《脉冲枪脉冲治疗仪中英文版（深度分析）》由会员分享，可在线阅读，更多相关《脉冲枪脉冲治疗仪中英文版（深度分析）（133页珍藏版）》请在金锄头文库上搜索。
1、脉冲脉冲治疗仪治疗仪TECHNIQUE1精编内容Impulse Adjusting Technique脉冲调整技术脉冲调整技术A Chiropractic Analysis of the spine & pelvis that incorporates findings from:整脊疗法结合下列的检查对脊椎和骨盆整脊疗法结合下列的检查对脊椎和骨盆进行分析进行分析History (signs & symptoms, pattern recognition):Exam Findings: Orthopedic tests (tests that have high sensitivity & s
2、pecificity)Joint alignmentJoint movement (symmetry with opposite side)Pain over bonePain over soft tissueMuscle and nerve reaction to movement and pressure病史（体征和症状，模式识别）：检查结果：骨科测试（具有较高的灵敏度和特异性的测试）关节对位对线关节运动（双侧对称）骨疼痛软组织疼痛肌肉和神经对运动和压力的反应2精编内容The Sacroiliac, Pubic, and Hip joints骶骨关节，耻骨，髋关节骶骨关节，耻骨，髋关节脉冲
3、脉冲治疗仪治疗仪TECHNIQUE3精编内容1. Bilateral1. BilateralNachlas TestNachlas Test1. 1.双侧双侧双侧双侧NachlasNachlas测试测试测试测试4. Compression4. CompressionTests for Tests for Lower Ext.Lower Ext.InvolvementInvolvement受累下肢的压迫测试受累下肢的压迫测试受累下肢的压迫测试受累下肢的压迫测试 3. Hip Rotation 3. Hip RotationTestsTests髋关节旋转测试髋关节旋转测试髋关节旋转测试髋关节旋转测
4、试2. Unilateral2. UnilateralNachlas TestNachlas Test单侧单侧单侧单侧NachlasNachlas测试测试测试测试5. Compression5. CompressionTests for Tests for Supra-PelvicSupra-PelvicInvolvementInvolvement受累盆骨上端的压迫测试受累盆骨上端的压迫测试受累盆骨上端的压迫测试受累盆骨上端的压迫测试Presence of PainRange of MotionAsymmetryStrength存在疼痛存在疼痛运动范围运动范围不对称性不对称性强度强度5 Ste
5、p Lumbo-Pelvic Analysis Flowchart5步腰腹骨盆分析流程图步腰腹骨盆分析流程图4精编内容Step 1: Bilateral Nachlas Test第第1步：双侧步：双侧Nachlas测试测试5精编内容6精编内容Step 2: Unilateral Nachlas Test第第2步：单侧步：单侧Nachlas测试测试7精编内容8精编内容Step 3: Hip Rotation Tests第第3步：髋关节旋转测试步：髋关节旋转测试9精编内容10精编内容Step 4: Lower Extremity Compression Tests第第4步：下肢压迫测试步：下肢压迫
6、测试11精编内容12精编内容Step 5: Supra-Pelvic Compression Test第第5步：盆腔上端压迫测试步：盆腔上端压迫测试13精编内容14精编内容Bilateral Nachlas Test双侧双侧Nachlas测试测试Positive阳性阳性Negative阴性阴性Unilateral PainBelow Waist腰部以下腰部以下单侧疼痛单侧疼痛SI JointInvolvementSI关节受累关节受累Unilateral PainAbove Waist腰部以上腰部以上单侧疼痛单侧疼痛LumbarInvolvement腰椎受累腰椎受累CentralLow Back
7、 Pain中间腰背疼痛中间腰背疼痛Lumbo-SacralInvolvement腰骶受累腰骶受累Proceed to Unilateral Nachlas Test开始单侧开始单侧Nachlas测试测试Flowchart for Step 1第第1步流程图步流程图Test and AdjustInvolved SIJ测试和调整受累的SIJTest and AdjustInvolved Lumbar测试和调整受累的腰椎Test and Lumbo-Sacral Joint(Dual Styluses)测试和调整腰骶关节(双针)15精编内容Neuromechanical Innovations S
8、lides TestStep 1: Bilateral Nachlas Test第第1步：双侧步：双侧Nachlas测试测试16精编内容Step 1: Bilateral Nachlas Test第第1步：双侧步：双侧Nachlas测试测试Clinical Considerations: 临床注意事项：临床注意事项：Ask, “Does this cause any pain anywhere?”Do both legs flex the same?Is one leg heavier than the other?How does the pelvis move during the tes
9、t?问诊“这会引起任何部位的疼痛吗？”两条腿屈曲程度相同吗？一条腿比另一条腿重吗？检查过程中盆骨如何移动？17精编内容Unilateral Nachlas Test单侧单侧Nachlas测试测试Positive阳性阳性Negative阴性阴性Unilateral PainBelow Waist腰部以下单侧疼痛腰部以下单侧疼痛SI JointInvolvementSI关节受累关节受累Unilateral PainAbove Waist腰部以上单侧疼痛腰部以上单侧疼痛LumbarInvolvement腰椎受累腰椎受累CentralLow Back Pain腰背部中间疼痛腰背部中间疼痛Lumbo-S
10、acralInvolvement腰骶受累腰骶受累Proceed toHip Rotation Tests开始髋关节旋转测试开始髋关节旋转测试Flowchart for Step 2第第2步流程图步流程图Test and AdjustInvolved SIJ测试和调整受累的SIJTest and AdjustInvolved Lumbar测试和调整受累的腰椎Test and Lumbo-Sacral Joint(Dual Styluses)测试腰骶关节(双针)18精编内容Step 2: Unilateral Nachlas Test第第2步：单侧步：单侧Nachlas测试测试Begin with
