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Trigenics® Myoneural Medicine: A Neurological Treatment System
Techniques
Written by James Fung, DC; Phillip McAllister, DC; Allan Oolo Austin, DC   
Tuesday, 15 March 2005 02:48

Defined, Trigenics® Myoneural Medicine is an energetic sensorimotor restoration system. It incorporates a neurologically-based, multimodal methodology for local or full-body assessment and treatment.  Simplistically, it restores optimum brain and body communication and is directed at treating the causative, aberrant neurology of neuromusculoskeletal dysfunction. Aberrant histology (adhesions) and arthrokinetic osteology (subluxations) are then far more effectively treated using soft tissue myofascial techniques and joint manipulation procedures.  Trigenics® can be applied as Western manual medicine to correct aberrant sensorimotor function or as Eastern meridian medicine to balance neurosomatic energetics.

Treatment procedures and outcome are based upon functional neurology. Trigenics® is not a soft tissue treatment technique, although the result of treatment using this technique is often the correction of many soft tissue conditions. From a manual medicine perspective, soft tissue myofascial techniques and osseous manipulation are still often needed to treat aberrant histology and arthrokinetic osteology. In some cases, Trigenics® works as a stand-alone system of care, although it is often used as an integral and critical component in a multidisciplinary approach to condition correction.
 
How Trigenics® Works

The myoneural procedures used involve the synergistic, simultaneous application of three main treatment techniques/modalities for a summative neurological effect: Reflex Neurology, Mechanoreceptor Manipulation and Cerebropulmonary Biofeedback. This mode of action works on the basis of integrating neurological convergence projection from both segmental (PNS) and suprasegmental (CNS) pathways.  After reviewing the methodologies used in Trigenics, Dr. Ted Carrick, DC, PhD, DACAN, DABCN, DACNB, DAAPM, FACCN, and founder of the ACA neurology diplomate program, stated that “the multimodal stimulation approach utilized in Trigenics® is consistent with the principles of neuroplasticity and enhanced corticoneural reorganization of the somatosensory and sensorimotor systems.”

Trigenics® is used on a very wide variety of patients, including infants and geriatrics, and can be used to treat many conditions. In addition to being used to accelerate rehabilitation and for structural correction, it can be used as an alternative no-force manipulation. Specific Trigenics® Sports Power Augmentation treatments clinically increase athletic power and performance to greater than normal levels. Other neurological applications can be used for restrictive capsular and bursal conditions, such as “frozen shoulder”.  Myoneural Exercises have also been developed to enhance patient recovery with neurologically enhanced exercise.

Trigenics® is often referred to as the “missing element” in neuromusculoskeletal care. In strictly using osseous manipulation to treat the vertebral subluxation complex, not correcting aberrant neurologic input (dysafferentation) to the muscular holding elements will lead to the frustrating outcome of chronic, recurring intervertebral dyskinesia. In treating musculoskeletal conditions, non-treatment of aberrant neural innervation and compensatory tone imbalances (short/weak muscles) will lead to the frustrating outcome of incomplete strength rehabilitation and functional restoration. Trigenics® provides the solution by firstly correcting aberrant proprioceptive neurology to provide for functional reafferentation and reefferentation. Treatment of aberrant histology (adhesions) and arthrokinetics (subluxation/dyskinesia) is subsequently addressed, using soft tissue myofascial techniques and chiropractic procedures.
 
Dystonia: A Case Study Using Trigenics® As the Primary Treatment

A 60-year-old male presented to the clinic on May 7, 2003, with complaints of bilateral neck discomfort over the two weeks prior.  The neck pain was primarily acute right-sided upper trapezius, without radiation into his arm.  The patient was also noticing increasing cervicogenic-type headache symptomatology into his right occipital area, with a tight hat-band feel at times. No recent trauma or accidents.  In 1981, the patient was diagnosed, specifically, with adult-onset cervical dystonia myoclonic variant symptomatology. He also stated that it took the doctors and neurology specialists 15 years to reach that diagnosis.  The patient feels better when he maintains an erect posture, and the symptoms of dystonia worsen when he turns his head to the right.  The patient is currently medicated with clonazepam for the dystonia symptoms.

