A M C T. 강사 - 유승모 MD. PhD ( 토 )

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1 A M C T 강사 - 유승모 MD. PhD ( 토 )

2 A Brief History of Activator Methods The ACTIVATOR METHOD of chiropractic analysis and low-force spinal adjusting technique originated in Redwood Falls, Minnesota in 1965 Warren C. Lee,D.C. (graduate of Northwestern College of Chiropractic, 1941) Arlan W. Fuhr, D.C. (Logan Basic college of Chiropractic, 1961). Since then, the procedure has become a major chiropractic clinical methodology, and is now used to some extent by approximately 21,000 doctors of chiropractic throughout the world 1

3 Terms Used in AMCT Activator Adjusting Instrument: A chiropractic adjusting instrument which provides a manually manipulatable instrument capable of providing a dynamic thrust which includes a controlled force of adjustment at a precise and specific line of drive at a high speed. 2

4 AAI-II( Activator Adjusting Instrument II ) 3

5 Terms Used in AMCT Facilitated Segment: A spinal segment which responds to various stimuli in a more intense and prolonged manner than is normal. Isolation Test: A specific active movement on the part of the patient to assist in locating and evaluating the subluxation or facilitated motion segments of the spine in small, incremental steps. 4

6 Terms Used in AMCT Line of Drive: The angle at which the Activator adjusting instrument contacts the vertebra to correct subluxations or misalignments. Pelvic Deficiency (P.D.) or Functional Short Leg: A leg that appears short due to a posterior inferior rotation of the ilium on the same side and observed when a patient is in a prone, non weight-bearing position. Another possible cause is a contraction of the supra pelvic muscles and should not be confused with an anatomical short leg. 5

7 Terms Used in AMCT Pressure Test: A light pressure applied into the direction of correction. Stress Test: A light pressure applied into the direction of the subluxation. 6

8 Terms Used in AMCT Subluxation: Just what a subluxation is still has not been proven, but, on the other hand, dis-qualification of the hypothesis of a subluxation has neither been proven. Activator Methods Chiropractic Technique accepts the definition of a subluxation along with its etiology and effects as reported in Basic Chiropractic Procedural Manual published by the American Chiropractic Association. 7

9 Terms Used in AMCT There are two major causes of subluxation: 1) inequality in muscular balance, and 2) abnormal structural support. The subluxation then causes local effects on tissue as well as mechanical and neurological effects. 8

10 LONG-SHORT RULE The Short-Long Rule applies when performing the various isolation tests from L5 through occiput (includes pubes) If the P.D leg LENGHENS at 90 degrees (Position No.2), this indicates subluxation or facilitation ON the P.D. SIDE. If the P.D leg SOORTENS at 90 degrees (Position No.2), this indicates subluxation or facilitation ON the SIDE OPPOSITE P.D. 9

11 Leg Testing 족지분석은 AMCT 기법의핵심요소이다. 정확하고세심한족지분석은치료의필요성을판정할수있도록한다. 초기단족검사는 subluxation이존재하느냐아니면다른신체부위에서의 facillitation 이냐를판정하는주된방법이다. 10

12 초기족지분석에서 4 가지필수과정 Patient palcement preserving postural distortions Visual observation noting leg length discrepancy Position #1 procedure identifying the PD leg Position #2 procedure specifically identifying subluxation malposition 11

13 Patient Placement 환자를방문시마다테이블에제대로위치시키는것이검사의정확성에결정적인역할을할수있다. 부적절한환자배치는단족차이감소, 다리의장단족의역전, 단족분석의불명확화를초래할수있다 12

14 Visual inspection Observe leg length discrepancy 환자의발에접촉하기전에대칭되는발의비교포인트 를이용해단족차이를검사한다. 비대칭적내반이있는지확인한다. 13

15 족지분석과정 14

16 족지분석과정 Take out supination and Plantar flexion in Position #1 15

17 족지분석순서 1. Take out supination and plantar flexion in position #1 2. Keep index fingers on metatarsal Phalangeal junction 16

18 족지분석순서 3. Keep Elbows tucked in 4. Shift thumbs onto balls of feet while elevating to position #2. 17

19 족지분석순서 5. Ensure that soles of shoes are level in position #2 6. Form a V in position #2 with heels about ½ inch apart and toes flared 18

20 Three Possibility Possibility One : Position #1에서짧았던다리가 Position #2에서길어지는현상을말한다. Possibility Two : Position #1에서짧았던다리가 Position #2에도짧은경우 Possibility Three : Position #1에서 even 했던다리가 Position #2에서도 even한경우 19

21 Pressure-Stress Testing Pressure Testing 1. The P.D. leg is short in position #1. 2. Apply a light pressure into the direction of correction. 3. If the legs become even in position #1, adjust into the direction of correction. Example : Left P.D. 20

22 Pressure-Stress Testing Stress Testing 1. The leg are even in position #1. 2. Apply a light pressure into the direction of subluxation. 3. If P.D. leg shortens in position #1, adjust into the direction of correction. Example : Left P.D. 21

