Rehabilitation


Is It Osteoarthritis?
Rehabilitation
Written by Kirk Lee, D.C.   
Thursday, 16 September 2010 16:12

Is It Osteoarthritis?

by Kirk Lee, D.C.

 

osteoarthritis


“Abnormal movement patterns

and too much early resistance

will aggravate the joints”

 

How often do you hear from a patient, “I would exercise, but it hurts!”? Let’s look at a case study which will be very familiar to you.  Mrs. Bones is a 56-year-old female who has a history of on-and-off left hip pain and bilateral knee pain, with her right knee pain being worse. She grades the hip pain as a 4 out of 10, the left knee a 5 out of 10 and the right knee a 6 out of 10 on a visual analog scale. She denies any history of trauma to the spine or knees. Mrs. Bones also gives reference to recent weight gain of 15 pounds over the last year. She feels her weight gain and sedentary office job has contributed to her condition.

 
Are We Checking for ADL’s?
Rehabilitation
Written by Dr. Kirk A. Lee, D.C., C.C.S.P.   
Sunday, 25 July 2010 00:00

images/Magazine/leearticleissue7.jpgSeems like today everything is described by initials–in part due to email and texting shortcuts–including how children with special needs can be labeled, ADD (Attention Deficit Disorder), and DD (Developmental Delay) to just name a few. Even many anatomy parts or common chiropractic phrases are better known for their initial description than listing the whole word, such as ACL for anterior cruciate ligament or CMT for chiropractic manipulative therapy. A commonly used term in our history taking of a patient involves their "activities of daily living" or better known as "ADL’s."

It is important that we ask our patients about their ADL’s for two important reasons. First, to have a better understanding of what their personal lifestyle involves. Second, it helps in our assessment to identify possible biomechanical stresses that are caused from the biomechanics they use or do not use when performing their job, hobbies, etc.

Often new patients will present to our office with no idea of why they hurt. They have no history of an accident, fall or trauma. In this scenario, we have to rule out other contributing factors like diet, possible pathology, socioeconomic factors as well as alterations in normal movement patterns or biomechanics. These are all factors that can occur over time and result in causing vertebral subluxation complexes. We consider these types of injury mechanism as repetitive stress syndromes or microtraumas. Let’s look at a case study where multiple ADL’s contribute to the neuro-musculoskeletal problems of a 25-year-old secretary, who is a mother of two young children and is training for her first half marathon.

 

 
Managing FHP in the Elderly
Rehabilitation
Written by Dr. Mark R. Payne, D.C.   
Sunday, 25 July 2010 00:00

I recently got some great questions from a doctor in south Florida who frequently encounters aging patients with large forward head translations, yet have pronounced, sometimes even hyperlordotic, cervical curves. We've all observed this posture, common among elderly patients, but many doctors aren't aware it needs to be managed differently than the typical case of FHP associated with cervical hypolordosis.

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Typically, we find cervical HYPOlordosis and FHP occurring together. Normally, forward head translation occurs as the cervical lordosis is lost. Such cases typically present with disc degeneration beginning in middle age and progressing rapidly throughout the years. Advanced disc disease is quite common by age sixty in most such cases.

But, the cases I want to focus on today are actually quite different. These are individuals, typically older, in which the head appears to have translated forward without any accompanying loss of the cervical lordosis. In many of these cases, you will actually observe a HYPERlordotic cervical spine! This preservation of the lordosis seems to provide a great deal of protection from cervical disc degeneration even when degeneration is rampant throughout the rest of the spine. So what happens to make the progression so dramatically different? And what can we learn in order to better manage these unique postures?

 
World's Best Traction
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Rehabilitation
Written by Dr. Mark R. Payne, D.C.   
Friday, 25 June 2010 00:00

Last month I discussed why there's no adjusting technique which is demonstrably better in terms of spinal correction. Obviously, there may be a host of situations when one technique is indicated (or contraindicated). That's just common sense. But, in terms of actually effecting real structural change to the spinal curves, it just doesn't matter much how or which technique system you use. Why? Because adjustments, regardless of technique, just aren't very effective at correcting postural imbalance. Bummer.

