Degree of Cervical Coupling C2= 2 degree rotation for 3 degree lateral flexion. C7= 1 degree rotation for 7.5 degree lateral flexion. There is a gradual decrease in coupled rotation downwards 8
Cervical IAR For flexion Extension it is the body of the sujacent vertebra. Extension is more superior anf Flexion is more inferior. For rotation it is the Central disc 8
Thoracic Segmental ROM Flexion/Extension for T1-T9 is 5 degrees, T10-T12 is 11 degrees, this is b/c lateral flexion is slightly more in T10-T12 (6 degrees) Rotation for T1 is 9 degrees and decreases to 2 degrees in T12 9
Thoracic Coupling Lateral Flexion causes rotation, but not as strong as in the cervicals T1-T3: Same direction as in Cervicals..T4-T12 Direction of Rotation Varies 9
Thoracic IAR For Flexion/extension it is the superior end plate of the subjacent(lower) vertebra. Extension is more superior and flexion is more inferior. Lateral Flexion causess an IAR on the opposite side of the subjacent(lower) body. Rotation is in mdl of disc 9
Lumbar Segmental ROM's Flexion /Extension=15 degrees and increase down (caudally). Lateral Flexion is about 6 degrees( L3=8 degrees , L5=3degrees) Rotation is 2 degrees 9
Lumbar Coupling With lateral flexion, SP go to the concavity (same side) L1-L4 go to the Convexity(opposite side) 9
Flexion/Extension Lumbar Coupling With rotation a coupled flexion or extension occurs dependant on the posture. With extension, there is coupled flexion and with flexion there is coupled extension!!!! 9
Lumbar IAR The flexion IAR is the Anterior disc, with extension the IAR is posterior and inferior to the disc, lateral flexion IAR is opposite sid eof the disc, Rotation is the anterior disc. Degeneration changes ALL. 9
Sacroiliac Joint There are two joints here..Synovial portion(auricular area) and the Syndesmotic portion(fibrous, joined by lig.) This MAY be ankylosed(fused) in 76% over 50 yoa. NOT REALLY 9
Sacoiliac ROM We have known they actually move for a long time, but has been accepted. Walhein, 1983 use pins in vivo to prove there is a 2-3 mm vertical translation and rotation of 3 degrees 9
SI Joint ROM's Motion if sacrum is in relation to the ilium. Anterior Translation=3mm..Lateral translation=.75mm..Lateral rotation=1.5 degrees one side..Rotation=6 degrees one side 9
SI Joint IAR Frontal Plane Motion is a broad scatter, so is the sagittal plane motion 9
Lateral Disc Bulge Antalgic lean seen in patients the ease pain..Pt leans away from a lateral disc bulge 9
Medial Disc Bulge Pt leans toward a medial disc bulge 9
Leg Raising Tests SLR, Braggards, Siccards, Well Leg Raise, Fajerstajns, Coc 9
Intrathecal Pressure Tests Valsalva, Naffzigars 9
Leg Raising Tests used for.. a Mechanical stretching of the sciatic nerve 9
SLR Straight Leg Raise..flexion of the symptomatic leg, knee strait, positive if there is pain like complaint 9
Braggards SLR with ankle dorsiflexion...confirms the SLR
Siccards Confirms SLR..dorsiflex big toe 9
Well Leg Raise SLR with opposite leg..positive if pain in symptomatic leg 9
Fajersztajns Test Braggards with opposite leg. 9
Bechterew's Test Combination test with Pt seated with knee extension for pain..increases pressure 9
Lindner's Test Neck forcefully Flexed..increases pressure 9
Valsalvas test Pt deeply inhales and holes breath then 'bears down' Positive if pain increases. This increases the thecal pressure 9
Naffzigers Test Examiner compresses jugular veins of Pt. Positive if pain increases 9
Prophylaxis means... prevention 9
How should you stand for long Prds? With alternating foot on a stool 9
What is the best 'relaxing chair' Back 120 degrees, arm rests, thigh support, and 5 degrees lumbar support 9
How should you lift? object close to body, lift with legs, keep back strait, with Valsalva 9
Should you push or pull? Pushing reduces disc load 9
How should you sleep? On back, or sidewith support of knees..never on stomach 9
Cox Distraction James M Cox wrote 'Low back Pain' 1999, origionator of Cox distraction, used for Facet syndrome which is the most common condition 6
Cox Study, JMPT '82 & '84 Showed that 26% Pt with LBP have facet syndrome 6
How much weight do facet J carry? 3-33% of compression normally and 45% torsional strength...Degenerated discs carry as much as 47-7% due to extra articular impingement of facet tips on the adjacent lamina 6
What is Macnabs Line? Lines on a Lateral X-ray A-P on the end plates. The more anterior the lines intersect, the more sever the facet syndrome. Normal is 5 degrees 6
What is Facet Imbrication? When the Superior facet rises into the IVF causing Nerve root Compresssion 6
What was the Lora and Long Study published in Spine, 1976? Described pain patterns when the facet joints were irritated..patterns were specific into the buuttock, thigh and leg 6