11、 side of involvement (symptomatic side first);Reproduction of symptoms unilaterally confirms SI joint involvementTest both sides with Unilateral Nachlas Test从受累侧开始(先测试有症状侧)单侧症状再现证实SI关节侵犯用单侧Nachlas测试法检查两侧19精编内容Step 2: Unilateral Nachlas Test第第2步：单侧步：单侧Nachlas测试测试20精编内容Flowchart for Step 2第第2步流程图步流程图U
12、nilateral Nachlas Test单侧单侧Nachlas测试测试Positive阳性阳性Negative阴性阴性Unilateral PainBelow Waist腰部以下单侧疼痛腰部以下单侧疼痛SI JointInvolvement骶髂关节受累骶髂关节受累Unilateral PainAbove Waist腰部以上单侧疼痛腰部以上单侧疼痛LumbarInvolvement腰椎受累腰椎受累CentralLow Back Pain腰背部中间疼痛腰背部中间疼痛Lumbo-SacralInvolvement腰骶受累腰骶受累Proceed toHip Rotation Tests开始髋关节旋
13、转测试开始髋关节旋转测试Test and AdjustInvolved SIJ测试和调整受累的SIJTest and AdjustInvolved Lumbar测试和调整受累的腰椎Test and Lumbo-Sacral Joint(Dual Styluses)测试腰骶关节(双针)21精编内容Unilateral Nachlas Test单侧单侧Nachlas测试测试Positive阳性阳性Unilateral PainBelow Waist腰部以下单侧疼痛腰部以下单侧疼痛SI JointInvolvementSI关节受累关节受累Test and AdjustInvolved SIJ测试和调
14、整受累的SIJConfirm with SI Joint Compression Test通过通过SI关节压迫测试确认关节压迫测试确认22精编内容23精编内容Literature review of tests to diagnose a SI lesion:用测试去诊断SI病变的相关文献综述：Binkley, et al, “Diagnostic classification of patients with low back pain: report on a survey of physical therapy experts,” Physical Therapy, 1993:73Sym
15、metry Tests: 对称性测试：对称性测试：poor reliability and validity. 信度和效度差信度和效度差Pain Provocation Tests: 疼痛激发测试：疼痛激发测试：evidence supports the validity of some pain provocation tests.证据支持某些疼痛激发测试的效度。证据支持某些疼痛激发测试的效度。24精编内容Prone Hip Extension Test俯卧伸髋测试“Sacral Cup,” Dr. Major DeJarnette, (The American Chiropractor,
16、May 2007)“Prone hip extension test” (aka, “sacral cup test”) “俯卧伸髋测试俯卧伸髋测试”（又名（又名“骶杯测试骶杯测试”）Tests the strength of the muscles crossing the posterior aspect of the SI joint.测试横跨SI关节后端的肌肉力量。SI sprain reduces patients ability to extend the hip.SI扭伤降低患者的伸髋能力。25精编内容SI joint horizontal sectionSI关节关节 - 水平横
17、切位水平横切位SI capsule contains a dense plexus of unmyelinated nerve fibers indicative of a nociceptive receptor system. SI关节囊含有密集的无髓鞘神经纤维丛，提示痛觉受体系统。Wyke, “Receptor systems in lumbosacral tissues in relation to the productionof low back pain,” American Academy of Orthopaedic Surgeons Symposium onIdiopath
18、ic Low Back Pain, Mosby, 1982Location of SI adjustmentSI调整部位26精编内容27精编内容Sacroiliac Adjustment骶髂调整骶髂调整Sacroiliac Joint Adjustment骶髂关节调整骶髂关节调整 SCP: Sacroiliac joint, medial aspect of PSIS LOD: Anterior-Superior Setting: High or Medium SCP：骶髂关节，PSIS内侧 LOD：前-上 设置：设置：高或中28精编内容 Impulse iQ Adjusting Instru
19、ment Audible Indicators & Clinical Decision Making脉冲脉冲IQ调整仪器的发声指标及临床决策调整仪器的发声指标及临床决策Significant Improvement in at Least 2 Components of PART Documentation inRe-Assessment of Clinical Indicators在临床指标再评估中，PART文件中至少有2部分有明显改善AccelerationResponseMaximized加速反应最大化Single BeepSingle Beep单声单声单声单声Yes是No否Re-Ass
20、ess Clinical Indicators重新评估临床指标Adjustment of Level orArea Successful水平或位置调整成功Adjustment of Level orArea Not Successful水平或位置调整不成功29精编内容Significant Improvement in at Least 2Components of PART Documentation inRe-Assessment of Clinical Indicators在临床指标再评估中，PART文件中至少有2部分有明显改善36 ThrustsAccelerationResponse
21、 Not YetMaximized36次推力后加速反应尚未达到最大化Double BeepDouble Beep双声双声双声双声Yes是No否Re-Assess Clinical Indicators临床指标再评估Adjustment of Level orArea Successful水平或位置调整成功Adjustment of Level orArea Not Successful水平或位置调整不成功 Insure Contact was Correct with Consistent Preload Throughout Adjustment在进行调整过程中确保接触正确和加压稳定 Imp
