Professional Documents
Culture Documents
Contents
ACC & Paradigms..................................................................................................................................................... 2
Study Guide Questions..................................................................................................................................... 4
Axonal Aberration/ Trophic Models............................................................................................................... 6
Questions............................................................................................................................................................... 7
References................................................................................................................................................................. 9
Questions............................................................................................................................................................ 11
Inflammation Theory......................................................................................................................................... 13
Multiple Choice Questions........................................................................................................................... 16
Immobilization degeneration/stability....................................................................................................... 18
Study Guide Questions.................................................................................................................................. 21
Instability Hypothesis........................................................................................................................................ 23
Myelopathy............................................................................................................................................................. 28
Multiple Choice Question............................................................................................................................. 30
Neuroimmune Hypothesis............................................................................................................................... 32
Study guide questions:.................................................................................................................................. 34
Neuropathology/Neural compression/traction models/LMNL.......................................................35
Multiple Choice Questions........................................................................................................................... 37
Proprioceptive Insult/Dysafferentation..................................................................................................... 39
Multiple choice questions:........................................................................................................................... 41
Segmental Dysfunction and Sympatheticotonia...................................................................................... 43
Study Guide Questions.................................................................................................................................. 49
Spinal buckling/Biomechanical Models:.................................................................................................... 51
Study Guide Questions.................................................................................................................................. 63
VSC 5 Faye Model................................................................................................................................................. 65
Possible Questions of VSC 5........................................................................................................................ 68
2 Science the Philosophy of the VSC Study
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Summary
As the ACC recognized the need for some level of consistency throughout
Chiropractic in order to have a more uniform appearance to the world, their paradigm was
proposed and adopted, providing a unity that hasn’t previously been reached. While the
uniqueness associated with the art of Chiropractic is a beautiful thing, moving forward and
growing our relations with other healthcare providers will be aided in the unity
“theoretical, educational, legislative, research, and clinical practice goals.” The ACC
paradigm shows it as foundational to work with other healthcare practitioners when that is
in the patient’s best interest and at its core states the purpose of Chiropractic is to optimize
the health of the patient.
The biopsychosocial model assumes health as the natural state for a human being.
Any departure from that health, regardless of its presentation (sickness, emotional distress,
etc.), will show an impact on the other areas and is a result of that individual’s inability to
adapt to life’s stressors.
Patient-centered paradigm goes further than recognizing the connectedness of the
body because it involves the care of the total person and also puts the patient in a position
of control of their care. Both involving them in the decisions around their care and
encouraging them to be consciously aware of their health rather than accepting the excuse
that life or bad health “happened to them.”
Chiropractic Relevance
This is relevant to chiropractic because, in the ACC paradigm, it is the responsibility
as a portal of entry doctor to know when and why to refer a patient out and co-manage with
other healthcare professionals. This is the way that our healthcare system is moving and it
is important that we move with it.
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Terminology
● Subluxation - an articular lesion less than a dislocation
● Subluxation syndrome - an aggregate of signs that relate to pathophysiology or
dysfunction of spinal and pelvic motion segments or to peripheral joints
● Manipulation - a manual procedure that involves a directed thrust to move a joint
past the physiological ROM without exceeding the anatomical limit
● Adjustment - any chiropractic therapeutic procedure that uses a controlled force,
leverage, direction, amplitude, and velocity directed at specific joints or anatomic
regions
2 Essay Questions
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● List the six (6) doctrines that form the principles and philosophy of traditional
chiropractic.
○ Vitalism, holism, naturalism, humanism, conservatism, and rationalism
● Describe three (3) of the characteristics of the patient-centered care
paradigm.
○ Recognition and facilitation of the Innate organization and adaptation of the
person
○ Recognition that care should ideally focus on the total person
○ Acknowledgment and respect for the patient’s values, beliefs, expectations,
and health care needs
○ Promotion of the patient’s health through a preference for drugless,
minimally invasive and conservative care
○ A proactive approach that encourages patients to take responsibility for their
health
○ The patient and patient-centered practitioner act as partners in decision
making, emphasizing clinically effective and economically appropriate care
based on various levels of evidence
References
Gatterman, M. I. (Ed.) (2005). Foundations of Chiropractic: Subluxation (2nd ed.) St. Louis:
Mosby.
Leach, Robert A., and Reed B. Phillips. The Chiropractic Theories: a Synopsis of Scientific
History:
The effects of trauma on the neural mechanism of AXT was first noted by Osteopathic
researchers in 1962. At the University of Colorado, chiropractic researchers have also done very
in-depth work in documenting and quantifying the effects of trauma on the neural mechanism of
AXT. There is no primary proponent for AXT (Leach, 2004).
Summary:
Evidence has recently suggests that AXT may be significant not only in development and
maturation of the nervous system but in sensory signaling and modulation of inflammatory
processes as well. There are fast and slow AXT fibers, these fibers travel in opposite directions
on the nerve fiber. AXT can also be termed as neuroplasmic transport. The axoplasmic aberration
hypothesis appears to be valid, in that when spinal nerves or roots are compressed or irritated by
intervertebral subluxation or segmental facilitation, AXT could be changed with substantial
consequences (Leach, 2004).
Chiropractic Relevance:
Research has provided evidence that pressure of even 50 mm/Hg on the vagus nerve for
2 hours could cause altered sensory fast AXT input. These studies presented that the pressure
needed to alter the anterograde nerve flow vary depending on the diameter of the nerve and the
extent of time it was compressed; the longer a nerve was compressed the longer it took to return
to normal (Leach, 2004). Even a dysfunction in the ion gradients or local ischemia could “block”
the flow of the nerve. Thus, if there is pressure on a nerve due to a musculoskeletal cause,
chiropractors should have ability to locate and correct for this compression. Chiropractic can
help treat and prevent compression on nerves. It can also help the body function to its optimal
level so that the ion balance is ideal for that there is no impediment to FAXT.
Segmental Dysfunction
They differ in the way that they are impacted - Segmental dysfunction is produced by
fixation of a single motion segment and isn't causing compression on a nerve directly.
AXT is affected due to compression that doesn't permit for the maintenance and growth
of a single nerve.
