Since I have started teaching a 6th trimester class at a chiropractic college, I am once
again faced with the realization that the board examinations still insist upon asking
questions about Gonstead, Meric, and Upper Cervical - “LISTINGS.”
Everyone knows that a motion unit functions as rotations around the X, Y, and Z axes.
Adjusting, changes the motion dysfunction around these axes and re activates the
dysafferentation from the hypo mobile joints back to the CNS. Trying to improve a listing
by adjusting in the mirror opposite direction only begins to restore normal joint function.
Some motion units need to be adjusted for “PR” and “PL” because the motion unit can
not rotate from posterior to anterior, bilaterally. Another situation is that the motion unit
on the x-ray from which the listing is taken, can actually be quite mobile and not
dysfunctional. It doesn’t really need to be adjusted even though it rates a listing.
Listings lead the user away from actually working with the whole, closed kinematic,
locomotor system. Board exams like to regionalize technique and treatment, similar to
how insurance companies only like you to treat the painful, inflammatory component of
a patients’ condition. For example, a patient complaining of headaches may have very
dysfunctional sacroiliac joints that are causing a symptom producing, upper cervical
dysfunction. Restoring function to the S/I joints for the first few visits are not seen as
“medically necessary” by the insurance companies. They think like most others that
headaches come from the neck therefore only the neck should be treated.
Those of us in the functional model realize we are always treating the closed kinematic,
locomotor system. A dysfunction anywhere in the system will cause an adaptation by all
the other joints in the system. The adaptation is via the muscular system. Joints are
compelled to be rotated and tilted as part of the adaptation response. By trial and
observation we must find the single or multiple major dysfunctions to which the rest of
the system is adapting. These so called “Major” fixations and dysfunctions are treated
by a series of treatments, in order to get the specific changes to our treatments’
imposed demand….better known as the S.A.I.D. Principle.
For our soap notes we state the range of motion that is lost in a motion unit. For
example: C-5, C-6 lateral flexion and flexion. If I adjust that motion unit and get an
audible release I draw a small circle and place a check mark through it. If I don’t get an
audible release I place an “x” in the circle. Remember for best insurance
reimbursement, note what the patient reports at each visit, what your new assessment
is after testing for reflexes, springing pain, SLR, active ROM etc., all followed by
recording what you did and finally the next appointment and any home care instructions.
The old fashioned, so-called “travel card” is useless for recording proper soap notes.
When I did a little insurance work to see first hand why chiropractors had so much
trouble getting insurance payments, I was embarrassed by the abundance of absent or
ridiculously skimpy notes in patients’ files. If you show necessity and record what you
did on about 4 lines, your collection problems will be solved before they occur. The
comprehensive notes can be copied and mailed in as your report. Occasionally they will
request a full narrative report but not often. They move on past your patients’ case and
“attack” a poorly, substantiated case.
I write these notes in the case history file during the time I am with the patient. Don’t
leave them to do at the end of the day. It only takes a minute or two during the visit. All
needing attention at the end of the day takes an hour, if you had a busy day.
I like to change the order of SOAP. I like to say to a patient, “Sit on the palpation stool
and lets see what we need to do today” This is where I do most of my “objective” signs
such as motion palpation. I finish the tests that require a supine or prone posture and
then write in my findings and assessment of their status regarding the healing response.
Now if they haven’t already told me, I ask them how their specific symptoms are doing
and record by paraphrasing their comments. I then treat them and record what I did for
them.
Lastly I check off the treatment, diagnosis etc. on the 3 part super bill…one part for
them, one copy for them to send into the insurance company and one copy for our
business files. I hand them the three part form and ask them to give it to the front desk
so they can “settle up.” This form has the next visit day/date written in so that the front
desk person can book the next appointment.
Practice can be hassle free seeing 3 patients per half hour with three treatment rooms.
Super efficient doctors can give quality care seeing 3 patients every 20 minutes using 3
treatment rooms. My treatment rooms are 8’ x 12’ and have the modalities in each
room. My rehab is low tech and I get patients to purchase a gym ball for the core
exercise follow-up to the treatments that restored joint function and the reversal of the
inflammatory component of their condition. They all purchase a copy of “Goodbye Back
Pain” as their manual to a full recovery including core conditioning at the first visit.
