脈沖槍(中英文)

1、脈沖治療儀TECHNIQUEImpulse Adjusting Technique脈沖調(diào)整技術(shù)A Chiropractic Analysis of the spine & pelvis that incorporates findings from:整脊療法結(jié)合下列的檢查對脊椎和骨盆進(jìn)行分析History (signs & symptoms, pattern recognition):Exam Findings: Orthopedic tests (tests that have high sensitivity & specificity)Joint alignmentJoint movem

2、ent (symmetry with opposite side)Pain over bonePain over soft tissueMuscle and nerve reaction to movement and pressure病史（體征和癥狀，模式識別）：檢查結(jié)果：骨科測試（具有較高的靈敏度和特異性的測試）關(guān)節(jié)對位對線關(guān)節(jié)運(yùn)動(dòng)（雙側(cè)對稱）骨疼痛軟組織疼痛肌肉和神經(jīng)對運(yùn)動(dòng)和壓力的反應(yīng)The Sacroiliac, Pubic, and Hip joints骶骨關(guān)節(jié)，恥骨，髖關(guān)節(jié)脈沖治療儀TECHNIQUE1. BilateralNachlas Test1.雙側(cè)Nachlas測試4. C

3、ompressionTests for Lower Ext.Involvement受累下肢的壓迫測試 3. Hip RotationTests髖關(guān)節(jié)旋轉(zhuǎn)測試2. UnilateralNachlas Test單側(cè)Nachlas測試5. CompressionTests for Supra-PelvicInvolvement受累盆骨上端的壓迫測試Presence of PainRange of MotionAsymmetryStrength存在疼痛運(yùn)動(dòng)范圍不對稱性強(qiáng)度5 Step Lumbo-Pelvic Analysis Flowchart5步腰腹骨盆分析流程圖Step 1: Bilateral

4、 Nachlas Test第1步：雙側(cè)Nachlas測試Step 2: Unilateral Nachlas Test第2步：單側(cè)Nachlas測試Step 3: Hip Rotation Tests第3步：髖關(guān)節(jié)旋轉(zhuǎn)測試Step 4: Lower Extremity Compression Tests第4步：下肢壓迫測試Step 5: Supra-Pelvic Compression Test第5步：盆腔上端壓迫測試Bilateral Nachlas Test雙側(cè)Nachlas測試Positive陽性Negative陰性Unilateral PainBelow Waist腰部以下單側(cè)疼痛SI

5、 JointInvolvementSI關(guān)節(jié)受累Unilateral PainAbove Waist腰部以上單側(cè)疼痛LumbarInvolvement腰椎受累CentralLow Back Pain中間腰背疼痛Lumbo-SacralInvolvement腰骶受累Proceed to Unilateral Nachlas Test開始單側(cè)Nachlas測試Flowchart for Step 1第1步流程圖Test and AdjustInvolved SIJ測試和調(diào)整受累的SIJTest and AdjustInvolved Lumbar測試和調(diào)整受累的腰椎Test and Lumbo-Sac

6、ral Joint(Dual Styluses)測試和調(diào)整腰骶關(guān)節(jié)(雙針)Neuromechanical Innovations Slides TestStep 1: Bilateral Nachlas Test第1步：雙側(cè)Nachlas測試Step 1: Bilateral Nachlas Test第1步：雙側(cè)Nachlas測試Clinical Considerations: 臨床注意事項(xiàng)：Ask, “Does this cause any pain anywhere?”Do both legs flex the same?Is one leg heavier than the other?

