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Snoring and Sleep Apnea - Structural Implications
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Techniques
Written by George Roth, D.C., N.D.   
Tuesday, 15 March 2005 02:34

The uvula and soft pallet may come into partial or total contact on the back wall of the upper airway.  When the contact is partial or intermittent, snoring (a loud vibration of these soft tissues) may result.  The tongue may also drop posteriorly onto the back wall of the upper airway, coming into contact with the uvula and soft pallet, thus forming a tight blockage, preventing any air from entering the lungs.  Respiratory effort on the part of the diaphragm and chest may cause the blockage to seal tighter.  In order to breathe, the person must arouse or awaken, causing tension in the tongue and, thereby, opening the airway, allowing air to pass into the lungs.  Apnea, sleep apnea or obstructive sleep apnea is defined as the cessation of breathing for 10 or more seconds while asleep.1  Traditional methods of treatment usually involve Continuous Positive Airway Pressure (CPAP) devices.  Matrix Repatterning techniques were used in ten cases of long-standing, moderate to severe cases of upper airway obstruction.
 
Matrix Repatterning

Matrix Repatterning uses a manual scanning procedure to determine the location of primary structural restrictions, followed by mechanical testing to determine specific vectors of fascial tension.  Treatment is generally applied manually, with light force directed into the resistance barriers.  Matrix Repatterning is based on a revolutionary, new model of the underlying structure of organic tissue—the Tensegrity Matrix—which explains the complex interrelationship of all the structural components of the body.  It extends the basic concept of the tissue response to injury, beyond the level of joint, muscle and ligament, to include all structures of the body as potential sources of dysfunction.2

The tensegrity matrix model of the body, as elaborated by Stephen Levin, M.D.3 and Donald Ingber, M.D., Ph.D.,4 holds that the body tissues are composed of interconnected tension icosahedra (complex triangular trusses), which inherently provide a balance between stability and mobility.  This structural model explains many of the observed phenomena related to body support, movement, response to stress and trauma, as well as the effects of various therapeutic interventions.  This theory has been verified by several studies in recent years.  According to Ingber, a key investigator who has proven the existence of this structural model at the cellular level, “The principles of tensegrity apply at essentially every detectable size scale in the human body.  At the macroscopic level, the 206 bones that constitute our skeleton are pulled up against the force of gravity and stabilized in a vertical form by the pull of tensile muscles, tendons and ligaments.  In other words, in the complex tensegrity structure inside every one of us, bones are the compression struts, and muscles, tendons and ligaments are the tension-bearing members.”4
 
Mechanism of Upper Airway Obstruction

The upper airway is constructed of the hard and soft palate above, the posterior pharynx, the tongue, and the epiglottis at the level of the tracheo-esophageal junction below.  There are several mechanisms of partial or complete obstruction.

When the ability of the tissues to adapt or compensate becomes overwhelmed by mechanical or physiologic stress, the fascial system responds by altering the patterns of tension and elasticity.  The tensegrity matrix explains the physiologic changes, which manifest in injured or strained tissue.  The apparent fibrosis of muscle and fascia can be seen as an altered electro-mechanical relationship at the molecular level.  The matrix is, thus, converted from a neutral, flexible form to a strained, high-energy, linearly-stiffened mode as shown in Figure 1.

Obstruction may occur by approximation of several structures and tissues.  This may include the soft palate retracting toward the posterior pharyngeal wall, the soft palate descending to approximate the posterior aspect of the tongue, the tongue retracting toward the posterior pharynx, or descending to approximate the epiglottis.  These tissues may deviate from their functional positions within the upper airway due to a number of structural dysfunctions, including cranial vertex or occipital trauma, leading to descent and/or protraction of the cranial base, along with the maxillary portion of the roof of the upper airway.  Vertex compression, in our studies, has also shown a tendency to lead to radial expansion of the upper cervical vertebrae (an intraosseous deformation), leading to loss of anterior/posterior dimension of the upper airway.  Facial trauma may cause deviation of the maxilla or mandible.  Hyperflexion injury of the cervico-thoracic spine may also induce an approximation of the posterior tissues toward the tongue and epiglottis.  This is common in motor vehicle collisions (rear end or front end) and in falls onto the back of the head or upper back.  Several other mechanisms of structural dysfunction are also currently under investigation.

