(1) Biomechanics: Adjusting Ergonomics and Physiology

Question 1

What group of individuals at a whole are more at risk for low back pain?

Answer 1

health care professionals

chiros are a high risk group

Question 2

What percentage of chiropractors have a lifetime incidence of LBP?

Answer 2

74%

Question 3

What was found to have a significant effect on low back pain for chiropractors?

Answer 3

table height

Question 4

There was a study done on table height, high, medium, and low— what were the findings for each?

Answer 4

Medium height table = LEAST strain for Lumbar and Thoracic adjusting

Highest height table = LEAST strain for Cervical adjusting

Lowest height table = sig. increased ALL forces measured in blow back for all adjusting :(

Question 5

What did having the table height adjusted to match the adjustment done reduce?

Answer 5

reduced sagittal flexion by over 20%

Question 6

What should we utilize as the fulcrum when we bend over?

Answer 6

movement of the iliofemoral joint!!!

NOT the lumbar spine

Question 7

Why should we utilize the iliofemoral joint when we bend over?

Answer 7

• decreases pressure on IVD

- decreases tension at posterior disc and ligaments

Question 8

What are the MC sites of injury practitioners reported?

Answer 8

wrist, hand, shoulder, and low back

Question 9

What movement provides the most mechanical stability for the wrist?

Answer 9

radial deviation and extension

Question 10

What movement provides the best mechanical stability for the shoulder?

Answer 10

external rotation with keeping elbow in toward body

Question 11

Where should our center of gravity be when adjusting?

Answer 11

aligned to your adjusting

Question 12

What is the definition of a Subluxation offered up by DD Palmer?

Answer 12

“subluxation of a vertebra is a slight deviation from its normal relation to adjacent vertebrae causing an alteration and narrowing of IVF”

Question 13

What is the real primary cause of disease?

Answer 13

tension; and the cause of tension is PRESSURE and the cause of pressure in 95% of diseased conditions is SUBLUXATED VERTEBAE

Question 14

In what percentage of diseased conditions is a subluxated vertebrae the cause? What about he other percent?

Answer 14

95% is due to subluxated vertebrae

other 5% is the luxation of other bones besides those in vertebral column

Question 15

Who offered up the term

“pinged nerve” for chiropractic use?

Answer 15

NOT chiropractors–> it was offered up by the Medical doctors

joint subluxations alone are extremely unlikely to “pinch” spinal NRs at margins of IVF

Question 16

What are spinal subluxations hypothesized to induce?

Answer 16

induce NR compression as result of direct anatomic compression of neural elements w/in IVF—> result in NR dysfunction–> induce dysfunction of somatic or visceral tissues they supplied

Question 17

What was marked or prolonged compression of NRs hypothesized to induce?

Answer 17

loss of function

Question 18

What was more moderate compression of NRs hypothesized to lead to?

Answer 18

increased neural activity and increased pain, paresthesias, and hypertonic muscles

Question 19

What did DD Palmer have to say about the medical doctors using the term “pinged nerve”?

Answer 19

“occlusion is not the cause of disease. Nerves are IMPINGED upon, pressed against, NOT squeezed or pinched”

Question 20

Describe what DD Palmer means by an “impinged nerve” (instead of using “pinched nerve”).

Answer 20

an impinged nerve has pressure on ONE SIDE ONLY.

Question 21

What does the author of Chiropractic state about how nerves can be impinged vs pinched?

Answer 21

nerves may be impinged upon by any displaced bone, but PINCHED only by Fx and extreme displacement

Question 22

What does DD Palmer really say that we need to think of the word “impingement” as?

Answer 22

use the word IMPINGEMENT in sense of PRESSURE–> and remember that instead of squeezing or pinching a nerve–> an impingement only increases its tension by stretching

Question 23

What was the issue with BJ Palmer proving the impact a subluxation has on neural tissue by using cadavers?

Answer 23

• bone is hard and does not shrink much after death
• brain and nerves are softest body substances and DO shrink as high as 85% after death
• formaldehyde also shrinks bodies

Question 24

How did BJ Palmer get around the issue of cadavers not being suitable evidence?

Answer 24

• deep-freeze bodies IMMEDIATELY at death
• therefore NO shrinkage of body
• proved brain FILLED cranial cavity; spinal cord FILLED neural canal; nerves FILLED IVF
• any sufficient occlusion COULD produce pressure and interference w/ normal flow of nerve force

Question 25

What structure do the DRGs lie within? What are they lacking? What does this make the susceptible to?