22、ulse iQ Adjusting Instrument Audible Indicators & Clinical Decision Making脉冲脉冲IQ调整仪器的发声指示及临床决策调整仪器的发声指示及临床决策30精编内容Significant Improvement in at Least 2Components of PART Documentation inRe-Assessment of Clinical Indicators在临床指标再评估中，PART文件中至少有2部分有明显改善No SignificantImprovementin AccelerationResponse加速
23、反应无显著改善No BeepNo Beep无声无声无声无声Yes是No否Re-Assess Clinical Indicators重新评估临床指标Adjustment of Level orArea Successful水平或位置调整成功Adjustment of Level orArea Not Successful水平或位置调整不成功 Insure Segmental Contact Point was Correct Insure Line of Drive Was Correct Consider that Area May Not Change保证节段接触点正确确保方向正确考虑位置可
24、能不变 Impulse iQ Adjusting Instrument Audible Indicators & Clinical Decision Making脉冲脉冲IQ调整仪器的发声指示及临床决策调整仪器的发声指示及临床决策31精编内容“Interactions between the vestibular and proprioceptive inputs triggering and modulating human balance-correcting responses differ across muscles,” Allum & Honnegger, Experimental
25、 Brain 前庭和本体冲动之间的互动，透过肌肉诱发和调整人的平衡-纠正反射的不同Research, 1998:121Unilaterally reduced or altered hip or SI motion produces rotation of the trunk.单侧髋或骶髂关节活动减少或改变而引起躯干旋转。This excites lumbar joint receptors triggering muscular contractions (primarily the QL) to counter the rotary forces and provide stability
26、.这刺激腰椎关节受体，引发肌肉收缩（主要是腰方肌QL）抵抗旋转力，并提供稳定。32精编内容“Differences in lumbopelvic motion between people with and people without low back pain during two lower limb movement test,” Scholtes, et al, Clinical Biomechanics, 2008:24腰背痛和无腰背痛的人在下肢活动测试时的不同的腰骨盆运动“During (prone) knee flexion and hip lateral (external)
27、 rotation, people with low back pain demonstrated a greater maximal lumbopelvic rotation angle and earlier lumbopelvic rotation, compared to people without low back pain.”“在（俯卧）膝关节屈伸和髋关节外侧（向外）旋转期间，腰痛者与无腰疼者相比，最大腰盆旋转角度更大，且腰盆旋转更早。”33精编内容In patients without low back pain but with “positive abnormal spin
28、e patterns:对于无腰痛但有“脊椎异常模式阳性的人中：the mean onset times for the hamstring, ipsilateral erector spinae, and contralateral erector spinae muscles were prior to the onset of leg movement during prone extension.在俯卧伸展期间，腘绳肌、同侧竖脊肌和对侧竖脊肌肌肉的平均启动时间在腿部运动启动之前之前。the mean onset time for the gluteus maximus occurred
29、after (inhibited) the onset of leg movement.臀大肌的平均启动时间在腿部运动开始之后之后（被抑制）。“An investigation into motor pattern differences used during prone hip extension between subjects with and without low back pain,” Bruno, Bagust, Clinical Chiropractic, 2007:10腰痛病人和无腰痛者在俯卧位髋伸展的运动模式之间的不同34精编内容PI-EXAS-INPSAI35精编内容P
30、ubic Symphysis Dysfunction耻骨联合功能障碍Adjust up on the AS ilim side,Down on the PI ilium side.AS髂骨端向上，PI髂骨端向下调整36精编内容Flowchart for Step 3第第3步流程图步流程图Hip Rotation Tests髋关节旋转测试髋关节旋转测试InternalRotation内旋内旋ExternalRotation外旋外旋Positive阳性阳性Negative阴性阴性Positive阳性阳性Negative阴性阴性AdjustPosteriorTrochanter调整后方转子调整后方转
31、子Proceed toLower Ext.Compression Tests继续下肢压迫测试继续下肢压迫测试AdjustAnteriorTrochanter调整前方转子调整前方转子Proceed toLower Ext.Compression Tests继续下肢压迫测试继续下肢压迫测试HyperactiveInternal Rotators内旋肌过度活跃HyperactiveExternal Rotators外旋肌过度活跃Normal: 35-40 degrees正常：正常：35-40度度Normal: 50-60 degrees正常：正常：50-60度度37精编内容Step 3: Hip R