Assessment

In cases of upper airway obstruction, a specific airway obstruction test (AOT), developed by the author, was also used to verify partial or complete obstruction.  This involves placing the patient in an accentuated position of upper cervical hyperflexion or moderate extension, along with varying degrees of rotation or lateral flexion.  The ease or difficulty of breathing, along with the amount of airflow turbulence noise, was recorded for each position.  The dysfunctional structural patterns associated with snoring and sleep apnea (see above) were then evaluated using the standard Matrix Repatterning assessment.
 
Method of Treatment

A maximum of four treatments to resolve these patterns were administered over a maximum period of two months for ten patients with moderate to severe upper airway obstruction.  Two of these cases were previously diagnosed with significant sleep apnea, as verified by sleep studies. 

Results

AOT was improved significantly in 80 percent of the cases.  Patients (and spouses, or sleeping partners) reported a cessation or a significant improvement in snoring in 70 percent of the cases.  The two individuals, diagnosed with sleep apnea, reported they were able to sleep through the night without the assistance of a CPAP machine, on which they were previously dependant.  These findings suggest that structural dysfunction may play a role in the development of upper airway obstruction and that Matrix Repatterning procedures may be beneficial in the management of these conditions.  The findings suggest that a randomized controlled trial within a broader population base might be indicated.

Key Terms:
Matrix Repatterning,
Upper Airway Obstruction (UAO),
Airway Obstruction Test (AOT),
Continuous Positive Airway Pressure (CPAP).

References

1. Exar EN, Collop NA: The upper airway resistance syndrome. Chest 1999 Apr; 115(4): 1127-39
2. The Matrix Repatterning Program for Pain Relief, GB Roth, New Harbinger Publications, Oakland CA, 2005.
3. The Importance of Soft Tissues for Structural Support of the Body, SM Levin.  Positional Release Therapy: Assessment & Treatment of Musculoskeletal Dysfunction, K D’Ambrogio & GB Roth, Mosby-Elsevier, St. Louis, 1997.
4. The Architecture of Life, DE Ingber, Scientific American, Vol. 1, 1998

George B. Roth, BSc, DC, ND, is President of The Roth Institute, and on the Post-Graduate Faculty of Logan College of Chiropractic. He can be reached by phone at 416-977-6841, email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it , or visit www.rothinsitute.com.

 
Techniques: Diversity of Art and Science
Techniques
Written by David Jackson, DC   
Tuesday, 15 March 2005 02:33

Chiropractic is an incredibly diverse profession, boasting more than 100 different techniques (one list puts the number closer to 120 and one online source even claims there are 200).

Some are extremely well known, such as Diversified or Atlas Orthogonal Technique. Others possess a smaller (but often extremely loyal) following, such as the McTimody Technique or the Columbia Technique. Most doctors incorporate several techniques into their practices and many attend frequent seminars to learn new techniques in the hope of improving the quality of care they provide patients.  While this array of techniques contributes to the rich texture of our profession, developing a technique requires more than merely modifying an adjusting table and giving seminars.

Craig Nelson, DC, in an article titled “The Nelson Method—Five Steps to Your Own Technique” (Journal of Manipulative and Physiological Therapeutics, vol. 16, No. 2 Feb. 93, pp.115-117), gave facetious advice on how to start a technique. After suggestions about coming up with a name and sounding scientific (“complicated mathematical equations work really well”), he advised, “Don’t attempt to test the reliability or effectiveness of your technique. You do not want to ask questions you do not know the answer to.” Luckily for chiropractic, and chiropractic patients, most developers ignored that last piece of advice and conducted at least some—often extensive—research on their techniques before introducing them to the profession.

But the lack of solid research into chiropractic, in general, and techniques in particular, is distressing and has not gone unnoticed by our critics. An online information page put out by AETNA insurance notes that, “There are more than 100 chiropractic and spinal manipulative adjusting techniques, and practitioners may vary in their approaches.” The page goes on to make such statements as, “Overall, the quality of studies has been poor. Better-quality research is necessary to make a clear conclusion,” (referring to neck pain). “However, because of weaknesses in this research, no clear conclusions can be drawn,” (referring to asthma). “Because there are a limited number of studies in humans and weaknesses in existing research, it is unclear if chiropractic techniques are beneficial....” (Referring to just about everything else).

The lack of high-quality research is a problem we must address, if chiropractic is to be accepted by the public; and technique developers are in an ideal position to help compile that research. According to the Council on Chiropractic Practice (CCP) Guidelines, “Techniques and methods for correcting subluxation must be judged on their intended outcome and most, if not all, chiropractic techniques have some physiological and/or structural outcome that measures their results.”

