The taxation system

Many in chiropractic have used the terms "sub­

luxation" and "fixation" interchangeably, and there have been numerous definitions and descriptions of both. We will not attempt to define either a subluxation or a fixation here; rather, we will explain the functional differences between the two as observed by manual muscle testing in applied kinesiology.

A fixation involves at least two vertebrae, and usu­

ally three. The triple vertebrae involvement is probably due to the muscular attachment of the rotatores longus and brevis, with the longus spanning a three-vertebrae complex. The differences between vertebral subluxations and fixations are listed below.

Subluxations Fixations

Structures Involved

One specific structure of the spinal column is involved in In a fixation complex a minimum of two structures will a subluxation. It can be a vertebra, a portion of the pel- be involved, and they will have restricted movement vis, or the occiput that is out of normal function with the between them. Usually three vertebrae are involved in rest of the spinal column. a fixation; however, there may be two or up to five (and

possibly even more).

Muscle Weakness

There is no consistency of muscle weakness associated There are specific bilateral muscular weaknesses com-with vertebral subluxations. The wide range of neuro- monly associated with vertebral fixations (discussed on logic ramifications can cause almost any muscle asso- the next page).

ciated with a specific spinal subluxation to be weak.

Therapy Localization

Therapy localization over a subluxation will cause a strong When therapy localizing over a vertebral fixation, a pre-indicator muscle to weaken, or a muscle weak as a di- viously strong indicator muscle will not weaken unless rect result of the subluxation to strengthen. there is an attempt to introduce motion into the fixation complex. This is done by therapy localizing over the sus­

pected fixation complex while the patient actively moves the spine in that area. In the presence of a fixation, an indicator muscle will weaken. Therapy localization over a fixation will strengthen the bilateral muscle weakness associated with the fixation.

Challenge

The vertebra or other spinal structure is challenged with There will usually be no reaction to a single-point chal-a single point of contchal-act. lenge. Challenge is accomplished by challenging two

vertebrae at the same time, usually by pressing in op­

posite directions on the spinous or transverse processes.

Static X-ray

A subluxated vertebra is usually observable as misaligned Generally no misalignment between fixed spinal structures on a static x-ray film. is observed on x-ray. The mechanism at fault is a lack of motion between contiguous vertebrae, rather than a mis­

alignment causing apparent encroachment on the radix of the nerve.

Motion X-ray

Serial static x-rays or cineroentgenography will usually There will usually be hypokinesis of the spinal fixation show aberrant movement of the subluxated vertebra. complex.

This is apparently due to stimulation of the hyperac-tive intrinsic muscle or muscles involved with the sub-luxation complex.

Correction

A subluxation can be adjusted with a single point of con- A fixation requires a two-handed contact or some other

tact. method of stabilizing one of the structures while the other

is manipulated, because a single-handed contact just moves the entire complex rather than unlocking the mechanism. Occasionally a fixation complex is unlocked with a single-handed contact; however, such results are due more to luck than calculated correction.

Bilateral Muscle Weakness of Fixations When a fixation complex is present in the spinal column, it has a specific bilateral muscle weakness. The bilateral weakness observed by Goodheart3s reveals many spinal fixations that would otherwise be over­

looked.

Fixation levels associated with muscles that test weak bilaterally are as follows:

1 . Occipital fixation - bilateral psoas muscles.

2. Upper cervical fixation - bilateral gluteus maxim us muscles.

3. Lower cervical fixation - bilateral popliteus muscles.

3-30. Psoas

3-32. Popliteus

3-34. Teres major

3-36. Neck extensors - group

4. Cervicodorsal fixation - bilateral deltoid muscles (rarely, bilateral serratus anticus muscles) .

5. Thoracic fixations - bilateral teres major muscles.

6. Dorsolumbar junction fixation - bilateral lower tra­

pezius muscles.

7. Lumbar fixation - neck extensors test weak when tested together bilaterally.

8. Sacral fixation - neck extensors test weak bilater­

ally when tested individually or as a group.

