Full Spine Technique®Andrew Still's principles of osteopathy established a decade earlier. •Ernst...

Full Spine Technique®

Dr.,PhD., Seungmo Yoo

[email protected]

법정비급여

• 실비 의료보험 적용

• 고지 의무

– 제45조(비급여 진료 비용 등의 고지)

– 비급여 진료 비용을 환자 또는 환자 보호자가 쉽

게 알 수 있도록 고지하여야 한다

– 환자로부터 징수하는 제증명 수수료의 비용을 게

시

– 고지·게시한 금액을 초과하여 징수할 수 없다

제42조의2(비급여진료비용등의고지)

① 법 제45조제1항에 따라 의료기관 개설자는 비급여 대상의 항목(행위·약제

및 치료재료를 말한다. 이하 이 조에서 같다)과 그 가격을 적은 책자 등을 접수

창구 등 환자 또는 환자의 보호자가 쉽게 볼 수 있는 장소에 갖추어 두어야 한

다. 이 경우 비급여 대상의 항목을 묶어 1회 비용으로 정하여 총액을 표기할 수

있다.

② 법 제45조제2항에 따라 의료기관 개설자는 진료기록부 사본·진단서 등 제증

명수수료의 비용을 접수창구 등 환자 및 환자의 보호자가 쉽게 볼 수 있는 장소

에 게시하여야 한다.

③ 인터넷 홈페이지를 운영하는 병원급 의료기관은 제1항 및 제2항의 사항을

제1항 및 제2항의 방법 외에 이용자가 알아보기 쉽도록 인터넷 홈페이지에 따

로 표시하여야 한다

Medical Care vs Chiropractic Care

Balance = 均衡

Mental Balance

Physical Balance

Chemical Balance

Health(Balance) vs Disease(Unbalance)

Balance

Unbalance

History of Chiropractic

• The roots of chiropractic care

– can be traced all the way back to the

beginning of recorded time.

– Writings from China and Greece written in

2700 B.C. and 1500 B.C. mention spinal

manipulation and the maneuvering of the

lower extremities to ease low back pain.

• Hippocrates

– the Greek physician, who lived from 460 to

357 B.C., also published texts detailing the

importance of chiropractic care.

– In one of his writings he declares, "Get

knowledge of the spine, for this is the

requisite for many diseases".


• D.D.Palmer

– began in 1895 when Daniel David Palmer of Iowa performed the first

chiropractic adjustment on a partially deaf janitor, Harvey Lillard, who then

mentioned a few days later to Palmer that his hearing seemed better.

• Palmer, D.D. (1910) The Science, Art and Philosophy of Chiropractic Portland,

Oregon: Portland Printing House Company

– This led to Palmer opening a school of chiropractic two years later

– The word "chiropractic" was coined from Greek root words by Rev. Samel

Weed.

– Chiropractic's early philosophy was rooted in vitalism, naturalism,

magnetism, spiritualism and other constructs that were not amenable to the

scientific method.


• D.D.Palmer

– Chiropractic's founder, D.D. Palmer, attempted to

merge science and metaphysics.

• Leach, Robert (2004). The Chiropractic Theories: A

Textbook of Scientific Research. Lippincott, Williams and

Wilkins. p. 15.

– In 1896, D.D. Palmer's first descriptions and underlying

philosophy of chiropractic was strikingly similar to

Andrew Still's principles of osteopathy established a

decade earlier.

• Ernst E (2008). "Chiropractic: a critical evaluation". J Pain

Symptom Manage 35 (5): 544–62.


• D.D.Palmer

– Palmer drew further distinctions by noting that he

was the first to use short-lever HVLA manipulative

techniques using the spinous process and

transverse processes as mechanical levers.

– He described the effects of chiropractic spinal

manipulation as being mediated primarily by the

nervous system.

• D.D. Palmer's Lifeline


• Chiropractic Milestones

– 1896 (January/April): Dr. D.D. Palmer administers two adjustments to the spine of Mr.

Harvey Lillard in an effort to improve his hearing.23

– 1896 (Spring): Reverend Samuel Weed suggests Greek stems from which D.D. Palmer

devises the term "chiropractic," meaning done by hand.35

– 1896 (July): D.D. Palmer obtains a corporate charter for the Palmer School of Magnetic

Cure, wherein he teaches chiropractic; Leroy Baker is D.D. Palmer's first chiropractic

student.30,36,39

– 1906: The Universal Chiropractors' Association (UCA) is founded in Davenport, Iowa, to

provide legal protective services to chiropractors charged with the unlicensed practice of

medicine; the UCA will gradually expand its services to educational and political actions.22

– 1907: Shegetaro Morikubo, DC, a 1906 graduate of the Palmer School of Chiropractic, is

the earliest known chiropractor to be acquitted of unlicensed practice - by a jury in

LaCrosse, Wis. His legal defense will form the basis for future trials, "philosophy," and

legislative efforts.22,32



– 1910: D.D. Palmer releases his most important and best known book: The Chiropractor's Adjuster:

The Science, Art & Philosophy of Chiropractic.26

– 1913 (April 20): Kansas passes the first chiropractic statute; however, formation of a Board of

Chiropractic Examiners is delayed because the governor refuses to appoint members of the board on

the grounds that all chiropractors had practiced illegally prior to passage of the statute.27,34

– 1913 (Oct. 20): D.D. Palmer, founder of chiropractic, passes away at his home in Los Angeles. Death

is due to typhoid fever, but son B.J. Palmer, DC, will be unfairly accused of patricide.12,29

– 1918-1922: World War I ends and the U.S. government pays the tuition for returning veterans;

chiropractic college enrollments skyrocket; the Palmer School of Chiropractic achieves a student body

of 3,000.9,15,17

– 1922: The American Chiropractic Association (ACA) is first organized in opposition to Dr. B.J. Palmer

and the Universal Chiropractors' Association.16

– 1924 (August): B.J. Palmer, DC, officially introduces the neuro-calometer.13,17



– 1925: Wisconsin and Connecticut pass the first basic science statutes; these laws will eventually

spread to 24 American states and a few Canadian provinces.10,21

– 1926 (September): B.J. Palmer, DC, fails in his bid for re-election as secretary of the Universal

Chiropractors' Association, and one week later, establishes the Chiropractic Health Bureau, later

renamed the International Chiropractors Association (ICA).11,17

– 1926 (September): The International Congress of Chiropractic Examining Boards is founded in Kansas

City33; this federation will be reorganized as the Council of State Chiropractic Examining Boards in

1934, and renamed the Federation of Chiropractic Licensing Boards circa 1970.

