Rehabilitation


Poor Posture and the Tweet Generation
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Rehabilitation
Written by Joseph Ventura D.C.   
Tuesday, 01 May 2012 17:15
postureandtextingConsider the conclusions from two recent studies:

“A significant linear trend for increasing sagittal plane postural translations of the head, thorax, pelvis, and knee was found in children age from 4 years to 12 years.”1
 
“Poor posture was diagnosed in 38.3% children, more frequently in boys. A significantly different occurrence of poor posture was found between 7-year-old and 11-year-old children (33.0% and 40.8%, respectively). The most frequently detected defects were as follows: protruding scapulae (50% of all children), increased lumbar lordosis (32%), and round back (31%). Children with poor posture reported headache and pain in the cervical and lumbar spine more frequently.”2
 
Study after study is validating what chiropractors have been seeing for the past decade or more: Children at a younger and younger age are seeking relief from adult type pain and discomfort. What could be the cause of this increased frequency of young patients seeking care? The author believes it is the result of sociological and technological pressures that have only developed within the past generation, the Tweet Generation.
 
It began in the early 90s when schools eliminated lockers and required children to carry their lockers in backpacks. A couple of years later that child began playing handheld video games. Next came the cell phone for kids with affordable family plans. But the child didn’t use the phone to make and receive calls. They used them for texting. Massive amounts of texting. The author’s 11-year-old daughter sent out 11,000 text messages in one month.
 
Next we go back to a change made at the school level. As the Internet expanded so did the reliance of schools on the Internet as a method of delivering content. So, as a result, time in front of a computer at school and at home was required.
 
The connection between all these activities is clear: Since the early 90s children from the age of nine up through young adulthood, their musculoskeletal formative years, have engaged in activities that create a Forward Head Posture environment. These activities have literally molded their bodies into an abnormal posture profile. Re-read the conclusions of the studies cited at the beginning of this article. For those readers not yet alarmed at those conclusions, consider these other studies.
  • “All measures of health status showed significantly poorer scores as C7 plumb line deviation in creased.”3
  • “Older men and women with hyperkyphotic posture have higher mortality rates.”4
  • “Spinal pain, headache, mood, blood pressure, pulse, and lung capacity are among the functions most easily influenced by posture.”5
What is being done to raise adult awareness of this growing trend in children? Not much. Every State requires a school scoliosis exam. During a school scoliosis exam a child is also examined from the side, but only to observe evidence of gross kyphosis. And in most States that part of the exam is not mandatory. Studies have shown that 4.2% of the children screened for scoliosis trigger a referral for radiographs. And of those 4% only a small fraction will require advanced treatment. It appears that nobody is educating parents and schools about the 30% of children in that same age group that are experiencing Forward Head Posture and its effects.
 
Forward Head Posture Epidemic

posturemodernstressorsWhile developing a new posture grid for school posture exams, the author placed a typical middle school youth in front of the grid and asked the youth to send out a text. It was discovered that the head was placed in a position 4.5” in front of the shoulders and placed the shoulder joints in internal rotation. The typical youth can text up to 30 hours per month.
 
Combined with other technology and social stressors, today’s youth is at a greater risk for “molded” forward head posture than any past generation. 
 
Considering the important immediate and future health ramifications of poor posture, accurate posture exams and counseling with parents, children and schools should be a part of every wellness practice.
 
The author recently examined over 1,000 posture exams from a single office. Using sophisticated posture analysis software, deviations from normal were calculated and charted.
 
"16 years ago I estimated that 80% of the population had FHP. I was surprised and concerned to learn that in such a large population the number was 96.5%"
 
The additional mechanical loads from FHP stress and eventually break down the spine, disks, muscles, etc. In other words, FHP could be the CAUSE of patient complaints.
 
There are several methods of identifying FHP and systems available for correction.  For additional information about these options contact the author.
 
