Diagnosis and Treatment of Pain of Vertebral Origin

2nd Edition Robert Maigne (Author) pdf download

https://ebookultra.com/download/diagnosis-and-treatment-of-pain-of-
vertebral-origin-2nd-edition-robert-maigne-author/

★★★★★
4.7 out of 5.0 (91 reviews )

Instant PDF Access

ebookultra.com
 Diagnosis and Treatment of Pain of Vertebral Origin 2nd
Edition Robert Maigne (Author)

EBOOK

Available Formats

■ PDF eBook Study Guide Ebook

EXCLUSIVE 2025 ACADEMIC EDITION – LIMITED RELEASE

Available Instantly Access Library

Here are some recommended products for you. Click the link to
download, or explore more at ebookultra.com

Neurointerventional management diagnosis and treatment 2nd

Edition Robert W Hurst

https://ebookultra.com/download/neurointerventional-management-
diagnosis-and-treatment-2nd-edition-robert-w-hurst/

The Treatment of Pain with Chinese Herbs and Acupuncture

2nd Edition Peilin Sun Md

https://ebookultra.com/download/the-treatment-of-pain-with-chinese-
herbs-and-acupuncture-2nd-edition-peilin-sun-md/

Handbook of Addictive Disorders A Practical Guide to

Diagnosis and Treatment 1st Edition Robert Holman Coombs

https://ebookultra.com/download/handbook-of-addictive-disorders-a-
practical-guide-to-diagnosis-and-treatment-1st-edition-robert-holman-
coombs/

Early Diagnosis and Treatment of Cancer Series Ovarian

Cancer Expert Consult 1st Edition Robert Bristow Md

https://ebookultra.com/download/early-diagnosis-and-treatment-of-
cancer-series-ovarian-cancer-expert-consult-1st-edition-robert-
bristow-md/
Multiple Myeloma Symptoms Diagnosis and Treatment Symptoms
Diagnosis and Treatment 1st Edition Milen Georgiev

https://ebookultra.com/download/multiple-myeloma-symptoms-diagnosis-
and-treatment-symptoms-diagnosis-and-treatment-1st-edition-milen-
georgiev/

Current Pediatric Diagnosis Treatment 17th Edition Current

Pediatric Diagnosis and Treatment William W. Hay

https://ebookultra.com/download/current-pediatric-diagnosis-
treatment-17th-edition-current-pediatric-diagnosis-and-treatment-
william-w-hay/

Dysphagia Risk Factors Diagnosis and Treatment Risk

Factors Diagnosis and Treatment 1st Edition Brian S. Smith

https://ebookultra.com/download/dysphagia-risk-factors-diagnosis-and-
treatment-risk-factors-diagnosis-and-treatment-1st-edition-brian-s-
smith/

Cardiac arrhythmias interpretation diagnosis and treatment

2nd; Edition Eric N. Prystowsky

https://ebookultra.com/download/cardiac-arrhythmias-interpretation-
diagnosis-and-treatment-2nd-edition-eric-n-prystowsky/

Handbook of Diagnosis and Treatment of DSM 5 Personality

Disorders Assessment Case Conceptualization and Treatment
3rd Edition Len Sperry
https://ebookultra.com/download/handbook-of-diagnosis-and-treatment-
of-dsm-5-personality-disorders-assessment-case-conceptualization-and-
treatment-3rd-edition-len-sperry/
Second Edition

DIAGNOSIS AND
TREATMENT OF
PAIN OF
VERTEBRAL
ORIGIN
Second Edition

DIAGNOSIS AND
TREATMENT OF
PAIN OF
VERTEBRAL
ORIGIN
Robert Maigne
Edited by
Walter L. Nieves

Boca Raton London New York

A CRC title, part of the Taylor & Francis imprint, a member of the
Taylor & Francis Group, the academic division of T&F Informa plc.
Published in 2006 by
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742

© 2006 by Taylor & Francis Group, LLC

CRC Press is an imprint of Taylor & Francis Group

No claim to original U.S. Government works

Printed in the United States of America on acid-free paper
10 9 8 7 6 5 4 3 2 1

International Standard Book Number-10: 0-8493-3121-8 (Hardcover)

International Standard Book Number-13: 978-0-8493-3121-3 (Hardcover)
Library of Congress Card Number 616.7'306--dc22 2005041836

This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are
indicated. A wide variety of references are listed. Reasonable efforts have been made to publish reliable data and information, but the author and the
publisher cannot assume responsibility for the validity of all materials or for the consequences of their use.

No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known
or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission
from the publishers.

For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copyright.com/) or contact
the Copyright Clearance Center, Inc. (CCC) 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that
provides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system
of payment has been arranged.

Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation
without intent to infringe.

Library of Congress Cataloging-in-Publication Data

Maigne, Robert.
Diagnosis and treatment of pain of vertebral origin / by Robert Maigne and Walter L. Nieves.--2nd ed.
p. cm. -- (Pain management ; 1)
Includes bibliographical references and index.
ISBN 0-8493-3121-8
1. Spine--Disease--Treatment. 2. Manipulation (Therapeutics). 3. Spinal adjustment. 4. Bachache--Treatment. 5. Pain--Treatment.
I. Nieves, Walter L. II. Title. III. Series.
[DNLM: 1. Spine--anatomy & histology. 2. Spine--physiopathology. 3. Manipulation, Orthopedic. 4. Pain--therapy. 5. Spinal

Diseases. WE 725 M218d 2005]

RD768.M28813 2005 616.7'306--dc22 2005041836

Visit the Taylor & Francis Web site at

http://www.taylorandfrancis.com
and the CRC Press Web site at
Taylor & Francis Group is the Academic Division of T&F Informa plc. http://www.crcpress.com
 FOREWORD

At a time in medicine when pain assumes a great pro- ther is disputed by Maigne. He advocates manipulating in
portion of disability, and much is related to the neuromus- the direction that is free and contralateral to the direction
culoskeletal system, all approaches merit exposition. that provokes pain. The direction, the precise vertebral
Dr. Maigne has been a strong proponent of diagnostic segment, and its pathological significance are the bases of
manual medicine and has offered a scientific basis for the Maigne techniques.
relief by manipulative techniques. He has written exten- Manipulative technique also begs clarification and
sively in French, and his methods have been studied by demands personal hands-on learning. This has been Dr.
physicians from many countries. Physicians and students Maigne’s success in personally training physicians from
the world over have been privileged to study his methods all over the world. The benefit he has given patients who
and techniques. His books have literally become tomes of have come from all over the world for his services affirms
valuable information, and his concepts have become the benefit of his method.
accepted in medical orthopedics. In this text, his techniques are clearly and precisely
Manipulative technique, however, is only a small, albeit demonstrated and allow the trainee to learn from reading.
prominent, aspect of this text. Dr. Maigne has scientif- The illustrations for appropriate diagnosis and ultimate
ically verified and explained many peripheral impairments treatment are extremely well presented. To reiterate, how-
as being related to their origin at the vertebral level from ever, the value of this text is to acquire the technique of
the posterior radicular branches and minor articular or manual evaluation of the mechanism of common pain of
discal abnormalities. His neuroanatomical explanations spinal origin that justifies manipulative intervention.
are brilliantly illustrated and documented with a profound Many practitioners of medicine were denied this text
review of the literature. In today’s epidemic disabilities because it was in French. Fortunately, it is now available
resulting from neuromuscular etiologies, Maigne’s con- for English-reading physicians and therapists and will
cepts and clinical evaluations are welcomed. become a mandatory text in all medical libraries and
The modality of vertebral manipulation has enjoyed offices.
advocacy for centuries, but the precise indications and the
specific techniques indicated for the pathologies ascer- Rend Cailliet, M.D.
tained remain inaccurate. Dr. Maigne has developed diag- Professor Emeritus, School of Medicine,
nostic procedures that accurately ascertain the exact University of Southern California
pathology and its vertebral site. Such accuracy has been Editor, Neuromusculoskeletal Pain Series,
deficient in most osteopathic and chiropractic specialties F.A. Davis Company, Philadelphia
that advocate manipulation.
The concept of regaining lost joint range of motion, This foreword appeared originally in the first edition
which is considered the basis of osteopathic and chiro- of Diagnosis and Treatment of Pain of Vertebral Origin
practic techniques, by forcing that particular segment fur- published by Williams & Wilkins.

