Мануальная терапия, лечение позвоночника, остеохондроза, сколиоза, дисплазии ТБС

Glossary of terms

Methods of manual diagnostics are the main instrument in searching of localization and variants of formations pathobiomechanicalchanges. However in most guides it’s reduced to palpable assess the situation of the elements of the musculoskeletal system and analysis of active and passive movements of the joints, to palpation, painfulness and intensity of tissues and limitation of movement in it and do not taking into account its mutual interference. Clinical biomechanics so far from manual therapy, so do not promote the development of manual therapy as a science. Without denying the importance of such methods of appraisement in diagnosis of pathobiomechanical methods, I would like to mention the necessary of wide using and instrumental methods of its analyses. 

Glossary of terms

The main task of glossary –is to acquaint the reader with definition using at the website.

At first there are definitions that defining biomechanics pathobiomechanical changes in static and dynamic patterns of the musculoskeletal system, methods of their diagnosis and manual therapy.

Biomechanics

The angularmotion (rotation) – it is movement of the body, wherein all its points are rotate around the axis. According to the plane of rotation it called flexion, extension, the rotation, lateroflexion (right, left).

Linear motion (displacement) –it is movement of the body, wherein all its points are moving evenly along the axis. According to the plane of rotation it called: cranial, caudal, lateral (left and right), ventral, dorsal.

Spiral movement – it is form of movement of the body, wherein all its points moving at the same time along and around the axis. According to the plane of rotation it formed by combination: flexion/extensionswith lateraldisplacement, lateroflexion (left and right) with the ventral / dorsal displacement, rotation (left and right) with the caudal-cranial displacement.

Dextromovement – it is spiraling movementof the body, wherein rotation its points to the right accompanied by caudaldisplacement, rotation to the left – cranial. For example, flexion by lateralto the left, right by lateral extensions, lateroflexionrightbyventral, lateroflexionleft -dorsal.

Levorotatoryspiraling movement – it is spiraling movement of the body, wherein rotation of its points to the right are accompanied by cranial displacement; rotation to the left – by caudal. For example, flexion by lateral to the right, extensions –by  lateral to the left, to the right lateroflexion – by  dorsal, lateroflexionto the left — by ventral. 

Biomechanical servo-mechanism – is self regulation of recovering of interposition of elements of the musculoskeletal system, after finishing of the movement at the expense of natural transition a spiraling movement to another.

Musculoskeletal system – is collection ofbony(musculoskeletal), muscle (postural tonicity-force balance of antagonist muscles in different regions of spine and extremities), ligament (ligament balance of the visceral organs, capsular ligaments, joints of the spine and extremities) and membrane (balance within the vertebral and intracranial membranes) systems.

Musculoskeletal  system– is set ofregions ofthe spine, extremities and pelvis designed to perform static anddynamic problems ofthe body.

Static problem – it is maintaining of the vertical position of the body through formation of optimalstaticstereotype. There are such elements of musculoskeletal system: static stereotype regional postural muscle balance, vertebral motion segment, the joints of the limbs.

The dynamic problem — it is perform of complex of hard movements through formation optimaldynamic stereotype.  There are elements of musculoskeletal system forits execution: dynamic stereotype, motor patterns, phasic muscles, vertebral motion segment, and the joints of the limbs.

Optimalstaticstereotype(the optimalstatic) – it is maintaining the regularity of gravitational weight bearing regions of the spine and limbs having minimal expenditure ofmuscular contraction.  Visual criteria:  location of the projection of common centerof gravity 3-5 s-m ahead the axis of ankle joints, parallelism boards of the region.

Locomotive stereotype – it is combination of congenital and acquired reflexes that appeared on the basement of stereotyped repeated pulses as a manifestation of adaptation of musculoskeletal system to external and internally factors afferentinfluences of the formation of serial and parallel switching on and off of motor patterns accordingly intended target, keeping sufficiency of volume, the adequacy ofthe trajectory and power (in the absence excessive movements in the neighboring and remote regions).

Region – it is a part of the spine or extremities, designed for making some static and dynamic problems. The part of spine (cervical, thoracic,lumbar) limited by bony protrusions surrounding elements of the musculoskeletal system that formed its boards (skull, shoulder girdle, the lower edge of the chest, the wings of the pelvis) and have certain direction – as physiologicalbending (lordosis, kyphosis). Parts of the extremities (shoulder, upper arm, thigh, tibias) are limited by joints that providing it. Statistical problem – it is fixation different part of body (head, shoulders, chest), keeping intra-abdominal pressure through postural balanceof opposing muscles. Dynamic problem – execution of simple movement acts through formation of typical motor patterns.

