Podcast
Questions and Answers
A patient presents with restricted spinal motion. Which of the following is LEAST likely to be associated with this somatic dysfunction?
A patient presents with restricted spinal motion. Which of the following is LEAST likely to be associated with this somatic dysfunction?
- Normal neural elements (correct)
- Altered vascular elements
- Myofascial structural changes
- Impaired lymphatic elements
When diagnosing spinal somatic dysfunction, what is the correct order of steps a practitioner should follow?
When diagnosing spinal somatic dysfunction, what is the correct order of steps a practitioner should follow?
- Name the dysfunction, assess TART, understand normal mechanics, identify spinal levels
- Assess TART, name the dysfunction, understand normal mechanics, identify spinal levels
- Understand normal mechanics, identify spinal levels, assess TART, name the dysfunction (correct)
- Identify spinal levels, understand normal mechanics, name the dysfunction, assess TART
When referencing the motion of an individual vertebrae, what specific point on the vertebra is used as the reference point?
When referencing the motion of an individual vertebrae, what specific point on the vertebra is used as the reference point?
- The tip of the transverse process
- The inferior endplate of the vertebral body
- The center of the spinous process
- The anterior-superiormost point of the vertebral body (correct)
If the anterior-superiormost point of a vertebra rotates to the right, how will the spinous process move in relation to its initial position?
If the anterior-superiormost point of a vertebra rotates to the right, how will the spinous process move in relation to its initial position?
In left sidebending, what movement does the reference point on the vertebra undergo relative to its original position?
In left sidebending, what movement does the reference point on the vertebra undergo relative to its original position?
During spinal flexion, how does the spinous process move in relation to its original position?
During spinal flexion, how does the spinous process move in relation to its original position?
In what plane of motion does spinal rotation occur?
In what plane of motion does spinal rotation occur?
What axis of motion is associated with sidebending of the spine?
What axis of motion is associated with sidebending of the spine?
In the context of spinal anatomy, what does 'convexity' refer to?
In the context of spinal anatomy, what does 'convexity' refer to?
According to the 'Rule of Threes' for the thoracic spine, where is the spinous process of T1 located in relation to its transverse process?
According to the 'Rule of Threes' for the thoracic spine, where is the spinous process of T1 located in relation to its transverse process?
According to the 'Rule of Threes', where does the spinous process of T7 typically reside in relation to its transverse process?
According to the 'Rule of Threes', where does the spinous process of T7 typically reside in relation to its transverse process?
If a practitioner identifies a spinous process located halfway between the transverse processes of T4 and T5, which vertebral level does this spinous process belong to?
If a practitioner identifies a spinous process located halfway between the transverse processes of T4 and T5, which vertebral level does this spinous process belong to?
During examination of a patient's thoracic spine, you note that the spinous process of T8 moves inferiorly. What motion is the T8 vertebra undergoing?
During examination of a patient's thoracic spine, you note that the spinous process of T8 moves inferiorly. What motion is the T8 vertebra undergoing?
During palpation of the T6 vertebra, the left transverse process is found to be more posterior than the right. Which motion is the T6 vertebra most likely experiencing?
During palpation of the T6 vertebra, the left transverse process is found to be more posterior than the right. Which motion is the T6 vertebra most likely experiencing?
Which statement accurately reflects Fryette's Laws of Spinal Motion for the thoracic and lumbar spine?
Which statement accurately reflects Fryette's Laws of Spinal Motion for the thoracic and lumbar spine?
In Type I somatic dysfunction, what is the typical relationship between sidebending and rotation?
In Type I somatic dysfunction, what is the typical relationship between sidebending and rotation?
Which characteristic is associated with Type II somatic dysfunction?
Which characteristic is associated with Type II somatic dysfunction?
What is the primary difference between Type I and Type II Fryette's principles?
What is the primary difference between Type I and Type II Fryette's principles?
What is a key characteristic of Fryette's Law III regarding spinal motion?
What is a key characteristic of Fryette's Law III regarding spinal motion?
How does motion typically occur in the C2-C7 joints of the cervical spine?