Segmental dysfunction is like axonal aberration in that a single nerve root/nerve will be
affected, thus representing as a single nerve pathology.
Exams to differentiate them would be NVC for AXT and chiropractic evaluation for
segmental dysfunction.
Neuropathology
Similar signs or symptoms is that they both are affected by nerve compression
AXT is directly related to nerve compression so it won’t effect on nerve conductivity but
the effects of neuropathology decrease of conductivity.
Things that separate AXT from this theory is the words: anterograde/retrograde
movement or the patient stating that the pain “moves”
Patient Presentation:
Patient will present with unilateral radiating pain moving in different areas of the body,
thus not following a specific dermatome. It is possible to see both upper and lower motor neuron
signs in AXT.
Exam Findings:
While taking the patient’s history, they may describe the pain as “moving around”. Blood
work would show a higher number of trophic factors, such as nerve growth factor (NGF).
Special Tests:
NVC or EMG
Questions:
1. Which of the following chiropractic theories could be considered to explain why pain
“moves” from distal to proximal on a patient?
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A. Axonal Aberration
B. VSC 5 Model
C. Dural Torque
D. Proprioceptive insult
2. True or False: Axonal Aberration provides reasoning for the trophic needs to tissue.
3. Patient explains that their pain seems to be moving from their toes and up their leg. What
theory best represents this symptom?
A. Neuroplasmic Transport
B. Axoplasmic Aberration
C. Dural Torque
D. Somatosomatic Reflex
4. When a nerve is damaged or compressed, it undergoes a specific process that involves
Schwann cells recruiting macrophages to clear up the debris while also releasing growth
factors to create a favorable environment for nerve regrowth. What is the name of this
process?
A. Wallerian Degeneration
B. Proprioceptive Insult
C. Pruning
D. Neurotrophic Aberration
5. Both anterograde and retrograde AXT occurs. Which of the two involves a greater
number of constituents and is faster?
A. Retrograde
B. Anterograde
Answer Key
1. A
2. A
3. B
4. D
5. B
Essay Questions
1. Describe the five main points that Korr and other osteopathic investigators discovered
when it comes to axoplasmic aberration association with protein, muscles, and nerves.
Spikes and waves of axoplasmic transport can be observed, and each of four waves
carries different types of proteins. Transfer of proteins from nerve to muscles varies from
nerve-to-nerve transport. Transfer of proteins across the junction is selective. The neuron
supplies protein for muscles that is not found in the muscle. Thus, some proteins
synthesized in nerve are destined for muscle, others for nerves.
2. How does nerve compression play a significant role in aberrant AXT? FAXT block by
nerve compression is the possibility that local ischemia or changes in the ionic
environment dramatically alter the normal AXT mechanism. This is consistent with the
fact that alteration of the ionic balance within the neurons can block FAXT. It has also
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been shown that damaged nerves do not regain normal internodal spacing, which may be
associated with decreased nerve conduction velocities.
References
Leach, R. A. (2004). The Chiropractic Theories. Baltimore, Maryland: Lippincott Williams & Wilkins.
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Exam findings could be +orthos for myelopathy such as Lhermitte’s, and pathological reflex such as
Babinskis because it does affect the cord. Although not identical to myelopathy because it is affecting the
dura findings are similar. Paleness or turgor may be noted in the upper cervical region as well due to
ischemia. X ray findings could be lateral displacement of the atlas as well as canal stenosis. Since this is
not affecting the osseous structures other than bone alignment there most likely will not be visible x ray
findings related to Dural torque.
Questions:
C Dura D. subdermal
Which ligament could cause cord dysfunction?
A. Interspinal B. dentate
C sacrotuberous D. Alar
Which ways can the dentate ligament adversely influence the conduction of neural
impulses?
Greg Bell
Ronnie Chiasson
Colby Espenas
Abby Key
Daniel J. Perkins
Inflammation Theory
“Tissue and cellular responses to injury in the spine includes infiltration of histamine,
protein-derived factors, eicosanoids, proinflammatory cytokines, nitric oxide,
degradative enzymes, and substance P, and pre-stages development of spinal lesions.”
(Leach, 11t)
History
Summary
Inflammation is the body’s response to insult or injury. It is vital for the repair
process of tissue, but if uncontrolled can be more destructive than the original trauma
that triggered it (Leach, 131). Inflammation can be chronic or acute. Acute inflammation
is what we typically think of with an injury. The five signs are: rubor, calor, dolor, tumor,
and loss of function. These five cardinal signs are caused by the three phases of acute
inflammation. First the tissue level response associated with reddening and swelling as
capillaries increase permeability and cause pain and swelling in the affected area. Then
the cellular level response releases histamine granules and causes a contraction in the
endothelial cells lining the capillaries so leukocytes can travel through the capillary
walls. This is known as diapedesis or transmigration. It attracts macrophages by means
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of chemotaxis to clean up any bacteria or debris. Enzymes finally clear the area of
inflammatory stimulants during the biochemical response. If acute inflammation does
not resolve it can lead to the accumulation of leukocytes and macrophages and can
eventually lead to chronic systemic inflammation (Leach, 132). Management of the
inflammatory process is vital to proper recovery and we as chiropractors will be seeing it
on a daily basis.
Chiropractic Relevance
Explain the Physiological Attributes of the Chiropractic Theory (put N/A if not
relevant)
Compare and contrast the chiropractic theory with 2 other relevant theories.
Joint Immobilization or the lack of movement in a joint has been associated with
chronic inflammation. It was proposed by Skip Lantz that immobilization will lead to
localized venous stasis, thus creating a negative venous pressure that will eventually
lead to improper venous drainage and ensuing inflammation (Bergmann, 46).
Inflammation has its place amongst the other theories and is a component of nearly all
of them. Inflammation theory portrays inflammation as the primary component of the
dysfunctions rather than an assistant to an alternate primary
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Exam Findings
The exam findings for inflammation would be in line with the classic acute
presentation which would be noticeable swelling of the tissue caused by histamine,
bradykinin, and prostaglandins that causes blood vessels to leak fluid into the affected
tissue, at the location of the injury the skin will also be warm and painful to the touch
with noticeable skin redness. The only sign that continues from the acute phase to the
chronic phase is decrease in function of the affected joint and loss of mobility.