Regionalposturalmuscle balance – it is tonicity – force balance of opposing muscles that providing physical uniform loads on intervertebral disks and interarticular tissues. Visual criteria: parallelism of their borders, projection of regional central of gravity in the middle of its lower border.

Pattern (model, image, pattern, picture) – it is temporal and spatial relationship excitatoryandinhibitory processes that shows itself in qualitative and quantitative characterization of the static and dynamic of human.

Typical motor pattern – it is evolutionarysequenceinclusion of certain groups of muscles (agonists, synergists, antagonists, clamps, and converters) that realized as an elementary movement act, that each individual, but in fact is typical, and it is on all levels of automated movement. Visual criteria: unidirectionalmovement according to purpose with keeping sufficient the adequacy ofthe trajectoryand power.

Pathobiomechanicalchanges – it is fixation of elements of musculoskeletal system at one of stages of biomechanicalservomechanism of vertebralmotion segments, regions of spine and extremities and statistic at all. Visual criteria:  asymmetrical position (as leaved angular and / or linear movement in three planes) and disturbance of inter transfer (changing of volume and appearing of three-directionalmovement) its elements that reversible under the influence of manual therapy. There are pathogenetic and sanogenetic changes in mechanics that are differ from each other, and performs different static and dynamic changes.

Sanogeneticbiomechanicalchanges – it is static and dynamic sanogenic reactions of organism to biomechanics inconsistency of different elements of musculoskeletal system. Static – reacts on nociceptivehyperafferentationany genesis (sinuvertebralnogo irritation, intervertebral nerves, «fall» of the patient’s body in a static, etc.) It manifests itself as fixation of biomechanics servomechanism of corresponding element of musculoskeletal system.  Dynamic – reacts on decrease excitability and contractility of a muscle or muscle group. It manifests itself as substitutive including other muscle groups to accomplish the motor task.

Pathogenicchanges inbiomechanics – it is long-existingfunctionalblocks that support hypoafferentation ofpropriointero-exteroceptors, disturbance of tonicity – power balance between shortened andrelaxedmuscles , that supporting the “fall” of the patient’s body in a statistic, disturbance of excitatory processes between hypo excitability and muscle hyperexcitability, that supports the formation of an atypical motor patterns. As a results all above – listened changes of biomechanics become pathogenic reaction causing neurologicaldisorganization.

Pathobiomechanicalchanges ofstaticstereotype

Nonoptimal statics – it is uneven gravitational burdening of spine parts and extremities, that accompanied formation of “Stopped falling” of the patient’s body in vertical position and it requiring increased energy costs of muscle contraction for maintainingthe vertical position. Herewith one parts of the spine and extremities “causes drop of patient body”, but another “stop” it. Visual criteria: displacement of projection of common center of gravity beyond the support legs.

Regionalposturalmuscle imbalance – it is disturbance of functional tonicity-power relations between the shortenedandrelaxedmuscles of the same part of the spine or extremities. Visual criteria: disturbance of border’s parallelism of part, changing of projection of regional center of gravity according to the middle of its bottom border. According to localization there are pathogeneticandsanogenetic variants of formation.

Pathogenic significant postural muscle imbalance of the region – it is tonicity-force imbalance of the muscles, “causing” formation of “falling” body of the patient in statics. Visual criteria: “discrepancy” of the borders in the part and displacement projection regional center of gravity in direction of displacement of projection of general center of gravity.

Sanogenetic important postural muscle imbalance of the region — it is tonicity-force imbalance of the muscles, conducive “stopping” of the falling of patient’s body in statics. Visual criteria: direction of “divergence” non-parallelbordersof the region and displacement of projection of regional center of gravity oppositely to direction of displacement projection.

Scoliosis (spinal curvature) – it is appearing of additional bending in parts of spine and extremities in the frontal (lateroflexion) and / or horizontal (rotation) planes.

Functional scoliosis – it is asymmetrical position of region in direction of lateroflexion, rotation, in combination with hypohyperlordosis (kyphosis) of the spine in the statics.  Such combination of the movements formed as fixation of biomechanics servo-mechanism at one of the stages spiraling movement. Visual criteria: coincidence of the direction of lateroflexionbordersregions and direction of ventral / dorsal displacement of the regional center of gravity, flexion/extensionsand lateraldisplacement, rotation and hypo-hyperlordosis (kyphosis) of the spine.

   The shortening ofthe muscle – it is disturbance of its tonicity-forced characteristics as a result decreasesits lengthandincreasedheranxiety. Visual criteria: rapprochement in the place of muscleattachment in the middle position of body of the patient and during the execution of movements.

