Introduction to Manual Medicine by Heinz-Dieter Neumann M. D. (auth.), Wolfgang G. Gilliar D.

By Heinz-Dieter Neumann M. D. (auth.), Wolfgang G. Gilliar D. O. (eds.)

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The next step is to palpate whether the inferior spinous process rotates further than the superior spinous process (Fig. 35). The Segmental Manual Medicine Examination 43 Fig. 35. Segmental rotation testing at the lumbar spine Fig. 36. Segmental sidebending (lateral bending) motion testing at the lumbar spine. (After Eder and Tilscher 1988) I I Fig. 37. Testing of the flexion movement in a lumbar spine segment. (From Lewit 1985) Fig. 38. Testing of the extension movement in a lumbar spine segment.

E. which of the motion directions, should be evaluated first. Greenman (1984) therefore recommends to start the examination by evaluating the flexion and extension components first. " Either one of these motion components can be restricted. Depending on whether the joint is restricted in extension or flexion, sidebending and rotation movements at that joint are affected as well, but in different directions. (It The Segmental Manual Medicine Examination 37 Fig. 25 a, b. ) If, say, flexion is restricted at the left facet joint, sidebending to the right and rotation to the right are also affected (decreased).

The neutral position is only a small portion within the range of movement in the sagittal plane. According to Fryette, the cervical spine is unable to assume a neutral position, as the joint surfaces are always subject to loading force stress along with continued tension at the joint capsules. Rule 2: When the spine is either flexed or extended and sidebending is introduced, the vertebrae will rotate towards the concavity, that is to the same side. Summarizing the first and second rules, one can make the following conclusions: In the cervical spine, from C2 to C7, sidebending and rotation always occur in the same direction, independent of the degree of flexion or extension.

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