Diagnostics - Scan Lower Translatory Assessment - Neutral Position
Once an area of tissue texture abnormality and/or a posterior pillar is identified, the examiner proceeds to identify motion abnormalities of the dysfunctional segment(s). testing in the neutral position will indicate when abnormal resistance to sidebending is occurring, but it does not enable the examiner to know which facet is affected. For example, if resistance is encountered during left to right sidebending of C5 on C6, this indicates that there is abnormal resistance to left sidebending.
Abnormal resistance to left sidebending in the neutral position can result when:
something is preventing the facet on the left from closing
or something is preventing the facet on the right from opening.
Be sure to understand how translation of the vertebra from right to left produces the same effect on the facets as right sidebending, and that translation of the vertebra from left to right produces the same effect as left sidebending.
To determine which of these two conditions exists, the examiner needs to perform translational motion testing in both the backward bent (extension) and the forward bent (flexion) positions.
If resistance to left sidebending occurs in the forward bent position, it indicates that the right facet is failing to open properly. Increased resistance to right sidebending occurring in the forward bent position, indicates that the left facet is failing to open properly. This is because both facets must open for normal flexion to occur.
If resistance to left sidebending occurs in the backward bent position, it indicates that the left facet is failing to close properly. Increased resistance to right sidebending occurring in the backward bent position, indicates that the right facet is failing to close properly. This is because both facets must close for normal extension to occur.
The functionality of motion segments is most easily evaluated by employing translatory movement to the right and to the left to introduce a sidebending component. When testing a nonsymptomatic subject, the physician should feel translational resistance that is smooth and symmetric, indicating that the left and right facets are freely opening and closing as left and right sidebending occurs. Abnormal resistance to translation is an indication that either one facet is unable to fully open or that the contralateral facet is unable to fully close. For example, translating C5 from left to right on C6 tests the capacity C5 to left sidebend and left rotate on C6. Translation from left to right without abnormal resistance depends upon the ability of the left facet to close and the right facet to open. If there is resistance to translation from left to right, then there is restriction of left sidebending and left rotation of C5 on C6. It is inferred that this condition results from either the left facet being unable to close or the right facet being unable to open. In this , be sure to note that translation of the vertebra from right to left produces the same effect on the facets as right sidebending, and that translation of the vertebra from left to right produces the same effect as left sidebending.
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