9. Sacroiliac fixation - neck extensors test weak on one side only, and no other factor is found for the dysfunction.

3-31 . Gluteus maxim us

3-33. Middle deltoids

3-35. Lower trapezius

3-37. Neck extensors - right

The bilateral weakness appears to relate with the equilibrium proprioceptors located in the ligaments along the spine. Schmitt103 designed a model to dem­

onstrate this hypothesis. The most thoroughly studied spinal equilibrium proprioceptors are the tonic neck receptors in the infant or head-on-neck receptors in the adult. Their location relates with the upper cervical fixa­

tion and its associated bilateral gluteus maximus weak­

ness. Schmitt demonstrated that contraction of the neck extensor muscles to forcefully extend the head on the neck causes weakness in previously strong bilateral glu­

teus maxim us muscles as long as the contraction is held.

In individuals who can localize contraction of the extensor muscles, a similar demonstration can be per­

formed. Contraction of the mid-cervical extensor muscles causes weakness of the bilateral popliteus muscles. Contraction at the cervicodorsal j unction causes bilateral deltoid muscle weakness. The demon­

stration can be carried on down the spine with the appropriate muscles weakening with contraction, as long as the subject is capable of localizing contraction to a specific area. This demonstration is applicable in some subjects, but not all. The bilateral muscles do not weaken in those who have very organized nervous sys­

tems, apparently because their bodies recognize that weakening is not necessary under these conditions. Oth­

ers who do not demonstrate the bilateral weakening as described above may be incapable of isolating the muscle contraction to the localized area.

Another method to demonstrate a fIxation complex causing bilateral muscle weakness is to stimulate the in­

trinsic and paravertebral muscles of an area with sine wave current. While the localized muscles are contracting from the stimulation, the associated bilateral muscles will test weak. In a similar manner, a belt can be tightly placed around the innominate bones to create an artificial sa­

croiliac articulation fixation. In this case, the cervical ex­

tensor muscles will test weak while the belt is in place.

Evaluation and Correction

The general localization of a fixation complex is done in applied kinesiology by fInding bilateral muscle weakness. Not all cases of bilateral muscle weakness will have an associated fixation complex. There are occasions when the bilateral weakness is due to some other aspect of the five factors of the IVF To determine that the bilateral weakness is associated with a spinal fixation, have the individual therapy localize over the spinal area. If a fIxation is responsible, the muscles will no longer test weak as long as the therapy localization is held . It may be necessary to have the individual therapy localize with the dorsal surface of the hands instead of the palmar surface to eliminate the weak tests.

The method of fixation analysis and correction is a modification by Goodheart of Martindale's88 approach to evaluating the spinal column. The original system was

a complex method of motion palpation to fInd structures of the vertebral column that were in fixation, and the key motion that would unlock the vertebrae. Goodheart's adaptation of the system, combined with bilateral muscle tests, simplified the procedure considerably, but it is still somewhat more complicated than some other ap­

proaches. Its advantage is that it consistently unlocks vertebral fixation complexes in a specific manner; other more generalized approaches frequently fail to do this.

The procedure consists of three basic steps. The fIrst step finds the vertebrae involved in the fixation complex.

The second step determines the direction in which the vertebral motion is limited. The third step locates the vertebrae of the complex that are the keys to restoration of mobility.

Step 1 . To generally locate a fixation complex, test for bilateral weakness of the muscles associated with fixations. The fixation will be in the general area indi­

cated previously for bilateral muscle weakness. The fixa­

tion complex is further delineated by motion palpation.

Palpate for motion between adjacent vertebrae by press­

ing on the spinous or transverse processes of the verte­

brae to rotate them in opposite directions. Judge the motion available between the vertebrae; then reverse contacts to rotate the vertebrae against each other in the opposite direction. By progressively evaluating the mo­

tion between vertebrae, establish the upper and lower lim­

its of the fixation group. When outside the fixation group there will be a soft, yielding motion in both directions. Of course, the upper or lower limit may be defined by reach­

ing the occiput or sacrum.

3-38. Step 1 . Pressing alternately on two vertebrae in opposite directions, locate fixation complex by resis­

tance. Evaluate large arrows together. Continue until freedom of motion is found in both directions with a vertabra or structure above or below. This locates top and bottom of the fixation complex.

Step 2. The fixation complex will be able to rotate easily in one direction, but it will resist movement in the opposite direction. The top vertebra of the complex -found in step 1 - is the key in determining the direction in which rotation is locked, and which is freely movable.

This is usually accomplished by pressing the spinous pro­

cess both right and left, observing the direction in which it moves easily and has resistance. The motion of the top vertebra can also be evaluated by pressing on the trans­

verse or mamillary processes and observing for resistance on one side.

