This analysis method is by far one of the most useful for determination of loss of range of motion that I have found. This is a great way to show pre/post x-ray changes in a quantifiable way, and to show how the care you provided helped your patients by improving ligament stability in the cervical spine.
To establish hypomobility or hypermobility of vertebral segments in the sagittal plane, Penning's Method is a one of your greatest methods. This is done with functional examination of the cervical spine in flexion and extension, using radiographic analysis.
If there is a loss of range of motion present, several factors may be found in your patient. You as the attending Cape Girardeau Chiropractor will need to understand these variable factors in order to ensure that the "validity of assessment" criteria have been met according to standards. Doing so will also best help your patient should a personal injury case enter the court room and you find yourself on the witness stand.
The intention of this article is to briefly explain and help Cape Girardeau Chiropractors use this method of functional radiographic diagnosis of the cervical spine during flexion/extension. This will hopefully allow you to better serve your patients and to have solid pre/post analysis. There has been much research done on this topic by Dr Liberti, D.C., as well as many other Doctors and Physicians, such as Dr. Pennings himself.
Completion of Penning's Method
Penning's Method is known by many to be the most widely accepted and utilized method for determining flexion/extension motion. To start the extension film is superimposed on the flexion film, with the C7 vertebrae matching perfectly. Next a line is drawn along one of the edges of the extension film, onto the flexion film. You then do the same with C6. A second line is then drawn. You can now measure an angle between these two lines and this establishes the degree of motion between the C6 and C7 vertebra. You follow this sequence for the rest of the cervical spine to determine the degree of motion between all of the vertebrae. The average values of segmental motion are written about by Dr. Penning: Functional Pathology of the Cervical Spine, 1968 pg 1-25. These values can be compared to determine the amount of dysfunction present in your patient's cervical spine. It should be fairly easy for you to find some examples of these drawings elsewhere on the internet.
To reiterate this is a very valuable method for determining abnormal or pathological conditions such as hyper or hypomobility of the cervical spine.
Penning Method of Radiographic Determination of Loss of Range of Motion:
As an example if the normal for C2-C3 was 12.5 degrees and your patient was 20 degress, your percentage of normal would be 160%. If normal at C3-C4 was 18 degrees and your patient was 15 degrees your percentage of normal would be 83%. This is straight forward, if you would like all the normal values, these can easily be found on the internet.
The percentage of normal is figured out by dividing the patient's values by Penning's established normal values. For example C3-C4 15/18 = 83%. This essentially represents 83% of normal motion at the C3-C4 joint had been maintained. On the other hand you see that 17% of normal motion was lost when compared to the normal value as determined by Penning.
If you look at the C2-C3 level you see that you have 160% of normal motion, or 60% more than normal expected motion at this level. This is clear as to how to read this!
*Values above 100 are HYPERMOBILE
*Values below 100 are HYPOMOBILE
NORMAL at 100% (Values within 10% of 100 are considered to lie within the standard deviation of what is accepted as normal.) So anywhere between 90-110% for all intensive purposed is considered normal.
Further Analysis of example patient:
The interpretation of the above example is as follows; multiple areas of abnormal joint motion and dysfunction are present. Cervical Joint Hypomobility or a loss of normal joint range of motion was found at C3/C4, and C5/C6 motor units. Cervical Joint Hypermobility was present at the C2/C3 motor units.
You can also see a compensatory minimal Hypermobility present at C6/C7, but this falls within the normal standard of deviation.
Restated there are two areas of diminished joint range of motion and one with excessive motion involving the cervical spine segments during flexion/extension in the sagittal plane.
As is obvious, these abnormalities exist within the joints of the cervical spinal column and this analysis has been established radiographically.
As goes without saying, in addition to substantiating loss of joint range of motion, a Cape Girardeau Chiropractor should be looking to further evaluate possible existence of any neurological deficit (either sensory or motor). By simply looking at the mechanical and structural aspects of a particular case however, much can be objectively gained, and you will be able to stand with confidence in saying that structural integrity has improved on this patient if post care analysis shows improvement on Penning's Method. Any degree of improvement substantiates improvement to the patient's ligamentous integrity and of course increased normal range of motion. These two things alone could prove invaluable, should you find yourself testifying in court. I will soon be writing a Part II of this article titled "Objective Scales of Prognosis for Chiropractors doing Whiplash and Personal Injury Cases." If you have found this helpful I am sure this will go a long way to giving you the objective findings you need in validating patient care. If you need any further help finding more information on this, any Cape Girardeau Chiropractic Clinic can feel free to look at the resource box in order to contact me with further questions.
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