* Words in italics are defined elsewhere in the glossary.
Activities of Daily Living: The normal daily activities and functions a person must perform or fulfill to maintain cleanliness, self-grooming, home maintenance, eating, working and recreation.
Acupuncture: An oriental medicine treatment modality where needles are inserted in particular points on the “meridians” of Qi (channels of energy in the body). This is believed to have neurophysiologic effects which decrease pain and promote healing by balancing Qi.
Acute: A recent onset of an injury or problem. The precise time line of an acute condition can range from hours after onset to 16 weeks depending upon the standard of the particular physician or treatment provider.
Adduction: Movement of a limb toward the middle of the body. Opposite of Abduction.
Adhesions: Fibrosis tissue and scar tissue that bind together tissues which are usually not attached.
Adjustment: A chiropractic term which describes the skilled application of force to a joint or motion segment to improve intersegmental motion, decrease localized muscle tension, and restore normal motion and position.
Adson’s Test: A physical exam test used in evaluation of thoracic outlet syndrome at the junction of the brachial plexus and the scalene muscles of the neck. The patient is placed in the sitting position with one arm straight out to the side and extended slightly backwards. The patient then takes a deep breath and turns the head toward the side being tested. A positive test is loss or diminishment of the wrist pulse on the side being tested.
Annular Bulge: A bulging out of the annulus fibrosis, the tough fibrosis outer ring that provides support to the disc, which is diffuse and, usually due to degenerative changes or trauma, leading to degenerative changes. This condition may include partial rents or tears in the annulus fibrosis.
Annulus Fibrosis: The outer covering of the softer, gel-like nucleus pulposus of the intervertebral disc. The intervertebral discs are located between each of the vertebrae of the spine.
Anterior: Front side, the opposite of posterior. Synonymous with ventral.
Anterolisthesis: A vertebral segment which is moved forward relative to the segment below.
AP:Anterior to Posterior or front to back. This refers to the orientation of the patient to the x-ray beam. With AP films the patient faces away from the x-ray film and faces the x-ray machine. The x-ray photons pass from anterior to posterior through the patient. The image produced is a “front to back” view of the patient.
Arthralgia: Joint pain.
Arthrogram: The injection of radiographic dye into a joint that is then x-rayed. The contrast dye allows for better visualization of the joint and possible irregularities. Arthrograms are being progressively replaced by MRI.
Arthrosis: A disorder of a joint.
Articulation: The joint between bones. The movement of bones as a result of the joint.
Articular Surface: The surface of a joint, lined with cartilage and synovial fluid to lubricate joint movement.
Bursitis: Inflammation of pad-like fluid-filled sacs (bursa) found within the connecting tissue of the joints, as in the shoulder and knee.
Carpal Tunnel Syndrome: Soreness, tenderness, and weakness of the muscles of the thumb, index and middle fingers caused by pressure on the median nerve at the point at which it goes through the carpal tunnel of the wrist.
Cartilage: The dense connective tissue between the bodies of the vertebrae (the intervertebral discs) and between the articular surfaces of the joints.
Cervical: Referring to the neck. The cervical spine has seven vertebrae (C1 through C-7) which allow for head and neck movement.
Chiropractic: A branch of the healing arts focused on human health, disease processes, and physiological and biochemical aspects of the body including structural, spinal, musculoskeletal, neurological, vascular, nutritional, emotional and environmental relationships. Chiropractic procedures include the adjustment and manipulation of the articulations and adjacent tissues of the human body, particularly of the spinal column. Included is the treatment of intersegmental dysfunction for alleviation of related functional disorders. Chiropractors do not use medications or surgery.However, nutritional supplementation may be prescribed.
Clavicle: The “collar bone” which articulates with the scapula, acromion and the sternum.
Crepitus:Crunching, rubbing or snapping sounds heard or felt when moving a joint.
CT Scan: Also called CAT scan, Computer Tomography, Computer Assisted Tomography, or Computer Axial Tomography. The use of x-ray energy passing through the body at different angles and processed through a computer to produce a cross-sectional (axial) image of an area of the body. The current term, CT Scan, is the most accurate since reformatting has allowed other planes to be imaged besides just the axial plane.
Degenerative Changes: Degeneration of any joint due to wear and tear, trauma, or unusual postures. The degenerative changes include discspace narrowing, osteophytes or bony spurring. These type of changes can be seen both on x-ray and MRI imaging.
Degenerative Disc Disease: An intervertebral disc, which has suffered the effects of the aging process or the effects of trauma. A disc becomes degenerated over time, often spanning years. Often there are small circumferential tears in the annulus fibrosis, the tough outer covering of the disc. A degenerated disc is also characterized by a loss of its height due to a drying-out of the nucleus pulposus, the gelatinous material inside the disc. It is often caused by a loss of motion between the vertebrae above and below, thus decreasing the mechanical flow of nutrients to the disc.
