7q - cervical spine t & m midterm
TRANSCRIPT
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Cervical Spine Technique and Management - MidtermOutline1. Anatomy2. Biomechanics3. Chiropractic Analysis MAN Analysis
a. Subluxation/ Manipulable lesion/ Adjustable lesion(Locate u!lu"ation #ia$1. MotionAnalsis
Motion %alpation Motion &'ray
Cinema a)io*raphy
!. AlignmentAnalsis
". #eurologic Mani$estationAnalsis
Mani+estations o+ the u!lu"ation itsel+ (pain, ten)erness, tissue te"ture, re+le" analysis,
le* len*th analysis, muscle stren*th$
When all 3 agree, we have a high confidence that we are on the correct location!!
-. Chiropractic A)ustment. ther herapies
M%&T'(M
. Con)itions o+ the Cer#ical pine. Mana*ement +or these Con)itions4. 5ea)aches
Anatomo$ the Spinal Cord
Lar*est in the nec6 than any other area o+ the !o)y
Cer#ical 7ntumescentia C81 Contains Brachial %le"us
9ery sensiti#e structure
LAYERS from inside out:1. :loatin* in C:
Menin*es is +at
C: is +lui)
hus the spinal cor) +loats in +lui) helps +or shock absorption!
!. urroun)e) !y ;pi)ural :at
". urroun)e) !y the Spinal Column
Spinal Column1. )O&*' less compressi#e stren*th
Can lea) to compression +racture
a. Compression+racture
ually ;? :LA@
7+ A/B 2/3s, than pt. is consi)ere) sta!le
b. Schmorl,s#ode
c. )urst+racture
1
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%ieces !rea6 +ree allo=in* potential o+ Neurolo*ical )ama*e
!. OST'(%O(A(Ca. edicle
hortene) pe)icles =ill cause !o)y an) Articular %illar to o#erlap on Lateral &'ray.
%re)isposes to pinal Stenosis
b. /ncinate rocesses N yno#ial !ut has 5yaline Cartila*e
Can !e a source o+ ca#itation, !ut not pro#en
%rotects the 79: (ner#e root$ +rom the ?isc C spine disc lesions are LESS COMMON!
pertroph o$the /ncinaterocesses
1. @reater inci)ence o+ ?isc Bul*e %ro!lems2. &'ray e#i)enceD
a)io'opacity seen at Lo=er Bor)er o+ 9erte!ral Bo)y
c. Articularillar
Barrier !et=een Li*amentum :la#um an) the 79:
Li*amentum :la#um =ill lose elasticity =ith a*e an) can also hypertrophy lea)in* to "
Stenosis
Superior Sur$ace Superior an) osterior
%n$erior Sur$ace %n$erior an) Anterior
d. +acets
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!2 Annulus +ibrosis(inner#ation E $ecurrent %eningeal &erve$
Bul*e E causes more motor +in)in*s (anterior$
%# &NCNA'E (ROCESS
%rotects ner#e root +rom )isc !ul*e
?e*eneration o+ Lusch6a Joints E correlates =/?J?/arthritis I )isc protrusion
Anterior to 79: causes more motor +in)in*s (than sensory$
C# )Y*A(O(+YSEAL ,ON'
yno#ial Capsule/ Capsular Li*ament is #ery hi*hly inner#ate)
urroun)e) !y capsular li*ament
?e*enerati#e hypertrophic chan*e (spurs$ causes more sensory +in)in*s ()orsal$
yno#ial 5y*iene E maintain 7MB7B77N
3. 4%5AM'#TS re#ie=a. Anterior Lon-itudinal Li-ament anterior to 9erte!ral Bo)y (9B$
7nner#ate)
!. (osterior Lon-itudinal Li-ament' posterior to 9B
c. Supra.spinousLi-ament (Li*amentum Nuchae$ E o#er %
). nterspinousLi-ament E !et=een %
e. Li-amentum"la/um hi-h 0elastin1 .!/t LAM7NA o+ a)acent #erte!rae
AN;
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3. 7nterspinalis-. 7ntertrans#ersalis
b. Sub'Occipitals
ta!iliFe C'pine
Sensor similar to ype 3 li*amentous receptor in cat
#erve9 muscle ratioE )etermines control ()e"terity$1$ 5i*hest ratio E e"trinsic muscle o+ eye2$ imilar ratio E u!'ccipital muscles
Suboccipitals91. SuperiorOblique!. %n$eriorOblique". (ectus Capitusosterior Major3. (ectus Capitusosterior Minor - Most hi*hly inner#ate) muscle in the !o)y
:i!rous colla*en !ri)*e attachment !et=een this muscle an) the Menin*es o+ the pinal
Cor)
heory that this muscle is a source o+ muscle contraction headaches!!
