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Chiropractic Methods 4: lumbopelvic manual therapies - 33340


 

 
James J. Amundson, DC
3.25
75.0
1.5
3.5

Students will study the mechanics and techniques of low back adjusting. Emphasis is on understanding the normal mechanics and the pathomechanics of the lumbar spine and pelvic region and to safely apply techniques derived from various technique systems (e.g., Gonstead, Diversified, Motion Palpation, Thompson, Cox), to dysfunctional joints.

Provide the student with an introduction to high velocity, low amplitude thrust techniques for the lumbar spine and pelvis. Emphasis is on the development of the psychomotor skills necessary to safely apply the techniques to dysfunctional joints.

 
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    Graduates will demonstrate effective verbal, non-verbal, and written communication skills in a wide variety of contexts, including collaborative activities.
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Course Objectives
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  1. Understand normal joint structure and function in the lumbar and pelvic thoracic regions;
  2. Evaluate the lumbar spine and determine the location of a subluxation utilizing the P.A.R.T.S. acronym with an emphasis on motion palpation, static palpation and x-ray.
  3. Explain spinal function, how the areas of the spine interrelate to each other and to the extremities.
  4. Understand the role of provocative orthopedic and neurological tests on determining the nature and extent of the lesion.
  5. Utilize and assess various adjusting techniques based on the understanding of the biomechanics of the spine.
Materials
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A. Required Text(s):
  1. Bergmann, Peterson, Lawrence. Chiropractic Technique, Churchill Livingstone, 1993.
  2. Evans R. Illustrated Essentials in Orthopedic Physical Assessment, Mosby, 1994.

B. Recommended Text(s):
  1. Plaugher,Textbook of Clinical Chiropractic
  2. Kapandji, The Physiology of Joints, Vol III
  3. Hoppenfeld,Orthopedic Neurology

C. Required Materials for Lab:
  1. Lecture/Lab Notes - available in the bookstore
  2. gym shorts/gowns
  3. NO JEANS WILL BE ALLOWED IN LAB
  4. Videotape
Assignments
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  1. Read weekly assignments in required textbook
  2. Read class notes
Attendance
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Attendance is recommended but not required.
Grading Criteria
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A STUDENT MUST ACCUMULATE 75% OF THE POINTS AVAILABLE IN ORDER TO PASS THE COURSE.

FINAL GRADE CALCULATION:
100 points available:
  1. 60 total points: quizzes. During lab time
  2. 75-80 Midterm Exam. Case study format.
  3. 85-100 points Final Exam (multiple choice and case study) optional

NOTE: All makeup exams and quizzes will be assessed fee per the Student Handbook:

Quiz make-up $5.00
Major exam & final practical $30.00

Guaranteed grades are as follows:

A = 92% - 100%
B = 86% - 91.9%
C = 80% - 85.9%
D = 75% - 79.9%
F = 0% - 74.9%
Course Competencies
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-

COGNITIVE DOMAIN


  1. Students will understand and be able to apply the following concepts for manual thrust techniques used in the lumbar and pelvic regions:
    a. Patient positioning e. Vectors of force, line of drive
    b. Doctor positioning f. Tissue slack, articular slack
    c. Contact points on the hand g. Prestress - assisted, resisted, neutral
    d. Segmental contact points on the patient  

    Students will be able to construct and follow a rational diagnostic process in evaluating patients who present with the following low back and sacral complaints:

    a. pain d. trigger points
    b. muscle spasm e. radicular pain
    c. joint stiffness  

    In addition, students will be familiar with the following symptoms, which sometimes accompany certain low back and pelvic complaints:

    a. antalgic postures d. sciatica
    b. leg pain e. altered sensation
    c. altered gaits  

    Students will be able to explain the clinical utility and indications for the following diagnostic tests in patients with suspected low back and pelvic complaints:

    a
    		 x - ray
    b
    		 CT Scan
    c
    		 MRI

    Students will be able to describe the biomechanical behavior and functional differences associated with the:

    a. Lumbar spine - L1-L5
    • 3 joint complex - 2 synovial, 1 disc
    • lumbar curve
    • disc height to body height ratio
    • facets - 90 sagittal
    • segmental movement
    • coupled movement patterns
    b. Pelvic region
    • 3 joint complex - 2 synovial, 1 pubic symphysis
    • segmental movement
    • basic distortion pattern

    Students will be able to describe the functional differences and clinical significance associated with the following classification of physical maneuvers:

    a. Stretch Tests
    b. Compression Tests
    c. Distraction Tests
    d. Mechanical Tests

    Students will be able to describe the role and significance of neurological testing for the integrity of specific levels using:

    a. grading of muscle strength (myotome)
    b. superficial sensation to pin and light tough (dermatome)
    c. relation of pain of deep somatic origin (sclerotome)
    d. muscle stretch reflexes


Conditions:
LOW BACK AND PELVIC CONDITIONS

Students will be able to make case management decisions regarding common low back and pelvic conditions based on their understanding of the following information regarding each condition. ( See key on the following page for description of codes.)

