A M C T

강사 - 유승모 MD. PhD.

2014. 10. 4. (토)

A Brief History of Activator Methods

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• The ACTIVATOR METHOD of chiropractic analysis and low-force spinal adjusting technique originated in Redwood Falls, Minnesota in 1965

• Warren C. Lee,D.C. (graduate of Northwestern College of Chiropractic, 1941)

• Arlan W. Fuhr, D.C. (Logan Basic college of Chiropractic, 1961).

• Since then, the procedure has become a major chiropractic clinical methodology, and is now used to some extent by approximately 21,000 doctors of chiropractic throughout the world

Terms Used in AMCT

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Activator Adjusting Instrument: A chiropractic

adjusting instrument which provides a manually

manipulatable instrument capable of providing a

dynamic thrust which includes a controlled force of

adjustment at a precise and specific line of drive at a

high speed.

AAI-II( Activator Adjusting Instrument II )

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Terms Used in AMCT

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• Facilitated Segment: A spinal segment which

responds to various stimuli in a more intense and

prolonged manner than is normal.

• Isolation Test: A specific active movement on the

part of the patient to assist in locating and

evaluating the subluxation or facilitated motion

segments of the spine in small, incremental steps.

Terms Used in AMCT

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• Line of Drive: The angle at which the Activator

adjusting instrument contacts the vertebra to correct

subluxations or misalignments.

• Pelvic Deficiency (P.D.) or Functional Short Leg: A leg

that appears “short” due to a posterior inferior rotation

of the ilium on the same side and observed when a

patient is in a prone, non weight-bearing position.

Another possible cause is a contraction of the supra

pelvic muscles and should not be confused with an

anatomical short leg.

Terms Used in AMCT

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• Pressure Test: A light pressure applied into the

direction of correction.

• Stress Test: A light pressure applied into the direction

of the subluxation.

Terms Used in AMCT

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• Subluxation: Just what a subluxation is still has not

been proven, but, on the other hand, dis-qualification

of the hypothesis of a subluxation has neither been

proven. Activator Methods Chiropractic Technique

accepts the definition of a subluxation along with its

etiology and effects as reported in Basic Chiropractic

Procedural Manual published by the American

Chiropractic Association.

Terms Used in AMCT

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• There are two major causes of subluxation: 1) inequality in

muscular balance, and 2) abnormal structural support. The

subluxation then causes local effects on tissue as well as

mechanical and neurological effects.

LONG-SHORT RULE

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• The Short-Long Rule applies when performing the

various isolation tests from L5 through occiput

(includes pubes)

• If the P.D leg LENGHENS at 90 degrees (Position No.2),

this indicates subluxation or facilitation ON the P.D.

SIDE.

• If the P.D leg SOORTENS at 90 degrees (Position No.2),

this indicates subluxation or facilitation ON the SIDE

OPPOSITE P.D.

Leg Testing

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• 족지 분석은 AMCT 기법의 핵심요소이다.

• 정확하고 세심한 족지 분석은 치료의 필요성을 판정할

수 있도록 한다.

• 초기 단족 검사는 subluxation이 존재 하느냐 아니면 다

른 신체 부위에서의 facillitation 이냐를 판정하는 주된

방법이다.

초기 족지 분석에서 4가지 필수 과정

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• Patient palcement – preserving postural distortions

• Visual observation – noting leg length discrepancy

• Position #1 procedure – identifying the PD leg

• Position #2 procedure – specifically identifying

subluxation malposition

Patient Placement

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• 환자를 방문시마다 테이블에 제대로 위치시키는 것이

검사의 정확성에 결정적인 역할을 할 수 있다.

• 부적절한 환자 배치는 단족 차이 감소, 다리의 장단족의

역전, 단족 분석의 불명확화를 초래할 수 있다

Visual inspection – Observe leg length discrepancy

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• 환자의 발에 접촉하기 전에 대칭되는 발의 비교 포인트

를 이용해 단족 차이를 검사한다.

• 비대칭적 내반이 있는 지 확인 한다.

족지분석 과정

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족지분석 과정

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Take out supination and Plantar flexion in Position #1

족지 분석 순서

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1. Take out supination and plantar flexion in position #1

2. Keep index fingers on metatarsal – Phalangeal junction

족지 분석 순서

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3. Keep Elbows tucked in

4. Shift thumbs onto balls of feet while elevating to position #2.

족지 분석 순서

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5. Ensure that soles of shoes are level in position #2

6. Form a “V” in position #2 with heels about ½ inch apart and toes flared

Three Possibility

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• Possibility One : Position #1에서 짧았던 다리가

Position #2에서 길어지는 현상을 말한다.