Suboccipital Triangle
Ner#es e"it out o+ the u!'ccipital rian*le (7n+erior !li>ue, C% Maor an) uperior
!li>ue$
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c. OT'( M/SC4'S9 :4arger2
'rector Spinae muscles
ri*inate in the acrum
hus can palpate +or ten)erness here a lot o+ the time
1. Spinalis' % to %a. pinalis Cer#icis!. pinalis Capitus (to cciput instea) o+ another %$
2. 4ongissimus' 9% to 9%a. Lon*issimus Cer#icis!. Lon*issimus Capitus (to Mastoi) %rocess instea) o+ another
9%$
'cciput is the (P analog %astoid is the )*P analog
". %liocostalisa. 7liocostalis Cer#icis
Ner#eD %osterior !ranch o+ pinal Ner#e
Semispinalis9% !elo= to the % a!o#e
1. SemispinalisCervicis
!. SemispinalisCapitus
9% !elo= to cciput a!o#e (li6e the % o+ the s6ull$
Ner#eD
Splenius% !elo= to the 9% a!o#e
1. SpleniusCervicis
!. SpleniusCapitus
% !elo= to the Mastoi) a!o#e (9% o+ the s6ull$
@reater ccipital Ner#e
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4evator ScapulaeOrigin9 %s o+ C1' C-%nsertion9 uperior an*le o+ capula#erveD Cer#ical Ner#e C3'C- ?orsal capular C
Trape;ius
Origin9
;%
uperior Nuchal line
Li*amentum Nuchae
%s o+ C 12
%nsertion9
Cla#icle
Acromion
pine o+ capula
1. /pperTraps ele#ates capula2. MiddleTraps retracts capula3. 4o6erTraps )epresses capula
When upper and lower traps contract together, (capular
A+duction will occur!! Pec %ayor - %inor (err Ant
'7'(C%S'S +O( 4O
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8. Strapmusclesa. mohyoi) ' *oes !ac6 to the scapula!. ?i*astricc. Myohyoi) ' helps to open the a=). tylohyoi)e. hyroihyoi)
+. ternohyoi)*. ternothyroi)
Can all !e inure) an) cause &sphagia
=. latsma
5as N si*ni+icant +unction in humans
Terms o$ Conditions1. Concussion (!ump$
Hill cause temporary loss
2. Contusion (!ruise$
Hill cause permanent )ama*e
". Cervical %ntumessentia
Bul*e occurs at the area o+ Brachial Cor)s +rom C'1 re*ion
7t houses the !rachial ple"us
3. Stinger>)urner
Loo6 up in ol) material
8. )urning ands Sndrome
B/L tin*er +ollo=in* C'spine inury
=. Transient ?uadraplegia
%aralyFe) +ollo=in* a concussion (since it is a concussion temporary$
. SC%
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harnx > 4arnx > Trachea > 'sophagus1. harnx
Carries !oth +oo) an) air
!. 4arnx he =itchin* station
". Trachea' anterior attachment to the Laryn"
3. 'sophagus' posterior attachment to the Laryn"
7s +lat =hen nothin* is in it
Hill !ul*e out =ith a !olus o+ +oo) in it
8. Throid5land
?ama*e) )urin* acne treatment in many people
=. Stellate5anglion
7rritation or e"cess +unction E )arre 4ieou Sndrome
+unction E orner@s Sndrome9 ptosis mosis anhdrosis
(eticular +ormation1. Origin
Brainstem
@rey I =hite matter
!. +unctionso$ the (eticular +ormationa. Control o+ A7C %
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his possi!ly e"plains ho= an a)ustment helps stomach pro!lems, or other #isceral
pro!lems
Coul) also a++ect posture ne*ati#ely i+ su!lu"ation is not a))resse).
