Introduction to Spinal AdustingCervical Region

Donna M. Maitlen, B.S., D.C., C.C.S.P.

VSC Vertebral Subluxation Complex

Mechanical Components*Joint Malposition and Hypo and hyper-mobility

Neurobiologic Components*Nerve Root Compression (theory)*Visceral-Somatic dysfunction (autonomic)

Inflammation*Vascular and soft-tissue responses

Cause for Spinal Manipulation

Most of the time, we are adjusting patients based on the functional evaluation of the spine, typically using motion palpation techniques.

This means, most of our adjustments will be due to hypo-mobility as detected using our motion palpation with confirmatory static palpation findings.

You may also use devices that detect and measure pain and temperature to determine spinal joint dysfunction.

Anatomy Review

The facets of the cervicalspine angle upward from P-A at 45 degrees.

Contact points for adjustmentsare typically the articular pillars,the postero-lateral border of the spinous process, or the transverse process.

Mobility / Range of MotionRemember the segmental ranges of motion – these ranges help you define the subluxation complex.

The occipito-atlantial joint (C0-C1) has the most flexion / extension in the upper c-spine.

The atlantoaxial joint (C1-C2) has the most rotation in the upper c-spine.

Each joint has its own range

EXTRA CREDIT FOR THIS WEEK

Find out what the actual arch angle of a “Roman Arch” is – it is specific.

Compare and contrast this to the cervical lordosis of a newborn and the effect of a shallower or greater lordotic angle on the resistance to injury.

DUE WITHIN 1 WEEK FROM TODAY

Orthopedic TestingDiscovering contraindications to manipulation

Ruling out dangerous pathology

1. Vertebral Artery Testing – integrity of the vertebral artery

2. Compression Testing – integrity of foramen and body

3. Distraction Testing – integrity of musculature and foramen

4. Percussion Testing – integrity of bony structures

5. Valsalva Maneuver – integrity of neural structures

Protecting the Patient (and your license)

Down’s Syndrome: possible lack of a transverse ligament

Multiple risk factors of Osteoporosis

Atherosclerotic Plaque – CVA

History of sinus infection in conjunction with c-spine pain

Remember that much of your pathology DX comes from the proper history of the patient - listen AND ask.

Tests for Vertebral Artery Occlusion

In George's test, we first measure the bilateral blood pressure, pulse rates, and auscultate the subclavian and carotid arteries.

The patient is next asked to rotate the head right and left, and then rotate, laterally bend and extend in the seated position (Maigne's test) and in the supine position (DeKleijn's test).

Look for : Nystagmus and fatigue, Ask: Do you feel anything different? (do not lead

patient)

Evaluation of Spinal Segments

Seated• Observe active ROM (measure-especially before first

adjustment)• Static Palpation• Motion Palpation with end range overpressure• Flexion, extension, lateral flexion / medial glide, rotation• Instrumentation

Supine• Static Palpation – is anything different?• Motion Palpation • Flexion, lateral flexion / medial glide, rotation

Technique Set Up – Seated Index Push Moves

Indication: restriction of rotation lateral flexion or extension of C1Patient Position: relaxed, seatedDoctor Position: behind patient toward side of contactContact point: ventral surface of index finger(wrist straight as possible, forearm 90 degrees flex)Segmental Contact Point: Atlas transverse process (lateral or posterior)Indifferent hand: cradles patient’s headVector: P-A with rotation, P-A with Extension, or M-L

IMORTANT CONSIDERATIONS BEFORE ADJUSTING:*is patient relaxed?*have you maintained joint tension before thrust?

Technique Set Up – Supine Index Push Moves

Indication: Restricted rotation, lateral flexion or extensionPatient Position: Patient lies supineDoctor’s Position: Standing at head of table, 45 degrees to 90 degrees to patientContact Point: Ventrolateral surface of index finger, thumb or thenar rests on patient’s cheekSegmental Contact Point: Posterior articular pillarIndifferent hand: Cradles patient’s head supporting occiput and cervical spineVector: medial to lateral and superior to inferior

IMORTANT CONSIDERATIONS BEFORE ADJUSTING:*is patient relaxed?*have you maintained joint tension before thrust?

Doctor’s Presentation & Posture

The physical health of your body directly relates to and impacts your ability as a doctor to help people and to make a living.

TAKE CARE OF YOURSELF!!!!!!

Always consider your posture and core strength

Post Adjustment Management

Why is the subluxation or restriction present?

o Evaluate cervical spine for strength

o Biomechanics of neck curvature

o Posture

o Evaluate nutritional status, especially minerals

o Sleeping considerations – of posture and pillows

Review of Procedures – Efficiency of Order

Approach the patient with your questions in mind

Do your seated assessment before the patient lies down

• Observation, A-ROM, Orthopedics, R/O Pathology, vascular tests

Do your supine assessment • P-ROM, Vascular tests…

Pleasantries: assure the patient (before and after)