1、脈沖治療儀TECHNIQUEImpulse Adjusting Technique脈沖調整技術A Chiropractic Analysis of the spine & pelvis that incorporates findings from:整脊療法結合下列的檢查對脊椎和骨盆進行分析History (signs & symptoms, pattern recognition):Exam Findings: Orthopedic tests (tests that have high sensitivity & specificity)Joint alignmentJoint movem

2、ent (symmetry with opposite side)Pain over bonePain over soft tissueMuscle and nerve reaction to movement and pressure病史（體征和癥狀，模式識別）：檢查結果：骨科測試（具有較高的靈敏度和特異性的測試）關節對位對線關節運動（雙側對稱）骨疼痛軟組織疼痛肌肉和神經對運動和壓力的反應The Sacroiliac, Pubic, and Hip joints骶骨關節，恥骨，髖關節脈沖治療儀TECHNIQUE1. BilateralNachlas Test1.雙側Nachlas測試4. C

3、ompressionTests for Lower Ext.Involvement受累下肢的壓迫測試 3. Hip RotationTests髖關節旋轉測試2. UnilateralNachlas Test單側Nachlas測試5. CompressionTests for Supra-PelvicInvolvement受累盆骨上端的壓迫測試Presence of PainRange of MotionAsymmetryStrength存在疼痛運動范圍不對稱性強度5 Step Lumbo-Pelvic Analysis Flowchart5步腰腹骨盆分析流程圖Step 1: Bilateral

4、 Nachlas Test第1步：雙側Nachlas測試Step 2: Unilateral Nachlas Test第2步：單側Nachlas測試Step 3: Hip Rotation Tests第3步：髖關節旋轉測試Step 4: Lower Extremity Compression Tests第4步：下肢壓迫測試Step 5: Supra-Pelvic Compression Test第5步：盆腔上端壓迫測試Bilateral Nachlas Test雙側Nachlas測試Positive陽性Negative陰性Unilateral PainBelow Waist腰部以下單側疼痛SI

5、 JointInvolvementSI關節受累Unilateral PainAbove Waist腰部以上單側疼痛LumbarInvolvement腰椎受累CentralLow Back Pain中間腰背疼痛Lumbo-SacralInvolvement腰骶受累Proceed to Unilateral Nachlas Test開始單側Nachlas測試Flowchart for Step 1第1步流程圖Test and AdjustInvolved SIJ測試和調整受累的SIJTest and AdjustInvolved Lumbar測試和調整受累的腰椎Test and Lumbo-Sac

6、ral Joint(Dual Styluses)測試和調整腰骶關節(雙針)Neuromechanical Innovations Slides TestStep 1: Bilateral Nachlas Test第1步：雙側Nachlas測試Step 1: Bilateral Nachlas Test第1步：雙側Nachlas測試Clinical Considerations: 臨床注意事項：Ask, “Does this cause any pain anywhere?”Do both legs flex the same?Is one leg heavier than the other?

7、How does the pelvis move during the test?問診“這會引起任何部位的疼痛嗎？”兩條腿屈曲程度相同嗎？一條腿比另一條腿重嗎？檢查過程中盆骨如何移動？Unilateral Nachlas Test單側Nachlas測試Positive陽性Negative陰性Unilateral PainBelow Waist腰部以下單側疼痛SI JointInvolvementSI關節受累Unilateral PainAbove Waist腰部以上單側疼痛LumbarInvolvement腰椎受累CentralLow Back Pain腰背部中間疼痛Lumbo-SacralI

8、nvolvement腰骶受累Proceed toHip Rotation Tests開始髖關節旋轉測試Flowchart for Step 2第2步流程圖Test and AdjustInvolved SIJ測試和調整受累的SIJTest and AdjustInvolved Lumbar測試和調整受累的腰椎Test and Lumbo-Sacral Joint(Dual Styluses)測試腰骶關節(雙針)Step 2: Unilateral Nachlas Test第2步：單側Nachlas測試Begin with side of involvement (symptomatic sid

