3 chiropractic subluxation indicators

8/12/2019 3 Chiropractic Subluxation Indicators

1/46

Chiropractic SubluxationIndicators

Leg Length Inequality

Thermography

PalpationSpinographic X-Ray


2/46

Chiropractic Subluxation Indicators

The Specific Upper Cervical ChiropracticSpinograph is the most important andsignificant analytical tool used by thechiropractor to determine misalignment.

The following assessment tests are usedto determine the presence of neurologicinterference.

The presence of misalignment on x-raywith a positive, persistent and consistentindicator = subluxation


3/46

Subluxation

A complex of function and/or structuraland/or pathological articular changes thatcompromise neural integrity and may

influence organ system function andgeneral health.

Association of Chiropractic Colleges

Owens, E. J Can Chiropr Assoc 2002;46(4)


4/46

The Evidence-Based Subluxation

Operational Definitions of Subluxation

Technology Assessment (Osterbauer)

using palpation, ROM, LLI, VAS.

P.A.R.T.S. (Bergmann, Finer)

Function Definition (Owens, Pennacchio)

Pattern Analysis, LLI, X-ray, Palpation

Functional Spinal Lesion (Triano) Structural approach, buckling



5/46


What is needed?

An operational definition which describesSubluxation in the measurements used to

locate it. A definition which can be tested for

reliability and validity.



6/46


Still, no definition gives detail as to how thenervous system is effected in theSubluxation.

What is needed to help define the neurologiccomponent of subluxation? Tests:

Reliable (repeatability) Validated (accuracy, does the test do what it says itdoes)



7/46

Finding the UC Subluxation

Posture

Thermography

Palpation

X-Ray


8/46


9/46

Pelvic Unleveling

Upper Cervical Chiropractors havereported that 90% of their patients can bebalanced after the reduction of he UC

subluxation. Test it, get them up and have them walk, then

recheck.


10/46

Pelvic Unleveling

Proprioceptive impulses from nerve endings inligaments, joint capsules, tendons, and musclesform a very largepart of the input pattern andare most closely related to postural tone.

Other afferent fibers from the muscle spindlescarry impulse patterns about muscle length tothe CNS, where patterns must be integrated inhigher centers with patterns of changing tension

and position that have originated in otherproprioceptors.

Bailey. J Am Osteopath Assoc, 1978 77(6):452-455


11/46


12/46

Pelvic Unleveling

Leg Check Reliability

The observed difference (no measuringtool) in leg length is reliable within 3/8 of

an inch (mean + SD) The measured (measuring tool used) is

reliable to within 1/8 of an inch

Compressive leg checks have shown the

greatest degree of reliability The difference ina pre/post measurement

should > 4mm (1/8 inch)


13/46

Pelvic Unleveling

Important factors for the Leg lengthMeasurement

Proper patient positioning

Proper doctor positioning Measurement must be taken from he

vertical plane

Noise in the system must be reduced

and accounted for Patient movement, doctor movement,

accommodation


14/46


15/46

Anatometer


16/46

Anatometer

Measures pelvic distortion in the frontal(horizontal), transverse (rotatory), andfixed point (vertical) planes, as well asweight difference from side to side.

It is hypothesized that after a successfulreduction of an atlas subluxation, the

pelvis will return to zero degrees in allthree planes.

Studies have shown evidence of reliabilityand validity in pre/post posturalmeasurements with the Anatomitor


17/46

Thermometry

Thermocouple direct contact with the skin

Infrared allows for no contact with the skin

Both have shown to be reliable in producing pattern

When enough constant features are found, thepatient is considered in pattern and most likelyin a subluxated state

Thermographic study of patients with spinal rootcompression nearly always reveals thermalasymmetry... the American Medical Associations Council on ScientificAffairs, 1987


18/46

Neurophysiologic Basis For Infrared

Dermothermographic Scanning

Infrared imaging detects and analyzes the cutaneous infraredemissions of the body.

These surface thermal patterns are a direct reflection of thesympathetic and sensory nervous system's control over thedermal microcirculation.

The main controlling factor, however, is the sympatheticdivision.

This division of the autonomic nervous system controls thevasodilatory and vasoconstriction action of the body's arterial

supply. Theories espoused around the turn of the century, and before,

professed that the source of this surface heat came frominternal areas of the body (chiropractic - heat from nerves,medicine - heat from diseased organs).


19/46

Landmark research on the origin of skin surfacetemperature regulation has since clarified thesetheories.

In several studies, independent heat sources of

significant magnitude were placed at varying depthsunder the skin and an attempt to detect the heatsource was made with sensitive thermalinstruments.

It was found that if a heat source was placed 5 mm

or more under the skin it could not be detected.Consequently, if skin surface temperatures arealtered in any way, it must be a direct reflection ofthe controlling factors involved in the regulation ofthe dermal microvasculature.