References:
  1. Postural development in school children: a cross-sectional study. Chiropr Osteopat. 2007; 15:1 (ISSN: 1746-1340)
  2. Prevalence and risk factors of poor posture in school children in the Czech Republic. J Sch Health. 2007; 77(3):131-7 (ISSN: 0022-4391)
  3. SPINE, 2005
  4. Journal of the American Geriatrics Society, 2004
  5. American Journal of Pain Management, 1994
  6. Archives of Internal Medicine 2007
Joseph Ventura D.C. is owner of PostureSoftware.com, a 32-year-old company that develops software and marketing strategies for the chiropractic profession. Dr. Ventura can be reached at (888) 713-2093 or at This e-mail address is being protected from spambots. You need JavaScript enabled to view it
 
Fascial Release Using the Deep Muscle Stimulation to Improve Neck-Shoulder Pain
Rehabilitation
Written by Jeffrey Tucker, D.C.   
Tuesday, 23 August 2011 23:05

 

neckshoulderpain

F
ascial therapy has become a very popular technique over the past several years. Fascia is the term applied to all of the connective tissues fibers and glue of the human body. Many tools to perform fascial therapy have gained popularity amongst Chiropractors, physiotherapists, personal trainers, and massage therapists. In addition to our hands (ART, myofascial release), key instruments used for fascial therapy are Sound Assisted Soft Tissue Mobilization (SASTM) tools, Graston tools and the Deep Muscle Stimulator (DMS).

This essay aims to present the results of 30 patients performing the overhead deep squat assessment and discuss how the Deep Muscle Stimulator can be applied as the therapy to fascial dysfunction to improve the quality of the overhead deep squat assessment. The average numerical pain score (0-10, 10 being the worst pain) improved by 2-3 points with one 15 minute DMS treatment

Tom Myers, Luigi Stecco, Mike Clark, and many others have made significant contributions to our understanding of fascia, fascial connections, and fascial therapy. Though the diagnosis and treatment of fascial syndromes is varied and unfolding, one of the main focuses of treatment is on the concept that the endofascial fibers and interfascial planes need to glide along each other, stay hydrated, and not get stretched faster than they can allow. Myer’s work has been identifying the fascial interconnections that he calls anatomy trains. Recently there has been a wealth of research demonstrating evidence for fascial injury, remodeling, and evidence for effects of intervention. Poor fascial gliding could cause adverse tension, and given that many mechanoreceptors are embedded within fascia, altered proprioceptive afferents could then result in non-physiologic movements at joints.

Though the diagnosis and treatment of fascial syndromes is varied and unfolding, one of the main focuses of treatment is on the concept that the endofascial fibers and interfascial planes need to glide along each other, stay hydrated, and not get stretched faster than they can allow.

Over the last 11 years  Dr. Jake Pivaroff has developed a comprehensive assessment and treatment approach using a hand held device called the Deep Muscle Stimulator or ‘DMS’ that delivers vibration and percussion to the muscles and fascia. The DMS is made of stainless steel and titanium. The 2 inch round vibrating head moves at 2200 RPMs. Application of the DMS provides a vibratory sensation of 2-4 inches from the point of contact on the body. Hyperemia caused by the vibration could modify the extracellular matrix and restore gliding of mechanically stuck fascia. Dr. Pivaroff based the design and treatment of the DMS on original ideas, clinical experience and expertise.

I have used the overhead squat assessment and analysis on hundreds of individuals and provided fascial therapy using the DMS to improve movement and stability dysfunction. The overhead squat assessment as described by Clark & Lucett in their book NASM Essentials of Corrective Exercise Training assesses dynamic flexibility, core strength, balance, and overall neuromuscular control. The overhead squat test is performed with the individual standing with the feet shoulder-width apart and pointed straight ahead. The foot and ankle complex should be in a neutral position with shoes off. The client raises the arms overhead, with the elbows fully extended. The upper arm should bisect the torso. The client is instructed to “Sit back as if you are sitting in a chair” and return to the starting position. This is repeated 5 times. The assessment is similar to the overhead deep squat based on the Functional Movement Screen by Cook and Burton.