• Possibility Two : Position #1에서 짧았던 다리가

Position #2에도 짧은 경우

• Possibility Three : Position #1에서 even 했던 다리가

Position #2에서도 even한 경우

Pressure-Stress Testing

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Pressure Testing 1. The P.D. leg is short in position #1. 2. Apply a light pressure into the direction of correction. 3. If the legs become even in position #1, adjust into the direction of correction.

Example : Left P.D.

Pressure-Stress Testing

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Example : Left P.D.

Stress Testing 1. The leg are even in position #1. 2. Apply a light pressure into the direction of subluxation. 3. If P.D. leg shortens in position #1, adjust into the direction of correction.

Routine Procedure

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Testing Step One : P.D. leg Shortens in Position #2

Routine Procedure

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Testing Step Two : P.D. leg lengthens in Position #2

Knee And Feet

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Medial Knee : P.D. 측 내방 슬관절 subluxation이 있는지

pressure test를 실시한다.

Medial Knee : Medial, Superior로 subluxation 교정

의 방향은 Lateral, Inferior

Talus : Medial, Anterior, Inferior로 subluxation 교정

의 방향은 Lateral, Posterior, Superior로

Knee And Feet

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Lateral Knee : P.D. 측 외방 슬관절 subluxation이 있는지

pressure test를 실시한다.

Lateral Knee : Lateral, Superior로 subluxation 교정

의 방향은 Medial, Inferior

Cuboid : Lateral, Anterior, Inferior로 subluxation 교

정의 방향은 Medial, Posterior, Inferior

Medial Knees and Talus 교정

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Lateral Knee And Cuboid 교정

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6 Point Pelvic Pattern

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AS Ilium

Pressure Test : PD 반대측 장골능에 접촉하여 천장 관절

면과 평행되게 장골능에 부드럽게 하방 내측방 압력을

가한다.

PI Ilium

AS 교정후나 AS pressure test 음성으로 나온 경우 PD

측의 ilium 후하방 subluxation을 고려한다.

Pelvic Point

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Pelvic Point

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Pelvic Point

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Pelvic Point

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AS ilium

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AS Ilium Pressure Test : PD 반대측 장골능에 접촉하여

천장 관절면과 평행되게 장골능에 부드럽게 하방 내측방

압력을 가한다.

AS ilium

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AS Ilium Adjustment

PI ilium

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PI Ilium Pressure Test : PD side 천골 결절 인대의 하부에

무지로 가볍게 접촉한다

PI ilium

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PI Ilium Adjustment

Symphysis Pubis

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• 발 무릎, AS Ilium, PI ilium에의 테스트와 교정 후에

Position 1 이나 Position 2에서 보통 다리 길이가 균형을

이룰 수 있다.

• Isolation Test를 시행한다.

• Isolation Test : 환자의 양 무릎을 바짝 붙이도록 한다.

#2에서 PD leg가 짧아졌다면, PD 반대측 치골의 하방

subluxation을 의미한다.

Pubic bone isolation Test

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Subject

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Pubic bone Adjustment

Lumbar Isolation Test : L5

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Patient to place the forearm on the side of PD on the low back . After completing the 5th lumbar isolation test, ask the patient to return the forearm th the side of the body

L5 Adjustment

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Lumbar Isolation Test : L4

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Patient to place the forearm on the side opposite of PD over the lumbar vertebrae. After completing the 4th lumbar isolation test, ask the patient to return the forearm to the side of the body

Left PD

Possibility One

Possibility Two

Possibility Three

L4 Adjustment

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Contact Point : the mammillary process on the side indicated by the short-long rule LOC = anterior, superior, through the plane line of the facet

Lumbar Isolation Test : L2

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Patient to place both forearms on the lumbar vertebrae. After completing the 2th lumbar isolation test, ask the patient to return the forearm to the side of the body

L2 Adjustment

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Contact Point : the mammillary process on the side indicated by the short-long rule LOC = anterior, superior, through the plane line of the facet

Lower Thoracic Isolation Test :T12

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12th Thoracic Isolation Test : patient to place the forearm on the PD side next to the head. After completing the 12th Thoracic isolation test, ask the patient to return the forearm to the side of the body

T12 Adjustment

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Contact Point : Transverse process on the side indicated by the short-long rule LOC = anterior, superior, and slightly medial, through the 60° plane line of the facet

Contact Point : Body of the rib about 1/2inch lateral to the transverse process on the side of rib involvement. LOC = lateral and inferior at a 45° angle

Lower Thoracic Isolation Test :T8

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8th Thoracic Isolation Test : patient to place the forearm next to the head. After completing the 8th Thoracic isolation test, ask the patient to return the forearm to the side of the body

T8 Adjustment

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Contact Point : Transverse process on the side indicated by the short-long rule LOC = anterior, superior, and slightly medial, through the plane line of the facet

Contact Point : Body of the rib about ½ inch lateral to the transverse process on the side of rib involvement. LOC = lateral and inferior at a 45° angle

