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How to Use Spinal Nerves to Turn Off Pain Instantly!
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Rehabilitation
Written by Dr. Stephen Kaufman, D.C.   
Wednesday, 24 September 2008 16:42

Before I became a chiro-practor, I read many books about chiropractic. My limited understanding (a fantasy, really) was that chiropractors put some kind of secret pressure on spinal nerves that turned off pain instantly. After going to dozens of chiropractors and practicing for many years, I realized that this was, indeed, a hopeless fantasy. I never saw anything that consistently turned off pain by utilizing spinal nerves.

The Manual Spinal Nerve Block

One day, as I was doing research on the Internet, I came across an old Japanese chart demonstrating various neurological pathways. For some reason, the style and content of the chart triggered that ancient fantasy in my brain and an idea popped into my head. Suppose I applied a very specific form of pressure to spinal nerve roots utilizing known neurological pathways to try block pain with just manual pressure. The beauty of this theory was that it required no drugs or instruments—I could experiment using just my hands and a patient’s pain. Since the only thing involved was a type of light pressure on various nerves, it would be completely safe and pain free. (The specific pathways I was interested in were the spinothalamic tract and the tract of Lissauer.)

It’s important to note that the manual spinal nerve block procedure does not involve any type of thrusting or manipulation. Although various schools of chiropractic discuss the relationship between spinal nerves and various organs, to my knowledge, no other technique has demonstrated instant elimination of pain by stimulation of spinal nerves.

Working with this hypothesis, I eventually found that I could instantly turn off much muscular tenderness in areas that were sore to touch. These are often called "trigger points," but our definition of trigger points is very broad—it’s any area that’s more tender to pressure than the surrounding tissues or the same area on the opposite side of the body. Often, the exquisitely tender area would become normal (not tender to pressure) instantly with the application of the correct type of pressure to a spinal nerve root, even if that spinal nerve were a foot or more away from the sore spot. This worked consistently, even if the trigger point had been sore for many years, or there was acute pathology including fractures.

In many cases, chronic pain syndromes, such as cervical and lumbar disc pain, shoulder pain, TMJ pain, sciatica, and severe low back pain, responded rapidly to this procedure. Trigger points or areas of tenderness are well known to every chiropractor. Palpating the paraspinal area from the atlas down to L5 usually reveals multiple areas of extreme tenderness; even after adjustment, these areas often remain tender. Applying one of the manual spinal nerve blocks, in most cases, will cause an immediate reduction in tenderness of these points. In chronic cases, several treatments using this procedure will usually eliminate the trigger point on a long term basis. 

Numbness and Radicular Syndromes Often Respond as Well as Pain

Many doctors are afraid that numbness may be a more serious sign than pain. I have gotten many calls about patients with paraesthesias. In my experience, numbness often is due to altered circulation in muscles secondary to areas of constriction. Carefully examining the muscle that the related nerve travels through almost always reveals very painful areas (trigger points). Relieving these trigger points with manual spinal nerve blocks very often normalizes circulation rapidly. I used to tell my patients that numbness might take longer to respond than pain, but I’ve now seen many instances of it disappearing in seconds after the proper manual spinal nerve block has been performed.

Numbness and radicular symptoms in the arms and hands often is caused by trigger points in the upper trapezius muscle. Other contributors may originate in the SCM, neck extensor or scalene muscles. Numbness in the lower extremity is often caused by areas of constriction in the piriformis, gluteal, or quadratus muscles.

Utilizing different nerve pathways, there are actually ten manual spinal nerve blocks discovered so far. One near the atlas often has a wide ranging effect throughout the body. The stellate ganglion block seems to down regulate excessive sympathetic nervous activity and may profoundly reduce stress and the physical symptoms associated with it. One M.D. who specializes in Lyme’s disease has been using one of the parasympathetic techniques with dramatic effect on her patients with Lyme-related arthropathies (joint pains.)

Difficult Extremity Cases, Abdominal Pain and Even the Pain from Kidney Stones Respond.

