Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 1007
Clinical Information 252 CI

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: many of these issues are small, yet each issue is just that… an issue. If you take care of the small issues, then the larger issues often take care of themselves and you can focus on the larger issues… a larger, more profitable practice and more family time.

“A Biomechanical Treatment Plan”

This is directly from Dr. Weigand

“Guessing is BAD… Not guessing is GOOD” Mark Studin 2018

 

If you are coming to the NY Symposium October 27-28, we are having a bonus day on Friday, October 26th from 9 am to 5 pm with Dr. Weigand discussing this very issue, so you better understand it. If you have already let me know that you are coming… You don’t have to again… but if you haven’t… let me know via email.

 

The second option for that day is to study with both Dr. Owens and I on documentation and collections. There is no cost beyond sharing the cost of the room with everyone.

 

Form Dr. Ray Weigand:

 

How to determine a treatment/adjustment plan

  1. The goal is to re-establish normal coupling segmentally and regionally. As normal coupling occurs the spinal system becomes more functional. Treatment and correction are a continuum to optimum if optimum is possible. This includes restoring sagittal curves.
  2. The patient is trial matched to a left or right compensatory pattern. The physical findings associated with a right pattern are described on page 3. A left pattern is the mirror image.
  3. The patient goes into a right / left compensatory pattern in reaction to any biomechanical fault (subluxation). This happens because the spine uses the motions of gait as the pathway to compensation and torso rotation is a primary component. The geometry and physical findings of compensation are the same as a non-neutral position of gait.

Assessing the patient spine by solving the inter-dependent (coupling) relationship of the vertebral body rotation (VBR) and A/P stress lines (lateral bending)

There is an inter-dependent relationship of the vertebral body rotations to the lateral bending of the spine. This is referred to as coupling. When one event happens, another predictable event occurs at the same time.

The patient VBR (yellow horizontal bar graphs) and A/P stress lines (SL) (yellow vertical line) are illustrated. Data obtained from x-ray. Without comparison to a biomechanical model there is no particular insight into what to adjust. Most of the VBR are to the right. Stress lines appear nearly straight.

Overlay of optimum left torso rotation pattern illustrating ideal left VBR (blue hatched horizontal bar graphs). Most of the patient VBR (yellow) are on the side opposite of the left ideal pattern. The stress lines in the lumbar spine are bending opposite the left ideal pattern Stress Lines (SL). For this example, a left compensatory pattern is a poor match of co-dependent variables

Overlay of right torso rotation pattern (blue hatched bar graphs to the right). Most of the patient VBR (yellow) match the right ideal pattern.  The right compensatory pattern is the patient match and represents the rehabilitation goal.

VBR analysis: In comparison to the ideal pattern the most obvious biomechanical faults are C2, C3, T10, L3, L4, L5 as they are rotated to the wrong side. Simply stated; match the patient rotations to the ideal pattern. Any technique that can rotate the vertebra into correct position will work. 

With a right rotational pattern comes a Right PI, left AS, AI sacrum on the right, 5th lumbar should be rotated right.

Adjustments: The sacrum can be adjusted AI-R and the pelvis adjusted AS left. An AS adjustment is preferred over the PI because of the position of the fifth lumbar.  Adjustments: AI-R, AS-L, L5 L, L3 L, T10 L, T4 L, T2 R, C4 L.

Lateral Analysis combined with AP Analysis

 

A diminished cervical curve with anterior translation is the most common findings among patient with musculo-skeletal complaints.  Of and by itself it provokes a compensatory response with SI joint pain as the chief complaint.

The initial analysis is the Spinal Stress Units (SSU). The SSU measures the patient geometric departure from a balanced functional curve.

In this example the patient demonstrates a complete loss of the cervical curve and is rated “very Severe” for biomechanical abnormalities (precursors to pathology). Very severe is five standard deviations from the geometry of a intact balanced cervical curve. 

Adjustment vectors are determined by examining the motion data and determining the most dysfunctional segments in consideration with the A/P analysis. In general, a posterior to anterior force using a table with a drop cervical piece will address correcting the cervical curve. Also, C5 is the most logical place to adjust since it is the center of the curve. The A/P data is used to determine left/right adjusting vectors. Motion analysis determines superior to inferior (SI) LOC for the cervical segment being adjusted.

The motion study exams the symmetry of motion from neutral to flexion and neutral to extension. By knowing the ratio of flexion to extension adjustment vectors are determined. In this example C5 is fixated in flexion and the correct LOC is SI (superior to inferior rotating the vertebra into extension). C2 is completely fixated in flexion and the correct LOC for C2 is SI. Correcting C2 will help correct C1 as C1 is in a reciprocal functional relationship by being fixated in extension.

Motion analysis of the lumbar spine follows the same procedure.

Lateral bending studies of the cervical or lumbar regions reveal a higher level of biomechanical data for adjusting.

 

Bringing it all together on the treatment card.

 

The treatment card summarizes the graphical analysis. The specific segments are marked for adjusting.  In this example patient should have a right short leg due to the PI on the right with a right pattern.  However, the AS is adjusted because of the position of L5. The adjusting table pelvic section can be moved to the left to initiate right rotation (normal coupling) of L3, L4, L5. The pelvic section can also be lowered on the left to rotate the pelvis right.

The sacral tuberous ligament can be adjusted on the right with an Arthrostim with light pressure. Drop table AS-L, L5 L (adjust on left transverse), L3 L, L1 R, T10 L T4 L, T2 R, C5 R, PA SI, (C4 L SI). A description of the treatment card is included separately.

 

Physical findings associated with left right compensatory patterns.

 

 

Respectfully,

 

Mark Studin DC, FASBE(C), DAAPM, DAAMLP

Adjunct Associate Professor of Chiropractic, University of Bridgeport, College of Chiropractic

Adjunct Post Graduate Faculty, Cleveland University-Kansas City, College of Chiropractic

Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College

Graduate Medical Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences

 

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