Thermometry


20/46

Thermometry

Pattern analysis of paraspinal heat differentials isbased on the following 3 points:

Skin temperature is largely under the control ofthe sympathetic nervous system.

The nervous system should be changing,adapting, to meet internal and external demandson the body

The degree of dynamicness, the extent to whichthe nervous system is dynamic (adapting to meetinternal and external demands of the body), canbe assessed by comparing sequential skintemperature readings

Hart, Owens Jr. J Manipulative Physiol Ther 2004;27:109-17


21/46

Thermometry

Indirect measures of neural function, including paraspinalthermography, have been used to assess the impact ofvertebral subluxation on the nervous system.

Thermocouple devices were used in chiropractic as early as1924 to measure the side-to-side skin temperature

difference, with the information used as a clinical indicatorof the need for vertebral adjustment.

Plaugher et al showed fair to good interexaminer reliabilityfor the Nervoscope device as it is used to locate segmentalside-to-side temperature differences, as well as moderateto excellent intraexaminer reliability.

DeBoer et al specifically tested interexaminer andintraexaminer reliability of an infrared system and foundvery high reliability.

Owens et al. (J Manipulative Physiol Ther 2004;27:155-9


22/46


23/46

Thermometry

Conclusion: Intraexaminer andinterexaminer reliability of paraspinalthermal scans using the TyTron C-3000

were found to be very high, with ICCvalues between 0.91 and 0.98.

Changes seen in thermal scans whenproperly done are most likely due to

actual physiological changes rather thanequipment error.

Owens et al. (J Manipulative Physiol Ther 2004;27:155-9


24/46

Thermometry

Results: Cervical spine temperatures remained relatively

constant while lower back temperatures, ingeneral, decreased for the entire 31-minuterecording period. Although the results variedamong subjects, on the average, the patternsstabilized after 16 minutes.

Conclusions: the pattern becomes stable after 16 minutes.

Readings taken for the purpose of patternanalysis during this 16-minute period may beunreliable for some patients.

a 16-minute acclimation period is recommended.

Hart, Owens Jr. J Manipulative Physiol Ther 2004;27:109-17


25/46


26/46

Palpation

When the scanning palpation is positive inthe C-1 and C-2 area it relates to directneurological insult or neurological insult

with resultant trigger point. When the scanning palpation is positive

from C-3 to C-7 it relates to musclespasms, contractions, trigger points, and

posterior zygapophyseal jointcompression.

http://www.atlasorthogonality.com/PhysiciansSite/PhysHtml/Publ.DocumentationOf.htm


27/46

Scanning Palpation

Scanning Palpation Scanning palpation isthe tactile examination of the cervicalspine with objective findings of muscular

spasms, contractions, enlargements,swelling or osseous protuberances.

Subjective findings will be extremetenderness, pain, hypersensitivity,

hyperirritability and neurological insult inthe positive palpated areas.


28/46


29/46

Upper Cervical X-Rays

Palmer Hole-In-One, Palmer UpperCervical (PUC)

Orthogonal Studies

NUCCA, AO, ORTHOSPINOLOGY

Articular Studies

BLAIR, KESSINGER (KCUCS)


30/46


31/46

Normal Alignmentvon Torklus D, Gehle W. The Upper Cervical Spine, Regional Anatomy, Pathology and

Traumatology: A Systematic Radiologic Atlas and Textbook. Grune & Stratton, New York,1972.

normal atlas alignment has the anterior archbeing horizontal.

Uncoordinated movement between atlas and axiscan result in kyphosis as a compensatingmechanism.


32/46

Normal Alignment

The important observations arethat the atlas sits squarely uponthe axis with the densequidistant between the lateralmasses of the atlas, that the

lateral atlanto-axial joint spacesare open and their contiguoussurfaces parallel,

that the lateral margins of thelateral atlanto-axial surfaces areprecisely superimposed and

symmetrical, and that the bifidspinous process of the axis is inthe midline.

Harris JH. The Radiology of Acute Cervical Spine Trauma, Third Edition, Williams & Wilkins, Baltimore/London, 1996.

G RR Bi h i f C1 S bl i


33/46

Gregory RR. Biomechanics of C1 Subluxation

Production. Upper Cervical Monograph, 1988; 4(5):12.

. . . all vertebrae are capable of a normal rangeof motion only if they align to the vertical axis,i.e., are in their normal positions.

When in their normal positions, they can executeconcentric (from a common center) motion. To

the extent that they deviate from the verticalaxis, or normal position, they execute eccentric(off-center) motion, resulting in an abnormalrange of motion.

The cause of an abnormal range of motion lies in

a displaced vertebra; the correction of theabnormal range of motion lies in restoring thevertebra or vertebrae that are displaced.


