Diversified Format & Nomenclature PDF

Diversified Format of Teaching Technique & Abbreviations Used in Listings Nomenclature Diversified ⚫ A way not The way. There can be no “The way” because we are all different (patients & doctors). Make sure that what you are doing and being taught is biomechanically sound for your patient and ergon...

Diversified Format of Teaching Technique & Abbreviations Used in Listings Nomenclature Diversified ⚫ A way not The way. There can be no “The way” because we are all different (patients & doctors). Make sure that what you are doing and being taught is biomechanically sound for your patient and ergonomically sound for you. Be critical but professional. Ask questions. Diversified ⚫ Indications / Listings ⚫ ⚫ Static Model– Vertebrae stuck in space. Will not return to neutral. Can go further “out” with in it’s normal range of motion. Dynamic Model– Restricted with in it’s normal range of motion. Will return back to it’s neutral position. Diversified ⚫ Static Listings ⚫ ⚫ ⚫ ⚫ ACA-M (American Chiropractic Association – Medicare) PGF (Palmer-Gonstead-Firth) National Diversified (ND) Static Orthogonal (right-handed cartesian orthogonal coordinate system, X-Y-Z) Diversified ⚫ Dynamic Listings ⚫ ⚫ Mo-palp - Motion Palpation (excursion & end-feel) Dynamic Orthogonal (same system but written in terms of reduced movements) ⚫ ⚫ Along – is used to state someone or something is moving in one direction. Linear, translation. About /Around– used of movement to or among many different places or in no particular direction, all around or on all sides (such as around an axis), in rotation or succession, about a point or around a point (a point in space). Diversified ⚫ Anatomical reference points for static listings ⚫ ⚫ ⚫ ⚫ ACA-M = Radiographically determined vertebral body reference. Malposition – extension malposition, etc. PGF = Palpatory & radiographically determined spinous reference. Instrumentation used also. Static Orthogonal = Palpatory & radiographically determined vertebral body reference (Roentgenometrics). National Diversified = ⚫ ⚫ ⚫ Occiput – condyles C1 – TVP’s C2-7 – Articular pillars Diversified ⚫ ⚫ ⚫ ⚫ ⚫ Thoracic’s – TVP’s except AI & PI which is a body ref. as viewed laterally via x-ray Lumbar’s – Vertebral Body/Mammillary processes Pelvis – Innominate (ilium-PSIS, ischium, pubes) Sacrum – Sacral base Coccyx – Position of apex of coccyx Diversifed ⚫ ND abbreviations ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ R = right L = left L = lateral as 2nd character A = anterior P = posterior P = pelvis usually spelled out I = inferior S = superior Diversifed ⚫ More Abreviations ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ L-S= lumbosacral SB= sacral base SA= sacral apex AI= anterior-inferior ASB= anatomical snuff box ILA= inferolateral aspect LSP= left side posture = _____ side down*** RSP= right side posture = ______ side down*** Diversified Listings ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ LRR = Left Rotation Restriction RRR = Right Rotation Restriction RLFR = Right Lateral Flexion Restriction LLFR = Left Lateral Flexion Restriction AGR = Anterior Glide Restriction PGR = Posterior Glide Restriction RRROA = Rotation Restriction around Right Oblique Axis RRLOA = Rotation Restriction around Left Oblique Axis CRRROA = Counter-Rotation Restriction around Right Oblique Axis CRRLOA = Counter-Rotation Restriction around Left Oblique Axis RRTA = Rotation Restriction around Transverse Axis CRRTA = Counter-Rotation Restriction around Transverse Axis Diversified ⚫ Anatomical reference points for dynamic spinal listings ⚫ ⚫ Mo-palp = body reference Dynamic orthogonal = body reference Diversified ⚫ Format categories (more abreviations) ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ PP= Patient Position DP= Doctor Position CP= Contact Point SCP= Segmental Contact Point IH= Indifferent Hand LOD= Line of Drive* VEC= Vector* *LOD & VEC are used interchangeably in chiropractic texts All specific directions are in this power point are for lumbar rotation set up Diversified ⚫ Patient Position ⚫ For all techniques, how one positions the patient is very important. Not only for delivery of the adjustment but also for patient comfort for receiving the adjustment. “It’s all in how you tee up the ball.” Because of this, the equipment for optimal positioning becomes very important. It is under this heading that we will also describe appropriate table adjustments. Diversified ⚫ Patient Position: ⚫ ⚫ ⚫ ⚫ ⚫ LSP= RSP= Pts. Hips & shoulders should be _________ & ___________ Pts knees slightly ______. Feet of edge of table. Pt should be within ____ of the front edge of the table. You can measure by having them move up to your ______. Diversified ⚫ Patient Position ⚫ Set the patient’s pelvis ⚫ ⚫ ⚫ Gently pull Pt. off shoulder (the one resting on the table) IH: Position pts. Humerus anterior to mid axillary line ⚫ ⚫ ⚫ ⚫ ⚫ Rotate pelvis anteriorly without Abducting or Adducting