Upper Thoracic Isolation Test :T6

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6th Thoracic Isolation Test : The patient to turn the face to the PD side. After completing the 6th Thoracic isolation test, ask the patient to return the head to the neutral position

T6 Adjustment

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Contact Point : Body of the rib about 1/2inch lateral to the transverse process on the side of rib involvement. LOC = lateral and inferior at a 30° angle

Contact Point : Transverse process on the side indicated by the short-long rule LOC = anterior, superior, and slightly medial, through the plane line of the facet

Upper Thoracic Isolation Test :T4

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4th Thoracic Isolation Test : The patient to keep the face turned to the PD side; then instruct the patient to lift the shoulder on the PD side toward the ceiling and then relax. After completing the 4th Thoracic isolation test, ask the patient to return the head to the neutral position

Possibility One

Possibility Two

Possibility Three

Left PD

T4 Adjustment

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Contact Point : Transverse process on the side indicated by the short-long rule LOC = anterior, superior, and slightly medial, through the plane line of the facet

Contact Point : Body of the rib about 1/2inch lateral to the transverse process on the side of rib involvement. LOC = lateral and inferior at a 20° angle

Upper Thoracic Isolation Test :T1

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1th Thoracic Isolation Test : The patient to keep the face turned to the PD side; then instruct the patient to shrug the shoulder toward the ears and then relax. After completing the 1th Thoracic isolation test, ask the patient to return the head to the neutral position.

T1 Adjustment

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Contact Point : Body of the rib about 1/2inch lateral to the transverse process on the side of rib involvement. LOC = lateral and inferior

Contact Point : Transverse process on the side indicated by the short-long rule LOC = anterior and slightly medial, through the plane line of the facet

Shoulder Involvement

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• Medial subluxation of the Scapula • Medial ala of the scapula • Inferior humerus • Posterior-superior radius • Anterior Lunate

• Lateral subluxation of the Scapula – Lateral ala of the scapula – Superior humerus – Inferior-Medial ulna – Posterior Carpals

Shoulder Isolation Test

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• 환자의 얼굴을 PD side로 돌리게 하고 두 팔을 양측 테이블위에 놓게한다.

• PD side 먼저 검사하고 반대편 PD side를 검사한다. • PD side 팔꿈치를 몸통에 붙였다 떼도록 한다. • 그런 후 Position #2를 시행한다. • 검사 시행하는 쪽 견갑골의 inferior angle은 #2에서 장측 다리 방향으로 subluxation 된다.

• 이 test 결과로 medial scapula 인지 lateral scapula 인지를 결정한다.

Shoulder Isolation Test

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Medial Scapula Pattern

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Medial Scapula Pattern Adjust

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LOD = Lateral (Medial Scapula)

LOD = Superior (inferior humerus)

LOD = Anterior-Inferior (Proximal radius)

LOD = Posterior (anterior lunate)

Lateral Scapula Pattern

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Lateral Scapula Pattern Adjust

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LOD = Medial(Lateral Scapula) LOD = Inferior (superior humerus)

LOD = Lateral-superior (proximal head of ulna)

LOD = anterior (posterior carpals)

Lower Cervical Isolation Test : C7

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7th Cervical Isolation Test : After completing the upper extremity isolation procedur, ask the patient to keep the face turned to the PD side; then instruct the patient to return the head to the neutral face down position.

C7 Adjustment

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• Contact Point : Pedicle – lamina junction on the side of involvement

• LOC = anterior, superior and slightly medial, through the plane line of the facet

Lower Cervical Isolation Test : C5

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5th Cervical Isolation Test : Instruct the patient to lift the head off the table ½ inch (slight extension) and then return the head to the neutral face down position.

Left PD

Possibility One

Possibility Two

Possibility Three

C5 Adjustment

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• Contact Point : Pedicle – lamina junction on the side of involvement

• LOC = anterior, superior and slightly medial, through the plane line of the facet

Upper Cervical Isolation Test : C1-2

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Atlas-Axis Isolation Test : Instruct the patient to tucking the chin toward the chest(slight flexion) then return the head to the neutral face down position

Left PD

Atlas Axis No Involvement

C1 Adjustment

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Contact Point : lateral most aspect of the Transverse Process LOC = slightly medial

C2 Adjustment

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Contact Point : Pedicle – lamina junction on the side opposite PD LOC = anterior, superior and slightly medial, through the plane line of the facet

Posterior Occiput

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Posterior Occiput isolation test : Following isolation and adjustment of the C2-C1 segments, the patient’s head will be in the neutral, face-down position. Instruct the patient to gently push the face into the table which stresses the atlanto-occipital region

Posterior Occiput Adjustment

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• Contact Point : posterior aspect of the occiput at the inferior nuchal line

• LOC = straight anterior

감사합니다.

Outro

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