교정치료 시 알아야 할 총론

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1 교정치료시알아야할총론 대한밸런스의학회부회장 김경진 M.D.

2 Introduction of Chiropractic Origin Definition History Main technique Colleges and curriculums

3 Origin 1895년미국아이오와주 Daveport D.D.Palmer -현대척추교정치료의창시자 17년동안등통증과청력장애를갖고살던건물관리인 Harvey Lillard의등 (T5) 교정하여청력문제해결 Chiropractic 으로명명 참고 : 1860년 'Robert Koch' germ theory- The birth of Medicine

4 Definition Greek Chiro(cheilos) means 'hand' Praktos means 'done by hand' or 'hand manipulation' 손으로치료한다. Chiropractic is an important component of the US health care system and the largest alternative medical profession. Chiropractic is licensed in all 50 states in USA

5 Medicine 과카이로프락틱의차이

6 의미 1. 과학이다 ; 질병을치료하는특수한분야의연구결과가하나의체계에의해서조직화된지식이며, 현실에서검증할수있는법칙이기에과학이라할수있다. 2. 예술이다 ; 손으로시들어가는생명을살리는기술이며, 어긋난척추를바로잡는조작이며, 생명선압축을해제하기위해체계적인지식을사용하는창의적인예술이다. 3. 철학이다 ; 생명과건강의근원이무엇인가를탐구하며그속에서질병을치료하는원리와법칙을찾아내기에철학이라할수있다.

History of Chiropractic Daniel Devid Palmer (1846-1913 ) : Founder of Chiropractic 1845 : born in Port Perry, Ontario, Canada 1886 : began hand magnet healing.

7 History of Chiropractic Daniel Devid Palmer ( ) : Founder of Chiropractic 1845 : born in Port Perry, Ontario, Canada 1886 : began hand magnet healing : named his healing art as Chiropractic ( Roentogen이 X-ray를발견 1896 : established Palmer School in Davenport, Iowa : Roentogen won the first Nobel Prize in Physics : 의료법위반으로 23일간구속됨 이시기에그는자신은의사가아니라 "chiropractor" 라고선언함 1906년 : 구속에서풀려난후카이로프락틱을널리보급하려고미국을두루다녔으며그결실로몇곳의 chiropractic schools을세움 Meric Recoil Technique 을창시함

History of Chiropractic Bartlett Joshua Palmer (1882-1961) ~ Developer of Chiropractic 1882 : 아이오와주의 What Cheer에서출생 1902 : Palmer School 졸업 1906 : 아버지인 D.D. Palmer가구속되어 Palmer School의교장이됨.

8 History of Chiropractic Bartlett Joshua Palmer ( ) ~ Developer of Chiropractic 1882 : 아이오와주의 What Cheer에서출생 1902 : Palmer School 졸업 1906 : 아버지인 D.D. Palmer가구속되어 Palmer School의교장이됨 : 인체뼈의이미지를얻기위하여 X-ray를진단장비로받아들임 1913 : Kansas주가 Chiropractic license를인정한미국내첫번째주가됨 1974 : Louisiana주가 Chiropractic license를인정한미국내마지막주가됨 1915 : Major Subluxation( 아탈구 ) 의개념을제안함 "Displacements of spinal segment which is causing deterioration of the innate self healing power are only a few in the skeletal system in the body." : Hole In One Theory완성 There is only one major subluxation in a body, and it is almost always found at upper cervical spine. B.J.Palmer had created Toggle Recoil Technique only for upper cervical spine (C1 or C2) based on this theory.

9 Main technique Meric Recoil Technique Toggle Recoil Technique Diversified Technique Thompson Terminal Point Technique Gonstead Technique S.O.T S.T.O & Harmonic Technique Applied Kinesiology Logan Basic Technique Pierce-Stillwagon Technique

10 Chiropractic 테크닉종류 [ Meric Recoil Technique ] found by Dr. D. D. Palmer This technique uses quite rapid recoil of bilateral hands to adjust spinal segment under consideration of relationship between spinal segment and specific viscus. Cleveland college was teaching only this technique until quite recently. [ Toggle Recoil Technique ] found by Dr. B. J. Palmer This is very famous technique which adjusts only upper cervical spine(c1 or C2) according to the so called "Hole In One Theory". Hole In One Theory: An idea that major subluxation would be found on upper cervicals in many cases. Sherman College was teaching only this technique since its establishment until quite recently. [ Diversified Technique ] This technique was a main adjusting system untill D. D. Palmer and B. J. Palmer found Recoil Technique. This technique corrects rotatory displacement mainly. Because this technique was devised before the concept of major subluxation had been found, some adjusting method doesn't use contact with specific spinal segment. A general image for chiropractic care in Japan derives from this technique.

