This method of analysis is by far one of the most useful I have found in determining loss of range of motion. This is a great way to show the changes before and after the X-ray in a quantifiable way and to show how the care you provided helped your patients by improving the stability of the ligaments in the cervical spine.
To establish the hypomobility or hypermobility of the vertebral segments in the sagittal plane, the Penning method is one of his best methods. This is done with a 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 can be found in your patient. You, as the treating Cape Girardeau chiropractor, will need to understand these variable factors to ensure that the “validity of assessment” criteria are met according to the standards. Doing so will also help your patient better if a personal injury case enters the courtroom and you are on the witness stand.
The intent of this article is to briefly explain and assist Cape Girardeau chiropractors using this method of functional radiographic diagnosis of the cervical spine during flexion / extension. Hopefully this will allow you to better serve your patients and have a solid pre and post analysis. There has been a lot of research on this topic by Dr. Liberti, DC, as well as many other physicians and physicians, including Dr. Pennings himself.
Completion of the Penning method
The Penning method is known to many as the most widely accepted and used method for determining flexion / extension movement. To begin with, the extension film overlaps the flexion film, with the C7 vertebrae perfectly matching. Next, a line is drawn along one of the edges of the stretch film, on the flex film. Then you do the same with C6. Then a second line is drawn. Now you can measure an angle between these two lines and this sets the degree of movement between the C6 and C7 vertebrae. Follow this sequence for the rest of the cervical spine to determine the degree of movement between all vertebrae. Average Segmental Motion Values are written 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 that this is a very valuable method to determine abnormal or pathological conditions such as hyper or hypomobility of the cervical spine.
Writing method for radiographic determination of loss of range of motion:
For example, if normal for C2-C3 were 12.5 degrees and your patient was 20 degrees, your percentage of normal would be 160%. If the normal in C3-C4 was 18 degrees and your patient was 15 degrees, his percentage of normality would be 83%. This is straightforward, if you want all the normal values these can easily be found on the internet.
The percentage of normality is calculated by dividing the patient’s values by the normal values established by Penning. For example C3-C4 15/18 = 83%. This essentially represents 83% of the normal movement in the C3-C4 joint that had been maintained. On the other hand, you will see that 17% of the normal movement was lost compared to the normal value determined by Penning.
If you look at the C2-C3 level, you will see that you have 160% normal movement or 60% more normal expected movement at this level. This is clear as to how to read this!
* Values over 100 are HYPERMOBILE
* Values below 100 are HYPOMOBILE
100% NORMAL (values within 10% of 100 are considered within the standard deviation of what is accepted as normal). Therefore, any value between 90-110% for all intensive purposes is considered normal.
Additional analysis of the sample patient:
The interpretation of the previous example is as follows; multiple areas of abnormal movement and joint dysfunction are present. Cervical joint hypomobility or a loss of normal joint range of motion was found in the C3 / C4 and C5 / C6 motor units. Cervical joint hypermobility was present in the C2 / C3 motor units.
You can also see minimal compensatory hypermobility present at C6 / C7, but this falls within the standard of normal deviation.
Again, there are two areas of decreased joint range of motion and one with excessive motion involving the cervical spine segments during flexion / extension in the sagittal plane.
Obviously, these abnormalities exist within the joints of the cervical spine and this analysis has been established radiographically.
Obviously, in addition to corroborating the loss of joint range of motion, a Cape Girardeau chiropractor should further evaluate the possible existence of any neurological deficits (sensory or motor). However, simply by looking at the mechanical and structural aspects of a particular case, there is a lot to be done objectively, and you can be sure to say that the structural integrity has improved in this patient if the post-care analysis shows an improvement in the method. of Penning. Any degree of improvement confirms improved integrity of the patient’s ligaments and, of course, a greater normal range of motion. These two things alone could prove invaluable, should you find yourself testifying in court. I will soon write a Part II of this article titled “Objective Prognostic Scales for Chiropractors Performing Whiplash and Personal Injury Cases.” If it has been helpful to you, I am sure it will go a long way in helping you get the objective results you need to validate patient care. If you need further help finding more information on this, any Cape Girardeau Chiropractic Clinic can refer to the resource box to contact me with further questions.