Improving Your Junctions' Function: Utilizing clinical decision making with refining techniques of HVLAT for comfort and effectiveness Alec Kay, PT, MSPT, DMT, ATC, OCS, FAAOMPT Brian Power, PT, DPT, DMT, FAAOMPT 2105 AAOMPT Conference – Louisville, KY Sunday, October 25, 2015 INTRODUCTION: Alec Kay – PT, MSPT, DMT, ATC, OCS, FAAOMPT Alec received a Bachelors of Science in Exercise Physiology and was Certified as an Athletic Trainer in 1988 at the University of California, Davis. He was awarded a Masters of Science in Physical Therapy from the University of the Pacific in 1990. His additional post-graduate studies included completion of a Master of Orthopedic Manual Therapy in 1997 and a Doctor of Manual Therapy degree in 2000 from the Ola Grimsby Institute. Alec is currently teaching advanced techniques in manual therapy in the states as well as in Europe. Brian Power – PT, DPT, DMT, FAAOMPT Brian received a Bachelors of Science in Community Health in 1984. He then graduated from the University of Puget Sound in 1988 with a Bachelors of Science in Physical Therapy. He completed a four-year post-graduate program in Manual Therapy from the Ola Grimsby Institute in 1995. Brian was awarded a Doctor of Manual Therapy degree in 2005. Brian teaches post-graduate courses in manual therapy in the states and in Europe and Asia. SCHEDULE: 8.00 – Introduction 8.05 – Cervico-Thoracic indications and technique 8.15 – Upper Rib indications and technique 8.25 – Mid/Lower Rib indications and technique 8.35 – Thoraco-Lumbar indications and technique 8.45 – Lumbo-Sacral indications and technique 8.55 - Close Components of an OMT Examination www.olagrimsby.com ! Positional testing ! Palpation of the Carotid Artery ! Neurological examination ! Craniovertebral ligament testing ! Blood pressure ! Differentiation ! Refer on for further investigation ! Additional training unlock your future IFOMPT Cs Exam Guidelines 2012 IFOMPT Cervical Manipulation Survey www.olagrimsby.com All of the 20 member countries responded and recommended: • Use of sustained pre-manipulation position hold • Performance of craniovertebral ligament stress tests • Dizziness differentiation test • Hautant’s test unlock your future Carlesso and Rivett 2007 Examination / Risk www.olagrimsby.com 1. Initial Observation 2. History/Interview 3. Structural Inspection 4. Active Movements 5. Passive Movements 6. Resisted Movements X 3 7. Palpation 8. Neurological Examination 9. Specific Mobility Tests and Positional Faults 10. Specific Regional Tests 11. Additional Test (MRI, x-ray, etc.) 12. Correlation 13. Treatment 14. Prognosis unlock your future CONTRAINDICATIONS FOR SPINAL MANIPULATIVE THERAPY The following list of contraindications for spinal manipulative therapy was updated and adapted from Kleyhans AM, Terret AGJ, The prevention of complications from spinal manipulative Therapy, Aspects of Manipulative Therapy, 161-174 ABSOLUTE: Articular derangements: References: 1. Acute arthritis of any kind 9, 11, 13, 14, 18, 23, 24, 35, 38 2. RA with instability or acute 4, 9, 10, 11, 18, 23, 35, 38 3. Ankylosing spondylitis—acute 2, 8, 9, 10, 11, 13, 14, 18, 27, 35 4. Dislocation 9, 15, 36 5. Hypermobility of segment 9, 10, 11, 21, 24, 35 6. Ruptured ligaments 9, 35 7. Trauma of recent occurrence--whiplash 9, 35 8. Advanced degenerative changes 11 9. Congenital generalized hypermobility (Ehlers-Danlos syndrome) 11 Bone weakening and destructive disease: References: 1. Calve's disease 22 2. Fracture 9, 15, 23, 27, 29, 34, 35 3. Malignancy/tumor (primary/secondary) 4, 9, 10, 11, 13, 23, 24, 27, 35, 36 4. Osteomalcia 10, 11, 13, 22 5. Osteoporosis 2, 4, 9, 23, 27, 34, 35 6. Osteomyelitis 11, 14, 27, 33, 35 7. Tuberculosis (Pott's disease) 4, 11, 14, 23, 34, 35, 36 Circulatory disturbances: References: 1. Aneurysm 2. Anticoagulant therapy 6, 11, 13 3. Atherosclerosis 3, 13 4. Visceral arterial disease 11 5. Calcification of aorta 13 Disc lesions: References: 1. Prolapse with serious neurological changes 4, 5, 9, 10, 11, 13, 16, 17, 19, 27, 28, 35 2. Evidence of more than one spinal nerve root on one side 11 3. Cervical or thoracic joint conditions causing neurological signs in lower limbs 11, 13 