/pper Cervical Subluxation MAG a++ect (i.e. possi!ility o+ a++ectin*$1$ Autonomic +unctions2$ eticular Acti#ation ystem
7nsomnia A??
)iomechanics o$ the Spine1. +lexion/'xtension
Lo=er horacic 9erte!rae act li6e Lum!ars
A)ustments shoul) !e similar to Lum!ar a)ustmenti)e posture push
!. (otation
Most occurs in the horacic re*ion
to a)ust patients =ith ?isc Lesions in Lum!ar spine !ecause not that much rotation occurs
there
)iomechanics o$ the Cervical Spine
SEGMENT Flexion
Extension
Lateral
Flexion Rotation
C0/C1 Moderate Moderate
C1/C2 Moderate High
1. /pper Cervical Spinea. Motor units
cciput / Atlas motor unit
Atlas / A"is motor unit
b. +unction' ee notes Mo)erate amount o+ :le"ion/;"tension
Coupled MotionO$ /pper C-Spine
=o motions that are ;C"motor unit to CB>T1motor unit
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Coupled MotionO$ 4o6er C-Spine
CC8motor unit
1. @reatest motion2. @reatest le#era*e3. Ape" o+ C'spine
-. MC location o+
Arthritis
/isc lesion(!ut usually +oun) lo=er$
&C,s91. He use Couple) Motion to loc outse*ments so =e can a)ust only N; M
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!. permobilit
u**esti#e o+ li*ament inury
4ateral +lexion T(A/MA9
#O(MA4 T(A/MA
Side o$ 4ateral +lexion
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Ieeping head 4'0'4in (otation (i*ht otation =ithout Lateral :le"ion$
(ight (otationH75
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Normal E 3' -P
A#era*e E 20 ' 2(asymptomatic$
=. 4ong-term +lexion osture
Creates la" anterior li*aments shortens +i!ers (#ia #isco'elastic creep$
Creates ti*ht posterior li*aments
Management Considerations91. Antalgia
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'xtension 'xercise
1. o stren*then the muscles that are nee)e) +or N;C ;&;N7N
hese muscles ha#e a har)er time e"ten)in* !ecause %atient
has a military nec6
;"ercise also +lushes !loo) 5
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Chiropractic Analsis' 5;; 7 N @L? AN?A?MA# Analsis973 MotionAnalsis