Dystonia Brief

Dystonia is a neurological movement disorder affecting more than 300,000 people in North America. It is characterized by involuntary muscle contractions, which force certain parts of the body into abnormal, sometimes painful, movements or postures.1  Its pathophysiology is complex and is not fully understood.2 Dystonia can affect any part of the body including the arms and legs, trunk, neck, eyelids, face, or vocal cords.  It is not usually fatal, nor does it affect intellect.  If dystonia causes any type of impairment, it is because muscle contractions interfere with normal function.  Features such as cognition, strength, and the senses, including vision and hearing, are normal. Dystonia has numerous underlying etiologies,3 and is classified 3 ways: Age of onset, body distribution of symptoms or etiology. The classification of dystonia by etiology uses broad categories: Primary and secondary dystonia. Primary dystonia is defined by the existence of dystonia alone, without any underlying disorder.  Secondary forms of dystonia arise from and can be attributed to numerous causes, such as birth injury, trauma, toxins, or stroke.

Physical Examination

Orthopedic testing was negative for any structural pathologies.  Rhomberg’s, Houle’s, and Adson’s were also negative.  Vibration sense, light touch and temperature were unremarkable. Cervical range of motion was digitally measured using a dual function hand-held inclinometer/dynanometer.  Cervical range of motion findings are listed, comparing pre- and post-treatment measures. Manual muscle testing of the cervical and upper thoracic muscles was also digitally measured, using the  MicroFET 3.  The initial muscle strength test revealed equally bilateral weakness in nearly all the muscles tested.  On the last re-evaluation, the testing was done prior to treatment.

Treatment

The patient was seen two-to-three times per week for 12 weeks.  During each visit, the patient received 20 minutes of interferential nerve/muscle stimulation (IFC) on his cervical musculature, to relax muscles prior to the Trigenics® protocols.  The patient met with the kinesiologist on a monthly basis for exercise therapy, which was primarily designed for daily home utilization.  The patient was very diligent about keeping up with the at-home exercise regimen.  Three months after his last treatment, the patient reported that he was continuing to do well with the following findings: Cervical flexion had more than doubled, going from 20 to 45 degrees; cervical extension had more than tripled, going from 10 to 35 degrees, left head rotation increased from 60 to 75 degrees; right head rotation almost doubled, going from 40 to 70 degrees; left lateral head flexion almost doubled, going from 20 to 35 degrees; and right lateral head flexion more than tripled, going from 10 to 35 degrees.   

Digital muscle strength testing on the day of initial presentation of the cervico-thoracic musculature (including levator scapulae, upper trapezius, cervical extensor group, anterior scalenes, middle scalenes, sternocleidomastoid, suboccipitals, middle trapezius, rhomboids, pectoralis major middle head, pectoralis major lower head, pectoralis major upper head and pectoralis minor) revealed a summative strength measurement of 124.6 lbs of force on the right side of his body and 110.8 on the left side of his body. After 12 weeks of Trigenics® treatment, he had a summative measurement of 265.9 lbs on the right side and 220.0 on the left. This represents a 113.4% increase in his strength on the right side and 100% on the left.
 
Summary

Medical treatment of dystonia primarily relies on therapeutic agents, including anticholinergics, benzodiazepines, and botulinum toxin3 and neurofunctional surgery including deep brain stimulation.4,5

Trigenics® was recently redefined as a neuromanual sensorimotor restoration system.6 Its treatment protocols utilize a multimodal environmental stimulation, based upon a motoric window of change.  It works on the basis of neurological convergence projection from both segmental and suprasegmental pathways.  The myoneural procedures evoke a multimodal sensory motor activation at a rate specific to the patient, encouraging proper movement/muscle firing pattern, and beneficially altering the neurological input into the central nervous system.  Home exercises are important to reinforce the treatments.

The aforementioned case study demonstrates dramatic clinical results using Trigenics® for increasing range of motion and functional strength in focal dystonia in the cervical region.  In this case, significantly restricted ranges of motion were doubled or tripled. Also dramatic is the significant increase in strength, wherein the patient at least doubled his overall strength.