23 Routine Procedure Testing Step One : P.D. leg Shortens in Position #2 22

24 Routine Procedure Testing Step Two : P.D. leg lengthens in Position #2 23

25 Knee And Feet Medial Knee : P.D. 측내방슬관절 subluxation이있는지 pressure test를실시한다. Medial Knee : Medial, Superior로 subluxation 교정의방향은 Lateral, Inferior Talus : Medial, Anterior, Inferior로 subluxation 교정의방향은 Lateral, Posterior, Superior로 24

26 Knee And Feet Lateral Knee : P.D. 측외방슬관절 subluxation이있는지 pressure test를실시한다. Lateral Knee : Lateral, Superior로 subluxation 교정의방향은 Medial, Inferior Cuboid : Lateral, Anterior, Inferior로 subluxation 교정의방향은 Medial, Posterior, Inferior 25

27 Medial Knees and Talus 교정 26

28 Lateral Knee And Cuboid 교정 27

29 6 Point Pelvic Pattern AS Ilium Pressure Test : PD 반대측장골능에접촉하여천장관절면과평행되게장골능에부드럽게하방내측방압력을가한다. PI Ilium AS 교정후나 AS pressure test 음성으로나온경우 PD 측의 ilium 후하방 subluxation을고려한다. 28

30 Pelvic Point 29

31 Pelvic Point 30

32 Pelvic Point 31

33 Pelvic Point 32

34 AS ilium AS Ilium Pressure Test : PD 반대측장골능에접촉하여 천장관절면과평행되게장골능에부드럽게하방내측방 압력을가한다. 33

35 AS ilium AS Ilium Adjustment 34

36 PI ilium PI Ilium Pressure Test : PD side 천골결절인대의하부에 무지로가볍게접촉한다 35

37 PI ilium PI Ilium Adjustment 36

38 Symphysis Pubis 발무릎, AS Ilium, PI ilium에의테스트와교정후에 Position 1 이나 Position 2에서보통다리길이가균형을이룰수있다. Isolation Test를시행한다. Isolation Test : 환자의양무릎을바짝붙이도록한다. #2에서 PD leg가짧아졌다면, PD 반대측치골의하방 subluxation을의미한다. 37

39 Pubic bone isolation Test 38

40 Subject Pubic bone Adjustment 39

41 Lumbar Isolation Test : L5 Patient to place the forearm on the side of PD on the low back. After completing the 5 th lumbar isolation test, ask the patient to return the forearm th the side of the body 40

42 L5 Adjustment 41

43 Lumbar Isolation Test : L4 Patient to place the forearm on the side opposite of PD over the lumbar vertebrae. After completing the 4 th lumbar isolation test, ask the patient to return the forearm to the side of the body Left PD Possibility One Possibility Two Possibility Three 42

44 L4 Adjustment Contact Point : the mammillary process on the side indicated by the short-long rule LOC = anterior, superior, through the plane line of the facet 43

45 Lumbar Isolation Test : L2 Patient to place both forearms on the lumbar vertebrae. After completing the 2 th lumbar isolation test, ask the patient to return the forearm to the side of the body 44

46 L2 Adjustment Contact Point : the mammillary process on the side indicated by the short-long rule LOC = anterior, superior, through the plane line of the facet 45

47 Lower Thoracic Isolation Test :T12 12 th Thoracic Isolation Test : patient to place the forearm on the PD side next to the head. After completing the 12 th Thoracic isolation test, ask the patient to return the forearm to the side of the body 46

T12 Adjustment Contact Point : Transverse process on

anterior, superior, and slightly medial, through the 60

about 1/2inch lateral to the transverse process on the

48 T12 Adjustment Contact Point : Transverse process on the side indicated by the short-long rule LOC = anterior, superior, and slightly medial, through the 60 plane line of the facet Contact Point : Body of the rib about 1/2inch lateral to the transverse process on the side of rib involvement. LOC = lateral and inferior at a 45 angle 47

49 Lower Thoracic Isolation Test :T8 8 th Thoracic Isolation Test : patient to place the forearm next to the head. After completing the 8 th Thoracic isolation test, ask the patient to return the forearm to the side of the body 48

line of the facet Contact Point : Body of the rib about ½ inch lateral to the

50 T8 Adjustment Contact Point : Transverse process on the side indicated by the short-long rule LOC = anterior, superior, and slightly medial, through the plane line of the facet Contact Point : Body of the rib about ½ inch lateral to the transverse process on the side of rib involvement. LOC = lateral and inferior at a 45 angle 49

51 Upper Thoracic Isolation Test :T6 6 th Thoracic Isolation Test : The patient to turn the face to the PD side. After completing the 6 th Thoracic isolation test, ask the patient to return the head to the neutral position 50

line of the facet Contact Point : Body of the rib about 1/2inch lateral to the

52 T6 Adjustment Contact Point : Transverse process on the side indicated by the short-long rule LOC = anterior, superior, and slightly medial, through the plane line of the facet Contact Point : Body of the rib about 1/2inch lateral to the transverse process on the side of rib involvement. LOC = lateral and inferior at a 30 angle 51