Clincal Condition Etiol. & Epiderm Patho
Phys 		Nat. History & course Exam DX RX/Mgmt
Lumbalgia
2
1
1
1,3,4
1
Subluxation (lumbar)
2
2
2
1,3,4,6
1
Facet Syndrome
2
2
2
1,3,4,6
1
Disc
2
2
1
1,3,4,6
1
Sciatica
1
2
1
1,3,4
1
Cluneal nerve
2
2
2
1,3,4
1
Subluxation (Sacro-iliac)
2
2
2
1,3,4,6
1
Subluxation (Pubic)
2
2
2
1,3,4,6
1
Subluxation (Coccyx)
2
2
2
1,3,4,6
1

ELABORATION OF CODING DEFINITIONS REGARDING THE CONDITIONS

The following codes refer to the depth of coverage for etiology and epidemiology; pathophysiology,and; natural history and course:

0
 No coverage or content
1
 Introduction, without test items
2
 Moderate class discussion and/or handout material, with test items
3
 Extensive discussion and/or handout material, with test items

For Exam and Diagnosis, the following numbers indicate which aspects of exam and diagnosis of each condition are taught in this course:

1
 Presenting SX: Presenting symptoms related to condition are discussed
2
 History findings: Relevant personal and family history are discussed.
3
 Exam findings General physical exam findings are discussed.
4
 Chiro. findings: Posture, subluxation, muscle tone and length, trigger pts.
5
 Lab findings: Blood, urine, CSF
6
 Imaging findings: Normal, CT, CAT, MRI
7
 Special test findings:  

For Treatment/Management, the following numbers indicate which aspects of treatment and management of each condition are taught in this course:

1
 Chiropractic: Adjustments, soft tissue techniques
2
 PT: Physical therapy modalities of all types
3
 Nutrition/Suppl: Diet and supplement recommendations
4
 Exercise: Stretching, strengthening, aerobic exercise recommendations
5
 Lifestyle Mgmt: Stress reduction, smoking cessation, allergen avoidance
6
 Medical: Drugs, antibiotics, surgical procedures, radiotherapy
7
 Other: Acupressure/puncture, massage, homeopathic or herbal Rx
8
 Guidelines: If published, do you refer to them regarding this condition?


PSYCHOMOTOR DOMAIN


There are no psychomotor skills in this portion of the class. It is a lecture component only.

AFFECTIVE DOMAIN


Student will demonstrate integrity, sensitivity, respect, courtesy, compassion and professionalism at all times, both in lecture and labs, and will be able to apply the physical exam and treatment techniques learned in this course to any patient while demonstration those same qualities.
Weekly Calendar of Learning Objectives
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Week Dates Topics/Learning objectives
Week 1 -- LECTURE: Introduction: Syllabus, Introduction to course by reviewing the course syllabus, grading system and required paper. Review of the anatomy with a special interest on the bony formation, joint formation and alignment of the facets within the lumbar spine and the relationship to the sacrum and pelvis.
READINGS: Notes, B.P.L. pages 402-415
Labs:  Begin examination form with partners; continue examination form, introduce ortho's that are listed on form.
Week 2 -- LECTURE:
READINGS:
Labs: continue examination form and ortho's/neuro; finish exam form and turn in. 
Week 3 -- LECTURE:
READINGS:
Labs: Lumbar/pelvic, demonstrate exam flow. Additional ortho's.
Week 4 -- LECTURE:
READINGS:
Labs: Lumbar adjustments: rotations-mamillary push, spinous pull/push.
Quiz of ortho's
Week 5 -- LECTURE:
READINGS:
Labs: Review rotational adjustments. Begin lateral flexion malposition.
Quiz of lumbar rotational adjustments.
Week 6 -- LECTURE:
READINGS:
Labs:  Assessment of rotational and lateral flexion malpositions on partners.
Videotape lumber setups.
Quiz lateral flexion and rotational malpositions. 
Week 7 -- LECTURE: 
READINGS:
Week 8 -- MIDTERM EXAMS - NO CLASSES
LECTURE: Written Midterm  
READINGS: None - STUDY!
Labs: Demonstration of lumbar flexion-extension malpositions. Assess partners for lumber malpositions and deliver correction, if needed. 
Week 9 -- LECTURE:
READINGS:
Labs: Review all lumbar adjustments.
Quiz Lumbar setups
Week 10 -- LECTURE:
READINGS:
Labs:  Introduce Pelvic Adjustments, PI ilium, AS ilium, PS sacrum, AI sacrum. Assessment of partners for pelvic malpositions/correction, if needed.
Week 11 -- LECTURE:
READINGS:
Labs: Assess partners for lumbar and pelvic malposition. 
Videotape pelvic setups.
Quiz Pelvic setups. 
Week 12 -- LECTURE:
READINGS:
Labs: Drop piece, blocking, distraction. Additional adjustments of lumbar and pelvis. Some cervical/thoracic techniques.
Week 13 -- LECTURE & LABS:
Review for finals
Week 14 -- Final Exams As Scheduled
Week 15 -- Final Exams As Scheduled
Please Note
This schedule of lecture and lab topics and quizzes and exams may be changed during the course of the trimester as circumstances require. Whenever possible, such changes will be announced in class before the date and time in question. You are responsible for anything that transpires during lectures and labs, even when you are unable to attend. In the event that you miss a class session, make sure you check with a classmate about any announcements or schedule changes which may have been made. Makeup exams are allowed only according to the policies described in the current student handbook, which is available in the Student Affairs office.
Maintained by Northwestern College of Chiropractic
Last updated:04 August, 2004
 

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