The brain can be guided to change its signal patterns through appropriate stimulation of the sensorimotor system. We look forward to further advancements and testing with other patients using the above and additional parameters. As chiropractic doctors, we have the skills and attainable knowledge to produce results such as these, without drugs or invasive measures.

References

1.  www.dystonia-foundation.org
2.  Trost M. Dystonia update.  Curr Opin Neurol. Aug. 2003; 16(4):495-500.
3.  Langlois M, Richer F, Chouinard S.  New perspectives on dystonia.  Can J  Neurol Sci. Mar. 2003; 30 suppl 1:S34-44.
4.  Kupsh A, Kuehn A, Klaffke S,  Meissner W, Harnack D, Winter C, Haelbig TD, Kivi A, Arnold G, Einhaupl KM, Schneider GH, Trottenberg T.  Deep brain stimulation in dystonia.  J Neurol Feb. 2003; 250 Suppl 1:I47-52.
5.  Lozano AM, Abosch  A.  Pallidal stimulation for dystonia.  Adv Neurol  2004; 94:301-8.
6.  Austin A.  Lecture at the annual American Board of Chiropractic Sport Physician Symposium Mar. 2004, Las Vegas, Nevada.

Dr. James Fung is the Clinical Director of the Absolute Health Clinic in Toronto, Ontario, Canada. He received his undergraduate degree in Medical Genetics and Molecular Biology from University of Toronto and following that attended the Canadian Memorial Chiropractic College. For more information, visit www.absolutehealthclinic.com

A registered Trigenics Physician and Trigenics Instructor, Dr. Philip McAllister is the Clinical Director of the Back To Basics Chiropractic & Rehabilitation Centre in Guelph, Ontario, Canada, a multi-disciplinary center with the inclusion of Trigenics Myoneural Medicine.  For more information, visit www.backtobasicscentre.com

Canadian-Estonian chiropractor, Dr. Allan Gary Oolo Austin, is the originator of Trigenics.  Over 400 doctors and therapists throughout North America, Australia and Europe have now taken the Trigenics RTP program.  For more information, call 1-888-514-9355 or  visit www.trigenicsinstitute.com.

 
The Webster Technique in Pregnancy for Safer, Easier Births
Techniques
Written by Jeanne Ohm, D.C.   
Tuesday, 15 March 2005 02:44

pregnantbellyChiropractic care is essential for the pregnant mother. Her systems and organs are now providing for two, and their optimal function is critical for the baby’s healthy development. The mother’s spine and pelvis undergo many changes and adaptations to compensate for the growing baby, and the risk of interference to her nerve system is substantially increased. Specific chiropractic care throughout pregnancy works to improve nerve system function, providing greater health potential for both the mother and baby.

Another important reason for care throughout pregnancy is to help establish balance in the mother’s pelvis. Because of a lifetime of stress and trauma to her spine and pelvis, her pelvic opening may be compromised, resulting in a less than optimum passage for the baby. Williams Obstetrics text tells us that, “Any contraction of the pelvic diameters that diminishes the capacity of the pelvis can create dystocia (difficulty) during labor.” They further state that the diameter of the woman’s pelvis is decreased when the sacrum is displaced. Dr. Abraham Towbin, medical researcher on birth, tells us that the bony pelvis may become “deformed” this way, by trauma.

Additionally, these compensations to her spine and pelvis during pregnancy are likely to cause an imbalance to her pelvic muscles and ligaments. The woman’s pelvis supports her growing uterus with specific ligaments. When the pelvic bones are balanced, the uterus is able to enlarge symmetrically with the growing fetus. If the bones of the pelvis are subluxated, this will directly affect the way the uterus will be supported. Unequal ligament support of the uterus will cause torsion to the uterus, reducing the maximum amount of room for the developing fetus. Reduced space for the fetus is called intrauterine constraint.