Extremities respond well, too. I saw two cases of Osgood Schlatter’s disease with severe knee pain that both cleared rapidly when the appropriate manual spinal nerve blocks were applied. A two-year follow up showed no recurrence.

The manual spinal nerve blocks are the treatment of choice in chronic abdominal pain of many kinds. I’ve seen instant results in turning off pain in Crohn’s disease and ulcerative colitis. Post surgical pain following hernia surgery, hysterectomies, bowel surgery, etc., even if it’s been there for years, has disappeared in one or two treatments. One physician said, "This would revolutionize the way we do hernia surgery."

Even two patients with kidney stones got immediate relief; the stones passed quickly without further problem. By stimulating the related nerve roots and eliminating the palpatory pain over the kidney area, the patients’ pain disappeared. Relaxation of the musculature of the back then allowed the stones to pass through quickly.

Stephen Kaufman, D.C., graduated from Los Angeles Chiropractic College in 1978, and practices in Denver, CO. His techniques, Pain Neutralization Technique and Manual Spinal Nerve Blocks, represent a rapid new, lasting approach to pain. For further information, visit www.painneutralization.com or www.manualspinal.com, or call Dr. Kaufman at 1-800-774-5078 or 1-303-756-9567.

References:

1.  Baldry, Peter. M.D. Acupuncture, Trigger Points and Musculoskeletal Pain, Churchill Livingstone; 3 edition (2005)

2. Baldry, Peter.  Myofascial Pain and Fibromyalgia Syndromes: A Clinical Guide to Diagnosis and Management. (2001)

  1. Best and Taylor’s Physiological Basis of Medical Practice. (1979) Edited by John Brobeck. Pp. 9-80
  2. Graff-Radford SB. Myofascial pain: diagnosis and management. Curr Pain Headache Rep. 2004 Dec;8(6):463-7.
  3. Kaufman, Stephen, D.C. “Can Pain Be Turned Off Instantly By Using Neuromuscular Reflexes?” Townsend Letter for Doctors, 11/2007.
  4. Kaufman, Stephen, D.C. “Even Most Doctors Have Chronic Pain–Who Knew?“ Townsend Letter for Doctors, 05/08.
  5. Kaufman, Stephen. “Can Trigger Points Be Turned Off in Seconds Using Neurological Reflexes?” The American Chiropractor, Aug. 2007. p. 40-42.
  6. Matthews, Gary G. Neurobiology: Molecules, Cells and Systems. 2001.   Blackwell  Publishing.
  7. Rowen, Robert. M.D. “Permanently Eliminate Pain in Minutes.” Second Opinion Newsletter, July, 2006
  8. Rowen, Robert. M.D. “Chronic Pain Relief in Just 20 Seconds.” Second Opinion Newsletter, June, 2008.
  9. Schmidt, R. F. ed. Fundamental of Neurophysiology (1975). pp 102-114; 144-160
  10. Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, Gerber LH. Biochemicals Associated With Pain and Inflammation are Elevated in Sites Near to and Remote From Active Myofascial Trigger Points. Arch Phys Med Rehabil. 2008 Jan .
  11. Simons DG. New views of myofascial trigger points: etiology and diagnosis. Arch Phys Med Rehabil. 2008 Jan;89(1):157-9.
  12. Tanner, George A.  Rhoades, Rodney A. PhD., Medical Physiology, Lippincott Williams & Wilkins; 2 edition, 2003.
  13. Travell J, Rinzler, S The myofascial genesis of pain. Postgrad Med. 1952 May;11(5):425-34.
  14.  Travell, J. and Simons, D.G. Myofascial Pain and Dysfunction: the Trigger Point Manual. Vol. 1 and 2. Second edition, 1999. Liponcott, Williams and Wilkins.
 
Patient Safety and Extension Traction
Rehabilitation
Written by Dr. Mark R. Payne, D.C.   
Sunday, 27 July 2008 11:37

So far, we’ve discussed a couple of different variations on extension traction methods for restoring the cervical lordosis. Before we move on, let me just say a few words regarding patient safety and extension traction procedures.