“Goodbye Back Pain”, 2008 is available on Amazon.com (by Leonard J. Faye DC) .
Don't forget to visit us at: http://www.chiropracticmentor.com
Friday, June 26, 2009
Practice Article December 2008
Last month I was a keynote speaker for one of the sections of the World Federation of
Chiropractic Convention, held just outside Beijing, China. It was co-sponsored by the
World Health Organization and included representatives from Chinese Manual
Medicine. When we toured a combined traditional medical and Chinese medical
hospital, I was asked to explain chiropractic manipulation in 15 minutes. They had no
idea of the articular neurology and the biomechanics of the locomotor system as it
relates to manipulation.
The form of manipulation they demonstrated was called Chiuna and was mobilization
not producing any audible releases. Some of the stretching techniques were low force,
low amplitude lumbar rotation, which did produce audible releases quite often, the
doctor, said. The seated patients’ pelvis was held immobile with wide leather straps and
the spine was rotated, leaning forward from the waste. I wasn’t impressed.
My topic at the convention was on the subject of web-based distance learning of
chiropractic manipulation. There were representatives from most of the major colleges
from around the world. Only one college out of thirty, actually was employing video
presentations of the technique labs, which enables a student to pre-empt a class
presentation, as well as, review a lab presentation. Knowing what is going to be
presented, helps the learning of a psychomotor skill.
Practice makes perfect if the person is practicing perfectly. Practicing with a visual
reference is much better than trying to remember what was shown in the lab. Students
all learn psychomotor skills at different rates. By having a visual reference, the slower
learners of a certain skill can do extra review and practice. The goal is to be consciously
competent by clinic entrance. Without this method trimesters go by and skills not
learned in one tri are forgotten and never accomplished.
The videos I am familiar with, are the ones I made demonstrating Motion Palpation as
an indicator that a motion unit needs to be adjusted and in the specific directions it
needs to be adjusted. Yes, you read it right, DIRECTIONS. A motion unit allows
movement around the three axes in both directions. For example, flexion and extension
are two rotations around the x-axis. Rotation posterior to anterior and anterior to
posterior are two rotations around the y-axis. Joints have the ability to rest at a point
necessary to conform to our posture and the adaptation required by all the other joints
in the closed kinematic system. There is no absolute posture, we are always moving,
even in our sleep. To take a person and stand them in front of a bucky and take an
x-ray that is supposed to detect abnormal bone positions is very unscientific. The
result is a still picture of a mobile system. Reading this film can not tell us where
to adjust and around what axes to adjust.
I received some brochures about a technique that uses 4 full spine pictures to make an
analysis of posture sitting and standing. The guru stated that bones needed to be put
back in place, especially the ones misaligned anterior. The reason being no muscles
were designed to pull the vertebra backwards. What amazed me is that some people
were allowing him to use their names as satisfied customers.
I ask the question, “When are we going to relate chiropractic adjustments to
biomechanical dysfunction?”
In countries like Canada and Denmark where we do have a dominance of rational
chiropractors, the governments fund research and help us increase our knowledge
base. As a profession we can’t remain on the outside, with antiquated theories and
expect to survive.
Being in Beijing made me realize we are making great progress around the world but
here in the U.S.A. we have so many diverse groups all under the umbrella of
Chiropractic. Our associations are afraid to lose members by stating the rational,
scientific, evidence based model is what we promote. The religious fanatics who think
they can spin the atlas back to neutral and turn on innate, no matter what, are still
tolerated. Patients are getting joints cavitated, which are already mobile and normal.
Popping a normal joint is not therapeutic and prevents nothing.
The rest of the world is not steeped in the “Static” historical model. They change with
the discovery of new evidence and research. I am always hopeful that these articles will
help young doctors start out on the evolving path. I don’t want to be like B.J. Palmer. He
knew diddly-squat by comparison to a modern chiropractor. I understand he is a part of
our history and accept it as that. When I heard him speak in 1956 he was incoherent
and rambled on about the innate abilities of the body. It is called Physiology,
Biochemistry and the Immune System.
We are learning how Homeostasis is achieved and the relationship of the locomotor
system and the facilitation of the Sympathetic Nervous System and certain diseases
and syndromes. We are all pioneers in a very new field. We need to be rational and
realistic. We need to denounce the past and present nonsense and get on with the big
job at hand. Our job is to shift the paradigm both inside and outside the profession.
