badanie i leczenie kregoslupa.pdf

DIAGNOSIS

AND

TREATMENT

OF THE

NONOPERATIVE ORTHOPAEDIC MEDICINE AND MANUAL THERAPY

DOS WINKEL, PT

Instructor, Scientific Society of Flemish General Practitioners

Antwerp, Belgium

Director, Dutch and German Academy of Orthopaedic Medicine

Delft, the Netherlands and Gbttingen, Germany

President, Intenational Academy of Orthopaedic Medicine

GEERT AUFDEMKAMPE, PT

Instructor, Physical Therapy School

Hogeschool Midden Nederland

Utrecht, the Netherlands

ONNO G. MEIJER, MD, PHD

Movement Scientist

Free University

Amsterdam, the Netherlands

OMER MATTHIJS, PT

Instructor, International Academy of

Orthopaedic Medicine

Instructor, American Academy of

Orthopedic Medicine, Inc.

Tucson, Arizona

VALERIE PHELPS, PT

Instructor, International Academy of

Orthopaedic Medicine

Director and Instructor, American Academy of

Orthopedic Medicine, Inc.

Tucson, Arizona

AN ASPEN PUBLICATIONS

Aspen Publishers, Inc.

Gaithersburg, Maryland

1996

Ubrary of Congress CaLaloging-in-Publicauon Data

Diagnosis and treatmen. of the spine' nonoperalive orthopaedic

medicine and manual therapy I Dos Winkel . leL aLI.

p. cm.

Translation and adaptation of material previously published n

Dutch under the Litles: Onhopedische geneeskunde en manuele

therapie (deeI4a-c) by Dos Winkel, Geerl Aufdemkampe, and Onno G.Meijer

and Weke delen aandoeningen van het bewegingsapparaat (deell)

by Andry Vlecming, Dos Winkel, and Onllo G. Mejer.

Includes bibliographical references and index

ISBN 0·8342·0731·1

I. Spine-Diseases-Treatment. 2. Spine-Diseases-Physical

therapy. 3. Spine-Diseases. I. �lanipulation, Onhopedic.

II. Winkel, Dos . Ill. Winkel, Dos. Onhopedische geneeskunde en

manuele Lherapie. IV. Vleeming, Andry. Weke delen aandoeningen

van het bewegingsapparaat.

IDNLM: I Spinal Diseases-therapy. 2. Spmal Diseas>s

diagnosis. 3. Orthopedics-methods. WE 725 0536 1996a[

RD768.D52 1996

617.3'75-1c20

DNLMIDLC

for Library of Congress

95·31860

CIP

ll rights reser

.... ed.

Aspen Publishers, Inc., grants pennission for photocopying for linlited personal or intenal use. This consent does

not extenc!to other kinds of copying, such as copying for general distribution, for advertising or promotional

purposes, for creating new collective works, or for resale. For information, address

Aspen Publishers, Inc., Pennissions Department,

200 Orchard Ridge Drive, Suite 200, Gaithersburg, Maryland 20878.

The authors have made every efforllO ensure the accuracy or the inionl13t.ion

ofmation sources should be consulted, espeCially fOf new or unfamiliar procedures. It is the responsibility of

every practilioner to evaluate the appropriateness of a particular opinion in the conI ext or actual clinical situa

tions and with due consideraLion to new developmen.s. Authors, editors, and the publisher cannot be held r'

sponsible ror any typographical or other errors found in this book.

