SBC joint complex dysfunction

intervertebral subluxation exists with some frequency in the population

true

what is a common assertion to all chiropractic models about intervertebral subluxation

subluxation somehow alters the normal neurophysiological balances in a healthy individual

what are the things common to all subluxation concepts

kinesiologic dysfunction

neurophysiologic function

subluxation exerts a significant influence on the nervous system

what forms of kinesiologic dysfunction can be seen in all subluxation concepts

hypomobility

hypermobility

aberrant motion

what are fomrs of neurphysiologic dysfunction commmon to all subluxation concepts

deafferentation

nerve compression

altered axonoplasmic flow

what are local changes associated with subluxation

inflammatory

biochemical

what are the remote functions of subluxation

functional

pathological

what kind of mechanical treatments will mechanical lesions respond to

static

dynamic

what is joint complex dysfunction

type of subluxation

involves specific joint structures, muscles, ligaments, blood supply, and nerve supply

lesion that does get adjusted

how are clinical symptoms produced

dysfunction and pathoanatomy interacting

joint dysfunction= what?

loss of joint play movement that cant be produced with voluntary movement

hypomobility

what are consequences of joint dysfunction

joint can be painful when joint play lost

reflex effects can occur

imbalance in activity

what do imbalances in activity lead to

development of chain reactions of dysfunction

faulty movement pattern throughout locomotor system (

what are causes of joint dysfunction

trauma

immobilization

resolution of more serious pathology

disc degeneration

congenital anomalies

developmental factors

erosive arthritides

ligament instability

postural issues

what creates microtrauma

improper stabilization response to repetitive perturbation or asymmetrical loading from imbalance in activities of muscle that cross joint

what kind of trauma creates the most joint dysfunction

microtrauma

complete immobilization is not essential for connective tissue and joint degeneration to occur

true

what does stress deprivation lead to

degeneration

what can cause stress deprivation

underutilization/disuse

prolonged inactivity or bed rest

use of cervical collar or lumbosacral support

what are the biomechanical models of subluxation

spinal instability

spinal buckling

meniscoid entrapment

displaced disc fragment

muscle spasm

myofascial trigger point

periarticular connective tissue adhesions

what does poor adaptation to erect standing cause

prolonged maladapted posture or prolonged unchanging posture

what results due to the poor adaptation to erect standing

AHC

abnormal spinal postures while sitting without lumbar support

computer praying mantis posture

what direction of force can cause instability

acceleration-deceleration

what will be present on radiograph with instability

aberrant motion

post traumatic spondylosis 2-3 years post trauma

what are examples of arthritides that can cause instability

RA

AS

reiters syndrome

why can disc degeneration cause instability

structures are poorly vascularized

proteoglycan degradation in motion segments subjected to cyclic stress

what are triggering factors associated with subluxation/buckling

single overload events

prolonged static postures followed by incremental load

loading rate higher than 500 lbs/sec

what is intersegmental motion controlled by

appropriate joint stiffness

what is intersegmental motion proportional to

loads applied

what are intersegmental postures consistent with

intended tasks

what do joint and associated tissue loads remain below

injury threshold

what are bucking events precipitated by

factors associated with buckling

describe intersegmental motions during a buckling event

disproportionate than applied loads predict

what do the buckled configurations remain within

extremes of normal ROM

what are intersegmental postures inconsistent with

one or more intended tasks

what does postbuckling behavior resemble

prebuckling

what does one or more tasks do to tissue components in postbuckling behavior

stresses tissues near or past injury threshold

what do postbuckling behavior symptoms depend on

identity of tissue that surpasses injury threshold

what does resolving buckling behavior require

application of external force/moment int he form of appropriate movement/exercise or manipulation/adjustment

what is meniscoid entrapment

mechanical restriction

entrapment of intra-articular folds of synovial membrane within facet joints

what can meniscoid entrapment stimulate

nociceptors in the joint capsule

what can nocicpetor stimulation in the joint capsule produce

reflex muscle spasm

further restricted movement causing pain

if the meniscus is trapped on the left what will we observe

right antalgic lean

what are teh classic signs of segmental dysfunction

increased jt capsule tension

increased mechanoreceptor activity

increased nociception

decreased pain threshold

hypertonic paraspinal musculature

what can joint hypomobility in an entrapped joint meniscoid cause

capsular adhesions leading to obliteration of joint cavity

what can decreasing joint mobility lead to in an entrapped joint meniscoid

loss of bone minerals causing premature degradation

what did Giles conclude about chiro benefit

could be due to releasing entrapped synovial folds and stretching joints capsule

what will disc fragment displacement produce

mechanical restriction and muscle spasm via nociceptor stimulation

what is a displaced disc fragment

internal disc disruption

primary discogenic pain

what are IVJ and IVD well innervated by

nociceptors

what are nociceptors capable of generating

noxious impulses following injury that project to dorsal horn with relay to various interneurons

muscles often respond to nociception by developing sustained contraction is known as what

spasm

reflex spasm is only type of muscle dysfunction in which there is continuous electrical activity throughout entire muscle is known as

actual contraction

what are muscle spasms thought to be

protective mechanism

what are muscle spasms brought about by

barrages of nociceptive impulses of sufficient intensity to cause activation of alpha motor neurons in muscles

what can muscle spasms occur as a result of

intense nociception arising from any tissue

common with IVD degeneration

can a reflex spasm itself become the cause of pain

yes

describe some characteristics of a muscle spasm

can be cause of pain

self limiting condition (resolves spontaneously)

nociceptive impulse decrease, residual hypertonicity/inhibition remains

result from residual low-level nociception

why can a reflex spasm itself become the cause of pain

contraction can cause ischemia

what is meant by adaptive shortening

connective tissue elements of muscle are in continuously shortened states

muscles are shortened in resting states

describe adaptive shortening

muscle increased reactivity to central and peripheral stimuli

short muscle tend to dominate movement patterns

increased resistance to stretch

great overlap between muscles prone to tightness and those that tend to be hypertonic

describe muscle dysfunction

involved muscle originator of disturbance

origin can be in another muscle or joint

describe hypertonicity

increased resistance or reactivity or both

describe hypotonicity

decreased readiness for nervous system activation of this muscle

what is the primary cause of altered muscle tone

joint dysfunction

what is interneuron dysfunction

specific disruption occurs in interneuron network involved in interaction between mechanoreceptors and nociceptors and fusimotor system

if postural muscles become hypertonic (can also be weak) and/or phasic muscles become inhibited what is the result

postural syndromes

describe phasic muscle disturbances

inability to respond to stimuli in appropriate time/magnitude to adequately function

inhibited muscle may or may not be weak

describe postural muscle disturbances

increased reactivity to stimuli

possibly weak

inhibition of antagonist

what will hypertonic and inhibited muscles cause

alteration of pressure distribution over joints they cross

can interneuron dysfunction also produce joint dysfunction

yes

in the presence of interneuron dysfunction what will the resultant alteration of movement patterns cause in involved muscles

distort afferent picture CNS receives

disrupt centrally ordered motor programs

develop myofascial TrP

what are the effects of immobilization on periarticular tissues

degeneration of articular cartilage

alteration of glycosaminoglycans, hyaluronic acid, water content

contracture of joint capsule

ligamentous and articular adhesions

fibrosis from resolution of inflammation

are periarticular adhesions the likely cause of joint dysfunction in chronic situations

yes

fascial contracture

what joints can have adhesion formation

all synovial joints have ligaments and capsules that can cause restrictions in joint motion