It is going to happen with or without us।
दोन'टी फोरगेट तो विसित उस अत ह्त्त्प://व्व्व.चिरोप्रक्टिक्मेंटर.कॉम
Chiropractic Convention, held just outside Beijing, China. It was co-sponsored by the
World Health Organization and included representatives from Chinese Manual
Medicine. When we toured a combined traditional medical and Chinese medical
hospital, I was asked to explain chiropractic manipulation in 15 minutes. They had no
idea of the articular neurology and the biomechanics of the locomotor system as it
relates to manipulation.
The form of manipulation they demonstrated was called Chiuna and was mobilization
not producing any audible releases. Some of the stretching techniques were low force,
low amplitude lumbar rotation, which did produce audible releases quite often, the
doctor, said. The seated patients’ pelvis was held immobile with wide leather straps and
the spine was rotated, leaning forward from the waste. I wasn’t impressed.
My topic at the convention was on the subject of web-based distance learning of
chiropractic manipulation. There were representatives from most of the major colleges
from around the world. Only one college out of thirty, actually was employing video
presentations of the technique labs, which enables a student to pre-empt a class
presentation, as well as, review a lab presentation. Knowing what is going to be
presented, helps the learning of a psychomotor skill.
Practice makes perfect if the person is practicing perfectly. Practicing with a visual
reference is much better than trying to remember what was shown in the lab. Students
all learn psychomotor skills at different rates. By having a visual reference, the slower
learners of a certain skill can do extra review and practice. The goal is to be consciously
competent by clinic entrance. Without this method trimesters go by and skills not
learned in one tri are forgotten and never accomplished.
The videos I am familiar with, are the ones I made demonstrating Motion Palpation as
an indicator that a motion unit needs to be adjusted and in the specific directions it
needs to be adjusted. Yes, you read it right, DIRECTIONS. A motion unit allows
movement around the three axes in both directions. For example, flexion and extension
are two rotations around the x-axis. Rotation posterior to anterior and anterior to
posterior are two rotations around the y-axis. Joints have the ability to rest at a point
necessary to conform to our posture and the adaptation required by all the other joints
in the closed kinematic system. There is no absolute posture, we are always moving,
even in our sleep. To take a person and stand them in front of a bucky and take an
x-ray that is supposed to detect abnormal bone positions is very unscientific. The
result is a still picture of a mobile system. Reading this film can not tell us where
to adjust and around what axes to adjust.
I received some brochures about a technique that uses 4 full spine pictures to make an
analysis of posture sitting and standing. The guru stated that bones needed to be put
back in place, especially the ones misaligned anterior. The reason being no muscles
were designed to pull the vertebra backwards. What amazed me is that some people
were allowing him to use their names as satisfied customers.
I ask the question, “When are we going to relate chiropractic adjustments to
biomechanical dysfunction?”
In countries like Canada and Denmark where we do have a dominance of rational
chiropractors, the governments fund research and help us increase our knowledge
base. As a profession we can’t remain on the outside, with antiquated theories and
expect to survive.
Being in Beijing made me realize we are making great progress around the world but
here in the U.S.A. we have so many diverse groups all under the umbrella of
Chiropractic. Our associations are afraid to lose members by stating the rational,
scientific, evidence based model is what we promote. The religious fanatics who think
they can spin the atlas back to neutral and turn on innate, no matter what, are still
tolerated. Patients are getting joints cavitated, which are already mobile and normal.
Popping a normal joint is not therapeutic and prevents nothing.
The rest of the world is not steeped in the “Static” historical model. They change with
the discovery of new evidence and research. I am always hopeful that these articles will
help young doctors start out on the evolving path. I don’t want to be like B.J. Palmer. He
knew diddly-squat by comparison to a modern chiropractor. I understand he is a part of
our history and accept it as that. When I heard him speak in 1956 he was incoherent
and rambled on about the innate abilities of the body. It is called Physiology,
Biochemistry and the Immune System.