In fact, outcomes research is the key to establishing or choosing any technique. Our profession cannot afford to use or promote a technique out of blind loyalty or habit. As with every other aspect of chiropractic, we have to look at the literature and make sure the technique is the result of scientific research. Preferably, that research will have been published in a peer-reviewed journal, either by the developer or by doctors who use the technique in their practices.

Erin Elster, DC, whose research has been published in the Journal of Vertebral Subluxation Research, JMPT, and Today’s Chiropractic, has stated, “I encourage all doctors of chiropractic to publish their research using their chiropractic techniques and technologies, in order to expand the chiropractic knowledge base and to benefit the profession.”

The quality and amount of research on techniques is also critical in the development of chiropractic practice guidelines. Since chiropractors often define themselves and their services by the techniques they use, professional guidelines must address those techniques.

“The involvement of technique experts is crucial to the development of any chiropractic guideline,” states Matthew McCoy, DC, Vice President of the Council on Chiropractic Practice. “Unfortunately these dedicated and unsung heroes have effectively been shut out of other groups’ guideline development efforts and the research community. Instead, they need to be deeply involved in this process, since the art of chiropractic is the application of the philosophy and science.”

Involving technique experts in both research programs and guideline development has far-reaching benefits for the profession and for patients. Not only will it ensure the continued safety of chiropractic adjustments, but it will enable doctors to provide the evidenced-based care demanded by the public today.

Dr. Jackson is Chief Executive Officer, Research and Clinical Science (RCS), a private sector research program exploring issues of subluxation correction and chiropractic care as they relate to health and wellness. Previously, he served as president of Chiropractic Leadership Alliance and Creating Wellness Alliance. He was owner/operator of several private practice offices in California and Idaho that specialized in high volume, family wellness based care. Dr. Jackson may be reached at 800-909-1354; or, for more information, contact Barbara Bigham at 503-362-2145.

 
Where, When and When Not to Adjust
Techniques
Written by Arlan Fuhr, DC   
Tuesday, 15 February 2005 01:21

Today, with more and more studies concluding that the standard methods of chiropractic analysis are unreliable and not reproducible, many doctors of chiropractic are looking for a way to analyze the spine and extremities that can give them assurance.  Activator Methods Chiropractic Technique (AMCT) utilizes a protocol incorporating leg length analysis, pre- and post-adjustment, to determine exactly where, when and when NOT to adjust.  Therefore, this protocol not only helps to assure the doctor has found the affected spinal level but also enhances their confidence that the adjustment was successful.

Research has been conducted to evaluate interexaminer reliability using experienced chiropractors to measure reproducibility of prone leg length assessment and concludes that reliability of prone leg checks can be consistent.1 In comparison, static and motion palpation fall below what is clinically acceptable in terms of reliability.  AMCT utilizes prone extended leg length assessment (Position 1, Figure 1) to determine the functional short leg of the patient or pelvic deficient (PD) side, either the AS or PI ilium. Once the pelvic deficiency is corrected using precise contacts and lines of drive via the Activator adjusting instrument, the leg lengths become equal. (Figure 2).

ISOLATION TESTS: With the pelvis now balanced, screening for areas to adjust involves the use of active muscle tests called isolation tests. (Figure 3) Each isolation test corresponds to a specific vertebral segment.  The patient performs the requested motion and the doctor observes for any changes in leg length on the side that was originally the PD side.  If a change occurs, the doctor flexes the knees to 90 degrees (Position 2) and observes any change in the PD leg to determine which side of the spine to adjust.  If the PD leg lengthens in Position 2, the doctor adjusts the PD side of the corresponding segment on a specific contact (example, the mammillary or transverse process) with a precise line of drive utilizing the Activator adjusting instrument.  Correction will be observed in a post-adjustment leg check as the legs balance again.  If the patient’s leg lengths remain equal after the isolation test, no adjustment is required and the doctor moves on to test the next level of the spine.

AMCT conceives that the leg reactivity observed after an isolation test is due to facilitation as a result of nerve interference at the affected spinal level.  According to Malik Slosberg, DC, “normal muscles respond to normal, innocuous movements by appropriately contracting briefly to perform the requested movement and then relaxing.”

