Friday, June 26, 2009

Website Practice Article – November 2008

DYNAMIC CHIROPRACTIC CONCEPTS – Review Part II

Every biological system is constantly striving to be normal.

1) Biological systems have specific essential needs to function normally.
2) A constant or repeated imposed demand on a biological system, causes a specific
adaptation. S.A.I.D. PRINCIPLE
3) Adjusting is about changing the dynamic function of spinal and extremity motion
units.
4) Joint motion is positive or negative rotation around an X, Y, or Z-axis, and translation
along an axis. Most motions are coupled.
5) A motion unit can be hypomobile in one direction and hypermobile in another
direction.
6) A closed kinematic system can compensate within the system, to perform gross
ranges of movement in an abnormal fashion.
7) Joint dysfunction is a major etiological factor in degenerative joint disease,
radiculopathies, facilitated sympathetics, and the de-afferentation syndromes.
8) Hypomobility of a joint, progress from a muscular hypertonicity, spasm, fibrotic
degeneration, ligamentous inelasticity, overall joint degeneration leading to calcific
ankylosis. (Pathogenesis).
9) Correcting primary fixations (dysfunction), decreases the secondary compensatory
muscular fixations. These are often immediate changes.
10) Correcting secondary fixations causes a reaction as the compensation is a
necessary part of the closed kinematic adaptation.( These are the so-called
adjustments that “don’t hold”).
11) We adjust into the restrictions, often with multiple thrusts in one motion unit around
different axes. Tensing the restriction automatically tenses all the components of the
restrictive tissues so that the force delivered, arrives at the correct destination.
These components of force are too complex for our researchers to describe
completely so far. Dr. J. Triano et al. have published what has been done so far.
12) The pain response of the so-called manipulable lesion is the same as for the loss of
joint play as described by J. Mennell MD. Pain on challenging the restriction, that
goes away immediately the challenge is removed, is a positive indication. Pain that
lingers, is a sign of inflammation. Differentiate the site of inflammation: intra
articular/ligament, tendon/muscle, and neural or other non-manipulable pathologies.
13) Normal ligaments are never painful.
14) Soft tissues heal better and differently with motion. R.B. Salter.
15) Nerves pain when they are inflamed, stretched or chemically irritated. Compressive
pressure causes paresthesia (numbness) and atrophy.
16) Irritated sympathetics become facilitated and override “Shut Off” the
parasympathetics. Facilitated sympathetics cause the release of norepinepherine
and prolongs inflammation.
17) Chronic sympathecatonia leads to a failed G.A.S. and terminal diseases develop as
described by Dr. Hans Selye M.D. The Stress of Life
18) HOLISTIC VITALISM DOES NOT HAVE TO BE UNSCIENTIFIC AND
METAPHYSICAL as medicine would have the world believe.

LEARNING A PSYCHOMOTOR SKILL

1) Levels of learning: a) Unaware, unknown…Grade Level 0
b) Conscious awareness, no skill, (non-starters). Grade Level 1
c) Conscious incompetence, (quitters)…Grade Level 2-4
d) Conscious competence…Grade Level 5-9 Student Clinician
e) Unconscious competence (professional)…Grade Level 10
2) Be self-critical: make a list of all the procedures and techniques and grade your
skill level.
3) For each new technique:
a) Understand the biomechanics.
b) Learn to differentiate the hard, resistive, endplay of the loss of joint-play from the
normal jiggle present in a normal joint.
c) Recognize the component parts of the technique and practice the components
slowly and correctly.
d) Visualize the components flowing together and gradually increase the speed of
performing the complete adjustment.
e) Practice daily.
f) Grade your performance and record it on your list.
g) Continually work to soften your hands and contacts to achieve painless, smooth
adjustments.
h) Develop IMPULSE, BODY DROP, SHOULDER DROP, RECOIL, and
DROPPING YOUR BODY as methods of delivering the adjustive forces.
i) Learn comfortable lock-point and pre-thrust tension positions that determine the
line of drive.
j) Never thrust into a line of drive, like a hammer at a nail. Feel the resistance and
know the gapping can occur. Hammering hurts.
k) The objective is a high velocity, low amplitude thrust that gaps the joint and
causes cavitation and the resultant increase in joint function and afferentation to
normalize the closed kinematic system.



