Techniques


Scoliosis Correction - CLEAR Solutions
Techniques
Written by Dennis Woggon, DC, B.Sc.   
Saturday, 15 January 2005 00:07

Scoliosis is a dis-ease of the neuro-muscular skeletal system. The medical “Gold Standard” of treatment, which is bracing and surgery, has few positive results.  As spinal experts, the chiropractic profession should take the lead in the correction and stabilization of the scoliotic patient.

90% of the time the scoliosis patient presents with a standard posture; forward head posture, right head tilt, right high shoulder, right thoracic Cobb angle, left lumbo-dorsal Cobb angle, right posterior and left anterior hips sitting, and the opposite hip displacement standing.

Abnormal subluxation patterns and abnormal spinal biomechanics are present.  The active scoliosis usually presents with forward head posture and a loss of cervical lordosis.  The occiput and atlas have an extension malposition (posterior occiput).  This has a subluxation effect on the proprioceptive spinocerebeller loop, resulting in dysponesis in spinal growth torsion (idiopathic scoliosis).

Treatment

The forward head posture and loss of lordosis always precedes the scoliosis.  Therefore, before the A-P dimension of the scoliosis can be corrected, the cervical lordosis must first be re-established!  It is possible to change this abnormal position by re-training the nervous system.
Many scoliosis patients have a “Librarian Posture”, looking from the top of their ocular orbits.  This can be corrected by putting tape on the inside, superior half of a pair of glasses.   

The spinouses rotate into the concave rather than the convex side.  This abnormal rotation decreases abnormal mechanical tension on the nervous system.

Unfortunately, chiropractic manipulation frequently makes the condition worse by mobilizing fixated, compensated vertebra.  Adjusting on the “high side of the rainbow” is contraindicated.

A retrospective case series, entitled "Scoliosis treatment, using a combination of manipulative and rehabilitative therapy", by Mark Morningstar, Dennis Woggon and Gary Lawrence, was published in BMC Musculoskeletal Disorders, on September 14, 2004.  19 patients were monitored with scoliosis ranging from 15 to 52 degree Cobb angles.  After 4 to 6 weeks, there was an average reduction of 62% or 17 degrees.  8 of the 19 patients were no longer classified as scoliotic.

In order to achieve these results, specific chiropractic adjustments were provided along with rehabilitative procedures.  These procedures included specific spinal isometric exercises, proprioceptive neuromuscular re-education, cervical and lumbar lordosis restoration, muscle and ligament rehab and vibration therapy. 

A Scoliosis Spinal Weighting System is used with therapeutic glasses, shoulder weights and hip weights.  The scoliotic spine compresses and rotates 3-dimensioanlly.  To correct this, the spine must be tractioned and de-rotated.

A vibrating platform with mechanical spinal traction is utilized to decompress and de-rotate the spine simultaneously.

This also accomplished with a Vibrating Scoliosis Traction Chair.  The patient is placed in a chair on a vibrating platform on an air cushion.  Braces are used to pull the Cobb angles into the proper alignment.  The patient is then tractioned, while going through dynamic motion.  The vibratory effect overrides the body’s proprioceptive defenses.  This is done once a day for 20 minutes, compared to wearing a scoliosis brace for 23 hours.

Contrary to medical misinformation, scoliosis correction is not age dependant and does not stop at osseous maturity.  The ages of the patients we have worked with in our Clinic vary from 4 to 73 years old. 

Case Study

The following patient was a 44 year-old female.  The correction was accomplished in 8 weeks.

The protocols followed were specific spinal adjustments, cervical and lumbar lordosis restoration, specific spinal isometric exercises, proprioceptive neuromuscular re-education, muscle and ligament rehab and vibration therapy.