Laboratory findings for inflammation would be an increase in ESR, C-reactive protein,
interleukin-6, and white blood cell count.
Physical, Ortho, and Neuro:
Ortho - decreased ROM
Physical - pain, redness edema, heat, and bogginess
Imaging
Imaging that is appropriately used in the inflammation model is MRI and CT.
These images are best to visualize swelling in the tissue and structural changes that
could be occurring.
Exams
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When inflammation is occurring, one should always run blood work to determine
the cause. There are certain exams that should be performed. When someone has
inflammation, it could be due to diseases which could be determined with a CRP Blood
Test. ESR Blood Test could also be performed to determine inflammation. Both tests are
used to measure proteins in the blood.
Study Guide Questions with answer key for review purposes (if they are well
written questions, they could appear on the final).
2) Two days ago a patient fell down a small hillside while hiking and comes to your
office. While examining their back, you notice several scratches (most likely from
branches and rocks while the patient slid) the scratches are red and swollen. Who’s
theory would best fit?
a) Seyle
b) Lantz
c) D.D. Palmer
d) Gatterman-Goe
3) Which phase of the VSC model does the Inflammation Hypothesis by Skip Lantz fall
under?
a) Phase 2
b) Phase 1
c) Donald Trump’s twitter account
d) Phase 3
4) ____________ is/are often the first chemical mediator to affect the inflammatory
process.
a) Histamine
b) Leukocytes
c) Platelets
d) Prostaglandins
1. Using Lantz’s model, explain how rheumatoid arthritis can affect joint
alignment.
References:
Immobilization degeneration/stability
By: Cody Elenz, Shelby Franklin, Derek Hines, Kara Penson and Abigayle Welch
Definition: “Partial or total fixation, or immobilization of the spinal joints, especially when
combined with trauma, commonly promotes pro-inflammatory changes, cartilage and disc
destruction, and osteophytic bony and architectural changes” (Leach, 236).
Primary Proponent: Leach and Lantz
o Chiropractic relevance
o Why/how does this theory matter/apply to a practicing chiropractor and the profession?
- Movement is life
- Use it or lose it
- Adjustments help restore motion and prevent premature degeneration
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o Patient Education- Use simplified language to explain this theory in a manner anyone
could understand or relate to without having any sort of education past 7 th grade.
- When an old car sits for a long time, without any use, it becomes hard to start.
Things start to rust over and are no longer functional, making it harder for the car to
start. The same idea applies to your body.
o Explain the Physiological Attributes of the Chiropractic Theory (put N/A if not relevant)
o Neurologic Components / Systems
- Inflammation is induced by lack of mobility
o Compare and contrast the chiropractic theory with 2 other relevant theories.
- Proprioceptive Insult and SDF
o What special tests or imaging studies would differentiate them? Include findings on
these tests or imaging.
- X-Ray
- Immobilization: loss of joint spaces, degeneration of the spine, and
osteophytes
- PI: previous surgical scars, congenital anomalies
- SDF: looking for soft tissue changes and inflammation
o Are there any pathognomonic traits or characteristics that would differentiate them?
- Immobilization: chronic problem
- SDF: sympatheticonia and facilitation
- PI: previous surgery and congenital anomaly
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1) What two prominent Motion Palpation founding fathers first used the idea that
restricted motion is the key?
a) Langwothy and Paxson
b) Gillet and Smith
c) Schafer and Faye (found on the Immobilization Degeneration Hypothesis
Slide)
d) BJ and DD Palmer
2) What is the most important premise that prolonged immobilization lead to?
a) Reduced range of motion
b) Paraesthesia
c) Permanent Impairment (Found on the Immobilization Degeneration Slides)
d) Radiculopathy
3) Which phase in the Sandoz Model should you adjust on?
a) Articular overstress
b) Insufficiency & Instability
c) Episodic Fixations (Found on the Immobilization Degeneration Slides)
d) Stabilization
4) What class of structures is most known for demonstrating change following
immobilization?
a) Connective tissue (Found on the Immobilization Degeneration Slides)
b) Bones
c) Blood
d) Joints
5) What Phase does Immobilization Degeneration fall under in the VSC Model?
a) VSC 1
b) VSC 2
c) VSC 3 (Found on the Immobilization Degeneration Slides)
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d) VSC 4
Correct Answers:
1. C
2. C
3. C
4. A
5. C
Essay Questions
Explain why degeneration happens when a person undergoes surgery or fusion in their
spine?
In the presence of a surgical fusion the joint segments that typically took on motion
are now fused together. Well that new motion loss will be placed on the adjacent segments
above and below the fused vertebrae. The increase in motion in these adjacent joints will
make them hypermobile causing the body to want to turn them hypomobile which will lead
to degenerative changes.
References:
Leach, R. A. (2004). The chiropractic theories: A textbook of scientific research. Philadelphia,
PA: Lippincott Williams & Wilkins.
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Myelopathy
History:
Myelopathy is also known as Cord Compression or Compressive Myelopathy. Quoted by
Robert Leach, myelopathy “refers to destruction of spinal cord tissue typically caused by
pressure from neoplasms, hematomas, and other masses” (Leach, Pg 311). The primary
proponent of this theory was B.J. Palmer. His years of clinical research with the Hole in One
Technique (HIO) was the suggested method for myelopathy (Leach, pg 311).
Key Terms:
Myelopathy Torticollis Osteophytes
UMNL Fracture Ischemia associated with
Ligament laxity Dislocation Spondylosis
Cord compression Trauma Tumor
HIO Technique Transverse Ligament Headache
Downs Syndrome SIDS Numbness
Spastic Paralysis Sleep Apnea Tingling
Hyperreflexia Breech Deliveries Paresthesis
Pathological Reflexes Atlas Inversion Quadraplegia
Clonus Central Disc Herniation Transiet Paraplegia
Paresis Congenital Canal Stenosis
Chiropractic Relevance:
This theory applies to the practicing chiropractor because patient’s will present to your office
with signs and symptoms relating to myelopathy. It is then your job as a practicing physician to
be able to recognize the signs and symptoms in order to localize the lesion and provide the
patient with the most appropriate care.