– 1930: The National Chiropractic Association (NCA) is organized by amalgamation of the UCA and the

ACA.16,18,22

– 1931: Chittenden Turner authors The Rise of Chiropractic, an early history of the profession.33

– 1933: Warren L. Sausser, DC, of New York City introduces the upright, 14-inch x 36-inch, full-spine

X-ray to further Logan Basic Technique.28,38



– 1940 (July 20): The Allied Chiropractic Educational Institutions (ACEI), which includes

the Carver, Cleveland, Eastern, O'Neil-Ross, Palmer, Ratledge and Texas Colleges,

issue an ultimatum to the National Chiropractic Association and its Committee on

Education. The ACEI insists that instruction in physiotherapeutics and the lengthening

of the chiropractic curriculum must cease. This marks the start of a vigorous, three-

decade battle over chiropractic educational standards which will only be settled when

the CCE is recognized by the U.S. Office of Education in 1974.21

– 1941: The NCA publishes the first edition of Chiropractic Education: Outline of a

Standard Course, authored by former COSCEB president John J. Nugent, DC, who is

newly appointed as NCA's director of education.21,25

– 1944: The Chiropractic Research Foundation (today's FCER) is established by the

leadership of the National Chiropractic Association.20

– 1945: World War II ends and returning veterans enjoy the educational benefits of the

G.I. Bill; chiropractic college enrollments skyrocket.21



– 1945 (December): The National Chiropractic Insurance Company (today's NCMIC Group, Inc.)

is chartered by the board of directors of the National Chiropractic Association; it receives

authorization to sell malpractice insurance from the Iowa Commissioner of Insurance in early

1946.22

– 1947 (Aug. 4): At the urging of NCA Director of Education, John J. Nugent, DC, the NCA

House of Delegates establishes the Council on Education, forerunner of today's Council on

Chiropractic Education.21

– 1961 (May 27): B.J. Palmer, DC, PhC, dies in Sarasota, Fla.24 His passing gives hope that

greater unity within the profession is possible, and thereby prompts the formation of the

American Chiropractic Association three years later.

– 1962-63: The National Board of Chiropractic Examiners (NBCE) is founded and chartered by

the officers of the Council of State Chiropractic Examining Boards (COSCEB).19

– 1963 (November): The American Medical Association organizes its Committee on Quackery

with the explicit intent to contain and subsequently eliminate the chiropractic

profession.31,34



– 1963-64: The current American Chiropractic Association is founded through

merger of the NCA and a splinter group from the ICA.

– 1965: William D. Harper, MS, DC, and Joseph Janse, DC, ND, testify in federal

district court in Louisiana in the "England Case," an attempt to overturn the

state's restrictive medical practice act which deems the practice of chiropractic

as the practice of medicine; the case is lost and chiropractors will practice

illegally until 1974, when a chiropractic statute is finally enacted.1,34

– 1971: National College of Chiropractic achieves federally recognized regional

accreditation from the New York State Department of Education; the first

chiropractic school to achieve this distinction. Regional accreditation makes

National alumni license-eligible in the Empire State, and buttresses the efforts of

the Council on Chiropractic Education to achieve recognition from the U.S.

Office of Education as a specialty accrediting body.4,21



– 1972: The U.S. Congress authorizes payments to chiropractors for services rendered to

Medicare patients.34

– 1974 (Aug. 26): The Council on Chiropractic Education (CCE) is recognized by the U.S.

Commissioner of Education as an accrediting agency for chiropractic schools.21,34

– 1974: Louisiana becomes the 50th American state to authorize the practice of

chiropractic.8,34

– 1976 (October): Chiropractors Chester A. Wilk, Patricia A. Arthur, James W. Bryden, Steven C.

Lumsden and Michael D. Pedigo file suit against the AMA and several other defendant

organizations and individuals for violations of the Sherman Antitrust Act. 2,6,341978 (March):

The first issue of the Journal of Manipulative & Physiological Therapeutics, the profession's

pre-eminent scholarly and scientific periodical, is issued. The JMPT will be indexed in Index

Medicus commencing in 1981.14



– 1980 (October): The Association for the History of Chiropractic is founded at

Spears Chiropractic Hospital in Denver, and holds its first annual Conference on

Chiropractic History the following year at the Smithsonian Institute in Washington,

D.C.7

– 1987 (Aug. 27): Federal District Court Judge, Susan Getzendanner, finds in favor

of the plaintiffs in Wilk, et al. v AMA, et al.; various appeals to higher courts

sustain Getzendanner's ruling, which holds AMA, et al., in violation of the

Sherman Antitrust Act.6,34

– 1992: Walter I. Wardwell, PhD, authors, and Mosby-Yearbook publishes,

Chiropractic: History & Evolution of a New Profession, a scholarly textbook of

chiropractic history.34



– 1994: The U.S. Agency for Health Care Policy & Research

issues its Clinical Practice Guidelines for Acute Low Back

Problems in Adults, which recommends spinal manipulative

therapy for low back pain.5

– 1995: The chiropractic profession celebrates its centennial

with festivities in Washington, D.C. and Davenport, Iowa.

– 1996: The Association of Chiropractic Colleges issues its

"Paradigm" of chiropractic, which is widely endorsed by

state, national and international chiropractic organizations.3


1.Adams, Paul J. Trial of the England case. ACA Journal of Chiropractic 1965 (May);2(5):13,44.

2.AMA antitrust suit filed by chiropractors. Digest of Chiropractic Economics 1976 (Nov/Dec); 19(3):44-6.

3.Association of Chiropractic Colleges. Position paper #1. JMPT 1996 (Nov/Dec);19(9):634-7.