For more information, there is a free scoliosis download at www.clear-institute.com.  For more information about the Scoliosis Correction Seminar schedule, contact Michelle Youngblut at the Postgraduate department of Parker College of Chiropractic, 800-266-4723.  Dr. Woggon can be reached at 437 North 33rd Avenue, St. Cloud, MN 56303; call 320-252-5599; email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
Chiropractic Biophysics (CBP) Mirror Image Posture Adjusting
Techniques
Written by Deed E. Harrison, DC   
Tuesday, 14 December 2004 22:56

Posture is used by many in chiropractic to demonstrate to the patient that their structure is in abnormal alignment; e.g., health fair and mall screenings, plumb line analysis, visual analysis, and computerized plumb line analysis. However, few DC’s use the scientific analysis of head, rib cage, and pelvis postures in three-dimensions (3D) as rotations and translations along the three X, Y, and Z axes, such as performed by the Biotonix PosturePrintTM. In the early 1980’s, Dr. Don Harrison categorized human postures using this analysis.1,2

In CBP® Technique, we believe that the global postural subluxations (rotations and translations of the head, rib cage, and pelvis) are often missed, ignored, or assumed unrelated to a patient’s pre-senting condition by the evaluating doctor and, thus, are left uncorrected. In 1980, my father originated what was termed Mirror Image® adjustments, Mirror Image® exercises, and Mirror Image® traction to correct these global subluxations.1,2  Since becoming a DC, in 1996, I have added to these Mirror Image® procedures.3

There are some in chiropractic, who do not appreciate that abnormal postural displacements of the head, rib cage, and pelvis are, indeed, subluxations. In chiropractic, there are two parts to the definition of subluxation: 1) bone out of place from normal and 2) causes nerve interference.
 
1) Bone out of place: In kinematics research on the spine, it is known that a main motion (postural displacement) is needed to cause displacement of the spinal segments (coupled motion). For example, the main motion of anterior head translation (AHT) is known to cause a specific vertebral displacement pattern.4-6 With AHT, the lower cervical vertebra (C5-C7) will flex and the cervical segments C0-C4 will extend.4-6 In Figure 1, A-C, the coupling patterns for AHT are depicted. In Figure 1A, the neutral ideal alignment of the cervical spine is shown. In Figure 2B and C, a large amount of AHT is present. In large AHT subluxations (usually above 50 mm), the lower cervical spine will appear kyphotic and the upper cervical spine will be slightly lordotic. Thus, large head translations give the appearance of an S-curve with a lower cervical spine reversal.

2) Nerve Interference: My friends and colleagues, Dr. Dan Murphy and Dr. Chris Colloca, have outlined the neurological consequences of abnormal/asymmetrical posture via altered mechanoreceptor activity from spinal tissues8-12; while I (and co-authors)13-15 have written extensively about abnormal stresses and strains that the central nervous system experien-ces as a consequence of abnormal postures.

From the above brief review, it is apparent that postural displacements (main motion) with associated vertebral displacement (coupled motions) can cause altered nerve firing and abnormal nerve interference. Thus, postural displacements satisfy the historical definition of subluxation: bone out of place cause, nervous system interference. It may be obvious, but let me state that, to correct these global postural subluxations with CBP® Mirror Image® procedures, one must first determine exactly the directions of the rotations and translations of the global postural parts (head, rib cage, & pelvis).

In our seminars, we teach the separate rotations and translations of the head, rib cage, and pelvis, because of their complexity. While, in actual practice, we usually perform one full-spine lateral adjustment and one full-spine AP adjustment. This incorporates several postures at once and is more efficient.

To illustrate this idea, consider the common lateral posture in Figure 2.  This posture is composed of (1) a forward head posture (+TzH), (2) a posterior translation of the rib cage (-TzT), and (3) a forward translation of the pelvis (+TzP).  All these postures can be placed in their Mirror Image® for one set-up (see Figure 3).

Next,  I  wish to illustrate one common full-spine Mirror Image® set-up. Figure 4 illustrates a common AP posture, which is composed of a right low shoulder (right thoracic cage lateral flexion) and left head tilt (left lateral bending). Figure 5 depicts the CBP® Mirror Image® set-up/adjustment for this particular AP posture.

In summary, Mirror Image® postural set-ups/adjustments are unique in CBP® Technique. These methods were originated by Dr. Don Harrison in the early 1980’s. These set-ups/adjustments are the exact opposite posture (or in difficult cases, these may be in a more stressed position) of the patient’s initial presenting posture. While most doctors evaluate posture, they have not been taught the logical Mirror Image® methods that can result in routine postural correction. CBP® can make this claim of routine postural correction because we have investigated our methods with research designs. CBP® is the most published technique in the Index Medicus with over 80 published or in press research papers, of which six are Clinical Control Trials16-21 and five are Case Studies (these are available online at www.idealspine.com).