32、otation Test第第3步：髋关节旋转测试步：髋关节旋转测试Internal Rotation of the Right Hip右髋关节内旋External Rotation of the Right Hip右髋关节外旋38精编内容Step 3: Hip Rotation Test第第3步：髋关节旋转测试步：髋关节旋转测试Internal Rotation of the Left Hip左髋关节内旋External Rotation of the Left Hip左髋关节外旋39精编内容Step 3第第3步步Hip Rotation Tests髋关节旋转测试髋关节旋转测试Internal
33、Rotation内旋内旋Positive阳性阳性AdjustPosteriorTrochanter调整后方转子调整后方转子Hyperactive or InhibitedExternal Rotators外旋肌过度活跃或受抑制Internal rotation of right hip:右髋关节内旋35-40 degrees35-40度40精编内容41精编内容Posterior Hip Adjustment后方髋关节调整后方髋关节调整 SCP: Posterior aspect of the greater trochanter SCP:大转子的后面 LOD: Anterior LOD: 前
34、Setting: High or Medium 设置：高或中Posterior Hip Adjustment(For Loss of Hip Internal Rotation)后方髋关节调整后方髋关节调整（髋关节内旋受损）（髋关节内旋受损）42精编内容External Rotators外旋肌Muscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & Wilkins43精编内容44精编内容Flowchart for Step 3第第3步流程图步流程图Hip Rot
35、ationTests髋关节旋转测试髋关节旋转测试InternalRotation内旋内旋ExternalRotation外旋外旋Positive阳性阳性Negative阴性阴性Positive阳性阳性Negative阴性阴性AdjustPosteriorTrochanter调整后方转子调整后方转子Proceed toLower Ext.Compression Tests继续下肢压迫测试继续下肢压迫测试AdjustAnteriorTrochanter调整前方转子调整前方转子Proceed toLower Ext.Compression Tests继续下肢压迫测试继续下肢压迫测试Hyperacti
36、ve or InhibitedInternal Rotators内旋肌过度活跃或受抑制Hyperactive or InhibitedExternal Rotators外旋肌过度活跃或受抑制 45精编内容Step 3第第3步步Hip RotationTests髋关节旋转测试髋关节旋转测试ExternalRotation外旋外旋Positive阳性阳性AdjustAnteriorTrochanter调整前方转子调整前方转子Hyperactive or InhibitedInternal Rotators 内旋肌过度活跃或受抑制External rotation of right hip:右髋关节
37、外旋50-60 degrees50-60度46精编内容Anterior Hip Adjustment 前端髋关节调整前端髋关节调整 SCP: Anterior aspect of the greater trochanter SCP:大转子的前面 LOD: Posterior LOD: 后 Setting: High or Medium 设置：高或中Anterior Hip Adjustment(For Loss of Hip External Rotation)前端髋关节调整前端髋关节调整（髋关节外旋受损）（髋关节外旋受损）47精编内容Hip Internal Rotators: TFL髋关
38、节内旋肌：TFLMuscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & Wilkins48精编内容Hip Internal Rotators髋关节内旋肌Muscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & Wilkins49精编内容Unilateral Hip Rotation Range of Motion Asymmet
39、ry in Patients With Sacroiliac Joint Regional Pain有骶髂关节局部疼痛的病人单侧髋关节旋转范围不对称有骶髂关节局部疼痛的病人单侧髋关节旋转范围不对称Cibulka et al. Spine: Volume 23(9) 1 May 1998 pp 1009-15The patients with LBP with evidence of SIJ dysfunction had significantly reduced hip internal rotation unilaterally, specifically on the side of t
40、he posterior innominate.有证据显示骶髂关节功能失调的腰背痛病人，会有明显的单侧髋关节内旋受限，特别是在髂脊后旋的一侧。From the *Jefferson County Rehabilitation and Sports Clinic, Crystal City, Missouri, the Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, the Jefferson County Rehabilitation and Sports C
41、linic, Crystal City, Missouri, and the Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.来自*密苏里州水晶城杰斐逊县康复和体育诊所；密苏里州圣路易斯华盛顿大学医学院物理治疗课题组；密苏里州水晶城杰斐逊县康复和体育诊所；宾夕法尼亚州匹兹堡大学医学中心卫生和康复治疗科学学院物理治疗系。50精编内容“The Hip Joint
42、: Myofascial and Joint Patterns,” Marc Heller, DC, Dynamic 髋关节：肌筋膜和关节模式Chiropractic, May 7, 2007:“The hip joint is an absolutely critical component of both lower back and lower extremity problems.”“髋关节绝对是引起下腰部和下肢问题的关键部位。”51精编内容Internal rotation is the first motion affected with hip capsular problems
43、 and DJD.内旋是髋关节囊问题和关节退行性病变影响的第一个动作。“When you find a severe lack of internal rotation in the hip and this motion cannot be restored, the patient is usually on their way to hip replacement surgery.”“当您发现髋关节内旋严重受限且该动作无法恢复时，该患者通常要接受髋关节置换手术。”“The Hip Joint: Myofascial and Joint Patterns,” Marc Heller, DC