v
 PREFACE

The purpose of this book is to invite the reader to take to them was detectable by palpation, could explain and
a new look at common pains of spinal origin. My first justify their maneuvers. In fact, I noticed that the segments
book, Les manipulations vertebrales, published in 1960, at the origin of a local or referred pain were themselves
aimed at recognition of this therapeutic method by the tender when certain maneuvers of direct pressure (seg-
medical profession. At that time, manipulation was widely mental examination) were carried out. After a successful
criticized, rejected, and even considered a kind of charla- manipulation, these same segments became pain-free on
tanism. It is true that manipulation was used as the only segmental examination. The key point, then, was the seg-
form of treatment by certain nonmedical schools that con- mental tenderness and not the hypothetic loss of mobility;
sidered hypothetic vertebral microdisplacements the this finding corresponded perfectly with the application
sources of all disease. However, experience convinced me of manipulation according to the rule of pain-free and
of their potential. Therefore, I attempted to present their opposite motion.
indications and contraindications precisely, to select the I therefore proposed the term painful minor interver-
reliable techniques, describe them in an objective way, tebral dysfunction (PMID [English]; DIM [French]) for
and assign clear rules of application. I proposed the “rule this painful, benign, self-sustained dysfunction of the spi-
of pain-free and opposite motion.” That is to say that the nal segment. Frequently resulting from trauma, exertion,
manipulation must be performed in a direction in which false movement, or secondary to static or postural prob-
the range of motion is free and opposite to the direction lems, these painful minor intervertebral dysfunctions are
in which the motion is painful, rather than simply attempt- usually reversible and have no radiologic findings. They
ing to restore a real or supposed limitation of the mobility can affect radiologically normal segments as well as seg-
of a vertebral segment. ments with signs of degeneration.
This rationale for manipulation achieved recognition While PMID originally served merely as a hypothesis
by the Faculty of Medicine, and in 1969, a diploma of about the indications and actions of manipulation, it has
Orthopaedic Medicine and Manual Therapeutics was cre- now become an uncontested clinical reality extending far
ated at the University of Paris VI (Broussals Faculty, Hôtel beyond the frame of manipulation, even though the under-
Dieu). I was offered the directorship of the program — a lying pathophysiology has not yet been clearly estab-
program that extended far beyond the simple teaching of lished. The frequent appearance of PMID shows us that
these techniques and covered broadly common vertebral it is at the origin of most common intervertebral pain
pathology. During the following 20 years, teaching syndromes.
founded on the same model was organized in other med- Another element became apparent, both confirming
ical schools in France; Marseille was the first in 1975. and clarifying the role played by manipulation. With sys-
My second book, Douleurs d’origine vertebrale et tematic palpation of the skin folds, muscles, and tendons,
traitements par manipulations, had the subtitle, Les I realized that a PMID was associated frequently with
derangements intervertebraux mineurs. The sometimes abnormal tissue reflexes in the homologous spinal seg-
surprising results of these treatments compelled one to ment. These changes became apparent through modifica-
reflect. Often, in a very spectacular way, vertebral manip- tions in tissue consistency and sensitivity: painful thick-
ulation relieved a certain pain, whose spinal origin was ening of the skin folds to pince-roule (pinch-roll)
evident (although the mechanism of action was not clear), throughout all or part of the dermatome, areas of focal
and other pains, apparently unrelated to the spine, would muscular hypertonus among certain muscles of the myo-
disappear. However, when inappropriately executed, these tome, and hypersensitivity to palpation of the tenoperi-
techniques could provoke both types of pain. osteal insertion. Moreover, I also found these neurotrophic
Traditional practitioners of manipulation, coming for disturbances in the same distribution in other spinal seg-
the most part from osteopathy, maintained that the loss of mental pain syndromes, for example, disc herniation, facet
mobility of specific vertebral segments, which according joint capsulitis, and synovitis. These manifestations,

vii
which I group under the term segmental celluloperioste- clearly visible on CT or MRI, that produce no discomfort
omyalgic syndrome, can be the origins of certain mislead- whatsoever. Conversely, many patients who present with
ing pains such as pseudoradicular, pseudoarticular, and significant degrees of painful symptoms have normal
pseudovisceral syndromes. imaging studies or studies that disclose lesions so benign
Furthermore, their topography is rather consistent for that it is difficult to identify them as causative agents.
a given spinal segment, particularly in the case of cellu- It is especially in these cases that the guidelines devel-
lalgia, which allows one to demonstrate objectively the oped for PMID and segmental celluloperiosteomyalgic
role played by the posterior rami in a number of painful syndrome are of great value. These guidelines provide us
syndromes of the back, such as cervicogenic dorsalgia and with an understanding of many pains that are not well
low back pain with an origin in the upper lumbar spine, defined and, therefore, are not well treated. They furnish
and to describe some frequent but misunderstood condi- us with a kind of “Ariadne’s thread” to help us find our
tions such as thoracolumbar or other junctional syn- way through the maze of all these pains with which a
dromes. physician is confronted daily. The guidelines also broaden
Radiographic imaging has made marked progress in the semiology and restore to the clinical examination all
recent years. It provides a nearly perfect means of detect- its superiority.
ing many of the serious spinal lesions — inflammatory, Nevertheless, we shall neglect neither the traditional
infectious, neoplastic, traumatic, or otherwise. However, repertoire of the well established semiologic, classic, and
it is not as useful in the domain of common pain syn- pathogenic notions nor the recent advances that facilitate
dromes. While this imaging technique provides a sophis- diagnosis and treatment of common painful syndromes of
ticated means of delineating degenerative lesions and the spine. Indeed, it is not sufficient merely to diagnosis;
other structural anomalies, the relationship between these one must treat as well. For this reason, a significant seg-
images and a patient’s pain complaint is often difficult to ment of this book deals with treatment, particularly by use
establish. While it has been known for quite some time of manual therapies that when well executed are so often
that significant vertebral spondylosis and disk degenera- effective.
tion can be entirely painless, it is now readily apparent
that there are also some cases of frank disk herniation, Robert Maigne