So, if our adjustments aren't really cutting it, then what should we be doing to correct spines? (Drum roll please.) And the short answer is extension traction. Yes, I know extension traction only addresses one aspect of spinal structure...the sagittal spinal curves. But loss of the normal spinal curves is a big time problem for almost all of your adult patients. It also happens to be the one area where almost every chiropractor experiences consistent difficulty in producing corrections. It's true that there are other methods for addressing the sagittal curves, but none with a comparable track record. Extension traction is, hands down, the most effective and well documented method of postural correction available. And, with that authoritative sounding pronouncement by yours truly, you are no doubt ready to begin immediately equipping your office with the latest and greatest in extension traction modalities. Before you do though, you'll want to know which of the many available methods is most effective. (You do want to know about the "World's Best Traction" method don't you?)

Well of course you do! (Which is convenient, since I'm already two full paragraphs into this article.) So let's take a quick look at three tried and true methods of applying extension traction forces and highlight the pros and cons of each.

Compression Traction Methods

Compression Traction earned its nickname by virtue of the fact that the equipment used is designed to bend the head backward and inferiorly. (Hence the term "compression".) In Fig. One, the patient is placed on a popular compression traction device...the Dakota Traction. Force (in the direction of the yellow arrow) is applied to the forehead with an elastic band, bending the head backward and downward into full extension. The purpose is to stretch anterior ligament and musculature to allow for a more complete return of the neck to its normal lordosis. Compression traction was first studied in 1994 and found to produce nearly three times the correction of adjustments alone.1

Pros? Affordable, simple to use, works well on all neck configurations (military, S-shaped, etc.). Cons? Best suited for home use. Some patients may find compression traction uncomfortable. If this happens, you will need an alternate method (see Fig. 2).

http://www.theamericanchiropractor.com/images/payneissue61.jpg 

Compression CounterStressing Traction Methods

It didn't take long before chiropractors began to experiment with variations on simple compression traction. One such variation was first contributed by Dr. Joe Stynchula (Harrisburg, PA). Dr. Joe combined the seated use of a weighted head harness with a "counter stressing" strap to pull anterior into the lordosis. A couple of variations on the method have popped up over the years, but the basic concept remains the same. The head weight pulls the head backward and inferior, while the counterstressing strap functions as an adjustable fulcrum to introduce a buckling force into the mid neck.

http://www.theamericanchiropractor.com/images/payneissue62.jpgStynchula's method (AKA "Compression-CounterStressing" Traction) has also been studied and found to be essentially equal to compression traction in terms of restoring the cervical lordosis.2 Advantages include patient comfort, space efficiency, and ease of use. Fig. 2 shows the method in use. Compression-CounterStressing Traction is ideal for use in the professional office and also serves well as a backup method for home use, if patients can't handle the Dakota Traction (See Fig. 1)

Lumbar Extension Traction

Extension traction can also be effective at restoring the lumbar lordosis.3 Fig. 3 shows a simple method of passive lumbar extension traction for home use. The patient is shown tightening the unit to apply force into the lumbar lordosis (see yellow arrow.) The patient then relaxes for the duration of the treatment. The device can also be used seated for use in the office. Advantages of the method are its affordability, effectiveness, and ease of use.

So what's the "World's Best Traction"? Well, while I would love to pitch my own products, the truth is that almost any form of extension traction is likely to be effective, regardless of the manufacturer. The laws of physics apparently don't extend any special consideration to my company's products. If a product extends the spine effectively, and holds it in the desired position for the requisite amount of time, there will almost certainly be some correction. Certainly, quality, value, and customer service will always dictate who you should do business with and I'll be just bold enough here to say that we work very hard at those things. But that's where it ends. Be wary of manufacturers making claims of therapeutic superiority. In the same way that there's no "best" adjusting technique there's, likewise, no "best" traction method. I've shown you three basic ways of applying corrective forces which have been proven to work well. Just be sure any equipment you buy works in the general manner described here and I think you'll be pleased. In our next article, maybe we can talk about some other methods available to corrective care practitioners.

http://www.theamericanchiropractor.com/images/payneissue63.jpg

Dr. Mark Payne is the president of Matlin Mfg., a manufacturer and distributor of postural rehab products since 1988. A FREE SUBSCRIPTION to Postural Rehab...electronic newsletter on corrective chiropractic methods is available upon request. CALL 1-334-448-1210 or email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

References

1. Harrison DD; Jackson BL; Troyanovich S; Robertson GA; DeGeorge D; Barker WF. The efficacy of cervical extension-compression traction combined with diversified manipulation and drop table adjustments in the rehabilitation of cervical lordosis: A pilot study. J Manipulative Physiol Ther 1994; 17:454-464.