9、e first);Reproduction of symptoms unilaterally confirms SI joint involvementTest both sides with Unilateral Nachlas Test從受累側開始(先測試有癥狀側)單側癥狀再現證實SI關節侵犯用單側Nachlas測試法檢查兩側Step 2: Unilateral Nachlas Test第2步：單側Nachlas測試Flowchart for Step 2第2步流程圖Unilateral Nachlas Test單側Nachlas測試Positive陽性Negative陰性Unilater

10、al PainBelow Waist腰部以下單側疼痛SI JointInvolvement骶髂關節受累Unilateral PainAbove Waist腰部以上單側疼痛LumbarInvolvement腰椎受累CentralLow Back Pain腰背部中間疼痛Lumbo-SacralInvolvement腰骶受累Proceed toHip Rotation Tests開始髖關節旋轉測試Test and AdjustInvolved SIJ測試和調整受累的SIJTest and AdjustInvolved Lumbar測試和調整受累的腰椎Test and Lumbo-Sacral Joi

11、nt(Dual Styluses)測試腰骶關節(雙針)Unilateral Nachlas Test單側Nachlas測試Positive陽性Unilateral PainBelow Waist腰部以下單側疼痛SI JointInvolvementSI關節受累Test and AdjustInvolved SIJ測試和調整受累的SIJConfirm with SI Joint Compression Test通過SI關節壓迫測試確認Literature review of tests to diagnose a SI lesion:用測試去診斷SI病變的相關文獻綜述：Binkley, et a

12、l, “Diagnostic classification of patients with low back pain: report on a survey of physical therapy experts,” Physical Therapy, 1993:73Symmetry Tests: 對稱性測試：poor reliability and validity. 信度和效度差Pain Provocation Tests: 疼痛激發測試：evidence supports the validity of some pain provocation tests.證據支持某些疼痛激發測試

13、的效度。Prone Hip Extension Test俯臥伸髖測試“Sacral Cup,” Dr. Major DeJarnette, (The American Chiropractor, May 2007)“Prone hip extension test” (aka, “sacral cup test”) “俯臥伸髖測試”（又名“骶杯測試”）Tests the strength of the muscles crossing the posterior aspect of the SI joint.測試橫跨SI關節后端的肌肉力量。SI sprain reduces patients

14、ability to extend the hip.SI扭傷降低患者的伸髖能力。SI joint horizontal sectionSI關節 - 水平橫切位SI capsule contains a dense plexus of unmyelinated nerve fibers indicative of a nociceptive receptor system. SI關節囊含有密集的無髓鞘神經纖維叢，提示痛覺受體系統。Wyke, “Receptor systems in lumbosacral tissues in relation to the productionof low b

15、ack pain,” American Academy of Orthopaedic Surgeons Symposium onIdiopathic Low Back Pain, Mosby, 1982Location of SI adjustmentSI調整部位Sacroiliac Adjustment骶髂調整Sacroiliac Joint Adjustment骶髂關節調整 SCP: Sacroiliac joint, medial aspect of PSIS LOD: Anterior-Superior Setting: High or Medium SCP：骶髂關節，PSIS內側 L

16、OD：前-上 設置：高或中 Impulse iQ Adjusting Instrument Audible Indicators & Clinical Decision Making脈沖IQ調整儀器的發聲指標及臨床決策Significant Improvement in at Least 2 Components of PART Documentation inRe-Assessment of Clinical Indicators在臨床指標再評估中，PART文件中至少有2部分有明顯改善AccelerationResponseMaximized加速反應最大化Single Beep單聲Yes是N

17、o否Re-Assess Clinical Indicators重新評估臨床指標Adjustment of Level orArea Successful水平或位置調整成功Adjustment of Level orArea Not Successful水平或位置調整不成功Significant Improvement in at Least 2Components of PART Documentation inRe-Assessment of Clinical Indicators在臨床指標再評估中，PART文件中至少有2部分有明顯改善36 ThrustsAccelerationRespon