Deed E. Harrison, D.C., graduated from Life-West Chiropractic College in 1996. He has authored nearly 70 peer reviewed research articles in journals such as: the JMPT, Spine, Clinical Biomechanics, etc. Dr. Harrison is a manuscript reviewer for the orthopedic journals Spine and Clinical Anatomy. He is a member of The International Society for the Study of the Lumbar Spine (ISSLS) and is a lead instructor for CBP® Seminars.

References:

1. Harrison DD.  CBP® Technique: The Physics of Spinal Correction. National Library of Medicine #WE 725 4318C, 1982-97.
2. Harrison DD.  Spinal Biomechanics: A Chiropractic Perspective. National Library of Medicine #WE 725 4318C, 1982-97.
3. Harrison DE, Harrison DD, Haas JW.  CBP Structural Rehabilitation of the Cervical Spine. Evanston, WY: Harrison CBP Seminars, Inc., 2002, ISBN 0-9721314-0-X.
4. Ordway NR, et al. Cervical flexion, extension, protrusion, and retraction. A radiographic segmental analysis. Spine 1999;24:240-247.
5. Penning L. Normal movements of the cervical spine. Am J Roentgenol 1978;130:317-326.
6. Penning L. Kinematics of cervical spine injury. A functional radiological hypothesis. Eur Spine J 1995;4:126-132.
7. Harrison DD, Harrison DE, Janik TJ, Cailliet R, Haas JW, Ferrantelli J, Holland B. Modeling of the Sagittal Cervical Spine as a Method to Discriminate Hypo-Lordosis:  Results of Elliptical and Circular Modeling in 72 Asymptomatic Subjects, 52 Acute Neck Pain Subjects, and 70 Chronic Neck Pain Subjects. Spine 2004; 29(22):2485-92.
8. McLain RF (1994) Mechanoreceptor endings in human cervical facet joints. Spine 19:495-501.43.
9. McLain RF, Pickar JG (1998) Mechanoreceptor endings in human thoracic and lumbar facet joints. Spine 23:168-173.
10. Mendel T, Wink CS, Zimny ML (1992) Neural elements in human cervical intervertebral discs. Spine 17:132-135.
11. Perret C, Robert J (2001) Neurophysiological mechanism of the unloading reflex as a prognostic factor in the early stages of idiopathic adolescent scoliosis. Eur Spine J 10:363-365.
12. Roberts S, Eisenstein SM, Menage J, Evans EH, Ashton IK (1995) Mechanoreceptors in intervertebral discs. Morphology, distribution, and neuropeptides. Spine 20:2645-2651
13. Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A Review of Biomechanics of  the Central Nervous System.  PART I: Spinal Canal Deformations Due to Changes  in Posture. J Manipulative Physiol Ther 1999; 22(4):227-234.
14. Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A Review of Biomechanics of  the Central Nervous System.  PART II: Strains in the Spinal Cord from Postural Loads. J Manipulative Physiol Ther 1999; 22(5):322-332.
15. Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A Review of Biomechanics of the Central Nervous System.. PART III:  Neurologic Effects of Stresses and Strains.  J Manipulative Physiol Ther 1999; 22(6):399-410.
16. Harrison DE, Cailliet R, Betz JW, Harrison DD, Haas JW, Janik TJ, Holland B. Harrison Mirror Image Methods for Correcting Trunk List: A Non-randomized Clinical Control Trial. Eur Spine J 2004; In Press.
17. Harrison DE, Harrison DD, Haas JW, Betz JW, Janik TJ, Holland B. Conservative Methods to Correct Lateral Translations of the Head: A Non-randomized Clinical Control Trial. J Rehab Res Devel 2004;41(4):631-640.
18. Harrison DE, Harrison DD, Betz J, Janik TJ, Holland B, Colloca C. Increasing the Cervical Lordosis with CBP Seated Combined Extension-Compression and Transverse Load Cervical Traction with Cervical Manipulation: Non-randomized Clinical Control Trial. J  Manipulative Physiol Ther 2003; 26(3): 139-151.
19. Harrison DE, Harrison DD, Cailliet R, Janik TJ, Holland B. Changes in Sagittal Lumbar Configuration with a New Method of Extension Traction: Non-randomized Clinical Control Trial. Arch Phys Med Rehab 2002; 83(11): 1585-1591.
20. Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. New 3-Point Bending Traction Method of Restoring Cervical Lordosis Combined with Cervical Manipulation: Non-randomized Clinical Control Trial. Arch Phys Med Rehab 2002; 83(4): 447-453.
21. Harrison DD, Jackson BL, Troyanovich SJ, Robertson GA, DeGeorge D, Barker WF. The Efficacy of Cervical Extension-Compression Traction Combined with Diversified Manipulation and Drop Table Adjustments in the Rehabilitation of Cervical Lordosis. J Manipulative Physiol Ther 1994; 17(7): 454-464.