Motion %alpation
Motion &'ray
23 AlignmentAnalsis When A 3 agree, we have ()$'&6 confidence &'ray Analysis that our assessment is correct!!!
%osture Analysis
tatic %alpation
83 #eurologic Mani$estationanalsis
Collagen > 0ascular&iseases
heumatoi) Arthritis nee)s lots o+ tests to positi#ely 7? (only a positi#e o+ 5 is not *oo) enou*h$
Just li6e u!lu"ation theory
Chiropractic 0ital Signs1. AlignmentAnalsis
LA;AL 97;H
osturalAnalsis
%atient shoul) !e in their Neutral position
ry to i)enti+y +or Anterior Hei*ht Bearin* (#ia ;AM an) shoul)er
ali*nment$
7-raanalsis
1. Cervicalcurve measurement
C2' Cshoul) !e 3 '-S current a#era*e is 2S
!. 5eorge@s 4ine
7nsta!ility i+ !rea6 is 3. mm
". resence o$ Anterior
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Be sure to outline all pe)icles o+ &'ray to !e sure that there are no 9inkin- O6l si-ns
(metastasis o+ some sort$
(otation osture
At the pinolaminar Junction, % =ill !e either or L
Can also see i+ !oth %e)icles are e>ui')istant +rom !or)ers
1. maller %e)icle E Contralateral % rotation
2. Lar*er %e)icle E 7psilateral % rotation
4ateral +lexion osture Open
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Motion alpation +indings and their Corresponding 4istings9
+ixation 4isting rocedure
(ight osterior(otation+ixation
%L / % listin*
estricte) =hen pushin* on i*ht
Articular %illar !ecause it is stuc6on the Le+t
Contactin* i*ht Articular %illar,
+ully rotatin* to the Le+t
4e$t osterior(otation+ixation
%/L% listin* Contactin* Le+t Articular %illar,
+ully rotatin* to the i*ht
(ight 4ateral+lexion +ixation pen He)*e on i*ht
Contactin* Lateral aspect o+ i*ht
Articular %illar an) +ully Laterally+le" to=ar)s the i*ht (usin* the+in*er as the :ulcrum o+ motion$
Just li6e a Cer#ical emps mo#e
:i"ation note) =hen tryin* to
close )o=n the open =e)*e(=ont !e sprin*y =hen =e+ulcrum at that le#el$
4e$t 4ateral+lexion +ixation pen =e)*e on Le+t Contactin* Lateral aspect o+ Le+t
Articular %illar, +ully lateral +le" toLe+t =ith +in*er as :ulcrum
Complex 4istings1. (S / 4%
Static postural $indings Le+t otation posture
Le+t Lateral :le"ion posture
5ross (OM $indings i*ht rotation restriction
i*ht lateral +le"ion restriction
Star &iagram i*ht Lateral :le"ion estriction
Le+t %osterior otation :i"ation
!. 4% > (S
Static postural $indings i*ht otation posture
Le+t Lateral :le"ion posture
5ross (OM $indings Le+t rotation restriction
i*ht lateral +le"ion restriction
Star &iagram i*ht Lateral :le"ion estriction
i*ht %osterior otation :i"ation
". (% > 4S
Static postural $indings Le+t otation posture
i*ht Lateral :le"ion posture
5ross (OM $indings i*ht rotation restriction
Le+t lateral +le"ion restriction
Star &iagram Le+t Lateral :le"ion estriction
Le+t %osterior otation :i"ation
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3. 4S > (%
Static postural $indings i*ht otation posture
i*ht Lateral :le"ion posture
5ross (OM $indings i*ht rotation restriction
i*ht lateral +le"ion restriction
Star &iagram Le+t Lateral :le"ion estriction
i*ht %osterior otation :i"ation
A(& 4%ST%#5SHH
7n the Cer#ical pine, there are 2 Lo=er !li>ue an*lesD
a. (ight Anterior(otation +ixationb. 4e$t Anterior (otation +ixation
A#T'(%O( (OTAT%O# +%7AT%O#S(%ullin* A to % on Articular %illar$
p. 12 %A
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4ateral $lexion % 6ic6s to CNALA;AL
(otation % 6ic6s to CNALA;AL
". 7-ra Motion Analsisa. +lexion/ 'xtension 7-ras
Loo6in* +or the presence o+ !loc6in* (in)icates the le#el o+ u!lu"ation$
)locingE a!sence o+ mo#ement !et=een 2 a)acent su!ects
b. 4ateral+lexion 7-ras
A!sence o+ couple) motion (couple) motion o+ e"tension an) rotation$
7n)icati#e o+ u!lu"ation
c. Cineradiograph
a6es a lot o+ &'ray e"posure
3. Motion M(%
o i)enti+y occult ?isc Bul*es
#eurologic Mani$estions
A)ustments ha#e !een sho=n to help =ith ALL o+ these
ALL are possi!le mani+estations o+ a su!lu"ation
1. ain
9A / 9?