CAUTION: Extension traction procedures aren’t for everyone.

There I said it. Of course, I’ve been saying it constantly for the past twenty years or so. Nevertheless, I continue to run into doctors who have never screened a single patient before starting extension traction treatment. The purpose of this article is to get you, the doctor, focused on patient safety and to communicate what I know about the potential risks associated with extension traction procedures. Essentially, every therapeutic procedure carries with it some attendant risk and extension traction is no different. It is our duty to weigh potential risks against potential benefits. To minimize risks, it is important we do everything in our power to detect potentially "high risk" patients BEFORE they undergo any procedure which might carry with it an unacceptable level of danger.

I strongly believe we can minimize the risks associated with extension traction procedures by using simple, common sense screening procedures on every single patient before beginning treatment. That being said, there may still be some percentage of high risk patients who will slip through our safety net, for the simple reason that no screening procedure is likely to be 100 percent effective. I understand this whenever I consider using extension traction or any other type of therapy. You need to understand it, too. It is our duty to act according to the current state of knowledge; but, unfortunately, extension traction is still a relatively new procedure. The following information is the best I can offer you at this time. It is up to you, as the practitioner, to determine whether these methods are appropriate for each individual under your care.

As a general rule of thumb, you should not consider applying extension traction to any patient for whom spinal adjustment/manipulation would be contraindicated. By definition, extension traction procedures involve extension (backward bending) of the head and neck. Much has been written in the chiropractic literature about the possible dangers associated with extension of the head and neck, particularly when combined with cervical rotation. Although extension traction DOES NOT involve any rotation of the neck, it is still prudent to screen for any individuals who might be considered as "high risk" for physical treatment of the cervical spine.

During the patient history, you should screen for any conditions which might contribute to increased risk of injury/complications during extension traction and/or cervical spine manipulation. Such conditions might include: family history or predisposition to stroke; patient history of high blood pressure, hypertension, diabetes, atherosclerosis, arteriosclerosis, posterior osteophytic spurring, disc protrusion/prolapse, smoking, oral contraceptives, prolonged use of corticosteroids, Down’s Syndrome, or spinal stenosis. This list is not necessarily all inclusive; however, extreme caution is recommended if any of the above is present.

Contraindications

Factors which CONTRAINDICATE the use of extension traction include, but are not necessarily limited to: patient history of stroke or other cerebrovascular disease, a history of "drop attacks," black outs, loss of consciousness, disturbances of vision and/or dizziness or vertigo associated with head positioning, history of transient ischemic attacks, spinal fracture or instability, spinal malignancy, infection or disease of the cord or column including advanced osteoporosis, and hemophilia or other blood clotting disorders including anticoagulant therapy. All are factors of sufficient seriousness and should be considered ABSOLUTE contraindications to any attempts at extension traction. In the case of lumbar extension traction, I believe that pregnancy and/or the presence of aortic aneurysm also present unacceptable risk factors.

Provided none of the above items is present, the patient is put through a simple five-step screening procedure which includes the entire George’s Test procedure (bilateral BP, radial pulse, carotid artery auscultation, and vertebrobasilar maneuver) as well as a trial period of extension traction. If any significant pain/discomfort or, more notably, any neurological symptom is noted at any point during the screening, the doctor should discontinue all further attempts at extension traction until the cause can be determined.

Extension traction has been widely used for well over twenty years now and has a remarkable record of safety. We can help keep this safety record intact by thoroughly screening every patient for possible risk factors or contraindications prior to starting any program of extension traction. The responsibility to "do no harm" rests with each of us.

 

For a more complete discussion of Patient Safety: Screening Procedures and Suggested Treatment Protocols for Extension Traction, call Dr. Payne at 1-334-448-1210 for his free report on Patient Safety. Dr. Mark R. Payne is the president of Matlin Mfg., a manufacturer and distributor of postural rehab products since 1988. To download a full and unabridged version of this article, link to www.MatlinMfg.com.