In some cases, this constraint restricts the fetus’ positions during pregnancy, adversely affecting his/her developing spine and cranium. Additionally, these limitations on the fetus’ movement during pregnancy may prevent him/her from getting into the best possible position for birth. Any birth position other than the ideal vertex, occipital anterior position of the baby may indicate the inhibiting effects of constraint. Such mal-positions lead to longer more painful labors with increased medical interventions in birth. Often c-sections result and both the mother and baby miss the many benefits of a natural vaginal birth.

The Webster Technique, developed by Dr. Larry Webster, founder of the International Chiropractic Pediatric Association (ICPA), is a specific chiropractic analysis and adjustment for pregnant mothers. Working to correct sacral subluxations, this technique balances pelvic muscles and ligaments in the woman’s pelvis, reduces intrauterine constraint and allows the baby to get into the best possible position for birth. For many years, the ICPA has instructed numerous doctors in this technique, and their clinical results show a high success rate in allowing babies in the breech position to go into the normal head down or vertex position.

Dystocia is the obstetric term defined as difficult or prolonged labor. Based on the four physiological causes of dystocia as defined by Williams Obstetrics text, specific chiropractic adjustments address each of these reasons, potentially eliminating the physiological causes of dystocia. This means that the doctor of chiropractic can play a vital role in the prevention of dystocia when the patient is seen throughout pregnancy. Reducing the potential for dystocia lowers the incidence of medical interventions associated with difficult labor and delivery.

The Webster Technique offers the doctor of chiropractic a means of analysis and correction to be used throughout pregnancy to facilitate easier, safer deliveries.  As in all techniques during pregnancy, the analysis must be specific and the thrust gentle. The sacral adjustment may be done side posture when the practitioner avoids any torsion to the pelvic and respiratory diaphragms. The adjustment may be done prone with the use of pregnancy pillows for comfort and safety. In either mode, correcting the sacral misalignment is paramount.

Specific sacral analysis is performed on each visit throughout pregnancy to determine the correction needed. Care continues throughout pregnancy to restore and maintain balance in the pelvis. There are no known contraindications to this adjustment throughout pregnancy.

The ICPA offers doctors of chiropractic the opportunity to learn this technique as originally instructed by Dr. Webster and with variations pertinent to the many specific cases that come into your office. Specifically, the ICPA Perinatal Class offers the attendee an understanding of the physiological causes of dystocia and the specific adjustments relevant to its prevention.

It is important that doctors of chiropractic actively embrace the pregnant population into their practices.  The potential elimination of dystocia, because of the positive effects the chiropractic adjustment has on birth outcome, is an important service chiropractic offers.

References

1. Cunningham FG, et al, Dystocia Due to Pelvic Contraction, Williams Obstetrics, Nineteenth Ed. 1989.
2. Towbin A, “Dystocia”, Brain Damage in the Newborn and its Neurologic Sequelle, 1998.
3. Netter F. Pelvic Viscera and Perineum.  Atlas of Human Anatomy, 1994.
4. Hellstrom B. Sallmander U.  Prevention of Spinal Cord Injury in Hyperextension of the Fetal Head. JAMA 1968, 204(12): 1041-4.
5. Anriig C, Plaugher G.  Chiropractic Management of In-Utero Constraint. Pediatric Chiropractic, 1998; Chapter 5, page 102.

Jeanne Ohm, DC, has  practiced Family Chiropractic since 1981. She is currently Executive Director of the International Chiropractic Pediatric Association and is the instructor on Perinatal Care in their 360-Hour Diplomate program. She can be contacted via their site at: www.icpa4kids.com.

 
Reduce Spinal Scoliosis Without Braces or Surgery
Techniques
Written by R.B. Mawhiney, DC   
Tuesday, 15 March 2005 02:40

cobbangleDr. Hugh B. Logan, who founded Logan College of Chiropractic, first developed the basis for this procedure for the correction of scoliosis.  Over the last fifty years, I have modified, improved and updated the procedure to allow the chiropractor to produce consistent results. I established the International Scoliosis Research Center to provide research, consultation and seminars to the profession on this subject.  The doctor of chiropractic is the only health care professional capable of reducing a scoliosis without braces or surgery.