Contracted muscle – it is predominantlyposturalmuscle that do not reach its normal size at rest (placeof its attachment areapproach each other and move away from middle position), transversesize is increased, tone frequently increases.

Static hyperreactivity – it is hypersensitivity in 2 spindles with a chain of nuclei, that do slowly movements, disobey to law “All or nothing”, finally it leads to rigidity.

The pathogenic significance ofmuscleshortening – it is reducing of the length of muscle, so direction of its concentric contraction coincide with the direction of rapprochement of borders of sanogeneticsignificantregion.

Relaxedmuscle (inhibited, pseudoparalytic, extended muscle) – it has a length more than norm at rest (placeof its attachment retire themselves and deviate from middle position) transverse size is reduced, tone frequently reduced. Relaxed muscles become active in tension of shortened antagonist, but during its isometric contractionagainst resistance – it suppressed, power reduced to 4 points.

Muscle relaxation – it is disturbance of muscles’ tone-forced characteristics; as a result its length increased and reduce its excitability. Visual criteria: retire of themselves of insertions in the middle positions of patients’ body.

The pathogenic significance ofmuscle relaxation – it is increasing of length of the muscle and direction of its eccentric reduction (tension) coincide with retire of themselves of borders in the pathogenic significance of the region.

Sanogeneticsignificantmuscle relaxation – it is increasing length of the muscle, and direction of its eccentricreduction (tension) coincides with the direction of their removing of borders sanogenetic significant of the region. 

Muscular weakness – it is disorganization of neuromuscular providing and regulation of movement system as disturbance of coordination between braking and relief as a result of distortion proprioceptiveafferentations ofmuscle spindles, the Golgi apparatus, nerve root, reactivepattern, neurological disorganization of the nervous system as a whole, visceralinfluences.

Function blockspinalmotion segment – it is fixation of its biomechanics servomechanism at one stage of transition one spiral movement to another. There are muscular and articular versions of its developing. Visual criteria: asymmetric position of upstream spine according to downstream in three directions of angular movement (flexion/extensions, lateroflexionand rotation) and / or linear displacement (cranial/caudal, ventral/dorsal and lateral).

Pathogenic significancethe function block – it is located vertebralmotion segments, compensates their static overload or reduce the intensity of theproprioceptiveafferent from intervertebral disks and joints.

The pathobiomechanicalchanges of thedynamic stereotype

Non-optimalmotor stereotype – it is disturbance of movement regulation as a result of congenital deficiency of central coordinate structures, disturbance to adaptation to the changing conditions of life, disturbance of afferentsignalingfrom the periphery.

Non-optimalmotor stereotype – changes according to sustainableindividual uniquenessmovements and position of the body are caused by functional motor system that integrates geneticstructural and functionalproperties with acquired during the life features of musculoskeletal system, as a disturbance of sequence inclusion , as typical and as appeared atypical motor pattern.

Atypicalmotorpattern – it is disturbance of nervous regulation, that manifest itself by changing sequence of inclusion and types of its 5 muscle contraction as delayed inclusion by eccentrictype ofreductionagonist and by advanced inclusion of concentric type  contraction of another muscle. Visual criteria: appearing of additional movements, changing of volume, change the trajectoryand speed ofmovement.

The pathogenic significance of atypicalmotorpattern – it is simple movement act that disturbance dynamic stereotype requiring compensation of its dynamicinconsistency.

Sanogenetic significant atypical motor pattern – it is simple movement act that includes in performeddynamic stereotypeearlier than normal; it compensate dynamicinconsistency ofmotorpatterns that is designed for performance such movement problem.

Dynamic hyperreactivity – it is reaction of musclespindles with the nuclear bag at stimulus as quick and full contractions, that submit to the law “All or nothing” ; as a result in final state leads to spasticity and is most common forcontracted muscle. Visual criteria: appearing of the advancedinclusionmusclesin motion, unusual to it, concentrictype ofcontractile, causing inhibition ofagonist and disturbance typical motor pattern.

Hyperexcitability of shortened muscles – it is disturbance of tone-forced features of muscles as a result there is excitability. Visual criteria: advancinginclusionin its unusualmotorpatterns, inhibiting the activity ofagonists that are designed for performance this problem.

Sanogenetic significant shortened muscle hyperexcitability – it is inclusion of shortened muscle in simple movement act earlier than normal and concentrictype ofreduction; it compensates dynamicinconsistencyagonistsof motorpatterns that are designed for performance of this problem. Visual criteria: the direction ofitsconcentricreduction coincides with the direction of convergence ofregion borders, fulfilling movement.