Answer 25

w/in the interpedicular region (lacking epineural covering as exit IVF) compressive forces from pressure, inflammation, ischemia

Question 26

Will acute or chronically injured dorsal NRs respond more vigorously to mechanical deformation?

Answer 26

chronically injured

Question 27

T/F. It is necessary for spinal NRs to be directly compressed by bony structures in order to develop pathologic dysfunction.

Answer 27

FALSE-- it is NOT necessary

Question 28

What may sustained misalignment or inflammation of the spinal motion segment due to the local vascular structures? What does this lead to?

Answer 28

may stretch or compress local vascular structures----> leading to disruption of neural blood supply and neuroischemia

Question 29

Are the density of the sodium ion channels in the soma and initial segment of DRG cells relatively high or low? What may this cause?

Answer 29

density of sodium ion channels is relatively HIGH may be unusually excitable

Question 30

What is more susceptible to effects of mechanical compression, DRG or peripheral nerves? Why?

Answer 30

DRG-- b/c impaired or altered function is produced at substantially lower pressures

Question 31

Joint malposition contributing to dysfunction of the spinal NRs is more likely to occur by narrowing the more vulnerable________.

Answer 31

interpedicular zone

Question 32

What is the name of the guy that suggested the Vertebral Subluxation Complex as a conceptualization for organizing essential info relevant to Tx?

Answer 32

John Faye

Question 33

What are the two approaches that the Vertebral Subluxation complex allows for chiropractors to use to examine a person?

Answer 33

Orthoneurologic Exam Biomechanical analysis

Question 34

Which approach for the VSC, assesses the state of the pathologic tissue changes and also aids in determining the prognosis?

Answer 34

Orthoneurologic exam

Question 35

Which approach for the VSC, determines the therapeutic procedures to be used and the treatment schedule?

Answer 35

Biomechanical Analysis | ROM assessment

Question 36

Does chiropractic use a long-leverage or short-leverage technique?

Answer 36

short-leverages

Question 37

T/F. Adjustments are commonly associated with cavitation that always produces an audible.

Answer 37

False- it MAY produce an audible

Question 38

T/F. When there is a change in structure, there will be a change in function.

Answer 38

True

Question 39

What can Vertebral Hypomobility cause?

Answer 39

pain and abnormal spinal mechanics--> b/c of changes in sensory input from spinal and paraspinal tissues

Question 40

When is the timing for the best opportunity for optimal healing?

Answer 40

aggressive EARLY are and restoration of motion

Question 41

What is Facilitation?

Answer 41

persistent afferent input triggers a segmental cord response--> which induces development of pathologic reflexes

Question 42

What is the term for when lesions capable of inducing chronically altered proprioceptive and nociceptive input?

Answer 42

sensitization

Question 43

What theory of altered reflexes involves when afferent impulses from one body area can result in reflex activity in other body areas?

Answer 43

Somato-Somatic Reflex Hypothesis

Question 44

What theory is segmental muscle hypertonicity that may be associated with joint dysfunction an example of?

Answer 44

Somato-Somatic Reflex Hypothesis

Question 45

What theory of altered reflexes involves afferent impulses in one body area resulting in reflex activity in corresponding innervated visceral organ activity?

Answer 45

Somato-visceral Reflex Hypothesis

Question 46

What theory of altered reflexes is Heart palpations secondary to thoracic joint dysfunction an example of?

Answer 46

Somato-visceral Reflex Hypothesis

Question 47

What theory of altered reflexes involves visceral afferent fibers reflexly causing somatic problems?

Answer 47

Viscero-somatic Reflex Hyposthesis

Question 48

What theory of altered reflexes is pain and muscle tightness in the left shoulder with onset of MI an example of?

Answer 48

Viscero-somatic reflex hyposthesis

Question 49

What theory of altered reflexes involves visceral afferent impulses resulting in activation of visceral efferent output of the sympathetic of parasympathetic motor neurons?

Answer 49

Viscero-Visceral Reflex Hypothesis

Question 50

What theory of altered reflexes is distention of the gut resulting in increased contraction of the gut muscles an example of?