11 Chiropractic 테크닉종류 [ Thompson Terminal Point Technique ] found by Dr. Clay Thompson Dr. C. Thompson developed hydraulic drop table(thompson Table). He discovered pelvic displacement patterns and a relevance between pelvic displacements and difference of leg length. He introduced an examination to decide whether the major subluxation exists at the cervical spine or not. [ Gonstead Technique ] found by Dr. Clarence Gonstead Dr. C. Gonstead established X-ray analysing method to judge displacements of spinal segments and pelvic. He advocated that a vertebra can displace to posterior first of all. This idea is much different from diversified technique. This technique is based upon major subluxation and physiological function of the intervertebral disk, and uses an orthodox manipulative procedure. But there are not many experts in this technique because it is quite difficult to master this technique. He has built the largest chiropractic clinic in U.S. on Mt. Horeb, Wisconsin, which has seminar rooms, an airport for cessna, and a motel. [ Sacro Occipital Technique (S.O.T.) ] found by Dr. Major Bertland DeJarnette ( ) Dr. M. B. DeJarnette learned osteopathy from Dr. A. T. Still and learned cranial technique from Dr. Sutherland, then he graduated from Nebraska Chiropractic College.

12 Applied Kinesiology found by Dr. George Goodheart Dr. G. Goodheart found a relationship between each meridian and each muscle, nerve, neuro- vascular reflex point, neuro-lymph reflex point. This is very popular among people who have an acupuncture license in Japan, because it is easy for them to adapt, having knowledge of meridians.

13 Logan Basic Technique found by Dr. Hugh Logan This technique uses continuous pressure for a pelvic ligament with deep sensory reflex to adjust spinal segment.

14 Pierce-Stillwagon Technique found by Dr. Walter Pierce & Dr. Glenn Stillwagon This technique uses drop table as well as Thompson Terminal Point Technique. This is characterized by adjusting method and thought for fifith cervical & pelvic displacements. Toggle recoil Technique and Logan Basic Technique play a part of this technique.

15 미국 Chiropractic 대학 Palmer College of Chiropractic Life Chiropractic College West Cleveland Chiropractic College of Los Angeles Southern California U. of Health Sciences Chiropractic (LACC) Northwestern Health Sciences University Chiropractic Program University of Bridgeport College of Chiropractic Life University Sherman College of Straight Chiropractic National University of Health Sciences - Chiropractic Logan College of Chiropractic D'Youville College New York Chiropractic College Western States Chiropractic College Parker College of Chiropractic Texas Chiropractic College

16 Curriculum Chiropractic colleges are bound to fulfill the 4200 classroom hours standard which has been decided by the Council on Chiropractic Education(CCE). CCE has had offical status with the U.S.Department of Education since 1974, and is the sole accrediting agency for chiropractic education in the US. A sample curriculum for an accredited chiropractic college in North America appears below(cf#7).

17 교과과정

18 교과과정

19 교과과정

20 교과과정

21 Effects of chiropractic Pain relief Restoration of range of motion Relief of disability Return to activities of daily living Muscle strengthening Improved gait Improved posture

22 Adverse Effects of Chiropractic 최근논문리뷰에서보면카이로프락틱치료중심각한합병증이발생한 138 케이스중 8~10 케이스가경추교정치료의합병증으로밝혀졌다. VBA 문제, brainstem or cerebellar accidents, Spinal cord compression, Vertebral fracture, tracheal rupture, diaphragm paralysis, internal carotid hematoma etc.

23 PAIN 정의 척추통증의원인 통증에대한반응

24 통증의정의 an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage The International Association for the Study of Pain from a 1964 definition by Harold Merskey on_for_the_study_of_pain

25 척추통증의원인

26 통증에대한반응 A0 A1 A2 A3 A4 통증의강도 통증의감내한계선 병의시작 질병의완쾌 A B C D E 시간

27 바이오메카닉교정치료란? 미국의 White & Panjabi 박사의축의이론을인체에적용하여질환의원인을입체적으로분석하여근골격계에생기는문제점을약을사용하지않고근본적으로치료하는비수술적, 과학적인방법이다. 내환경을유지시켜주는 Hollistic Therapy 대부분현대의학에서는증상에대한치료가주종을이루고있다. 기존의근골격계치료방법은주사, 약, 물리치료, 수술이주종을이룸