44、, Dynamic Chiropractic, May 7, 2007:52精编内容Flowchart for Step 4第第4步流程图步流程图Lower ExtremityCompressionTests下肢压迫测试下肢压迫测试LateralHamstrings外侧腘绳肌外侧腘绳肌Peroneals腓骨肌腓骨肌Positive阳性阳性Negative阴性阴性Positive阳性阳性Negative阴性阴性ImpulseLateralHamstrings冲击外侧腘绳肌冲击外侧腘绳肌ImpulsePeroneals冲击腓骨肌冲击腓骨肌Proceed toSupra-pelvicCompress
45、ion Tests继续盆骨上方压迫测试继续盆骨上方压迫测试HyperactiveMuscles肌肉过度活跃HyperactiveMuscles肌肉过度活跃53精编内容Step 4第第4步步Lower ExtremityCompressionTests下肢压迫测试下肢压迫测试LateralHamstrings外侧腘绳肌外侧腘绳肌Positive阳性阳性ImpulseLateralHamstrings冲击外侧腘绳肌冲击外侧腘绳肌HyperactiveMuscles肌肉过度活跃Positive Findings:MyospasmTendernessTrigger PointsGuarding阳性结果
46、：肌痉挛柔软压痛触点保护54精编内容Lateral Hamstring (Biceps Femoris m.)外侧腘绳肌（股二头肌 股肌）Muscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & Wilkins55精编内容Step 4. Lower Extremity Compression Tests(for Lateral Hamstring and Peroneal m. involvement)第第4步下肢压迫测试步下肢压迫测试（外侧腘绳肌肉和腓骨肌受累
47、）Lateral Hamstring Compression Test外侧腘绳肌肉压迫测试Peroneal Compression Test腓骨肌压迫测试56精编内容Lateral Hamstring Adjustment外侧腘绳肌调整外侧腘绳肌调整 SCP: Taught/Tender area of muscle belly of Biceps Femoris m SCP:股二头肌肌腹的敏感压痛处 LOD: Anterior LOD: 前 Setting: Medium or Low 设置：中或低Lateral Hamstring Adjustment侧面腘绳肌调整57精编内容Step 4
48、第第4步步Lower ExtremityCompressionTests下肢压迫测试下肢压迫测试Peroneals腓骨肌腓骨肌Positive阳性阳性ImpulsePeroneals冲击腓骨肌冲击腓骨肌HyperactiveMuscles肌肉过度活跃58精编内容Peroneal m.腓骨肌Muscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & Wilkins59精编内容Step 4. Lower Extremity Compression Tests(for
49、Lateral Hamstring and Peroneal m. involvement)第第4步下肢压迫测试步下肢压迫测试（涉及侧面大腿肌肉和腓骨肌）Lateral Hamstring Compression Test外侧腘绳肌压迫测试Peroneal Compression Test腓骨肌压迫测试60精编内容Peroneal m. Adjustment腓骨肌调整腓骨肌调整SCP:Taught/Tender area of muscle belly of Peroneal m. SCP:腓骨肌肌腹的敏感压痛处LOD:Anterior LOD:前Setting: Medium or Low
50、设置：中或低Peroneal m. Adjustment腓骨肌调整腓骨肌调整61精编内容Flowchart for Step 5第第5步流程图步流程图Supra-pelvicCompressionTests盆骨上方压迫测试盆骨上方压迫测试LeftQuadratusLumborum左腰方肌左腰方肌RightQuadratusLumborum右腰方肌右腰方肌Positive阳性阳性Negative阴性阴性Positive阳性阳性Negative阴性阴性Impulse theQuadratusLumborum冲击腰方肌冲击腰方肌Proceed toProceed toLumbarLumbarAnal
51、ysisAnalysis继续腰椎分析继续腰椎分析继续腰椎分析继续腰椎分析Impulse theQuadratus Lumborum冲击腰方肌冲击腰方肌Proceed toProceed toLumbarLumbarAnalysisAnalysis继续腰椎分析继续腰椎分析继续腰椎分析继续腰椎分析HyperactiveQuadratus腰方肌过度活跃HyperactiveQuadratus腰方肌过度活跃62精编内容Step 5第第5步步Supra-pelvicCompressionTests盆骨上方压迫测试盆骨上方压迫测试QuadratusLumborum腰方肌腰方肌Positive阳性阳性Imp
52、ulse theQuadratusLumborum刺激腰方肌刺激腰方肌HyperactiveQuadratus腰方肌过度活跃Positive Findings:MyospasmTendernessTrigger PointsGuarding阳性结果：阳性结果：肌痉挛压痛触点保护63精编内容Step 5. Supra-Pelvic Compression Tests(for Quadratus Lumborum m. involvement)第5步 盆腔上方压迫测试（腰方肌受累）64精编内容Step 5. Supra-Pelvic Compression Tests(for Quadratus
53、Lumborum m. involvement)第5步 盆腔上方压迫测试（腰方肌受累）65精编内容Quadratus Lumborum m. Adjustment腰方肌调整腰方肌调整 SCP: Taught/Tender area of muscle belly of Quadratus Lumborum m. SCP：腰方肌肌腹的敏感痛处 LOD: Anterior LOD：前 Setting: Medium or Low 设置：中或低Quadratus Lumborum m. Adjustment腰方肌调整66精编内容 Summary of tests to identify the dy
