title: [Physical medicine in the diagnosis and treatment of functional disorders of the spinal column].
abstract: BACKGROUND
  Manual (Physical) Medicine is concerned with physiology, pathophysiology, diagnosis and therapy of the musculoskeletal system functional disorders. Functional disorders are caused by direct or indirect injury (muscular spasm), inflammation, sudden movements etc. Functional disorders in regard to decreased joint volume are also called segmental or peripheral joint dysfunction, somatic dysfunction and function blocking. Blocking means: reversible disorder with decreased functional joint movement; muscular spasms caused by neurophysiological changes including decreased movement; pain and functional disorder of internal organs and tissues being part of the joint. Intervertebral joints, intervertebral discs, muscles and their nerve control belong to such control circles which are integrated within an organism. The basic principles of Manual (Physical) Medicine are good knowledge of functional anatomy and three-dimensional imaging of biochemical functions of the spine. The most important functions of the spinal column are as follows: it is an organ of axis with a protective and supportive function and it enables normal walk and balance. The basic functional unit in the architecture of the vertebral column is the dynamic spinal segment. Its basic function is movement, posture maintenance and protection of spinal nerve roots. The functional disorder of one part of the dynamic segment cannot be isolated from other parts. Thus functional blocks within the fascial joints, abnormalities within intervertebral discs, changes within the ligament apparatus, and muscular disorders may be both causes and consequences at the same time. The dynamic segment is thus included into a mechanical functional circle. Its mechanical function is tightly connected with the statics of the whole body. Different leg length, severe abnormalities of great leg joints may cause blocks within the fascial joints. The vertebral dynamic segment is also a part of the nervous, functional reflex circle. Clinical symptoms associated with functional disorders within intervertebral joints are as follows: restricted joint mobility and nervous reflex disorders (local segmental and peripheral segmental injuries).
  In order to make physical diagnosis it is necessary to have good knowledge of anatomy, functional anatomy, kinesiology and neurology. History taking is of great importance for the physician who establishes physical therapy. It is also necessary to note various abnormalities, muscle atrophy and to analyze patient's walk. Palpation at rest reveals changes, skin disorders, subcutaneous and fatty tissues and muscles and it assesses the status of soft tissues. By physical examination of the spine it is possible to diagnose intervertebral joint blocks. Thus examination of joint mobility is performed. It is important to differ physiological, anatomic and pathologic ranges of mobility and to determine the greatest mobility and joint play. Joint play represents the property of the joint to achieve some additional mobility. This examination requires knowledge of a special technique. Palpation of local segmental irritation is performed on all spinal segments after a special technique examining bone-transversal joints as well as sacroiliac joints. Local irritation points, muscle spasms and tendomyosis are being detected. The diagnosis of blocks is also the therapeutic diagnosis at the same time. Physicians using physical medicine must apply x-ray of the spinal column, whereas the aim of physical therapy is to eliminate functional blocks, which occur in the form of reduced reversible mobility in one or more directions. Only physical examination can establish this, while apparatuses cannot objectivize it. Manipulative techniques on the spine should be performed only by specialists.
  Manual (Physical) therapy comprises numerous techniques and is used in various indications. (ABSTRACT TRUNCATED)
authors.affiliation: Sluzba za fizikalnu medicinu i rehabilitaciju, Zdravstveni centar Dr Gere Istvan, Senta. direktor@zdravstvosenta.co.yu
authors.forename: E
authors.initials: E
authors.lastname: Németh
mesh_terms: D000075202:Contraindications; D006801:Humans; D026741:Physical Therapy Modalities; D013122:Spinal Diseases / Q000175:diagnosis / Q000628:therapy*