The complex is considered locked posteriorly or anteriorly. Reference to posterior and anterior relates only to movement ability, not to the directional misalignment considered in vertebral subluxation analysis. If the right transverse process resists anterior movement, it indicates that the vertebra is locked posteriorly on that side. This is listed as a right posterior fixation. This, then, would indi­

cate that the left side is locked anteriorly, so the complex would be a left anterior fixation and a right posterior one.

"LOCKED"

ANTERIORLY ON LEFT

"LOCKED"

POSTERIORLY ON RIGHT

3-39. Step 2. Evaluate which direction vertebra can and cannot rotate. List which side is locked posteriorly and which is locked anteriorly.

The same type of analysis is made if the motion palpation is applied to the spinous process. If the spinous process is pushed from left to right and resists movement, the right side is locked posteriorly and the left side ante­

riorly.

Step 3. In step 1 the vertebrae involved in the fixa­

tion complex are located, giving top and bottom defini­

tion to the complex. In step 2, the direction in which the fixation complex is locked is established and nomencla­

ture assigned . Step 3 determines which side of the fixa­

tion is primary. The combined information from steps 1 , 2 , and 3 is used to determine which two vertebrae will be adjusted.

The primary side of fixation is found by compar­

ing bilaterally the resistance to digital pressure applied by the examiner over the facet articulations of the top two vertebrae in the complex. First, press anteriorly on one articulation and then on the other, making compari­

son. One side will resist more than the other, indicating the primary side of fixation.

The illustration given in step 2 shows the right side of the top vertebra not rotating anteriorly, indicating it is locked posteriorly, with the left side locked anteriorly. This information combines with the third step to give a final listing of the fixation complex. If resistance is felt at the right facet articulation, the fixation is on the right; thus it would be listed as a right posterior fixation. If the resis­

tance is found on the left, it is a left anterior fixation.

At this point a rule is applied. If the fixation is on

LESS RESISTANT

TO PRESSURE TO PRESSURE ^RESISTANT

3-40. Pressure over facet articulations of top two ver­

tebrae will have more resistance on one side than the other. Greater resistance is found on the side of primary fixation. Combine data of side of greater resistance with direction of rotation in which the top vertebra is locked, as was determined in Step 2. In these illustrations, right posterior fixation.

the posterior side, the top vertebra of the complex is ad­

justed on the vertebra immediately below. If the fixation is an anterior one, the bottom vertebra of the complex is adjusted on the vertebra above. Only the top two or bot­

tom two vertebrae are manipulated, but the entire com­

plex will unlock regardless of the number involved.

The contact points for unlocking a fixation are the transverse processes in the thoracic spine, mamillary pro­

cesses in the lumbar spine, and laminae in the cervical spine. The exception to this is the atlas; the contact point, of course, is the transverse process or lateral aspect of the posterior arch. The contact point for the vertebra adjacent to the top or bottom one is on the side opposite the fixation. The top or bottom vertebra is contacted on the side opposite the adjacent vertebra. The pattern, then, is to contact the top vertebra in a posterior fixation on the side of fixation, or the bottom vertebra on the side opposite fixation.

Example - Right Posterior Fixation

3-41 . Contact top vertebra on side of fixation and ver­

tebra below on opposite side. Give a quick one-two type adjustment, with first movement to top vertebra.

Contact for an anterior fixation described above is opposite that described by this author in previous publi­

cationsYS,116 Although the contact described for an an­

terior fixation in the previous publications has been effective for the author, it is opposite that described by Goodheart.38 This was pointed out by Conable,19 who made an analysis and hypothesis of how fixations are unlocked. The change here is to maintain consistency on

the subject. .

The manipulation to unlock a fixation is a two-step thrust. The first thrust is on the top or bottom vertebra of the complex, as indicated. Almost immediately following there is a quick thrust from the opposite hand on the ad­

jacent vertebra. There is usually an audible release; how­

ever, it is not necessary for effective correction. Effectiveness is indicated by strengthening of the bilateral muscle weak­

ness, and no positive therapy localization combined with spinal movement of the area.

Example - Left Anterior Fixation

3-42. Contact bottom vertebra opposite side of fixa­

tion and the vertebra immediately above on the side of fixation. Give a quick one-two type adjustment, first movement to bottom vertebra.

In document CATALONIA, PORTUGAL AND NAPLES (1640-1647) (página 52-57)