Answer 50

viscero-visceral reflex hypothesis

Question 51

In a study done of 100 patients with gastric or duodenal ulcers what percentage of the patients had T6-T9 scoliosis and what percentage had DDD?

Answer 51

86% had T6-9 scoliosis 90% had DDD

Question 52

In a study done of 100 patients with gastric or duodenal ulcers what percentage of the patients did the processes of the vertebral column seem to play a part in the peptic ulcers?

Answer 52

90%

Question 53

What theory of altered reflexes involves subluxations affecting upon the ascending paths of the reticular activating joints?

Answer 53

Somato-Psychic Reflex Hypothesis

Question 54

What theory of altered reflexes is joint dysfunction leading to conditions such as insomnia and restlessness an example of?

Answer 54

Somato-psychic reflex hypothesis

Question 55

What theory of altered reflexes involves significant conscious or unconscious stressors perpetuating sensitization of afferent nerve fibers, amplification of signals by amygdala and anterior cingulate cortex and reinforcement of efferent signals in the ANS?

Answer 55

Psycho-somatic reflex hypothesis

Question 56

What theory of altered reflexes is patients under significant emotional distress at the time of a car accident showing more neck pain 4 weeks post injury and example of?

Answer 56

Psycho-somatic reflex hypothesis

Question 57

Who proposed the Neurodystrophic Hypothesis?

Answer 57

Robert Leach DC

Question 58

What theory proposes that neural dysfunction/abnormal innervation is stressful to the viscera and other body structures and leads to lowered tissue resistance?

Answer 58

Neurodystrophic Hypothesis by Robert Leach DC

Question 59

What theory is kinetic aberration in T6-T9 through fatigue or central inhibitory affects may decrease the neuronal stimulation of the adrenals with resultant decrease of "resistance"?

Answer 59

Neurodystrophic Hypothesis

Question 60

What theory involves the three stages, Alarm Reaction, Stage of Resistance, and Stage of Exhaustion?

Answer 60

Selye's General Adaptation Syndrome think "GAS"--> b/c you run out of "gas"

Question 61

What are the three stages in the General Adaptation Syndrome theory?

Answer 61

1. Alarm Reaction-- body modify to defend against stressor 2. Stage of Resistance-- adrenaline rush to defend 3. Stage of Exhaustion-- limited resources and may collapse

Question 62

What may joint injury, chronic mechanical joint derangement, or joint immobilization initiate?

Answer 62

the Inflammatory and Vascular Components of the VSC

Question 63

What are the three inflammatory and vascular components of the VSC?

Answer 63

1. vascular congestion 2. ischemia 3. inflammation

Question 64

What will the potential for motion segment dysfunction or associated inflammation impeding blood flow through segmental venous structure lead to?

Answer 64

localized venous stasis---> that may lead to local ischemia, inflammation, and potential associated joint stiffness

Question 65

What may pain accompanying inflammation initiate? What may this lead to overtime?

Answer 65

local muscle contraction---> which overtime may lead to local ischemia and potentially MORE pain and muscle splinting

Question 66

What may the persistent inflammation and pain causing plastic changes in PNS and CNS lowering pain thresholds, give rise to?

Answer 66

1. Allodynia 2. Hyperalgesia 3. Sensitization of CNS (see with chronic pain)

Question 67

What should be suspected when a patient's pain is constant?

Answer 67

some degree of joint or soft tissue inflammation

Question 68

What is the term for CNS sensitization?

Answer 68

Allodynia

Question 69

What is the term for enhanced pain response?

Answer 69

Hyperalgesia

Question 70

What is the term for conditioned response to stimuli?

Answer 70

sensitization

Question 71

Out of all the subluxation theories, which is correct?

Answer 71

no ONE true or CORRECT theory!!! theory is state while reality is dynamic each theory represents portion of whole picture

Question 72

What are 3 scientifically accepted facts when it comes to the Vertebral Subluxation Complex?

Answer 72

1. Homeostasis-- enables body to stay alive in changing env. 2. Nervous System-- prime controller of homeostasis 3. Dysfunction of NS-- can be caused by faulty MSK relationships

Question 73

Due to the three scientifically accepted facts of the VSC, what does chiropractic hypothesize?

Answer 73

that BIOMECHANICAL aberrations in complex spinal structures can lead to LOSS OF NS integrity and the LOSS of health elsewhere in the body