 
Shin Splints and Rehab Care
Rehabilitation
Written by Dr. Kirk A. Lee, D.C., C.C.S.P.   
Sunday, 27 July 2008 11:33

Shin splints is one of the more common problems that can occur in active patients, especially during the spring and summer months. It is important to maintain an awareness of this frequent complaint and know the signs to look for during diagnosis. Help keep your active patients in step with their lifestyles!

 

Symptoms

 

The pain associated with shin splints can be in multiple locations or an individual area. The most common areas are along the inside or medial side of the tibia (shin bone) to just above your ankle bone (medial malleolus) and on the outside or lateral side of the tibia (shin bone). A third location can be behind the outside or lateral ankle bone (lateral maleolus); this pain can begin behind the ankle and radiate underneath the ankle bone and continue down into the foot.

 

Causative Factors

 

One of the causes for the pain associated with shin splints is excessive pronation, or rolling in of the foot. This causes a reduction in the arch of the foot so that the foot flattens. In turn, the flattening of the arch creates excessive pulling and stress on the muscles and ligaments of the lower leg, which all insert into the top or bottom of the foot.

Other causes can be from improper shoes, both from lack of adequate arch support, and wrong shoe styles based on your foot structure. Additionally, muscle imbalances may have occurred from poor biomechanics during running or the gait cycle. Other gait-related issues can be from foot placement during the gait cycle and cause additional stresses to be placed on the lower leg musculature.

Sudden changes in training, like increasing mileage too soon or excessive running on an incline or decline, place more stresses on the lower leg musculature.

 

Treatment

 

 

One of the first courses of action is assessing the gait cycle to correct poor technique and to help recognize postural deficits that may have resulted. This allows more precise determination in rehabilitation procedures and other care options.

Take care to recommend the proper shoe to match your patient’s foot type or structure. Additionally, consider the possibility of custom-made Spinal Pelvic Stabilizers, also known as orthotics, for additional correction or support of excessive movement within the foot.

Rehabilitation will include appropriate stretches based on the muscle groups that are involved. When needed, strengthening will be recommended through functional drills or specific exercises using rehab bands or other rehabilitation devices.

If postural or structural imbalances are noted, a recommendation for a chiropractic spinal examination may be recommended to correct these imbalances. This will be done through safe chiropractic manipulative therapies using either manual means or specific instrumentation based on what will serve your patient’s present condition.

 

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. Dr. Lee can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 

References

1. Gatorade Sports Science Institute, Sports Science Exchange. Should you Stretch before exercise? Vol. 20, Number 1. 2007.

2. McGill, S, PhD. Ultimate Back Fitness and Performance. Wabuno Publishers. 2004.

3. Alter, M. Understanding Flexibility. Sport Stretch. Human Kinetics. 2000.

4. Anderson, B. Stretching. Shelter Publications. 2000.

 

 
Compression-CounterStressing Traction in the Professional Office
Rehabilitation
Written by Dr. Mark R. Payne, D.C.   
Friday, 27 June 2008 14:14

Last month, I discussed the Dakota Traction™, a simple home device for use in restoring the cervical lordosis. This time, I want to discuss a simple extension traction procedure for use within the professional office. In-Office traction has two key advantages over home traction: It helps insure some degree of compliance, especially during the early phase of care, and provides a safe supervised environment to help patients become accustomed to a regimen of extension traction care and to become proficient at using the equipment. Let’s take a look at a simple and affordable method you can use in your office, known as Compression-CounterStressing Traction (AKA, the "Stynchula Method").

The method actually requires two simple devices. First, the patient is placed in a seated position, facing the wall, with a weighted traction harness placed so as to pull or "compress" the head downward and back into full extension (See Fig.1). A second device (the "counterstressing strap") is placed behind the patient’s neck and attached to the wall in front of the patient. The purpose of the counterstresssing strap is to pull forward into the lordosis while the head is being extended backward. The combined result is a focused stretching of the anterior soft tissues in such a way as to reinforce the cervical lordosis. This type of traction is often much more comfortable than many other methods because the counterstressing strap provides support to posterior facet joints which are often inflamed in the typical chiropractic patient.