Theory

It has been confirmed clinically that subluxation of the sacrum, both anterior and inferior, predisposes to the development of a scoliosis. The body of the lowest freely movable vertebrae will always rotate to the low side of its foundation. Utilization of the Mawhiney Procedure, utilizing Logan Basic Technique, heel lift application, restrictions and exercise, will reduce the scoliosis in a prescribed period of time.

Treatment procedure

The treatment is set on a minimum three-month evaluation period, incorporating Logan Basic Technique, bilateral weight scale evaluation, heel lift application, exercises and restrictions, and specific vertebral adjusting. Vertebral adjusting is very specific, because each section of the scoliosis develops in a progressive manor, and the vertebra to be adjusted must be adjusted in proper sequence.

Patient is seen three times per week for the first three weeks and then reduced to twice weekly for the next nine weeks.  In cases of Grade II scoliosis and above, a hanging X-ray is taken at the initial exam, to determine the extent of scoliosis reduction that can be anticipated in ninety days.  The hanging X-ray is achieved by having the patient hang, by their hands, for a two-minute period, and the exposure is made while the patient is suspended.  It was proved, in clinical trials, that this procedure will show the actual amount of reduction that may be obtained, which vertebral segments will rotate, and how much reduction will be made in the Cobb’s angle.

Heel lift application is determined by the sacral inferiority, the lowest freely movable vertebrae and the bilateral weight scales.  The heel lift application has nothing to do with a measurable leg length, but only with the sacral inferiority.

Ninety-day evaluation should demonstrate a 15% reduction in the scoliosis and the next ninety-day period would have the patient seen twice weekly. In advanced cases, a traction/distraction table would increase the scoliosis reduction expected in ninety days.

Each visit would first have the patient checked on the bilateral weight scales, to determine if the lift placement is correct in thickness to support the sacrum. The patient will respond to scoliosis reduction best with the use of an adjustable table such as the Zenith Hy-LO. A flat table does not allow for AP changes in the prone posture necessary to encourage results. The patient will then receive an application of Logan Basic Technique, for approximately five minutes. The contact is always on the low side of the sacrum and is best applied after the patient is manually positioned anatomically in the prone position, to encourage curvature reduction and muscle relaxation.

The patient is restricted from all contact sports and any activity that may traumatize the pelvis or sacrum. The only exercise utilized the first thirty days is the hanging exercise, done twice daily. This exercise consists of having the patient hang, by their hands, twice daily for an accumulated time of two minutes. Other exercises, such as free weights, may be added later.

Once the heel lift is placed and monitored, the scoliosis will reduce, allowing the Logan Basic Contact, specific vertebral adjusting, restrictions and exercise to control the speed of the reduction.

Conclusion

Proper chiropractic care has demonstrated, over the last seventy years, to be the only profession to reduce spinal scoliosis without the use of braces or surgery. It is a specialty subject and any chiropractor not properly trained in a college sponsored post-graduate course risks a malpractice problem if the scoliosis increases while the patient is under their care.

R. B. Mawhiney, D.C, D.I.S.R.C., graduated from Logan College in September 1953 and had a family practice, specializing in scoliosis, for forty-eight years before retiring.  He has been on the post-graduate faculty of ten chiropractic colleges, written thirteen books, and has published numerous clinical and scientific articles.  He presently teaches scoliosis reduction seminars and serves as a consultant to the profession by providing treatment procedures to doctors.

Dr. Mawhiney may be reached at 25540 Belle Helene, Leesburg, FL  34748; or by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

*The scoliosis manual, Chiropractic Procedures in Spinal Distortion Cases, is available through the author.

 
Manipulation Under Anesthesia or Joint Anesthesia
Techniques
Written by Peter M. Ferraro, DC   
Tuesday, 15 March 2005 02:38

Manipulation under Anesthesia (MUA) has been shown to be a viable approach in the treatment of chronic recalcitrant spinal pain.  The results have been remarkable in many patients who have exhausted efforts using conventional models of conservative management.

“Because of the advancement of new medications and the use of conscious sedation, the anesthesia element of the MUA makes the procedure one of the most easily adaptable neuromusculo skeletal treatment modalities that manual practitioners have at their disposal for chronic and certain acute neuromuscular skeletal problems.”1

This procedure has been widely used for centuries and recently has had major improvements in its efficiency by combining it with another mode of pain management, fluoroscopically guided intra- articular injection known as MUJA.