the hip NOT X chest +Y to oblique +Y distraction P2P= pocket 2 pocket Take care to keep the Pt. close to the front edge of table Maintain tension throughout the set up (spring) ⚫ Load & Hold/ don’t loose the potential energy you created Diversified ⚫ Patient Position & Doctor’s position ⚫ P2P= pocket 2 pocket ⚫ ⚫ ⚫ ⚫ Fencer’s stance straddling pts. flexed leg with good posture/ dr.’s front leg against the table Dr. shifts weight to their front leg to bring their hip (back leg) up to the pts hip by sliding up thigh to thigh Dr. rotates their pelvis towards HOT dropping their ASIS to contact the pts hip This causes the dr. to pivot : ▪ LSP: 10:00→11:00 & RSP: 2:00→1:00 Table abbreviations Diversified ⚫ Patient Position & Doctor’s position ⚫ P2P= pocket 2 pocket ⚫ ⚫ ⚫ Dr. allows pt to roll with and towards them as drs. back foot returns to floor in bowler’s stance Use pocket 2 pocket to roll pt. approximately 45 ˚ without losing tension from pin Drs. torso and lower body in line Ex. Dr. facing 11:00 should have legs in line @ 5:00 Diversified ⚫ Doctor Positioning ⚫ This is broken up (usually) into position & stance. Position covers where the doctor will be relative to the position of the patient. Some techniques will require the doctor to start in one position and then transition to another during the delivery of the adjustment. Stance covers what the doctor looks like when they get into the position to deliver the adjustment. This stance is the most stable position one can be in for adjustment delivery. Diversified ⚫ Doctor Postioning ⚫ Long fencer’s stance to set pelvis ⚫ ⚫ ⚫ Keep back straight After P2P, Drs. torso and lower body in line: ⚫ ⚫ ⚫ Dr.’s front foot under knee Ex. Dr. facing 11:00 should have legs in line @ 5:00 Dr. final position on target-‘hammer’ contacting ‘nail’ Dr. maintains good posture w/ sup leg against table & inf leg straight Diversified ⚫ Contact Point ⚫ CP refers to some aspect of the doctors body (hand, knee, forearm etc.) or appliance (tool, block, fulcrum etc.) that is used to and through which the adjustment is delivered. This will usually be further divided into tissue slack or pull used in the placement of the contact point and its action after it has been placed (what it is going to do when it gets there?). Diversified: Contact point ⚫ CP: Dr.’s pisiform/ proximal hypothenar of inferior hand Chiropractic hand position to protect your pisiform ⚫ ⚫ ⚫ ⚫ ⚫ ⚫ Wrist extension & MCP flexion with Hypothenar muscle should be contracted Use your pisiform→ proximal hypothenar to remove tissue slack with a L-M tissue pull (a little I-S but mostly L-M) CP should remain stable after tissue pull (don’t wiggle around, you might slip off SCP) Diversified ⚫ Segmental Contact Point ⚫ SCP refers to where the contact point is placed so as to deliver the adjustment and therefore to effect change within that segment. You are being taught a short lever, direct technique. We will therefore be as specific as possible in describing the segmental contact positions. Diversified: Lumbar Rotation Segmental Contact Point ⚫ SCP= mammillary process of involved segment \ ⚫ See charts for other SCP’s ⚫ RRR/LP: SCP= L-mammillary LRR/RP: SCP=R-mammillary ⚫ ⚫ ⚫ SCP must be secure and capable of receiving thrust without slipping NOTE: You cannot put your index finger on your pisiform (of the same hand) You MUST pick up your index finger before using your CP to tissue pull to the SCP Diversified ⚫ Indifferent Hand ⚫ ⚫ IH refers to what the other hand &/or arm is doing and therefore contributing to the adjustment. You will find some reference as to its position, tissue slack (if any) and action. This is sometimes referred to as the stabilization or support hand but that would be a reference as to its action. IH: Position pts. Humerus anterior to mid axillary line ⚫ ⚫ NOT X chest +Y to oblique +Y distraction Diversified ⚫ Line Of Drive ⚫ LOD covers not only the direction of the force generator but also how the force is being generated. Line of correction and vector is sometimes used to describe these entities. In a motion model LOD is determined with physical methods, by Mo-palp (excursion &/or end feel). A diminishment or restriction to normal motion is felt for and then HV-LA force is applied to break through that restrictive barrier. Diversified ⚫ LOD/VEC ⚫ ⚫ Spring the joint Load & Hold: Maintain tension (eccentric contraction of the triceps) as you drop ⚫ ⚫ Practice slowly lowering hands with partner pushing down on hands Dr. should be facing 11:00 or 1:00 with back straight (not twisted) and legs in line (5:00 or 7:00) Diversified 1 Side-Posture Lumbar Rotation (Involved side up) STATIC LISTING RP - L (1-5) Right Posterior LP – L (1-5) Left Posterior DYNAMIC LISTING LRR – L (1-5) Left Rotation Restriction RRR – L(1-5) Right rotation Restriction PP LSP RSP CP L-Pisiform R-Pisiform SCP R-mammillary of involved segment L-mammillary of involved segment TP L-M & slight I-S L-M & slight I-S LOD P-A & L-M P-A & L-M IH