 

Compression-Counterstressing traction has been around for well over a decade now and was recently evaluated in a non-randomized clinical control trial. Thirty patients were treated over approximately fourteen weeks using the traction method in combination with typical chiropractic manipulative therapy.1 Patients in the treatment group were matched against a control group receiving no treatment. The results were encouraging. Patients in the treatment group saw improvements on the order of 13.6 degrees in their overall cervical lordosis (Jackson’s Angle) and an improvement in forward head posture of approximately 11 mm, compared to none in the controls. On a more positive note, twenty one of the original thirty in the treatment group were maintaining their corrections over a year later! These results are well in line with studies on other variations of extension traction applications and are very close to what I have personally witnessed in my own office as well.

Patient Safety

Essentially, every therapeutic procedure carries some degree of risk and extension traction is no different. As a general rule of thumb, you should not consider applying cervical extension traction to any patient for whom spinal adjustment/manipulation of the neck would be contraindicated. Conditions which may contribute to increased risk of complications might include: high blood pressure, hypertension, diabetes, atherosclerosis, arteriosclerosis, posterior osteophytic spurring, disc protrusion/prolapse, smoking, oral contraceptives, prolonged use of corticosteroids, Down’s Syndrome, spinal stenosis, or any history of cerebrovascular disease. Doctors should also be very wary of patients presenting with any unexplained loss of consciousness, disturbances of vision or equilibrium, transient ischemic attacks, spinal fracture/ instability/malignancy or disease, hemophilia or other blood clotting disorders, including anticoagulant therapy. This list isn’t necessarily complete, but should provide interested doctors with a good idea of the types of conditions which may represent unacceptable risk factors. In addition to a complete history, all patients should undergo a physical screening procedure as well. A complete description of our patient screening procedure is available free upon request and I will discuss patient safety at more length in a future article.  

Treatment

Assuming there are no contraindications, adult patients generally start with three pounds of weight on the traction harness. The head is allowed to relax into full extension and the counterstressing strap is then angled and tensioned so as to properly reinforce the cervical lordosis and maximize patient comfort. Treatment time is generally increased about a minute or so each visit, according to patient tolerance. Although the optimum time for soft tissue stretch is probably in the 20-30 minute range, such longer sessions are best done by the patient at home. I prefer to keep In-Office traction sessions to a more manageable 10-12 minute range and then increase the weight slightly once the target time has been reached. It’s not unusual for patients to work up to five or six lbs of weight after only a few weeks of traction in the office.

In my opinion, Compression-CounterStressing Traction should be your number one choice for In-Office traction for several reasons. First, the method is easily learned by doctors and staff and will only cost about a hundred bucks per station to set up. Secondly, the method is well tolerated by most patients and so simple your patients will quickly learn how to transition themselves in and out of traction with minimal assistance. Third, it’s very space efficient. Traction stations can be placed about every 32 inches or so along the wall of your rehab area, so one small wall space can easily accommodate a number of patients at once. Finally, offering In-Office traction will help boost your bottom line while helping your patients achieve real and meaningful structural change. I routinely have clients call to say their new traction equipment paid for itself on day one.

 

For a more complete discussion of potential risk factors, patient screening procedures, and treatment protocols, call Dr. Payne at 1-334-448-1210 for his free report on Patient Safety. Dr. Mark R. Payne is the president of Matlin Mfg., a manufacturer and distributor of postural rehab products since 1988. To download a full and unabridged version of this article, link to www.MatlinMfg.com.

Reference

1. Harrison DE. Harrison DD, et al. "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, Volume 28, Issue 3, Pages 214-214.

 
Is Stretching Beneficial?
Rehabilitation
Written by Dr. Kirk A. Lee, D.C., C.C.S.P.   
Wednesday, 28 May 2008 10:29

Stretching has been part of sports for a long time. First, it was a mainstay before any exercise activity and was usually referred to as "calisthenics," involving activities like jumping jacks, push-ups, knee bends, or sit-ups, to name a few. Then a new trend developed, "stretching after activity." This actually made sense to give the athlete the opportunity to stretch the tightened muscles and joints after activity to increase ranges of motion and reduce soreness.