The key features of my client evaluation and treatment includes a static posture analysis, functional movement screen using the overhead deep squat assessment, and palpation of soft tissues and joints. Treatment includes inhibitory techniques (myofascial release using the DMS), then teaching clients stretching or lengthening techniques of overactive muscles, teaching clients how to perform activation techniques (isolated local and global muscle control stability retraining), and teaching clients whole body integrated dynamic movements. This is the corrective exercise continuum as taught by the National Academy of Sports Medicine (NASM).

One of the key principles in the DMS vibration is that it improves blood flow which can speed up recovery by increasing the availability of important nutrients as well as removing damaged tissue.

Using the DMS principles is a huge advantage to therapists retraining movement faults in patients with mobility disorders.

Two practitioners each observed 15 different patients with neck-shoulder pain using the overhead squat assessment to identify overactive muscles and fascial structures. The overhead squat assessment reveals common patterns of overactive myofascial structures. The most common compensation patterns observed are: one or both feet turn out, one or both knees move inward, the torso leans forward, the arms fall forward, and the head forward - chin poke posture occurs. In the literature these muscles have been shown to be dominant and overactive: gastrocnemius, soleus, adductors, hamstrings complex, psoas, TFL, rectus femoris, piriformis, quadratus lumborum, erector spinae, pectoralis major/minor, latissimus dorsi, teres major, upper trapezius, levator scapulae, SCM, scalenes.

For the purposes of this study the DMS was used over the gastrocsoleus, biceps femoris, TFL/ITB, latissimus dorsi, and levator scapulae. By treating these muscles with the DMS, changes in posture and alignment during movement were improved, as well as pain scores.

The DMS can help identify the most likely site of the source of pathology and symptoms which is often at a distance from the actual site of pain. The DMS technique involves vibration over the overactive muscles (to the deep muscular fascia) and is always applied at a distance from the actual site of pain. In this way, the method can be applied safely even during the acute phase of a cervical dysfunction. For example it is well known that excess lumbo-pelvic extension is associated with back pain and this can be caused by overactive hamstrings. Uncontrolled scapula forward tilt caused by overactive pectoralis and levator scapulae and underactive mid/lower trapzius muscles is associated with shoulder ‘impingement’ type symptoms; Yarwood et al did a study in 2011 that showed DMS exposure shows increases in ROM in those participants who have low and decreased flexibility for shoulder flexion and shoulder external rotation.

Within the myofascial and joint system uncontrolled movement needs to be controlled eg uncontrolled scapula forward tilt, uncontrolled lumbar flexion, uncontrolled lumbo-pelvic rotation. This is usually treated with stabilization exercises. However it’s important for treatment and rehab to identify the lack of give within the myofascial and joint systems. I find using the DMS reveals the taut and tender sites within the myofascial system. By moving the DMS device in multi-directional movements (side to side, up and down, criss-cross) I can differentiate muscle fibers and lack of fascia glide. Locating tissues that do not glide or are overactive will guide the treatment process.

Merging DMS into my practice has provided a useful tool for skin and surface tissue stimulation to enhance fascial proprioception. Kinser et al report positive results of flexibility following a stretching with vibration protocol. Tom Hydes has been doing a combination of motion with the Graston tools for many years. Direction of movement using the DMS is important in clinical terms.

Because each participant improved their neck-shoulder pain score, I think this shows the possible relationship between lower extremity involvement, possible previous injury (muscle, bone, etc) and residual and/or distant fascial adhesions. Fascial adherences and muscle overactivity may limit the patient’s ability to adapt to new strains and or posture patterns (that is, sitting at a computer for prolonged periods). I find that treatment of these distance sites of myofascial tightness can relieve pain, and produce an immediate change in neck-shoulder symptoms. There may be a release of tension along an entire myofascial connection from the feet, knees, hips, or lumbopelvic region that helps the neck.