Myelopathy can occur to patients of all varieties and is not restricted to a specific patient
population. What myelopathy is is when the is an problem with the the brain or spinal cord
causing the patients to experience symptoms and it is the job of their doctor to recognize these
symptoms and localize the area that the problem is stemming from.
Exam Findings:
Spastic Paralysis Hyperreflexia Pathological Reflexes
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Clonus Paresis
Increased ROM
Torticollis
Positive Valsalva
Positive Slumps Test
Positive Compression Test
Positive Distraction Test
Muscle Atrophy if Chronic
Muscle Weakness
30 Science the Philosophy of the VSC Study Guide Fall 18
References:
Leach, Robert A. The Chiropractic Theories: a Textbook of Scientific Research. Lippincott
Williams & Wilkins, 2004.
chaddock reflex. All lower extremity reflexes are 3+ and strength is ⅗. Which hypothesis
as discussed in class relates to our patient?
a. Neuroimmune
b. Proprioceptive Insult
c. Myelophathy
d. Viscerosomatic Reflex
2. When dealing with SIDS patients that have a cervical subluxation, most of the time they
have _______ atlas, causing myelopathy.
a. Inverted
b. Lateral
c. Posterior
d. Retroverted
3. Who is the primary proponent of the myelopathy theory?
a. DD Palmer
b. BJ Palmer
c. Skip Lantz
d. Hans Selye
4. What was the primary proponent of myelopathy responsible for creating?
a. Hole in One
b. Delivering the first adjustment
c. The Drop Table
d. The Activator
Essay Question:
1. If a patient presented with signs and symptoms of an upper motor neuron lesion name three
things that one may find on this patient’s imaging?
a. Osteophytes
b. Central Disc Herniation
c. Spinal Cord Tumor
2. What are the 2 names myelopathy may be referred to as?
a. Compressive Myelopathy
b. Cord Compression
32 Science the Philosophy of the VSC Study Guide Fall 18
Neuroimmune Hypothesis
Group Members:
Ryland Weum, Ralph Estevan Martinez, Jaylee Greanead, Asef Aghapour Maleki and
Melissa Perez
Theory Name:
Neuroimmune Hypothesis - AKA: Neuroimmunomodulation and Neurodystrophy
Theory Definition:
Spinal joint lesions may, through largely sympathetic mediated influences, modify
nonspecific and specific immune responses, and alter trophic function of the involved nerves.
History:
Hans Selye was a Canadian endocrinologist who first described the G.A.S. (General
Adaptation Syndrome) in 1936 and was initially laughed at. He was eventually able to separate the
physical effects of stress from other physical symptoms. General adaptation syndrome has three
stages: alarm, resistance and exhaustion.
G.A.S. 3 stages:
Alarm stage → First exposed to the stressor
Resistance stage → The body tries to fight back
o Results in:
Physiologic Adaptation Syndrome
Disease of Adaptation
Exhaustion/Adaptation stage → if the immune system fails, it results in disease of
adaptation
Summary:
Hans Selye was trying to determine whether or not a patient having a subluxation can
cause them to get sick, and vise-versa, adjusting a sick patient can increase their immune function.
Chiropractic relevance:
This theory is important because it could be the solution for a patient that comes in that
have not been feeling well, with a fever, or they have just been stressed out recently. This theory
suggests that a subluxation could be the cause for a patient's illness.
33 Science the Philosophy of the VSC Study Guide Fall 18
Patient presentation:
The patient will present complaining of being stressed out recently, not feeling well, having
a fever, and other signs and symptoms of being sick. No specific age or sex is indicated.
Exam findings:
Physical → patient will most likely present being sick, with possible fever.
Labs → Increased cortisol levels, increased IgG
Answer key:
1. A, C
2. C
3. A
Essay Questions:
1. List and describe the 3 stages of the General Adaptation Syndrome (G.A.S.) of the
neuroimmune hypothesis.
2. The neuroimmune hypothesis suggest that a subluxation might cause an illness such as:
fever, drowsiness, or other illnesses. How might a subluxation cause such issues?
3. How should the future research need to focus on the neuroimmune hypothesis regarding to
drive a preventive/curative treatment via chiropractic care?
References:
“Chapter 16.” The Chiropractic Theories: a Synopsis of Scientific Research, by Robert A. Leach
and Reed B. Phillips, Williams & Wilkins, 1986.
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Neuropathology/Neural compression/traction
models/LMNL
Jordan Hines, Jacob Wilson, Nathan Worden, Stephen Hamilton
Neuropathology
“Intervertebral subluxations may interfere with the normal transmission of nerve energy by
irritating or compressing spinal nerve roots.” (Leach Pg. 251)
History
The historical proponent of this theory was DD Palmer. The Theory has also been known
as the Neural Compression theory. This was a theory that was around however he placed
a new spin on it. He thought that there was an alteration of tonus. This would be a case of
too much or too little nerve function would lead to a disease state. He felt that this was
caused by a “bone out of place and lead to the development of the neuroimmune
hypothesis. The theory of the pinched nerve was investigated by many researches that
tried to discover the cause of the problem. People believed it was caused by
intervertebral subluxations or a disc herniation. This was a foundation theory for
chiropractic and many different people have investigated it over the last hundred years
but has been shown to be largely incorrect.
Summary: With the theory of Neuropathology, D.D. Palmer was trying to answer the
question of how a bone out of place or subluxation, effects a spinal nerve. D.D. Palmer
theorized that a bone out of place, due to accidents or poisons puts pressure on a spinal
nerve thereby increasing or decreasing its flow of nerve energy (Leach).
Bone out of place
Pressure on a nerve
Increased or decreased flow of energy
Lower motor neuron lesion
Nerve root compression
This theory can be related to a kink in a water hose. When you put a kink in a water hose
you stop the flow of water out of the hose. This is what theorized in neuropathology, when
a bone gets out of place it puts pressure on a nerve root thereby interrupting its flow of
energy.
environments. Subluxation adds to the stress response of the body, which diverts energy
away from the immune system, reproductive system, and gastrointestinal system; and re-
allocates that energy to the skeletal muscles, as well as the heart. Lack of motion could
also interfere with the neuronal information traveling down from the brain to the
autonomic nervous system, which controls bodily functions such as breathing, heart rate,
and the digestive processes.
