dr. rob demartino advanced training -...
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Advanced Training
Dr. Rob DeMartino
Advanced NRCT
Treatment
Dr. Robert DeMartino, D.C., Q.N.
Master Trainer for NRCT
Superior Health Solutions
Henderson, NV
X-Ray Evaluation
A more precise way to improve diagnosis.
A visual for patients so they can understand.
Allow for a higher level of diagnosis code.
Explains why some patients will get changes on Anterior and Posterior testing.
Explains why the lateral technique works.
Helps get more specific with treatment giving you a more exact line of drive.
Adds another component of care with cervical stabilization techniques necessary.
George’s Line
Case History
66 Year old female
3 Strokes within the last five years
Left side of the body weakness
Balance problems
Pain in both legs
Neck pain
Middle back pain
Cervical Lateral View w/ Extension
What was her listing?
C4 is retro unstable on C5
Bilateral Posterior!
It makes sense, because if the ligament
instability in her spine is on the posterior
aspect, than the translation of the bones
will be in a posterior position.
Therefore, the force of the NRC treatment
should be applied Posterior to Anterior.
Case History
24 year old female
Diagnosis of Still’s Disease (essentially
Juvenile RA with associated high fevers).
Chronic whole body pain.
Onset when she was 16 years old
following a “routine” surgery on a knee
injury.
Cervical Lateral View w/ Flexion
What was her listing?
C3 is unstable on C4 anteriorly.
Less so C2/3 and C4/5.
Bilateral Anterior!
Since the ligament damage is occurred in
the anterior position, it would make logical
sense that the nervous system would
respond to the Anterior to Posterior line of
drive.
But here is where it gets interesting…
The New X-Ray Angle
It is a twist on taking an AP open mouth cervical x-ray.
You set the patient up the exact same way, but you take the x-ray with the patient laterally bending their neck bringing their ear directly to the shoulder.
Take it with the bend to both sides.
You are looking for an overhang of the C1 lateral mass over the body of C2.
AP Open Mouth w/ Lateral Bend
Normal Example
Case History
16 year old
Diagnosed with fibromyalgia
Onset of symptoms came after she
crashed her bike into a light pole and
fractured her collarbone
Here are her APOM Lateral Bend X-rays
APOM w/ Lateral Bend
Case History
55 year old woman
30 years ago her car was T-boned by a
semi-truck that broke multiple bones in her
body.
Her pain was controlled with traditional
chiropractic for a long time, but within the
last few years she has gotten little to no
relief with any modality.
APOM w/ Lateral Bend to Left
APOM w/ Lateral Bend to Right
Patient Evaluation
Raglands Before and After
Muscle Testing
Leg Length evaluations
Neurologic testing
Therapy Localize
Lower Myotome Evaluations
Lower Body
S1:
Peroneus Tertius
Supine with foot in eversion
L5:
Toe Extensors
Supine with the toes in extension
L4:
Tibialis Anterior, Hamstring
Supine with foot inverted/ Supine with knee and hip at 90
degrees
Lower Myotome Evaluation
L3: Sartorius
Supine with knee/hip at 90 degrees and externally rotate the femur to cross the patient’s leg.
L2: Quadriceps
Supine with hip/knee at 90 degrees
L1: Illiopsoas
Supine with hip/knee at 90 degrees
Upper Myotome Evaluation
T1:
Finger Abducters
Fingers spread out
C8:
Finger Flexors (Grip)
Fingers flexed around your curled fingers
C7:
Triceps, Wrist Flexion, Finger Extension
Arm at side, elbow bent at 90 degrees, palms up
Upper Myotome Evaluation
C6:
Biceps, Wrist Extension
Arm at the side elbow bent at 90 degrees
C5:
Deltoid
Arms abducted 90 degrees or to patient ROM,
Elbow at 90 degrees and palms down
Upper Myotome Evaluation
C4:
Cervical Rotation
Have patient “Turn into your hand:
C3:
Lateral Flexion
Bringing ear to shoulder
C1/C2:
Flexion and Extension
Make sure you post and have square resistance