PRA 545 Article Review

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PRA 545Article Review
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Triano JJ. The functional spinal lesion an
evidence-based model of subluxation. Top Clin
Chiropr 20018(1)16-28.

• Manipulable disorder (subluxation in DC,
  somatic dysfunction in DO, and fixation or
  functional blockage in manual medicine)
  characterized as spinal joint strain/sprain with
  associated local and referred pain, and muscle
  spasm
• Spinal joint function assumed to become
  restricted or deranged

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Triano JJ. The functional spinal lesion an
evidence-based model of subluxation. Top Clin
Chiropr 20018(1)16-28.

• Proposed mechanisms for restricted function
  (fixation, blockage, hypomobility)
• Z-joint entrapment of an inclusion or meniscoid
  (innervated by nociceptors)
• Annular fragment entrapment at IVD (innervated by
  nociceptors)
• Adhesions and scar formation ? stiffness and
  ?myofascial
• Hyperactive deep intrinsic spinal musculature in
  unilateral, asymmetric patterns

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Triano JJ. The functional spinal lesion an
evidence-based model of subluxation. Top Clin
Chiropr 20018(1)16-28.

• Proposed mechanisms of action from SMT
• Releasing entrapped synovial or disc tissues
• Reducing pain and restoring mobility
• Breaking adhesions
• Stretching myofascial tissues

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Triano JJ. The functional spinal lesion an
evidence-based model of subluxation. Top Clin
Chiropr 20018(1)16-28.

• Neutral Zone A region of potential resting
  positions for the FSU
• It is a subcomponent within the range of motion,
  generally near its centre, in which very small
  applied loads result in relatively large
  displacement

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Neutral Zone
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Triano JJ. The functional spinal lesion an
evidence-based model of subluxation. Top Clin
Chiropr 20018(1)16-28.
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Neutral Zone
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27
40
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C1-C2 Axial Rotation
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Triano JJ. The functional spinal lesion an
evidence-based model of subluxation. Top Clin
Chiropr 20018(1)16-28.

• The concept of a normal rest position for a
  FSU, as commonly represented for static and
  motion palpation procedures, is technically
  erroneous.
• Because of the neutral zone component of range
  of motion, a vertebra cannot be expected to
  reliably return to a fixed starting position in
  relation to its adjacent member.
• Differences in static resting positions are
  likely to occur in normal, healthy subjects.

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Triano JJ. The functional spinal lesion an
evidence-based model of subluxation. Top Clin
Chiropr 20018(1)16-28.

• Hysteresis compounds the problem
• Prolonged static posture, or repeated activity,
  results in a temporary shift in the stiffness
  properties that influence the ability of the
  vertebra to elastically return to a prescribed
  initial position.

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Ross JK, Bereznick DE, McGill SM. Atlas-axis
facet asymmetry. Spine 199924(12)1202-1209.

• Typically, treatment (SMT) is then directed at
  the perceived restricted joint to restore normal
  function.
• That is, however, based on the assumption that
  in any joint pair, the geometry is identical.
• Should this not be the case, then palpatory
  findings do not necessarily indicate disease but
  rather anatomy.
• Therefore, in addition to reliability, the issue
  of validity of palpation must be considered.

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Ross JK, Bereznick DE, McGill SM. Atlas-axis
facet asymmetry. Spine 199924(12)1202-1209.

• Therefore, clinicians must realize that
  perceived restriction does not necessarily
  indicate pathologic motion but may simply reflect
  normal anatomy.
• Because spinal joint palpation assumes geometric
  symmetry from left to right and from one person
  to another, the implications of these data change
  the validity of palpation as a clinical test of
  spinal joint function.

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JK, Bereznick DE, McGill SM. Determining
cavitation location during lumbar and thoracic
spinal manipulation is spinal manipulation
accurate and specific? Spine 200429(13)1452-1457
.

• Clinicians using spinal manipulative therapy
  (SMT) claim to be very specific and accurate with
  the delivery of their dynamic thrust.
• Less than half of the lumbar cavitations occurred
  at the intended anatomic level
• Slightly greater than half of the thoracic
  cavitations occurred at the intended level
• Most procedures with multiple cavitations
  resulted in at least one cavitation emanating
  from the target level

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JK, Bereznick DE, McGill SM. Determining
cavitation location during lumbar and thoracic
spinal manipulation is spinal manipulation
accurate and specific? Spine 200429(13)1452-1457
.

• It appears from the data of this study that SMT
  is not as accurate as once assumed.
• Perhaps the clinical response is the result of
  the fact that, in most cases, many cavitations
  occur during the single manipulative procedure.
• By this shotgun approach, the offending joints
  are manipulated and the patient responds.

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JK, Bereznick DE, McGill SM. Determining
cavitation location during lumbar and thoracic
spinal manipulation is spinal manipulation
accurate and specific? Spine 200429(13)1452-1457
.

• Perhaps neurologic responses that occur during
  SMT are the mode by which this intervention
  exerts its effect.
• Whatever the case, techniques used to target
  treatment to a joint may not be necessary, but if
  accuracy is required, other techniques may need
  to be used.

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Triano JJ. Biomechanics of spinal manipulative
therapy. Spine J 20011(2)121-130.
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Ross JK, Bereznick DE, McGill SM. The frictional
properties at the thoracic skin-fascia interface
implications in spine manipulation. Clin Biomech
200217(4)297-303.