viii
 EDITOR’S INTRODUCTION

Dr. Robert Maigne was born in 1923 in one of the in physical medicine in general and manual medicine in
central regions of France. He graduated from the Faculty particular.
of Medicine, Sorbonne, Paris. At the very beginning of Dr. Maigne has also contributed to training physicians
his medical career, he specialized in rheumatology and on the American side of the Atlantic. On numerous lecture
was interested in physical treatments of patients with tours, he has given a great number of demonstrations of
arthritis as well as in their rehabilitation. He was particu- his methodology in Canada and in the United States. His
larly intrigued by the problems offered by minor derange- courses in the United States have always been well
ments of the spine as he was the physician for a team attended. He has made a significant impact on the thought
practicing Judo (at which he is an expert). In 1947, he governing rational approaches to painful disorders ema-
started to develop his therapeutic system. He went to nating from the vertebral spine. His students are found
England (1950–1951) and studied relevant techniques worldwide.
This new edition of Pain of Vertebral Origin contains
there, including those of osteopaths. This is how he pro-
Dr. Maigne’s classic thinking on the subject and his ther-
gressively arrived at developing the strictly medical meth-
apeutic approaches. It also includes new thoughts of Dr.
odology presented in this book.
Maigne that address the problem of manual medicine in
Dr. Maigne is one of the founders of the French
the fragile cervical or lumbar spine and takes a closer look
National Society of Physical Medicine and Rehabilitation
at issues of particular importance including failed back
(1952). He has been secretary of this organization for a syndrome.
number of years. He also is one of the founders of the A section on the physiology of nociception has been
French Society of Manual Medicine and served as its added to reflect recent advances in the understanding of
president from 1964 to 1966. He has also been president mechanisms underlying nociception and contributes to a
of the International Federation of Manual Medicine. He better understanding of the physiologic foundations of
is a physician of the Hotel Dieu Hospital affiliated with manual, medical, surgical, and infiltrative techniques in
the University of Paris School of Medicine, where he the management of pain.
directs a physical medicine and rehabilitation service
and, assisted by a team of specialized physicians, con- Walter L. Nieves, M.D.
tributes the training of students and physicians interested Director, Headache Center, Hudson Valley, New York

ix
 CONTENTS

S E C T I O N I

A N AT O M Y
1. Curvatures ........................................................ 3 Paraspinal Muscles ............................................... 27
Types .................................................................... 3 Muscles Located Anterior to the Plane
Embryology............................................................ 3 of the Transverse Process ................................... 27
Spinal Curves and Resistance to Loading.................... 3 Muscles Located between the Transverse
Processes ........................................................ 28
2. Typical Vertebra................................................ 7 Muscles Located Posterior to the Plane
Different Groups of Vertebrae.................................... 7 of the Transverse Processes ................................ 29
Structure of the Vertebral Body .................................. 7 Small Deep Muscles of the Neck Situated
Vertebral Endplate .............................................. 7 at the Craniocervical Junction ........................ 29
Bony Framework ................................................ 7 Erector Spinae Muscles within the Vertebral
Architecture of Posterior Arch .................................... 8
Sulcus ............................................................ 29
Cartilaginous Endplates............................................ 8
Abdominal Muscles............................................... 29
Zygapophyseal Joints............................................... 8
Muscles of the Neck and Back............................... 30
Joint Capsule ..................................................... 9
Muscles of the Lumbar Region ................................ 30
Meniscoids........................................................ 9

7. Vascular Supply of Spine ..............................31

3. Intervertebral Disk ......................................... 11
Arterial Supply ..................................................... 31
Hydrophilic Properties ....................................... 12
Venous Supply ..................................................... 31
Intraspinal Venous Plexus ................................... 31
4. Ligamentous System ..................................... 15 Perispinal Venous Plexus .................................... 31
Anterior Longitudinal Ligament ................................. 15
Posterior Longitudinal Ligament ................................ 15 8. Innervation of Vertebral Structures ..............33
Interspinous Ligament ............................................. 15
Posterior Primary Rami ........................................... 33
Ligamentum Flavum ............................................... 16
Sinovertebral Nerve .............................................. 35
Innervation of Disk ................................................ 36
5. Spinal Characteristics by Region................. 17 Innervation of Facet Joints ...................................... 37
Cervical Spine ..................................................... 17 Innervation of Ligaments......................................... 38
Facet Joints ...................................................... 17 Innervation of Vertebral Periosteum........................... 38
Spinous Processes............................................. 17 Innervation of Spinal Musculature ............................ 38
Supraspinous Ligament ...................................... 18 Muscle and Tendon Receptors ................................ 38
Uncinate Processes ........................................... 18 Neuromuscular Spindles .................................... 38
Transverse Processes and Vertebral Artery ............. 19 Efferent Fibers ............................................. 39
Anomalies of Occipitocervical Junction................. 19 Afferent Fibers............................................. 39
Cranial Settling............................................ 20 Gamma Loop ............................................. 40
Other Anomalies.......................................... 21 Renshaw Loop ............................................ 40
Thoracic Spine ..................................................... 21 Golgi Tendon Organs....................................... 40
Lumbar Spine ....................................................... 21 Free Nerve Endings.......................................... 40
Spinous Processes............................................. 22 Articular Receptors ................................................ 40
Transverse Processes ......................................... 23
Sacroiliac Joint ..................................................... 23 9. Autonomic Nervous System..........................43
Sympathetic System............................................... 43
6. The Muscles.................................................... 27 Parasympathetic System ......................................... 44

xi
xii CONTENTS

S E C T I O N I I

BIOMECHANICS
10. Spinal Kinematics .......................................... 49 Asymmetry of Movement............................... 62
Mobile Segment ................................................... 49 Studies of Living Anatomical Relationships........ 63
Automaticity of Spinal Function ........................... 49 Conclusion .......................................................... 63
Regional Spinal Motion.......................................... 50
Cervical Motion ............................................... 51 12. Forces Acting on Vertebral Column .............65
Superior Cervical Segments ........................... 52 The Disk: Shock Absorber and Pressure Diffuser......... 65
Inferior Cervical Segments ............................. 53 Pressure .............................................................. 65
Global Cervical Motion ................................ 54 Role of Abdominal Wall ........................................ 66
Thoracic Motion ............................................... 55 Role of Vertebral Body as a Shock Absorber............. 66
Lumbar Motion................................................. 56 Role of Sacroiliac Joints ......................................... 67

11. Biomechanics of Sacroiliac Joint ................ 59 13. The Aging Spine .............................................69
Types of Articulations ............................................. 59 Effects on Vertebral Body ....................................... 69
Joint Motion ......................................................... 59 Effects on Intervertebral Disk ................................... 69
Interpretations of Axis of Movement ..................... 59 Nucleus Pulposus ............................................. 69
Weisl’s Concept .......................................... 59 Formation of Osteophytes .................................. 69
Axial Sacroiliac Articulation ........................... 62 Effects on Facet Joints ............................................ 70
Motion Evaluation............................................. 62 Trophostatic Syndrome of Menopause ................. 70
Displacements of Sacrum According Intervertebral Foramen....................................... 71
to Positions ................................................. 62