Since the combination of these two procedures, our team of physicians, which include anesthesiologists, osteopathic physicians, and chiropractors, has successfully performed over five thousand manipulations under joint anesthesia.

Discussion

Manipulation under joint anesthesia (MUJA) was presented in 1999, at the Conference of the World Federation of Chiropractic, as an alternative to office manipulation.  There is literature that dates back to 1938, in which manipulation was performed following an anesthesia injection of the sacroiliac joints.2

In 1997, Nelson, Aspegren, and Bova studied the benefits of the use of epidural steroid injection and manipulation on patients with chronic low back pain.3

As described by the CPT 2003 Code 22505, spinal manipulation under anesthesia is defined as an outpatient manipulation of the posterior motor units of the spine, requiring anesthesia and designed to reduce fibroblastic proliferation and restore range of motion and visco-elasticity to the per capsular connective tissue and para vertebral musculature in areas of the spinal segmental dysfunction not amenable in office manipulation.4

Protocol

Upon careful selection of the patient by the persons performing the injection and delivering the manipulation, the patient is then assessed as to what type of injection will be performed at precisely what level.

The procedure is then executed in a properly equipped surgical suite to allow for optimal setting of both injections and the manipulation being performed.  Upon completion of the injection, whether it is an epidural, facet block, trans-foraminal, or sacroiliac, the manipulation under joint anesthesia is then performed.  A series of facial lengthening, tendon stretching and ligamentous mobilization along with the realignment of the joint are carried through while the patient continues under conscious sedation.  These results are attained by using passive stretches, myofascial release, and specific articular and adjustment procedures.

“The basic concepts behind the mobilization, manipulation, and adjusting procedures, while the patient is under a sedative/hypnotic, is to increase ligamentous, tendinous, and muscular flexibility that has not been achieved in the office therapeutic routine.  Standard manipulative techniques are used, but the physiologic state of the patient is changed and the procedure is done in a controlled environment.  When used on properly selected patients, it is more cost effective and more productive to the patient’s return to normal lifestyle than prolonged conservative care or possible surgical intervention.”5

The rational for using sedation is to allow those patients who cannot tolerate any use of manual techniques due to muscle guarding, spasm, severe pain, and muscle contractors to regain their activities of daily living and begin a structured regimen of home exercise.

The medication of choice used for conscious sedation is Propofol.  “This medication allows the patient to not respond to the initial pain stimuli with an immediate muscle contraction.  The maneuvers could then be performed without losing their end range. The natural protective mechanism are present, but slowed down temporarily, and pain is perceived at a lowered threshold and not remembered.”6

Conclusion

As discussed throughout this paper, MUJA is an excellent choice for patients who continue to suffer from recalcitrant pain.  There is an over abundance of chronic cases which have shown no improvement with conventional approaches to neuromusculoskeletal injuries along with spinal axial pain.  For this patient population, a course of manipulation under anesthesia should be considered as the next phase in their treatment prior to surgical intervention.  Standardization of this protocol would allow more potential patients, who continue to suffer, a chance to get their lives back and return to the activities they enjoyed prior to their injury.

References

1. Gordon R. Commentary:  Manipulation Under Anesthesia, Journal of Manipulative and Physiological Therapeutics. 2001 Vol. 24 Number 9.
2. Haldeman KO, Soto Hall R., The diagnosis and treatment of sacroiliac conditions by injection of procaine (Novocain). J Bone Joint Surgery 1938; 20-A :675-86.
3. Nelson L. Aspegren D, Bova C.  The use of epidural injection and manipulation on patients with chronic low back pain.  J. Manipulative Physiology Ther. 1197; 20: 263-6.
4. CPT 2003 American Medical Association 47-C Procedure Musculoskeletal/Surgery
5. Gordon R. Conservative.  Chiropractic adjustive therapy versus MUA adjustive therapy.  Florida Chiropractic J 1993;1:22-3.
6. Gordon R. Commentary:  Manipulation Under Anesthesia. Journal of Manipulative and Physiological Therapeutics 2001 Vol. 24 Number 9. 