How does motion typically occur in the C2-C7 joints of the cervical spine?
In Type I spinal mechanics, what term describes the vertebral segment exhibiting the greatest degree of rotation relative to its neighbors within a group curve?
In Type I spinal mechanics, what term describes the vertebral segment exhibiting the greatest degree of rotation relative to its neighbors within a group curve?
Which statement best describes how Type I somatic dysfunction is diagnosed?
Which statement best describes how Type I somatic dysfunction is diagnosed?
A patient is diagnosed with T3-5 NRRSL. Which of the following is most accurate?
A patient is diagnosed with T3-5 NRRSL. Which of the following is most accurate?
L4 ERrSr indicates:
L4 ERrSr indicates:
During palpation, you identify a vertebra where the right transverse process feels more posterior compared to the left. When testing motion, you determine vertebral motion improves in flexion. Which of the following is the most likely diagnosis?
During palpation, you identify a vertebra where the right transverse process feels more posterior compared to the left. When testing motion, you determine vertebral motion improves in flexion. Which of the following is the most likely diagnosis?
You palpate a patient's lumbar spine and find that the paraspinal valley feels more shallow on the right side from L1-L5. Motion palpation finds asymmetry is most pronounced while the patient is in the neutral position, improving in both flexion and extension. Which is most likely the diagnosis?
You palpate a patient's lumbar spine and find that the paraspinal valley feels more shallow on the right side from L1-L5. Motion palpation finds asymmetry is most pronounced while the patient is in the neutral position, improving in both flexion and extension. Which is most likely the diagnosis?
A vertebra exhibits a posterior right transverse process. Which direction is it rotated?
A vertebra exhibits a posterior right transverse process. Which direction is it rotated?
Three adjacent vertebrae exhibit posterior transverse processes on the left, and these asymmetries worsen during both flexion and extension. What type of dysfunction is present?
Three adjacent vertebrae exhibit posterior transverse processes on the left, and these asymmetries worsen during both flexion and extension. What type of dysfunction is present?
Three adjacent vertebrae have posterior transverse processes on the left, with asymmetry worsening in flexion and extension. In which direction are they rotated?
Three adjacent vertebrae have posterior transverse processes on the left, with asymmetry worsening in flexion and extension. In which direction are they rotated?
Three adjacent vertebrae have posterior transverse processes on the left, and the asymmetry worsens in flexion and extension. Which way are they sidebent?
Three adjacent vertebrae have posterior transverse processes on the left, and the asymmetry worsens in flexion and extension. Which way are they sidebent?
On examination of a patient's L2 vertebra, it is noted to prefer rotation to the left. The asymmetry is more pronounced in neutral and extension. What is the most likely diagnosis?
On examination of a patient's L2 vertebra, it is noted to prefer rotation to the left. The asymmetry is more pronounced in neutral and extension. What is the most likely diagnosis?
A high school football player presents to your clinic with a thoracic somatic dysfunction. Radiographs are negative for fracture, but the team physician cleared the player to return to play. You are palpating T3 and note that the corresponding spinous process is shifted to the patient's left in the transverse plane. Considering what you know about spinal biomechanics, what is the OPPOSITE motion direction of the patient's T3 vertebrae?
A high school football player presents to your clinic with a thoracic somatic dysfunction. Radiographs are negative for fracture, but the team physician cleared the player to return to play. You are palpating T3 and note that the corresponding spinous process is shifted to the patient's left in the transverse plane. Considering what you know about spinal biomechanics, what is the OPPOSITE motion direction of the patient's T3 vertebrae?
Which spinal region is best suited for sidebending considering the vertebral facet orientation?
Which spinal region is best suited for sidebending considering the vertebral facet orientation?
Which of the following is NOT associated with TART?
Which of the following is NOT associated with TART?
Which of the spinal motion concepts requires motion around an anteroposterior axis?
Which of the spinal motion concepts requires motion around an anteroposterior axis?
Which of the following best defines somatic dysfunction?
Which of the following best defines somatic dysfunction?
A clinician notes decreased spinal motion in a patient on the left side in the lumbar region. Which aspect of TART is being assessed here?