2. Harrison DE; Harrison DD; Betz JJ; Janik TJ; Holland B; Colloca CJ; Haas JW. Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse load cervical traction with cervical manipulation: nonrandomized clinical control trial. J Manipulative Physiol Ther. 2003 Mar-Apr;26(3):139-51.

3. Harrison DE; Cailliet R; Harrison DD; Janik TJ; Holland B. Changes in sagittal lumbar configuration with a new method of extension traction: nonrandomized clinical controlled trial. Arch Phys Med Rehabil. 2002 Nov; 83(11):1585-91.

 
Child Development and Structural Support
Rehabilitation
Written by Dr. Kirk A. Lee, D.C., C.C.S.P.   
Tuesday, 25 May 2010 00:00

The most common questions parents ask us involve concerns over proper development of their children. These developmental questions can spur from anxiety about height, weight, muscle and skeletal development. One area I am asked about quite frequently is a child’s walking or gait pattern. These questions often focus around concerns of not walking by a certain age, concerns about the direction their feet may be pointing, and even the development of leg length. Is one leg too short or is it too long? To add one more question to this list, "Should my child be wearing orthotics?"

We know their early years is when a child develops most of their skills of running, jumping, hopping, kicking, throwing, catching, balancing and climbing. Developing these skills is important between the ages of 3 to 5. When we consider the gait of the developing child, we know, beginning around two years old, that when a child stands, bowing of the legs and toeing in of the toes is common. From ages 3 to 5, the development often changes to a more "knock kneed" or valgus positioning at the knee, and toeing out is more common. When approaching the ages of 6 to 7 years old, the positioning of the knees and feet closely resembles the adult position.

This is also true of the three arches that make up the foot structure: medial, anterior and lateral arches. The importance of normal development of these arches allows the child a greater chance of improved gait biomechanics, especially allowing a normal heel-to-toe transition during the stance phase of the gait cycle. This major component of the gait cycle will aid the child as he develops the motor skills, which will allow him to jump higher, run faster and stand taller.

Considering the recommendation of custom-made, flexible orthotics for a child, we should examine the child as we would the adult:

• Are hereditary factors involved? (Are other family members wearing orthotics?)

• Is the gait pattern normal?

• Do they present with bowing of the Achilles, flaring of the feet (in or out), medial rotation of the patellas, unleveling of the pelvis or possible detection of a scoliosis?

• Finally, we should use the latest technology, such as scanning the foot, to further evaluate the foot structure.

http://www.theamericanchiropractor.com/images/iStock_000001577637Small.jpgWhen is it too early to give a recommendation of custom-made orthotics? We know that, by age six, the arches are quite far along in their development. You are the doctor and, if you think they will benefit the child, then make the recommendation based on your clinical findings.

Children will all develop different levels of motor skills as they mature. I would like to share with you some time frames that involve the development of some specific developmental patterns. Balance is mostly fine tuned between the ages of 10 to 11 for boys, 9 to 10 for girls. Kinesthetic differentiation is the ability to correctly estimate differences in form, distance, timing, and the amount of strength required to perform movement. This is important from age 6 to 7 and again at 10 to 11 for both boys and girls. Reaction to acoustical and visual signs are best developed from ages 8 to 10 for both boys and girls. Rhythmic motion is developed from ages 9 to 10 for boys and 7 to 9 for girls. Spatial orientation occurs at ages 12 to 14 for boys and girls, while synchronization of movement in time occurs for both boys and girls from the ages of 6 to 8.

We know, in today’s society, many children would rather stay indoors and play a video game instead of going out and playing ball or skipping rope. However, we know this can contribute to childhood obesity, which is now reaching epidemic proportions. We must encourage our patients to take their children outside to play and explain the importance of helping children develop so they will have a head start on a healthy lifestyle. It is our oath as doctors of chiropractic that, "I will serve my patient to the best of my ability."

 

 

A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan.

 
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