With the advances of technology and research, numerous studies have been conducted on the pros and cons of stretching in injury reduction and performance enhancing. Many of these studies have found that there is no actual benefit in stretching prior to activities and, in some cases, it actually inhibits performance when an athlete overstretches a muscle or muscle group.

However, some factors need to be considered when we look at these studies. Most were performed on athletes who were already conditioned, like experienced runners, for example. A typical runner would perform a short stretch of the lower leg muscles and begin the run—starting at a slower pace to stimulate circulation, loosen joints and muscles. Then, gradually increasing the pace to his or her training level, the runner would finally end the work out with a cool down period and more thorough stretching designed to loosen tight muscles and joints. As we look at the above scenario, it seems the purpose is not to stretch muscles, but the joints. From a physiology standpoint, if we were to tear muscle tissue, we know the end result would be swelling, tissue discoloration and possible palpable mass (hematoma). The ultimate tightness that may or may not develop within the muscle comes from the repetitive concentric and eccentric contraction of the muscle.

Perhaps the real answer to reducing injury is through the generalized easy jog or "warm-up" to loosen up the structural joints: ankle, knee, hip, spine, shoulder, elbow and wrist. Consider the anatomy of these joints; most are enclosed by a capsular ligament which—like any other ligamentous tissue—when overstretched from a specific trauma or repetitive trauma, results in a pain syndrome.

Anatomy-wise, we know muscle tissue—due to its high blood and nerve supply—heals quicker than tendonous and ligamentous tissue. The secret to stretching could be stimulating a slight stretch on the capsules, not major muscle groups. A good example of this is the patient who enters our office with a "frozen shoulder." When we muscle test the patient’s rotator cuff muscles, it may produce pain on specific movements, but we feel resistance and a positive end point. Usually these are negative on MRI of any tearing of muscle tissue, so what is creating his pain and restricted ranges of motion?

Through our consultation, we might identify a precursory movement, like reaching high into a cabinet for something or reaching up to hang a picture on a wall. If the involved joint had not been loosened or been placed in sequences leading up to the movement, it did not take the muscle past its range of motion but actually stressed the capsular ligament.

The majority of our practices are not made up of the conditioned athlete, but of the factory worker, office personnel, and farmer. These patients do repetitive activities; when they overexert a joint, it results in a pain cycle causing them to call their friendly chiropractor.

So, do we instruct our patients to perform certain stretches to avoid injury? The answer varies from patient to patient. If the patient participates in an activity that requires maximum flexibility, like diving, swimming, or gymnastics, we must ensure that they have full ranges of motion in all joints.1 If our patient is an athlete, we may want to recommend certain stretches based on previous injury or measurable restrictions in a specific range of motion, with an emphasis on proper warm-up and stretching afterwards. For our non-athletic patients, we should tailor stretches to their activities of daily living.

A primary consideration for all our patients, in preventing injuries and reaggravation, is to maintain a healthy level of cardiovascular conditioning. Simple activities, such as walking, go a long way in developing a good level of fitness. As Stuart McGill points out, "Only biomechanical overload can cause tissue damage."2

Some practical tips for helping patients avoid injury:

• If stretches are recommended, have the patient warm-up muscles and joints with a light aerobic activity (walking, jogging, etc.)

• Stretches should be done slowly, holding the stretch for fifteen to thirty seconds and repeated up to two to three times per muscle group

• Tailor stretches to be job or sport specific

• Above all else, make sure the stretch is being performed in a proper movement pattern to not compromise other tissues and joints

 

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.

 

References

1. Gatorade Sports Science Institute, Sports Science Exchange. Should you Stretch before exercise? Vol. 20, Number 1. 2007.

2. McGill, S, PhD. Ultimate Back Fitness and Performance. Wabuno Publishers. 2004.

3. Alter, M. Understanding Flexibility. Sport Stretch. Human Kinetics. 2000.

4. Anderson, B. Stretching. Shelter Publications. 2000.

 

 
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