34/46

Sweat RW. Atlas Orthogonality, Part One of

Three.Today's Chiropr, 1983; 12(2):10-14.

OR-THOG-O-NAL-I-TY (N) - the quality or state ofbeing orthogonal.

OR-THOG-O-NAL (ADJ) - having to do with orinvolving right angles, intersecting at right angles,

mutually perpendicular. In abnormal or congenital conditions where one

occipital condyle is higher than the other, innatealways tries to adapt by having one lateral mass widerthan the other, or one side of the axis body higherthan the other side to keep the body balanced asvertical as possible.

In our orthogonal adjusting procedure we are alwaystrying to make the head vertical, the atlas horizontal,and the cervical spine vertical.


35/46


36/46


37/46

Gottlieb MS.J Manipulate Physiol Ther, 1994;

17(5):314-320

Palpation and unaided visual examination was performedon thirty atlases. The shape, size, angle, texture, border,and number or superior articular facets on each atlas wererecorded to determine symmetry.

Results: The classically described kidney-shaped facet wasan infrequent finding.

Upon comparison of right and left sides, none (0%) of thefacets were mirror images of symmetry, while nineteen ofthe atlases (63%) had grossly asymmetrical facets, andeleven out of thirty atlases (37%) had facets which wereonly slightly asymmetrical in regard to shape, border,

depth, and angle. Furthermore, seven of the nineteen grossly asymmetrical

atlases (37%) had three or four separate superior articularfacets. Three atlases had two facets on the left and one onthe right, while two atlases had two facets on the right witha single facet on the left, and two atlases had four superior

facets (two on each side).


38/46

Van Roy P, Caboor D, DeBoelpaep S, Barbaix E,

Clarys JP. Man Therapy, 1997; 2{1):24-36.

This study found that upon examining 82atlas vertebrae, the posterior arch showed

the highest number of asymmetries.

They found: unequal grooves for thevertebral artery, tropism of the superior

facets, frequent asymmetries of the atlastransverse processes and foramina.

If h mm tr i t h n rth n l r i l


39/46

If such asymmetry exists, how can orthogonal cervical

alignment be considered normaftAs Dr. John D. Grostic so

clearly stated?

The Grostic Procedure did not dictate the"normal position" of the atlas. It instead provideda system of measurement that made possible thelocating of that position of the atlas that resultedin the removal of abnormal clinical findings for

the greatest period of time. This procedure no more dictates the "normal"

position of atlas than physiology texts dictate thenormal oral temperature to be 98.6 degrees.

The Procedure has made it possible to observe

clinically the effect of various positions of theatlas on the findings of clinical tests.

X ra designed to acco nt


40/46

X-ray designed to account

asymmetry

William G. Blair, DC, developed his upper cervicalchiropractic procedure in part because of his concern overasymmetry in this region of the spine.

79% asymmetrically anterior to the contralateral condyle.

77% the foramen magnum apex turned off center.

77% short occipital condyle compared to the contralateralside when compared with the orbital floor.

64% short condyle compared with a baseline of the skull.

66% short condyle compared with a vertical median line.

C2 odontoid process is off-center of the axis body in 57% of

cases.


41/46

Asymmetry

When significant architectural asymmetry exists in occipito-atlanto-axial articulations, there usually appear to bedevelopmental adaptations. For example, when oneoccipital condyle appears shorter, the atlas lateral massand/or the axis superior articulating surface has been

commonly observed to be larger on the ipsilateral side. This could be true particularly if an injury occurred at birth

and the body adapted over time to improve thearchitectural balance.

Dr. Blair believed that the upper cervical subluxationoccurred at the articulation and required a different

approach to its analysis, in comparison to the orthogonally-based procedures.

(Grostic/Orthospinology doctors have observed thisasymmetry to occur in -20% of cases in clinical practice).

Eriksens editorial comment


42/46

X-rays

Lateral Vertex Nasium


43/46

X-rays

Base Posterior Right Protracto Left Protracto APOM

Left Lateral stereo, Right Shift

P l H l I O P l U


44/46

Palmer Hole-In-One, Palmer Upper

Cervical (PUC)

Base Posterior

Anterior-Posterior Open Mouth (APOM)

Neutral Lateral

Nasium

Anterior-Posterior Cervical (AP Cervical)

may also be included


45/46

Orthogonal X-rays

Nasium

Vertex

Neutral Lateral

Post x-ray for correction validation


46/46

Blair X-Rays

Used by the Blair and Knee Chest UpperCervical Specific techniques.

Articular Study of the cervical spine.

Series includes: (along with APOM, AP cervical and theLateral cervical)

Base Posterior

Left and Right Oblique Nasium (Blair Protractos)

Stereo Lateral Cervicals

3 chiropractic subluxation indicators

Documents