We are learning how Homeostasis is achieved and the relationship of the locomotor
system and the facilitation of the Sympathetic Nervous System and certain diseases
and syndromes. We are all pioneers in a very new field. We need to be rational and
realistic. We need to denounce the past and present nonsense and get on with the big
job at hand. Our job is to shift the paradigm both inside and outside the profession.
It is going to happen with or without us।
दोन'टी फोरगेट तो विसित उस अत ह्त्त्प://व्व्व.चिरोप्रक्टिक्मेंटर.कॉम
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
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
Website Practice Article – October 2008
Dynamic Chiropractic Concepts and Principles – Review Part I
The first one hundred years of Chiropractic, has been a transition from purely faith-
based practitioners, to scientifically educated doctors, who are very aware of the
pathologies of disease. The dilemma that has developed is that the doctor still has to
have faith, confidence and belief in what he or she is doing, to be a busy healer. Rather
than resolve the conflict, some choose to believe the old subluxation model and follow a
classic system. Others chose to become comfortable in a sea of relativity.
I developed the heuristic model of the subluxation complex and learned as much as I
could about the scientific and rational evidence of holistic, vitalistic healing as it related
to the licensed practice of Chiropractic.
The goal for each of us is to become confident in our knowledge of the subluxation
complex and to possess the necessary adjusting skills to feel truly professional. This
confidence and knowledge, allows an honest line of communication to develop between
the doctor and the patient, which creates the bond necessary to promote healing and
exited patients that refer others.
Whether you are a predominately right-brained, faith-based doctor or a predominately
left-brained, science-based doctor; mimicking and practicing is essential for mastering
the hundreds of spinal and extremity adjustments. At this stage of our rational
development, the outcome of applying these procedures is a leap of faith, for all of us.
For this reason, each of us must know that we know; when, where, why, how and how
often, we need to adjust our patients. If you can believe in a system, these questions
are answered for you and practice is made simple. If you are more like I am, then I
suggest you become comfortable with all the relative facts of the matter at hand and
enjoy the journey. Learning will become your professional way of life. Patients will
respect and refer you because of your knowledge, adjusting skills, and the healing
experiences that occur. There are obviously two ways to get to the same place.
Think about it! The worse place for a chiropractor to be is between the two stools.
Neither full of the belief that removing “subluxations”, “works”: nor fully confident and
comfortable wallowing in a sea of relative facts and procedures. The contents of this
course has helped thousands of left-brained, chiropractors get enthusiastic and
dedicated to vitalistic, holistic healing and working to further the scientific and rational
development of our profession. Many have developed very successful and prestigious
practices, and a few have made research their priority in life, as there are still more
questions than answers.
Our EMPHASIS will be on the clinical application of the techniques and the diagnostic
work-ups. How much time you spend on the literature base will be up to you. Clinical
results are very dependent on patient compliance. Patient compliance is best when the
doctor and the patient have the same concept of the condition being treated or of
prevention.
THE SUBLUXATION COMPLEX
The Subluxation Complex is a heuristic model described by me in 1967, to organize and
co-relate clinical procedures, the basic sciences and research. Getting comfortable with
not correcting a “subluxation” is very difficult for Chiropractors old and new. Becoming
professionally knowledgeable with the components of the “Subluxation Complex” is the
task at hand and in my opinion the reason we need to remain autonomous from M.D.s
and P.T.s.
Each of these categories is a huge field of study. As a general practitioner we can only
hope to familiarize ourselves with the relevant information, except for the spinal and
extremity adjusting, where we are the experts. If we fail to maintain our skills, we must
expect others to take our place.
I dread the thought of our neophytes trading these skills , for a hand held or mounted,
mechanical device. Some report over thirty-five percent have already given up on
learning to adjust expertly. To me this is like thirty-five percent of dentists not being
capable of filling a tooth cavity.
To look into the “subluxation complex” concept I suggest you start reading one hour a
day. In three or four months you will see the difference in the way you advise your
patients on their treatment schedules for acute and chronic conditions.
Reading References:
1) www.ChiropracticMentor.com: L.J. Faye, D.C. - Videos, practice articles.
2) Motion Palpation and Chiropractic Technique: Schafer and Faye, pub MPI.
3) Foundations of Chiropractic, Subluxation: Meridel I. Gatterman, pub Mosby.
4) Chiropractic Technique: Bergmann, Peterson, Lawrence, pub Churchill Lvgst.