18、se Not YetMaximized36次推力后加速反應尚未達到最大化Double Beep雙聲Yes是No否Re-Assess Clinical Indicators臨床指標再評估Adjustment of Level orArea Successful水平或位置調整成功Adjustment of Level orArea Not Successful水平或位置調整不成功 Insure Contact was Correct with Consistent Preload Throughout Adjustment在進行調整過程中確保接觸正確和加壓穩定 Impulse iQ Adjusti

19、ng Instrument Audible Indicators & Clinical Decision Making脈沖IQ調整儀器的發聲指示及臨床決策Significant Improvement in at Least 2Components of PART Documentation inRe-Assessment of Clinical Indicators在臨床指標再評估中，PART文件中至少有2部分有明顯改善No SignificantImprovementin AccelerationResponse加速反應無顯著改善No Beep無聲Yes是No否Re-Assess Clin

20、ical Indicators重新評估臨床指標Adjustment of Level orArea Successful水平或位置調整成功Adjustment of Level orArea Not Successful水平或位置調整不成功 Insure Segmental Contact Point was Correct Insure Line of Drive Was Correct Consider that Area May Not Change保證節段接觸點正確確保方向正確考慮位置可能不變 Impulse iQ Adjusting Instrument Audible Indica

21、tors & Clinical Decision Making脈沖IQ調整儀器的發聲指示及臨床決策“Interactions between the vestibular and proprioceptive inputs triggering and modulating human balance-correcting responses differ across muscles,” Allum & Honnegger, Experimental Brain 前庭和本體沖動之間的互動，透過肌肉誘發和調整人的平衡-糾正反射的不同Research, 1998:121Unilaterally

22、reduced or altered hip or SI motion produces rotation of the trunk.單側髖或骶髂關節活動減少或改變而引起軀干旋轉。This excites lumbar joint receptors triggering muscular contractions (primarily the QL) to counter the rotary forces and provide stability.這刺激腰椎關節受體，引發肌肉收縮（主要是腰方肌QL）抵抗旋轉力，并提供穩定。“Differences in lumbopelvic motio

23、n between people with and people without low back pain during two lower limb movement test,” Scholtes, et al, Clinical Biomechanics, 2008:24腰背痛和無腰背痛的人在下肢活動測試時的不同的腰骨盆運動“During (prone) knee flexion and hip lateral (external) rotation, people with low back pain demonstrated a greater maximal lumbopelvi

24、c rotation angle and earlier lumbopelvic rotation, compared to people without low back pain.”“在（俯臥）膝關節屈伸和髖關節外側（向外）旋轉期間，腰痛者與無腰疼者相比，最大腰盆旋轉角度更大，且腰盆旋轉更早。”In patients without low back pain but with “positive abnormal spine patterns:對于無腰痛但有“脊椎異常模式陽性的人中：the mean onset times for the hamstring, ipsilateral e

25、rector spinae, and contralateral erector spinae muscles were prior to the onset of leg movement during prone extension.在俯臥伸展期間，腘繩肌、同側豎脊肌和對側豎脊肌肌肉的平均啟動時間在腿部運動啟動之前。the mean onset time for the gluteus maximus occurred after (inhibited) the onset of leg movement.臀大肌的平均啟動時間在腿部運動開始之后（被抑制）。“An investigation

26、 into motor pattern differences used during prone hip extension between subjects with and without low back pain,” Bruno, Bagust, Clinical Chiropractic, 2007:10腰痛病人和無腰痛者在俯臥位髖伸展的運動模式之間的不同PI-EXAS-INPSAIPubic Symphysis Dysfunction恥骨聯合功能障礙Adjust up on the AS ilim side,Down on the PI ilium side.AS髂骨端向上，PI

