r. Warren Hammer has been in practice for 50 years. He graduated from Brooklyn College (BA) in 1955, Lincoln Chiropractic (DC) in 1960; Diplomate, American Board of Chiropractic Orthopedists in 1975; instructor in spinal biomechanics, NYCC; University of Bridgeport (Human Biology-Nutrition, MS) 1979. He is a consultant for Graston Technique©. He attended seminars at Gonstead Clinic (20 X), Cyriax, Nimmo technique, ART, Mulligan, Voyer, Fascial Manipulation®, and others.
TAC: What made you become interested in soft tissue methods?
Dr. Warren Hammer (Dr. H): Early on, I realized that spinal and joint manipulation, while extremely important as a treatment modality, was only part of the picture regarding the treatment of musculoskeletal conditions. I wrote years ago about chiropractic tunnel vision regarding “subluxation” and spinal involvement. The spine is a passive structure, moved by muscles and supported by connective tissue. How can you neglect these areas? For me, the big realization about soft tissue began when I noticed that spinal and shoulder adjustments, plus some modalities such as ultrasound, were not the answer to the treatment of most shoulder problems. I might add that this also applies to most other areas of the body.
TAC: How do chiropractors respond to your position on the role of chiropractic in health care?
Dr. H: Years ago, I used to receive threatening letters stating that I was not adhering to chiropractic “philosophy,”etc. It may sound like blasphemy to some, but I feel that the future of our profession depends on us departing from some of the original ideas of chiropractic. These ideas have been overemphasized and have slowed down our progress. Have we ever asked ourselves why we are treating the same percentage of the population that we did 50 years ago? In a recent volume of American Chiropractor, outgoing president of NUHS, Dr. James Winterstein was asked about the future of our profession. He stated that the new science called mechano-biology whereby mechanical input can affect human physiology down to the celluar and biomechanical level is very important for our profession. He stated that “when you work on the fascia, these fibrocytes communicate directly with one another, and they invest every organ in the human body.” “What we do biomechanically has an effect that goes far beyond the bones, joints, ligaments, and muscles.” “This has been the basis for the profession since the beginning.” I feel that what we do biomechanically, though, has to include much more than the spinal adjustment.
TAC: What is it about fascia that chiropractors have been overlooking?
Dr. H: Seems that in the US, except for the Rolfers (Structural Integrationists), up until recently almost everyone has been overlooking fascia. Except possibly in Europe where Fascial Manipulation® has been taught for the past 15 years. The most ubiquitous connective tissue in the body is the fascia. It has been defined as the connective tissue system that permeates the human body, forming a whole-body continuous three-dimensional matrix of structural support. It interpenetrates and surrounds all organs, muscles, bones, and nerve fibers. Every muscle fiber and every muscle belly is surrounded by fascia. It is extremely important because it transmits almost 40% of the force of a muscle contraction and possibly more important, the fascia is a sensory organ that communicates with the CNS. Muscle spindle cells that function to help regulate muscle function are in the fascia. If the fascia is densified and unable to slide over and within muscle, then the spindle cell cannot provide normal feedback to the CNS. There will be an incoordination of muscle function leading to eventual pain and malfunction, and the individual becomes an accident waiting to happen.
TAC: Do subluxations affect the fascia?
Dr. H: More likely, densified fascia affects the subluxation. Often after soft tissue treatment there are less spinal fixations palpated. Actually, an adjustment is a type of soft tissue treatment affecting the capsules, associated ligaments and muscles, and probably some local fascia. But due to the global distribution of fascia, the whole fascial system has to be considered along with the articular component.
TAC: Can you in a few words tell us about the Fascial Manipulation (FM) course?
Dr. H: I went to Italy for two separate weeks to learn the work and recently introduced it to the US with Antonio Stecco, MD. FM looks at the entire body from a global perspective based on an anatomical and neurophysiological understanding of the fascial system. Based on FM interpretation of the myofascial kinetic plane, for example, treatment of an old ankle fracture (fascial disruption) finally prevents the recurrent compensatory low back pain.
We must recognize the importance of our total structure and not get stuck on just treating its parts.
TAC: Can you think of one change that a chiropractor can do to significantly impact his or her practice’s growth immediately?Dr. H:
Simple, get people well in a short period of time. Fill your “tool box” with as many healing tools as possible and apply them to the particular patient’s problem. I am not interested in gimmicks that create an immediate growth in practice. We are all in practice for the long haul and creating satisfied, referring patients has always been the key to growth for all types of doctors. I believe in a doctor having a healthy frustration, meaning that you can never be content until all of the patients you accept get well. Since this cannot really happen, allow your “healthy frustration” to continue to find out why you were not able to get them well.TAC: Where do you see the future of chiropractic headed? Dr. H:
The future of chiropractic depends on how soon our colleges can teach the gestalt of healing. We must recognize the importance of our total structure and not get stuck on just treating its parts. The physical therapists seem to be developing this concept and are now graduating DPTs (doctors of physical therapy). They are teaching spinal and joint manipulation, and while they have not nearly reached our proficiency, they continue to stress a soft tissue paradigm. From what I see, however, they are still weak in the soft tissue arena, but to their credit, they are not stuck on original concepts. Frankly, I worry about our future.TAC: Any final words for our readers?Dr. H:
The old adage that we should treat patients as we would want ourselves to be treated is truer than ever. I want my doctor to know everything possible about what he treats. I want my doctor to open his or her mind and never be satisfied with his or her state of knowledge. I want my doctor to be interested in getting me well as quickly as possible and not make me a lifelong contributor to his or her financial well-being.Visit www.warrenhammer.com for more information.