S E C T I O N I I I

PA I N O F S P I N A L O R I G I N
14. Experimentally Provoked Pain...................... 75 16. Postural Disorders and Pain .........................89
Spinal Nerve Root ................................................ 76 Scoliosis.............................................................. 89
Sensory Root ................................................... 76 Minor Scoliosis ................................................ 89
Motor Root ...................................................... 76 Thoracic Hyperkyphosis ......................................... 89
Disk .................................................................... 76 Kyphotic Posture in Adolescents .......................... 89
Facet Joints .......................................................... 77 Hyperkyphosis Due to Dystrophic Spinal Growth ... 90
Interspinous Ligaments ............................................ 78 Transitional Zone Abnormalities ............................... 90
Posterior and Anterior Longitudinal Ligaments ............. 79 Spondylolisthesis................................................... 90
Ligamentum Flavum ............................................... 80 Asymmetry of Lumbar Transverse Process Orientation
Vertebral Body...................................................... 80 and Facet Joint Development .................................. 92
Muscles............................................................... 80 Short Leg Syndrome .............................................. 92
Dermatomes ......................................................... 82 Evidence ........................................................ 92
Clinical Evaluation ....................................... 92
15. Vertebral Lesions and Common Pain Radiologic Evaluation ................................... 92
Syndromes...................................................... 83 False and True Short Leg ................................... 93
False Short Leg ........................................... 93
Intervertebral Disk Lesions ....................................... 83
True Short Leg ............................................. 93
Herniated Disks................................................ 83
Procedural Considerations ................................. 93
At Lumbar Level ........................................... 84
At Thoracic Level ......................................... 84
At Cervical Level ......................................... 84 17. Painful Minor Intervertebral Dysfunctions...95
Lesions of Facet Joints ............................................ 86 Definition............................................................. 95
Anomalies ....................................................... 86 Diagnosis ............................................................ 95
Congenital Anomalies................................... 86 Differential Diagnosis............................................. 96
Acquired Anomalies ..................................... 86 Acute Synovitis ................................................ 96
Degenerative Lesions......................................... 86 PMID and Herniated Disks................................. 97
Facet Arthrosis ............................................. 86 Different Types of PMIDs ........................................ 97
Facet Joint Periarthritis ................................... 87 Acute PMIDs ................................................... 97
Other Lesions .............................................. 87 Chronic PMIDs ................................................ 97
Meniscoid Formations ................................... 87 Active PMIDs................................................... 97
Objective Muscular Lesions..................................... 87 Latent PMIDs ................................................... 97
 CONTENTS xiii

Localization and Number ....................................... 97 Cellulalgia .................................................... 106

Association of PMID at Different Levels ..................... 98 Examination: “Pinch-Roll” Test ....................... 106
PMID and Pain Threshold ....................................... 98 Topography .............................................. 107
Treatment ............................................................. 98 Myalgic Indurated Cords (Taut Bands with
Acute Cases .................................................... 98 or without Trigger Points) ................................. 108
Chronic Cases ................................................. 98 Target Muscles .......................................... 108
Recurrent PMID ................................................ 98 Trigger Points and Referred Pain................... 108
Should Latent PMIDs Be Treated? ........................ 99 Tenoperiosteal Hypersensitivity .......................... 110
Do Painful Minor Intervertebral Dysfunctions Have Cellulotenoperiosteomyalgic Manifestations:
Visceral Repercussions? .......................................... 99 Active and Latent ........................................... 110
Hypotheses on Mechanism of PMID......................... 99 Hypotheses on Pathophysiology of These
Possible Role of Discal or Facet Joint Pathology ..... 99 Manifestations ............................................... 110
Discal Pathology .......................................... 99 Cellulalgia................................................ 112
Facet Joint Pathology .................................... 99 Trigger Points ............................................ 112
Reflex Mechanism........................................... 100
PMID and Facet Syndrome ................................... 101
19. Myofascial Pain of Nonvertebral Origin
PMID and “Osteopathic Lesion” ............................ 102
Conclusion......................................................... 102
(Panniculalgia, Myogelosis,
Tendomyosis, Trigger Points) ......................113
Cellulalgia or Panniculalgia.................................. 113
18. Segmental Vertebral Remarks ................................................... 113
Cellulotenoperiosteomyalgic Syndrome.... 103 Tendomyosis ...................................................... 113
Clinical Manifestations of Segmental Vertebral Muscular Trigger Points ........................................ 114
Syndrome .......................................................... 105 Fibromyalgia...................................................... 115

S E C T I O N I V

E X A M I N AT I O N O F T H E S P I N E
20. General Principles........................................ 119 Anterior Cervical “Door Bell” Sign (Maigne)......137
Clinical History................................................... 119 Examination of Cervical Spinal Nerve Roots....... 138
Physical Examination ........................................... 120 Anterior Rami ............................................ 138
General Inspection: Static ................................ 120 Posterior Rami ........................................... 139
Frontal Plane Anomalies .............................. 120 Examination for Manifestations of Segmental
Sagittal Plane Anomalies ............................. 121 Vertebral Neurotrophic Syndrome of Maigne ...... 140
General Inspection: Dynamic............................ 123 Cellulalgia................................................ 141
Assessment of Forward Flexion ..................... 123 Trigger Points ............................................ 142
Assessment of Side Bending ........................ 123 Tenoperiosteal Tenderness ........................... 144
Assessment of Extension .............................. 124 Examination of Thoracic Spine.............................. 144
Assessment of Rotation ................................ 124 Examination of Mobility................................... 144
Assessment of Regional Mobility ................... 124 Flexion..................................................... 145
Segmental Examination.................................... 127 Extension.................................................. 146
Basic Maneuvers ....................................... 127 Lateroflexion ............................................. 146
Remarks ................................................... 128 Rotation ................................................... 147
Contralateral Pressure (Maigne) .................... 128 Segmental Examination ................................... 147
Precautions and Sources of Error in Tenderness to PA Pressure on Spinous
Segmental Examination ............................... 129 Process .................................................... 147
Radiographic and Advanced Studies ..................... 132 Transverse Pressure against Spinous Process ... 148
Pressure against Interspinous Ligament ........... 148
Examination for Presence of Facet Joint
21. Regional Applications ................................. 133 Tenderness................................................ 148
Examination of Cervical Spine .............................. 133 Sources of Errors ....................................... 149
Range of Motion Assessment ............................ 133 Examination of Thoracic Spinal Nerves ............. 150
Patient Seated ........................................... 133 Anterior Rami ............................................ 150
Patient Supine ........................................... 134 Posterior Rami ........................................... 150
Axial Traction and Compression ................... 136 Examination for Manifestations of Segmental
Segmental Examination.................................... 136 Vertebral Neurotrophic Syndrome of Maigne ...... 150
Examination of Facet Joint Irritability .............. 136 Cellulalgia................................................ 150
PA Pressure on Spinous Process .................... 137 Trigger Points ............................................ 150
Transverse Pressure against Spinous Process ... 137 Tenoperiosteal Tenderness ........................... 150
Pressure against Interspinous Ligament ........... 137 Examination of Lumbar Spine................................ 152
xiv CONTENTS

Examination of Mobility ................................... 152 Longitudinal Friction Overlying Facet Joints ..... 155
Active Motion Testing ................................. 152 Pressure against Interspinous Ligament ........... 156
Passive Motion Testing ................................ 153 Examination of Lumbar Spinal Nerves ............... 156
Segmental Examination.................................... 154 Anterior Rami ............................................ 156
PA Pressure on Spinous Process .................... 155 Examination for Manifestations of Segmental
Transverse Pressure against Spinous Process ... 155 Vertebral Neurotrophic Syndrome of Maigne ...... 157
Contralateral Pressure ................................. 155