7、How does the pelvis move during the test?問診“這會(huì)引起任何部位的疼痛嗎？”兩條腿屈曲程度相同嗎？一條腿比另一條腿重嗎？檢查過程中盆骨如何移動(dòng)？Unilateral Nachlas Test單側(cè)Nachlas測試Positive陽性Negative陰性Unilateral PainBelow Waist腰部以下單側(cè)疼痛SI JointInvolvementSI關(guān)節(jié)受累Unilateral PainAbove Waist腰部以上單側(cè)疼痛LumbarInvolvement腰椎受累CentralLow Back Pain腰背部中間疼痛Lumbo-SacralI

8、nvolvement腰骶受累Proceed toHip Rotation Tests開始髖關(guān)節(jié)旋轉(zhuǎn)測試Flowchart for Step 2第2步流程圖Test and AdjustInvolved SIJ測試和調(diào)整受累的SIJTest and AdjustInvolved Lumbar測試和調(diào)整受累的腰椎Test and Lumbo-Sacral Joint(Dual Styluses)測試腰骶關(guān)節(jié)(雙針)Step 2: Unilateral Nachlas Test第2步：單側(cè)Nachlas測試Begin with side of involvement (symptomatic sid

9、e first);Reproduction of symptoms unilaterally confirms SI joint involvementTest both sides with Unilateral Nachlas Test從受累側(cè)開始(先測試有癥狀側(cè))單側(cè)癥狀再現(xiàn)證實(shí)SI關(guān)節(jié)侵犯用單側(cè)Nachlas測試法檢查兩側(cè)Step 2: Unilateral Nachlas Test第2步：單側(cè)Nachlas測試Flowchart for Step 2第2步流程圖Unilateral Nachlas Test單側(cè)Nachlas測試Positive陽性Negative陰性Unilater

10、al PainBelow Waist腰部以下單側(cè)疼痛SI JointInvolvement骶髂關(guān)節(jié)受累Unilateral PainAbove Waist腰部以上單側(cè)疼痛LumbarInvolvement腰椎受累CentralLow Back Pain腰背部中間疼痛Lumbo-SacralInvolvement腰骶受累Proceed toHip Rotation Tests開始髖關(guān)節(jié)旋轉(zhuǎn)測試Test and AdjustInvolved SIJ測試和調(diào)整受累的SIJTest and AdjustInvolved Lumbar測試和調(diào)整受累的腰椎Test and Lumbo-Sacral Joi

11、nt(Dual Styluses)測試腰骶關(guān)節(jié)(雙針)Unilateral Nachlas Test單側(cè)Nachlas測試Positive陽性Unilateral PainBelow Waist腰部以下單側(cè)疼痛SI JointInvolvementSI關(guān)節(jié)受累Test and AdjustInvolved SIJ測試和調(diào)整受累的SIJConfirm with SI Joint Compression Test通過SI關(guān)節(jié)壓迫測試確認(rèn)Literature review of tests to diagnose a SI lesion:用測試去診斷SI病變的相關(guān)文獻(xiàn)綜述：Binkley, et a

12、l, “Diagnostic classification of patients with low back pain: report on a survey of physical therapy experts,” Physical Therapy, 1993:73Symmetry Tests: 對稱性測試：poor reliability and validity. 信度和效度差Pain Provocation Tests: 疼痛激發(fā)測試：evidence supports the validity of some pain provocation tests.證據(jù)支持某些疼痛激發(fā)測試

13、的效度。Prone Hip Extension Test俯臥伸髖測試“Sacral Cup,” Dr. Major DeJarnette, (The American Chiropractor, May 2007)“Prone hip extension test” (aka, “sacral cup test”) “俯臥伸髖測試”（又名“骶杯測試”）Tests the strength of the muscles crossing the posterior aspect of the SI joint.測試橫跨SI關(guān)節(jié)后端的肌肉力量。SI sprain reduces patients

14、ability to extend the hip.SI扭傷降低患者的伸髖能力。SI joint horizontal sectionSI關(guān)節(jié) - 水平橫切位SI capsule contains a dense plexus of unmyelinated nerve fibers indicative of a nociceptive receptor system. SI關(guān)節(jié)囊含有密集的無髓鞘神經(jīng)纖維叢，提示痛覺受體系統(tǒng)。Wyke, “Receptor systems in lumbosacral tissues in relation to the productionof low b