Therefore, in unaffected areas, these movements do not appear to alter relative leg lengths.  He goes on to say, “When a muscle group is facilitated, its response to stretch or contraction may be both excessive and prolonged.  Such alterations of muscle response apparently affect the functional leg length and result in alteration of relative leg lengths.”2

If facilitation is present, an exaggerated contraction of paraspinal muscles occurs and leg reactivity is observed.  Decades of documented clinical observation from doctors of chiropractic internationally have culminated into this protocol for analysis.   In one reliability study, 72 subjects were examined by two DC’s, for upper cervical subluxation, using a chin tuck isolation test.  Good reliability between examiners was found.3

Drs. Warren Lee and Arlan Fuhr founded instrument adjusting over 35 years ago.  Not only does an instrument allow the doctor to passively adjust the patient, but it also provides a specific contact, force, speed and line of drive so that you can be assured to affect the joint as efficiently as possible. The latest Activator adjusting instrument, Activator IV (Figure 4), has a reproducible preload and four precision force settings that have been studied in independent labora-tories.The minimal force setting starts at approximately 19 lbs and the instrument ranges up to a maximal force setting of approximately 55 lbs. Today, the Activator is still the fastest adjusting instrument. It is over 300 times faster than a manual thrust.4

At this speed, the doctor is affecting the involved joint before the muscle spindle reflex is initiated.  To compare the effects of manual adjusting to instrument adjusting, we can look at a bone movement study where a manual lumbar side-posture adjustment using 540N of force moved L4 1.1 mm.5  In a similar study, the Activator adjusting instrument moved L4 1.6 mm with a force of 140N.6

STUDY IN CLINICAL SETTING:  The following is a case series that will help illustrate the effectiveness of the AMCT protocol and adjustments in a clinical setting.  The purpose of this paper was to determine if there was a basis for the treatment of Temporomandibular disease (TMD) using the chiropractic protocol developed by Activator Methods, Inc.  The study was set in a private, solo practice of an Activator advanced proficiency rated chiropractor with 15 years experience.  Nine adult volunteers with articular TMD were recruited from the practice of the treating clinician.  Change was measured from baseline to follow-up using a Visual Analog Scale (VAS) for temporomandibular joint (TMJ) pain and maximum active mouth opening without pain. AMCT protocol for full spine and TMJ analysis and adjusting (Figure 5) was followed. Participants were typically seen three times per week for two weeks and, according to individual progress, thereafter for six more weeks. The results showed a median VAS decrease of 45 mm (range 21-71) and all experienced improvement. The median increase of mouth opening was 9 mm (range 1-15) with improvement in all.  The results of this prospective case series indicate that the TMD symptoms of these participants improved following a course of treatment using the AMCT protocol.7

AMCT is now taught in almost every chiropractic college in the United States.  With over 140 peer-reviewed articles and conference presentations published, doctors of chiropractic can be assured that, by choosing AMCT as their primary method of analysis and adjustment, they are offering their patients an effective and safe treatment and will have fewer doubts about where, when and when NOT to adjust!

For more information, contact Activator Methods, International, 2950 N. Seventh St. Suite 200, Phoenix, AZ 85014; or call (602) 224-0220.  www.activator.com

References

1. Nguyen, et al., JMPT 1999; 22(9):565-9.
2. Malik Slosberg DC, MS, in Today’s Chiropractic 17:17,1998. 
3. Youngquist, et al., JMPT 1989; 12:93-97.
4. Keller, et al., JMPT 1999; 22(2):75-86.
5. Maigne, Guillon, JMPT 2000; 23:531-536.
6. Nathan, et al., JMPT 1994; 17(7):431-44.
7. DeVocht, et al., JMPT 2003; 26(7): 421-425.

 
Case Study: Rotator Cuff Impingement Syndrome
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Techniques
Written by Dr. Mitch Mally   
Tuesday, 15 February 2005 01:19

History and Subjective Complaints:

A 24-year-old professional/international circuit tennis player presents with a right shoulder injury, 6 months post U.S. Open.

Objective Findings:

Decreased right shoulder flexion, abduction and external rotation.

X-Ray:

Absent 8-10 mm subacromial space, laterally rotated vertebral border of the right scapula, antetilted glenoid labrum.

Diagnosis:

Protracted laterally antetilted right scapula causing rotator cuff impingement syndrome.

Treatment:

Specialized manipulative decompression of involved protracted/antetilted right scapula, medial-inferior sternoclavicular joint and anterior-inferior medially rotated right humerus (Mally Technique)

Nutrition:

Anti-inflammatory vitamins (bromelain, papain, trypsin, chymotrypsin, bioflavonoids) and vitamin B6.