54、sfunctional SI joint (PI Ilium):确定功能失调性SI关节（PI髂骨）的测试摘要： 1. Pain in one SI, buttock, thigh with Bilateral Nachlas test2. Positive Nachlas test (the fixated SI joint)3. Pain in the fixated SI with compression or digital palpation4. Reduced prone hip extension on fixated side5. Asymmetrically reduced h
55、ip rotation on fixated SI joint side6. Hypertonic (with trigger points) lateral hamstring on fixated side7. Hypertonic QL on fixated side1. 双侧Nachlas测试法检查SI、臀部、大腿疼痛2. 阳性Nachlas测试（固定的SI关节）3. 采用压迫或手指触诊检查固定的SI疼痛4. 减少固定端的侧俯卧伸髋5. 不对称性减少固定的SI关节端的髋关节旋转6. 固定侧外侧腘绳肌张力升高（触点）7. 固定侧腰方肌张力升高67精编内容Cervical Spine颈椎颈
56、椎脉冲脉冲调整调整TECHNIQUE68精编内容Cervical Zygapophyseal Joint Pain Referral Patterns颈椎椎骨关节突关节疼痛转诊模式颈椎椎骨关节突关节疼痛转诊模式69精编内容Cervical Spine颈椎颈椎The articular facets of C3 through C7 are oriented at 45 degrees to the transverse plane & parallel to the frontal plane. C3-C7 的关节面与横切面成45度，与额状面平行。70精编内容71精编内容Kinematics
57、of C3 through C7C3-C7的运动学的运动学(Management of Common Musculoskeletal Disorders, Hertling & Kessler, 1990, Lippincott)Rotation and lateral bending occur together to the same side (coupling).同侧一起发生旋转和侧屈（耦合）。“As one articular facet joint slides forward and upward, its mate slides backward and downward, t
58、ranslating to a sidebending component in the frontal plane and a rotatory component in the transverse plane.”“一个小关节突关节向前和向上滑动，其配对体向后和向下滑动，转化成在额状面的侧弯和横切面的旋转”72精编内容C3 & 4 right facets not gliding anterior and superior.C3和C4右面没有前上滑动73精编内容Kinematics of Occiput-C1-C2枕部枕部C1-C2的运动学的运动学Occiput-C1: 13 degree
59、s of flexion-extension 8 degrees of lateral bending 10 degrees of axial rotation 枕部- C1： 13度屈-伸 8度侧弯 10度轴向旋转C1-C2: 10 degrees of flexion-extension 0 degrees of lateral bending 65 degrees of axial rotation C1 - C2： 10度屈-伸 0度侧弯 65度轴向旋转74精编内容75精编内容Cervical Compression Test:脊椎压迫测试：脊椎压迫测试：76精编内容Cervical
60、Compression Test:颈椎压迫测试：颈椎压迫测试：“+” in the area of the C-spine that pain and/or restriction is felt:在颈椎部位感到疼痛和/或束缚感“+”号：mid to lower C-spine - usually a loss of lordotic curve with inability to move into lordosis, primarily between C6-C3; upper C-spine usually suboccipital spasm interfering with norm
61、al occipital glide and C1-C2 movement.中-低段颈椎- 通常是前凸弯曲消失，不能活动到前屈位，主要在C6 C3上段颈椎 - 通常枕下痉挛，干扰正常的枕滑行和C1 - C2运动。Also tells examiner of presence of radicular pain indicating possible space occupying lesion.还告诉检查者存在根性疼痛，表明可能有占位性病变。77精编内容Cervical compression test:颈椎压迫测试：颈椎压迫测试：Patient reports pain in upper n
62、eck or skull begin with C2 analysis. Turn head to right and then left.Adjust C2 on side of restriction, not side of pain.患者报告颈部或颅骨疼痛 - 开始C2分析。头先转向右侧，然后向左。在束缚感的一侧调整C2，不痛。78精编内容Right Cervical Rotation Test (for C2):右颈旋转测试（右颈旋转测试（C2）：）：79精编内容C2 adjustment (TP):C2调整（调整（TP）：）：80精编内容-SCP: C2 LPJ-LOD: Ante
63、rior-Superior-Setting: Low-Thrust(s): Single-SCP：C2 LPJ-LOD：前上-设置：低-推力：单个Cervical Spine颈椎颈椎81精编内容Occiput adjustment: (single stylus)枕部调整：（单针）枕部调整：（单针）82精编内容C1 adjustment:C1调整：调整：83精编内容-SCP: C1 TP-LOD: Medial-Setting: Low-Thrust(s): Single-SCP：C1TP- LOD：内侧-设置：低-推力：单个84精编内容-SCP: Occiput-LOD: Anterior-
64、Superior-Setting: Low or Medium-Thrust(s): Single-Double stylus- SCP：枕部-LOD：前-上-设置：低或中-推力：单个- 双针85精编内容-SCP: C2 Bilateral LPJ-LOD: Anterior-Superior-Setting: Medium or Low-Thrust(s): Single or Multiple-Double stylus-SCP：C2双边LPJ-LOD：前-上-设置：“中”或“低”-推力：单个或多重- 双针86精编内容If cervical compression test produce
