MINNESOTA CHIROPRACTIC

ASSOCIATION

ANNUAL CONVENTION

MARCH 15-17, 2018

Joseph J. Sweere DC, DABCO, DACBOH, FICC

Professor, Clinical Sciences

Director – H.C. Sweere for Clinical Biomechanics &

Applied Ergonomics

Northwestern Health Sciences University

Bloomington, MN 55431

Telephone 952-888-4777, Ext 269

E-mail: jsweere@nwhealth.edu

“Returning the Injured Worker

to the

Workplace”

The Two Most Common Time-Loss Work

Injuries:

1. The Lower Spine

2. Shoulders

Introduction

Concerns for:

The Self-Employed

The Employed Worker

The Athlete The Homemaker

Simple Base-line Ortho/Neuro Tests

The Standing Heel Drop Test

Combining Linder, Soto-Hall and the Von

Becterew’s Tests for Space Occupying

Lesions of the Spinal Canal

Identifying the Lesion in Mechanical Lower

Spinal Pain (“The Big Four”)

Sorenson’s (Biering-Sorenson) Spinal

Extensor Muscle Strength Test

The Pyriformis Syndrome

In sciatica presentations,

perform a simple test to

determine whether the

pyriformis muscle may be origin

of the symptoms

Typical Shoulder Presentations

Impingement Syndrome - Loss of

Abduction (“Frozen Shoulder”)

The Painful Shoulder

Normal A.B. (abduction) ROM of

the Arm (elbow and wrist locked)

Restricted ROM – Loss of Abduction

of the Affected Shoulder/Arm

Initial Phase of the

Palpation of the Proximal Humerus

Identifying the Bony Landmarks –

Recess 1” Lateral to the A.C. Joint

Motion Palpation of the Humeral

Head – (7 to 10 mm glide is normal)

Apply Deep Caudal and Medial

Compression Force to the Upper Humerus

The Painful Shoulder

….the Origin of the Infraspinatous

Identifying the Location of the

Trigger Point

Apply Steady Pressure Until

Referred Pain Dissipates

The Painful Elbow…

The Terres Major

Observe for Scapular Flair

Asymmetries (normal pictured)

Line of Drive is toward the apex of

the shoulder

The Hatcher-Murphy Syndrome

Dr. Francis Murphy discovery:

Subluxated occiput relationship to

Frozen Shoulder Syndrome

Spinal Accessory (cranial 11)

disturbance

Prevents downward excursion of the

scapula

Hatcher-Murphy Syndrome –

Subluxated Occiput

The Hatcher-Murphy Disorder – Occiputal

Subluxation - Frozen Shoulder Syndrome

The Return to Work Policy?

Two Questions to Ask:

Does the Employer have a

dynamic, well-understood “Return

to Work Policy?

Why and How did the worker

become injured in the first place?

(The BSI?)

“Work is Therapeutic!”

Some Additional Clinical Pearls . . .

The “Toe Out”

Gait or Presentation

Hip Joint Disorders in all Age Groups

1. Developmental Dysplasia of the hip in

infants

2. Perthe’s Disease in 4 to 8 year olds

3. Slipping of the femoral cap in adolescents

4. Avascular Necrosis (AVN)in middle-age

adults

5. Degenerative Hip Disease (Malum Coxae

Senilis) in the aged

Herniated Disc Protocol

- Demonstration -

Knees and Elbows -

Active Movement

Stay Active (to Tolerance)

Avoid bed rest (and recliner

and couch rest too!)

Avoid Prolonged Sitting

The SCM – Critical Importance in

Headache Management

Plantar Fasciitis – Heel Spurs

Adusting the Subluxated

Calcaneous

Note Heel Spur on Posterior-

Superior aspect of the Calcaneous

Ring-finger Contact to Achilles

Insertion

Set-up Positioning of the Patient’s

Foot

Observe Full Extension of the Leg

Manual Muscle Stripping

Muscle Stripping the Calf

Musculature – Rolling Pin

Dominant Yellow Elastic

Ligamentous Fibers

The

“Hypermobile”

Thumb Test

The TFL Trigger Point

In patients who present with any

expression of buttock or lower

extremity symptoms, evaluate and

treat the trigger point found in the

vertical muscular fibers of the tensor-

fascia-lata

Wide Stance Lifting

1. Feet positioned 12” wider than shoulder

width

2. Feet positioned on either side of the load

to be transferred

3. Toes pointing at 45 degree angle away

rom the load

4. Center your body mass directly over the

load (in line with your sternum)

Wide Stance Lifting, Continued

5. With loads without handles, tilt the load

away from your body to create

“handles” (using the corners of the object)

6. Preserve your lumbar arc

7. Lift with your thigh and pelvic muscles

rather than your spinal muscles

Questions/Feedback?

Thank You!