27、髂骨端向下調整Flowchart for Step 3第3步流程圖Hip Rotation Tests髖關節旋轉測試InternalRotation內旋ExternalRotation外旋Positive陽性Negative陰性Positive陽性Negative陰性AdjustPosteriorTrochanter調整后方轉子Proceed toLower Ext.Compression Tests繼續下肢壓迫測試AdjustAnteriorTrochanter調整前方轉子Proceed toLower Ext.Compression Tests繼續下肢壓迫測試HyperactiveInte

28、rnal Rotators內旋肌過度活躍HyperactiveExternal Rotators外旋肌過度活躍Normal: 35-40 degrees正常：35-40度Normal: 50-60 degrees正常：50-60度Step 3: Hip Rotation Test第3步：髖關節旋轉測試Internal Rotation of the Right Hip右髖關節內旋External Rotation of the Right Hip右髖關節外旋Step 3: Hip Rotation Test第3步：髖關節旋轉測試Internal Rotation of the Left Hip

29、左髖關節內旋External Rotation of the Left Hip左髖關節外旋Step 3第3步Hip Rotation Tests髖關節旋轉測試InternalRotation內旋Positive陽性AdjustPosteriorTrochanter調整后方轉子Hyperactive or InhibitedExternal Rotators外旋肌過度活躍或受抑制Internal rotation of right hip:右髖關節內旋35-40 degrees35-40度Posterior Hip Adjustment后方髖關節調整 SCP: Posterior aspect

30、of the greater trochanter SCP:大轉子的后面 LOD: Anterior LOD: 前 Setting: High or Medium 設置：高或中Posterior Hip Adjustment(For Loss of Hip Internal Rotation)后方髖關節調整（髖關節內旋受損）External Rotators外旋肌Muscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & WilkinsFlowchart for

31、Step 3第3步流程圖Hip RotationTests髖關節旋轉測試InternalRotation內旋ExternalRotation外旋Positive陽性Negative陰性Positive陽性Negative陰性AdjustPosteriorTrochanter調整后方轉子Proceed toLower Ext.Compression Tests繼續下肢壓迫測試AdjustAnteriorTrochanter調整前方轉子Proceed toLower Ext.Compression Tests繼續下肢壓迫測試Hyperactive or InhibitedInternal Rota

32、tors內旋肌過度活躍或受抑制Hyperactive or InhibitedExternal Rotators外旋肌過度活躍或受抑制 Step 3第3步Hip RotationTests髖關節旋轉測試ExternalRotation外旋Positive陽性AdjustAnteriorTrochanter調整前方轉子Hyperactive or InhibitedInternal Rotators 內旋肌過度活躍或受抑制External rotation of right hip:右髖關節外旋50-60 degrees50-60度Anterior Hip Adjustment 前端髖關節調整

33、SCP: Anterior aspect of the greater trochanter SCP:大轉子的前面 LOD: Posterior LOD: 后 Setting: High or Medium 設置：高或中Anterior Hip Adjustment(For Loss of Hip External Rotation)前端髖關節調整（髖關節外旋受損）Hip Internal Rotators: TFL髖關節內旋肌：TFLMuscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippin

34、cott Williams & WilkinsHip Internal Rotators髖關節內旋肌Muscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & WilkinsUnilateral Hip Rotation Range of Motion Asymmetry in Patients With Sacroiliac Joint Regional Pain有骶髂關節局部疼痛的病人單側髖關節旋轉范圍不對稱Cibulka et al. Spine: Volu

35、me 23(9) 1 May 1998 pp 1009-15The patients with LBP with evidence of SIJ dysfunction had significantly reduced hip internal rotation unilaterally, specifically on the side of the posterior innominate.有證據顯示骶髂關節功能失調的腰背痛病人，會有明顯的單側髖關節內旋受限，特別是在髂脊后旋的一側。From the *Jefferson County Rehabilitation and Sports