28 바이오메카닉교정치료 교정치료 = 均衡의治療 = Balance 내환경의유지 ( Homeostasis ) 이론적배경 미국의 Dr. White & Panjabi-축 CBP( D.C Don Harrison) SOT( D.C De Janette ) Deversified, Gonstead, AMCT, etc. Full spine technique

29 Subluxation 정의 원인 5 Components of the vertebral subluxation

30 Subluxation 의정의 과거 : bone out of place 라고뼈에국한 현재 : 광의의의미로우리인체에생기는단지 불편함을포함하여이상증후군

31 Subluxation 원인 아탈구 (Subluxation) 의원인을살펴보면여러가지원인이작용하여생긴다고할수있다. 인간은평면구조로되어있지않고입체구조로되어있기때문에이해하기쉽지않다. 즉아탈구 (subluxation) 가인체에서일어나는원인은바로스트레스 (Stress) 때문이다.

32 스트레스의종류 물리적스트레스 화학적스트레스 정신적스트레스

33 5 Component of the Vertebral Subluxation Spinal kinesiopathology ( 척추운동병리 ) Neuropathophysiology (Neuropathology) Myopathology Histopathology Pathophysiology/Pathology

34 Spiral Kinesiopathology ( 척추운동병리 ) Hypomobility ( Fixation theory ; H.Gillet) Hypermobility ( Illi ) Loss of Joint play ( J.Mennel ) Compensation ( 과가동성 + 저가동성 = 정상 / 같은운동단위에서과가동성과저가동성은일어날수있다 ) Change of axis of movement

35 Neuropathophysiology (Neuropathology) Irritation -> Facilitation (Anterior Horn -> Muscles Hypertonic / Lateral Horn -> Sympathetic Vasomotor 항진 / Posterior Horn -> 감각이상 ) Pressure -> Degeneration ( Atrophy, Sympathetic Atonia, Anesthesia ) Decreased Axoplasmic flow

36 Myopathology Spasm -> Compensation, Facilitation ( Visceromotor reflex ), Hillton s law Atonia

37 Histopathology Cellular flow of inflammatory process 추간공내의 edema, 체액순환의흐름저 해

38 Pathophysiology/Pathology local and distant to spine

39 Subluxation

40 자세분석전반 (Thorough Postural Analysis) 자세분석의목적은환자의비정상자세를완벽하게복원하고앞으로의치료에대한정보제공등이다. 그리고수안요법은전신치료법이기에인체전체를파악하는데주안을두어야하며한분절만을파악하여치료한다는것은이론적으로맞지않는것이다. 먼저전후에서인체의자세를분석할때중력선과 Y-축의일치정도를전이및회전변위표기법에따라표시한다. 전방에서는 glabella, 인중, symphysis menti가일치하는지 episternal notch, 배꼽, symphysis pubis, both knee 사이가 Y-축상에있는지파악한다. 측방에서는 external auditory meatus, acromion의중앙, iliac crest의최상부, acetabulum의중앙, lateral knee, mid-ankle부위가일직선상에있는지를분석할수있어야한다. 머리기울기, 어깨높이, hip의높이, 측면에서본귀와어깨, hip, 발목의위치등을파악해야한다.

41 자세분석전반 (Thorough Postural Analysis)

42 TOPOGRAPHICAL LANDMARKS Anterior Landmarks Hyoid bone : 3번경추의반대편 갑상연골 : 4-5번경추의반대편에위치 Jugular notch : T2의반대편에위치 검상돌기 : 흉추 10번의반대편에위치 배꼽 : 요추 3번의반대편에위치 ASIS : anterior superior iliac spine

43 TOPOGRAPHICAL LANDMARKS Posterior Landmarks EOP : 후두골의기저에서중앙선에위치 C1의 TP : Mastoid process의전방하방에위치 C2의 SP : EOP에서첫번째로현저하게융기된뼈. C7의 SP : 하부경추의가장현저하게융기된뼈. T1의 SP: 상부흉추중에서가장현저하게융기된뼈 T3의 SP : 견갑골의 spine의뿌리부근에점을찍고양측을잇는선이지나는중심선부근 T6의 SP : 엎드렸을때견갑골하각을잇는선이지나는곳의 SP T7의 SP : 앉아있거나서있을때견갑골하각을잇는선이지나는중심부근 L4 의 SP : 장골능최상부에양측에점을찍고그점을잇는선이지나는중심부근 S2의결절 : 후상장골극의내방