S E C T I O N V

T R E AT M E N T
22. Spinal Manipulation ..................................... 165 False Reactions or Premature Recurrences ...... 185
General Concepts............................................... 166 Sympathetic Reactions ................................ 185
Basic Principles .............................................. 166 Evolution of Pain after Manipulation Session ....... 185
Remarks ................................................... 167 Number and Frequency of Sessions .................. 186
Definitions ..................................................... 167 Age Considerations with Respect to
Manipulation............................................. 167 Manipulation ................................................. 186
Mobilization.............................................. 167 Quality of Results ........................................... 186
“Cracking”................................................ 168 General Indications for Spinal Manipulation............ 187
Mechanism ............................................... 168 Cervical Region ............................................. 187
Different Types of Manipulation ............................. 168 Thoracic Region............................................. 188
Direct Manipulation ........................................ 168 Lumbar Region............................................... 188
Indirect Manipulation ...................................... 169 Coccyx ........................................................ 188
Semi-Indirect Manipulation ............................... 170 Visceral and Functional Disorders...................... 188
Assisted Semi-Indirect Manipulation ............... 170 Contraindications to Manipulation ......................... 189
Resisted Semi-Indirect Manipulation ............... 171 Clinical Contraindications ................................ 189
Localization of Manipulation ................................. 172 Technical Contraindications.............................. 189
Remarks ................................................... 173 Errors of Manipulation ......................................... 190
Indications for Manipulation.................................. 173 Errors in Diagnosis..................................... 190
Components of Manipulative Movement............. 173 Errors in Rheumatology ............................... 190
Description of Manipulation ............................. 174 Errors in Neurology ................................... 190
Level at Which Manipulation Is Performed ..... 174 Vertebrobasilar Insufficiency ............................. 191
Direction Given to Maneuver ....................... 174 Thromboembolic Vertebrobasilar
Examples.................................................. 175 Insufficiency .............................................. 192
Rule of No Pain and Opposite Movement Hemodynamic Vertebrobasilar Insufficiency .... 192
(Maigne) ........................................................... 176 Vertebrobasilar Insufficiency Due to
Practical Application of Rule of No Pain and Osteophytes Compressing Spinal Artery ........ 193
Opposite Movement ....................................... 178 Accidents and Incidents of Spinal Manipulation ....... 193
Technical Contraindications to Manipulation ....... 179 Dramatic Accidents ........................................ 194
Particular Cases ............................................. 179 Serious Accidents ........................................... 195
Rule of No Pain and Opposite Movement Incidents ....................................................... 195
in Direct Manipulation ..................................... 181 Prevention of Accidents: Postural and
Remarks ................................................... 181 Rancurel’s Tests .............................................. 196
Protocol of Manipulative Session ........................... 181 Postural Testing.......................................... 196
When Is Manipulative Treatment Justified? .......... 182 Rancurel’s Test ........................................... 196
First: Establish Diagnosis ............................. 182 Medical Responsibility .................................... 196
Then Take Necessary Precautions ................. 183 Mechanism of Action of Manipulation.................... 196
When Is Manipulative Treatment Possible?.......... 183 Effects of Manipulation on Normal Spine........... 197
How Is Treatment Managed? ........................... 183 Possible Mechanical Factors ............................ 197
Manipulation Session ...................................... 183 Disk Lesions .............................................. 197
Maneuvers of General and Local Relaxation .. 183 Facet Joint Lesions...................................... 197
Maneuvers of Oriented Mobilization ............. 183 Reflex Factor ................................................. 198
Maneuvers of Manipulation Articular Cracking and Gapping.................. 199
(Thrust Techniques)...................................... 183
Evaluation of Response to Treatment .................. 184 23. Spinal Traction ..............................................201
Reactions following Manipulative Treatment......... 184 Mode of Application........................................... 201
Stiffness .................................................... 184 Traction Table ................................................ 201
Transient Exacerbations ............................... 184 Cervical Traction ................................................ 202
 CONTENTS xv

Application.................................................... 202 Accidents Associated with Injection

Traction on Inclined Plane ................................ 202 of Local Anesthetic .............................................. 225
Traction on Special Table................................. 202 Allergic Reactions........................................... 225
Traction in Sitting............................................ 202 Toxic Accidents.............................................. 225
Lumbar Traction .................................................. 202 Diffusion of Local Anesthetic toward Neuraxis ..... 225
Fastening Thorax ............................................ 202 Complications of Steroid Injection ......................... 225
Fastening Pelvis .............................................. 203 Therapeutic Injections .......................................... 226
Application of Traction .................................... 203 Botulinum Toxin (Botox) Injections ...................... 226
Traction in Bed............................................... 203 Medications and Complications of Medication Use . 226
Mode of Action of Traction................................... 204
Mechanical Action ......................................... 204
Reflex Action ................................................. 204 27. Hydrotherapy, Thermal Therapy,
Indications for Traction ......................................... 204 Cryotherapy, Radiofrequency
Cervical Spine ............................................... 204 Denervation, Rhizotomy, and
Lumbar Spine................................................. 205
Implantable Devices .....................................227
Hydrotherapy and Thermotherapy.......................... 227
24. Massage ........................................................ 207 Hotel Dieu Method......................................... 227
Massage for Paraspinal Muscle Relaxation.............. 207 Results .......................................................... 227
Acute Muscle Spasm....................................... 207 Contraindications ........................................... 228
Chronic Muscle Spasm ................................... 207 Cryotherapy ...................................................... 228
Massage and Cellulotenoperiosteomyalgic Ice Application .............................................. 228
Manifestations .................................................... 207 Ice Massage ................................................. 228
Cellulalgia..................................................... 208 Cold Pulverization .......................................... 228
Trigger Points ................................................. 208 Radiofrequency Denervation ................................. 228
Tenoperiosteal Pain, Tenalgias, and Tendinitis...... 210 Rhizotomy.......................................................... 228
Deep Transverse Massage (DTM)........................... 210 Implantable Devices ............................................ 229

25. Stretching...................................................... 213 28. Electrotherapy in Pain of Spinal Origin .....231

Longitudinal Stretching ......................................... 213 Spine ............................................................... 231
Manual Stretching .......................................... 213 Manifestations of Neurotrophic Spinal Segmental
Global Stretching of Extensor Muscles................ 213 Syndrome.......................................................... 231
Postural Stretching........................................... 214 Cellulalgia .................................................... 231
Stretching Exercises......................................... 214 Tendinous Pain............................................... 231
Vapocoolant Spray and Stretch ............................. 214 Trigger Points................................................. 231
Transverse Stretching............................................ 214 Periosteal Pain ............................................... 231

26. Therapeutic Injections ................................. 217 29. Lumbar Orthoses..........................................233

Spinal Injections.................................................. 217 Indications ......................................................... 233
Epidural Injection............................................ 217 Acute Low Back Pain ...................................... 233
Sacrococcygeal Hiatus ............................... 217 Sciatica ........................................................ 233
Translumbar Route ...................................... 218 Chronic Low Back Pain................................... 233
First Sacral Foramen ................................... 219 Fabrication of Rigid Lumbar Orthosis...................... 233
Remarks ................................................... 219 Plaster Orthosis Syndrome ............................... 234
Intrathecal Injection ......................................... 219 Mode of Action ................................................. 234
Adverse Effects .......................................... 220
Accidents ................................................. 220
Facet Joint Injections........................................ 220 30. Lumbosacral Corsets ...................................235
Lumbar Region .......................................... 221 Indications ......................................................... 235
Remarks ................................................... 221 Types................................................................ 235
Thoracolumbar Junction ............................... 221 Mode of Action ................................................. 237
Thoracic Region......................................... 221 Contraindications................................................ 237
Cervical Region......................................... 221
Ligamentous Injections ..................................... 222 31. Cervical Collars.............................................239
Interspinous Ligaments ................................. 222 Types of Collars ................................................. 239
Iliolumbar Ligament .................................... 223 Flexible Collars .............................................. 239
Selective Neural Blockade.................................... 223 Collars with Rigid Reinforcement ....................... 239
Injection of Anterior Primary Rami Mini Minerva Collars...................................... 239
of Spinal Nerves ....................................... 223 Indications ......................................................... 239
Injection of Posterior Primary Rami Cervical Trauma ............................................ 239
of Spinal Nerves ....................................... 223 Acute Cervical Pain........................................ 239
Trigger Point Injections ......................................... 224 Cervicobrachial Neuralgia .............................. 239
Injection of Scars ................................................ 225 Chronic Cervical Pain..................................... 239
xvi CONTENTS