15、ack pain,” American Academy of Orthopaedic Surgeons Symposium onIdiopathic Low Back Pain, Mosby, 1982Location of SI adjustmentSI調(diào)整部位Sacroiliac Adjustment骶髂調(diào)整Sacroiliac Joint Adjustment骶髂關(guān)節(jié)調(diào)整 SCP: Sacroiliac joint, medial aspect of PSIS LOD: Anterior-Superior Setting: High or Medium SCP：骶髂關(guān)節(jié)，PSIS內(nèi)側(cè) L

16、OD：前-上 設(shè)置：高或中 Impulse iQ Adjusting Instrument Audible Indicators & Clinical Decision Making脈沖IQ調(diào)整儀器的發(fā)聲指標(biāo)及臨床決策Significant Improvement in at Least 2 Components of PART Documentation inRe-Assessment of Clinical Indicators在臨床指標(biāo)再評估中，PART文件中至少有2部分有明顯改善AccelerationResponseMaximized加速反應(yīng)最大化Single Beep單聲Yes是N

17、o否Re-Assess Clinical Indicators重新評估臨床指標(biāo)Adjustment of Level orArea Successful水平或位置調(diào)整成功Adjustment of Level orArea Not Successful水平或位置調(diào)整不成功Significant Improvement in at Least 2Components of PART Documentation inRe-Assessment of Clinical Indicators在臨床指標(biāo)再評估中，PART文件中至少有2部分有明顯改善36 ThrustsAccelerationRespon

18、se Not YetMaximized36次推力后加速反應(yīng)尚未達(dá)到最大化Double Beep雙聲Yes是No否Re-Assess Clinical Indicators臨床指標(biāo)再評估Adjustment of Level orArea Successful水平或位置調(diào)整成功Adjustment of Level orArea Not Successful水平或位置調(diào)整不成功 Insure Contact was Correct with Consistent Preload Throughout Adjustment在進(jìn)行調(diào)整過程中確保接觸正確和加壓穩(wěn)定 Impulse iQ Adjusti

19、ng Instrument Audible Indicators & Clinical Decision Making脈沖IQ調(diào)整儀器的發(fā)聲指示及臨床決策Significant Improvement in at Least 2Components of PART Documentation inRe-Assessment of Clinical Indicators在臨床指標(biāo)再評估中，PART文件中至少有2部分有明顯改善No SignificantImprovementin AccelerationResponse加速反應(yīng)無顯著改善No Beep無聲Yes是No否Re-Assess Clin

20、ical Indicators重新評估臨床指標(biāo)Adjustment of Level orArea Successful水平或位置調(diào)整成功Adjustment of Level orArea Not Successful水平或位置調(diào)整不成功 Insure Segmental Contact Point was Correct Insure Line of Drive Was Correct Consider that Area May Not Change保證節(jié)段接觸點(diǎn)正確確保方向正確考慮位置可能不變 Impulse iQ Adjusting Instrument Audible Indica

21、tors & Clinical Decision Making脈沖IQ調(diào)整儀器的發(fā)聲指示及臨床決策“Interactions between the vestibular and proprioceptive inputs triggering and modulating human balance-correcting responses differ across muscles,” Allum & Honnegger, Experimental Brain 前庭和本體沖動(dòng)之間的互動(dòng)，透過肌肉誘發(fā)和調(diào)整人的平衡-糾正反射的不同Research, 1998:121Unilaterally

22、reduced or altered hip or SI motion produces rotation of the trunk.單側(cè)髖或骶髂關(guān)節(jié)活動(dòng)減少或改變而引起軀干旋轉(zhuǎn)。This excites lumbar joint receptors triggering muscular contractions (primarily the QL) to counter the rotary forces and provide stability.這刺激腰椎關(guān)節(jié)受體，引發(fā)肌肉收縮（主要是腰方肌QL）抵抗旋轉(zhuǎn)力，并提供穩(wěn)定?！癉ifferences in lumbopelvic motio