4.Beideman, Ronald P. In the Making of a Profession: The National College of Chiropractic, 1906-1981. Lombard, IL: National College of Chiropractic, 1995.

5.Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14. Rockville, MD: AHCPR Publication No. 95-0642, 1994.

6.Chapman-Smith, David. The Wilk case. JMPT 1989 (Apr);12(2):142-6.

7.Chiropractic historical society formed in Denver. Digest of Chiropractic Economics 1980 (Nov/Dec);23(3):4.

8.Espina, Michael A., Jr. Governor Edwards signs new law. Digest of Chiropractic Economics 1974 (July/Aug);17(1):50-1.

9.Ferguson, Alana K., Wiese, Glenda C. How many chiropractic schools? An analysis of institutions that offered the DC degree. Chiropractic History 1988 (July);8(1):26-36.

10.Gevitz, Norman. "A coarse sieve"; basic science boards and medical licensure in the United States. Journal of the History of Medicine & Allied Sciences 1988;43:36-63.

History of Chiropractic : Reference

11. Gibbons, Russell W. Vision to action: a history of ICA: the first 60 years. ICA Review 1986 (Mar/Apr);42(2):33-64 (Supplement).

12.Gibbons, Russell W. "With malice aforethought": revisiting the B.J. Palmer "patricide" controversy. Chiropractic History 1994 (June);14(1):28-34.

13.Keating, Joseph C. Introducing the neurocalometer: a view from the Fountain Head. Journal of the Canadian Chiropractic Association 1991 (Sept);35(3):165-78.

14.Keating, Joseph C. Toward a Philosophy of the Science of Chiropractic: A Primer for Clinicians. Stockton, CA: Stockton Foundation for Chiropractic Research, 1992.

15.Keating, Joseph C. The influence of World War I upon the chiropractic profession. Journal of Chiropractic Humanities 1994;4:36-55.

16.Keating, Joseph C. The short life and enduring influence of the American Chiropractic Association, 1922-1930. Chiropractic History 1996 (June);16(1):50-64.

17.Keating, Joseph C. B.J. of Davenport: The Early Years of Chiropractic. Davenport, IA: Association for the History of Chiropractic, 1997.

18.Keating, Joseph C. Roots of the NCMIC: Loran M. Rogers & the National Chiropractic Association, 1930-1946. Chiropractic History 2000 (June);20(1):39-55.

19.Keating, Joseph C. Birth of the National Board of Chiropractic Examiners. Journal of Chiropractic Education 2003 (Fall);17(2):89-104.

20.Keating, Joseph C., Green, Bart N., Johnson, Claire D. "Research" and "science" in the first half of the chiropractic century. JMPT 1995 (July/Aug);18(6):357-78.


21.Keating, Joseph C., Callender, Alana K., Cleveland, Carl S. A History of Chiropractic Education in North America: Report to the Council on Chiropractic Education. Davenport, IA: Association for the History of Chiropractic, 1998.

22.Keating, Joseph C., Sportelli, Louis, Siordia, Lawrence. We Take Care of Our Own: NCMIC and the Story of Malpractice Insurance in Chiropractic. Clive, IA: NCMIC Group, Inc., 2004.

23.Lillard, Harvey. Deaf seventeen years. The Chiropractic 1897 (Jan);No. 17, p. 3.

24.Luckey, William L. Dr. B.J. Palmer dies at age 79; called developer of chiropractic. Digest of Chiropractic Economics 1961 (May/June);3(6):21, 31.

25.Nugent, John J. Chiropractic Education: Outline of a Standard Course. Webster City, IA: National Chiropractic Association, 1941.

26.Palmer, Daniel David. The Chiropractor's Adjuster: The Science, Art and Philosophy of Chiropractic. Portland, OR: Portland Printing House, 1910.

27.Rehm, William S. Kansas coconuts: legalizing chiropractic in the first state, 1910-1915. Chiropractic History 1995 (Dec);15(2):43-50.

28.Sausser, Warren L. New spinographic technique: the full length X-ray plate is a success. The Chiropractic Journal (NCA) 1933 (July);1(7):25.

29.Siordia, Lawrence, Keating, Joseph C. Laid to uneasy rest: D.D. Palmer, 1913. Chiropractic History 1999 (June);19(1):23-31.

30.The Chiropractor 1906 (June);2(7):20.


31.Trever, William. In the Public Interest. Los Angeles: Scriptures Unlimited, 1972.

32.Troyanovich, Stephen J., Keating, Joseph C. Wisconsin versus chiropractic: the trials at La Crosse and the birth of a chiropractic champion. Chiropractic History 2005 (Summer);25(1):37-45.

33.Turner, Chittenden. The Rise of Chiropractic. Los Angeles: Powell Publishing Company, 1931.

34.Wardwell, Walter I. Chiropractic: History and Evolution of a New Profession. St. Louis: Mosby, 1992.

35.Weed, Samuel. The Chiropractor 1905 (Apr);1(5):16-7.

36.Wiese, Glenda. New questions: why did D.D. not use "chiropractic" in his 1896 charter? Chiropractic History 1986;6:63.

37.Willis, John C. Notes from the editor. Chiropractic History 1996 (June);16(1):2.

38.Young, Kenneth J. Warren L. Sausser, DC: influence unrecognized. Chiropractic History 1997 (June);17(1):75-83.

39.Zarbuck, Merwyn V. Chiropractic parallax. Part 3. IPSCA Journal of Chiropractic 1988c (Jul);9(3):4-6, 17-9.


• Dr. Yoo

– In the year 1994, I started Chiropractic. Later, I teached chiropractic

technique to many medical doctors in Suan Medical association and my Dr.

Yoo biomechanic research institute.

– This is really my passion ~ studying the biophysics and many chiropractic

techniques. The fruits of these efforts have resulted in Full Spine Technique.

– My Full Spine Technique(FST) is very easy to learn and very effective

technique

– We developed a new seminar program called Full Spine Technique which

combines our clinical experience -based technique together with patient

and practice management procedures ~ Systems ~ to improve your patient

care and your practice.


• My Lecture In the Chosun medical university


• History of Chiropractic

• Chiropractic: Why Choose Conservative

Care First?