Dr. Peter M. Ferraro is a 1996 graduate of New York Chiropractic College. He began early in his career specializing in the treatment of herniated disc injuries by becoming certified in the Cox Distraction techniques at National Chiropractic College. In the past four years, Dr. Ferraro has become certified in Manipulation Under Anesthesia and has performed over 5,000 MUA/MUJA treatments.

For more information, Dr. Ferraro can be reached at 973-478-2212 or at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
The Evolution of Bloodless Surgery and Chiropractic
Techniques
Written by Charles L. Blum, DC   
Tuesday, 15 March 2005 02:37

Bloodless Surgery or Chiropractic Manipulative Reflex Technique (CMRT) encompasses the  relationship between somatovisceral and viscerosomatic reflexes and, therefore, between the somatic and autonomic nervous systems. R. J. Last in his book, Anatomy: Regional and Applied, points out:

There is only one nervous system.  It supplies the body wall and limbs (somatic) and viscera (autonomic).  Its plan is simple.  It consists of afferent (sensory) and efferent (motor) pathways, with association and commissural pathways to connect and coordinate the two.  There is no more than this, in spite of the many pages devoted to its study.1

Bloodless Surgery has historically been used in chiropractic as a term describing soft tissue treatment affecting an organ and its related vertebral relationship or viscerosomatic and somatovisceral reflexes.2,3  Bloodless surgery has also been used to describe methods of manipulating joints and soft tissue without being related to the viscera.4

James F. McGinnis was a chiropractor that relocated to California in the early 1920’s, where he earned a naturopathic doctorate.  In the 1930’s, he became one of the best known of several chiropractic bloodless surgeons and traveled around the nation to teach his methods.2 Around this time, Major Bertrand DeJarnette, developer of Sacro Occipital Technique, was also practicing and teaching extensive methods of bloodless surgery. DeJarnette published a comprehensive book on the topic, entitled Technic and Practice of Bloodless Surgery, in 1939, which remains the most complete discussion on the topic to date.3

During this time, DeJarnette used chromotherapy, which was purported to affect the physiology of the patient.  The process involved the “filtering of white light through special screens or filters”5 through a mechanism called the chromoclast.  He would use this device to help with his bloodless surgery procedures and found that it appeared to have, among other therapeutic characteristics, anesthetic properties.  During the 1940’s, DeJarnette stopped teaching and selling the chromoclast, as he reported that those using the device were not using it properly and might cause the patient harm, for which he did not want to be held responsible.

He continued to teach and practice bloodless surgery through the 1940’s, and began its modification to use more reflex applications and referred pain indicators, as a method of affecting organ symtomatology. In the 1950’s, he furthered his investigations into reflexes and their effect on the viscera and related vertebra.  By the early 1960’s, DeJarnette modified the nature of Sacro Occipital Technique’s method of bloodless surgery from its 1939 procedures, which might take two-to-four hours of preparation and treatment, to procedures that could be practiced in a span of 15 minutes.6,7  For multiple reasons, he decided to change the name of his method of affecting referred pain pathways, viscerosomatic/somatovisceral reflexes, and direct organ manipulation to Chiropractic Manipulative Reflex Technique (CMRT).

CMRT is used as a method of treating the spine or vertebra visceral syndromes associated with viscerosomatic or somatovisceral reflexes,8-10 dysafferentation at the spinal joint complex,11 and visceral mimicry type somatic relationships.12  Treatment involves location and analysis of an affected vertebra in a reflex arc, by way of occipital fiber muscular palpation, similar to trigger point analysis or Dvorak and Dvorak’s spondylogenic reflex syndromes.13  Once specific vertebra reflex arcs are located, corroborated with referred pain pathways and clinical symtomatology, then the specific vertebra to be treated is isolated by pain provocation, muscle tension and vasomotor symtomatology.  Often times, if a vertebral dysfunction is chronic or unresponsive to chiropractic spinal manipulation, then a viscerosomatic or somatovisceral component is evaluated.14  Treatment of the viscerosomatic or somatovisceral component is performed using soft tissue manipulation, myofascial release techniques and reflex balancing methods.7