Effective myofascial release may improve the release of tension, decrease activity of overactive neuromyofascial tissues, improve local stability muscle (to control translation) recruitment, and improve functional movements such as the squat. There is general agreement that lack of stability in the myofascial system will result in uncontrolled translation at a motion segment. If muscle length is altered resulting in ineffective active stability mechanisms, then tension development will be reduced and the muscle system (to control through range movements) will be unable to generate proper force for efficient movement. There is an optimum length tension relationship that the DMS can help restore. Any dysfunction in this system will result in faulty range at one or more motion segments.

In the clinical environment the overhead squat assessment can be used to assess for dynamic flexibility, core strength, and overall neuromuscular control. Any movement pattern dysfunction should be matched with symptoms and disabilities.

Using the DMS as an assessment tool to provide local therapy to a suspected overactive muscle and then repeating the overhead squat assessment and noting improvement or lack of change, can help the practitioner make prioritizing decisions about the choice of location and which myofascial structures to target therapy. In other words, if a change was made that improved the squat, then the specific muscle treated would also need to be stretched at home on there own. Teaching patients which muscles need strengthening is also an important component to treatment.

I use DMS treatments to focus on fascial release.

Using the DMS principles is a huge advantage to therapists retraining movement faults in patients with mobility disorders. A specific assessment is needed to identify the individual’s dysfunction and once established DMS therapy can be used to retrain the movement faults.

 

Dr. Jeffrey Tucker is a certified instructor for the Functional Movement Screen (FMS) workshops, the National Academy of Sports Medicine (NASM) workshops, and is a  post-graduate instructor for the entire Diplomate program offered by the American Chiropractic Rehabilitation Board.

 
Get Those Patients Walking
Rehabilitation
Written by Kirk Lee, D.C.   
Tuesday, 19 July 2011 17:52

racewalkingNow that we are in the middle of summer, many of our patients ask us about outdoor activities and what they should do and not do. We usually instruct our patients to warm up a little with some walking and some simple range of motion stretches involving the major muscle groups before starting their outdoor projects. For our more sedimentary patients, we may even tell them to take time every 15 minutes to stand up and stretch after they have been in one specific posture for a period of time. For many people, spring and summer bring on a new resolution of getting out and exercising more frequently. This commonly is in the form of walking, jogging, and for some, running.

Besides recommending specific stretches to our patients, there are other concerns we should discuss with them to help support them as they begin to exercise. They may seem like common sense tips but, for many patients who do not regularly exercise, these tips will be a good reminder to them to be safe and healthy as they exercise.

Discussion points to have with patients who are starting exercise routines:

• How to stay hydrated—A safe recommendation is drinking at least 50 percent of their body weight in ounces over a given day.

• Wearing appropriate workout clothing—This includes reflective clothing if patients are walking in the early morning or once the sun is beginning to set. Rain gear can be helpful to keep them on their regime and not using bad weather as an excuse to skip exercise.

• Use of adequate sunscreen or wearing a hat when appropriate. 

6 S’s of Running/Walking

I like to keep most of the focus on what is called the “6 S’s of running/walking.” These include stretching, speed, strength, surface, shoes and structure. Paying attention to each of these six points makes a world of difference for patients to stay healthy while beginning an exercise regime.

We already mentioned stretching earlier, but it is important that even the casual walker do some stretching, especially in the lower legs. Stretching of the gastrocnemius and Achilles are crucial, because these are common areas of cramping for beginning walkers and runners. The older our patient is, the more vulnerable he or she is to Achilles strains and sprains, which can be very slow healing and interfere with normal gait pattern movements. One very important aspect of stretching is to remind patients to stretch again after they have exercised to help loosen up the muscle groups and reduce lactic acid build ups.

Speed can mean different things to many people. Our focus should be on developing a comfortable pace for patients. They should not start out going too fast or too far too soon. Building up speed and distance on a weekly goal can be achieved by most people. Many overuse injuries are caused by simply trying to do too much before the body is ready to handle the pace or distance the runner is trying to achieve.