A clinician notes decreased spinal motion in a patient on the left side in the lumbar region. Which aspect of TART is being assessed here?
What is the predominant plane in which flexion and extension movements occur in the spine?
What is the predominant plane in which flexion and extension movements occur in the spine?
Which of the following best describes the motion of the spinous process during flexion of a typical lumbar vertebra?
Which of the following best describes the motion of the spinous process during flexion of a typical lumbar vertebra?
Which component of the vertebral segment is the primary stabilizer, providing the most mechanical support?
Which component of the vertebral segment is the primary stabilizer, providing the most mechanical support?
In human spinal biomechanics, what is the best method for describing the position of a vertebra?
In human spinal biomechanics, what is the best method for describing the position of a vertebra?
The primary purpose of the spinal column is to:
The primary purpose of the spinal column is to:
A 24-year-old female presents to your clinic with chronic lower back pain after a motor vehicle accident. You perform a thorough history, physical, and neuromusculoskeletal examination, where you note spinal dysfunction as a key contributor to her pain syndrome. You decide to perform osteopatic manipulation by palpating the patient's spinal motion. What is the goal of palpation?
A 24-year-old female presents to your clinic with chronic lower back pain after a motor vehicle accident. You perform a thorough history, physical, and neuromusculoskeletal examination, where you note spinal dysfunction as a key contributor to her pain syndrome. You decide to perform osteopatic manipulation by palpating the patient's spinal motion. What is the goal of palpation?
According to Fryette's third law, if motion is introduced in one plane, what happens to motion in the other two planes?
According to Fryette's third law, if motion is introduced in one plane, what happens to motion in the other two planes?
In the cervical spine, specifically at the C2-C7 joints, how does sidebending relate to rotation?
In the cervical spine, specifically at the C2-C7 joints, how does sidebending relate to rotation?
What is the typical behavior of the C0-C1 joint (occipitoatlantal joint) in terms of sidebending and rotation mechanics?
What is the typical behavior of the C0-C1 joint (occipitoatlantal joint) in terms of sidebending and rotation mechanics?
What is the primary motion occurring at the C1-C2 joint (atlantoaxial joint)?
What is the primary motion occurring at the C1-C2 joint (atlantoaxial joint)?
While assessing a patient you identify a single vertebral segment restricted in extension with coupled sidebending and rotation to the same side. According to Fryette's principles, what type of spinal dysfunction is most likely present?
While assessing a patient you identify a single vertebral segment restricted in extension with coupled sidebending and rotation to the same side. According to Fryette's principles, what type of spinal dysfunction is most likely present?
You are assessing a patient. You identify a group of vertebrae from T1-T4 that are restricted in their ability to flex and extend. When sidebending to the right, the entire group of vertebrae rotates to the left. What is the most likely diagnosis, according to Fryette’s principles?
You are assessing a patient. You identify a group of vertebrae from T1-T4 that are restricted in their ability to flex and extend. When sidebending to the right, the entire group of vertebrae rotates to the left. What is the most likely diagnosis, according to Fryette’s principles?
When diagnosing somatic dysfunctions, what does the acronym 'TART' stand for?
When diagnosing somatic dysfunctions, what does the acronym 'TART' stand for?
Which of the following most accurately describes the relationship between somatic dysfunction and spinal motion?
Which of the following most accurately describes the relationship between somatic dysfunction and spinal motion?
When utilizing TART criteria, what is being assessed when a practitioner identifies a shallow paraspinal valley on one side of the spine?
When utilizing TART criteria, what is being assessed when a practitioner identifies a shallow paraspinal valley on one side of the spine?
According to the 'Rule of Threes' in the thoracic spine, what is the location of the spinous process of T10 in relation to its transverse process?
According to the 'Rule of Threes' in the thoracic spine, what is the location of the spinous process of T10 in relation to its transverse process?
Your patient has lumbar somatic dysfunction. What does the 'L' in the notation 'L3 F RrSl' indicate in the diagnosis?
Your patient has lumbar somatic dysfunction. What does the 'L' in the notation 'L3 F RrSl' indicate in the diagnosis?