THE ADJUSTMENT

We will consider a procedure that causes an audible gapping of a joint, an adjustment.
An adjustment can be therapeutic or non-therapeutic, depending on the state of the joint
being adjusted. A long or short lever, with high or low velocity and with low or high
amplitude can deliver the force used to achieve an adjustment. Manipulation will be
considered a synonym. These HVLA adjustments cause the greatest afferentation from
the joint mechano receptors.

Mobilization is the non-audible version of an adjustment or manipulation. It does not
increase the mobility as dramatically, but it does have therapeutic value. It usually
employs long levers and low velocity forc es. Mechanical devices have been shown to
cause movement in joints but fail to produce the audible cavitation of an adjustment;
therefore they are a mobilization using short levers, high velocity and low amplitude. It is
estimated over thirty percent of our profession use mechanical devices in their
treatment procedures.


Traction is usually the application of a low velocity force along an axis of translation and
uses time to produce a creep effect to decompress a motion unit. Intermittent traction
will also stimulate the mechano-receptors. Experiments with the Leander motorized
traction table proved joints adjust with about fifty percent less force when distracted.

Soft tissue techniques, stretching, exercise, diet and life style advice all get woven into
the fabric of a chiropractic office visit.


THE THRUSTS

Impulse vs. Fast Hands
Impulse creates very high velocity with very low amplitude, which is the ultimate goal.
Fast hands are relatively slower and dramatically higher amplitude.

Body Drop plus impulse

Shoulder Drop plus impulse

Recoil

Long Lever with low velocity



PRE-ADJUSTMENT CHOICE OF TECHNIQUE

I like to follow the advice of Henri Gillet and adjust the most fixated motion unit in the
spinal / extremity, locomotor system. This means attempting to free all the ranges of
motion in the motion unit in the one office visit. By observing the response, immediately
and at the next visit, one can determine the significance of the adjustments given. I
choose the technique that increases the lost rotation motion around a specific axis and
allows the softest contact and least pain to the patient.

Sometimes the coupled motion is involved and more than one elem ent of fixation is
addressed at the same time. This approach is the most difficult for doctors to put into
practice. Try to explain more; adjust less, for the overall response in the closed
kinematic system. Less is more.

In my opinion it is worse to leave a motion unit partially adjusted and partially adjust
many motion units this way. It is better to improve the function at one level as much as
possible and demand the most adaptation to the new afferent feed-back into the spinal
cord and central nervous system. It is not uncommon after changing the dynamic
function of the sacroiliac joints to find much less sub-occipital muscle tension, enough to
relieve headaches.

The more technique you can deliver at the competent conscious level at least, the
easier it is to choose the most comfortable and effective adjustments.


The PAIN RESPONSE to motion palpation at the level of the adjustment is significant
and must be differentiated from the pain of inflammation. Pain response by the patient
has a high level of inter-examiner reliability.

Technique is now being described as muscle assisted or resisted. As far as I can tell
from my own experience this does not play a part in helping me choose a specific
technique. It could determine whether you wish to move the upper portion of a motion
unit or the lower portion. i.e. C7 with T1 or T1 with T2. Muscle assisted moves the lower
and muscle resisted the upper.

Since motion assisted adjusting requires about half the force, I use this method as often
as possible.



DYNAMICS vs. STATICS

The significance of curve analysis to my way of thinking (paradigm) is more like a way
of keeping score. You can’t just change the score. You change the processes that lead
up to a change in the score. The resting position of the dynamic system determines the
static picture. To change the static picture you have to change the dynamic function. I
prefer to analyze the biomechanical function and restore the dysfunctions towards
normal than to thrust according to a listing from the static analys is.