23、n between people with and people without low back pain during two lower limb movement test,” Scholtes, et al, Clinical Biomechanics, 2008:24腰背痛和無腰背痛的人在下肢活動(dòng)測試時(shí)的不同的腰骨盆運(yùn)動(dòng)“During (prone) knee flexion and hip lateral (external) rotation, people with low back pain demonstrated a greater maximal lumbopelvi

24、c rotation angle and earlier lumbopelvic rotation, compared to people without low back pain.”“在（俯臥）膝關(guān)節(jié)屈伸和髖關(guān)節(jié)外側(cè)（向外）旋轉(zhuǎn)期間，腰痛者與無腰疼者相比，最大腰盆旋轉(zhuǎn)角度更大，且腰盆旋轉(zhuǎn)更早。”In patients without low back pain but with “positive abnormal spine patterns:對于無腰痛但有“脊椎異常模式陽性的人中：the mean onset times for the hamstring, ipsilateral e

25、rector spinae, and contralateral erector spinae muscles were prior to the onset of leg movement during prone extension.在俯臥伸展期間，腘繩肌、同側(cè)豎脊肌和對側(cè)豎脊肌肌肉的平均啟動(dòng)時(shí)間在腿部運(yùn)動(dòng)啟動(dòng)之前。the mean onset time for the gluteus maximus occurred after (inhibited) the onset of leg movement.臀大肌的平均啟動(dòng)時(shí)間在腿部運(yùn)動(dòng)開始之后（被抑制）?！癆n investigation

26、 into motor pattern differences used during prone hip extension between subjects with and without low back pain,” Bruno, Bagust, Clinical Chiropractic, 2007:10腰痛病人和無腰痛者在俯臥位髖伸展的運(yùn)動(dòng)模式之間的不同PI-EXAS-INPSAIPubic Symphysis Dysfunction恥骨聯(lián)合功能障礙Adjust up on the AS ilim side,Down on the PI ilium side.AS髂骨端向上，PI

27、髂骨端向下調(diào)整Flowchart for Step 3第3步流程圖Hip Rotation Tests髖關(guān)節(jié)旋轉(zhuǎn)測試InternalRotation內(nèi)旋ExternalRotation外旋Positive陽性Negative陰性Positive陽性Negative陰性AdjustPosteriorTrochanter調(diào)整后方轉(zhuǎn)子Proceed toLower Ext.Compression Tests繼續(xù)下肢壓迫測試AdjustAnteriorTrochanter調(diào)整前方轉(zhuǎn)子Proceed toLower Ext.Compression Tests繼續(xù)下肢壓迫測試HyperactiveInte

28、rnal Rotators內(nèi)旋肌過度活躍HyperactiveExternal Rotators外旋肌過度活躍Normal: 35-40 degrees正常：35-40度Normal: 50-60 degrees正常：50-60度Step 3: Hip Rotation Test第3步：髖關(guān)節(jié)旋轉(zhuǎn)測試Internal Rotation of the Right Hip右髖關(guān)節(jié)內(nèi)旋External Rotation of the Right Hip右髖關(guān)節(jié)外旋Step 3: Hip Rotation Test第3步：髖關(guān)節(jié)旋轉(zhuǎn)測試Internal Rotation of the Left Hip

29、左髖關(guān)節(jié)內(nèi)旋External Rotation of the Left Hip左髖關(guān)節(jié)外旋Step 3第3步Hip Rotation Tests髖關(guān)節(jié)旋轉(zhuǎn)測試InternalRotation內(nèi)旋Positive陽性AdjustPosteriorTrochanter調(diào)整后方轉(zhuǎn)子Hyperactive or InhibitedExternal Rotators外旋肌過度活躍或受抑制Internal rotation of right hip:右髖關(guān)節(jié)內(nèi)旋35-40 degrees35-40度Posterior Hip Adjustment后方髖關(guān)節(jié)調(diào)整 SCP: Posterior aspect

