Motion Palpation. Listing System C2 - L5 & Motion Palpation

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1 All materials contained in this PowerPoint Presentation are protected by copyright laws, and may not be reproduced, republished, distributed, transmitted electronically, displayed, broadcast or otherwise exploited in any manner without the express prior written permission of Ramneek S. Bhogal, DC, DABCI. Ramneek S. Bhogal, DC, DABCI either owns the intellectual property in all the information and media in this PowerPoint Presentation or has obtained permission of the owner to use the content in this presentation. You may download or print this material for your own personal and educational use only, without altering or removing any trademark, copyright or other notice from such material. Listing System C2 - L5 & Motion Palpation Viewing this PowerPoint Presentation constitutes explicit agreement with the terms of this copyright declaration. Motion Palpation Defined Technique developed by Henri Gillet, a Belgian chiropractor, in which the practitioner's hands are used to feel the motion of specific segments of the spine while the patient moves. The purpose is evaluation of the dynamic movement of the extravertebral and vertebral joints to assess dysfunction between the joints. Mosby's Dictionary of Complementary and Alternative Medicine. (c) 2005, Elsevier. Motion Palpation Advantages Widely utilized across chiropractic Not specific to any one technique Good reliability with a protocol and experience Provides quality kinematic information Can be augmented for all populations Correlated to listings on x-ray (verified or derived) Disadvantages Motion Palpation Unreliable when used as a stand alone tool Poor reliability without a protocol and experience Acute presentations can interfere with outcomes Requires patient to be interactive (which can take time) Has become the major indicator to many practitioners Motion Palpation Insightful about which component of the subluxation complex? Kinesiopathology Relative position Global ROM Intersegmental fixation 1

2 Documentation Insightful about which components of the PART system? P Pain and Tenderness A Asymmetry / Misalignment R Range of Motion Listing System Required Proficiencies: P-A Extension, Rotation, and Lateral Bend Lower cervical motion palpation (C2 C7) Thoracic motion palpation (T1 - T12) Lumbar motion palpation (L1 L5) History Symptomatology Visualization Posture / Leg Check Instrumentation Static and Motion Palpation Lifestyle Education 4 T s Adjust With Appropriate Technique Vertebral Subluxation Complex Spinography Listing System A listing is derived from spinographic analysis Qualifies the actual misalignment found on x-ray Facilitates the adjustment with appropriate technique (Methodology / LOC) Listing System Requires a frame of reference. An arbitrary set of axes, landmarks, or conditions that determine how something will be approached or physically described. -Merriam-Webster Dictionary Creates reproducibility and understanding by the doctor(s) Listing System Considerations Anatomical variability Important to have a reproducible analysis Static picture of a dynamic entity Important to re-evaluate Proper positioning (neutral) Protocol is a frame of reference Acute patient? 2

3 Characterize these segments Which direction has the spinous deviated? Which direction has the spinous deviated? Know which system you are using! Listing System Considerations Palmer-Gonstead System Comparison to segment below Palmer Upper Cervical Specific Comparison to foramen magnum Our focus will be P-G System Specifically C2-L5 The spinous process is the preferred SCP Listing System Components Posteriority P notation Spinous Laterality (Body Rotation) R or L notation Lateral Wedging S or I notation Lamina / Transverse/Mammillary 3

4 P PR PRS PR L/T/M PRI L/T/M Listing System P PL PLS PL L/T/M PLI L/T/M P Listing P Listing P Listing P Listing PR 4

5 5

6 Lateral Wedging Global or Multisegmental Wedging Scoliosis Lateral Curvature Global Wedging: Scoliosis or Lateral Curve is noted Segmental Wedging Stand Alone Segmental Wedge: No scoliosis/curve noted Lateral Wedging Regardless of the type of wedge that is observed, when rendering care, it is clinical practice to make contact on the side of convexity (open wedge) so as not to exacerbate the convexity (open wedge). As a result, the L / T / M is utilized. Remember: Spinous is preferred SCP Lets add lateral wedge 6

7 T 6 T 8 L 2 L 4 7

8 C 5 C 5 T 4 C 6 Segment of interest (C5) has no wedge relative to segment below but a global curve is noted in the spine above. T 5 Segment of interest (T4) has no wedge relative to segment below but a global curve is noted in the spine above. References Repeatability over time of posture, radiograph positioning, and radiograph line drawing: an analysis of six control groups. Harrison DE, Harrison DD, Colloca CJ, Betz J, Janik TJ, Holland B. J Manipulative Physiol Ther Feb;26(2): Erratum in: J Manipulative Physiol Ther Mar- Apr;26(3):211. Chiropractic biophysics digitized radiographic mensuration analysis of the anteroposterior cervicothoracic view: a reliability study. Troyanovich SJ, Harrison D, Harrison DD, Harrison SO, Janik T, Holland B. J Manipulative Physiol Ther Sep;23(7): Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis. Harrison DE, Harrison DD, Cailliet R, Troyanovich SJ, Janik TJ, Holland B. Spine (Phila Pa 1976) Aug 15;25(16): Chiropractic biophysics lateral cervical film analysis reliability. Jackson BL, Harrison DD, Robertson GA, Barker WF. J Manipulative Physiol Ther Jul-Aug;16(6): Biomechanical analysis by chiropractic radiography: Part III. Lack of effect of projectional distortion on Gonstead vertebral endplate lines. Zengel F, Davis BP. J Manipulative Physiol Ther Dec;11(6):