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Basic Laserology® Outline BBaassiicc LLaasseerroollooggyy®® OOuuttlliinnee A. Examination of the cervical spine (Pgs. 16-25) History • Where is the primary injury (ies) or condition(s) • When did the condition first occur; acute, subacute, chronic • What are the factors that make better or worse (sleeping, driving, motion etc.) • How does the patient describe the injury/condition/symptoms • Frequency and duration of symptoms • Effect on work status or activity of daily living • Occupation • Activities • Previous injuries and/or surgeries • Patient age Phase 1 Examination of Neck & Upper Extremities 1) Patient performs active range of motion of the cervical spine; flexion/extension, right and left lateral flexion, right and left rotation. • Compare normal vs. abnormal • Evaluate and document exacerbation and location of pain 2) Test intrinsic muscles for symmetry of strength a) Anterior to posterior b) Right to left lateral flexion c) Right to left rotation 3) Check muscle strength of primary stabilizers a) Scalenes (face up arms to the side) b) Sternocleidomastoid (face up arms to the side) c) Neck Extensors (lying face down) d) Neck Extensors with rotation right and left (lying face down) e) Levator scapula (seated) Treatment of Primary Muscles 1) Laser the cervical spine for 60 seconds with frequencies 9 – neurology, 16 – tissue memory, 42 – lymphatic, 53 – general organ. 2) Adjust with VAIII both posterior and anterior subluxations (Optional) 3) Recheck primary muscles for correction NOTE:- In all cases the practitioner has an indicator for treatment found on the pretest, specific treatment is applied and the indicator is retested. If the indicator is corrected go on to the next area to test. If the indicator is still active then progress through treatment options, spine, brain, peripheral nerve entrapment, organs and emotions. On subsequent visits evaluate previous weaknesses and correct. Patient only progresses after stability is accomplished. Phase II Muscle Response Testing (MRT) Muscle response testing is accomplished by the practitioner using a strong indicator muscle and having the patient perform movements of the cervical spine. This is used as an evaluation tool as well as treatment. 1 of 91 BBaassiicc LLaasseerroollooggyy®® OOuuttlliinnee • Flexion/Extension primarily evaluates C1/C2 • Right/Left Lateral flexion primarily evaluates C3 • Right/Left rotation primarily evaluates C4 and Cranial nerve 11 Muscle response testing may be performed using a series of incremented stress; Series #1 a) Performed by using a strong indicator muscle and the patient performing Flexion/Extension (reset) b) Right/Left lateral (reset) c) Right/Left rotation (reset) Series #2 a) Performed by using a strong indicator muscle and the patient squeezing their knees together while performing, Flexion/Extension (reset) b) Rt/Lt lateral flexion (reset) c) Rt/Lt lateral rotation (reset) Series #3 a) Performed by using a strong indicator muscle and the patient squeezing their knees together while performing the cervical ranges of motion against resistance; Flexion/Extension (reset) b) Rt/Lt lateral flexion (reset) c) Rt/Lt lateral rotation (reset) Series #4 a) Performed by using a strong indicator muscle and the patient placing the palm of their hand flat on their forehead while performing the cervical ranges of motion, Flexion/Extension (reset) b) Rt/Lt lateral flexion (reset) c) Rt/Lt lateral rotation (reset) Phase III Myofascial release using the Erchonia® 3LT® Laser and the Erchonia Percussor Phase IV (Advanced Seminar Only) Rehabilitation 1) Motion rehab 2 of 91 BBaassiicc LLaasseerroollooggyy®® OOuuttlliinnee B. Shoulder (Pgs.26-39) History • Where is the primary injury (ies) or condition(s) • When did the condition first occur; acute, subacute, chronic • What are the factors that make better or worse (sleeping, driving, motion etc.) • How does the patient describe the injury/condition/symptoms • Frequency and duration of symptoms • Effect on work status or activity of daily living • Occupation • Activities • Previous injuries and/or surgeries • Patient age Phase I – Examination 1) Shoulder ROM- Have the patient seated and bring the arms up in abduction slow and purposeful. The practitioner is looking for symmetry of motion, proper tracking, compensatory motion, pain and discomfort on the way up and down. a) Active - abduction, flexion, extension b) Passive - abduction 2) Check muscle strength of myotomes (C5-T1) – These are the big telephone cables. We are evaluating and correcting stability of the trunk. The practitioner will evaluate the the myotomes and treat accordingly. a) C5 mid deltoid b) C6 bicep c) C7 tricep d) C8 finger flexors e) T1 finger abductors 3) Evaluate long lever strength a) Mid deltoid b) Anterior deltoid -forward