• Pain : Chiropractic can help

https://www.youtube.com/watch?feature=player_detailpage&v=HbOE-xxFiTM

https://www.youtube.com/watch?feature=player_detailpage&v=b4nd8L37TLU

https://www.youtube.com/watch?feature=player_detailpage&v=Q0FWesDQJ_8

What is Full Spine Technique ?

• Health = Balance of Mental, Chemical, Physical state

• 교정치료 = 均衡의 治療= Balance (= Hollistic therapy)

• Homeostasis


• Bases of Technique

– Dr. White & Panjabi-axis

– CBP( D.C Don Harrison)

– Deversified technqiue

– Gonstead technique

– Leander technique

– AMCT

– SOT( D.C De Janette )

– Others


• Homeostasis (Live Blood Demonstration)

정상적인혈액상

교정치료전

교정치료후

The Merits of Full Spine Technique

• Easy to learn

• Easy to approach

• More Scientific technique – Axis Base

• Very effective

– Case 1. HNP (L4~L5)

– Case 2. Scoliosis

• Non Insurance base

About the Founder

• Dr. Yoo

– In Korea

• Dr. Weber (CBP)

• Dr. Colemann (CBP)

• Dr. Pettibon (Pettibon technique)

• Dr. Donald Harrison and Deanne Harrison(CBP)

• Dr. Stillwagon(Pierce Stillwagon Technique)

• Dr. Leander(Leander technique)

• Dr. Nancy(Extremity)

• Principle of Axis ( Dr. White & Panjabi )

– Clinical biomechanics of the spine

– Augustus A. White, Manohar M. Panjabi

About the Developer

• Dr. Yoo

– In USA

• Dr. Stillwagon Clinc (Pierce Stillwagon Technique)

• Dr. Weber Clinic(Diversified and CBP) : 3425 S Tacoma WayTacoma, WA

98409 (253) 471-2225 (Office) Dr. Vernon A. Weber Sr., DC

• Dr. Colemann Clinic (CBP) : 1344 E Main St. Othello, WA 99344 , (509)

488-9679 (Office) (509) 488-9670 (Fax)

• Dr. Christopher J. Colloca Clinic (AMCT) : Neuromechanical Innovations,

Intrnational Spine Research (INSPIRE) Foundation, Colloca Estate, 888 •

294 • 4750

• Dr. Nancy : Extremity

• Live Blood demonstration Seminar

Co-workers & Instructors of FST

• Dr. Ph.D., Seungmo Yoo, President

• Dr. Kyungjin Kim, Vice President

• Dr. Manwoo Lee

• Dr. Kangho Kim

• Dr. Eul Choi

• Dr. Younghoon Kim

Principle of Full Spine Technique

Subluxation (아탈구)

• Definition

• Past ; bone out of place

• Present ; 우리인체에생기는단지불편함을포함하

여 이상증후군, dis-ease, disease, symptom,

abnormal sign (Mental level, Physical level, Chemical

level)


Subluxation (아탈구)

• Kinds of Stress

• Mental stress

• Physical stress

• Chemical stress

• Pain Sensitivity


• 손과 접촉의 관계


접촉수 ( Contact hand ) 또는교정수 ; 교정또는치료를위하여환자의몸에닿는의사의손을말한다.

보조수또는안정수(Indifferent Hand or

Stabilization Hand ) ; 접촉수로치료위치를접촉하여치료를할때보조수는환자의 setting에서움직임을방지하기위하여사용한다

• Axis (Translation) : Tz / Tx / Ty


• Axis (Translation) : Tz / Tx / Ty


양의방향으로 head가 z-축에대하여전이가일어나있다면표

기법은 +Tzh로표기한다

• Axis (Rotation) : Rz / Rx / Ry


• Axis (Rotation) : Rz / Rx / Ry


양의방향으로 head가 z-축에대하여회전변위가일어나있다

면표기법은 +Rzh로표기한다

• Affects of Reversible Change


• Adjustment

– Set up

– Skin Pull

– High Speed

– Low amplitude

– LOC=Line of correction / LOD=Line of Drive

– Open Wedge -> Close


Effects of Full Spine Technique

• Pain relief

• Restoration of range of motion

• Relief of disability

• Return to activities of daily living

• Muscle strengthening

• Improved gait

• Improved posture

Article• Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial

• Joshua A. Clelanda,b, , Maj. John D. Childsc, Meghann McRaed, Jessica A. Palmera, Thomas Stowell

• Abstract

– Mechanical neck pain is a common occurrence in the general population resulting in a considerable economic burden.

– Often physical therapists will incorporate manual therapies directed at the cervical spine including joint mobilization and manipulation into the management of patients with cervical pain.

– Although the effectiveness of mobilization and manipulation of the cervical spine has been well documented, the small inherent risks associated with these techniques has led clinicians to frequently utilize manipulation directed at the thoracic spine in this patient population.

– It is hypothesized that thoracic spine manipulation may elicit similar therapeutic benefits as cervical spine manipulation while minimizing the magnitude of risk associated with the cervical technique.

– The purpose of this randomized clinical trial was to investigate the immediate effects of thoracic spine manipulation on perceived pain levels in patients presenting with neck pain.

– The results suggest that thoracic spine manipulation results in immediate analgesic effects in patients with mechanical neck pain.

– Further studies are needed to determine the effects of thoracic spine manipulation in patients with neck pain on long-term outcomes including function and disability.

Indication of Full Spine Technique

• Neck, mid back and low back

pain

• Chronic muscle pain and

inflammation

• Acute and chronic muscle spasm

• Decreased spinal range of motion

• Chronic fibrositis

• Nerve entrapment

• Pseudo-sciatica

• Sciatica where disc bulges are

contained less than 5 mm

• Failed back surgery

• Chronic occipital or tension

headaches

• Conditions where narcotic pain

relievers are of little benefit

• Traumatic torticollis

• RSD

Contraindication of Full Spine Technique

• Malignancy with metastasis to bone

• Tuberculosis of the bone

• Fractures

• Acute arthritis

• Acute gout

• Uncontrolled diabetic neuropathy

• Syphilitic articular or periarticular lesions

• Gonorrheal spinal arthritis

• Excessive spinal osteoporosis

• Evidence of cord or caudal compression by tumor, ankylosis and

malacia bone disease.

