<p> Extremity-Specific Evaluation Eric Nelson, DC CCSP President ANJC Sports Council</p><p>With the recent New Jersey Supreme Court decision allowing NJ chiropractors to once again perform extremity adjustments, a hot topic of discussion lately has been centered on how to document the relationship between an extremity adjustment and a spinal condition. </p><p>According to the ruling, determining a casual nexus between an extremity and spinal condition should be done on a case-by-case basis. While there is no established protocol, it’s probably a good idea to demonstrate this relationship with thorough documentation.</p><p>One proposed method is to perform an extremity-specific evaluation. In addition to ruling out red flags, the goal of this evaluation will be used to gather information that will clearly demonstrate the relationship between spine and extremity. </p><p>This evaluation should contain a thorough history that highlights the chief complaint and any impact this complaint has on the patient’s spine. The exam should also contain postural and gait analysis, range of motion (including active, passive, and resistive), orthopedic and neurological tests, muscle assessment (length, tenderness, trigger points, etc.), the evaluation of movement patterns, and of course, joint dysfunction/subluxation analysis.</p><p>In addition to containing your findings, your documentation should contain a summary paragraph that highlights your findings and clearly demonstrates the relationship required by the recent NJ Supreme Court decision.</p><p>One aspect of this exam that should be pointed out is the evaluation of movement patterns. By watching our patients perform certain movements, we can clearly see the impact of an extremity condition on their spine. </p><p>According to the late Vladimir Janda, MD there are six basic movement patterns that provide overall information about the movement quality of a particular patient: hip extension, hip abduction, curl-up, push-up, neck flexion, and shoulder abduction.1 </p><p>A great example would be to look at a faulty hip extension movement pattern in a patient that requires a chiropractic adjustment to their hip. For normal extension of the hip at the terminal stance phase of gait to occur, the normal sequence of muscle activation can be observed with the patient in the prone position. </p><p>During straight leg lifting into extension, the sequence should be hamstring, gluteus maximus, and then the erector spinae activation. One possible faulty pattern that can occur would be when the erector spinae on the ipsilateral side or even the shoulder girdle muscles initiate the movement and activation of the gluteus maximus is delayed, decreased, or even absent.1 </p><p>Due to the overactivity of the erector spinae, there is a clear connection between dysfunction in the hip and spine. Further spinal and extremity joint dysfunction/subluxation analysis can be performed to confirm this.</p><p>By performing an extremity-specific evaluation that contains the above-mentioned components and provided that there is indeed a casual nexus between a spine and extremity condition, it should be easy to demonstrate and document this connection. 1. Liebenson, C. Rehabilitation of the Spine, A Practitioner’s Manual 2nd Edition, 2007.</p>