Principles Pt. 1

FAST =

message impulse (endoneural tube = axon)

A fibers (alpha-fastest) and (Beta-fast)

Quick, stabbing and sharp muscle proprioceptors → proprioceptors = fastest of all A fibers

Withdrawal reflex, 10-30 meters/second

LARGE, MYELINATED and fast

Group III nociceptors

Lamina II and IV

pain goes up and down the tract of Lissauer

C-fibers

Fast (not the fastest)

burning and achy, reticular formation

Deep viscera and somite, substance P and inflammation

SMALL, UNMYELINATED, “less fast”

group IV nociceptors, Lamina II

Convergence

input from large fibers will inhibit small pain fibers

Soma =

full of Neurotransmitters → synapses out in soma = lots of NTs to facilitate them

Hillock

area where action potential is reached / not reached

Thick myelinated nerves are mor sensitive to

compression than non-myelinated or thinly myelinated nerves

Slow / AXT = trophic (microtubular network in epineurium) → fast

Antegrade (400mm / day)

proximal to distal

feeding (protein and sugars)

(FAXT) fast axoplasmic transport

bulk

slow

Slow / AXT = trophic (microtubular network in epineurium) → slow

Retrograde (1-3 mm / day)

Terminals to cell body

Recycling (NGF and neurotransmitters)

Neuroplasticity

collateral fibers

slower

ANS balancing system: 3 components

sympathetics

parasympathetics

enteric (intestinal wall of GI tract)

All ANS preganglionic fibers are

cholinergic, only sympathetic portion have adrenergic (post ganglion) fibers

Sympathetic (“domino effect”)

T1-L2/L2 (interomedial cell column or sympathetic chain)

“fight or flight”

eyes DILATE, TACHYCARDIA

Sympathetics have exclusive control over temperature

Vasomotor = shunt to large muscles

Pilomotor = hair on end

Sudomotor = wet palms

Sympathetic → intrasegmental

exit directly to organ

Sympathetic → intersegmental

ascend or descend before exit

Sympathetic: short preganglionic nerve

Acetylcholine

Sympathetic: Long postganglionic nerve

Epinephrine and Norepinephrine

Epinephrine uses

Alpha and beta catecholamines → BRONCHOCHONSTRICTION exclusively in fight or flight

Norepinephrine uses

ALPHA only!

decreased threshold, increased action potential, increased pain

Sympathetic → supra-renal glands have

chromaffin cells that synthesize catecholamines for sympathetic post ganglionic fibers

Alpha catecholamines EXCITE smooth muscle (nor and epi)

Beta catecholamines INHIBIT smooth muscle (epi only)

Parasympathetic (“vegetative component”)

CN 3, 7, 9 and 10 (vagus), S2-S4 (bowel and bladder)

cranio-sacral

Not body walls or limbs

BRADYCARDIA, increased saliva, increased GI Enzymes, Decreased heart, lung and respiration

Stores, conserves and replenishes body energy

Parasympathetic Long preganglionic nerve

Acetylcholine

Parasympathetic short postganglionic nerve

acetylcholine

Enteric system

Not innervated by CNS, can be influenced by a few nerves from sympathetics and parasympathetics but can ‘act’ autonomously

Uses NT VIP (vaso intestinal peptide in gut, DRG, brain)

Includes: myenteric and submucosal plexuses

in times of great stress, sympatheticotonia can override enteric system and decrease GI function

Aganglionic = Hirschsprung’s disease

Selye → developed LAS and GAS (general adaptation syndrome)

he described the bodies reaction to chronic stress in stages

Selye: Alarm

perception of chronic stress

Thymicolymphatic, lymph involution, decreased WBC, increased eosinophils, increased ACTH, increased cortisol

Selye: resistance

depends on heredity, nutrition, sleep, sodium, corticoids

Selye: exhaustion

diseases of adaptation (kidney, RA, thyroid, ulcer, etc)

Perceived chronic stress causes

neuroendocrine response (often pituitary) this suppresses the thymicolymphatic system and reduces the resistance of the body (decreased immunity)

The neurodystrophic theory

uses much of selye’s work. sympathetic nervous system immunity

it is the link: CNS → Sympathetics → immunity

Sympathetic cell column travels close to

anterior aspect of disc, body and costovertebral joints

can be effected structurally by: AS, severe osteoporosis, diaphragm. psoas major

stress effects cortisol examples include: selye, PTSD, fibromyalgia

Acute stress =

increased immunity

Chronic stress

decreased immunity

Sympathetic chain can be directly compressed by

anterior thoracic body osteophytes

Upper cervical subluxation can effect upper cervical ganglion because the ganglion is the

largest near the C2 TP and vertebral artery

Cervicogenic headache

Cervical headache subluxation usually located at C0-C1 (general population C2-C3)

Headache due to convergence projection

signs and symptoms of most headaches: hypomobility, trigger points, and decreased ROM