Complications of Full Spine Technique

1. Vertebral – basilar stroke

2. Pathologic fracture

3. Transverse ligament rupture

4. Increased instability

5. Permanent neurological deficits

6. Rib Fracture

7. Perforation of Tympanic Membrane

Common cold

Acute or Chronic Otitis Media

Full Spine Technique Protocol (Diagnosis)

• History Taking

– 자세한 병력 청취와 기록은 질병, 예후, 그리

고 적절한 치료에 대한 귀중한 정보 제공


• History Taking (PQRST Method for Pain Assessment)

① P = Provokes ; What causes pain?, What makes it better?, Worse?

② Q = Quality ; What does it feel like?, Is it sharp?, Dull?,

Stabbing?, Burning?, Crushing? ( Try to let patient describe the

pain, sometimes they say what they think you would like to hear. )

③ R = Radiates ; Where does the pain radiate?, Is it in one

place?, Does it go anywhere else?, Did it start elsewhere and

now localised to one spot?

④ S = Severity ; How severe is the pain on a scale of 1 - 10?,

( This is a difficult one as the rating will differ from patient to

patient. )

⑤ T = Time ; Time pain started?, How long did it last?


• History Taking (SOAP)

① Subjective ; The subjective portion is evaluated by taking the

patient's history

② Objective ; The objective portion is evaluated by observation and

special tests that measure an objective component

③ Assessment ; The assessment is based on the compilation of the

subjective and objective findings and the examination

④ Plan ; The plan may include further testing and/or treatment

options


• Range of Motion

– 보험청구 EX 773

• 월1회 이상 실시하더라도 1회만 산정가능

• 너 773


• Range of Motion

– Goniometer


• Range of Motion


• Range of Motion (참고문헌)

– Photographic Manual of Regional

Orthopaedic and Neurologic Tests , Joseph

J. Cipriano DC (Author)

– Musculoskeletal Assessment, Joint range

of motion and manual muscle strength,

Hazel M. Clarkson


• Physical examination(Topographical Landmarks)

– Anterior Landmarks

1. Hyoid bone : 3번 경추의 반대편

2. 갑상 연골 : 4-5번 경추의 반대편에 위치

3. Jugular notch : T2의 반대편에 위치

4. 검상돌기 : 흉추 10번의 반대편에 위치

5. 배꼽 : 요추 3번의 반대편에 위치

6. ASIS : anterior superior iliac spine


• Physical examination(Topographical Landmarks)

– Posterior Landmarks

1. EOP : 후두골의 기저에서 중앙선에 위치

2. C1의 TP : Mastoid process의 전방 하방에 위치

3. C2의 SP : EOP에서 첫번 째로 현저하게 융기된 뼈.

4. C7의 SP : 하부 경추의 가장 현저하게 융기된 뼈.

5. T1의 SP: 상부 흉추 중에서 가장 현저하게 융기된 뼈

6. T3의 SP : 견갑골의 spine의 뿌리 부근에 점을 찍고 양측을 잇는 선이 지나는 중심선

부근

7. T6의 SP : 엎드렸을 때 견갑골 하각을 잇는 선이 지나는 곳의 SP

8. T7의 SP : 앉아 있거나 서있을 때 견갑골 하각을 잇는 선이 지나는 중심 부근

9. L4 의 SP : 장골능 최상부에 양측에 점을 찍고 그 점을 잇는 선이 지나는 중심 부근

10. S2의 결절 : 후상 장골극의 내방


• Physical examination (Orthopaedic Test)

– Head and Neck Tests



– Trunk and Abdomen Tests



– Hip And Pelvis Tests


• Posture analysis

– Anterior

• glabella, 인중, symphysis menti, episternal notch, 배꼽, symphysis pubis,

both knee 사이가 동일한 Y-축상에 있는지

– Lateral

• external auditory meatus, acromion의 중앙, iliac crest의 최상부,

acetabulum의 중앙, lateral knee, mid-ankle부위가 일직선상에 있는지


• Posture analysis

머리기울기, 어깨높이, hip

의높이, 측면에서본귀와

어깨, hip, 발목의위치등을

파악


• Leg Length Analysis

단족 = short leg

1. anatomical short leg ( 해부학적단족 ) : 선천적또는후

천적으로골절이나수술로짧아진다리를말한다.

2. 2. functional short leg ( 기능적단족 ) = Pelvic

deficiency : 실제다리길이는같지만인체를구성하고

있는근육, 신경등의장애로인하여일시적으로또는영

구적으로다리길이가짧아지는경우-이런경우가수기

요법의대상이된다.

• Leg Length Analysis (단족의 원인)

– Neuromuscular contraction

• 근육의 불균형은 Bulboreticular formation의 imbalance의 결과로 야기된다.

• Bulboreticular formation의 두 종류

– Facilitory area – 근육 수축

» Reticular formation : Upper & Lateral portions of the medullar, Pons,

Mescencephalon, Diencephalon

» Vestibular nuclei

– Inhibitory area – 근육 이완

» Basal ganglia

» Cerebellum

» Cerebral Cortex


• Leg Length Analysis (단족의 원인)

– Biomechanical malposition

• Gonstead 박사

• 방사선 사진으로 검사할 때 정상적인 골반은 대퇴두부(femur

head)의 높이를 수평으로 보여줄 것이다.

• 뒤쪽으로 혹은 바깥쪽으로 malposition(위치이상)이 된 장골 때

문에 대퇴두부(femur head)의 한쪽은 낮은 위치가 된다.

• 대퇴두부(femur head)는 앞쪽으로 혹은 안쪽으로

malposition(위치이상)이 된 장골 쪽으로 올라갈 것이다.

• 골반의 양쪽으로 malposition(위치이상)이 존재하는 것처럼 관

찰되는 단족의 원인은 이런 malposition(위치이상)의 결합인 것

이다.