What makes vertebral levels T1-T3 unique according to The Rule of Threes?
What makes vertebral levels T1-T3 unique according to The Rule of Threes?
Which plane of motion primarily guides the flexion and extension movements of the spine?
Which plane of motion primarily guides the flexion and extension movements of the spine?
Which axis of motion is associated with rotation of the spine?
Which axis of motion is associated with rotation of the spine?
Which spinal region's facet orientation favors greater rotation?
Which spinal region's facet orientation favors greater rotation?
Which spinal region is best suited for flexion and extension movements considering the vertebral facet orientation?
Which spinal region is best suited for flexion and extension movements considering the vertebral facet orientation?
In a Type I Fryette's principle, what is the orientation of the motion?
In a Type I Fryette's principle, what is the orientation of the motion?
A patient is examined in the prone position. On palpation of the patient's T4 vertebra, the practitioner notes a prominence of the right transverse process, suggesting it is more posterior than the left. Which of the following is the OPPOSITE motion direction of the patient's T4 vertebrae?
A patient is examined in the prone position. On palpation of the patient's T4 vertebra, the practitioner notes a prominence of the right transverse process, suggesting it is more posterior than the left. Which of the following is the OPPOSITE motion direction of the patient's T4 vertebrae?
When the anterior-superiormost point of a vertebra rotates to the left, in which direction with the spinous process move in relation to its initial position?
When the anterior-superiormost point of a vertebra rotates to the left, in which direction with the spinous process move in relation to its initial position?
If a practitioner identifies a spinous process located one segment below the transverse processes of T7, which vertebral level does this spinous process belong to?
If a practitioner identifies a spinous process located one segment below the transverse processes of T7, which vertebral level does this spinous process belong to?
During examination of a patient's thoracic spine, you note the spinous process of T6 move superiorly. What motion is the T6 vertebra undergoing?
During examination of a patient's thoracic spine, you note the spinous process of T6 move superiorly. What motion is the T6 vertebra undergoing?
During palpation of the T7 vertebra, the right transverse process is found to be more posterior than the left. Which motion is the T7 vertebra most likely experiencing?
During palpation of the T7 vertebra, the right transverse process is found to be more posterior than the left. Which motion is the T7 vertebra most likely experiencing?
Which of the following statements accurately reflects Fryette's Laws of Spinal Motion for the thoracic and lumbar spine regarding coupled motion in neutral?
Which of the following statements accurately reflects Fryette's Laws of Spinal Motion for the thoracic and lumbar spine regarding coupled motion in neutral?
A patient is diagnosed with T1-3 NRrSl. Which statement is the most accurate?
A patient is diagnosed with T1-3 NRrSl. Which statement is the most accurate?
A clinician palpates a group of vertebrae in neutral, noting that the right transverse processes feel more posterior on T2, T3 and T4. Sidebending the patient to the right, the provider notes the asymmetry becomes less prominent. What is the most likely diagnosis?
A clinician palpates a group of vertebrae in neutral, noting that the right transverse processes feel more posterior on T2, T3 and T4. Sidebending the patient to the right, the provider notes the asymmetry becomes less prominent. What is the most likely diagnosis?
A patient presents with asymmetry at the L5 vertebral level. Palpation reveals the left transverse process is more posterior than the right. Furthermore, the patient feels more comfortable when flexing forward, which seems to reduce the asymmetry. What is the most likely diagnosis?
A patient presents with asymmetry at the L5 vertebral level. Palpation reveals the left transverse process is more posterior than the right. Furthermore, the patient feels more comfortable when flexing forward, which seems to reduce the asymmetry. What is the most likely diagnosis?
Three adjacent vertebrae exhibit posterior rotations on the right, and these asymmetries worsen during both flexion and extension. Which motion is limited?
Three adjacent vertebrae exhibit posterior rotations on the right, and these asymmetries worsen during both flexion and extension. Which motion is limited?
On examination of a patient's L4 vertebra, it is noted to rotate easier to the right. The asymmetry is more pronounced in flexion and extension. What is the most likely diagnosis?
