Flexion /Distraction AT5422 Introduction to Flexion / Distraction

Leander Technique A method of introducing a patient’s spine to continuous passive motion for a short period of time for the purpose of analyzing the degree of motion or fixation of a spinal motion unit, augmenting the manual adjustment, and then re-checking to ascertain the efficacy of the adjustment.

Leander Technique –Terminology & Definitions Spinal Motion Unit Distraction Long Axis Distraction (LAD) Long Axis Fixation (LAF) Motion Assisted Palpation (MAP) Motion Adjusting (MA)

Spinal Motion Unit Is made up of two adjacent vertebrae and their intervening soft tissues. Motion or fixation is described in terms relative to the subjacent vertebra.

Leander Technique –Terminology & Definitions Spinal Motion Unit Distraction Long Axis Distraction (LAD) Long Axis Fixation (LAF) Motion Assisted Palpation (MAP) Motion Adjusting (MA)

Distraction Distraction: The separation of joint surfaces through mechanical means, and is an articular phenomenon rather than simply a musculotendinous stretching, as in the case of traction.

Leander Technique –Terminology & Definitions Spinal Motion Unit Distraction Long Axis Distraction (LAD) Long Axis Fixation (LAF) Motion Assisted Palpation (MAP) Motion Adjusting (MA)

Long Axis Distraction L.A.D. is the separation of vertebral joint surfaces in the Y plane of the three plane coordinate system. It is generally palpable as a separation of adjacent spinous processed during motorized flexion distraction.

Leander Technique –Terminology & Definitions Spinal Motion Unit Distraction Long Axis Distraction (LAD) Long Axis Fixation (LAF) Motion Assisted Palpation (MAP) Motion Adjusting (MA)

Long Axis Fixation L.A.F. is the restriction of the normal separation of vertebral joint surfaces. It is represented by a lack of palpable separation of the spinous processes when the spine is under motorized flexion distraction.

Leander Technique –Terminology & Definitions Spinal Motion Unit Distraction Long Axis Distraction (LAD) Long Axis Fixation (LAF) Motion Assisted Palpation (MAP) Motion Adjusting (MA)

Motion Assisted Palpation Palpation of vertebral long axis, rotation, and lateral flexion joint play, or the lack thereof, during motorized flexion distraction, and lumbar flexion and extension joint play during side posture lateral table flexion.

Leander Technique –Terminology & Definitions Spinal Motion Unit Distraction Long Axis Distraction (LAD) Long Axis Fixation (LAF) Motion Assisted Palpation (MAP) Motion Adjusting (MA)

Motion Adjusting Motion adjusting is the manual correction of single or multiple joint fixation while the motion unit is placed in continuous passive flexion distraction on a motorized flexion distraction table.

F/D Benefits – 4 main benefits 1) Increase of the intervertebral disc height to remove annular distortion in the pain sensitive peripheral annular fibers. 2) Allow the nucleus pulposus to assume it’s central position within the annulus and relieve irritation of the pain sensitive fibers.

F/D Benefits – 4 main benefits 3) Restore vertebral joints to their physiological relationships of motion 4) Improve posture and motion while relieving pain and improving body function

Orthogonal System Six Degrees of Freedom Flexion…+  X Extension...-  X Rotation...+/-  Y Lateral Flexion…+/-  Z

Six Degrees of Freedom Rotation about the X axis In the sagittal plane…Flexion and extension

Six Degrees of Freedom Rotation about the Y axis In the transverse plane…Rotation

Six Degrees of Freedom Rotation about the Z axis In the coronal plane…Lateral flexion

Subluxation A motion segment, in which alignment, movement integrity, and/or physiological function are altered although contact between joint surfaces remains intact.

F/D Conditions The following are spinal conditions treated on a motorized Flexion/Distraction table: 1) Sciatica 2) General back pain 3) Scoliosis 4) Facet Syndrome 5) Spondylisthesis 6) Joint Dysfunction 7) DJD

Possible Listings TVP - RP/LP Vertebral Body - BR/BL Spinous Process - PL/PR Orthogonal - +/-  Y

Motion Assisted Palpation (MAP) Motion assisted palpation is the analysis of spinal joint motion during motorized continuous passive motion flexion distraction.

During motorized flexion/distraction, there should be a small yet palpable separation occurring between two adjacent vertebrae. Long Axis Distraction (LAD)

Loss of the normal movement between spinous processes: Long Axis Fixation (LAF) »Primary Fixation

Secondary Component When present will be at the same level as the primary fixation. Rotation Lateral wedging All of the above and more

Thoracic (Rotation) Head rotation to one side causes the spinous processes to rotate to the opposite side…approximately the level of L2.

Lateral flexion Lack of movement of the spinous processes during lateral flexion indicates an open wedging on the side of attempted lateral bending.

Lumbar (Lateral Flexion) From C2 to T6, the spinous processes will tend to rotate away from the direction of lateral flexion (toward the convexity) From T6 on down, the spinous processes will tend to rotate towards the direction of lateral flexion (toward the concavity)

Malposition Describes an abnormal position of an object.

Misalignment = Malposition Malposition = Fixation Fixation = next slide

Fixation – Loss of normal motion of the joint. The fixation can be found anywhere within the normal physiological range of the joint when the examiner motion palpates the segment.

Causes of a Fixation Trauma Toxins Thoughts Postural Defects Disuse Congenital abnormalities

S/S of Fixation Pain Spasm Edema Loss of tone and strength Impaired circulation Formation of trigger points Hypo/Hypermobility

Fixation is where the vertebral body is stuck. Restriction is where the vertebral body cannot go.