K. Jeffrey Miller, DC, MBA Chiropractic Orthopedist

KJ Miller2013

The Motor Unit and Disc Anatomy

The “Motion Segment” or “Motor Unit”

▪ Two vertebra and their intervening soft tissues

The great retaining ligament of the spine

▪ The nucleus

▪ The annulus

KJ Miller2013

KJ Miller2013

KJ Miller2013

Disc Pressure

KJ Miller2013

Lying on Back Standing Walking Twisting Sitting Cough Jump Strain Laugh

30kg/cm 2 70kg/cm2 85kg/cm2 90kg/cm2 100kg/cm2 110kg/cm2 110kg/cm2 120kg/cm2 120kg/cm2

KJ Miller2013

KJ Miller2013

Sitting in a Bathtub Sitting in a Recliner

Legs Up vs.

Fully Reclined

Bowel Movements Dejerine’s Triad = ADL (cough, sneeze, strain, laugh)

KJ Miller2013

The Majority of Disc, Radicular and Sciatic Tests are Performed

Lying on the Back-30kg/cm2

Bechterew’s-Slump are Performed

Seated-100kg/cm2

Supine vs. Seated MR Scans

KJ Miller2013

SLR-Lasegue’s Lying 30 kg/cm2 in the Disc

Neri’s Bowing Standing then bending 70-120 kg/cm2 in the disc

Slump-Bechterew’s Sitting 100 kg/cm2 in the Disc

Escalating Pressure in the Disc

KJ Miller2013

KJ Miller2013

Lying on the Back 30kg/cm2 Standing 70kg/cm2

Standing with a Brace 30kg/cm2

Pressure Reduced by 40kg/cm2

KJ Miller2013

Miller 2002

KJ Miller2013

KJ Miller2013

Compression and Torsion Injuries

KJ Miller2013

KJ Miller2013

KJ Miller2013

KJ Miller2013

KJ Miller2013

Miller 2002

KJ Miller2013

Pre-manipulation Test

Farfan’s Torsion Test with the patient in the side posture position

Stude, DE. A Functional Pre-manipulation Spinal Orthopedic Assessment

Maneuver, Journal of Chiropractic medicine, Number 2, Volume 4, Spring, 2005.

KJ Miller2013

Pre-manipulation Test

Stude, DE. A Functional Pre-manipulation Spinal Orthopedic Assessment Maneuver, Journal of Chiropractic medicine, Number 2, Volume 4, Spring, 2005.

KJ Miller2013

KJ Miller2013

NORTHWESTERN

Closer in performance to the actual treatment

Performance and results can be effected by spasm/pain

More strenuous for the patient

The test itself might result in treatment

FARFAN’S

Harder to perform on larger patents

Table considerations Performance and results

can be effected by spasm/pain

KJ Miller2013

After studying Farfan’s reasoning and torsion test you will discover that the entire concept can be boiled down to knowing if the patient is left handed, ambidextrous or right handed

Just ask the patient

Guess and impress!

KJ Miller2013

Physical Testing

KJ Miller2013

SLR-Lasegue’s Lying 30 kg/cm2 in the Disc

Neri’s Bowing Standing then bending 70-120 kg/cm2 in the disc

Slump-Bechterew’s Sitting 100 kg/cm2 in the Disc

Escalating Pressure in the Disc

KJ Miller2013

Miller 2002

Tests for Neuromeningeal Tract Tension

The Most Complicated Yet Most Productive Test

KJ Miller2013

KJ Miller2013

Miller 2002

IN THEORY The majority of disc lesions protrude lateral to the

left or right and then lie either medial or lateral to the nerve root.

Medial and lateral refer to the relationship of the disc lesion to the nerve root.

Lateral disc protrusions that are lateral to the nerve root are the most common presentation

KJ Miller2013

KJ Miller2013

KJ Miller2013

Miller 2002

KJ Miller2013

Miller 2002

Antalgia Sign SLR/Bragard’s CSLR/Fajersztajn’s Kemp’s Slump

KJ Miller2013

The sciatic nerve

Over, under, through

FAIR position

Side lying, seated, supine

The Piriformis Test

The Pace Test Bonnets Internal foot rotation Pre-adjustment and

FAIR

Miller KJ, Camidge C, Marry M. Piriformis Syndrome; a Text Book Description, JACA On-line, November-December 2012.

KJ Miller2013

Nachemson and Farfan

KJ Miller2013

Considering Compression Injuries, Torsion Injuries & Radiculopathy

KJ Miller2013

Compression Injuries

Distraction may be primary option

Side posture secondary, with side of handedness up when radiculopathy is absent

KJ Miller2013

Torsion Injuries

Unilateral torsion injuries w/o radiculopathy

Side of handedness up

Bilateral torsion injuries

Flexion Distraction preferred

Side posture is a relative contraindication

KJ Miller2013

Antalgia without Radiculopathy

Adjust in a position that exaggerates the antalgic position

KJ Miller2013

Miller 2002

Side Posture-Radiculopathy

Lateral Disc Protrusion = Adjust with the side of leg pain up

Medial Disc Protrusion = Adjust with the side of leg pain down

This works with the antalgic posturing of the patient and the biomechanics of the pathology

KJ Miller2013

Miller 2002

Side Posture and Piriformis

Side posture not recommended as a direcdt treatment

Soft tissue work

KJ Miller2013