Cervicogenic dorsalgia

neck problem causes pain between shoulder blades

structural causes usually indicate nociceptive referral from disc and dura

Horner’s syndrome can cause

blurring of vision

vertigo has multiple causes including

neuro, vascular, physical

Brain hibernation (aka ischemic periumbra)

decreased blood flow and decreased function

cells alive, but function ceased, if circulation restored, cells can be reactivated

Can be milk like giddy, nervousness, headache, tantrum, etc. adjustments can help

Adjustment can increase CSF flow

Disc (derangement)

30-50 y/o, reoccurrence frequency, long recovery, surgery rarely helps

contra: cauda equina syndrome

Treatment of disc

adjustment first 2 weeks, increased pain frequency, side posture, flexion-distraction, extension mobilization

corset, traction, ice, massage, electrical therapy

Exercises: flexion decreases pain 37%, extension decreases pain 33%

Autism

theories of brain growth disturbances (amoxicillin)

Alzheimer’s

neurotangles consisting of microtubule protein tau

seizures

decrease in GABA

Myasthenia gravis

auto antibodies attacking ACH receptors

Herpes virus

uses retrograde channels to get the neurosoma and hide (Dormant)

Local anesthetic blocks

action potentials by binding sodium channels

Potassium and sodium are electrolytes, so

edema and dehydration effect neural transmission

Catecholamines

dopamine can make norepinephrine, norepinephrine can make epinephrine

Cholinergic drugs affect

acetylcholine

Noradrenergic drugs affect

NE

Beta blockers affect

EPI Only

Equilibrium triad

Muscle: GTO and muscle spindle

Vestibular (inner ear)

visual system

Golgi tendon organ

TENSION

fatigue and rapid stretch

Muscle spindle

constant control, CNS communication

Anterior vertebral joint is for

weight bearing → body and disc 75% of weight

Posterior vertebral joint is for

movement → facet 25% of weight

Lateral bending stresses

intertransverse ligaments

L5 → can have

corpotransverse ligament (ilio-lumbar ligament) → checks rotation

The nerve roots most vulnerable in

lateral bending are lower cervical nerve roots and brachial plexus

Dura mater forms the

epineurium passes through IVF

transforaminal ligaments (TFL)

ligamentous band crossing IVF

can fill 1/3 of IVF → 1-4 transforaminal ligaments at each level

Biomechanical stress is disturbed most by

unilateral problems (unilateral sacralization)

Nuclear fibers resist

compression

annular fibers resist

torsion (outer 1/3 sensory and vasomotor) (inner 1/3 most sensitive)

Nuclear impression (notochordal remnant)

is from disc and alar plate (cupid’s bow AP xray)

Disc is made up of

nucleus, annulus and end plate (weakest with compression forces)

endplate is 1mm thicker in the medial region

Sinu vertebral (aka recurrent meningeal nerve) → segmental artery follows spinal nerve)

PLL, annular fibrosis, posterior joint flava, dura, veins, fat

Posterior rami

paraspinals, multifidi, fascia, S-I joint, posterior joint, supraspinous ligament

Muscles

create movement

Ligaments

restrict movement

joints

guide movement

Alar ligament

1.) checks rotation and lateral bending (check and dentate ligament)

2.) upper alar ligament restricts contralateral lateral bending (occiput- C2)

3.) lower alar ligament restricts ipsilateral rotation (C1-C2)

Apical ligament

top of dens (suspensory ligament)

Transverse ligament

checks flexion and extension, FLEXION compresses cord (portion of cruciate ligament)

located in groove posterior to the dens, synovium on either side

Flava ligament

most elastin (yellow ligament) most important ligament to absorb flexion forces

Cervical and thoracic: flava ligament

compressive myelopathy

Lumbars: flava ligament

radicular compression, causes radiculopathy

ALL

damaged in hyperextension

PLL

causes most disc damage (discopathy), thinnest at L5

Interspinous and nuchal

damaged in hyperflexion

rectus capitus major attaches to

meninges between C1 and C2

RCP minor attaches to meninges

between occiput and C1

Cervical curve

C2-T2

Thoracic curve

T2-T12 (Apex T7)

Lumbar curve

T12-L5 (Apex L3)

Co-C1

more flexion if chin is retracted

C1-C2

creates V shape ADI In flexion

Mid cervicals

most lateral bending

Lower cervicals

have “stair step” translation, most flexion-extension (C5-C6)

Upper cervical facets

35 degree angle

Lower cervical facets

60 degree angle

Upper throacics

most rotation

lower thoracics

most flexion/extension and lateral bending, most motion at T11-T12 (not true ribs)

L5-S1

most flexion-extension

L1-L2

second most flexion-extension

Rotation is very limited in the lumbars

primary purpose of lumbar facets is to reduce rotation

Hypomobility

restriction of motion (smith, langworthy, paxon)

Hypermobility

excessive motion, not life threatening

Instability

pathological state causing intolerable and dangerous signs and symptoms

non-manipulable (contraindication to adjustment)