30、of the greater trochanter SCP:大轉(zhuǎn)子的后面 LOD: Anterior LOD: 前 Setting: High or Medium 設(shè)置：高或中Posterior Hip Adjustment(For Loss of Hip Internal Rotation)后方髖關(guān)節(jié)調(diào)整（髖關(guān)節(jié)內(nèi)旋受損）External Rotators外旋肌Muscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & WilkinsFlowchart for

31、Step 3第3步流程圖Hip RotationTests髖關(guān)節(jié)旋轉(zhuǎn)測試InternalRotation內(nèi)旋ExternalRotation外旋Positive陽性Negative陰性Positive陽性Negative陰性AdjustPosteriorTrochanter調(diào)整后方轉(zhuǎn)子Proceed toLower Ext.Compression Tests繼續(xù)下肢壓迫測試AdjustAnteriorTrochanter調(diào)整前方轉(zhuǎn)子Proceed toLower Ext.Compression Tests繼續(xù)下肢壓迫測試Hyperactive or InhibitedInternal Rota

32、tors內(nèi)旋肌過度活躍或受抑制Hyperactive or InhibitedExternal Rotators外旋肌過度活躍或受抑制 Step 3第3步Hip RotationTests髖關(guān)節(jié)旋轉(zhuǎn)測試ExternalRotation外旋Positive陽性AdjustAnteriorTrochanter調(diào)整前方轉(zhuǎn)子Hyperactive or InhibitedInternal Rotators 內(nèi)旋肌過度活躍或受抑制External rotation of right hip:右髖關(guān)節(jié)外旋50-60 degrees50-60度Anterior Hip Adjustment 前端髖關(guān)節(jié)調(diào)整

33、SCP: Anterior aspect of the greater trochanter SCP:大轉(zhuǎn)子的前面 LOD: Posterior LOD: 后 Setting: High or Medium 設(shè)置：高或中Anterior Hip Adjustment(For Loss of Hip External Rotation)前端髖關(guān)節(jié)調(diào)整（髖關(guān)節(jié)外旋受損）Hip Internal Rotators: TFL髖關(guān)節(jié)內(nèi)旋?。篢FLMuscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippin

34、cott Williams & WilkinsHip Internal Rotators髖關(guān)節(jié)內(nèi)旋肌Muscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & WilkinsUnilateral Hip Rotation Range of Motion Asymmetry in Patients With Sacroiliac Joint Regional Pain有骶髂關(guān)節(jié)局部疼痛的病人單側(cè)髖關(guān)節(jié)旋轉(zhuǎn)范圍不對稱Cibulka et al. Spine: Volu

35、me 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 the posterior innominate.有證據(jù)顯示骶髂關(guān)節(jié)功能失調(diào)的腰背痛病人，會(huì)有明顯的單側(cè)髖關(guān)節(jié)內(nèi)旋受限，特別是在髂脊后旋的一側(cè)。From the *Jefferson County Rehabilitation and Sports

36、Clinic, Crystal City, Missouri, the Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, the Jefferson County Rehabilitation and Sports Clinic, Crystal City, Missouri, and the Department of Physical Therapy, School of Health and Rehabilitation Sciences, Univers

37、ity of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.來自*密蘇里州水晶城杰斐遜縣康復(fù)和體育診所；密蘇里州圣路易斯華盛頓大學(xué)醫(yī)學(xué)院物理治療課題組；密蘇里州水晶城杰斐遜縣康復(fù)和體育診所；賓夕法尼亞州匹茲堡大學(xué)醫(yī)學(xué)中心衛(wèi)生和康復(fù)治療科學(xué)學(xué)院物理治療系?！癟he Hip Joint: Myofascial and Joint Patterns,” Marc Heller, DC, Dynamic 髖關(guān)節(jié)：肌筋膜和關(guān)節(jié)模式Chiropractic, May 7, 2007:“The hip joint is an absolutely c

