Changes in apparent leg length (LL) (leg retraction) have been used by many as a means of locating subluxation in various joints. The leg check is based on the assumption that unequal muscular contraction (e.g. hyper irritable muscles) about the spine and pelvis have the ability to retract one leg relative to the other. Despite claims of usefulness, many problems are inherent in the prone leg check such as: a) measurement error; b) subject positioning by the examiner (expectancy bias); c) interference with the surface of the examination table; d) possible overwhelming effects of large muscles over smaller intersegmental muscles and; e) lack of information of the validity of subluxation (eg. segmental aberration) and it’s supposed neurological effects. While observation of leg retraction has not yet been correlated with patient outcome or health measures, it is implied that the phenomenon apparent changes in LL occur due to altered tonic neck and back reflexes which coordinate spinal movements and posture. A video recording has been made of a patient who exhibited an unusually large amount of leg retraction which appeared to be due to asymmetrical contraction of their supra-pelvic musculature upon maneuvers such as tucking their chin.
The purpose of this study is to quantify the involuntary movements which nave been observed about the spine, pelvis and extremities using a 2D motion analysis system.
A subject exhibiting a large involuntary leg retraction will be sought. The patient will be positioned prone on an adjusting table. Retro reflective markers will be placed about their spine, pelvis and extremities. The markers will be recorded by two video cameras during maneuvers which cause the leg to retract.
This data will yield 2D maker locations which will be used to quantify the amount and type of movement.
Despite claims of utility of the prone leg check to locate subluxation and treatment success, many confounders occur. Lack of objective documentation and theoretical basis of the leg retraction phenomena has hindered its acceptance as an examination procedure. Only indirect evidence exists for its validity in several small observational studies where it was used to determine were to adjust. Motion analysis, and EMG studies may help in understanding the physiology of this phenomena using. Further work is necessary to correlate the relationship of leg retraction to other methods of subluxation assessment, treatment outcome and patient health status, if any.
Reference: Paul J. Osterbauer,DC; Arlan W. Fuhr,DC. Proceedings of the California Chiropractic Foundation’s 7th Annual Conference on Research and Education, June 19-21,1992; pp.291-292.
Back pain is frequently accompanied by pain radiating in to the buttock and above the knee. In severe cases it can extend below the knee into the foot. Precise diagnosis, of the cause of leg pain is difficult due to a multiplicity of, causes. First. it can be due to referral from structures of the spine and pelvis, such as facet, sacroiliac joints, spinal ligaments, and muscles. This type of pain is characterized by a diffuse ache. Second, impingement of the nerve roots which join to form the sciatic nerve. by mechanical means is possible (e.g.. disc bulge, muscular tension, bony architecture. etc.) or by swelling secondary to inflammation. If the nerve roots are affected the pattern of pain usually follows specific derma tomes, and may be accompanied by one or more neurologic symptom’s. These two causes may occur concomitantly, creating a confusing clinical picture. While special examinations such as electro diagnostic tests and imaging studies may be helpful in making a diagnosis, they are not always definitive and require close correlation with clinical findings.
Despite reports of effectiveness for treatments such as bed rest, surgery, exercises, injections, physical therapy modalities and chiropractic manipulation, no standard approach is recognized in the profession. This is not surprising since it has been estimated that 80% of patients with painful sciatic radiation are said to recover in within 3 months. (1) Few reports are available documenting cases and long term follow-up with standard outcome measures (e.g., Oswestry disability questionnaire[OLBQ], visual analog scale, or orthopedic tests). (2) This study presents a case of chronic sciatica treated by mechanical force, manually assisted short lever adjusting, high voltage electrotherapy and a video assisted, home stretching program documented with common, easy to use, outcome assessment tools over a period of two years.
Reference: Paul J. Osterbauer. D.C., Arlan w. Fuhr. D.C. Activator Methods Inc. Phoenix, Arizona; Proceedings of the California Chiropractic Foundation’s 293 7th Annual Conference on Research and Education , Palm Springs , CA , June 19-21, 1992, pp. 293-5.
Low back pain (LBP) is a common health problem among the elderly, affecting up to 90% of the over 65 population, and accounting for nearly $1 billion per year in Medicare payments alone. By far the greatest single cause of low back pain in the elderly is mechanical derangements occurring within the confines of the lumbar spine as a consequence of chronic degenerative joint disease which, in itself, is often painless and of little or no clinical significance. Most of these cases (many of whom are presently being unsuccessfully treated in medical clinics and/or hospitals) would quite likely respond very well to routine office-based conservative chiropractic care. However, insofar as there is no conclusive data to support any particular method of chiropractic treatment for these cases, nor has there been any standardized procedures established by which such data might be collected for analysis, the issue is problematic inasmuch as most chiropractic physicians have had little training in clinical research methodology. Therefore, a “practitioner scientist” protocol was developed whereby selected office-based chiropractic physicians would collect the necessary data and provide treatment according to specified procedures under the direction of an experienced clinical researcher. Basic inclusion/exclusion criteria were chosen for a standardized approach to the diagnosis of mechanical low back pain in the elderly and its treatment by conservative chiropractic technics.
Inclusion criteria are as follows:
- Age: 65 and over
- Present episode of LBP greater than three months duration
- Greater than 20 percent Modified Oswestry disability score (MODS)
- Primary pain localized to the lumbar spine (L1-S1)
- No prior chiropractic or medical treatment for present episode of LBP
- No radicular or neurological symptoms
- Any three of the following positive orthopedic tests:
- Kemp’s test (include only if it increased lumbar pain)
- Adam’s and supported Adam’s test (both equally cause pain in the lumbar spine)
- Goldthwait’s test (evokes lumbar pain or makes it worse, does not increase radiation of pain into the leg)
- Hyperextension test
- Pain evoked on spinous process percussion which seated patient’s lumbar spine is flexed
Exclusion criteria are as follows:
- History of serious medical illness
- Psychological disturbances
- Recent trauma (major bruises; fractures; auto accidents; etc.)
- Leg or buttock pain of suspected neurological involvement
- Anomalies such as spondylolisthesis
- Uncertain diagnosis
- referred pain of viscero-somatic origin
- Change in diagnosis; new symptoms; deteriorating health while study is underway
- More than two weeks of missed appointments
Reference: Paul J. Osterbauer, DC, Tom DeVita, DC, Arlan W. Fuhr, DC. Proceedings of the FCER’s Third Annual International Conference on Spinal Manipulation. Washington. D.C., April 12-13. 1991. pp. 230-1.