5) Review of the literature supporting a scientific basis for the Chiropractic Subluxation
Complex. Dishman R.W , J.M.P.T. 1985; 8:163-74.
6) Foundations of Chiropractic - Lantz C.A. has an updated the model with many
articles. He is an author of a chapter in this book.
7) Mechanically Assisted Manual Techniques: Distraction Procedures. Bergmann and
Davis, pub Mosby.
From the above references the heuristic model of subluxation complex should be fully
comprehended and your interests should be identified for future study.
Don't forget to visit us at: http://www.chiropracticmentor.com/
The first one hundred years of Chiropractic, has been a transition from purely faith-
based practitioners, to scientifically educated doctors, who are very aware of the
pathologies of disease. The dilemma that has developed is that the doctor still has to
have faith, confidence and belief in what he or she is doing, to be a busy healer. Rather
than resolve the conflict, some choose to believe the old subluxation model and follow a
classic system. Others chose to become comfortable in a sea of relativity.
I developed the heuristic model of the subluxation complex and learned as much as I
could about the scientific and rational evidence of holistic, vitalistic healing as it related
to the licensed practice of Chiropractic.
The goal for each of us is to become confident in our knowledge of the subluxation
complex and to possess the necessary adjusting skills to feel truly professional. This
confidence and knowledge, allows an honest line of communication to develop between
the doctor and the patient, which creates the bond necessary to promote healing and
exited patients that refer others.
Whether you are a predominately right-brained, faith-based doctor or a predominately
left-brained, science-based doctor; mimicking and practicing is essential for mastering
the hundreds of spinal and extremity adjustments. At this stage of our rational
development, the outcome of applying these procedures is a leap of faith, for all of us.
For this reason, each of us must know that we know; when, where, why, how and how
often, we need to adjust our patients. If you can believe in a system, these questions
are answered for you and practice is made simple. If you are more like I am, then I
suggest you become comfortable with all the relative facts of the matter at hand and
enjoy the journey. Learning will become your professional way of life. Patients will
respect and refer you because of your knowledge, adjusting skills, and the healing
experiences that occur. There are obviously two ways to get to the same place.
Think about it! The worse place for a chiropractor to be is between the two stools.
Neither full of the belief that removing “subluxations”, “works”: nor fully confident and
comfortable wallowing in a sea of relative facts and procedures. The contents of this
course has helped thousands of left-brained, chiropractors get enthusiastic and
dedicated to vitalistic, holistic healing and working to further the scientific and rational
development of our profession. Many have developed very successful and prestigious
practices, and a few have made research their priority in life, as there are still more
questions than answers.
Our EMPHASIS will be on the clinical application of the techniques and the diagnostic
work-ups. How much time you spend on the literature base will be up to you. Clinical
results are very dependent on patient compliance. Patient compliance is best when the
doctor and the patient have the same concept of the condition being treated or of
prevention.
THE SUBLUXATION COMPLEX
The Subluxation Complex is a heuristic model described by me in 1967, to organize and
co-relate clinical procedures, the basic sciences and research. Getting comfortable with
not correcting a “subluxation” is very difficult for Chiropractors old and new. Becoming
professionally knowledgeable with the components of the “Subluxation Complex” is the
task at hand and in my opinion the reason we need to remain autonomous from M.D.s
and P.T.s.
Each of these categories is a huge field of study. As a general practitioner we can only
hope to familiarize ourselves with the relevant information, except for the spinal and
extremity adjusting, where we are the experts. If we fail to maintain our skills, we must
expect others to take our place.
I dread the thought of our neophytes trading these skills , for a hand held or mounted,
mechanical device. Some report over thirty-five percent have already given up on
learning to adjust expertly. To me this is like thirty-five percent of dentists not being
capable of filling a tooth cavity.
To look into the “subluxation complex” concept I suggest you start reading one hour a
day. In three or four months you will see the difference in the way you advise your
patients on their treatment schedules for acute and chronic conditions.
Reading References:
1) www.ChiropracticMentor.com: L.J. Faye, D.C. - Videos, practice articles.
2) Motion Palpation and Chiropractic Technique: Schafer and Faye, pub MPI.
3) Foundations of Chiropractic, Subluxation: Meridel I. Gatterman, pub Mosby.