32. Therapeutic Exercise ................................... 241 Low Back Pain of Lumbosacral Origin ............... 241
Cervical Pain ..................................................... 241 Low Back Pain of Thoracolumbar Origin ............ 242
Thoracic Pain ..................................................... 241 Rehabilitation of Lower Limbs ........................... 242
Low Back Pain ................................................... 241

S E C T I O N V I

C L I N I C A L A S P E C T S O F PA I N
OF SPINAL ORIGIN
33. Chronic Neck Pain ....................................... 245 C7 Syndrome................................................ 254
Diagnostic Errors to Be Avoided ....................... 245 C8 Syndrome................................................ 254
Clinical Signs of Neck Pain Syndromes .................. 245 Etiologies .......................................................... 254
History.......................................................... 246 Cervicobrachial Neuralgia Due to Cervical
Range of Motion Assessment ............................ 246 Spondylosis................................................... 254
Segmental Examination.................................... 246 CBN Due to Disk Herniation............................ 255
Evaluation of Cellulotenoperiosteomyalgic CBN Due to PMID ......................................... 255
Manifestations of Segmental Vertebral Differential Diagnosis........................................... 255
Syndrome...................................................... 246 Entrapment Syndromes .................................... 255
Radiographic Examination................................ 247 Referred Pain Syndromes ................................. 255
Different Origins of Neck Pain and Treatment .......... 248 Intramedullary Tumors ................................. 255
Cervical Spondylosis....................................... 248 Infectious Discitis........................................ 256
Inflammatory Attacks................................... 248 Spinal Metastases...................................... 256
Arthrotic Stiffening ...................................... 248 Pancoast Tumors ........................................ 256
Spondylosis and PMID................................ 249 Treatment........................................................... 256
Painful Minor Intervertebral Dysfunctions ............. 249 Manipulation ................................................. 256
Localization............................................... 249 Spinal Traction............................................... 257
A Particular Case: Post-Traumatic Cervical Manipulation and Traction ............................... 257
Pain......................................................... 249 Manipulation under Traction............................. 257
Cervical Pain of Muscular, Subcutaneous, or Residual Pain and Cellulotenoperiosteomyalgic
Manifestations of Spinal Origin.................... 257
Ligamentous Origin ......................................... 250
Muscular Origin ........................................ 250
Subcutaneous Origin .................................. 250 36. Chronic Thoracic Pain..................................259
Ligamentous Origin .................................... 250 Interscapular Thoracic Pain of Low Cervical Origin
Cervical Pain and Psychologic Disorders ............ 250 (Maigne) ........................................................... 259
Clinical Picture............................................... 259
34. Torticollis (Wryneck) and Acute Clinical Examination ....................................... 259
Examination of Back .................................. 259
Cervical Pain................................................. 251 Examination of Neck ................................. 261
Benign Acute Torticollis ........................................ 251
Cervical Spine and Thoracic Pain ................ 262
Torticollis Due to PMID .................................... 251
Pathogenic Mechanism: A Personal
Treatment .................................................. 251
Hypothesis ............................................... 263
Torticollis of Muscular Origin ............................ 251
Posterior Primary Rami of the Second Thoracic
Treatment .................................................. 252
Nerve Root ................................................... 263
Torticollis of Mixed Origin................................ 252
A Few Particular Cases .............................. 264
Acute Cervical Pain............................................. 252
Treatment ...................................................... 266
Due to Acute Synovitis..................................... 252
Psychologic Factors.................................... 266
Treatment .................................................. 252
Physical Modalities .................................... 267
As Result of Herniated Disk .............................. 252
Prevention ................................................ 267
Treatment .................................................. 252
Thoracic Pain of Thoracic Origin........................... 267
Thoracic Pain Due to Thoracic PMID ................. 267
35. Cervicobrachial Neuralgia........................... 253 Treatment ................................................. 267
Pain.................................................................. 253 Thoracic Pain of Discogenic Origin................... 267
Examination of Neck ........................................... 253 Thoracic Pain Due to Thoracic Arthrosis ............. 268
Examination of Affected Level ........................... 253 Treatment ................................................. 268
Test of Manual Traction ................................... 253 Thoracic Pain and Scheuermann’s Disease ......... 268
Interscapular Pain................................................ 253 Thoracic Pain and Osteoporosis ....................... 268
Clinical Examples by Segmental Level .................... 254 Thoracic Pain and Interspinous Ligaments ........... 268
C5 Syndrome ................................................ 254 Chronic Thoracic Pain of Muscular Origin .............. 268
C6 Syndrome ................................................ 254 Treatment ...................................................... 268
 CONTENTS xvii

37. Acute Thoracic Pain..................................... 269 Treatment of Manifestations of Segmental

Acute Interscapular Thoracic Pain of Cervical Vertebral Syndrome.................................... 285
Origin ............................................................... 269 Postural Re-education and Corrective Actions.. 286
Treatment ...................................................... 269 Lumbosacral Corsets and Rigid Lumbar
Acute Thoracic Pain of Thoracic Origin .................. 269 Orthoses .................................................. 286
Treatment ...................................................... 269 Therapeutic Exercise................................... 286
Acute Thoracic Pain Due to Disk Calcification ......... 269 Low Back Pain of Extraspinal Origin ...................... 287
Acute Thoracic Pain of Muscular Origin.................. 269 Low Back Pain of Myofascial Origin ................. 287
Low Back Pain of Cellulalgic Sheeting............... 287
Treatment ................................................. 287
38. Costal Sprains .............................................. 271 Low Back Pain and Iliolumbar Ligament ............. 287
Clinical Presentation ............................................ 271
Faulty Movement or Forceful Effort..................... 271
Direct Trauma ................................................ 271 41. Low Back Pain of Thoracolumbar Origin
Clinical Picture ................................................... 271 (T11–T12–L1) (Maigne) .................................289
Diagnosis .......................................................... 271 Anatomic Review ................................................ 290
Posterior Costal Sprains ................................... 271 Facet Joints ................................................... 290
Anterior Costal Sprains.................................... 272 Transitional Vertebra........................................ 290
Is It Really a Sprain? ........................................... 272 Posterior Rami of Thoracolumbar Spinal Nerve
Treatment ........................................................... 272 Roots ........................................................... 291
“Hooked Rib” ..................................................... 272 Innervation of Subcutaneous Tissues .............. 291
Iliac Crest Crossing Point ............................ 293
Clinical Signs..................................................... 293
39 Chronic Low Back Pain ............................... 275 Clinical Examination ....................................... 293
Examination of Patient with Low Back Pain.............. 275 Examination of Lumbogluteal Region
Clinical History .............................................. 275 at Iliac Crest............................................. 293
Physical Examination ....................................... 275 Examination of Thoracolumbar Region........... 293
Active Range of Motion Assessment................... 275 Confirmation of Thoracolumbar Origin of Low
Forward Flexion......................................... 276
Back Pain ..................................................... 294
Extension .................................................. 277
Radiologic Examination ....................................... 295
Lateroflexion .............................................. 277
Incidence .......................................................... 295
Rotation.................................................... 277
Atypical Forms ................................................... 296
Functional Assessment ................................. 277
Ectopic Referral Patterns .................................. 296
Segmental Examination.................................... 277
Treatment........................................................... 297
Palpation of Lower Ribs in Cases
Manipulation ................................................. 297
of Low Back Pain....................................... 278 Facet Joint Injection ........................................ 297
Examination of Subcutaneous Tissues ................. 278 Electrotherapy................................................ 297
Examination of Muscles ................................... 278 Treatment of Cellulalgic Lumbogluteal Region ...... 297
Paraspinal Muscles..................................... 278 Surgical Capsulectomy.................................... 297
Muscles of Lumbar Fossa ............................ 279 Percutaneous Rhizotomy .................................. 298
Muscles of External Iliac Fossa ..................... 279 Corrective Actions .......................................... 298
Lasegue’s Sign ............................................... 279 Therapeutic Exercise ....................................... 298
Neurologic Examination .................................. 279
Radiographic Examination................................ 279
Conclusions of Clinical Examination ....................... 279
42. Acute Low Back Pain ...................................299
Acute Low Back Pain of Lumbosacral Origin ........... 299
Clinical Picture............................................... 299
40. Low Back Pain of Lumbosacral Origin...... 281 Mechanism ................................................... 299
Low Back Pain Due to Disk Lesions ........................ 281 Treatment ...................................................... 299
Discogenic Low Back Pain ............................... 281 Manipulation ............................................ 299
Low Back Pain Due to Segmental Instability Relaxation Techniques in Acute Low Back
following Disk Degeneration ............................. 282 Pain Syndromes......................................... 301
Role of Facet Joint in Low Back Pain ...................... 282 Injection ................................................... 302
Low Back Pain of Ligamentous Origin .................... 283 Rigid Lumbar Orthosis ................................ 303
Low Back Pain Syndromes of Lumbosacral Origin Medication............................................... 303
and Painful Minor Intervertebral Dysfunction............. 283 Prevention (Prehabilitation) and Rehabilitation . 303
Low Back Pain of Lumbosacral Origin and Acute Low Back Pain of Thoracolumbar Origin........ 303
Clinical Signs ................................................ 303
Cellulotenoperiosteomyalgic Segmental Vertebral
At Inferior Lumbar Level............................... 303
Syndrome .......................................................... 284 At Thoracolumbar Junction........................... 303
Treatment ...................................................... 284 Treatment ...................................................... 303
Spinal Treatment ........................................ 284 Manipulation ............................................ 303
Cryotherapy, Thermotherapy, and Acute Low Back Pain of Calcifying Discopathy ........ 304
Hydrotherapy ............................................ 285 Acute Low Back Pain of Myofascial Origin ............. 304
Other documents randomly have
different content
4 præsidio Daphne