Many patients use strength as an excuse not to exercise. We have all heard it a million times, “I do not have enough strength to do....” The important thing here is just getting the patient to do something. They need to understand that strength will be gained by being active, not inactive.

Where people live can decide how and when they walk or run. The important factor in surface is staying on a level and fairly smooth surface. For more experienced walkers and runners, adding hills, unlevel surfaces (grass, dirt roads or paths) can make a walk or run more challenging. For our beginners, the smoother and the flatter, the better. It is common today to see people walking in shopping malls, schools, etc. The goal is to just get out there!

The last two S’s—shoes and structure—are very important, regardless if our patient is a beginner or a seasoned veteran. Wearing the correct shoe can make all the difference between enjoying a good experience or a bad experience. The last thing we want is our patient to be discouraged due to blisters or sore feet. Your recommendation of the correct shoe is vital. If you are not comfortable making a recommendation, then recommend that your patient go to a running store to get correct information on what shoe is best for them. Running shoes are designed on three types of foot structure: the supinator, neutral and hyper-pronated foot. The supinator, or high-arched foot, is usually demonstrated as a C-shaped shoe. This shoe is usually more flexible and has additional shock-absorbing support. The neutral foot shoe is semi-curved with adequate support and shock absorbing capabilities. The flat foot, or hyper-pronated foot, requires a shoe that is referred to as a motion control shoe. It is designed to add additional support on the medial side of the shoe to assist with pronation. This shoe is usually straighter in its appearance.

I am often asked by doctors when I am lecturing, “If we place a patient in a motion control shoe, do we still need to recommend an individually-designed, flexible orthotic?”

The answer is YES! Remember, the individually-designed orthotic is designed to balance the three arches of the foot to allow a symmetrical heel-to-toe transition. If you put your hand inside the shoe, you will find that the shoe is usually flat on the inside. The additional stability to the shoe is placed in the medial side for additional support as the weight bearing forces go medial. They are not designed to correct a fallen or dropped arched.

The last of our six S’s is structure. No one does structure better than the doctor of chiropractic. Because of our education, philosophy and the art of the adjustment, we continue to be the leading profession that the consumer seeks for manipulative therapy. We must continue to keep it that way. The use of individually-designed orthotics can be essential to help stabilize the kinetic chain to allow the chiropractic adjustment to hold longer in correcting or stabilizing our patients’ neuro-musculoskeletal conditions that result from the different types of subluxation. We must also consider posture of our patient when we recommend rehabilitative procedures to help with strengthening muscle imbalances. The right nutrition is key in assisting to reduce inflammation and improve healing. All of these are important aspects to think about when giving exercise recommendations to our patients.

 

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.

 
Can Whole-Body Vibration Be Harmful to Your Health? Questions & Answers for Chiropractors Utilizing Vibration Therapy
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Rehabilitation
Written by A. Joshua Woggon, D.C.   
Saturday, 25 June 2011 03:10

vibrationtherapy

O
steoporosis and obesity are important health concerns in the United States.  Whole-body Vibration (WBV) therapy has the potential to make a significant impact upon musculoskeletal health and wellness in the coming decade.1,2 It also has the potential of causing significant musculoskeletal harm, and becoming a significant source of doctor liability, if improperly applied.

Many educated readers may recall the lawsuits that arose in the 1990’s regarding the use of decompression therapy in chiropractic clinics, who utilized the literature provided to them by the companies supplying the decompression therapy equipment and were, ultimately, found to be culpable in lieu of the company who wrote the recommendations for the equipment sold.  In today’s litigious society, the buck stops at you, Doc.

It is the responsibility of the doctor to ensure that the equipment in the clinic is incapable of causing musculoskeletal harm.

Whole-body vibration therapy equipment has this same potential to result in “open-and-shut” litigation in the 21st century chiropractic office.  It is the responsibility of the doctor to ensure that the equipment in the clinic is incapable of causing musculoskeletal harm.

