Continuing Education for Osteopathic Physicians Greenman | Osteopathic Principles and Practice Greenman

Cervical Spine Diagnostics

Overview Structural diagnosis in manual medicine is directed toward evaluation of the musculosketal system with the goal of identification of somatic dysfunction.

Somatic Dysfunction may be diagnosed by the presence of some, but not necessarily all, of the following:

Tissue Texture Abnormalities -- Tissues may feel hypertonic, rigid, fibrosed, atrophied, or edematous.
Asymmetric Motion -- Bones, muscles, or joints may lack symmetry when compared to related structures.
Restriction of Motion -- A joint will have reduced range of motion (ROM).
Tenderness to Touch -- Palpation of tissues may be painful.

While assessing for asymmetry of motion, the examiner is specifically interested in the range and quality of passive motion. This includes the end-feel of direct and indirect barriers. Within a range of passive motion, the elastic barrier will have a characteristic feel at the end points as a result of passively induced tension within the joints and surrounding tissues. Each joint can be moved through a certain limited range of motion. The force that is required by an examiner to produce passive motion increases as the end point (anatomical barrier) is approached. (ROM) is limited by the anatomical integrity of the joint and its supporting ligaments, muscles, and fascia. Exceeding the anatomical barrier results in fracture, dislocation, or violation of tissue integrity. Somewhere within the total range of motion (the distance from one anatomical barrier to the other) is located the middle neutral point. Join Dr. Philip E. Greenman, D.O., F.A.A.O., as he discusses the concept of ease and bind and how it relates to the neutral point.

Also located within the total range of motion is the . The maximum limit of passive motion occurs at the , which is reached when all tension has been taken up within the joint and its surrounding tissues. There is a small distance between the anatomical barrier and the elastic barrier that is known as the . It is within this space that high-velocity, low amplitude thrust appears to generate the popping sound which results from this particular mode of treatment. The magnitude of the is somewhat less than that available with passive movement, and the end point of this range is called the .

Under normal circumstances, equal rotational forces will produce . However, when pathology is present, equal rotational forces will . For example, when there is a .

No commercial support was received for the development of this content. The developers and presenters have no conflicts to disclose. This product is intended for instructional use only. It is not designed for clinical or diagnostic purposes. The authors, producers, and publishers of these materials shall not be held liable for any loss and/or injury arising from the use of information and procedures contained in these programs.