5o= )oes it a++ect A?Ls
!. Tenderness
Al*ometry / ?olorimetry
en)erness in)icates possi!leD
u!lu"ation 5ypermo!ility
". Musclespasm
?ecrease) issue Compliance
3. Muscle Si;eand Strength
Myotomal )istri!ution o+ =ea6ness / atrophy
Can also use ?s
8. resence o$ aresthesiaor per>poesthesia
?ermatomal pattern
=. Cervical&ere$ield Test
Le* Len*th est
5a#e patient rotate hea) to !oth )irections
u!lu"ation causes irritation o+ %ropioceptors in nec6, causin* stimulus to casca)e )o=n to
%el#is
B. Sintemperature changesa. @o'scope
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b. hermo*raphyc. 7n+rare) computin*d. #euro dermo Thermograph
Measures temperature chan*es in the s6in
Mechanism)ased on the Smpathetic #.S.
N causes an in ympathetic acti#ity at the le#el o+ the u!lu"ation
roblem
7+ there =as a Subluxation9
7t =oul) sprea) the A%s up an) )o=n the ympathetic chain
his =oul) cause a more 6idespreadheat )i++erential
ossible (eason9 An inflamed 87oint capsule is what is causing the heat reading
J. 'lectricalSin (esistance
Measures electrical resistance !ecause the s6in s=eats
K. Muscle Testing(Applie) inesiolo*y$
Theor
MeasuresQpee) o+ ma"imum contractionR 4ocing
A LStrong muscleR E no su!lu"ation
ouchin* the su!lu"ation =ill !loc6 the propioceptor mechanism
his causes a slo=in* o+ the spee) o+ Ma"imum Contraction ma6in*
it =ea6
Therap 4ocali;ation Challen*in* #erte!rae to=ar)s su!lu"ation =ill ma6e it =ea6er
Challenge Testing %ushin* #erte!rae to=ar)s correction ma6es it stron*er
Surrogate Testing Challen*e urro*ate =hile he/she is touchin* the patient
1. 4eg4ength Analsis
?irectional Non':orce echni>ue herapy localiFation
Challen*e estin*
hompson ?rop echni>ue
11. endulumTechnique
Mo#in* crystal o#er su!lu"ation =ill rotate cloc6=ise +or a % an) countercloc6=ise +or a %L
1!. Aura
Ha#in* han) o#er !ac6
CORREC'N* S&%L&:A'ONS ;A$,&S'MEN'S#
7# S/)4/7AT%O# A(T%C/4A(SE speci+ic thrust *i#es speci+ic correction
2# ST'0'#SO# T'O(*E innate
8# Osseus ad
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Contact
(houl) !ecom+orta!le yet
+irm$
1. )onprominence
%
Articular %illar
Lamina
9% / Mammilary process
!. TissuepullE usually in )irection o+ thrust
B7M;C5AN7CD Allo=s us to !rin* one speci$icoint into QensionR
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"2 in Muscle tension ' s 79: siFe
his impro#es ANG :oraminal ;ncroachment con)ition
hus can !e & +or +oraminal encroachment
32
inain F Tenderness
?ue to lesion !ein* remo#e)
Q@ate heory ;++ectR
82 #erve Compression > %rritation
79: siFe
Ner#e root encroachment
Motion increases #ascular +lo=
?;C;A; in+lammation
9ltimately decreasing nerve root
compression!!
=2 Alignment s
ALL CAN CC
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3. CO(& COM('SS%O#
;LA79; CNA7N?7CA7ND1. e#ere %A7N / A7N o+ Cer#ical )isc2. Anytime there is Severe pain)urin* the Qset'upR3. 5ypermo!lity
-. ?isc lesions. ?J?