4) Chiropractic Technique: Bergmann, Peterson, Lawrence, pub Churchill Lvgst.
5) Review of the literature supporting a scientific basis for the Chiropractic Subluxation
Complex. Dishman R.W , J.M.P.T. 1985; 8:163-74.
6) Foundations of Chiropractic - Lantz C.A. has an updated the model with many
articles. He is an author of a chapter in this book.
7) Mechanically Assisted Manual Techniques: Distraction Procedures. Bergmann and
Davis, pub Mosby.
From the above references the heuristic model of subluxation complex should be fully
comprehended and your interests should be identified for future study.
Don't forget to visit us at: http://www.chiropracticmentor.com/
Practice Article September 2008 – Learning Psychomotor Skills
The following is taken from the National Guidelines for Educating EMS
Instructors – August 2002 – Module 17, pages 139-143
MODULE 17: TEACHING PSYCHOMOTOR SKILLS
Cognitive goals
At the completion of this module the student-instructor should be able to:
17.1 Define psychomotor skills
17.2 Explain the relationship between cognitive and affective objectives to
psychomotor objectives
17.3 Describe teaching methods appropriate for learning a psychomotor skill
17.4 Describe classroom activities used to teach and practice psychomotor skills
17.5 List methods to enhance the experience of psychomotor skill practice in the
Classroom
Psychomotor goals
At the completion of this module the student-instructor should be able to:
17.1 Demonstrate proper facilitation technique when demonstrating EMS skills
17.2 Demonstrate the use of corrective feedback during a skill demonstration
17.3 Create a skill session lesson plan whic h maximizes student practice time
17.4 Create a skill scenario which enhances realism
Affective goals
At the completion of this module the student-instructor should be able to:
17.1 Acknowledge the need to teach the mechanics of a skill before students can
apply higher level thinking about the process
17.2 Value the need for students to practice until they attain mastery level
17.3 Model excellence in skill performance
Declarative
I. Why this module is important
A. Psychomotor skill development is crucial to good patient care by the
EMS provider.
1. Psychomotor skills are used to provide patient care and also to
ensure the safety of the members of the team
2. There are many ways to perform medically acceptable skills
behaviors
a. Need to know steps of skills performance in order to
effectively apply critical thinking skills in situations they will
face in the field setting
B. Instructors plan their approach to teaching students how to perform skills
in order to maximize the student’s abilities
II. Understanding the psychomotor domain
A. Definitions
1. The psychomotor domain involves the skills of the EMS profession
2. Skill, action, muscle movement and manual manipulation
III. Five levels of psychomotor skills
A. Imitation
1. Student repeats what is done by the instructor
2. “See one, do one”
3. Avoid modeling wrong behavior because the student will do as you
do
4. Some skills are learned entirely by observation, with no need for
formal instruction
B. Manipulation
1. Using guidelines as a basis or foundation for the skill (skill sheets)
2. May make mistakes
a. Making mistakes and thinking through corrective actions is a
significant way to learn
3. Perfect practice makes perfect
a. Practice of a skill is not enough, students must perform the
skill correctly
4. The student begins to develop his or her own style and techniques
a. Ensure students are performing medically acceptable
behaviors
C. Precision
1. The student has practiced sufficiently to perform skill without
mistakes
2. Student generally can only perform the skill in a limited setting
a. Example: student can splint a broken arm if patient is sitting
up but cannot perform with same level of precision if patient
is lying down
D. Articulation
1. The student is able to integrate cognitive and affective components
with skill performance
a. Understands why the skill is done a certain way
b. Knows when the skill is indicated
2. Performs skill proficiently with style
3. Can perform skill in context
a. Example: student is able to splint broken arm regardless of
patient position
E. Naturalization
1. Mastery level skill performance without cognition
2. Also called "muscle memory"
3. Ability to multitask effectively
4. Can perform skill perfectly during scenario, simulation, or actual
patient situation
IV. Teaching psychomotor skills
A. Whole-part-whole technique is useful
1. Requires that the skill be demonstrated 3 times as follows:
a. WHOLE: The instructor demonstrates the entire skill,
beginning to end while briefly naming each action or step
b. PART: The instructor demonstrates the skill again, step-by-
step, explaining each part in detail
c. WHOLE: The instructor demonstrates the entire skill,
beginning to end, without interruption and usually without
commentary
2. This technique provides an accurate example of the skill done in
repetition
a. If students were not completely focused on the skill
demonstration one time there are two other opportunities
for them to watch the presentation
3. This technique provides a rationale for how the skill has been
performed
a. Students may or may not be allowed to interject questions as
the demonstration is going on, but generally discussion is
allowed dur ing the middle, step-by-step “part”
demonstration
4. This technique works well for both analytic and global learners
a. Analytic learners appreciate the step-by-step presentation and
global learners appreciate the overview
b. Module 7: Learning Styles has more information on analytic
and global learners