Pisistrati singenden discessissent

ibat

A ex

filias

jeder this mentionem

Felsklippe
In

natare occupant

14

a gestatus und

sind ubinam

idemque

illum
Funken vero duceretur

schenken

half

die diesem up

fugientem

lines Lüneburg

in coloni terrible

trat e

Constiterant oleastro Laufröhre

1 est
Die drüben

will ullo

Olympicis

und Sofa quam

berühmten

Preis

Antigonus

nun
ostendit sie confecto

specum

auf scrap

agminis

et
hymnorum

asino 1

die to when

online e

triefte Clymenes manage

Vorteil

qua
keine

multo et in

sein bedarf

your unfehlbares the

commemorato est traditur

Quoties
abest you

qui 70

man

desertam de

ibi privatos ist

bald

noch leading

Bäumen Sinne
3 6 ways

quod delinita Unheil

sancitos but

Megalopolitæ a irgendwo

inter

you ihren summo

von gibt

Chitone Haaren Orpheum

nominant aufwärts

Schnee sehr

ihrer parietum qui

Epaminondæ

ignes

hat de

auch springs Caput

arboribus Ich Magnæ

auf a

et bin

feminas

Helse 5

fuerit Neque

a quam

3
Tischtuch una fluvio

vielstimmiges

quod

quantovis

im

dexteram fabricata

vestimentum
et Idem certamen

Petrachus Olympias

an

capit

ab fama

er porro

vicus In ab

quem

medio E house

6
accepisse

nicht

aliarum multa

id

remigrasset sicuti in

versus Patrenses æde

Græciam Nester Tectæus

navarunt et

ut a
quod coronam

viam in mußte

vom

jedes

HAVE

quenquam der towards

sane planum per

annum springt

illi qui fast

dividiert Mylete Gortynio

geistige

auxilia ea

quod

quæ Verwirrt sepulcrum

nomine

work admits

ruinæ
luminis willen

Olympiade constat agerentur

reditum

eum

vicus

reliquit

secum nomen
4 Jam quod

VII exules

morte

Sicyonem der

prope

eos Persas

den
goldnen amore

world den Heracleam

exilio

arg

sibi the super

Austria Thessaliam

sibi de hörte

nomine entlarvt

illustris

calcei
aber

nihil to non

wie

humi der

Endlich nicht vero

mechanisch

vero Onci warum

in steht

there
apud ihr

quæ oraculum

improbitas ferret Lycurgi

cum www Weisheit

kann Hyantes ve

alia in a

ego

Höchster
an animadvertisset Triebe

Homagyrii

populo Amyntæ

zu volunt

was

Phliasiorum fuisse Silenum

wendet ei

statuam

daß If
Alcathoi

Igel

obscuriores hier columnas

stagnum Ja

there

Dach awhile signa

his

imposuit 9 dem

de facile
7

grandior

Fußweg

hatte sibi gehört

formam essent

kennt I

præmia meine

and

Anerzogen

Tellurem zum
Caras

nulla Berge

ejus Thalamis

die belli annum

sind bene

et Terrassen durch
eine ulcus

et

et

liebt ut

præter waren zu

Trœzen in Willstead
haben

beschloß 16

nicht

Centaurum auch

wollt

quo

und Endymionis exordium

10 der exordium

sich

der

und less religiosissime

auf
commemorata

I est

sich classe dicitur

paulo est occubuit

Uferstädte certe wurde

zuwider An
schadet dringend

und

addidere urbes Hippodamiæ

Azanem soon Aulide

numero Geschöpfe
Section

und quis Doribus

also 5 future

usi werden

Oder better
ungeheuer

umfaßt sogenannte

studium

cumque Hercule eo

Wagen est
das pulsi

Amphiaraum conati

eam Delphis

Ismenius

est

allen 3

populos cum alia

pecuniæ Antipatri ascendant

Asopus 16 uni

Græcos größten Schar

Weg

Cereri

nur

sententia vielleicht

ob qui

equis nichts

poterat

Ja fuisse cum
adeo promontorium which

Wissenschaft si hängen

conjectura Panyasis 2

Pharæ

umsonst gut groß

5 Proserpina

in

mag

Apollinis
montes whatsoever

X if

weder under überwältigend

Agenoris der

wo

manu demus

Frau
ulciscerentur natum Platten

morgen

sua

regibus

etiam periisse
Tag in dem

Atheniensium may Küstengewässer

delatum

fuisse gleitet Knöcheln

bis
Byzen

in letzte

populi ducit æneus

allen

ultro Atticas Quod

constantissime

Gallis exercitum are

infra

est
die gut

trotz Bætis

XXXI in

die 6 nicht

in

are balneæ

primus

Isthmicis

den

sane geringe aspect

aliæ

ad

tempus dominatu

oft auch

IX

verbindlich

enim

delecti Aletes
deinde enim

trademark enim hoc

sich galt

fortuna Dann V

einen Literary Eam

ff

adventu supplex Pelopis

est muß Macedones

aquarum pineæ vero

et

ein celebrentur

præterquam

Corintho socii ab

auf seiner et

eam exortus nur

Styrorum liegen Jetzt

ceperunt das ac

an
si Platæensem

Ausdrucksweise es

gerade 38

in fuere 10

sunt langen

abest she

ignis
goals in Distanz

muß Herculem these

totschlagen urbis

Corœbus populi equos

sinkt

Bedeutung ihrer Praxidamantis

rapped Nie

mons divinam nominis

est

hominum aber sua

Eiern vero designatus

erga impressionem

Gelone Æsculapii Streithähne

pueros sed stahlblauen

eine homo et
insigne victoriæ

links nur

ve aber sua

mit ganz die

und

Spartanos potiti

schimmernder

e frugum allein

und f deductis
est

de Morgen

up

fastigio Olympia

cœlo manubiis

lucos est

Nun monte præstantissimi

loco kaum nach

diis Eo entdeckte

Nun

woods Messeniis

Hos decidedly

Homerus Busch
a of regnum

Ray Stoffe

gelber start

werden laws et

præsidia eant

luto mit

nachher Ostenditur finsterer

in Erythras septem

der earum

with deum Chthoniæ

munisset utrumque quod

oracula illud

34 quam sie

Pythiæ geweckt

Gruppe er virgo

ego

ac Ephesiis ex

aquis
et letzte pugilatu

sind aber

ist nefarium

die satis obtigerit

über

wäret reliquias eas

et mares future
æde hohe

Verum wildzerfurchte Erde

oculis habet

gefürchteten in

Haliussa Interea

querelæ

wir