No matter the intent, both adjustments will change the dynamic function of the spine, if
the dysfunction is a primary fault in the closed kinematic system. If the adjustment is in
the compensated area of the closed kinematic system, then the compensation re-
establishes itself and little changes. There are obviously static and dynamic norms,
which we ideally strive towards.

CLOSED KINEMATIC SYSTEM

Understanding the spinal column is in dynamic co-ordination with our extremities and
its’ own intersegmental movements is the key to full spine and extremity adjusting, soft
tissue work, neuromuscular re-education, stretching, rehabilitation, etc. etc.

THE MANIPULATIVE LESION

The dysfunctional, hypomobile joints of the closed kinematic locomotor system are the
joints we adjust. They are usually pain free at rest, feel restricted at end range and pain
when tested for springy end-feel. This end-feel pain response is relieved immediately on
removing test tension. The reason for the restriction of motion can be purely muscular.
As the joint progresses, in its’ pathogenesis, the ligaments restrict the range, and finally
degenerative changes cause a loss of freedom of movement. We encourage the use of
a double diagnosis to co-relate the findings of the biomechanical insults and the stage
of the pathology. Often a hypermobility develops in one or more range of motion in the
motion unit.



THE AUDIBLE RELEASE

The load separation graphs of researchers have put to rest the idea a non-audible
adjustment is the same as an audible separation of a joint



S.A.I.D.

The Specific Adaptation to an Imposed Demand. This law of nature is why we need
treatment schedules of three times a week, reducing to two times a week and so on.
Failure to understand the dynamics of this Law, makes forming treatment schedules
and estimating prognoses, a conflict that destroys the confidence of many chiropractors.




THE ORTHO-NEURO EXAM

It is impossible to judge the stage of the pathology and pr edict with any accuracy the
treatment schedules needed and for how long, without conducting an adequate
orthopedic, functional assessment and neurological examination. These findings will
determine the x-rays and other tests required to make decisions that are in the patients’
best interest.

Neurologically we need to know the areas where the nerves are compressed or
facilitated and can they recover? Or, are the neural effects entirely de-afferentation and
the articular neural mechanisms not normal. The classic tests interpreted by a
chiropractor can have different significance than to a non-chiropractor. Know the
difference.



CONTRA INDICATIONS TO ADJUSTING PROCEDURES

Besides the classic list we need not discuss, I wish to emphasize the failure to stop
adjusting a motion unit that continues to “need an adjustment”. It is compensation and
you need to find the cause of this recurring fixation. It can be biomechanical, a response
to an allergen, a viscero-somatic reflex, etc. Stop adjusting the same segment over and
over again. Investigate, investigate and inves tigate some more. Refer if you can’t solve
the problem, because there is one for sure.








COMMENT

These notes are not meant to be complete. My goal since I started teaching in 1967
was to help produce chiropractors that were comfortable with the western model of
pathology and the holistic, vitalistic concepts and practice procedures of Chiropractic.
The heuristic model of the “Subluxation Complex” demands that the practitioner is a
lifetime reader and implementer of rational concepts based on the evidence at hand.
There is no formula or method to follow.

Many doctors have chosen our path and many have specialized in one component of
the complex. I have chosen to be an expert in the clinical application and the execution
of the adjustment. We need competent practitioners and academic specialists. Make
your goal to get comfortable in this sea of relativity.

I have persisted in my teaching because I get great pleasure from hearing from past
students and doctors of their personal success. Success not only monetarily but also in
self-esteem.

Every patient should be given the opportunity to possess a normal, mobile, healthy
spine and the knowledge we can offer about health in general. The public is moving
towards so-called alternative methods. It is critical that we promote good health as the
result of a normal functioning spine, correct nutrition, life-style decisions and mental
attitudes in an unpolluted environment. Our enthusiasm must not wane. Start the
crusade with your patients in the college clinic and/or your practice; you will find the
attitude is contagious.

“BE THEIR FAMILY HEALTH COACH” Quote M. Percival D.C.

Don't forget to visit us at : http://chiropracticmentor.com

No comments:

Post a Comment