Disc Bulge: A broad-based enlargement of the annulus fibrosis extending past the edges of the adjoining vertebral end plates with herniation of the nucleus pulposus into or through the annulus fibrosis. See Bulging Disc.
Disc Herniation: See Herniated Disc.
Discectomy: The surgical removal of the bulging or extruding disc material (nucleus pulposus). Access to the bulging or extruding disc material may be had by removal of thelamina of the vertebral body (laminectomy) or the cutting of an opening in the lamina (laminotomy). Discectomy may be done in conjunction with a foraminotomy and/or afusion.
Discogenic Pain: Pain coming from the nerves embedded in the annular wall of the disc. Pain can arise from chemical or mechanical irritation of these nerves as a result of damage to the intervertebral disc. The outer portion of the annulushas sensory nerves and trauma or degenerative changes to the annulus can cause pain.
Double Crush Syndrome: A nerve entrapment at two or more places along a nerve. Most typically the diagnosis refers to a carpaltunnel syndrome, cubital tunnel syndrome, and/or ulnar neuropathy nerve compression at the elbow, co-existing with pressure on the spinal nerve in the neck, causing numbness or tingling, muscle weakness or loss of reflex in the arm or hand.
EMG: Electromyogram or Electromyelogram. A test to evaluate the motor function of the peripheral nerves and the related spinal nerves. The test involves use of a needle to test nerve conduction speed. The method of the EMG is to insert small needles in muscle groups and observe for electrical indications of denervation or loss of nerve function.
Epidural Block: The injection of anesthetic into the epidural space in order to block or desensitize a specific nerve at particular points of a nerve pathway.
Facet Joint Dysfunction: A vertebral motion segment whose joint does not move freely in all directions or moves excessively. Commonly used by treatment providers to refer to a syndrome producing facet joint pain.
Facet Joints: A set of paired joints representing the articulation (joining) of the back portions of two adjoining vertebrae at the back of each vertebra articulating with thevertebra above and vertebra below. An injured or degenerative facet joint may be the source of spinal pain and stiffness. Also referred to as zygapophyseal joint.
Facet Neurotomy: A therapeutic technique whereby the medial branch nerve supply to the facet is cut. This is done surgically, most often with radio frequency current. SeeMedial Branch Neurotomy. Sometimes called Facet Rhizotomy.
Fibromyalgia:A syndrome involving diffuse systemic muscle pain. The diagnostic criteria has been defined by the American College of Rheumatology as pain at 11of 18 tender point sites, presence of subcutaneous nodules, and a history of widespread pain for more than three months. Trauma can be a cause of this syndrome.
Fibrosis: Abnormal formation of scar tissue.
Flexion-Extension Injury: A sprain/strain injury of the cervical spine and adjacent structures caused by a hyperextension-hyperflexion injury. See Acceleration-Deceleration Injury, Whiplash Injury.
Fluoroscopy: An x-ray machine capable of producing both still images and “real-time” motion of the joints or vertebrae. Often used to visualize intervertebral joint motion through flexion and extension of the neck or back or to place a syringe needle at a targeted site.
Foramen: The opening between the vertebrae through which the spinal nerve root and spinal nerve sheath pass to exit the spinal canal. The size of the foramen may be reduced by degenerative joint disease, a herniated disc, bulging disc, bone spurs,facet joint hypertrophy, or by soft tissue (cyst, tumor, ligament, etc.).
Frontal-Occipital Headaches: Pain emanating from the base of the skull or in the back of the head and radiating to the forehead. This headache pain is often secondary toacceleration-deceleration injuries (also know as hyperextension-hyperflexion injuries or whiplash) involving the upper joints of the neck (O-C1, C1-2, C2-3 joints).
Fusion: A surgical procedure performed to eliminate spinal pain or immobilize unstable joint segments. Can be used to treat degenerative disc disease and to immobilize injuredvertebral segments. A bone graft is placed across a spinal segment which then grows together with the patient’s bone and the area is immobilized. There is a loss of motion between two vertebrae that are fused together. The graft can be an autograft (bone taken from the patient) or an allograft (cadaver bone).
Glasgow Coma Scale: A grading system for determining neurological function and mental status (alertness) after a traumatic injury to the head. Eye opening, verbal response, and motor response are graded. The lowest score is 3 and a normal score is 15.
Gross Instability: An orthopedic spine term which refers to excessive motion between two joints or two vertebral segments. In spinal evaluation, gross instability usually indicates ligamentous injury.