65、s pain in mid to lower cervical spine, proceed to lateral flexion test.Begin at C3 on side of restriction, not pain.如果颈椎压迫试验造成中下段颈椎疼痛，则开始侧屈试验。开始在C3束缚感侧，不痛。87精编内容Right Cervical lateral bending test for C3-C7:C3 - C7颈右侧弯测试：颈右侧弯测试：88精编内容Right C3-7 TP adjustment: 右侧右侧C3-7 TP调整：调整：89精编内容-SCP: Cervical LP
66、J-LOD: Anterior-Superior-Setting: Medium or Low-Thrust(s): Multiple-SCP：颈椎LPJ-LOD：前-上-设置：“中”或“低”-推力：多重Cervical Spine颈椎颈椎90精编内容Cervical dual stylus adjustment to restore lordosis:颈椎双针调整恢复前凸：颈椎双针调整恢复前凸：91精编内容-SCP: Cervical Bilateral LPJ-LOD: Anterior-Superior-Setting: Medium or Low-Thrust(s): Single o
67、r Multiple-SCP：颈部双侧LPJ-LOD：前-上-设置：“中”或“低”-推力：单个或多重92精编内容93精编内容94精编内容Muscles that hinder Occiput -C7 correction:阻碍枕部阻碍枕部- C7肌肉的矫正：肌肉的矫正：ScalenesUpper TrapeziusLevator scapulaeSplenius capitis斜角肌上斜方肌肩胛提肌夹肌95精编内容Scalenes:斜角肌斜角肌O: TPs of C2-7I: 1st & 2nd ribsO：C2-7的TPsI：第1、2肋骨Muscles, Testing and Functi
68、on with Posture and Pain, Kendall et al, 2005, Lippincott Williams & Wilkins96精编内容Kulkarni et al. Quantitative Study of Muscle Spindles in Suboccipital Muscles of Human Foetuses. 胎儿枕下肌肉肌梭的定量研究Neurology India, 49, December 2001: 355-9.The density, distribution and morphology of muscle spindles were s
69、tudied in the upper cervical spineDensity of Muscle Spindles Per Gram Of Muscle:研究了上颈椎肌梭的密度、分布和形态每克肌肉中的肌梭密度：- Inferior Oblique242- 下斜肌 242 - Superior Oblique190 - 上斜肌 190- Rectus Capitis Posterior Major 98 - 头后大直肌 98 - Rectus Capitis Posterior Minor 98 - 头后小直肌 98 - Lateral Pterygoid 20.3- 翼状肌 20.3 -
70、 Opponnens Pollicis 17.3- 对掌拇肌 17.3 - First Lumbrical 16.5 - 第一蚓状肌 16.5 - Trapezius 2.2 - 斜方肌 2.2 - Latissimus Dorsi 1.4 - 背阔肌 1.497精编内容98精编内容“A distinct pattern of myofascial findings in patients after whiplash injury,” Murphy, Archives of Physical Medicine and Rehabilitation, 89:7, July, 2008“颈部扭伤
71、伤后患者肌筋膜检查发现的不同模式，” Murphy ，物理医学与康复档案，89:2008年7月7日85.1 % had positive trigger points in the semispinalis capitis muscle.Reduced cervical ROM is a prominent finding.Myofascial tension of the scalene muscles causes a functional thoracic outlet syndrome that may explain brachialgia.Patients with whiplas
72、h display more trigger points in the semispinalis capitis muscle, which is localized in the upper neck, consistent with a C1-2 facet injury.85.1的人在头半棘肌有触发点。颈椎ROM减少是一个突出的发现。斜角肌的肌筋膜紧张引起功能性胸廓出口综合征，这可能解释臂痛的原因。颈部扭伤患者在头半棘肌具有更多的触发点，位于上颈段，与C1- 2关节突损伤一致。99精编内容Scalene Adjustment:斜角肌调整：斜角肌调整：100精编内容 Upper trap
73、ezius:上斜方肌：上斜方肌：O: occiput & cervicalsI: Lateral 1/3 of clavicle & acromial processO：枕部&颈部I：锁骨&肩峰外侧1/3Muscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & Wilkins101精编内容Upper Trap Adjustment:斜方肌上部调整：斜方肌上部调整：102精编内容Levator scapulae:肩胛提肌：肩胛提肌：O: C1-4 TPsI: me
74、dial-upper border of scapulaI：肩胛骨内侧上缘Muscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & Wilkins103精编内容Levator Scapulae Adjustment:肩胛提肌调整：肩胛提肌调整：104精编内容Splenius cervicis & capitis:颈夹肌和头夹肌：颈夹肌和头夹肌：O: Ligamentum nuchae & TPs of C7 & T1-6O：颈背韧带C7 & T1-6之TPsI:
75、 Occiput to C3I：枕部至C3Muscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & Wilkins105精编内容Splenius test and adjustment:夹肌测试和调整：夹肌测试和调整：Upper thoracic compression test and adjustment上胸椎压缩测试和调整106精编内容Posterior neck “glide:”颈后颈后“滑动滑动”：107精编内容Against resistance:抗
