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Segmental definition--Part IV. Updating the differential for somatic and visceral inputs.

The first three parts of this series presented a standardized method of motion testing for motor behaviors specific to segmental dysfunction. When applied to clinical research studies, analysis of these palpatory data differentiated viscero-somatic from somato-somatic reflex manifestations in the thoracic region of subjects with renal dysfunction and/or hypertension. This update for the differential adds new observations regarding palpable findings, specifically at the spinal levels where linkage of costal and vertebral motion asymmetries identified the presence of increased visceral inputs. At each level, the examiner can make a simple comparison for accord in response to two sidebending motion tests in the seated position, one introduced through the shoulders and trunk and one through the head and neck. Lack of accord is a distinctive characteristic of the linked spinal/costal site of visceral input. Also, with regard to linkage sites, behavioral responses to motion tests introduced through the lower extremities suggest new applications for manipulative intervention. The new descriptive clinical data about segmental motion behaviors described in this report provide a basis for new questions in neuromusculoskeletal research.

Humans↗

[Manual medicine of the spine--indication, diagnostic and therapeutic possibilities].

Manual medicine developed rapidly during the last 40 years and became an integral part of standard medicine. The basic idea behind the methods used is that several acute and chronic disorders the spine and peripheral articulations are caused by functional disturbances in one or more spinal motion segments, and also in peripheral joints, always accompanied by reflectory muscular reactions. These changes must be detected and treated specifically. The diagnosis for manual therapy is always complementary to general medical examination. Knowledge of absolute and relative contraindications is the basis for every manual therapy. Therapeutically, apart from the actual mobilization with or without impulse, the so-called neuromuscular techniques are used; these are acting together with the muscle force of the patient and with the thereby triggered reflex-mechanisms. Whereas the latter techniques are also used in physiotherapy, mobilization with impulse should be practised nowadays only by trained physicians and chiropractitioners, since the risks involved are considerable. It is of great importance that the therapy is not limited just to the manipulation of the functionally disturbed motion segment but that in addition muscular disbalance is treated.

Contraindications↗

An alternative method of teaching strain/counterstrain manipulation.

The range-of-motion box enables the operator to visualize how to carry a joint through extremes of motion range for range-of-motion evaluations and to locate the position of comfort in relaxation of tender points. It is helpful for teaching the novice counterstrain manipulation and for instructing fellow practitioners. Examples are illustrated for the cervicothoracic region, but the concept is applicable to other parts of the body as well.

Audiovisual Aids↗