Unfortunately, there is a doctor reading this article who is providing their post-menopausal osteoporotic patients with a WBV device designed for healthy athletes.  According to Rubin, this doctor—by following the manufacturer’s guidelines for using their equipment—is providing patients with WBV dosage that exceeds the safe limits for WBV exposure as established by the International Standards Organization (ISO), Section 2631-1.3

Research suggests bone remodeling occurs best within frequencies around 25-45 Hertz.

WBV is the perfect adjunctive therapy to chiropractic when applied properly.  Be sure to ask the right questions when purchasing a WBV platform for your office: Is it safe?  Is it effective?  Just as an AM/FM radio must be “tuned-in” to the ideal settings for maximum musical enjoyment, so must WBV therapy be “tuned-in” to the ideal frequency and amplitude for the maximum targeted physiological benefit.  As an example, to-date, research suggests bone remodeling occurs best within frequencies around 25-45 Hertz.4 If you are utilizing a WBV platform that operates outside these frequencies, your patients should not expect to achieve improvements in bone mineral density from their use of WBV therapy.  Also, frequencies ≤ 20 Hz or ≥70 Hz may not be effective and may, in fact, be harmful; they should be avoided.5

Whole-body vibration has the potential to provide chiropractors with a significant source of professional revenue, while positively impacting their patients’ long-term outcomes.  It also has the potential to expose doctors to liability for inflicting permanent musculoskeletal harm.  Choose wisely!

 

Dr. A. Joshua Woggon, a 2010 Graduate of Parker College, is the Director of the CLEAR Scoliosis Treatment and Research Clinic in Dallas, Texas (www.clearscoliosisclinic.com), and the Director of Research for CLEAR Institute, a Non-Profit Organization dedicated to advancing chiropractic scoliosis correction (www.clear-institute.org). He can be contacted at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 

Research & References

1) Rubin C., Recker R.,  Cullen  D., Ryaby, J., McCabe and K.  McLeod:  Prevention  of postmenopausal bone loss by a low-magnitude, high-frequency mechanical stimuli: a clinical trial assessing compliance, efficacy, and safety. J. Bone Miner. Res. 19 (3) (2004), pp. 343–351.

2) V. Gilsanz, T.A.L. Wren, M. Sanchez, F. Dorey, S. Judex and C. Rubin: Low-level, high-frequency mechanical signals enhance musculoskeletal development of young women with low BMD.  J. Bone Miner. Res. 21 (9) (2006), pp. 1464–1474.

3) Rubin: Contraindications and potential dangers of the use of  vibration  as a treatment for osteoporosis and other musculoskeletal diseases. April 2007.

4) Prisby,  et  al:  Effects  of  whole  body  vibration  on  the skeleton and other organ systems in man and animal models: What we know and what we need to know.  Ageing Research Reviews 2008;7:319-329.

5) Totosy de Zepetnek, Giangregorio & Craven: Whole-body vibration as a potential intervention for people with low bone mineral density and osteoporosis: A review.  Journal of Rehab. Res. & Dev. 2009.

 
The Misunderstood Component in Musculo-Skeletal Health Care
Rehabilitation
Written by Burl Pettibon, D.C., F.A.C.B.S., F.R.C.C.M., Phd. (Hon)   
Wednesday, 11 May 2011 20:32

backadjustmentmay

I
s it possible to walk through a doorway when the door is closed? That strange question is a metaphor that can be used to describe the difference in research-based rehabilitation to prepare the spine for corrective procedures with little to no pain versus no preparation at all or, worse yet, substituting bilateral strengthening exercises for rehab to prepare the spine for corrections that are often both painful and ineffective.

Gym type exercises are often called rehabilitation exercises. However, the two have little in common. Gym type exercises are isotonic that work and shorten muscles, thereby opposing positional changes. Phasic muscles are enervated by a1-motor fibers and are consciously controlled and, when totally fatigued or injured, become flaccid. Postural muscles are enervated by a2-motor fibers and are autonomic nerve controlled. The strengthening of these muscles requires isometric exercises. When they are fatigued or injured, they become spastic. It is critical to understand that postural muscles dominate one’s spinal position and function as well as posture, stance and gait.

