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By Heinz-Dieter Neumann M. D. (auth.), Wolfgang G. Gilliar D. O. (eds.)
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After Bischoff 1988) \ Fig. 42. Functional segmental diagnosis utilizing the irritation points at the cervical spine (during extension testing). (After Bischoff 1988) Fig. 43. Functional segmental diagnosis utilizing the irritation points at the cervical spine (during rotation testing). 2 Thoracic and Lumbar Spine Tl-T4 Patient positioning: prone. Examiner positioning: to the side of the patient, either right or left side; either sitting or standing. The fingertips are placed two fingerbreadths lateral to the spinous processes of the incriminated segments.
Kimberly (1979) has diagrammatically outlined these joint movements and barriers (see Fig. 19). Neut ral Pass ive ; Act ive Ivo luntary) movement Pass ive Physio logical barrier Ana t omical barrier Fig. 19. Physiological and anatomical barriers A joint with impaired function suffers a loss of mobility. In addition to the physiological and anatomical barriers in a normally functioning joint, there exists what has become known as the pathological barrier, which can restrict either active or passive movement or both.
For a drawer to be functional for instance, it must have sufficient room to move, albeit ever so small, in up-down and sideside directions, which is not related to the drawer's functional movement of forward and backward. Similarly, each joint has some play in directions other than that of its functional movement. The "play" is made up of small gliding processes not contributing directly to the main direction of a joint's movement. In a normal, non-impeded joint, the examiner can feel a fine shifting of joint surfaces against each other, tangential to the plane of the joint, by moving one joint partner against the other stationary partner.