38、ritical component of both lower back and lower extremity problems.”“髖關(guān)節(jié)絕對是引起下腰部和下肢問題的關(guān)鍵部位?！盜nternal rotation is the first motion affected with hip capsular problems and DJD.內(nèi)旋是髖關(guān)節(jié)囊問題和關(guān)節(jié)退行性病變影響的第一個(gè)動(dòng)作?！癢hen you find a severe lack of internal rotation in the hip and this motion cannot be restored, the

39、patient is usually on their way to hip replacement surgery.”“當(dāng)您發(fā)現(xiàn)髖關(guān)節(jié)內(nèi)旋嚴(yán)重受限且該動(dòng)作無法恢復(fù)時(shí)，該患者通常要接受髖關(guān)節(jié)置換手術(shù)。”“The Hip Joint: Myofascial and Joint Patterns,” Marc Heller, DC, Dynamic Chiropractic, May 7, 2007:Flowchart for Step 4第4步流程圖Lower ExtremityCompressionTests下肢壓迫測試LateralHamstrings外側(cè)腘繩肌Peroneals腓骨肌Pos

40、itive陽性Negative陰性Positive陽性Negative陰性ImpulseLateralHamstrings沖擊外側(cè)腘繩肌ImpulsePeroneals沖擊腓骨肌Proceed toSupra-pelvicCompression Tests繼續(xù)盆骨上方壓迫測試HyperactiveMuscles肌肉過度活躍HyperactiveMuscles肌肉過度活躍Step 4第4步Lower ExtremityCompressionTests下肢壓迫測試LateralHamstrings外側(cè)腘繩肌Positive陽性ImpulseLateralHamstrings沖擊外側(cè)腘繩肌Hyper

41、activeMuscles肌肉過度活躍Positive Findings:MyospasmTendernessTrigger PointsGuarding陽性結(jié)果：肌痙攣柔軟壓痛觸點(diǎn)保護(hù)Lateral Hamstring (Biceps Femoris m.)外側(cè)腘繩?。ü啥^肌 股?。㎝uscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & WilkinsStep 4. Lower Extremity Compression Tests(for Lateral

42、 Hamstring and Peroneal m. involvement)第4步下肢壓迫測試（外側(cè)腘繩肌肉和腓骨肌受累）Lateral Hamstring Compression Test外側(cè)腘繩肌肉壓迫測試Peroneal Compression Test腓骨肌壓迫測試Lateral Hamstring Adjustment外側(cè)腘繩肌調(diào)整 SCP: Taught/Tender area of muscle belly of Biceps Femoris m SCP:股二頭肌肌腹的敏感壓痛處 LOD: Anterior LOD: 前 Setting: Medium or Low 設(shè)置：中或

43、低Lateral Hamstring Adjustment側(cè)面腘繩肌調(diào)整Step 4第4步Lower ExtremityCompressionTests下肢壓迫測試Peroneals腓骨肌Positive陽性ImpulsePeroneals沖擊腓骨肌HyperactiveMuscles肌肉過度活躍Peroneal m.腓骨肌Muscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & WilkinsStep 4. Lower Extremity Compressio

44、n Tests(for Lateral Hamstring and Peroneal m. involvement)第4步下肢壓迫測試（涉及側(cè)面大腿肌肉和腓骨?。㎜ateral Hamstring Compression Test外側(cè)腘繩肌壓迫測試Peroneal Compression Test腓骨肌壓迫測試Peroneal m. Adjustment腓骨肌調(diào)整SCP:Taught/Tender area of muscle belly of Peroneal m. SCP:腓骨肌肌腹的敏感壓痛處LOD:Anterior LOD:前Setting: Medium or Low 設(shè)置：中或低P

45、eroneal m. Adjustment腓骨肌調(diào)整Flowchart for Step 5第5步流程圖Supra-pelvicCompressionTests盆骨上方壓迫測試LeftQuadratusLumborum左腰方肌RightQuadratusLumborum右腰方肌Positive陽性Negative陰性Positive陽性Negative陰性Impulse theQuadratusLumborum沖擊腰方肌Proceed toLumbarAnalysis繼續(xù)腰椎分析Impulse theQuadratus Lumborum沖擊腰方肌Proceed toLumbarAnalysis