What is rehabilitation and why is it necessary for quality patient care? Dorland’s Medical Dictionary 26th Ed. defines rehabilitation as:

1. “The restoration of normal form and function after injury or illness.”

2. “The restoration of an ill or injured patient to self-sufficiency or to gainful employment at the highest attainable skill in the shortest period of time”.

The profession of chiropractic claims that the adjustment is for the restoration of normal form and function of the spine through correction of spinal displacement subluxations. We can agree that abnormal/subluxated spinal forms cause abnormal functions.

Surveys show that the clinical procedures taught in chiropractic colleges and practiced by 84% of the profession involve the use of a sudden applied force into the subluxated spine, referred to as an adjustment or treatment.

What do the adjusting forces actually do? Is it possible to physically correct spinal displacement subluxations without first preparing the spine to welcome the force through rehabilitating the soft tissues that hold the static spine upright while in a normal or abnormal (subluxated) position?

We can agree that abnormal/subluxated spinal forms cause abnormal functions.

Research published in 1996, by JMPT, titled “Lasting Changes in Passive Range of Motion after Spinal Mobilization,” a Randomized, Blind Controlled Trial, tested spinal changes produced by diversified and toggle recoil adjusting. Their findings were that these adjustments caused about a 5% increase in mobility and the changes lasted for about 7 days. A more recent article published in the Spine Journal demonstrated with pre and post MRI studies that the same kinds of adjusting resulted in the spine becoming measurably more displaced than before it was adjusted. Chiropractic adjusting, without first performing rehabilitation to prepare the spinal soft tissues for change, typically has shown little success in making gross structural spinal and postural changes. This also was tested and published in JMPT. The authors were Harrison, et al in 1997, and Lantz et al, in 2001. In 1975, Jowett and Fidler published research in Orthop. Clin., N. Amer. that proved the body changes phasic fibers into postural muscle fibers on the convex side of spinal displacement subluxations; hypo mobility and nerve root compression were also noted.

Neuro-muscular research has proven that the dynamic stretch reflex guards all body parts including spinal position, even if it is in a subluxated position from being changed by sudden applied forces. Guyton’s Physiology 5th and 6th Edition, explains how the dynamic stretch reflex causes muscles to replace body parts after a dynamic force has displaced them. Muscles intercept sudden applied forces of up to .3 of a second in speed. The phasic muscle fibers can contract fast enough to counteract these sudden applied forces. This reflex protection is automatic, unless the force is faster than .3 seconds or so great that they tear the muscles and then the ligaments, thereby causing spinal subluxations.

The protective energy of the muscles can be greatly reduced by slowly stretching the phasic and postural muscles rather than attempting to exercise them. To be effective, stretching should last at least 40 seconds and include all muscles involved.

Hysteresis can temporarily remove up to 95% of the ligament’s holding energy and lasts for approximately six minutes.

Ligament research has proven that to instantly change a vertebrae’s position, the adjusting force would have to overcome 40% of the ligament’s resisting force. Such high forces are impossible for a doctor to produce and could crush the vertebrae before the ligament entered the plastic range necessary, before instant positional change of a vertebra can occur. However, rehabilitation procedures that cause disks and ligaments to go through full range loading and unloading cycle’s for 2 to 5 minutes produces a condition called hysteresis, which gradually lowers the resistance of spinal disks and ligaments, thereby making changes in spinal position possible, easy and pain free. Hysteresis can temporarily remove up to 95% of the ligament’s holding energy and lasts for approximately six minutes after loading and unloading cycles are discontinued. Within 15 to 20 minutes after loading and unloading cycles are discontinued, the ligaments regain all of their holding energy.