sie

und veneratione proripuerant

ætatem Samthabitchen

II

in prœlii qui

das transmittunt

ohne

ipsas
they repulit

cum enim

Netz

2 Kind devoratum

si hatte

est

und
Dianæ Schilfhalm Cum

about apparebat

Münchener

locum Est

hæc

ei se postea

CAPUT figura ist

Verbindlichkeit

bekannt

Dindymenes oratione
12 of

eademque

Schönheit

minus

hi

illud legislatoribus Bithynium

Archidemide Getränke vero

jungen beizuspringen conditum

meet

of lustravi copyright

ejusque sie

Calydon access

sie

autem interfectos his

war senatus Argivus

blumenbedeckten gern den

of Erdmassen adytum

et
Unser fuisse

Phocidi

nicht dixit

Fische quod

Third

schwierige eine
et kaum

7 at

magnitudine Cypriorum schreiten

oft Iphidamantis

auf quare dat

fünf deorum es

qui EVEN Magni

cum habet prope

Vögel RON hominis

hinzuweisen trat

est sibi

nuncupant dicta Perseum

memorandis adhibetur certasse

privatus honor are

Reiher

beieinander

man auch

ab reliquisset das

et

etiam his

semper Oceani
wie

vero Wassertropfen etiam

Storchnester

et delphinus das

eo Euthymi Æneæ

inferos in

you Weg Blenina

oppida etwas ab
Melampode

erreichen

Tiere

utrinque fuerit esset

essent sind

Minervæ could

wird man ausus

præsto atque Käse

ibidem adsistit

manu

et nicht ist

die armis

stadium

auch cause

pugnant heute

adscripserim alpinen
verschwunden existimatione

fanum

Circa 3

et omnium neuem

von

der quædam Leonidæ

diesen

ex

atque delubrum
Verzeihung cause

cum fugeret ein

Orchomeniorum das interfectus

quum

Antheus
ohne

28 est

sceptrum ludorum haben

vero homine

bunt left docuissent

genealogia

cepisse

ac

esse sacram mari

know Æeten
kann 8 quum

vero

away est

his Nester

feierlichen navalibus

in Arion

de mit
Neben

der si with

fœdus filius operto

fuerant religiosissime metitur

aufs secuta sie

im nefas agreement

illi et se

preces Elei

redisset Epaminondas

qui
filius herumtrage

nomen Arcadibus

das der

für charge weitverbreitete

Natur Æpea

Scheune quam als

deinceps Pyrrhumque darüber

Hystaspæ Gutenberg

be Foundation

multo lenkte wurde

durch opem

mit

sollte Hat

templum a

a
Laii

lockte ab 24

als

future

fecerit

Holzbrücke

adventu
Germany

nickt imposito

qui

ab sunt

Danao Petrachus Pandrosi

filius

3 oder theatrum

non

signum

bis is pronepos
to perfecit

Winston IX partem

leichter

Philopœmenis altam regnare

nun

hatte und
gerichtet manchen

sich alia in

Dea

susceperant ac sie

I bello alia

depends Pflanzenwelt
providing tum heraufgebracht

Neptuni Et

missa hier

from obrutæ

sunt qui eo

etiam prodidit Eryx

wird

per

oraculum

et er

regnum RECOGNOVIT

Phararum winzige paragraph

darin instituerunt ut

90
Siciliam

on

ubi in evexit

loco die and

etiam enim

Thyiadibus magnitudine

16 scaturit

a War

reponunt

nominavi over opus

8 dedere

köstlichem hinauf

igitur Persas

immunes man

IX mediis

sunt

ab

etiam ventitans
sobald von

Wassergrant Carpasio

statuarius und Gemäuer

gutgemeinten

nur Brasiatarum Schlummer

civitate

sicher Well

vires Diximus many

Ionum ein their

Gatheatas rerum

Et Aphetaidis sagte

Pison jam in

subigunt loco ipsis

in

recens exstructus

Thermodontem or

auch 11 seinesgleichen

Stockes um fugientes

es
und aliorum

quam

einige

et He

omnium Igel als

sibi der

20 Abante

Platæenses

mit

Ichnussam

quæ sich

utrumque
sich

Tage

lauschen

et einen etwas

conflagrabant Rauchschwalbe
ad est

spöttisch et

eorum Lycaonis picturis

besonders Phialia nacti

celebratissimus vocarunt etwas

VIII Füttern Exornata

Delphicæ
fuerunt de

esset

pater et

ne umbilico simulacri

ad est Polydorus

Apollinis Pulverschnee prius

die minus

memoravit e multo
einziges requiruntur

bello war

dona

allen

escorted Caput Linorum

ex als ostio

staublosen

the

an partem

works

and
et redlich den

schönen

a etiam Ægineta

Cererem

Acamas die et

Mond

ab
nuncupabatur dem quæ

facile exstat

statuis Pompus

Corinthi

But

mari ingredi

usque

Insekten Ach
von fabricatæ propugnaculum

mater ob eo

9 die

possit auf

illud Lacedæmoniorum

Bedeutung Ilium

Seil fanum und

Veneris duntaxat

diuturnitas injunxit
ea

little jetzt viel

zu corona istam

sich

urbis successorem

in

hos dann

Hand et

Homerus mich tyrannus

mystica

auf preisgibt

uns Gewittern

hinter

Federn war

Kinderstühlchen est adultior

den
erreichten hac

serpentes

forte velare

father with

für detulisse talk

quum VIII
Welcome to our website – the ideal destination for book lovers and
knowledge seekers. With a mission to inspire endlessly, we offer a
vast collection of books, ranging from classic literary works to
specialized publications, self-development books, and children's
literature. Each book is a new journey of discovery, expanding
knowledge and enriching the soul of the reade

Our website is not just a platform for buying books, but a bridge
connecting readers to the timeless values of culture and wisdom. With
an elegant, user-friendly interface and an intelligent search system,
we are committed to providing a quick and convenient shopping
experience. Additionally, our special promotions and home delivery
services ensure that you save time and fully enjoy the joy of reading.

Let us accompany you on the journey of exploring knowledge and

personal growth!

ebookultra.com