76、阻力：抗阻力： 108精编内容From horizontal:水平角度：水平角度： correct 正确incorrect不正确109精编内容Thoracic Spine胸椎胸椎脉冲脉冲调整调整TECHNIQUE110精编内容Thoracic compression test:胸椎压迫测试：胸椎压迫测试：111精编内容“Thoracic costotransverse joint pain patterns: a study in normal volunteers,” Young et al, BMC Musculoskeletal Disorders, 2008:9“胸肋横突关节疼痛模式：
77、一项正常志愿者的研究胸肋横突关节疼痛模式：一项正常志愿者的研究”，Young等人，BMC肌肉骨骼疾病，2008:9Intra-articular injections in 21 CT joints of 8 pain-free volunteers produced:在8名无疼痛志愿者的21个CT关节处进行关节腔内注射，产生：A deep dull ache, and pressure sensation.Pain patterns were superficial to the injected joint.No production of chest wall, upper extrem
78、ity, or pseudovisceral pain.Only T2 referred pain 2 segments caudally and cranially.一种深刻的隐痛和压迫感。疼痛模式为注射关节的浅表。没有产生胸壁、上肢或假性内脏疼痛。只有T2的尾端和颅端2段牵涉痛。112精编内容-SCP: Thoracic TP-LOD: Anterior-Superior-Setting: Medium or Low-Thrust(s): Single- SCP：胸TP- LOD：前-上- 设置：“中”或“低”- 推力：单个Thoracic Pain胸痛胸痛113精编内容-SCP: Med
79、ial Posterior Rib Head-LOD: Lateral-Inferior-Setting: Medium or Low-Thrust(s): Single or Multiple- SCP：内侧后肋头- LOD：横向-下- 设置：“中”或“低”- 推力：单个或多个Thoracic Pain胸痛胸痛114精编内容Thoracic dual stylus adjustment:胸部双针调整：胸部双针调整：115精编内容-SCP: Anterior Rib-LOD: Lateral - Inferior-Setting: Low or Medium-Thrust(s): Single
80、- SCP：前肋骨- LOD：横向 -下- 设置：低或中- 推力：单一Chest Pain胸痛胸痛116精编内容 Lower Extremity下肢下肢Foot/Ankle 足足/踝关节踝关节Knee 膝关节膝关节Hip 髋关节髋关节The Neuromechanical System脉冲脉冲调整调整TECHNIQUE117精编内容Common Conditions of the Lower Extremity:下肢的常见疾病：下肢的常见疾病：Foot / Ankle 足/踝Plantar Fascitis / Heel PainAchilles TendonitisInversion Ank
81、le SprainEversion Ankle SprainInstep PainMetatarsalgia足底筋膜炎/足跟痛跟腱炎内翻踝关节扭伤外翻踝关节扭伤脚背疼痛跖骨痛118精编内容119精编内容Combination of eversion,abduction, and dorsiflexion外翻、外展和背屈结合Normal calcaneal eversion is 4 to 8 degrees.正常跟骨外翻是4至8度。120精编内容Plantar Fascitis足底筋膜炎足底筋膜炎121精编内容Common Associated Foot Subluxations常见相关的足半
82、脱位常见相关的足半脱位 Medial Calcaneus Inferior-medial Talus Inferior-medial Navicular Inferior Medial Cuneiform Inferior 1st Metatarsal Inferior Lateral Cuneiform 内侧跟骨 下内侧距骨 下内侧舟骨 下内侧楔形骨 下第一跖骨 下侧向楔形骨Plantar Fascitis足底筋膜炎足底筋膜炎122精编内容Plantar Fascitis足底筋膜炎足底筋膜炎Medial Calcaneus-LOD: Lateral-Setting: Low or Mediu
83、m内侧跟骨内侧跟骨- LOD：侧面- 设置：低或中 123精编内容Plantar Fascitis足底筋膜炎足底筋膜炎Inferior-medial Talus-LOD: Superior & Lateral-Setting: Low or Medium距骨下内侧距骨下内侧- LOD：上端及侧面- 设置：低或中 124精编内容Plantar Fascitis足底筋膜炎足底筋膜炎Inferior-medial Navicular-LOD: Superior & Lateral-Setting: Low or Medium下内侧舟骨下内侧舟骨- LOD：上端及侧面- 设置：低或中 125精编内容P
84、lantar Fascitis足底筋膜炎足底筋膜炎Inferior Cuneiform-LOD: Superior-Setting: Low or Medium下楔形骨下楔形骨- LOD：上端-设置：低或中 126精编内容Plantar Fascitis足底筋膜炎足底筋膜炎Inferior 1st Metatarsal-LOD: Superior-Setting: Low or Medium下第一跖骨下第一跖骨- LOD：上端：上端-设置：低或中设置：低或中 127精编内容Plantar Fascitis足底筋膜炎足底筋膜炎Inferior Lateral Cuneiform下外侧楔形骨下外侧
85、楔形骨-LOD: Superior-Setting: Low or Medium-LOD：上端-设置：低或中128精编内容Plantar Fascitis足底筋膜炎足底筋膜炎Common Segmental Contact Points常见的节段接触点xxxxxxxxxxxxxxxxPlantar Fascitis足底筋膜炎足底筋膜炎129精编内容Plantar Fascitis足底筋膜炎足底筋膜炎130精编内容Plantar Fascitis足底筋膜炎足底筋膜炎131精编内容Plantar Fascitis足底筋膜炎足底筋膜炎Proprioception 本体觉本体觉132精编内容Proprioception本体觉本体觉133精编内容