The pathogenic significance of the shortened muscle hyperexcitability – it is inclusion of shortened muscle in some motor patterns, performing different (in courses) movement tasks, suppressing normal activity of its muscles agonists. Visual criteria: the direction of its concentric reduction coincides with the direction of convergenceregion borders, wrenching or fully switch off motor pattern from performing dynamic stereotype.

Gipoexcitability — it is reduced sensitivity of the motor neuron to the stimulus, as a result of inhibitory effect of fiber synapses Type 1A antagonistic muscles and type 1B from Golgi apparatus of muscles antagonists are the most characteristic for the relaxed (stretched) muscle. Visual criteria: delayed inclusion of gipoexcitable muscle to performing movements that “facilitate” activity of other muscles groups and accompanied by disturbance of typical motor pattern.

Gipoexcitability of relaxed muscle – it is disturbance of its tone-forced characteristics as a result excitability reduced. Visual criteria: backward inclusion in that motor pattern, there it has a role of antagonist.

The pathogenic significance gipoexcitability of relaxed muscles – it is inclusion of relaxed muscle in motor pattern, where it is a antagonist of later norm and eccentrictype ofreduction. Visual criteria: the direction of the eccentric contraction of the muscle-agonist coincided with the direction of self remove borders of the region, including in movement with tardiness or do not include in it at all.

Functional block – it is limitation of motion of the spinal motion segment or joints, extremities as a result of fixation its biomechanics serve mechanism at one of the stages of transition one spiraling movement into another. There are muscleand joint variants of its developing. Visual criteria: limitation of angular movement(muscular version) or linear displacement(articular version) between vertebralmotion segments or adjacent extremities of joints.

Localhypermobility - it is increasing of movement in the spinalmotion segments as a result of reversiblelinear displacement ofa vertebra, which is located next to thespinalmotion segment which has functional block. Visual criteria: linear displacement of thevertebralmotionregion, in a direction appropriate to (according to the law ofspiraling movement) “fixed” angular movement of the adjacent vertebral motion segment.

 Instability – it is increasing movement of the spinal motion segments or limbs joints that forming as a manifestation of the structural elements of the insolvency of the musculoskeletal system. Visual criteria: angularorlinear displacement ofthe spine that do not connect to localization and diction of the functional blocks of neighboring spinal motion segments.

Methods of manual therapy

Hygiene of doctors’ poses – it is prevention overloading doctors’ spine during the process of performing manual session. Doctor tries to keep rectifiedlumbarlordosis. Visual criteria: Extension of the pelvis, easy flexion joints of the feet, flattening the physiological curves of the spine.

Hygienedoctors’ movements – it is decrease in themuscle forcerequired during treatment session; relaxation doctors’ hand to increasing their tactile skills.  Visual criteria:performance of movements in the desired direction by moving force of gravity of the body or power of reduction of the pelvic girdle and thighs at his hands.

Occlusion – it is the way of fixation vertebralmotion segments that located next to blockedvertebralmotion segments, helps to protect it from the manual influence and switch off all its movements.

Maintaining (mitnehmer) – it is a treatment manual method aimed at involving upstream blocked vertebra spinal motion segment in movement without fixing downstream.

Antitaking (gegenhalter)- it is a treatment manual method, aimed at keeping the downstream blocked vertebra spinal motion segment from movement.

Mobilization – it is method of manual impact, providing partial or complete restoration of pain-free movement with the help of repeating rhythmicpassivemovements ofparts of the body or adjacentvertebrae according to each other in a linearorangular direction.

Manipulation- it is one-stageremoval ofrestrictionsin the joint though a linear push in the cranial (caudal) cranio-ventral-lateral direction.

Reeducation (reeducation – retraining) – it is restore the ability of relaxed muscles to perform static and dynamic loads with the help of special exercises. It performed after the removal of the causes of muscle weakness. 

Static reeducation – it is recovery of postural activity of relaxed muscle with the help of special exercises.

Dynamic reeducation – it is recovery of excitability of muscle and its inclusion in motor pattern according to role of antagonist, synergist, neutralizer and catch with the help of special exercises.

Postisometricrelaxation (PIR) – it is relaxation of shortened muscle after its preliminary activation (isometric tension, the phase delay of breathing: inhale-exhale, the inclusion of motor synergies muscles, trunk, neck and limbs).

L.F. Vasylyeva  -Manual  diagnosis and therapy. Clinical biomechanics and patobiomechanics . A guide for doctors  — St. Petersburg , Foliant 2001 , c. -399


Write to the consultation and treatment by phone.: +38 0442273251, +38 0679204647

Leave a question