Loading and unloading cycles in the cervical spine requires slow, intermittent traction, while effective loading and unloading cycles in the lumbo-sacral spine require full range, figure 8 cycles that are slowly applied, requiring 4 seconds to complete one cycle after the ligaments are completely stretched. The figure-8 cycles also mix and re-mix the protoglycine aggregate of the disk’s nucleus necessary for making and maintenance of a perfect jell. Like fluids, the jelled nucleus is non-compressible. When perfected, it equally transfers body weight from the vertebrae above to the vertebrae below, thereby providing a foundation for maintenance of the corrected spine’s form and function. In addition, the figure-8 motion pumps the cerebral-spinal fluids necessary for the metabolic interchange of glucose to feed the brain, thereby giving the patient a feeling of mental and physical well being—an additional benefit of the rehab procedures! Home care instructions work in tandem with clinical care and will include the use of deep, diaphragmatic breathing in coordination with specific rehabilitation procedures. These procedures take into account the fact that the thoracic spine is approximately 13 times less flexible than the cervical spine and approximately 3 times less flexible than the lumbar spine; therefore, thoracic loading and unloading cycles require more time and concerted rehabilitation procedures. Patients are taught to prepare their spine both in the clinic before being seen, as well as at home before daily activities and rest.

Change is inevitable for the growth of any profession; without it, stagnation and eventual decline is the end result. Through the use of clinical research and documentation with new and more efficient methodologies, we grow in our knowledge and our abilities. The Pettibon Biomechanics Institute has published several retrospective as well as blinded studies, proving through pre- and post- X-rays that permanent spinal corrections are possible after the spinal soft tissues have been prepared through our holistic rehabilitation procedures. Research can be found at www.pettiboninstitute.org.

 

Burl R. Pettibon, DC, FABCS, FRCCM, PhD. (Hon) has guided The Pettibon Institute’s direction, continuing education offerings, and research since the Institute's inception as the Pettibon Spinal Bio-Mechanics Institute in 1981. As a teacher, inventor, and researcher, Dr. Pettibon’s influence and contributions to the science of chiropractic are legendary. Dr. Pettibon has been an extension faculty member and lecturer at Palmer College of Chiropractic for more than 35 years. He has also been an extension faculty member at Life University, Logan College of Chiropractic, Parker College of Chiropractic, and Cleveland Chiropractic College—where he received his degree in 1956. Dr. Pettibon has written more than 65 papers and books on chiropractic care and research. Over the course of his career, he has developed 25 clinics. At the present time, the profession is using the more than 50 rehabilitative products that he has invented to make the detection and correction of vertebral displacements both easier and more accurate. He currently holds four patents. Papers and books are also available through www.pettibonsystem.com.

References

1.Morningstar MW, Strauchman MN, Weeks DA, Spinal Manipulation and Anterior Headweighting for the Correction of Forward Head Posture and Cervical Hypolordosis: A Pilot Study, Spring 2003, Number 2, Volume 2, Journal of Chiropractic Medicine.

2.Horseman I, Morningstar MW, Radiographic disk height increase after a trial of multimodal spine rehabilitation and vibration traction: a retrospective case series, 2008 7, 140-145, Journal of Chiropractic Medicine, 2008.

3.Schwab MJ, Chiropractic management of a 47-year-old firefighter with lumbar disk extrusion, 7, 146-154, Journal of Chiropractic Medicine, 2008.

4.Saunders ES, Woggon E, Cohen C, Robinson DH, Improvement of Cervical Lordosis and Reduction of Forward Head Posture with Anterior Head Weighting and Proprioceptive Balancing Protocols, J. Vertebral Subluxation Res., April 27, 2003.

5.Morningstar MW, Cervical curve restoration and forward head posture reduction for the treatment of Mechanical thoracic pain using the Pettibon corrective and rehabilitative procedures, Summer 2002, Number 3, Volume 1, Journal of Chiropractic Medicine.

6.Morningstar MW, Cervical hyperlordosis, forward head posture, and lumbar Kyphosis correction: a novel treatment for Mid-thoracic pain, Spring 2003, Number 3, Volume 2, Journal of Chiropractic Medicine.

 
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