Bloodless Surgery, has been used and taught by Sacro Occipital Technique (SOT) chiropractors since 1939 and was practiced much more extensively in the 1930’s and 40’s.  Since 1960, it has been called CMRT, and focuses predominately on the vertebra and viscerosomatic/somatovisceral relationships. CMRT is listed as a chiropractic technique throughout the chiropractic literature.15-19 SOT clinicians using these methods of CMRT and bloodless surgery for years are beginning to publish their methods in the literature which is helping to further establish this successful method of care, used for decades by chiropractors.20-24

Presently, those interested in learning about SOT and CMRT, as taught by Major Bertrand DeJarnette, can attend seminars by Sacro Occipital Technique Organization–USA (SOTO-USA) and can visit the website for seminar information and research updates at www.soto-usa.org, or call (781) 237-6673.  Currently, SOTO-USA is the only organization that is teaching CMRT, specifically, as developed by DeJarnette.

Dr. Charles L. Blum is the President of Sacro Occipital Technique Organization–USA (SOTO-USA), PO Box 24936, Winston-Salem, NC 27114-4936.  For more information call 336-760-1618, or email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

For DeJarnette SOT, dentocranial co-treatment, and up to date integrated SOT treatments, SOTO-USA will be having its yearly clinical symposium in St. Louis, MO October 6-9th, 2005.

References

1. Last RJ, Anatomy: Regional and Applied, Sixth Edition, Churchill Livingstone: New York, 1978:20.
2. Keating JC James F. McGinnis, D.C., N.D., C.P. (1873-1947): Spinographer, Educator, Marketer and Bloodless Surgeon Chiropractic History, 1998; 18(2): 63-79.
3. DeJarnette MB, Technique and practice of bloodless surgery, Privately Published, Nebraska City, NB, 1939.
4. Taylor H, Sir Herbert Barker: Bone-Setter and Early Advocate of “Bloodless Surgery”   Journal of the American Chiropractic Association 1995  Jul; 32(7): 27-32.
5. DeJarnette MB, Chromotherapy, Privately Published, Nebraska City, NB, 1941.
6. DeJarnette MB, Chiropractic Manipulative Reflex Technique, Privately Published, Nebraska City, NB, 1964.
7. Blum CL, Monk R, Chiropractic Manipulative Reflex Technique, Sacro Occipital Technique Organization–USA, Winston-Salem, NC, 2004.
8. Budgell BS, Reflex effects of subluxation: the autonomic nervous system.  J Manipulative Physiol Ther 2000 Feb;23(2):104-6
9. Budgell BS, Spinal Manipulative Therapy and Visceral Disorder.  Chiropractic Journal of Australia  1999  Dec; 29(4): 123-8
10. Sato A  The reflex effects of spinal somatic nerve stimulation on visceral function. J Manipulative Physiol Ther.  1992 Jan;15(1):57-61.
11. Seaman DR, Winterstein JF, Dysafferentation: A Novel Term to Describe the Neuropathophysiological Effects of Joint Complex Dysfunction. A Look at Likely Mechanisms of Symptom Generation.  Journal of Manipulative and Physiological Therapeutics. 1998 May; 21(4):  267-80
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19. Cooperstein R, Gleberzon BJ, Technique Systems in Chiropractic:  Churchill Livingstone: New York, NY April 2004: 209, 211, 214, 217.
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22. Blum, CL, Role of Chiropractic and Sacro Occipital Technique in Asthma, Chiropractic Technique, Nov 1999; 10(4): 174-180.
23. Blum CL, Chiropractic care of diabetes mellitus? A Case History, Journal of Vertebral Subluxation Research, Accepted for publication April 2003.  
24. Blum CL, Resolution of gallbladder visceral or mimicry pain, subsequent to surgical intervention, International Research and Philosophy Symposium Sherman College of Chiropractic, Spartanburg, SC, Oct 9-19, 2004: 10-11.

 
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