 
Chiropractic & Carpal Tunnel Syndrome
Techniques
Written by Dr. Mitch Mally   
Sunday, 14 November 2004 22:26

When attempting to gain entry into the industrial health care delivery system for the treatment, rehabilitation and prevention of repetitive stress injuries (RSI’s), the chiropractor must first know how to diagnose differentially, follow a standard protocol, be prepared to disclose how many cases he/she has successfully treated and provide references, as well as identify additional specialized training and expertise in the field of RSI’s and cumulative trauma disorders (CTD’s).

Epidemiologically, reports indicate that RSI’s and CTD’s constitute the highest incidence of occupational injuries. The serious magnitude of CTD’s in the workplace has, according to many, reached “epidemic proportions.”

The United States Department of Labor, Bureau of Labor Statistics (BLS), released a survey of occupational illnesses and injuries indicating that, “Over the past several years, disorders associated with repeated trauma have increased significantly, both in number and as a percentage of total occupational illnesses reported.”

According to the Occupational Safety and Health Administration (OSHA), the survey reveals increases in rates of occupa-tional injuries and illnesses, as a direct result of an em-phasis on more accurate record keeping and focus on job safety and health. The results also demonstrated parallel increases in injuries reported to the industries that OSHA targeted for its vigorous enforcement.

There exist several functional facts and fictional fantasies regarding the diagnosis, treatment, rehabilitation and case management for RSI/CTD patients. There will always be philosophical and clinical diversity among chiropractic and allopathic practitioners. Moreover, treatment options vary significantly from nutrition, manipulation of the carpals, physical therapy, flexible splinting and ergonomic recommendations while on the job, to off work cortisone injection, rigid splinting, NSAID’s, surgery and re-operations.

With the advent of specialized X-Rays of the carpal tunnel (X-POSER) that clearly demonstrate the osseous occlusion and biomechanical collapse of the carpal arch, optional MRI confirms the soft tissue components by visualization, flattening and increased signal intensity of the median nerve and a characteristic palmar bowing of the flexor retinaculum. A detailed history should include occupational, domestic, habitual and athletic relative questioning, orthopedic testing, nerve conduction velocity (NCV) to differentially diagnose CTS from the four other less common median nerve entrapments from the elbow to the hand (Pronator Teres Syndrome, Anterior Interosseous Syndrome, Palmar Fascitis, Collateral Digital Nerve Syndrome).

While other conditions may contribute to or mimic CTS, remember that the definition of CTS is median nerve entrapment at the wrist, etiologically the result of a decrease in the size of the carpal tunnel and/or an increase in the contents therein.

Treating Carpal Tunnel Syndrome

As previously noted, chiropractic treatment should include physical therapy, nutrition (bromelain, papain, trypsin, chymotrypsin, citrus bioflavonoids and vitamin B6) and Low Level Laser Therapy that dramatically reduces inflammation, improves circulation, accelerates recovery, reduces scar tissue and promotes healing by stimulating the immune system.

A quandary over which laser technology to purchase exists, ranging from laser pointer wavelength frequencies of 630-650 nm to the most effective laser with 830-850 nm wavelength. For more accurate information, visit the FDA website, and review the FDA clearance and statements on the various laser products and companies. Do your homework!!!