On examination of a patient's L4 vertebra, it is noted to rotate easier to the right. The asymmetry is more pronounced in flexion and extension. What is the most likely diagnosis?
Which of the following is the first step when diagnosing spinal somatic dysfunction?
Which of the following is the first step when diagnosing spinal somatic dysfunction?
Why is understanding normal spinal biomechanics crucial in diagnosing somatic dysfunction?
Why is understanding normal spinal biomechanics crucial in diagnosing somatic dysfunction?
A 35-year-old male presents with constant midthoracic pain. The doctor notes the patient has a scoliosis and is palpating the patient to determine the area of greatest restriction as indicated the TART elements. What is the goal of palpation in this scenario?
A 35-year-old male presents with constant midthoracic pain. The doctor notes the patient has a scoliosis and is palpating the patient to determine the area of greatest restriction as indicated the TART elements. What is the goal of palpation in this scenario?
A patient reports that their back pain is worse when extending. Given this information, which direction is the somatic dysfunction named?
A patient reports that their back pain is worse when extending. Given this information, which direction is the somatic dysfunction named?
Which of the following best defines 'rotation' when describing vertebral motion?
Which of the following best defines 'rotation' when describing vertebral motion?
What is the convex side of the scoliotic curve called?
What is the convex side of the scoliotic curve called?
Why is it important to understand the Fryette's principle?
Why is it important to understand the Fryette's principle?
Flashcards
Why do we have a spine?
Why do we have a spine?
Protect the spinal cord and provide support for the upper body.
What are the motions of the spine?
What are the motions of the spine?
Flexion, extension, sidebending (lateral flexion), and rotation.
Diagnosing spinal somatic dysfunction
Diagnosing spinal somatic dysfunction
Understand normal mechanics, identify spinal levels, assess TART, and name the dysfunction.
Reference point for Vertebrae motion
Reference point for Vertebrae motion
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Right Rotation
Right Rotation
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Left Rotation
Left Rotation
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Left Sidebending
Left Sidebending
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Right Sidebending
Right Sidebending
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Flexion
Flexion
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Extension
Extension
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Axis and plane of Rotation
Axis and plane of Rotation
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Axis and plane of Flexion/Extension
Axis and plane of Flexion/Extension
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Axis and plane of Sidebending
Axis and plane of Sidebending
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Convexity
Convexity
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Concavity
Concavity
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Rule of Threes
Rule of Threes
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Fryette's Laws of Spinal Motion
Fryette's Laws of Spinal Motion
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Type I Somatic Dysfunction
Type I Somatic Dysfunction
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Type II Somatic Dysfunction
Type II Somatic Dysfunction
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Fryette Law III
Fryette Law III
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Cervical Spine Mechanics
Cervical Spine Mechanics
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Somatic Dysfunction
Somatic Dysfunction
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TART
TART
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Right Rotation Palpation
Right Rotation Palpation
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Palpation of TART
Palpation of TART
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Type II Dysfunction Palpation
Type II Dysfunction Palpation
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Type 1 Dysfunction Palpation
Type 1 Dysfunction Palpation
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Rules For Naming DYSFUNCTION
Rules For Naming DYSFUNCTION
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Spinal Somatic dysfunction is based on
Spinal Somatic dysfunction is based on
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Things That Guide Spinal ROM
Things That Guide Spinal ROM
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Other Influences of Spinal ROM
Other Influences of Spinal ROM
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Primary determinants of spinal ROM
Primary determinants of spinal ROM
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Study Notes
Lecture Objectives
- Discuss the relationship of somatic dysfunction to spinal motion
- Discuss the relationship of tissue changes to somatic dysfunction
- Discuss TART
- State the Rule of Threes
- Discuss Fryette's 3 principles and their limitations
- Discuss the role of the vertebral facets in control of motion
- Describe the general dysfunctional motions of the spine and how to diagnose them
Why have a Spine?
