1 module 6 effects produced by spinal manipulation (herzog chapter 5) biomechanics of gait (nordin...
TRANSCRIPT
![Page 1: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/1.jpg)
1
Module 6
Effects Produced by Spinal Manipulation (Herzog Chapter 5)
Biomechanics of Gait (Nordin Chapter 18 & web downloads)
Biomechanics of the Shoulder (Nordin Chapter 12)
Biomechanics (TECH 71613)
James W. DeVocht, DC, PhD
![Page 2: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/2.jpg)
2
Force-time history of chiropractic adjustment
Herzog Fig 5-1
100 – 200 msec for most manual adjustments
![Page 3: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/3.jpg)
3
Measurable responses elicited by chiropractic adjustments
Herzog page 195
1. Mechanical responses
2. Neuromuscular reflex responses
3. Physiologic responses
![Page 4: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/4.jpg)
4
1. Mechanical Response
Herzog Fig 5-4
![Page 5: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/5.jpg)
5
Mechanical Response as a function of timeof T10 & T12 for thrust on transverse process
of T11 in an unembalmed, post rigor, human cadaver
Herzog Fig 5-5
![Page 6: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/6.jpg)
6
2. Neuromuscular Reflex Responses (reflex pathway for muscle spindle)
Herzog Fig 5-6
Ia
Can be inhibitory or excitatory
![Page 7: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/7.jpg)
7Herzog Fig 5-7
Spindle reflex response
Capsule mechanoreceptor
response
![Page 8: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/8.jpg)
8
EMG Reflex Response
Herzog Fig 5-8
50 – 200 msec
t: delay from beginning of thrust to beginning of EMG responseResponse typically lasts 100-400 msec, then disappears
![Page 9: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/9.jpg)
9
Simultaneous Responses to SM
Herzog Fig 5-9 (Manual Thrust on T4) Herzog Fig 5-10 (Activator Thrust on T6)VAG: cavitation response LAT: latissimus dorsiT6 & T4: levels of spinalis
![Page 10: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/10.jpg)
10
Time Delays Regarding EMG values
Herzog Fig 5-12
t: thrust onset to 1st EMG
t1: 1st EMG to onset of muscle force
t2: muscle force onset to peak muscle force
![Page 11: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/11.jpg)
11
Release of muscle spasm
Herzog Fig 5-13
![Page 12: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/12.jpg)
12
Activator Adjusting Instrument with accelerometer attached
![Page 13: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/13.jpg)
13
Taking surface EMG data during Activator treatment
![Page 14: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/14.jpg)
14
Release of muscle spasm
DeVocht, 2003JMPT, 26(7), 421-425
![Page 15: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/15.jpg)
15
EMG Data from Pre-Post Treatment
![Page 16: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/16.jpg)
16
Can be generated by fast or slow thrust(more likely with fast thrust)
Herzog page 204
3. Physiologic effect produced during SM:Articular noise (audible release)
![Page 17: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/17.jpg)
17
Schematic representation of force-displacement curve (includes audible release)
Herzog Fig 5-13
![Page 18: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/18.jpg)
18
Model of Joint Cavitation
Brodeur 1995, Fig 8JMPT, 18:3, p 160
A: Normal joint with no external loads
B: Initial distention, ligament invaginates
C: Tensile force up, snaps ligament back which now has some slack in it
D: Volume has increased, bubbles form
E: Ligament tightens as tensile force continues
F: Stable situation with increased volume and joint space
http://www.youtube.com/watch?v=LxtAeGtL9SE boiling:
![Page 19: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/19.jpg)
19
Joint separation before & after cavitation
Brodeur 1995 Fig 4JMPT, 18:3, p 157
![Page 20: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/20.jpg)
20
Is an audible release necessary?