Gross Range of Motion: A term that usually refers to the overall range of motion of a spinal region. See Range of Motion (ROM).
Herniated Disc: A rupture of the annulus fibrosis, through which the inner disc material (nucleus pulposus) extrudes. This may put pressure on the exiting spinal nerve and/or cause an inflammatory reaction leading to radiculopathy or weakness, numbness, and/or tingling in the arms or legs.
Hyperkyphosis: Abnormally increased spinal curve in the mid back.
Hyperlordosis: An abnormally increased spinal curve in the neck or low back.
Hypertonicity: An increase in muscle tone or muscle tension.
Impingement: Abnormal compression or encroachment of one anatomical structure on another.
Impingement Syndrome: A syndrome in which soft tissue is entrapped or impinged between two hard (bone) tissue structures with resultant inflammation, pain, and dysfunction.
Intersegmental Dysfunction: Disease or mechanical dysfunction of the vertebrae as they function with each other, resulting in symptoms of pain, discomfort or loss of motion.
Lumbar: Relating to the low back. The lumbar spine has five vertebrae stacked on top of the sacrum (L1 – L5).
Lumbar Sprain: An acute injury to the ligaments of the low back.
Lumbar Strain: An acute injury to the musculature and tendons of the low back.
Manipulation: The general application of a force to a joint that takes it beyond its normal or restricted range of motion. This term applies generally to joint manipulations by manual therapy practitioners.
Massage Therapy: Deep or light pressure applied to the musculoskeletal system for the purpose of muscle relaxation, myofascial release, increasing joint function, increasing lymphatic drainage, realigning scar tissue, or increasing local blood flow.
Maximum Medical Improvement (MMI): A medical-legal term used in insurance claims to describe a point in time when the patient’s condition will no longer improve with or without further healthcare treatment.
Migraine Headache: A headache caused by excessive dilation of the arteries in the brain. Symptoms include severe head pain, sensitivity to light (photophobia), occasionally sensitivity to smells, nausea, dizziness, vomiting and/or visual disturbances.See Vascular Headache.
Myelogram: The injection of a radiographic contrast liquid into the subarachnoid space through a space through a lumbar puncture. This effectively outlines the spinal cord andspinal nerves on an x-ray.
Myofascial Pain Syndrome: Pain coming from the muscles and fascia which in turn, is spread out to other areas of the body.
Nerve Conduction Study: Evaluates the function of peripheral nerves and the related spinal nerves. A nerve conduction study records the speed (velocity) of small electrical impulses upon the pathways of a nerve or nerves in order to determine if they are functioning properly.
Nerve Root: A bundle of the motor and sensory branches which join to form a spinal nerve which exits the spinal cord through a bony opening called the intervertebral foramen. Two nerves leave at each spinal motion segment, one on the right and one on the left.
Neurogenic TOS: A thoracic outlet syndrome involving compression of the brachial plexus passing out of the neck, under the clavicle, and through the axilla. The compression can cause denervation of the corresponding muscle groups, or pain involving the neck and arm. See Thoracic Outlet Syndrome.
Neurotomy: The cutting or division of a medial branch nerve by surgical means to temporarily or permanently prevent the transmission of pain. Often misnamed rhizotomy.
Nucleus Pulposus: The soft, squishy and spongy inner portion of the intervertebral disc.
Osteoarthritis: The most common form of arthritis involving the effects of wear and tear on the body’s structures. In the spine this is a degenerative process that includesspondylosis, spurring of the vertebral bodies, and deterioration of the facet joints. Cartilage degeneration is the hallmark of this type of arthritis.
Peripheral Neuropathy: A generalized “slowing” of the peripheral nervous system which is often characterized by decreased sensation in a stocking and glove distribution in the feet and hands. This condition can sometimes be diagnosed with a nerve conduction study.
Physiatrist: A medical doctor who has completed residency training in Physical Medicine and Rehabilitation. A specialist in rehabilitation and outpatient non-operative orthopedicmusculoskeletal care. Board certification is given by the American Academy of Physical Medicine and Rehabilitation.
Physical Capacity Evaluation: A test of physical strength and stamina used to determine work restrictions and work tolerance. See Functional Capacity Evaluation.
Physical Therapy: Treatment for musculoskeletal and neurological disorders provided by a licensed physical therapist. Usually involving exercise, electrical modalities, andmyofascial techniques.
Post-Concussive Syndrome: Any alteration in cerebral function caused by direct or indirect forces transmitted to the head resulting in brief loss of consciousness, light-headedness, vertigo, cognitive and memory dysfunction, tinnitus, difficulty concentrating, amnesia, headaches, balance disorder, nausea and/or vomiting.