Upper Thoracic Isolation Test :T4 4 th Thoracic Isolation Test : The patient to keep the face turned to the PD side; then instruct the patient to lift the shoulder on the PD side toward the

53 Upper Thoracic Isolation Test :T4 4 th Thoracic Isolation Test : The patient to keep the face turned to the PD side; then instruct the patient to lift the shoulder on the PD side toward the ceiling and then relax. After completing the 4 th Thoracic isolation test, ask the patient to return the head to the neutral position Left PD Possibility One Possibility Two Possibility Three 52

54 T4 Adjustment Contact Point : Transverse process on the side indicated by the short-long rule LOC = anterior, superior, and slightly medial, through the plane line of the facet Contact Point : Body of the rib about 1/2inch lateral to the transverse process on the side of rib involvement. LOC = lateral and inferior at a 20 angle 53

Upper Thoracic Isolation Test :T1 1 th Thoracic Isolation Test : The patient to keep the face turned to the PD side; then instruct the patient to shrug

55 Upper Thoracic Isolation Test :T1 1 th Thoracic Isolation Test : The patient to keep the face turned to the PD side; then instruct the patient to shrug the shoulder toward the ears and then relax. After completing the 1 th Thoracic isolation test, ask the patient to return the head to the neutral position. 54

T1 Adjustment Contact Point : Transverse process on the side indicated by the short-long rule LOC = anterior and slightly medial, through the plane line

56 T1 Adjustment Contact Point : Transverse process on the side indicated by the short-long rule LOC = anterior and slightly medial, through the plane line of the facet Contact Point : Body of the rib about 1/2inch lateral to the transverse process on the side of rib involvement. LOC = lateral and inferior 55

57 Shoulder Involvement Medial subluxation of the Scapula Medial ala of the scapula Inferior humerus Posterior-superior radius Anterior Lunate Lateral subluxation of the Scapula Lateral ala of the scapula Superior humerus Inferior-Medial ulna Posterior Carpals 56

58 Shoulder Isolation Test 환자의얼굴을 PD side 로돌리게하고두팔을양측테이블위에놓게한다. PD side 먼저검사하고반대편 PD side 를검사한다. PD side 팔꿈치를몸통에붙였다떼도록한다. 그런후 Position #2 를시행한다. 검사시행하는쪽견갑골의 inferior angle 은 #2 에서장측다리방향으로 subluxation 된다. 이 test 결과로 medial scapula 인지 lateral scapula 인지를결정한다. 57

59 Shoulder Isolation Test 58

60 Medial Scapula Pattern 59

61 Medial Scapula Pattern Adjust LOD = Lateral (Medial Scapula) LOD = Superior (inferior humerus) LOD = Anterior -Inferior (Proxim al radius) LOD = Posterior (anterior lunate) 60

62 Lateral Scapula Pattern 61

63 Lateral Scapula Pattern Adjust LOD = Medial(Lateral Scapula) LOD = Inferior (superior humerus) LOD = Lateral-superior (proximal head of ulna) LOD = anterior (posterior carpals) 62

64 Lower Cervical Isolation Test : C7 7 th Cervical Isolation Test : After completing the upper extremity isolation procedur, ask the patient to keep the face turned to the PD side; then instruct the patient to return the head to the neutral face down position. 63

65 C7 Adjustment Contact Point : Pedicle lamina junction on the side of involvement LOC = anterior, superior and slightly medial, through the plane line of the facet 64

66 Lower Cervical Isolation Test : C5 5 th Cervical Isolation Test : Instruct the patient to lift the head off the table ½ inch (slight extension) and then return the head to the neutral face down position. Left PD Possibility One Possibility Two Possibility Three 65

67 C5 Adjustment Contact Point : Pedicle lamina junction on the side of involvement LOC = anterior, superior and slightly medial, through the plane line of the facet 66

68 Upper Cervical Isolation Test : C1-2 Atlas-Axis Isolation Test : Instruct the patient to tucking the chin toward the chest(slight flexion) then return the head to the neutral face down position Left PD Atlas Axis No Involvement 67

69 C1 Adjustment Contact Point : lateral most aspect of the Transverse Process LOC = slightly medial 68

70 C2 Adjustment Contact Point : Pedicle lamina junction on the side opposite PD LOC = anterior, superior and slightly medial, through the plane line of the facet 69

71 Posterior Occiput Posterior Occiput isolation test : Following isolation and adjustment of the C2-C1 segments, the patient s head will be in the neutral, face-down position. Instruct the patient to gently push the face into the table which stresses the atlanto-occipital region 70

72 Posterior Occiput Adjustment Contact Point : posterior aspect of the occiput at the inferior nuchal line LOC = straight anterior 71

73 Outro 감사합니다. 72

National Boards Part 4 Technique. Exam Format 5 stations (1 doctor and 1 patient). 2 setups per station (5 minutes) cervical

1 National Boards Part 4 Technique Exam Format 5 stations (1 doctor and 1 patient). 2 setups per station (5 minutes) cervical thoracic lumbar pelvic extremity Expect examiner interaction Graded on a Scantron