4. Acute cervical or lumbar herniation 9 5. Thoracic herniation 9 Neurologic dysfunction: References: 1. Micturition with sacral root involvement 5, 35 2. Painful movement in all directions 23 3. Transverse myelitis 11 4. Severe root pain 11 5. Malformations of spinal cord including syringomyelia 10 Unclassified: References: 1. Infectious disease 13, 23, 27 2. Uncooperative patient or patient intolerance 10, 23 3. Advanced diabetes when tissue value may be low 11, 13 4. Undiagnosed pain 11 RELATIVE: Articular derangements: References: 1. Ankylosing spondylitis after acute stage 2, 9, 29, 33, 35 2. Articular deformity 5, 9 3. Congenital anomalies 12, 18, 23, 32, 37, 38 4. Hypertrophic spondyloarthritis 9, 13, 33 5. Osteoarthritis - especially severe or advanced 9, 13, 35 6. Osteochondrosis 9 7. RA - subacute 13, 27, 38 8. Torticollis 5 9. Inflamed joint 13 Bone weakening and modifying disease: References: 1. Hemangioma 31, 34 2. Paget's disease 11, 22, 27, 33 3. Scheuermann's disease 1, 14, 18, 23, 27 4. Spondylolisthesis/spondylolysis with symptoms 9, 13, 14, 33 Disc lesions: References: 1. Posterolateral and posteromedial disc protrusions 13 2. Degeneraative disease 17, 28, 35 Neurological dysfunction: References: 1. Myelopathy 5, 35 2. Non-vertebragenous pain 27, 35 3. Pyramidal tract involvement 5 4. Radicular pain with disc lesion 13, 35 5. Viscerosomatic reflex pain 27, 35 Unclassified: References: 1. Abdominal hernia 30 2. Asthma 1, 30 3. Dysmenorrhea 30 4. Epicondylitis 8 5. Long term steroid use 13 6. Low pain threshold 13 7. Peptic ulcer 18 8. Post spinal surgery 27 9. Pregnancy, especially first trimester 5, 13, 27, 33 10. Scoliosis 11, 13, 35 11. Psychogenic disorders with dependence on manual therapy 9, 13 12. Patients who have been treated recently by another practitioner 13 13. Signs and symptoms do not match 13 REGIONAL: Thoracic spine: References: 1. Scoliosis 11 2. Unilateral hemi-vertebrae 12 Lumbar spine: References: 1. Accessory sacroiliac joint 2. Baastrup's disease 12, 23 3. Cleft vertebra in sagittal plane 12 4. Facet tropism 12, 18 5. Knife clasp syndrome 6. Nuclear impression 12 7. Progressive osteoarthritis of sacroiliac joint 9 8. Pseudosacralization 12, 18 9. Sacralization, lumbarization 11, 12, 18 10. Spina bifida occulta 11, 18 11. Spondylolisthesis (neighboring segments okay) 9, 18 Bibliography 1. Beyeler W, Scheuermann's disease and its chiropractic management, Annals of Swiss Chiropractors Assoc, 1:70, 1960. 2. Bollier W, Inflammatory, infections and neoplastic disease of the lumbar spine, Annals of Swiss Chiropractors Assoc, 1960b. 3. Boshes LD, Vascular accidents associated with neck manipulation, JAMA 1652:1710, 1959. 4. Bourdillon JF, Spinal manipulation, 3rd edition, Appleton-Century-Croft, New York, 1982. 5. Cyriax J, Textbook of orthopedic medicine, vol. II, 10th edition, Balliere Tindall, London, 1980. 6. Dabbert O, Freeman DG, Weis AJ, Spinal meningeal hematome, warfarin therapy and chiropractic adjustment, JAMA 214:11, 1970. 7. Davidson KC, Weiford EC, Dixon GD, Traumatic vertebral artery pseudoaneurysm following chiropractic manipulation, Neuroradiology, 115:651, 1975. 8. Droz JM, Indications and contraindications of vertebral manipulations, Annals of Swill Chiropractors Assoc, 5:8, 1971. 9. 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Miller RG, Burton R, Stroke following chiropractic manipulation of the spine, JAMA, 229:189, 1974 27. Nwuga VC, Manipulations of the spine, Williams and Wilkins, Baltimore, 1976. 28. Odom GL, Neck ache and back ache. Proceedings of the NINCDS Conference on Neck Ache and Back Ache, Charles C. Thomas, Illinois, 1970. 29. Rinsky LS, Reynolds GG, Jameson RM, Hamilton RD, Cervical spine cord injury after chiropractic adjustment, Paraplegia, 13:227-233, 1976. 30. Sandoz R, About some problems pertaining to the choice of indications for chiropractic theapy. Annals of the Swiss Chiropractors Assoc, 3:201, 1965. 31. Sandoz R, Presentation and discussion of a few cases of lumbo-abdominal pain, Annals of the Swiss Chiropractic Assoc, 4, 1969. 32. Sandoz R, Newer trends in the pathogenesis of spinal disorders, Annals of the Swiss Chiropractors Assoc, 5, 1960.