Mild nerve compression, for a brief period, can cause demyelination of a nerve. It can
also cause edema, and/or hemorrhage in the endoneurial space of the dorsal root
ganglia. Edema can be more pronounced after a rapid onset of compression to the nerve.
Chronic nerve compression has been shown to cause edema. Transient severe nerve
compression has demonstrated proximal edema with fiber disarray; and Wallerian
degeneration distally down the nerve fiber. It has been shown that chronic severe nerve
compression will produce edema, and due to that, the nerve escapes the perineurium to
develop new pathways or will cause the nerve to remyelinate (Leach pg. 264).
The Neuropathology Hypothesis can be closely related to the Myelopathy Hypothesis and
Axoplasmic Transport Hypothesis.
Myelopathy Hypothesis:
These two theories are very similar in a couple ways. Both theories state
that altered nerve conduction is due to compression on a nerve. The compression will
likely exhibit unilateral LMNL’s signs and symptoms. There are a few differences between
the two theories. For AXT, there is compression at the nerve root, rootlet, or compression
anywhere along the nerve. The pain can also move along the path of the nerve, the
movement can be anterograde (forward) or retrograde (backward). Neuropathology has
compression only at the nerve root and the pain will not travel along the path of the
nerve. Clinically you may find that a patient with AXT will have certain neuro findings such
as hyporeflexia, decreased MSR’s, decreased muscle strength and may have decreased
sensory findings. Blood work can display a higher number of trophic factors which help in
aiding growth of nerves (NGF). At this moment there is no specific imaging that can help
diagnose AXT.
Clinical/Patient Presentation
Signs and Symptoms: sciatica, limitation of back mobility, depressed or absent ankle
reflexes, diminished or absent patellar reflexes, weakness or atrophy of certain muscles,
or paresis of the quadriceps and hamstrings (Leach pg. 256)
Patients History Indicators: MOI with rotation, compression, and/or torsional forces
2. A patient presents with pain that radiates down a dermatomal pattern. Which
model does this associate with?
A. Neuropathology
B. Neuroimmune
C. Segmental dysfunction
D. Myelopathy
C. Clonus
D. Hyporeflexia
Answers:
1. B
2. A
3. D
4. D
Essay Questions:
Discuss what one might expect to find in the acute cases of neuropathology.
In the acute case, one should expect irritation and hyperesthesia.
Proprioceptive Insult/Dysafferentation
Emily Dubrick, Chad Kirkpatrick, Chris Mata, Alexandria Miller, Stephany Uc
History:
Primary Proponent: N/A
Historical View: It is a subcomponent of the somatosomatic reflex model.
Any other relevant historical concepts or ideas: It can also be known as
“mechanoreceptor funk.”
Summary:
What question is/was the theory trying to answer/explain? It is trying to explain that
altered biomechanics results in altered proprioception
Key terms or concepts that go with this theory: post traumatic, post surgical,
congenital anomaly, such as congenital blocked-vertebra, hemi-vertebra, sacralization,
lumbarization, surgical fusions
Chiropractic relevance
Why/how does this theory matter/apply to a practicing chiropractor and the
profession? It allows them to see that it is a biomechanical aberration, where there is
sensory flood in the posterior horn affecting interneuron pools
Patient Education- Use simplified language to explain this theory in a manner
anyone could understand or relate to without having any sort of education past 7 th
grade.
If there is something in the body that normally wouldn't be there then the risk of body
awareness can decrease. This can stem from extra anatomy or fusions that you were born
with or from surgical interventions like hip replacement. The alteration from normal affects
the ability to maintain optimal stability and motion in the body. This sometimes is shown by
a clumsy nature or altered sensation to touch.
Explain the Physiological Attributes of the Chiropractic Theory (put N/A if not relevant)
Neurologic Components / Systems: Increased/abnormal input into the cord (posterior
horn) or brainstem (upper cervical spine) causing aberrant interpretation or processing of
proprioceptive information
Vascular Components (if applicable): N/A
Biomechanical / Anatomical Components: Altered biomechanics resulting in altered
proprioceptive input. This typically applies with post traumatic or post surgical
biomechanical aberrations. Congenital anomalies such as hemi-vertebra, congenital
fusion, etc., may predispose someone to this phenomenon.
Compare and contrast the chiropractic theory with 2 other relevant theories.
What are the similar signs or symptoms? Altered segmental positioning can be
present in both theories which leads to functional failure as well as altered sensory
input.
What are the different signs or symptoms? Proprioceptive insult results from a
congenital or surgical cause where spinal buckling results from prolonged static
posture/load. The history should indicate which theory applies.
What special tests or imaging studies would differentiate them? Include
findings on these tests or imaging. Both congenital anomalies and spinal
buckling may be seen on x-ray imaging. Congenital anomalies will be noticed as
variances in normal anatomy. Spinal buckling needs to be more severe to be
noticed on film. If it is not a severe change in position, palpation may be the only
indication of abnormal positioning.
Are there any pathognomonic traits or characteristics that would
differentiate them? With proprioceptive insult we are looking for a history of
surgery or a known congenital anomaly. If one of these is in the history and we
notice altered sensory input, we would attribute this to proprioceptive insult. In the
case of spinal buckling postural changes may be an immediate sign when
accompanied by functional failure (Hollandsworth).
Clinical / Patient Presentation:
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2. It appears that you have 6 lumbar vertebrae on a recent x-ray. What theory can this be?
a. Proprioceptive insult
b. Axoplasmic Transport
c. A&B
d. All of the above
4. A patient presents to your office with signs of altered sensory input. What would be important to
ask in the history for this patient to confirm that this is caused by what you assume is
proprioceptive insult? (MACA)
a. Have you been drinking enough water?
b. Have you been involved in any car accidents lately?
c. Have you had any recent surgeries?
d. Do you have any congenital anomalies that you are aware of?
Answers:
1. A, C, & D
2. A
3. B
4. C & D
Essay Questions:
42 Science the Philosophy of the VSC Study Guide Fall 18
1. Describe how you would take a history for a patient if you suspected that
proprioceptive insult was involved in their current presentation.
Ask if they have any congenital anomalies that they are aware of.
Ask for a full traumatic injury history.