Editorial Hesources: HUlh BloolII

Library of Congress Ca.llog Card Number: 95-31860

ISBN,0·8.342·0731·1

P1"inled in Ow L 'niled Statcs of America

234 5

Table of Contents

Contributors ................... v

5. Thoracic Spine ............ . . 389

5.1 Functional Anatomy ......... 393

5.2 Examination ............... 401

5.3 Pathology.................. 441

5.4 Treatment ................. 481

Thoracic Spine Review

Questions ................... 540

Thoracic Spine Review Answers ... 541

6. Cervical Spine ............... 542

6.1 Functional Anatomy. . . . . . . .. 546

6.2 Examination ............... 559

6.3 Pathology.................. 60 1

6.4 Treatment ................. 669

Cervical Spine Review

Questions ................... 711

Cervical Spine Review Answers ... 712

7. Temporomandibular Joint .... . 728

7. 1 Craniomandibular ........... 72 8

7. 2 Examination ............... 74 3

7. 3 Treatment ................. 76 5

Preface ..... . .................. ii

PART I-SURFACE ANATOY OF

THE SPINE AND GENERAL

ASPECTS OF BACK PAIN ........ 1

1. Surface Anatomy of the Spinal

Colunm .................... 3

l.1 General Inspection of the Head,

Neck, and Trunk. . . . . . . . . . . . 5

l.2 Palpation of the Head, Neck,

and Trunk ................. 10

1. 3 Schematic Topography of the

Blood Vessels and Nerves of the

Head, Neck, and Trw1k . . . . . . . 31

2. General Aspects of Examination

and Treatment . . . . . . . . . . . . . .. 38

Editor's Preface ................ 39

2.1 Fnctional Anatomy. . . . . . . . . 40

2.2 Examination ............... 48

2.3 Pathology . . . . . . . . . . . . . . . . . . 56

2.4 Treatment ................. 59

PART 111- INNERVATION AND

KINEMATICS OF THE SPINAL

COLUMN ...................... 769

8. Innervation of the Spinal

Colunm and Its Related

Structures .. . .. ........... . . 771

Editor's Preface ................ 771

Introduction. . . . . . . . . . . . . . . . . .. 771

General Considerations .......... 772

Spinal Innervation in Detail . . . . . .. 774

Innervation Patterns ............ 777

Multisegmental Innervation . . . . . .. 779

9. Kinematics of the Spinal

Colunm . . ........ . ......... 782

Editor'S Preface ................ 782

Introduction ................... 782

Ifluence of the Form of the Spinal

Colwnn ..................... 783

Influence of the Position of the

Zygapophyseal Joints .......... 788

Resulting Kinematic Coupling . . . .. 789

PART II-FUNCTIONAL ANATOMY

OF THE SPINE AND

TRANSITIONAL JOINTS ......... 69

3. Sacroiliac Joint . . . . . . . . . . . . .. 71

3.1 Functional Anatomy ......... 72

3.2 Examination ............... 92

3.3 Pathology . . . . . . . . . . . . . . . . .. 105

3.4 Treatment: Manual

Mobilzation . . . . . . . . . . . . . . .. 124

.. 4. Lumbar Spine ............. . . 137

4.1 Functional Anatomy ......... 14 2

4.2 Examination ............... 15 3

4.3 Pathology.................. 196

4.4 Treatment ................. 267

Lumbar Spine Review Questions . .. 36 2

Lumbar Spine Review Answers . . .. 36 3

Appendix 4-A Patient Handbook . .. 36 4

iv DIAGNOSIS ND TREATMENT OF THE SPINE

10. Stability of the Spinal

Column .................... 794

Editor's Preface ................ 794

Introduction .......... . . . . . . . . . 794

Bending the Spinal Column As a

Rod ........................ 796

Stability of the Spinal Column in

Large Deviations . . . . . . . . . . . . .. 797

Stability of the Spinal Column in

Changing Material Properties 799

15. Research on Efectiveness of

Traction of the Spinal

Column .. . . . ............... 877

Editor's Preface .. . ............. 877

Introduction .... . .... . ....... 877

Separation Studies ............ 878

Clinical Research Studies of

Traction of the Spinal Column 878

Conclusion ........... . ...

881

�16. Exercise Therapy in the

Treatment of Low Back

Pain . . .... . . . .............. 883

Editor's Preface . . .. . ... . ....... 883

Research on Effectiveness of

Classic Exercise Therapy ...... .

Research on Effectiveness of Back

Schools .................... .

Conclusion

11. Imaging Techniques of the

Spinal Column . . . . . . . . . . . . . .. 802

Editor's Preface ................ 803

Introduction .. . ... . ............ 794

Techniques . . . ................. 803

Pathology .... . ..... . ... . ... .. . 825

884

12. Prevention of Back and Neck

Pain by Improving Posture . . . .. 837

Editor's Preface . . .............. 837

Introduction . . ................. 837

Forms of Load . . . . . . . . . . . . . . . . .. 838

Conclusion .................... 846

891

895

17. Integrative Approach to

Diagnosis and Treatment

Editor's Preface ............... .

Introduction .................. .

Psychosomatic Approaches ...... .

Recognizing Psychosomatic

Complaints ................. .

Treatment from a Psychosomatic

Viewpoint .................. .

897

898

899

13. Mobilization of the Spinal

Column .................... 848

Editor's Preface . . .. . ... .. .... . . 848

Introduction . . . . . . ........ . ... . 848

Force Transmissions in

Monosegmental Mobilization . ... 849

Conclusion ........ . . . ......... 858

901

907

Appendix A-Algorithms for the

Diagnosis and Treatment of the

Sacroiliac Joint and for General

Spine Pathology .............. .

14. Research on Efectiveness of

Manual Therapy for the Spinal

Column .................... 861

Editor's Preface ................ 861

Introduction ...... . ............ 862

True Experimental Research on

Effectiveness of Manual Therapy

in Treating Low Back Pain . . . . .. 863

Conclusion ..... . .............. 868

Controversy over Findings in

Bitish Medical Jounal.

917

Appendix B-Algorithms for the

Diagnosis and Treatment of

Lumbar Spine Pathology ........ 922

Appendix C-Pathology of the

Thoracic Spine ........ . . .. . . .. 931

872

Appendix D-Pathology of the

Cervical Spine . . ..... .. .. . . ... 937

Index ...... . . . . . . . .... .. .... .. 947

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