Van Akkerveeken's Lines, Spine 1979 These lines used to indicate if there is instability in the facet syndrome. A lateral FULL EXTENSION X-ray used drawn like Macnab's. Unstable if 3mm or more greater distance..poor prognosis 6
Medical Subluxation A luxation is a complete dislocation, therefore a subluxation is a partion dislocation. 6
Chiro Subluxation An abnormal physical relationship b/tw adjacent anatomical structures 6
ICD codes 839.1=Subluxation in Cervical 839.2 Thoracic 839.3 Lumber's ...739.X for Inter segmental Dysfunction 6`
Flexion or Extension? Cox=Flexion McKenzie=Extension 6
Flexion Distraction techniques Cox=Lubars should be flexed in facet syndrome....Leander says Lumbars shouls be in normal lordosis(extension)=WRONG 6
Function of Spinal Muscles Stiffness, Stability, physiologi mvmnts, Protection, Post Injury 6
What aspect is damaged if you see impact coming? Soft tissue 6
What aspect is damages if you DO NOT see impact coming? Bone 6
Isometric Force Contraction of muscle with no length change but force changes 6
Isotonic force muscle contraction with no change in force but a change in length 6
Force-Length Curve contains active and passive lenths od force 6
Active Physical Properties max force is at 120-130% of resting length..like a wind up pitch. There is very little force at 50% of resting length 6
Passive Physical Properties There is no force until 100%, like a ligament 6
Stiffness Curve A msr of resistance offered to external loads as a structure deformed. Active Curve - Increases rapidly and then saturates Passive- Linear like a ligament 6
Relaxed Standing Posture Back Muscle activity is low, Longissimus and Rotatores are continuously moving, ads and psoas have slight acctivity...realxed sitting same 6
External Load Studies With weight in hands..increases muscle activity as load moves foward, lateral flexion causes contralateral activity 6
Flexion of Trunk Lumbar inter segmental Flexion the first 60 degrees and the pelvis is locked by the Gluts and Hamstrings. The next 25 degrees is from hip flexion and at full flexion only the iliocostalis moves 6
Extension of Trunk Back M. active only at the beginning and end. 6
Lateral Bending Increased M activity on both sides, with higher activity ipsilaterally. Therefore the trunk bends by the IMBALANCE OF FORCES. With a load there is more force on the contralateral side 6
Preload Preload is generated by the back M. pulling down on the posterior spinal structures to help balance the torque across the fulcrum of the disc. 6
Elastic Properties of the Cord semi fluid cohesive mass, stretches 10% of its length 7
Load Displacement Curve Two Phases, phase one cord folds and unfolds, phase two is properties of SC material 7
Compression of SC There is a large initial deformation and gradual resistance to buckling 7
Stress-Strain Curve non linear after 4-5% strain..Large hysteresis 7
SC Motion Flexion=first unfolds, then stretches. Extension=First folds, then compresses 7
Denticulate Ligaments Angled from cord to dura, transfers TENSILE forces(not shear), and tethers in place 7
Nerve Roots 170mm long at S1, avg 1.2mm/sq in cross section, procted by dural sleeve and CSF 7
Nerve Root Entrapment MUST hav Degeneration, usually in Lateral Canal (IVF) due to hypertrophy of Facets or Lig Flavum 7
Strain Change in length or angle in a material subjected to a load. the change in length divided by the origional length 7
Failure Strain of Nerve Root 18% stretch needed. Failure load more in IVF 7
Nerve Root Studies 30-50mm changes blood flow, vascular permiablity and axonal transport..if maintained nerve function decreases. 7
Nerve Root Compression by Pedowitz, Rydevik (1988,99) Used cauda equina in Pigs, 50mm Hg=No changes after 4 hours...100mm Hg after 2 hours=57% reduction in motor(restored) 74% reduction in sensory(not fully restored)....200mm Hg after 4 hrs=100% motor reduction(minimal recovery) 100% reduction sensory(NEVER 7
Kinematics Motion with NO FORCE 7
Kinetics motion WITH force 7
Translation direction in a straite motion 7
Functional Spinal Unit motion segment..relative to subjacent vertebra 7
Translation motion of a rigid body in a straite line 7
IAR Plane motion by that point in time 7
Helical Axis of Motion HAM-3D motion 7
Degrees of Freedom number of coordinated neeeded to specify position ...vertebra is always 6 7
ROM Displacement from one extreme to another...for each six degrees of freedom 7
Neutral Zone between neutral position and initiation position 7
Elastic Zone between neutral zone and ROM 7
Plastic Zone between end of elastic zone and point of failure, MICRO TRAUMA 7
Coupling a consistant association of one motion about the axis with another motion about a second axis 7
Pattern of Motion a configuration of a path that the geometric center of a body describes as it moves thru its ROM 7
Paradoxical Motion Occurs when there is typical flexion patterns at the FSU when the overall motion should be extension. 7
Created by: hwhite