Rehabilitation varies from puddy to weights. However, I, personally, utilize an in-office state-of-the-art system that trains the patient during rehab; and, after 4 weeks (3x/wk), I equip the patient with a home unit for continued compliance. Patients are sent home with a written colored pictorial guide, treatment plan and progress forms on NCR paper and are required to provide the doctor with copies of the prescribed and completed exercises.

For more information on advanced techniques, products and Dr. Mally’s 2005 seminars, including the all new 1 on 1 seminars, please e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
Energize Your Practice with Active Release Techniques (ART)
Techniques
Written by Anthony Criscuolo, DC   
Sunday, 14 November 2004 22:24

How would you like to dramatically improve your patient outcomes and have patients enthusiastic about their treatment?  Would you like to see positive post treatment changes in range of motion, muscle strength, and pain in one treatment?  Well, thousands of doctors have discovered these benefits and more by utilizing ART in their practices.

So, what is ART?

ART is a hands-on touch and case management system, which trains the practitioner to accurately diagnose and effectively treat most soft tissue injuries.  It differs from many other soft tissue techniques in not only the principles and application, but also in the training.  It is so different that it has been granted a patent.  ART providers learn to use their hands to evaluate the texture, tension, and movement of tendons, ligaments, muscle, fascia, and nerves.  I often say that an ART provider is like a “soft tissue detective”. 

Who developed ART?

P. Michael Leahy, DC, developed ART by combining his knowledge and education in both engineering and chiropractic.  Dr. Leahy believed that professional education for the treatment of muscle, tendon, fascia and nerve had generally been neglected.  The early successes achieved with the treatment by Dr. Leahy propelled him to not only further his own understanding, but to train others.  Dr. Leahy also developed the Law of Repetitive Motion and the Cumulative Injury Cycle to describe the mechanism of repetitive stress or motion injuries.  The cost for treatment of these injuries in North America alone exceeds $200 billion dollars.  With the proper evaluation and treatment, these costs can drastically be reduced.  That is one of the goals of ART.

What kinds of patients or conditions respond to ART?

The highest profile is the athlete.  Many athletes suffer from repetitive strain disorders due to the nature of their training or competition.  The efficacy of ART treatment for sports injuries is demonstrated by the demand for ART by all levels of athletes.  Many professional teams have employed ART providers as part of their medical staff.  Athletes of all ages and levels of competition are able to return to play much quicker after an injury following treatment with ART.  In fact, ART is very often the only treatment that allows an athlete to return when all other interventions have failed.

How about work related injuries?

A large number of insurance carriers are contracting exclusively with ART providers to treat their worker’s compensation claims.  Why?  Better patient outcomes and reduced treatment costs.  One insurance carrier I work with shared their treatment savings of $440,000 on fourteen work-related cases of carpal tunnel symptoms.  And what about those chronic cases hanging around your office?  They will quickly resolve and be very appreciative of your new training.  Due to overwhelming telephone inquiries from potential patients to locate an ART provider in their area, the ART website has a provider locator.  This is also very useful for locating ART providers for your patients when they travel or move.

How can you train to become an ART provider?

The training involves three separate modules–upper extremity, lower extremity, and spine.  Each module includes a workbook and DVD with all the module protocols.  Each workshop runs from Thursday through Saturday with testing on Sunday.  Each module has its own written and hands-on practical examination.  There are two highly trained instructors for every 10-14 seminar attendees, which is necessary to provide and insure the quality of the hands-on instruction. By the time a practitioner successfully completes the training, they will be trained to treat over 300 muscular injuries and 100 nerve entrapments.  There is even an advanced level training program called Performance Care, in which providers evaluate the body in motion and treat sites preventing optimum performance.  Currently, there are two seminars per month presented in locations worldwide.  The seminar schedule is posted at www.activerelease.com.
 
How can I learn more?

By going to the official website— www.activerelease.com.

 
Go to the Source of Subluxation with Neuromuscular Reeducation
Techniques
Written by Peter J. Levy, D.C.   
Tuesday, 14 September 2004 21:43

Are you looking for a way to improve your skills?  Get patients better faster? Build a large referral base? Have a cash practice? Charge what you’re worth?

Read on!!!