46、繼續(xù)腰椎分析HyperactiveQuadratus腰方肌過度活躍HyperactiveQuadratus腰方肌過度活躍Step 5第5步Supra-pelvicCompressionTests盆骨上方壓迫測試QuadratusLumborum腰方肌Positive陽性Impulse theQuadratusLumborum刺激腰方肌HyperactiveQuadratus腰方肌過度活躍Positive Findings:MyospasmTendernessTrigger PointsGuarding陽性結(jié)果：肌痙攣壓痛觸點(diǎn)保護(hù)Step 5. Supra-Pelvic Compression

47、Tests(for Quadratus Lumborum m. involvement)第5步 盆腔上方壓迫測試（腰方肌受累）Step 5. Supra-Pelvic Compression Tests(for Quadratus Lumborum m. involvement)第5步 盆腔上方壓迫測試（腰方肌受累）Quadratus Lumborum m. Adjustment腰方肌調(diào)整 SCP: Taught/Tender area of muscle belly of Quadratus Lumborum m. SCP：腰方肌肌腹的敏感痛處 LOD: Anterior LOD：前 Set

48、ting: Medium or Low 設(shè)置：中或低Quadratus Lumborum m. Adjustment腰方肌調(diào)整 Summary of tests to identify the dysfunctional SI joint (PI Ilium):確定功能失調(diào)性SI關(guān)節(jié)（PI髂骨）的測試摘要： 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 compre

49、ssion or digital palpation4. Reduced prone hip extension on fixated side5. Asymmetrically reduced hip rotation on fixated SI joint side6. Hypertonic (with trigger points) lateral hamstring on fixated side7. Hypertonic QL on fixated side1. 雙側(cè)Nachlas測試法檢查SI、臀部、大腿疼痛2. 陽性Nachlas測試（固定的SI關(guān)節(jié)）3. 采用壓迫或手指觸診檢查

50、固定的SI疼痛4. 減少固定端的側(cè)俯臥伸髖5. 不對稱性減少固定的SI關(guān)節(jié)端的髖關(guān)節(jié)旋轉(zhuǎn)6. 固定側(cè)外側(cè)腘繩肌張力升高（觸點(diǎn)）7. 固定側(cè)腰方肌張力升高Cervical Spine頸椎脈沖調(diào)整TECHNIQUECervical Zygapophyseal Joint Pain Referral Patterns頸椎椎骨關(guān)節(jié)突關(guān)節(jié)疼痛轉(zhuǎn)診模式Cervical Spine頸椎The articular facets of C3 through C7 are oriented at 45 degrees to the transverse plane & parallel to the fronta

51、l plane. C3-C7 的關(guān)節(jié)面與橫切面成45度，與額狀面平行。Kinematics of C3 through C7C3-C7的運(yùn)動(dòng)學(xué)(Management of Common Musculoskeletal Disorders, Hertling & Kessler, 1990, Lippincott)Rotation and lateral bending occur together to the same side (coupling).同側(cè)一起發(fā)生旋轉(zhuǎn)和側(cè)屈（耦合）?！癆s one articular facet joint slides forward and upward

52、, its mate slides backward and downward, translating to a sidebending component in the frontal plane and a rotatory component in the transverse plane.”“一個(gè)小關(guān)節(jié)突關(guān)節(jié)向前和向上滑動(dòng)，其配對體向后和向下滑動(dòng)，轉(zhuǎn)化成在額狀面的側(cè)彎和橫切面的旋轉(zhuǎn)”C3 & 4 right facets not gliding anterior and superior.C3和C4右面沒有前上滑動(dòng)Kinematics of Occiput-C1-C2枕部C1-C2的