=# NON osseus ad /oesn;t make a
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xercise F(ehabilitation
1. assive (OMa3 Results
tren*thens scars
a)hesions
b3 '5pes of (assi/e ROM . E4ercise B Rehabilitation73 *ross ROM
nly ;N? AN@; =ithout pain
23 Stair.steppin-
QAnterior translationR =ith pt. upine
"i-ure.(+rom $ ' QAnterior translationR =ith pt. upine
=hile mo#in* hea) in a :i*ure 4 motion
83 Mobiliation(speci+ic$ Qset'upR H75
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OT'( T'(A%'S1. So$t-Tissue Therapies
uantity o+ +orce is an art (touch chan*es +rom patient to patient
ela" to pressure (=ant patient to rela" so you can push )eeper$
a (oint (ressure 'ri--er (oint(can use in conunction =/other therapies$
(ROCE$&RE: )o allow patient to rela.1. A)ust 1st
2. 5eat/col)
%rior to therapy (to )esensitiFe tissues$
3. opical a*ents
-. %oint pressure =ith #i!ration
. Muscle contraction
%ressure =ith %A79; or AC79; mo#ement
Contract Antagonistcauses inhi!ition an) rela"ation o+ the treate) muscle
. :ollo= =/stretch
b3 Cross."iber "riction Massa-e1. ?irection o+ mo#ement E perpen)icular to =ea6 +i!ers
s car stren*th
ear scar tissue perpendicular to *rain o+ muscle to stren*then
Can use all o+ the pre#iously mentione) mo)alities to %;% the patient !ecause this
therapy hurtsH
c Strippin- Massa-e> go parallel to the fibers
%ushin* meta!olites
1. AR' Acti/e Release 'echniDue stretches the a)hesions
?urin* therapy patient contracts anta*onistic muscles
:ollo= =/ice U stretch i+ #i*orous
2. Traction V o+ BH to a maximumo+ 30 0 l!sa3 +alter '5pe> over the door traction
1. Chin strap an) ccipital strap
is6 o+ MJ inury
2.
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d3 %ntermittentTraction
s A)hesions
7s B;; than Constant raction
$emoves edema by increasing *A("9A$ P9%P2&6!!
e3 ositions1. 'xtension Traction
7ncreases C'spine cur#e
!. #eutral Traction
7ncreases 79: siFe
". Slight +lexion Traction
:oraminal ;ncroachment )ecreases
3. T
5eat herapy
Cryotherapy Col) Motor Ner#e timulation
-. Orthopedic SupportsE Cer#ical Collars ' N tractiona. o+t +oam collar
?ecreases M
?ecreases =ei*ht !earin*
Allows muscles to $A!!
!. emporary use only
3 months MA& (usually only 1 2 months$
c. (isso$ overuse - emporary
Hea6ness Atrophy
A)hesions
:i"ations
8. #utritional Supplementsa3 Antiinflammatory protocolb3 Proteolytic en#ymes: %romelain 'r5ptin Ch5motr5ptinc3 *alerianroot muscle rela"antd3 B 5)P controls pain an) )epressione3 Cartilage (epair
6lucosamine sulfate
"hondroitin sulfate 0 %(%
. &rugs ?Cs are allo=e) to Qrecommen)R Cs (7lle*al to Qprescri!eR$
He can only tell them to ta6e =hat the !ottle recommen)s, no more
a Anti.inflammator5C&(A2/(@
i)e e++ect o+ stomach complications
a6e =/+oo) to )ecrease the ris6 o+ @7 !lee)in*
Aspirin 7!upro+en
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Napro"en (Alee#e$
b AcetaminophenC)ylenol@E pain relie#er only, N Anti'in+lammatory
Hill mas6 the pain allo=in* them to hurt themsel#es e#en more