Rehab:

6 weeks of reconstruction and work hardening, rhomboid and deltoid strengthening.

Addendum:

Failed post-op impingement surgery is very high, with misdiagnosis and connective tissue hyperplasia the highest cause of failure. Misdiagnosis leads to erroneous results and, in this case, permanent disability and loss of dominant shoulder motion. Post chiropractic extremity manipulation by Dr. Mally yielded a return to the tennis courts and a very excited world-class competitive athlete.

For more information, Dr. Mally can be reached by e-mail at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
Breakthrough Pre-Adjustment Technique to Fully Activate Innate and De-stress the Body
Techniques
Written by Paul Yanick, Ph.D.   
Saturday, 15 January 2005 00:09

Can you imagine having a fuller understanding of why adjustments hold or don’t hold and a more accurate description of why innate’s powerful influence on healing in the organism may be inhibited? The key to unlocking multiple channels of innate intelligence is related to adrenal gland physiology and the body’s ability to store, maintain and balance coherent energy.

Yin and Yang Influences on Adjustments

Homeostatic systems of the body involve self-correcting and self-balancing energetic feedback loops that are dependent on the balance of the polarities of yang and yin or of the sympathetic and parasympathetic nervous systems (adrenergic and cholinergic). A reduced flow of innate commonly starts at the sacrum, a sensitive register to stress and the locus of powerful meridians. In acupuncture-energetic physiology, the polarities of the governing vessel-GV (posterior) and the conception vessel-CV (anterior) meridians via the adrenals exert 90% control on how innate integrates and distributes healing energy throughout the body.

Causes of Allergic and Inflammatory Disorders

The adrenal-kidney yang influence on the CV and GV meridians and free flow of liver energy explains why many patients with hypoadrenia don’t hold adjustments or are extremely difficult to adjust in the cervical and thoracic spine. The adrenals extend their defensive armor against stressors (including toxic chemicals and chaotic frequencies) into the energetic system of the body, whereby the musculature of the chest and upper back (pericardium energetic zone) becomes chronically constricted.

Since hypoadrenia causes chronic and prolonged infection and unwanted inflammation (root causes of cardiovascular and many degenerative diseases) and has a powerful influence on the flow of innate healing energies, a pre-adjustment technique to activate the full range of innate healing is highly desirable. Hypoadrenia causes excessive or stagnant energy to build up in the liver, thereby inhibiting enzymatic detoxification and steroidogenesis (the formation of hormones) and triggering a wide spectrum of allergic and pro-inflammatory disorders.

The daily stresses that wear down the adrenals and our physical and emotional constitution are compensated by GV and CV “safety energy circuits” located in the sacrum and cranium. Functioning as circuit breakers, they protect the body and activate innate healing against the damage caused by stressors. Vertebrae subluxations can be viewed as the consequence of sacral subluxations or brain interferences caused by an overload of these protective circuits.

The Quantum Repatterning Technique™ (QRT) utilizes a simple and fast 10-minute pre-adjustment Sacral-Cranial Balancing protocol that acts as a jumper cable to restart the flow of energy through the GV and CV “broken circuits” and relax sacral muscles and ligaments, so that sacral adjustments are made with ease and without force. Once the sacrum is balanced, increasing muscle flexibility allows adjustments to really open up the cervical, thoracic and lumbar vertebrae.

This pre-adjustment technique is based on decades of research in brain-organ proprioception, electro acupuncture, and chiropractic. D.D. Palmer, George Goodheart, M.T. Morter and others viewed sacral and brain interferences as the primary sources of nerve interference.  In just ten minutes, this amazing technique allows the muscles of the pelvis and neck to relax,with hypertonic and hyportonic “left-right” discrepancies realigned. Commonly, the patient reports a rapid, pulsating release of stagnant energy and dramatic improvements in the flexibility and range of motion of the sacrum and the entire spine. As one patient noted, “It’s stress without distress!”  This amazing resilience to stress is a result of a balanced body with balanced hormones from the adrenal-guided process of steroidogenesis.

NOTE: To learn more about Dr. Yanick’s Cranial-Sacral Pre-Adjustment protocol, read his manual, The Quantum Repatterning Technique, available at www.quantumenergy.com.

Dr. Yanick is a world renowned expert on and founder of Quantum Medicine and QRT.  He has published extensively on Quantum Medicine.  You may contact Dr. Yanick by fax at 845-340-8606 or e-mail at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Visit www.quantumenergy.com for more information.

 
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