Flexion Distraction

Objectives

1. Go over the definition of Leander Technique

2. Present the concept of functional spinal unit

3. Review the orthogonal system

4. Contrast concepts of fixation/malposition/restriction

5. Introduce Pathological consequences

Leander Technique

A method of introducing a patient’s spine to continuous passive motion for a short period of time for the purpose of analyzing the degree of motion or

fixation of a spinal motion unit, augmenting the manual adjustment,

and then re-checking to ascertain the efficacy of the adjustment.

Spinal Motion Unit

Is made up of two adjacent vertebrae and their

intervening soft tissues. Motion or fixation is

described in terms relative to the subjacent vertebra.

Anterior Longitudinal Ligament

Posterior Longitudinal Ligament

Ligamentum FlavumIntertransverse Ligament

Interspinous Ligament

Supraspinous Ligament

Facet Capsular Ligament

Motion Assisted Palpation (MAP)

Motion assisted palpation is the analysis of spinal joint motion during motorized continuous

passive motion flexion distraction.

During motorized flexion/distraction, there should be a small yet palpable separation

occurring between two adjacent vertebrae.

Long Axis Distraction (LAD)

Loss of the normal movement between spinous processes:

•Long Axis Fixation (LAF)

•Primary Fixation

Orthogonal System

Subluxation

• Subluxation: an aberrant relationship between two adjacent articular structures that may have functional or pathological sequelae, causing an alteration in the biomechanical and / or neurophysiological reflections of theses articular structures, their proximal structures, and / or body systems that may be directly or indirectly affected by them.

–ACA, 1987

Subluxation• A.C.C. (Association of Chiropractic Colleges) definition of a

subluxation:

• A subluxation is a complex of functional and / or structural and / or pathological articular changes that comprise neural integrity and may influence organ system function and general health.

Joint Dysfunction

• Two types of clinical presentation that are most commonly seen in chiropractic offices:

• 1) Traumatic• 2) Overuse injuries-- usually seen at soft tissue

level

Joint Dysfunction

• The capsular ligament is the primary soft tissue affected. The capsular ligament has poor blood supply so when damage occurs, which is by sprain, healing is slow. But during the reparative stage and if further macro-trauma or micro-trauma is occurring by repetitive forces, fibroblasts will infiltrate the damaged area. These fibroblasts secrete collagen.

Joint Dysfunction

• The fibroblasts come mainly from the damaged ligaments or by blood supply from other areas, and will form in irregular patterns thus creating scar tissue or adhesions. Once adhesions are formed, which can take place in six to eight weeks, functional disability to the area can occur.

Joint Dysfunction

• Scar tissue/adhesions create functional disability and pain because the two main factors of scar tissue are:

• To Protect the injured area from further trauma by forming a less elastic tissue.

• To prevent further movement from occurring at the level of injury

Joint Dysfunction

• Sequence of Pathophysiology of either micro- or micro-trauma are:

• 1) Hyperemia--excess blood in an area.

• 2) Passive congestion--obstruction of escape of blood from an area.

• 3) Consolidation of protein exudate• 4) Formation of fibrinous coagulate• 5) Fibroblast organzation• 6) Fibrosis (scar tissue/adhesion)• 7) Ischemia…which creates further fibrotic formation.

Joint Dysfunction

• Artificial immobilization of joints have shown the following

pathological changes:• 1) Intra-articular edema• 2) Joint capsule shrinkage• 3) Calcification• 4) Osteophytic formation• 5) Intra-articular adhesions• 6) Shortening of peri-articular connective tissue.• 7) Adhesions between the capsule and the meningeal covering

of the nerve root.

Joint Dysfunction

• Therefore, the object of any manipulative procedure/treatment, such as motion flexion/distraction, is restoration of full and painless range of motion. Forced movement as in manipulation, ruptures adhesions about a joint and

is curative.

Joint Dysfunction

• By the usage of motion flexion/distraction, the principle is to affect the soft tissue problem with the use of manipulation & passive motion…thus, effecting the fibrosis. By affecting the fibrosis and breaking up adhesions, new blood flow will occur…especially in areas that had been ischemic…Thus, creating new movement into a hypomobile joint, and allowing synovial fluid to reoccur.

F/D Benefits

• 1) Increase of the intervertebral disc height to remove annular distortion in the pain sensitive peripheral annular fibers.

• 2) Allow the nucleus pulposus to assume it’s central position within the annulus and relieve irritation of the pain sensitive fibers.

• 3) Restore vertebral joints to their physiological relationships of motion

• 4) Improve posture and motion while relieving pain and improving body function

F/D Conditions

• The following are spinal conditions treated on a motorized Flexion/Distraction table:

• 1) Sciatica• 2) General back pain• 3) Scoliosis• 4) Facet Syndrome• 5) Spondylolisthesis• 6) Joint Dysfunction• 7) DJD

Diagnostic Tool

• Advantages of motorized flexion-distraction procedures:

– The doctors hands are free to motion palpate and observe increases or decreases in long axis distraction of a specific joint, or between two or more fixed spinal segments.

– The freedom to motion palpate with both hands and observe motion of the articular joints in lateral flexion and/or rotation.

– After a corrective spinal adjusting technique has been applied, changes can be observed.

– Apply specific inter-articular long axis distraction and /or specific muscle stretching for therapeutic purposes.

Contraindications

• Distraction should be discontinued if a patient complains of dizziness, nausea, undue discomfort or pain, motor weakness or other adverse sensory changes such as numbness. Any condition for which immobilization would be indicated would have traction contraindicated.

Contraindications

• General contraindications for the use of distraction are:• Cancer• Osteoporosis• Healing noncompressive fractures and dislocations• Arthritis, acute inflammatory (e.g., R.A.)• Neoplastic states (e.g., malignancy)• Joint instability, such as grade IV spondylolisthesis• Pregnancy…Thoracolumbar traction would be contraindicated in advanced states.

• Cardiovascular disease, advanced state• Bone infection• Acute traumatic syndromes• Muscle spasm…Severe• Acute disc fragmentation• Spinal cord compression or pathology