What is the answer to the ongoing problems with insurance companies, work comp, personal injury and the volumes of paperwork and billing required?  How do you, the practitioner, actually get someone better quickly and efficiently and charge cash?   How do you generate a “ waiting list” practice?

Neuromuscular Reeducationsm is a “stand-alone” hands-on technique/approach to the evaluation and functional treatment of 90+% of the soft tissue injuries a professional will see in practice. Every muscle in the body is surrounded by a smooth fascial sheath; every muscular fascicule and fibril is surrounded by fascia that can exert pressures of over 2,000 pounds per square inch. When an area is injured, whether it’s muscle, connective tissue, fascia, tendon or some combination of these elements (as most injuries are), the body handles this inflammatory response of the tissues to trauma the only way it knows how, through a hyperplasia of the affected tissue followed by a fibrous healing, the laying down of a less elastic, second grade, poorly vascularized scar tissue to protect the involved areas. Adhesions occur wherever damage and inflammation have occurred and they limit both strength and range of motion.

Once there is fibrous healing, these adhesions pull us out of a three-dimensional orientation with gravity. As a muscle tendon begins to stretch and encounters an adhesion, the muscle contracts to prevent any further stretching and to protect the area involved. The result is that the muscles involved are not as strong and the range of motion is limited in the involved joint. Adhesions can affect areas that are quite small, sometimes just a few muscle fibers and, other times, there can be a number of areas like that scattered throughout a muscle group.

So you think you know what Neuromuscular Reeducationsm  is? When a patient comes in with an arm that doesn’t abduct and there is no bony involvement, can you name the three abductors of the arm at the shoulder joint?  If working on those three muscles, supraspinatus, deltoid and long head of the biceps when the arm is externally rotated doesn’t make a difference, what one muscle would you work on next to have a 90% chance of success?  Subscapularis!

“How could that be?” you might ask.  “Subscapularis is an internal rotator of the arm at the shoulder joint.”  And when you work on the subscapularis and, within a minute, their arm easily abducts up over their head, what do you do next?

Neuromuscular Reeducationsm got its start almost twenty years ago.  Its developer, Dr. Gary Glum, worked on many of the top athletes in the highly competitive world of professional athletics:  Football, baseball, track and field, weight lifting and more. People came to him needing fast relief from their problems and wanting to be “back on the field” in short order. 

That’s where this particular technique sets itself apart. Doctors need an easy way to figure out which muscles are involved in the area of complaint and then an easy way to apply the technique. They need to be able to quickly evaluate and treat the involved area and generate RESULTS (read pain relief, ease of motion or increased flexibility), so that the patient is perfectly clear that they are in the hands of a highly skilled practitioner. After the first one or two visits, the doctor has narrowed down the involved musculature in the given area and a high percentage of patients experience, by their own record keeping, a 50%-80% improvement of their symptoms. Enough of a dramatic improvement to have them singing your praises…and coming back to have other parts of their body restored to the same level of flexibility as the newly restored area you just worked on. Do superb soft tissue work and then bring on the magic of a great, specific adjustment. There is no better combination and your patients will know it.

The actual technique requires a highly specific knowledge of the musculo-skeletal system and is taught through a seventeen-hour, hands-on seminar. That’s the best way to learn where, how and to what extent to apply the work.

Knowing the muscles of a given area, the origins, insertions, actions and synergists…that’s our bread and butter. We own that body of work…and a little review, particularly in this class, brings it all back quickly. The involved joint is gently moved through the entire range of motion, deep pressure is applied to specific areas of all of the muscles that cross the joint, not just where there is pain, and particular attention is paid to the origin and insertion points of each muscle as well as its function.

For more information and 2004 seminar schedule, go to www.neuromuscularreeducation.com or call Dr. Peter J. Levy, D.C. directly at 800-304-4NMR.

 
«StartPrev11121314151617181920NextEnd»

Page 17 of 20
 
TAC Cover
TCA Cover
BL Cover

Click on image above
to view the
Digital Edition


Advertisement

Advertisement

requestmagazinebutton

 

TAC Publications

The American Chiropractor Magazine: Digital Issues | Past Issues | Buyer's Guide

 

More Information

TAC Editorial: About | Circulation | Contact

Sales: Advertising | Subscriptions | Media Kit