• Leg Length Analysis


어떤다리가더짧은가를결정하기위해서신발

뒷굽의재봉선(SIM)을살펴본다

• X-ray check (영상분석)

– 경추 (Cervical) : AP - Cervical


Listing line 또는 Base Line

추체의 body 하단에서

좌우의모서리에서각

각의점을찍는다.

각각의점을연결하는

가상의선을긋고이선

을 listing line 이라고한

다


– 경추 (Cervical) : Lateral - Cervical


Foramen magnum line

후두과( occipital condyle)의

후방면이두개골(skull)의하

벽(floor)과연결되는지점에

점을찍는다.

후두골기저부의 squama가

위로향하는지점에점을찍

는다.

1과 2의두점을연결하는선

을그린다. 이선을 foramen

magnum line이라고한다




Atlas plane line

atlas의전방중앙에점을

찍는다.

atlas의후궁의가장좁은

곳의중앙에점을찍는다




Odontoid line

odontoid process (OD)의상부

에서 base 까지를 4등분하여

위에서부터 1/4정도내려와

그중앙에점을찍는다.

OD의기저부와경추 2번추

체가만나는지점에서 OD의

중앙에점을찍는다.




Odontoid perpendicular line

그림에서와같이 Odontoid

process의기저부에서약간

밑으로하여 OD line과수직

이되는선을긋고이선을

odontoid perpendicular line

이라고한다




Disc plane lines

경추 2번부터흉추 1번까지각추체(body)

하연의전방과후방에각각점을찍는다

각각의추체에찍은전방과후방의점을잇

는가상의선을긋고이선들보다추체의길

이에 1/4에해당하는위치로상향평행이동

하여선을긋고이선을 disc plane line이라

고한다




Bite line

항상같은조건으로측방사진을얻기위한

요령으로지면과 bite 선이평행이되도록촬

영을하여야한다.

이런조건으로사진을찍어야우리가측정하

는경추에대한스트레스각도를해석하는

데있어서의미를갖게된다




George’s line

경추또는요추의추체후연

의상, 하에점을찍고이점

들을연결하는연속된선을

긋는데바로이선을

George’s line이라고한다.

이선이깨지면경추또는요

추에 Subluxation을의심할

수있다




Stress angle그림과같이경추 2번의추체

후연에각각점을찍는다. 두

점을잇는선을그린다 –

Superior stress line

그림과같이경추 7번의추체

후연에각각점을찍는다. 두

점을잇는선을그린다. –

Inferior stress line

선이서로만나서이루는각도를스트레스

각이라고한다


– 경추 (Cervical) : AP Open Mouth


Transverse Condyle line

후두의좌우

Mastoid notch에

점을각각찍는

다.

두점을잇는

선을긋는다




Transverse Atlas line

환추(경추1번)의

횡돌기

( transverse

process )가환추

의 lateral mass

와만나는하부

에각각점을찍

는다

두점을연결

하는선을긋

고이선을

Transverse

atlas line이라

고한다




Axis Plane Line

경추 2번의

Pedicle

shadow의중

앙에각각점

을찍는다

두점을연

결하는선을

긋고이선

을 Axis

plane line이

라고한다


– 요추 (Lumbar)


Stress angle

요추의스트레스각을재기위하여

superior stress line을작도할때 L1이기준이고

inferior stress line을작도할때 L5가기준이다


– 요추 (Lumbar)


Visual Posteriority

척추전반에걸쳐척추의하나또는일부가후방

으로 translation 된상태를말하며아래사진에서

는요추 4번과요추 5번에서요추 5번의위에있

는요추 4번의추체가후방으로 translation 되어

있는현상을말하며여기에서는요추 4번을

Posteriority가있다고한다.


– 요추 (Lumbar)


Disc Degeneration ( 디스크퇴행 )사진과같이디스크의공간이좁

아져원래대로회복이되지않는

상황을말한다. 이런현상이지속

되면 foraminal enchroachment현

상이일어난다.

foraminal enchroachment현상은

디스크퇴행의한현상으로볼수

있다


– 요추 (Lumbar)


Eburnation

End plates를따라불투과된방사선이아

래사진에서와같이희게나타나는데이

런현상을말하며디스크가 stress를받고

있음을알수있다


– 요추 (Lumbar)


Foraminal Enchroachment

디스크의퇴행성변화등으로인하여후관절부

위에서두개의인접척추가서로가까워지는현

상으로추간공의크기가감소하게된다


– 요추 (Lumbar)


Vertebral Stacking

사진에서우리는정상요추만곡도가소실된것

을관찰할수있다. 측방사진에서보면요추의만

곡도가감소되어military curve의형태를보이고

있다.

이런현상이일어나면 Stack의가장밑에있는분

절에위치한디스크가 stress를많이받게되어문

제를유발할수있다


– 요추 (Lumbar)


Stair stepping

사진에보이는것처럼계단식으로요추의추체들

이후방으로밀리는현상을보이는것을 stair

stepping 이라한다


– 요추 (Lumbar)


Thin Disc

정상적인디스크공간을확보하지못하고디스크

에 dehydration 현상이일어나디스크공간이협

소해진것을관찰할수있다.

퇴행성변화의한현상으로볼수있다


– 요추 (Lumbar)


Hour Glassing

퇴행성으로골밀도가감소하면

서마치모래시계모양으로추체

가변하는것을말한다


– 요추 (Lumbar)


Exostosis = bone spur

퇴행성으로 bone에

골극이형성


– 요추 (Lumbar)


Anterolisthesis

일반적으로척추의추체가전방으로하

나이상 translation이일어나는것을말

하며사진에서는요추 4번의추체가전

방으로밀려나와있는것을보여주고있

다


– 요추 (Lumbar)


Retrolisthesis

일반적으로척추의추체가후방으로

translation되는현상을말하며측방사

진에서요추 4번의추체가후방으로밀

려있는것을보여주고있다


– 요추 (Lumbar)


척추분리증(spondylolisthesis)을분류하는방법

Meyerding's method - L5이척추분리증일때추체의

후방에서천골방향으로선을긋는다. L5의하부분절

인천골(sacrum)을백분율에서와유사한양상으로네

개의부분으로나눈다. 이 line이네개로나뉘어진부

분중어느곳을통과하는지를주의깊게분석한다. 이

선이후방의 1/4에해당되는부분을통과하면등급 I

이라하며, 전방의 1/4 부위를통과하면등급 IV로분

류한다.

