AAT ROM PDF

Diversified ⚫ ROM – range of motion ⚫ ⚫ ⚫ Midline neutral (neutral axis) Neutral zone Pathological neutral Diversified ⚫ Midline neutral (neutral axis) – A longitudinal line in a long structure where normal axial stresses are zero when the structure is subjected to bending. That is to say there...

Diversified ⚫ ROM – range of motion ⚫ ⚫ ⚫ Midline neutral (neutral axis) Neutral zone Pathological neutral Diversified ⚫ Midline neutral (neutral axis) – A longitudinal line in a long structure where normal axial stresses are zero when the structure is subjected to bending. That is to say there are no “stresses” imposed upon the soft tissue components about the joint. Diversified ⚫ Neutral zone – The initial phase of ROM is called the neutral zone (NZ) and is usually quite small. An exception to the rule is the atlanto-axial joint (C1-2) where the NZ makes up 75% (30 degrees) of the total ROM for Y axis motion (40-45). Therefore the NZ can be thought as the free-play or “slop” of the motion segment or joint laxity around the neutral position. Diversified ⚫ NZ continued – Also described as the displacement between the neutral position and the initiation point (beginning) of spinal resistance to physiological motion. Translatory and rotatory neutral zones are expressed in meters and degrees, respectively. The neutral zone can be expressed for each of the six degrees of freedom. Diversified ⚫ NZ continued – Starting from the neutral position, there is large deformation due to application of a small load. After this “easy” deformation, again called “free-play” or “joint play”, there is increasing resistance offered by the tissue. Thus, the motion that takes place between the neutral position (mid-line) and the beginning of significant resistance is the NZ. Diversified ⚫ Pathological neutral – The NZ has been shown to increase with: ⚫ ⚫ ⚫ ⚫ Degeneration (joint & disc) Surgical injury Repetitive cyclic loads High-speed trauma ⚫ Limits of Motion (Barriers) Neutral Lumbar 2° Left Lumbar Rotation = + Θ Y Barriers to Motion ⚫ ⚫ ⚫ (Barrier Method) 1st barrier is called physiologic and represents the end of A-ROM. 2nd barrier is called elastic and represents the end of P-ROM. 3rd barrier is called anatomic or anatomical and represents the end of joint motion that causes no permanent damage to the structures that limit or “check” motion and are important to joint stability. Full (restriction free) joint motion ⚫ ⚫ Is that motion attained through complete and un-encumbered motion with assistance (passive) up to that joints anatomical barrier. To get from the elastic barrier to the anatomic barrier requires a force that exceeds the strength of those things (capsular, fluid & surface tension etc.) that normally restrict joint motion creating that elastic barrier. Brut strength vs HV-LA ⚫ ⚫ One can over come those entities that limit motion about the elastic barrier by ever increasing tension until the joint releases (cavitates). Or, a better (preferred) way is to breach the elastic barrier via a HV-LA thrust or impulse. This is done by speed and is a demonstration of Bernoulli’s principle. With speed one can over come the CoF that restricts its motion. CoF CoF ⚫ The nice thing about joint surfaces is their very low “Coefficients of Friction” (CoF). This becomes a very forgiving system when we apply it to developing our manipulative skills. This gives us some latitude when we are not exactly aligned with the joint surfaces. The spaces between the barriers. ⚫ The space created between the physiologic barrier and the elastic barrier or the space created between the different distances attained with A-ROM & PROM is where we perform mobilization. This is an aspect of joint motion that one can not do to them self or by them self. It requires outside assistance and therefore is passive in nature. We use this area (work with in this space) to increase ROM when we can not, for some reason, perform the preferred HVLA. HV-LA (High Velocity-Low Amplitude) ⚫ The best and most efficient way to breach the elastic barrier is through a high velocity (speed), low amplitude (small depth) force. Analogy: pulling a band aid off. Once this is done we move in to a new space between the elastic barrier and the anatomical barrier called the para-physiological space. The joint motion, at this point is greatly increased. Cavitation ⚫ After the one breeches the elastic barrier the joint should cavitate. This is the pop or crack that one customarily hears. This an air mass (usually nitrogen) rushing back in to a closed space created by a joint that has had a significant loss of motion (for many reasons) and has formed a vacuum. Think in terms of a suction cup or 2 pieces of glass held together by a small amount of fluid. To cavitate or not to cavitate ⚫ This appears to be a dividing point in chiropractic. There are some philosophies / techniques with in chiropractic that state a chiropractic adjustment does not have to cavitate a joint in order to be of benefit to the patient. This is where they make a distinction in terms between manipulation & adjustment. They are mostly static based ideologies. On the other side they would ask; if your are not cavitating the joint then what are you doing, what are you trying to achieve, what is your purpose? Open discussion…………coffee talk. Anatomical barrier ⚫ We can breech this barrier in degrees (plastic zone). These are usually graded. There are plastic changes of tissues about the joint that occur initially before total separation &/or permanent damage. Changes to this barrier effect future joint stability. Bartol’s Classification Bartol’s Classification The chiropractor as a wellness practitioner (1999 Coulter, I., Chiropractic: A Philosophy for Alternative Health Care) ⚫ “The notion of a wellness practitioner, and in fact the wellness movement, has arisen from a critique of the current health-care system and the doctor-patient relationship. In essence, the critics have argued that we do not have a health-care system but a sick-care system, the focus of which is on disease (the physiological expression) and illness (the social expression) rather than on health as such. The chiropractor as a wellness practitioner (1999 Coulter, I., Chiropractic: A Philosophy for Alternative Health Care) ⚫ This critique has focused extensively on biomedicine, and includes the following: ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ An historical re-evaluation of the contribution of medicine to health The changing epidemiology of illnesses, from infections to behavior-induced illness The discovery of iatrogenic illness The recognition of the importance of psychosomatic illness The recognition of the role of social and historical factors on health Studies of inequities in health care and the unequal burden of illness A consumer critique A humanist critique focusing on the bureaucracy and impersonality of contemporary medicine Cross-cultural studies The economic critique of escalating costs The chiropractor as a wellness practitioner (1999 Coulter, I., Chiropractic: A Philosophy for Alternative Health Care) ⚫ This state of affairs has many causes, but for many critics the main causes are as follows: ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ Medicine embracing the ideology of scientism The biologizing of illness The reduction of illness to specific causes The daulism embraced between mind and body The elevation of pathology/anatomy as the basis for diagnosis and intervention The loss of the traditional “whole person” perspective The chiropractor as a wellness practitioner (1999 Coulter, I., Chiropractic: A Philosophy for Alternative Health Care) ⚫ Wellness practitioners are conceived as the antithesis of current medical practitioners. They are holistic ( non-reductionist), humanistic, naturalistic (use natural remedies); conservative (the least therapy being the best therapy), egalitarian, caring, and use a low level of technology. An important element of the wellness movement is that health is something other than simply the absence of disease. [wholistic] The chiropractor as a wellness practitioner (1999 Coulter, I., Chiropractic: A Philosophy for Alternative Health Care) ⚫ Wellness is more than a concept. It is a way of life, an integrated enjoyable approach to living that emphasizes the importance of achieving harmony in all parts of the person; mind, body, spirit. It is a lifestyle that creates the greatest potential for personal wellbeing. More than the absence of illness, it is a balance among all the aspects of the person. The chiropractor as a wellness practitioner (1999 Coulter, I., Chiropractic: A Philosophy for Alternative Health Care) ⚫ ⚫ ⚫ Disease refers to a disordered biology. The subjective experience of disease, and the behavior associated with it, is illness (referred to by sociologist as ‘the sick role’). In a wellness paradigm, however, there is the recognition that health involves much more than the absence of disease, and health care should therefore involve more than the treatment of disease. The chiropractor as a wellness practitioner (1999 Coulter, I., Chiropractic: A Philosophy for Alternative Health Care) ⚫ ⚫ It also posits that treatment is distinguishable from care. In a wellness paradigm, health care involves both treatment therapies (such as manipulation) and also a whole range of activities aimed at overall health ‘care’ of the individual, such as identifying illness behavior, restorative care, health promotion, health enhancement through lifestyle counseling, and behavior modification.” (poz-its = to lay dow n or assume as a fact or principle; postulate) The chiropractor as a wellness practitioner (1999 Coulter, I., Chiropractic: A Philosophy for Alternative Health Care) ⚫ ⚫ Health in a wellness paradigm is viewed in terms of human potential.” “A person’s optimum state of health is equivalent to the state of the set of conditions which fulfill his or her realistic chosen and biological potentials. Some of these conditions are the highest importance for all people. Others are variable, dependent upon individual abilities and circumstances.” (Seedhouse in Coulter) The philosophy of wellness and its 4 principles ⚫ 1. Health is the natural state of the individual, and the natural tendency of the body is to maintain or restore that health ⚫ 2. Health is an expression of biological, psychological, social and spiritual factors, and disease and illness is multi-causal ⚫ 3. Optimal health is unique for any single individual, and the individual also bears some responsibility for their health – the practitioner is simply a facilitator of health ⚫ 4. There is a fundamental and central role for the structure and function of the neuro-musculo-skeletal system in the maintenance of good health and combating disease The ADJUSTMENT ⚫ Central to chiropractic wellness and left unanswered is whether an adjustment as such has a unique role in wellness care over and above its role as a treatment therapy. The ADJUSTMENT ⚫ ⚫ Balduc has attempted to identify the unique role of the adjustment by focusing on the anatomical and physiological mechanisms that promote wellness: “The central feature of this wellness knowledge is the appreciation that the nervous system plays a prominent role in total body (holistic) physiology.” As seen from a wellness point of view, the body is equipped with an integrative physiology. Balduc saw the subluxation as a challenge to the integrity of this system, and its removal a restoration of that integrity. The ADJUSTMENT ⚫ Jamison also proposes a similar self-organizing biological system with adjustment triggering the rule-governed process, which then initiates the process of wellness. The treatment of a single subluxation at one level has repercussions throughout the system, and it is this that affects the total system. A structural intervention therefore has global effects. The key to this is the role of the chiropractor in health promotion as a primary contact provider. The ADJUSTMENT ⚫ ⚫ Specifically Jamison states; “The goal of chiropractic consultation, rather than being documentation of a particular diagnostic entity, is correction of a dysfunction with the relief of pain, restoration of function and enhancement of wellbeing.” This is also mirrored by Vernon’s four staged practice management paradigm: ⚫ Reduction of pain ⚫ Recovery of function ⚫ Rehabilitation ⚫ Reinforcement