53、運(yùn)動(dòng)學(xué)Occiput-C1: 13 degrees of flexion-extension 8 degrees of lateral bending 10 degrees of axial rotation 枕部- C1： 13度屈-伸 8度側(cè)彎 10度軸向旋轉(zhuǎn)C1-C2: 10 degrees of flexion-extension 0 degrees of lateral bending 65 degrees of axial rotation C1 - C2： 10度屈-伸 0度側(cè)彎 65度軸向旋轉(zhuǎn)Cervical Compression Test:脊椎壓迫測試：Cervical C

54、ompression Test:頸椎壓迫測試：“+” in the area of the C-spine that pain and/or restriction is felt:在頸椎部位感到疼痛和/或束縛感“+”號：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 normal occip

55、ital glide and C1-C2 movement.中-低段頸椎- 通常是前凸彎曲消失，不能活動(dòng)到前屈位，主要在C6 C3上段頸椎 - 通常枕下痙攣，干擾正常的枕滑行和C1 - C2運(yùn)動(dòng)。Also tells examiner of presence of radicular pain indicating possible space occupying lesion.還告訴檢查者存在根性疼痛，表明可能有占位性病變。Cervical compression test:頸椎壓迫測試：Patient reports pain in upper neck or skull begin wi

56、th C2 analysis. Turn head to right and then left.Adjust C2 on side of restriction, not side of pain.患者報(bào)告頸部或顱骨疼痛 - 開始C2分析。頭先轉(zhuǎn)向右側(cè)，然后向左。在束縛感的一側(cè)調(diào)整C2，不痛。Right Cervical Rotation Test (for C2):右頸旋轉(zhuǎn)測試（C2）：C2 adjustment (TP):C2調(diào)整（TP）：-SCP: C2 LPJ-LOD: Anterior-Superior-Setting: Low-Thrust(s): Single-SCP：C2 L

57、PJ-LOD：前上-設(shè)置：低-推力：單個(gè)Cervical Spine頸椎Occiput adjustment: (single stylus)枕部調(diào)整：（單針）C1 adjustment:C1調(diào)整：-SCP: C1 TP-LOD: Medial-Setting: Low-Thrust(s): Single-SCP：C1TP- LOD：內(nèi)側(cè)-設(shè)置：低-推力：單個(gè)-SCP: Occiput-LOD: Anterior-Superior-Setting: Low or Medium-Thrust(s): Single-Double stylus- SCP：枕部-LOD：前-上-設(shè)置：低或中-推力：單

58、個(gè)- 雙針-SCP: C2 Bilateral LPJ-LOD: Anterior-Superior-Setting: Medium or Low-Thrust(s): Single or Multiple-Double stylus-SCP：C2雙邊LPJ-LOD：前-上-設(shè)置：“中”或“低”-推力：單個(gè)或多重- 雙針I(yè)f cervical compression test produces pain in mid to lower cervical spine, proceed to lateral flexion test.Begin at C3 on side of restricti

59、on, not pain.如果頸椎壓迫試驗(yàn)造成中下段頸椎疼痛，則開始側(cè)屈試驗(yàn)。開始在C3束縛感側(cè)，不痛。Right Cervical lateral bending test for C3-C7:C3 - C7頸右側(cè)彎測試：Right C3-7 TP adjustment: 右側(cè)C3-7 TP調(diào)整：-SCP: Cervical LPJ-LOD: Anterior-Superior-Setting: Medium or Low-Thrust(s): Multiple-SCP：頸椎LPJ-LOD：前-上-設(shè)置：“中”或“低”-推力：多重Cervical Spine頸椎Cervical dual s

60、tylus adjustment to restore lordosis:頸椎雙針調(diào)整恢復(fù)前凸：-SCP: Cervical Bilateral LPJ-LOD: Anterior-Superior-Setting: Medium or Low-Thrust(s): Single or Multiple-SCP：頸部雙側(cè)LPJ-LOD：前-上-設(shè)置：“中”或“低”-推力：單個(gè)或多重Muscles that hinder Occiput -C7 correction:阻礙枕部- C7肌肉的矯正：ScalenesUpper TrapeziusLevator scapulaeSplenius cap