• X-ray check (영상분석) : 골반 (Pelvis)


Femur head line

대퇴골두의양쪽최상부에 사진과같이점을

찍는다



Femur head line

두점을잇는선을긋고이선을 Femur head

line이라고한다



Femur head line

무명골의길이를측정하기위하여먼저장골

능의양쪽최상부에각각점을찍는다



Femur head line

그두점을지나는선을그리는데그요령은

대퇴골두선과평행으로이동시켜각각 2인치

정도의길이로긋고이선들을장골능선이라

고한다



Femur head line

좌골최하단의양측에각각점을찍는다



Femur head line

femur head line과평행이되도록좌골최하

단의점까지자를이동시켜 각각 2인치정도

의선을긋는다



Femur head line

선을그리고나서무명골의길이를재기위

하여 a,b,c,d의길이를측정한다. ( a+b의길

이와 c+d의길이를비교한다.) 만일 a+b

< c+d이면 a+b쪽은 AS ilium 이고 c+d쪽은

PI ilium이된다

• X-ray check (영상분석) : 장골 (Ilium)의 분석


AS Ilium = + Rx

1. 무명골(innominate)과폐쇄공(obturator foramen)

의수직높이감소.

2. 생리적장족 side가된다.

PI Ilium= - Rx

1. 무명골과 obturator foramen의수직높이증가

2. 생리학적단족 side가된다.

• X-ray check (영상분석) : 장골 (Ilium)의 분석


① Ex Ilium

① PSIS 와 PIIS 모두천골의중심

에서멀어진다.

② ilium의좌우폭이감소한다

② IN Ilium

① PSIS & PIIS가 dorsal S-I 관절

부위에서안으로이동한다.

② ilium 의좌우폭이넓어짐

• Listing Systems


Designation of the spatial orientation of one vertebra in

relation to adjacent segments.

Each segment is listed in relation to the segment below.

• Listing Systems (Palmer-Gonstead)


i. C2 through L5

Point of reference is always the spinous process

a. First letter is always a P (for posterior – slipped into

extension)

b. Second letter is either R or L (rotation)

c. Third letter, if present, is either S or I (wedging)

a. Hard to palpate

b. Easily seen on x-ray



C2 through L5

Examples

a. PR

b. PL

c. PRI

d. PRS

e. PLI

f. PLS



ii. Ilium

1. Point of reference is the PSIS

a. If the PSIS rocks back – PI ilium

b. If the PSIS rocks anterior – AS ilium

c. If the PSIS is medial – IN ilium

d. If the PSIS is lateral – EX ilium



ii. Ilium

Examples

a. PI

b. AS

c. IN

d. EX

f. ASIN

g. PIEX

h. ASEX



iii. Sacrum

1. Point of reference is the base of the sacrum

list the posterior portion of the base

2. Examples

a. P-R (dash denotes a sacral listing)

b. P-L

c. PI-R

d. PI-L

e. Base Posterior

f. Apex posterior



iv. Coccyx

1. Point of reference is the Apex of the coccyx

2. Examples

a. A – anterior

b. AR – anterior and right

c. AL – anterior and left



v. Atlas

• Point of reference is the anterior tubercle.

• First letter is always an A (anterior)

• Second letter is S or I (superior, inferior) – taken from

lateral view X-ray

• Third letter is R or L (translation side)

• Fourth letter is A or P (anterior or posterior) referring to

the anteriority or posteriority of the side of laterality.



vi. Occiput

• Point of reference is mastoid process

• First two letters are either AS (hyperlordosis) or PS (military neck)

• Second two letters are either RS or LS denoting which side is superior

• Third two letters are either RA, RP, LA, or LP denoting if the superior side

is anterior or posterior.

• Examples:

a. AS

b. PS

c. ASRS

d. ASLS

e. PSRS

f. PSLS

g. ASRSRA

h. ASRSRP

i. ASLSLA

j. ASLSLP

• Listing Systems (National)


i. C2 through L5

• Point of reference is always the vertebral body

• First letter is either R or L (rotation)

• Second letter is always a P (posterior)

• Third letter, if present, is either S or I (wedging)

• Hard to palpate

• Easily seen on x-ray

• Examples

a. LP

b. RP

c. LPI

d. LPS

e. RPI

f. RPS



ii. Ilium (Same as PG)

• Point of reference is the PSIS

• If the PSIS rocks back – PI ilium

• If the PSIS rocks anterior – AS ilium

• If the PSIS is medial – IN ilium

• If the PSIS is lateral – EX ilium

• Examples

a. PI

b. AS

c. IN

d. EX

e. PIIN

f. ASIN

g. PIEX

h. ASEX



iii. Sacrum (Same as PG)

• Point of reference is the base of the sacrum; list the

posterior portion of the base

• Examples

a. P-R (dash denotes a sacral listing)

b. P-L

c. PI-R

d. PI-L

e. Base Posterior

f. Apex posterior



iv. Coccyx (Same as PG)

1. Point of reference is apex

2. Examples

a. A – anterior

b. AR – anterior right

c. AL – anterior left



v. Atlas (Same as PG)

• Point of reference is the anterior tubercle.

• First letter is always an A (anterior)

• Second letter is S or I (superior, inferior) – taken from

lateral view X-ray

• Third letter is R or L (translation side)

• Fourth letter is A or P (anterior or posterior) referring to

the anteriority or posteriority of the side of laterality.



vi. Occiput (Same as PG)

• Point of reference is mastoid process

• First two letters are either AS (hyperlordosis) or PS

(military neck)

• Second two letters are either RS or LS denoting which

side is superior

• Third two letters are either RA, RP, LA, or LP denoting if

the superior side is anterior or posterior.