Ask for a full surgical and hospitalization history.
Palpate and observe for any obvious signs of surgery or trauma such as scars or
altered skin pigmentation.
2. Describe the concept of proprioceptive insult as you would to a patient if you were
trying to help them understand the cause of their pain.
There is garbage in your nervous system that we need to remove so that your
body can function properly.
The surgery/trauma/anomaly you have is interfering with your body’s
communication system. Follow with an explanation of how your nervous system is
your bodies communicating system and how it is used to heal itself.
Your body is having a hard time sensing itself and its surroundings due to _____.
We are going to try and help your body heal itself to correct this through
chiropractic care.
Safety pin example.
REFERENCES:
Hollandsworth, Dr. Dana, D.C. Powerpoint on Proprioceptive Insult. Presentation from Parker
University, SPVSC, Fall 2018.
Leach, Robert A. The Chiropractic Theories: A Textbook of Scientific Research. LLW, pages
192-194.
Segmental Dysfunction
Segmental Dysfunction (SDF) or “segmental facilitation” is equated to abnormal or
irregular spinal function in the form of an “incomplete luxation” or “dislocation” that is
limited to a single motion segment where the contact between the joint surfaces becomes
altered. A single motion segment is consistent of both somatic and viscera, the intervertebral
disc, nerve which innervates and any connecting soft tissue. (Leach page 137 and Redwood
page 115)
“This term is often utilized by chiropractors to describe a spinal lesion as if fits within the
acceptance of Medicare guidelines within the United States.” (Hollandsworth SDF)
SDF = lack of ROM
VSC Phase 1
Early Research/Views
In 1940 a group of Osteopathic researchers used thirty young men to explain the
theory of “facilitation”. The research noted that when pressure even as small as 1Kg was
applied directly over the spinous process hyperexcitability could be observed in either one or
both sides of the erector spinae muscles. Furthermore, their research noted that even when
pressure was applied to distal segments spikes in excitability could be seen. Their research
determined that the areas had become “facilitated” therefore resulting in them having a
lower threshold to activity.
Neurobiological model
● Triad of signs of SDF
○ 1. Spinous tenderness/point tenderness to adjacent paraspinals
○ 2. Aberrant/ loss of normal motion
○ 3. Abnormal contraction of tension within adjacent paraspinal
Non-inflammatory
Korr: Fixation Theory-Pathway from start to finish 1. Hypomobility of motor unit 2.
Hypermobility above and below 3. Segmental facilitation excess sensory input into the cord
4. Posterior horn interneuron pools flooded 5. Lateral horn fires up 6. Sympatheticotonia
abnormal reflexes/sympathetic response.
▪ Sympatheticotonia
Inflammatory
45 Science the Philosophy of the VSC Study Guide Fall 18
Evans: The spine will seek optimal minimal energy configuration, if constraints are
removed
● Minimal energy Hypothesis
● Evans invented the PulStarFRAS
● Constraints preventing optimal minimal energy configuration.
o Joint fixation caused by inflammation in and about the
spine
o Muscle spasms
o Fibro-adipose tissue and scar tissue
o Ultimately degeneration
History
There are a multitude of studies regarding Hypertension, Thyroid related issue, along with
Vascular functions.
“Medical Physiologist Arthur C. Guyton in his studies became convinced that when it
came to Hypertension it was the result of excessive sympathetic activity, which resulted in a
renal weakness” (Leach)
Raynaud’s Syndrome is another example of Sympatheticotonia.
Sympatheticotonia summary
The theory of sympatheticotonia is a component of Korr’s SDF and Korr’s Fixation Theory.
Korr explained that there is a neurological component to Segmental dysfunction, and that
can be explained by the concept of segmental facilitation. Segmental Facilitation is a result of
the sympathetic system being overstressed. The Sympathetic nervous system is housed in
the thoracic spine T1-L2, and when the body is undergoing stress, muscle tightness/tension
fires up the sympathetics which can cause the thoracic spine to no longer function properly,
which will result in decrease ROM and malaise. The body can no longer handle the stress,
and the result is a sympathetic facilitated state. Individuals undergoing excess stress are
more likely to be affected by sympatheticotonia.
Chiropractic Relevance
This theory applies to the chiropractor in a segmental dysfunction way. If there is a
spinal lesion it could cause abnormal motion or no motion at all.Paxson, Langworthy and
Smith felt as though all subsets lead to segmental facilitation. There are many subsets within
SDF but there are two neurobiological models. The first is Non-inflammation where Korr
describes fixation model/sympatheticotonia and Patterson talks about spinal learning. The
second in inflammation where Dvorak focuses on postural muscle, Goe talks about trigger
points, Mense refers to trigger points. Also, Evans focuses his energy on multiple adjusting
instruments.
Patient Education
This concept is very simple for patients to understand. This theory allows patients to
picture the positioning of dysfunction. I would explain that SDF can lead to a spinal lesion
which creates abnormal motion or no motion at all which is called fixation. Then would
explain that if we treat them with chiropractic care we can alter postural muscles, decrease
trigger points and tenderness in the segment. So that SDF remain won’t t remain in the body.
Compare and Contrast the chiropractic theory with 2 other relevant theories.
We are comparing this theory with Neuropathology theory and Myelopathy theory.
Exam Findings
Physical, Ortho, and Neuro.
Exam finding will be a decreased AROM and PROM, orthopedic findings will be found
based on level of SDF, neurological exam could be without any pathological finding or with
dermatomes and myotomes of involved vertebral level segment
2. Give 3 examples of a patient who presents with segmental dysfunction and what you
would do to treat them.
References
Dana Hollandsworth lecture notes “Segmental Dysfunction SPVSC” fall tri 6 lecture notes
Dana Hollandsworth lecture notes “The Chiropractic Theories SPVSC” fall tri 6 lecture notes
Leach, R. A. (2004). The chiropractic theories: a textbook of scientific research (4th ed.).
Philadelphia, PA: Lippincott Williams & Wilkins.
Redwood, Daniel, and Carl S. Cleveland. Fundamentals of Chiropractic. 2nd ed. N.p.: Mosby,
n.d. Amazon Digital Services, Inc., 21 Aug. 2003. Web.