- Protect the spinal cord
- Provide support for the upper half of the body
Motions of the Spine
- Flexion
- Extension
- Sidebending (aka lateral flexion)
- Rotation
Diagnosing Spinal Somatic Dysfunction
- Understand the normal mechanics
- Know how to identify specific spinal levels
- Assess TART which is Tenderness, Asymmetry, Restriction of motion and Tissue texture changes
- Name the dysfunction
Reference Point
- The Anterior-Superiormost point of the Vertebral Body is used as a reference for motion
Vertebral Rotation
- Right Rotation: The point of reference rotates to the right, and the spinous process moves to the left.
- Left Rotation: The point of reference rotates to the left, and the spinous process moves to the right.
Vertebral Sidebending
- Left Sidebending: The point of reference tilts toward the left, and the spinous process tilts left as well.
- Right Sidebending: The point of reference tilts toward the right, and the spinous process tilts right as well.
Flexion and Extension
- Flexion: The reference point moves inferiorly and the spinous process moves superiorly.
- Extension: The point of reference moves superiorly, and the spinous process moves inferiorly.
Planes and Axes of Motion
- Rotation occurs in the Transverse plane along the Vertical axis
- Sidebending occurs in the Coronal plane along the Anterior-Posterior axis.
- Flexion and Extension occur in the Sagittal plane along the Transverse axis
Convexity and Concavity of the Spine
- The direction of Spinal alignment includes areas of Convexity and Concavity
Rule of Threes for the Thoracic Spine
- Identifies where the tip of the spinous process will fall in relation to the level of the vertebra's transverse process
- T1-T3: Spinous process (SP) is at the same level as its transverse process (TP).
- T4-T6: SP is ½ segment below its TP.
- T7-T9: SP is one segment below its TP.
- T10: SP is one segment below its TP
- T11: SP is ½ segment below its TP.
- T12: SP is at the same level as its TP.
Cervical Spine Mechanics
- C0-C1 joint (Occipitoatlantal joint): always exhibits sidebending and rotation in OPPOSITE directions
- C1-C2 joint (Atlantoaxial joint): exhibits only rotation
- C2-C7 joints: exhibits rotation and sidebending to SAME side caused by cervical anatomy, including uncovertebral joints (joints of Luschka)
Fryette's Laws of Spinal Motion
- Principles that determine thoracic and lumbar spinal mechanics and patterns of dysfunction
- They hold true for nearly all Spinal Somatic Dysfunction
Fryette Type I Spinal Mechanics
- Also known as “Group Curve” or "Neutral mechanics"
- Occurs in Neutral (no preference for flexion/extension)
- Inducing Sidebending to one side results in vertebral Rotation to the OPPOSITE side
Type I Somatic Dysfunction
- Group of vertebrae that exhibit asymmetry in neutral with sidebending and rotation to opposite sides
- The Apex is the segment that exhibits the MOST rotation relative to the ANATOMIC position
- Often, but not always, in the middle of the group curve
Fryette Type II Spinal Mechanics
- Single segment mechanics aka "Non neutral mechanics"
- Occurs in Hyperflexion or Hyperextension (non-neutral spine)
Type II Somatic Dysfunction
- Inducing sidebending while in Hyperflexion/hyperextension of a SINGLE vertebra results in that vertebra rotating to the SAME side
- A single (sometimes 2) vertebra that exhibits asymmetry in flexion OR extension, with sidebending and rotation to the same sides.
Fryette Law III
- Initiating motion at any vertebral segment in any one plane of motion will modify the mobility of that segment in the other two planes of motion
Summary of Spinal Mechanics
- T/L Type I: Occurs In Neutral, involves 3+ vertebrae, with Opposite Rotation & Sidebending - T/L Type II: Occurs In Flex/Ext, involves 1 or 2 vertebrae, with Same Rotation & Sidebending
- C0-C1: Occurs In Flex/Ext, involves C0-C1 only (OA), with Opposite Rotation & Sidebending
- C1-C2: Occurs In Flex, involves C1-C2 only (AA), with Rotation ONLY
- C2-C7: Occurs In Flex/Ext, involves Single or Multiple vertebrae, with Same Rotation & Sidebending
Somatic Dysfunction
- Impaired or altered function of related components of the somatic (body framework) system including the skeletal, arthrodial and myofascial structures, and their related vascular, lymphatic, and neural elements.