36、Clinic, Crystal City, Missouri, the Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, the Jefferson County Rehabilitation and Sports Clinic, Crystal City, Missouri, and the Department of Physical Therapy, School of Health and Rehabilitation Sciences, Univers

37、ity of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.來自*密蘇里州水晶城杰斐遜縣康復和體育診所；密蘇里州圣路易斯華盛頓大學醫學院物理治療課題組；密蘇里州水晶城杰斐遜縣康復和體育診所；賓夕法尼亞州匹茲堡大學醫學中心衛生和康復治療科學學院物理治療系。“The Hip Joint: Myofascial and Joint Patterns,” Marc Heller, DC, Dynamic 髖關節：肌筋膜和關節模式Chiropractic, May 7, 2007:“The hip joint is an absolutely c

38、ritical component of both lower back and lower extremity problems.”“髖關節絕對是引起下腰部和下肢問題的關鍵部位。”Internal rotation is the first motion affected with hip capsular problems and DJD.內旋是髖關節囊問題和關節退行性病變影響的第一個動作。“When you find a severe lack of internal rotation in the hip and this motion cannot be restored, the

39、patient is usually on their way to hip replacement surgery.”“當您發現髖關節內旋嚴重受限且該動作無法恢復時，該患者通常要接受髖關節置換手術。”“The Hip Joint: Myofascial and Joint Patterns,” Marc Heller, DC, Dynamic Chiropractic, May 7, 2007:Flowchart for Step 4第4步流程圖Lower ExtremityCompressionTests下肢壓迫測試LateralHamstrings外側腘繩肌Peroneals腓骨肌Pos

40、itive陽性Negative陰性Positive陽性Negative陰性ImpulseLateralHamstrings沖擊外側腘繩肌ImpulsePeroneals沖擊腓骨肌Proceed toSupra-pelvicCompression Tests繼續盆骨上方壓迫測試HyperactiveMuscles肌肉過度活躍HyperactiveMuscles肌肉過度活躍Step 4第4步Lower ExtremityCompressionTests下肢壓迫測試LateralHamstrings外側腘繩肌Positive陽性ImpulseLateralHamstrings沖擊外側腘繩肌Hyper

41、activeMuscles肌肉過度活躍Positive Findings:MyospasmTendernessTrigger PointsGuarding陽性結果：肌痙攣柔軟壓痛觸點保護Lateral Hamstring (Biceps Femoris m.)外側腘繩肌（股二頭肌 股肌）Muscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & WilkinsStep 4. Lower Extremity Compression Tests(for Lateral

42、 Hamstring and Peroneal m. involvement)第4步下肢壓迫測試（外側腘繩肌肉和腓骨肌受累）Lateral Hamstring Compression Test外側腘繩肌肉壓迫測試Peroneal Compression Test腓骨肌壓迫測試Lateral Hamstring Adjustment外側腘繩肌調整 SCP: Taught/Tender area of muscle belly of Biceps Femoris m SCP:股二頭肌肌腹的敏感壓痛處 LOD: Anterior LOD: 前 Setting: Medium or Low 設置：中或

43、低Lateral Hamstring Adjustment側面腘繩肌調整Step 4第4步Lower ExtremityCompressionTests下肢壓迫測試Peroneals腓骨肌Positive陽性ImpulsePeroneals沖擊腓骨肌HyperactiveMuscles肌肉過度活躍Peroneal m.腓骨肌Muscles, Testing and Function with Posture and Pain, Kendall et al, 2005, Lippincott Williams & WilkinsStep 4. Lower Extremity Compressio

44、n Tests(for Lateral Hamstring and Peroneal m. involvement)第4步下肢壓迫測試（涉及側面大腿肌肉和腓骨肌）Lateral Hamstring Compression Test外側腘繩肌壓迫測試Peroneal Compression Test腓骨肌壓迫測試Peroneal m. Adjustment腓骨肌調整SCP:Taught/Tender area of muscle belly of Peroneal m. SCP:腓骨肌肌腹的敏感壓痛處LOD:Anterior LOD:前Setting: Medium or Low 設置：中或低P