51 Science the Philosophy of the VSC Study Guide Fall 18
-Chiropractic Relevance
Why does this matter/apply to chiropractic? As chiropractors, we see patients with a
broad range of back issues and biomechanical changes. Spinal buckling can occur
from prolonged postural changes, and we have the knowledge to rehab the
components affecting posture, i.e. muscles, ligaments, joints. Altered biomechanics
or joint dynamics can be restored or increased through chiropractic care.
Chiropractors can focus on functional movements of key stabilizing muscles to
decrease the effects of spinal buckling.
Patient Education: This model can affect patients who are in careers where they sit
at desks for extended periods of time, or are hunched/bent over while carrying
heavy loads can really benefit from chiropractic care to prevent spinal buckling.
This can be explained to patients that our bodies were not meant to be flexed
forward because after awhile we lose the ability and strength to remain upright,
causing our back muscles to get weak. Also, being in a flexed posture we decrease
the ability to be under a load of pressure comfortably. For example, it is easier and
healthier on the body for someone to pick up a heavy box with the back and chest
upright than bent over at the waist. We can educate the importance of good posture
and how it affects long term biomechanics and overall spinal health.
-Explain the Physiological Attributes of the Chiropractic Theory: Several tissues are
involved in spinal buckling because of the anatomical and biomechanical changes to
the spine. Nerves and nerve roots can becomes irritated due to spinal changes
causing presentation of tingling, numbness, and other paresthesias. Osseous
structures are affected because of the articular changes in the joints and facets.
Prolonged Immobilization
Symptoms/signs: facet, disc,
leads to Permanent
nerve, ligament, or muscle.
Impairment
- Motion changes, radicular or
scleratogenous referral, Due to: trauma, old age,
and/or spasm. chiropractic subluxations that
eventually lead to loss of
Inflammation may be present movement
or not.
Sandoz & Kirkaldy – Willis
Primary proponent: Triano models
A process of progression
from phase 1 to 3. That may
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-Exam Findings
Since spinal buckling is correlated with prolonged fixation, prolonged
exposure to vibration, or sudden axial loading the symptoms may arise locally or
peripherally. Symptoms are usually correlated to the specific segment that is
involved in buckling. Example; tissue involved, facet involved, disc involved. Refered
pain, reflex response or neural inflammation can be expressed.
-Physical, Ortho, and Neuro:
N/A
-Imaging Needed
N/A
-Special Exams with findings
N/A
Sources:
1. Gatterman, M.I. (2005). Foundations of chiropractic: Subluxation. St. Louis:
Mosby.
2. Leach, R. A. (2004). The chiropractic theories: A textbook of scientific
research(4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
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Spinal Reflex:
“A basic chiropractic hypothesis holds that abnormal spinal biomechanics and
muscle dysfunction have effects, via the nervous system, throughout the body and
that the chiropractic adjustment is applied not only to restore range of motion and
alignment, but also to cause or relieve reflex effects in the nervous system.”
Somatoautonomic reflex:
“Spinal joint lesions may trigger facilitation-induced reflexes that impair or disturb
visceral function.”
History:
oWho is the primary proponent:
Langworthy, Paxon and Smith
oWhat was the historical view, if any, of this idea?:
Originally this idea was not accepted because it didn’t align with D.D.
Palmer’s pinched nerve theory.
Summary:
o What question is/was the theory trying to answer/explain?:
How chiropractic helped with visceral dysfunction
o Key terms or concepts that go with this theory.
SNS and PNS balance, most widely accepted hypothesis relating
chiropractic and viscera dysfunction or “global effects” of VSC,
sympathecotonia- reflex sympathetic dystrophy, cental and peripheral
modulation
Patient present with gallstones and presents with right shoulder pain. What reflex is
this?
A. Viscerosomatic
B. Somatosomatic
C. Viscerovisceral
D. Somatoviseral
Essay Questions
How will SAR help you in your practice and if not explain why this theory doesn’t
apply.
Reference:
Leach, R. A. (2004). The Chiropractic Theories: A Textbook of Scientific
Research(4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
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Name
History
None available
Summary
Cervical spinal joint lesions may compromise the vertebral arteries, especially in the
presence of anomalies within the vertebrobasilar system
Drop Attacks=Pathognomonic
VSC phase 2 instability
Osteophyte, subluxation (VSC 2), or fracture-dislocation of cervical vertebra (C1/2 or
C5/6)When signs of VBI are present: stop adjusting, observe pt. for resolution and refer
pt. if signs do not subside
Signs of VBI
F: face
A: Arms
S: Speech
T: Time
Chiropractic relevance
Why/how does this theory matter/apply to a practicing chiropractor and the profession?
Patient Education - use simplified language to explain this theory in a manner anyone
could understand or relate to without having any sort of education past 7th grade.
The Vertebral Arteries carry blood to your brain. They run through your vertebrae on
both sides of your neck. If your bones are out of place, or you have something that is
pressing on these arteries, then your brain will not be able to receive blood and this
situation can be life threatening. It is important before performing an adjustment, to
make sure that your vertebral arteries are not in any danger.
Explain the Physiological Attributes of the Chiropractic Theory (put N/A if not
relevant)
The Vertebral arteries supply the brainstem and the cranium with blood flow. Without
proper blood flow, the patient can experience double vision, dizziness, difficulty with
speech, difficulty swallowing, nausea, numbness, uncontrolled eye movements, loss of
body movements, and difficulty keeping balance.
The vertebral arteries run through the transverse foramen on the top six vertebrae of the
cervical neck. They arise cephalad from branches of the subclavian arteries. After
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traveling through the transverse foramen, they enter the cranium through the foramen
magnum. At the base of the medulla, these arteries come together to form the basilar
artery. The cerebellum and the cortex are then supplied from further branches.
Compare and contrast the chiropractic theory with 2 other relevant theories.
Another theory sharing similarities with VBI is B.J. Palmer’s myelopathy hypothesis
which like VBI focuses on the cervical spine. Signs and symptoms of compressive
myelopathy can include anything but most notably headaches, numbness, tingling,
paresthesia, torticollis and any number of neurologic findings as a result of fractures,
dislocations, subluxations, pathology creating pressure on the brainstem. Myelopathy
hypothesis is also heavily implicated in SIDS which may further link the two theories as
SIDS is believed to be the result of hypoxia perhaps in part as result of decreased blood
flow.