flexion Phase II Stabilization 1) Stabilize 2° muscles of the shoulder a) Rotator cuff i) Supraspinatous ii) Infraspinatous iii) Teres Minor iv) Subscapularis b) Posterior Deltoid c) Inverted anterior deltoid d) Pec clavicular e) Pec sternal f) Subclavius g) Latissimus dorsi 3 of 91 BBaassiicc LLaasseerroollooggyy®® OOuuttlliinnee Treatment 1) Using the Erchonia PL5000 place the neurological head (4, 9, 33, 60) on the appropriate spinal region and the programmable head (9, 16, 42, 53) over the muscle of involvement. Treat for 30-60 seconds and re-evaluate. Phase III Myofascial release using the Erchonia® 3LT®Laser and the Erchonia Percussor Phase IV (Advanced Seminar Only) Rehabilitation using the Erchonia® 3LT® Laser and the Erchonia Percussor NOTE:- In all cases the practitioner has an indicator for treatment found on the pretest, specific treatment is applied and the indicator is retested. If the indicator is corrected go on to the next area to test. If the indicator is still active then progress through treatment options, spine, brain, peripheral nerve entrapment, organs and emotions. On subsequent visits evaluate previous weaknesses and correct. Patient only progresses after stability is accomplished. 4 of 91 BBaassiicc LLaasseerroollooggyy®® OOuuttlliinnee C. Peripheral Nerve Entrapments (Pgs. 40-44) Carpal Tunnel Examination- 1) Supination (palm up) with elbow extension- a) Muscle test the strength of Opponens pollicus digiti & minimi (pinkie to thumb) 2) Pronation (palm down) with elbow extension- isolates entrapments elbow and below a) Muscle test the strength of Opponens pollicus digiti & minimi (pinkie to thumb) Diagnosis 1) Use the laser diagnostically (10 s) at each possible entrapment site until strength is achieved. a) C/S b) Brachial Plexus c) Coracobrachialis d) Quadra e) Triangular spaces f) Ulnar at the lateral elbow g) Median at the pronator teres h) Retinaculum Treatment 1) Use the laser therapeutically at the site of entrapment with frequencies 9 – neurology, 16 – tissue memory, 21 – adrenals, 36 – peripheral nerve entrapment (120-180 s) 2) Percuss / Manually release area of entrapment 3) Use the Erchonia® Adjuster to correct any structural subluxations NOTE:- In all cases the practitioner has an indicator for treatment found on the pretest, specific treatment is applied and the indicator is retested. If the indicator is corrected go on to the next area to test. If the indicator is still active then progress through treatment options, spine, brain, peripheral nerve entrapment, organs and emotions. On subsequent visits evaluate previous weaknesses and correct. Patient only progresses after stability is accomplished. Lower Extremities - Possible Nerve Entrapment areas 1) Femoral nerve at the Psoas 2) Sciatic nerve at the Piriformis 3) Obturator nerve at the obturator foramen (below the pubic symphisis) 4) Common peroneal nerve at the posterior fibular head 5) Tibial nerve at the tarsal tunnel 5 of 91 BBaassiicc LLaasseerroollooggyy®® OOuuttlliinnee D. Low Back Protocol (Pgs. 45-65) There are many causes of low back pain and these can be divided into the broad categories of traumatic and non-traumatic. 1) Traumatic a) Soft tissue sprain (ligaments)/strain (muscular) b) Fractures c) Subluxations and dislocations d) Herniated discs 2) Non-traumatic a) Arthritis b) Degenerative disc disease c) Side effects from medication (cholesterol lowering drugs) History • Where is the primary injury (ies) or condition(s) • When did the condition first occur; acute, subacute, chronic • What are the factors that make better or worse (sleeping, driving, motion etc.) • How does the patient describe the injury/condition/symptoms • Frequency and duration of symptoms • Effect on work status or activity of daily living • Occupation • Activities • Previous injuries and/or surgeries • Patient age Phase I Examination 1) Physical examination of the low back should be done on every patient looking for visual inspection of: a) Posture b) Muscle symmetry c) Scars d) Gait 2) Range of Motion a) Patient standing perform ACTIVE Range Of Motion- Flexion, Extension, R/L Lateral Flexion, Right/Left Rotate. b) While the patient lies face up on the table test Range Of Motion of abductors and hamstrings. 3) Orthopedic tests a) Valsalva Maneuver-intrathecal pressure/space occupying lesion b) Fabere Test- Grade severity with ROM of bent leg c) Bilateral Straight leg lift/with cervical compression to determine cervical or low back priority Treatment 4) Reset pubic bone (adjust) a) Pelvic Adduction b) Pelvic Adduction with internal rotation c) Pelvic Adduction with external rotation d) Pelvic Abduction 6 of 91 BBaassiicc LLaasseerroollooggyy®® OOuuttlliinnee e) Pelvic Abduction w/ IR f) Pelvic Abduction w/ER 5) Check muscle strength of 1° stabilizers
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