Exam 3 Subluxation Part 3

Question 1

T/F: Neural facilitation would respectively manifest as motor excitation, sympathetic vasomotor excitation, and sensory excitation.

Answer 1

True

Question 2

T/F: Neural facilitation would exhibit as motor depression, sympathetic vasomotor depression, and sensory depression.

Answer 2

False; this is neural inhibition

Question 3

T/F: When a joint becomes fixated, another joint typically has to compensate for the lack of motion. Therefore, a site of fixation/subluxation is often seen as asymptomatic.

Answer 3

true, meanwhile the compensating hypermobile joint is highly expressive

Question 4

What are the 6 various stages of motion? Which stages make up the Zone of Physiological Movement?

Answer 4

Active ROM,
Passive ROM,
Joint Play, 
Normal Physiologic Barrier,
Normal Anatomic Barrier,
and Elastic Barrier;

Active and Passive ROMs make up the Zone of Physiological Movement

Question 5

What stage of motion can be described as the point to which a patient may actively move any given joint?

Answer 5

Normal Physiologic Barrier

Question 6

Which stage of motion can be described as the normal barrier to motion when all tension has been taken up within the joint and its surrounding tissues?

Answer 6

Elastic Barrier

Question 7

T/F: Passive ROM can be described as what the patient is able to accomplish on their own.

Answer 7

False; this true of active ROM, Passive requires external assistance

Question 8

What stage of motion is small but precise accessory movement within synovial joints independent of voluntary muscle movements.

Answer 8

Joint Play

Question 9

What is the term for the point to which a joint may be passively moved beyond the physiological barrier?

Answer 9

Normal Anatomic Barrier

Question 10

Where does the zone of Joint Play reside?

Answer 10

Paraphysiological Zone of Movement

Question 11

Where is the HVLA chiropractic adjustment delivered?

Answer 11

At the end of the paraphysiologic space

Question 12

When a HVLA thrust is applied and the articular surfaces separate overcoming an elastic barrier of resistance, what is the audible release called that is often heard?

Answer 12

cavitation

Question 13

T/F: Cavitation is indicative of a successful adjustment.

Answer 13

False, cavitation merely suggests that the ROM of a joint has been extended into the paraphysiological space

Question 14

T/F: The paraphysiological range of motion is within the limit of anatomical integrity created by capsular ligaments.

Answer 14

True, hence adjustments don’t tear ligaments

Question 15

T/F: Sprains occur in the paraphysiologic range.

Answer 15

False; sprains occur beyond the paraphysiologic range

Question 16

Historically, what is the major reason chiropractors are consulted?

Answer 16

treatment of NMS dysfunction and disease

Question 17

T/F: Extending the length of immobilization has not been shown to slow the healing process.

Answer 17

False; excessive immobilization can retard and impair the healing process

Question 18

T/F: The specific mechanism by which adjustments effect a reduction in symptoms has not been determined.

Answer 18

True

Question 19

T/F: While the last decade has seen a significant increase in the evaluation and measurement of the forces produced in the application of HVLA adjustments, information regarding the effects of adjustive forces on biologic tissue is still limited.

Answer 19

True

Question 20

What two periods characterize a manual HVLA adjustment?

Answer 20

a prethrust (preload) period and a thrust period

Question 21

T/F: The forces delivered during an adjustment have been measured and correspond to approximately 1/3-2/3 of the treating doctor’s body weight.

Answer 21

True

Question 22

When measured, the adjustive forces delivered were the lowest in which region of the spine?

Answer 22

cervical spine

Question 23

Adjustive pretension and peak forces may vary between doctors, but cetain characteristics of HVLA adjustments stand out.

Answer 23

See slide 59 for specifics

Question 24

T/F: Among experienced/trained chiropractors, there is a consistent small drop in preload force befroe the impulse is delivered.

Answer 24

True

Question 25

T/F: Even trained/experienced chiropractors do not have the ability to consistently and significantly modify the prethrust tension, peak velocity, and/or duration of their adjustive thrusts.

Answer 25

False; they have been recorded doing just that

Question 26

T/F: Research has not yet confirmed that spinal segments move during adjustive thrusts.

Answer 26

False; it has however the location and directions of movement may not fully match our clinical assumptions

Question 27

Spinal movements have been documented on fresh-frozen cadavers following HVLA adjustments. Where is the significant movement localized to?

Answer 27

the contacted segment and motion segments above and below

Question 28

What type of imaging did Cramer and co-workers use to study the effect of side posture positioning and thrust on Z-joint movement and gapping in the lumbar spine?

Answer 28

MRI

Question 29

During Cramer's study, lumbar side posture spinal positioning demonstrated increased separation (gapping) of which joints?

Answer 29

Z-joints

Question 30

What is the term for "the formation of vapor and gas bubbles within fluid through local reduction of pressure" where the pressure inside the liquid drops below the vapor pressure, bubble formation and collapse occur, and a cracking sound is heard?

Answer 30

cavitation

Question 31

T/F: At the point of joint cavitation, there is a sudden decrease in joint separation without a proportional increase in the applied load.

Answer 31

False; there is a sudden INCREASE in joint separation

Question 32

After a joint cavitates, there is an inability to produce another cavitation of the same joint for approximately 20 minutes. What is this 20 minute period called?

Answer 32

the refractory period

Question 33

T/F: The bubbles formed within the MP joint cavitation consist of water vapor and blood gases and have been measured at 80% nitrogen.

Answer 33

False; 80% carbon dioxide

Question 34

T/F: Any procedure that produces joint separation has the potential to cause the cracking sound.

Answer 34

True

Question 35

Where does the cracking sound occur?

Answer 35

paraphysiologic space

Question 36

What is the most likely reason when an adjustment does not produce cavitation (assuming the adjustment was performed properly)?

Answer 36

the joint capsule is very tight, not allowing for sufficient joint separation to produce cavitation

Question 37

One theory of cavitation states that the newly formed bubbles within the joint rush from the higher-pressure periphery to the relative low-pressure pocket generated in the center of the distracted joint. What causes the audible cracking sound in this theory?

Answer 37

collapse of the bubbles (postcavitation phenomenon)

Question 38

One theory of cavitation offers an explanation for why some individuals with very tight or loose joint capsules do not "crack." According to this theory, the cracking sound come when the capsular ligaments snap away from what?

Answer 38

away from the synovial fluid

Question 39

T/F: Cavitation is associated with an increase in passive ROM, temporarily increased joint space, a ~20 minute refractory period, and an increased joint separation.

Answer 39

True

Question 40

T/F: While cavitation is not commonly used by chiropractors as evidence of a successfully delivered adjustment, the process of cavitation is therapeutic in and of itself.

Answer 40

False; While cavitation is commonly used as evidence for success, cavitation is NOT assumed to be therapeutic in and of itself