However, while many of these signs and symptoms overlap with those of VBI,
myelopathy hypothesis focuses of vertebral interference to nerve signals not necessarily
to vascular flow.
What special tests or imaging studies would differentiate them? Include findings on these
tests or imaging.
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Science the Philosophy of the VSC Study Guide Fall 2018
Tests or imaging for VBI may include thermographic patterns as manifestation of uneven
vasoconstriction from right side of the body to left. Usually a half degree difference is
considered substantial. Transcranial doppler sonography is the imaging modality of
choice to detect VBI and can be coupled with high resolution MR to provide a clear
visualization of a blocked vessel. Myelopathy hypothesis and instability theory would
both employ x-ray or CT imaging to arrive at upper cervical specific listings or to look at
disc space degeneration. In addition, upper cervical would also employ thermographic
pattern analysis.
Are there any pathognomonic traits or characteristics that would differentiate them?
Signs and symptoms, age/sex
According to Robert A. Leach in “the chiropractic theories” the signs and symptoms of VBI are as follows
Ataxia, diplopia, dizziness, drop attacks, dysarthria, dysphagia, falling to one side, nausea, numbness,
nystagmus, visual disturbance, vomiting. (Leach, 2004). These symptoms fall under the chiropractic VSC
phase 2 model. The most common age is 3135 years of age with no sex predilection.
Patient history indicators
The pathognomonic trait or characteristic for VBI are “drop attacks”
Exam findings
Examine and observe for nystagmus and diplopia. Neurologic examinations such as tandem gait and
Romberg tests.
Orthopedic test
De Kleyn test.
Imaging used for the theory with findings (if any)
Transcranial doppler sonography is the modality most sensitive to diagnose VBI.
Magnetic resonance angiogram reveals abnormal circle of Willis.
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Special Exams with findings
Transcranial Doppler sonography has been advocated for identification of patients with vertebrobasilar
compromise
Multiple Choice Questions with 4 answer choices
1. A patient presents to your office. He says he needs an adjustment because of neck pain.
After the adjustment, you notice 3 signs of VBI. What should you do?
a. Call 911
b. Adjust the other side
c. Trigger Point Therapy
d. Stop Adjusting
1. Which one is NOT a cause of VBI?
a. Instability
b. Asymmetry of Arteries
c. Cervical Spondylosis
d. Vasodilation
1. What VSC phase is VBI a part of?
a. VSC 1
b. VSC 2
c. VSC 3
d. VSC 4
2. Which is NOT a DDX for VBI?
a. Meniere Disease
b. Brain Tumor
c. Lateral Atlas Subluxation
d. ALS
3. What is a pathognomonic symptom associated with VBI
a. Dizzy
b. Nystagmus
c. Drop attack
d. Diplopia
1. Write and Explain the steps to identifying the most common symptoms of a
stroke. FAST (Explain every warning)
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Science the Philosophy of the VSC Study Guide Fall 2018
Sources
Souza, T. A. (2009). Differential Diagnosis and Management for the Chiropractor:
Protocols and Algorithms (4th ed.). Sudbury, MA: Jones and Bartlett Publishers, pp. 49-
68
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Key Terms:
● Subluxation complex
● Neuropathophysiology
● Kinesiopathology
● Myopathology
● Histopathology
● Biochemical
● Dynamic
● Fixation
Chiropractic Relevance
-Explain the Physiological Attributes of the Chiropractic Theory (put N/A if not
relevant)
According to the fifth component of the Faye model, pathophysiology occurs as a
result of nervous system dysfunction. Imbalances within the autonomic nervous
system can present either in a sympathetic or parasympathetic state and can affect
organ systems. Pre Inflammatory stress can induce hormonal and chemical
imbalances such as the production of histamine, prostaglandin, and bradykinin. If
the body is under stress for an extended period of time local adaptation syndrome
can develop into General Adaptation syndrome (GAS). GAS consists of three
progressive stages beginning in an alarm/fight or flight state. Next the body
develops resistance via the parasympathetic nervous system attempting to balance
the body. Finally the body gets exhausted and becomes susceptible to disease.
-Clinical/Patient Presentation
A patient will typically present with general back pain located anywhere in
the spine. The patient doesn’t have to be any particular age or sex. The pain can be
from a recent trauma such as a car accident or falling. The pain can also come on
gradually without any specific causal event. Often times a patient will complain of
radiating symptoms such as numbness and tingling, or dull achy pain that follows
nerve distribution patterns, or even visceral dysfunction related to the affected
nerve root level, depending on which segment is affected.
The main patient history indicators would be any sort of neurological
symptoms that occur in tandem with any sort of presentation of back or neck pain.
This may be, as stated before, any sort of numbness or tingling following nerve root
distributions, as well as any muscle spasms or muscle atrophy, or even visceral
disfunction or decreased efficiency of visceral function.
As far as physical exams, orthopedic exams and neurological exams, pay
attention most to your ortho’s relating to facet syndromes or muscle strain/sprain,
your sensory, motor and msr neuro exams, and your motion palpation findings.
Specific ortho’s may include Jackson’s compression test, or Spurling’s compression
test. You can also do SLR, O’Donehue’s, and any ULNT tests. These all help to evoke
neurological symptoms related to segmental disfunction, and will help to guide
which nerve roots to test in your neurological exam. The neuro exam will consist of a
sensory exam testing vibratory sense, light touch, and pain, along with motor exams
and MSRs. Once these have been performed, static and motion palpation to confirm
findings and specific segments involved that are producing the presenting
symptoms.
1. Which of the following is NOT apart of the 5 component model of the VSC?
A. Kinesiopathology
B. Histopathology
C. Biochemical Component/pathophysiology
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D. Surgicopathology
3. Which of the follow law’s is defined as “Bone will adapt to the loads under which
it is placed”?
A. Weigert’s Law
B. Wolff’s Law
C. Hilton’s Law
D. Newton’s Law
Essay Question 1:
Please describe how Kinesiopathology affects a patients, and how it can be fixed?
Essay Question 2:
Please give an describe and give an example of Wolff’s law?