V. Progressing through the psychomotor domain levels of skill acquisition
A. Novice to expert
1. Allow students to progress at their own pace
a. If you move students too quickly they may not understand
what they are doing and will not acquire good thinking skills
2. Although the demonstration may provide information on the
performance of the entire skill from start to finish, students
should be allowed to learn the individual parts of the skill before
pulling it all together and demonstrating the whole skill
3. Students should master individual skills before placing them in
context of a scenario or simulation
4. Students should be allowed ample time to practice a skill before
being tested
5. The need for constant direct supervision should diminish as practice
time and skill level increases
B. From novice to mastery level
1. Demonstrate the skill to students
2. Students practice using a skills check sheet
3. Students memorize the steps of the skill until they can verbalize the
sequence without error
4. Students perform the skill stating each step as they perform it
5. Students perform the skill while answering questions about their
performance
6. Students perform the skill in context of a scenario or actual patient
situation
VI. Providing feedback during psychomotor skill development
A. Interrupt and correct the wrong behavior in beginners to prevent mastery
(muscle memory) of the wrong technique
B. Practice sessions should end on a correct performance or demonstration
of the skill
C. Allow advanced students to identify and correct their own mistakes under
limited supervision
D. Adult learners need encouragement and positive feedback to reinforce
the correct behaviors
1. Adult learners need good role models of correct technique
a. Primary instructors, secondary instructors, skills
instructors, clinical faculty and preceptors are all
important in developing students and these
individuals should be carefully selected for suitability
to their individual roles
E. Allow adults to develop their own style of the standard technique after
mastery has been achieved
1. There are numerous ways to do things right
a. Focus on what is considered medically acceptable behaviors
instead of demanding rote performance or parroted skills
b. Spend time helping students develop high level thinking skills
so they can differentiate between options and adequately
solve problems
VII. Improving psychomotor skill development during a skills session
A. Have all necessary equipment set up before session begins
B. Use realistic and current equipment that is in proper working order
C. Use standardized skills sheets
D. Allow ample practice time in class, at breaks and during other times
E. Always model correct psychomotor skills behavior
F. Keep students active and involved
G. Insist students respect equipment and skills
H. Ensure competence in the individual skills before using scenarios
I. Adding realism
1. Place need for skill in context with a real life scenario or simulation
2. Limit objectives of the scenario to three learning points
a. As students become more sophisticated using critical thinking
skills you can add more dimensions to the scenarios
3. Make the scenario realistic
4. Use actual equipment
5. Consider moulage, props, background noises, etc.
VIII. Maximizing skill session time
A. Assign students in a skill group to each of the following roles according
to the size of group
1. Evaluator: uses a skill sheet or records steps as they are
performed
a. Videotape and audiotape may also be helpful in creating a
record
b. Allowing several students to critique and provide feedback will
illustrate how easy it is for observers to miss steps students
may perform
c. This technique also allows students to improve their own skill
performance as they watch the skill being repeated
2. Information provider: uses a script and supplies information as it is
requested
3. Team leader: primary patient care provider
4. Partner or assistant: performs care as directed by team leader
5. Patient: faithfully portrays signs and symptoms according to
scenario
6. Bystander #1: acts as a distractor or helper
7. Bystander #2: acts as a distractor or helper
B. Distribute a written scenario to be practiced
1. Can use real calls to create scenarios
2. Medical textbook publishing companies have books of scenarios
3. Most textbooks have scenarios in each chapter
4. EMS professional organizations websites have scenarios
C. Begin scenario with the reading of the dispatch information
D. Do not interrupt the scenario
1. Mastery of individual skills should have already been obtained
2. Can comment on timing and decision making later
3. Safety compromises may necessitate your intervention, but do not
interfere if it is not a clear safety danger
E. Group performance evaluation
1. Utilize a positive-negative-positive format
a. Begin with positive statements and general comments
b. Move into constructive feedback and areas for improvement
c. End with positive reinforcement
2. Patient care leader should comment on what he or she did
correctly, then what needs improvement
a. Remember that students are often their greatest critics;
encourage them to look for positive aspects of their
performance
3. Assistant critiques the team’s performance
4. Patient comments on how he or she was treated
5. Bystanders add their observations
6. Evaluator comments on timing, sequencing, prioritization, and skills
performance
7. Students should rotate through each role then begin another
scenario
8. This method keeps everybody active and involved in the skills
practice time
Bibliographic References
Burke, J. Ed. (1989). Competency-based Education and Training. New York: The Falmer
Press.