• Examples: a. AS / b. PS / c. ASRS / d. ASLS / e. PSRS / f. PSLS

g. ASRSRA / h. ASRSRP /i. ASLSLA / j. ASLSLP

• Listing Systems (c. Medicare/Houston Conference)


Flexion malposition

Extension malposition

Right lateral flexion malposition

Left lateral flexion malposition

Right rotation malposition

Left rotation malposition

Anteriolisthesis

Retrolisthesis

Right lateral listhesis

Left lateral listhesis

Left rotational malposition/left

lateral flexion malposition

Right rotational malposition/right


Left rotational malposition/right


Right rotational malposition/left


• Listing Systems (d. International (aka Right handed orthogonal))


Hints: + is clockwise.

Right lateral flexion: +oz

Left lateral flexion: -oz

Right rotation: -oy

Left rotation:+oy

Flexion: +ox

Extension: -ox

Cephalad translation: +y

Caudal translation: -y

Right translation: -x

Left translation:+x

Anterior translation:+z

Posterior translation: -z

• Listing Systems (Simple Listing; Spinous 기준)


• Thermography– 노-776 (EZ776) 체온열 검사 (Thermography)

– 인정 비급여


• Thermography– 노-776 (EZ776) 체온열 검사 (Thermography)

– 인정 비급여


임상적유용성

통증진단

치료효과판정과치료방향즉각적결정.

가병판별시유용.

MRI 등의 필요여부를 알려주는

1차적 Screening test 유용.

척추질환 : 급,만성요통, 좌골신경통, 척추

추간판질환, 척추강협착증, 척추분리증, 척

추골전위증

• 혈액학적 검사

– Complete Blood Count with Differential

– CRP

– RA

– ESR

– Uric acid

– Alkaline Phosphatase

– Calcium

– Vit D 25-OH


• 치료 Plan

– 평균 치료 기간 ; 20회 과정, 대개 5~6회 경부터 호전을 보임, 환자들이 치료 받는데도 왜 자꾸 아프냐고 호소함, 약 5~6회는 더아플 수 있다고 안내하면 됨

– 병증의 정도에 따라 분류

• Mild(약 10회~15회)

• Moderate (약 15회~20회)

• Severe (약 20회 ~30회 )

– VAS Scale

Full Spine Technique Protocol (Treatment Plan)

• Principle of Correction


① LOC

② skin pull

③ High speed

④ Low amplitude

⑤ Set up

⑥ open wedge side -> close ; CP

• Lumbar problem (Type I)


① 족지분석

② 골반교정 (PI, AS) ; drop

• AS (Anterior Superior) = + Rx ; ischium contact

• PI (Posterior Inferior) = - Rx ; PSIS contact

③ Posterior double thenar technique

④ TOS

⑤ Side posture ; AS -->PI = +Rx --> -Rx ; Ischium contact

⑥ Ant. thoracic adjustment

⑦ Side posture ; PI-->AS = -Rx --> +Rx ; PSIS contact

AS (Anterior Superior) = + Rx PI (-Rx)

Ischium contact

PI (Posterior Inferior) = - Rx AS (+Rx)

PSIS contact

Posterior double thenar technique

Side posture, AS-->PI

Ischium contact

Ant. thoracic adjustment (T6~T8)

Side posture, PI (-Rx) --> AS (+Rx)

PSIS contact

• Lumbar problem (Others)


Lumbosacral Balance technique

+ Rz = Right Bending / - Rz = Left Bending



Lumbar Region (+ Rz / - Rz)



Lumbar Region (+ Tz / -Tz)

• Thoracic problem (Others)


Cross Hand Technique

• Pelvis Problem (Others)


Lt side Internal Rotation = + Ry



Double AS = Double + Rx



Double PI = Double - Rx

• Cervical Problem (Type II)


① 족지분석

② 골반교정 (PI, AS) ; drop

• AS (Anterior Superior) = + Rx ; ischium contact

• PI (Posterior Inferior) = - Rx ; PSIS contact

③ Posterior double thenar technique

④ TOS

⑤ Side posture ; AS -->PI = +Rx --> -Rx ; Ischium contact

⑥ Ant. thoracic adjustment

⑦ Side posture ; PI-->AS = -Rx --> +Rx ; PSIS contact

⑧ Supine Cervical Break

Supine Cervical Break

Facet line

Vertebrovascular Accidents ; Soft, Gentle

• Cervical Pproblem (Others)


Drop technique

• Cervical Pproblem (Others)


Thumb Technique

• History taking

• ROM

• Physical examination

– Topographical Landmarks

• Anterior

• Posterior

• Palpation

• Orthopaedic test

• 일반 X-ray 촬영 : Listing

• 체온열 검사

Full Spine Technique Protocol (Reassessment)

Most Frequently Used Techniques(ACA)

1. Diversified 95.9%

2. Extremity manipulating/adjusting

95.5%

3. Activator Methods 62.8%

4. Gonstead 58.5%

5. Cox Flexion/Distraction 58.0%

6. Thompson 55.9%

7. Sacro Occipital Technique [SOT]

41.3%

8. Applied Kinesiology 43.2%

9. NIMMO/Receptor Tonus 40.0%

10. Cranial 37.3%

11. Manipulative/Adjustive

Instruments 34.5%

12. Palmer upper cervical [HIO]

28.8%

13. Logan Basic 28.7%

14. Meric 19.9%

15. Pierce-Stillwagon 17.1%

Article review

• 교정치료의 실제적용(설문조사, 치료계획, 검사, 평가, 치료 후 설문조사)

저자명: 주상연, 옥선명, 유승모

- Conclusions

• 교정치료후환자의전반적인효과및안전성, 효용성평가는의

사,환자, 그리고건강보혐평가하는실무자모두에게필요하다.

• 교정치료후효과판정은쉽게이용할수있는여러설문지를이

용하여, 환자의기능적인평가, 통증변화, 운동범위변화, 환자만

족도변화에대한기록으로이루어질수있겠다.

• 물론국내에서교정치료(도수치료)는비급여항목으로되어있

다.

감사합니다

Full Spine Technique®Andrew Still's principles of osteopathy established a decade earlier. •Ernst...

Documents

Transcript of Full Spine Technique®Andrew Still's principles of osteopathy established a decade earlier. •Ernst...