45、eroneal m. Adjustment腓骨肌調整Flowchart for Step 5第5步流程圖Supra-pelvicCompressionTests盆骨上方壓迫測試LeftQuadratusLumborum左腰方肌RightQuadratusLumborum右腰方肌Positive陽性Negative陰性Positive陽性Negative陰性Impulse theQuadratusLumborum沖擊腰方肌Proceed toLumbarAnalysis繼續腰椎分析Impulse theQuadratus Lumborum沖擊腰方肌Proceed toLumbarAnalysis

46、繼續腰椎分析HyperactiveQuadratus腰方肌過度活躍HyperactiveQuadratus腰方肌過度活躍Step 5第5步Supra-pelvicCompressionTests盆骨上方壓迫測試QuadratusLumborum腰方肌Positive陽性Impulse theQuadratusLumborum刺激腰方肌HyperactiveQuadratus腰方肌過度活躍Positive Findings:MyospasmTendernessTrigger PointsGuarding陽性結果：肌痙攣壓痛觸點保護Step 5. Supra-Pelvic Compression

47、Tests(for Quadratus Lumborum m. involvement)第5步 盆腔上方壓迫測試（腰方肌受累）Step 5. Supra-Pelvic Compression Tests(for Quadratus Lumborum m. involvement)第5步 盆腔上方壓迫測試（腰方肌受累）Quadratus Lumborum m. Adjustment腰方肌調整 SCP: Taught/Tender area of muscle belly of Quadratus Lumborum m. SCP：腰方肌肌腹的敏感痛處 LOD: Anterior LOD：前 Set

48、ting: Medium or Low 設置：中或低Quadratus Lumborum m. Adjustment腰方肌調整 Summary of tests to identify the dysfunctional SI joint (PI Ilium):確定功能失調性SI關節（PI髂骨）的測試摘要： 1. Pain in one SI, buttock, thigh with Bilateral Nachlas test2. Positive Nachlas test (the fixated SI joint)3. Pain in the fixated SI with compre

49、ssion or digital palpation4. Reduced prone hip extension on fixated side5. Asymmetrically reduced hip rotation on fixated SI joint side6. Hypertonic (with trigger points) lateral hamstring on fixated side7. Hypertonic QL on fixated side1. 雙側Nachlas測試法檢查SI、臀部、大腿疼痛2. 陽性Nachlas測試（固定的SI關節）3. 采用壓迫或手指觸診檢查

50、固定的SI疼痛4. 減少固定端的側俯臥伸髖5. 不對稱性減少固定的SI關節端的髖關節旋轉6. 固定側外側腘繩肌張力升高（觸點）7. 固定側腰方肌張力升高Cervical Spine頸椎脈沖調整TECHNIQUECervical Zygapophyseal Joint Pain Referral Patterns頸椎椎骨關節突關節疼痛轉診模式Cervical Spine頸椎The articular facets of C3 through C7 are oriented at 45 degrees to the transverse plane & parallel to the fronta

51、l plane. C3-C7 的關節面與橫切面成45度，與額狀面平行。Kinematics of C3 through C7C3-C7的運動學(Management of Common Musculoskeletal Disorders, Hertling & Kessler, 1990, Lippincott)Rotation and lateral bending occur together to the same side (coupling).同側一起發生旋轉和側屈（耦合）。“As one articular facet joint slides forward and upward

52、, its mate slides backward and downward, translating to a sidebending component in the frontal plane and a rotatory component in the transverse plane.”“一個小關節突關節向前和向上滑動，其配對體向后和向下滑動，轉化成在額狀面的側彎和橫切面的旋轉”C3 & 4 right facets not gliding anterior and superior.C3和C4右面沒有前上滑動Kinematics of Occiput-C1-C2枕部C1-C2的