44 약어해설 A : anterior / P : Posterior S : superior / I : inferior SCP : segmental contact point CP : Contact point, Skin Pull, Set up In : Internal rotation, Ex : External rotation SH : stabilization hand, CH : contact hand DP : doctor position, PP : patient position LOC : Line of correction = LOD : Line of Drive High Speed, Low Amplitude

45 손과접촉의관계 접촉수 ( Contact hand ) 또는교정수 교정또는치료를위하여환자의몸에닿는의사의손을말한다. 보조수또는안정수 (Indifferent Hand or Stabilization Hand ) 접촉수로치료위치를접촉하여치료를할때보조수는환자의 setting에서움직임을방지하기위하여사용한다.

46 손과접촉의관계 1. Pisiform 2. Hypothenar 3. Metacarpal 4. Digital 5. Index 6. Web 7. Thumb 8. Thenar 9. Calcaneal

47 의사의자세 Toggle Stance : 의사의두발은어깨넓이만큼벌리도록하고허리와무릎 은약간구부린상태에서환자의옆에선다.

48 의사의자세 Fencer s Stance : 발끝은전방을향하도록, 전방의무릎은약간구 부리고, 뒤쪽의무릎은펴고, 허리는곧게세워환자의옆에선다.

49 환자의자세 Side Lying

50 족지분석 (Leg length analysis) 단족 = short leg Anatomical short leg ( 해부학적단족 ) : 선천적또는후천적으로골절이나수술로짧아진다리를말한다. Functional short leg ( 기능적단족 ) = Pelvic deficiency : 실제다리길이는같지만인체를구성하고있는근육, 신경등의장애로인하여일시적으로또는영구적으로다리길이가짧아지는경우- 이런경우가수기요법의대상이된다.

51 단족의원인 Neuromuscular contraction Biomechanical malposition Anatomical shortness

52 Neuromuscular Contraction 근육의불균형은 Bulboreticular formation 의 imbalance의결과로야기된다. Bulboreticular formation의두종류 Facilitory area 근육수축 Inhibitory area 근육이완

53 Biomechanical Malposition Gonstead 박사 : 방사선사진으로검사할때정상적인골반은대퇴두부 (femur head) 의높이를수평으로보여줄것이다. 뒤쪽으로혹은바깥쪽으로 malposition( 위치이상 ) 이된장골때문에대퇴두부 (femur head) 의한쪽은낮은위치가된다. 대퇴두부 (femur head) 는앞쪽으로혹은안쪽으로 malposition( 위치이상 ) 이된장골쪽으로올라갈것이다. 골반의양쪽으로 malposition( 위치이상 ) 이존재하는것처럼관찰되는단족의원인은이런 malposition( 위치이상 ) 의결합인것이다.

54 실제족지길이측정법 전상장골극 ( anterior superior iliac spine ) 에서부터경골하내과 ( medial malleolus ) 의끝까지의거리를측정하며이를극과간격 ( spine-malleola distance, SMD ) 이라부른다.

55 신전위치에서의족지분석 복와위로눕게하고환자의머리외후두융기에가상의점을찍고골반제2 천골결절부위에가상의점을찍고양무릎사이에가상의점을찍어세점을지나는가상의선을그린후그선이일직선이되도록 setting을한다.

56 신전위치에서의족지분석 ( 옆모습 )

57 신전위치에서의족지분석 inversion 과 eversion 을제거한다. ( 사진참조 )

58 신전위치에서의족지분석 족지분석을위한 position 1 에서의발의위치는발목 부위에서 90 도가되도록한다.

59 신전위치에서의족지분석

60 신전위치에서의족지분석 어떤다리가더짧은가를결정하기위해서신발뒷굽의 재봉선 (SIM) 을살펴본다.

61 Royal road to Expert is 감사합니다.

Module IV 닥터유 바이오 메카닉 교정치료

Module IV 닥터유 바이오 메카닉 교정치료 Module IV 닥터유바이오메카닉교정치료 연자 : MD.,Ph.D. Seungmo Yoo 일시 : 2014 년 7 월 27 일 장소 : 백범기념관 2 닥터유바이오메카닉연구회 3 약력 MD, PhD., 유승모 전 ) 대한의사협회보험이사및정책이사전 ) 가톨릭여의도성모병원보완의학센터초빙교수전 ) 보건복지부건강정책심의위원회위원전 ) 메디칼타임즈발행인겸편집인 현 )