Post-Traumatic Stress Disorder: An abnormal amount of psychological stress after some traumatic event. This may occur after an auto accident. The patient may experience anxiety with driving. It is a specific psychological diagnosis.
Radiculopathy:Dysfunction of a nerve root that can cause (1) numbness or tingling in a specific pattern corresponding to that nerve root or (2) muscle weakness in the muscles supplied by that nerve, or (3) loss of reflex associated with that nerve.
Range of Motion: (ROM) The range of movement of a joint or a spinal area that is measured and compared to normal. Restrictions in the range of motion of a joint or spinal area indicates some type of dysfunction.
Referred Pain: Pain that originates in one part of the body, but is felt in another part of the body.
Reflex Sympathetic Dystrophy: A clinically determined syndrome characterized by burning, atrophy, hypersensitivity, temperature changes in the affected area, and decreased range of motion. The cause is usually trauma. This has recently been renamed Complex Regional Pain Syndrome.
Rotator Cuff Impingement: Compression of any of the rotator cuff or tendonous fibers at the shoulder joint underneath the supraspinatus tendon.
Sciatica: A description of pain and/or numbness associated with inflammation of the sciatic nerve, usually due to compression of the spinal nerve between fifth lumbar (L5) and first sacral vertebrae(S1). It is often the result of a herniatednucleus pulposus at the L4-5 or L5-S1 levels.
Sciatic Nerve: The major nerve supplying motor and sensory functions to the legs. This is the largest peripheral nerve in the body. This nerve later divides to form the tibial and peroneal nerve. It arises from the L4, L5, and S1-S3 spinal nerves. It emerges from the lumbar spine and sacrum into the gluteal region through the sciatic notch. It is the largest diameter nerve in the body.
Segmental Dysfunction: Refers to vertebral segments which are not moving normally in relation to one another.
Segmental Instability: Motion of a spinal motion segment which significantly exceeds normal range of motion for that segment so that further over-stretching of the supportingsoft tissue may occur.
Selective Nerve Root Block: Injection of an anti-inflammatory and local anesthetic onto the sleeve surrounding a spinal nerve. This can be done for both therapeutic and diagnostic purposes to determine if a spinal nerve is causing pain. Also known as a Spinal NerveBlock.
SPECT: An acronym for Single Photon Emission Computed Tomography, a nuclear-radiographic technique. Often used to detect presence of fractures or other boneabnormalities.
Spinal Cord: The extension of the central nervous system which extends from the brain stem to the cauda equina and is surrounded by the spinal canal. This acts as a conduit for information to and from the brain as it relates to the rest of the body.
Spondylolisthesis: Forward or backward displacement of one vertebra in the relation to the adjacent vertebra below. Depending on the amount of the displacement, spondylolisthesis may require surgical intervention to fuse the spine.
Sprain: Trauma to the joint capsule or ligaments, causing pain and impairment of joint movement, depending upon the degree of severity of injury to the ligaments.
Strain: Trauma to the muscle or tendonsas a result of violent contraction or excessive stretching.
Subluxation Complex: A chiropractic term relating to the various components of a spinal subluxation. These components include spinal kinesiopathology (abnormal spinal position or movement), myopathology (abnormal muscle function), neuropathology (abnormal nerve function), histopathology (abnormal soft tissue function), and pathophysiology (resultant degenerative processes.
Surface EMG: A graphic record of micro-voltage present in muscles in static or active contraction as measured by sensors placed upon the skin.
Temporomandibular Joint (TMJ): The jaw joint between the mandible and the articular surface of the temporal bone. This joint allows opening and closing of the jaw, as well as numerous other movements. The joint contains a disc.
Therapeutic Massage: Deep or light pressure applied to the musculoskeletal system for the purpose of muscle relaxation, myofascial release, or increasing local blood flow and lymph flow.
Thoracic Outlet Syndrome: TOS. Compression of the neurovascular bundle in the shoulder, collarbone and neck (usually irritation of nerves within the bundle). The compression may cause decreased or abnormal blood flow into the arms, often associated with certain overhead positions of the arms. Symptoms include paresthesia, numbness, pain in the arm and hand, and weakness in the hand.
Trigger Point (TP): A taut, palpable spot in muscle that is painful to touch and refers pain to another body area.
Upper Cervical Dysfunction: A restriction or abnormal movement of the top two vertebral joints in the neck following a neck injury. A common cause of headaches.
Vertebra: One of the twenty-four (24) bones that make up the spine. There are three types: cervical (seven in number), thoracic (twelve), and lumbar (five), with each section possessing unique characteristics. The sacralvertebrae are fused in one bone.
Zygapophyseal: Of or pertaining to the facet joints.
Zygapophyseal Joint: Same as facet joint.