53、運動學Occiput-C1: 13 degrees of flexion-extension 8 degrees of lateral bending 10 degrees of axial rotation 枕部- C1： 13度屈-伸 8度側彎 10度軸向旋轉C1-C2: 10 degrees of flexion-extension 0 degrees of lateral bending 65 degrees of axial rotation C1 - C2： 10度屈-伸 0度側彎 65度軸向旋轉Cervical Compression Test:脊椎壓迫測試：Cervical C

54、ompression Test:頸椎壓迫測試：“+” in the area of the C-spine that pain and/or restriction is felt:在頸椎部位感到疼痛和/或束縛感“+”號：mid to lower C-spine - usually a loss of lordotic curve with inability to move into lordosis, primarily between C6-C3; upper C-spine usually suboccipital spasm interfering with normal occip

55、ital glide and C1-C2 movement.中-低段頸椎- 通常是前凸彎曲消失，不能活動到前屈位，主要在C6 C3上段頸椎 - 通常枕下痙攣，干擾正常的枕滑行和C1 - C2運動。Also tells examiner of presence of radicular pain indicating possible space occupying lesion.還告訴檢查者存在根性疼痛，表明可能有占位性病變。Cervical compression test:頸椎壓迫測試：Patient reports pain in upper neck or skull begin wi

56、th C2 analysis. Turn head to right and then left.Adjust C2 on side of restriction, not side of pain.患者報告頸部或顱骨疼痛 - 開始C2分析。頭先轉向右側，然后向左。在束縛感的一側調整C2，不痛。Right Cervical Rotation Test (for C2):右頸旋轉測試（C2）：C2 adjustment (TP):C2調整（TP）：-SCP: C2 LPJ-LOD: Anterior-Superior-Setting: Low-Thrust(s): Single-SCP：C2 L

57、PJ-LOD：前上-設置：低-推力：單個Cervical Spine頸椎Occiput adjustment: (single stylus)枕部調整：（單針）C1 adjustment:C1調整：-SCP: C1 TP-LOD: Medial-Setting: Low-Thrust(s): Single-SCP：C1TP- LOD：內側-設置：低-推力：單個-SCP: Occiput-LOD: Anterior-Superior-Setting: Low or Medium-Thrust(s): Single-Double stylus- SCP：枕部-LOD：前-上-設置：低或中-推力：單

58、個- 雙針-SCP: C2 Bilateral LPJ-LOD: Anterior-Superior-Setting: Medium or Low-Thrust(s): Single or Multiple-Double stylus-SCP：C2雙邊LPJ-LOD：前-上-設置：“中”或“低”-推力：單個或多重- 雙針If cervical compression test produces pain in mid to lower cervical spine, proceed to lateral flexion test.Begin at C3 on side of restricti

59、on, not pain.如果頸椎壓迫試驗造成中下段頸椎疼痛，則開始側屈試驗。開始在C3束縛感側，不痛。Right Cervical lateral bending test for C3-C7:C3 - C7頸右側彎測試：Right C3-7 TP adjustment: 右側C3-7 TP調整：-SCP: Cervical LPJ-LOD: Anterior-Superior-Setting: Medium or Low-Thrust(s): Multiple-SCP：頸椎LPJ-LOD：前-上-設置：“中”或“低”-推力：多重Cervical Spine頸椎Cervical dual s

60、tylus adjustment to restore lordosis:頸椎雙針調整恢復前凸：-SCP: Cervical Bilateral LPJ-LOD: Anterior-Superior-Setting: Medium or Low-Thrust(s): Single or Multiple-SCP：頸部雙側LPJ-LOD：前-上-設置：“中”或“低”-推力：單個或多重Muscles that hinder Occiput -C7 correction:阻礙枕部- C7肌肉的矯正：ScalenesUpper TrapeziusLevator scapulaeSplenius cap