- Treatable using osteopathic manipulative treatment.
- The positional and motion aspects are best described using at three parameters
- position of a body part as determined by palpation and referenced to its adjacent defined structure
- directions in which motion is freer
- directions in which motion is restricted.
Somatic Dysfunction and Spinal Motion
- Somatic dysfunction can be identified by these signs
- Tenderness
- Asymmetry
- Restricted Range of Motion
- Tissue Texture Abnormalities
TART Examples in Spinal Motion
- Feeling a more posterior transverse process on one side compared to the other using Palpation
- Motion Testing demonstrates less vertebral motion when pressing on one transverse process compared to pressing on the opposite TP
Right Rotation Palpation Results
- Transverse Process will feel more posterior
- Transverse Process will resist anterior pressure (inducing Left rotation)
- Paraspinal Valley will feel more shallow
Type II Dysfunction Palpation Results
- Right Transverse process will be more posterior
- Right Paraspinal Valley will feel shallower
- Will NOT improve in Neutral (still posterior)
- Will improve (feels more symmetrical) in Flexion OR Extension
- It will not improve in the opposite motion (Ex: more symmetrical in Flexion = more posterior in Extension)
- Will be coupled with preference for Right Sidebending (same side)
Type I Dysfunction Palpation Results
- Right Transverse processes of T1-12 will be more posterior
- Right Paraspinal Valleys will feel shallower
- Will be most pronounced in Neutral (TPs more posterior)
- This will be equally prounounced (TPs posterior) in Flexion AND Extension AND Neutral
- This will coupled with preference for LEFT Sidebending (opposite to rotation preference)
Diagnosis of Vertebral Somatic Dysfunction
- Dysfunction is named for the direction of ease
Spinal Notation
- SD = Spinal Dysfunction
Example
- T1-12 N R_R S_L
- T1-12 = Dysfunctional Spinal Segments
- N = Preference: Neutral vs. Flexion vs. Extension
- R_R = Rotational Preference: Left vs. Right (Rotated Right here)
- S_L = Sidebending Preference: Left vs. Right (Sidebent Left here)
Spinal Somatic Dysfunction
- Named for the Dysfunction Segment's Position in Space
Examples in notation
- L2 F R_R S_R = L2 FRSR
- T8 E R_L S_L = T8 E SLR
- T3-5 N R_R S_L = T3-5 NRRSL
Facet Orientation
- Serves a Load Bearing and ROM Guiding role
Facet Orientation by spinal region
- Cervical facet is Parallel in the Frontal Plane and 45 degrees in the Transverse Plane
- Overall Orientation = BUM (Backwards, Upwards, Medial)
- Physiologic Motions = Flexion/Extension, Sidebending, Rotation
- Thoracic facet is 20 degrees in the Frontal Plane and 60 degrees in the Transverse Plane
- Overall Orientation = BUL (Backwards, Upwards, Lateral)
- Physiologic Motions = Some Flexion/Extension, Sidebending, Rotation
- Lumbar facet is 45 degrees in the Frontal Plane and 90 degrees in the Transverse Plane
- Overall Orientation = BM (Backwards, Medial)
- Physiologic Motions = Flexion/Extension, less Sidebending, nearly 0 Rotation
Spinal ROM Guidance factors
- Includes Intervertebral Discs and Articulations with other bony structures
- Articulations with Skull, Ribs, and Sacrum
- Ligaments, specifically the Anterior Longitudinal Ligament
- Includes Associated musculature, Soft tissue, and Inherent asymmetries (tropism) of facets)
- Includes Accumulated trauma, degeneration, wear/tear
Somatic Dysfunction and Spinal Motion
- Primary somatic dysfunction is caused by trauma or repetitive microtrauma
- Secondary somatic dsyfunction is caused by Local arthritis, Larger deformities like scoliosis, Viscerosomatic reflexes and Somatosomatic reflexes:
- all of these may affect the facet joints, ligaments, muscles, etc, restricting overall spinal motion & causing TART
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