Herzog page 206
Sound or feel of cavitation often used as indication that the adjustment was “successful”
Many chiropractors will repeat an adjustment if
there was no discernable “release”
![Page 21: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/21.jpg)
21
Force-time histories of 2 attempts for cavitation
Herzog Fig 5-15
1st attempt: dotted line2nd attempt: solid line
- 2nd attempt usually has higher peak force
- Usually has higher rate of force application
- Often does result in cavitation
![Page 22: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/22.jpg)
22
Recent studies suggest that there is little if any clinical significance concerning whether or not an audible pop occurs in connection with a spinal manipulation
Flynn 2006JMPT 29:1 p 44
![Page 23: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/23.jpg)
23
forefoot hindfoot(talus &calcaneus)
midfoot“instep”
Transverse Divisions of the Foot
![Page 24: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/24.jpg)
24
Lateral Foot - calcaneus - cuboid - metatarsals & phalanges of toes 4 & 5
Medial Foot - talus - navicular - cuneiforms - metatarsals & phalanges of toes 1, 2, & 3
Longitudinal Divisions of the Foot
![Page 25: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/25.jpg)
25
Ankle Joint: Pure Hingecomprised of tibia, fibula, & talus
mortise joint: rectangular space between medial & lateral malleoli
![Page 26: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/26.jpg)
26
Full Gait Cycle, or Stride(refers to movement of one leg)
Stance phase
- Foot in contact with floor
- 60% of cycle when walking
Swing phase (40% when walking)
- Foot has no contact with the floor
- 40% of cycle when walking
Nordin page 440
![Page 27: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/27.jpg)
27
Sequence of Gait Cycle (walking)
Nordin Fig 18-1
TO: toe off (left & right) HC: heel contact (left & right)
![Page 28: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/28.jpg)
28
Stance Phase has 6 Parts
1. Initial contact (hind foot touches floor)
2. Loading (sole contact floor, body weight shifts)
3. Midstance (tibia rotates over talus)
4. Terminal stance (weight shifts from hind & mid to forefoot)
5. Pre-swing (weight shifts to contralateral leg)
6. Toe off (forefoot leaves the floor)
Nordin page 440-1
![Page 29: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/29.jpg)
29
Center of pressure changes during stance phase
from www.drpribut.com/sports/spgait.html
![Page 30: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/30.jpg)
30
Swing Phase has 3 parts
1. Initial swing
(from toe off until opposite stance foot)
2. Mid-swing
(ends when tibia is vertical)
3. Terminal swing
(ends when heel contacts the floor)
Nordin page 441
![Page 31: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/31.jpg)
31
Total vertical displacement about 5 cmTotal medial-lateral displacement about 4 cm
Neumann Fig 15-13
![Page 32: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/32.jpg)
32
Spatial sequence of gait cycle (running)
Nordin Fig 18-2
![Page 33: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/33.jpg)
33
Windlass Effect
![Page 34: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/34.jpg)
34
Talofibular & Calcaneofibular Ligaments
lateral viewcommonly injured
http://video.google.com/videoplay?docid=-4399476076864988236&q=broken+ankle+tennis&total=9&start=0&num=100&so=0&type=search&plindex=5 tennis accident (35 sec)
![Page 35: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/35.jpg)
35
Biomechanics of the Shoulder(involves 4 articulations)
Nordin Fig 12-1
![Page 36: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/36.jpg)
36
Sternoclavicular Joint
Nordin Fig 12-4
Articulation with first rib
![Page 37: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/37.jpg)
37
Movements of the Sternoclavicular
Joint
Nordin Fig 12-5
![Page 38: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/38.jpg)
38
Acromioclavicular Joint
Nordin Fig 12-6
![Page 39: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/39.jpg)
39
Glenohumeral Joint
Nordin Fig 12-8
Tendon of the long headof the biceps lies downin the bicipital groove
![Page 40: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/40.jpg)
40
Glenoid Labrum(provides 50% of depth of glenohumural joint)
Nordin Fig 12-10
![Page 41: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/41.jpg)
41
SLAP lesion(Superior Labrum from A – P)
Nordin Fig 12-11
![Page 42: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/42.jpg)
42
Scapulothoracic Articulation
Nordin Fig 12-13
![Page 43: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/43.jpg)
43
Musculature Between Scapula & Thorax(stabilizes scapula – prevents winging)
Nordin Fig 12-14http://www.youtube.com/watch?v=HepHiQOsT-E
http://www.youtube.com/watch?v=814TZ4WUEKk
![Page 44: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/44.jpg)
44
Lateral bending of spine enhancesability to position upper extremity
Nordin Fig 12-15
![Page 45: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/45.jpg)
45
Rotator Cuff Musculature(4 muscles)
Nordin Fig 12-17
![Page 46: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/46.jpg)
46
Primary motions of the shoulder
Nordin Fig 12-2
![Page 47: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/47.jpg)
47
Optimal motion of the shoulder(in plane of long axis of the scapula)
Nordin Fig 12-3
![Page 48: 1 Module 6 Effects Produced by Spinal Manipulation (Herzog Chapter 5) Biomechanics of Gait (Nordin Chapter 18 & web downloads) Biomechanics of the Shoulder](https://reader030.vdocument.in/reader030/viewer/2022013101/56649cee5503460f949bc779/html5/thumbnails/48.jpg)
48
Forward elevation or abduction of armrequires synchronous rotation of scapula
Nordin Fig 12-22
http://www.youtube.com/watch?v=hGOTf3Xl6Qs&mode=related&search=