Kolb, D. A. (1984). Experiential Learning. (1984). New York: Simon & Schuster Trade.
Millis, B., & Cottello, P. (1998). Cooperative Learning For Higher Education Faculty.
Phoenix: Oryx Press.
Watson, A., (1980). Learning psychomotor skills in TAFE. Educational Psychology for
TAFE Teachers.
Visit us at http://www.chiropracticmentor.com and get a chance to watch our manipulation videoes
Instructors – August 2002 – Module 17, pages 139-143
MODULE 17: TEACHING PSYCHOMOTOR SKILLS
Cognitive goals
At the completion of this module the student-instructor should be able to:
17.1 Define psychomotor skills
17.2 Explain the relationship between cognitive and affective objectives to
psychomotor objectives
17.3 Describe teaching methods appropriate for learning a psychomotor skill
17.4 Describe classroom activities used to teach and practice psychomotor skills
17.5 List methods to enhance the experience of psychomotor skill practice in the
Classroom
Psychomotor goals
At the completion of this module the student-instructor should be able to:
17.1 Demonstrate proper facilitation technique when demonstrating EMS skills
17.2 Demonstrate the use of corrective feedback during a skill demonstration
17.3 Create a skill session lesson plan whic h maximizes student practice time
17.4 Create a skill scenario which enhances realism
Affective goals
At the completion of this module the student-instructor should be able to:
17.1 Acknowledge the need to teach the mechanics of a skill before students can
apply higher level thinking about the process
17.2 Value the need for students to practice until they attain mastery level
17.3 Model excellence in skill performance
Declarative
I. Why this module is important
A. Psychomotor skill development is crucial to good patient care by the
EMS provider.
1. Psychomotor skills are used to provide patient care and also to
ensure the safety of the members of the team
2. There are many ways to perform medically acceptable skills
behaviors
a. Need to know steps of skills performance in order to
effectively apply critical thinking skills in situations they will
face in the field setting
B. Instructors plan their approach to teaching students how to perform skills
in order to maximize the student’s abilities
II. Understanding the psychomotor domain
A. Definitions
1. The psychomotor domain involves the skills of the EMS profession
2. Skill, action, muscle movement and manual manipulation
III. Five levels of psychomotor skills
A. Imitation
1. Student repeats what is done by the instructor
2. “See one, do one”
3. Avoid modeling wrong behavior because the student will do as you
do
4. Some skills are learned entirely by observation, with no need for
formal instruction
B. Manipulation
1. Using guidelines as a basis or foundation for the skill (skill sheets)
2. May make mistakes
a. Making mistakes and thinking through corrective actions is a
significant way to learn
3. Perfect practice makes perfect
a. Practice of a skill is not enough, students must perform the
skill correctly
4. The student begins to develop his or her own style and techniques
a. Ensure students are performing medically acceptable
behaviors
C. Precision
1. The student has practiced sufficiently to perform skill without
mistakes
2. Student generally can only perform the skill in a limited setting
a. Example: student can splint a broken arm if patient is sitting
up but cannot perform with same level of precision if patient
is lying down
D. Articulation
1. The student is able to integrate cognitive and affective components
with skill performance
a. Understands why the skill is done a certain way
b. Knows when the skill is indicated
2. Performs skill proficiently with style
3. Can perform skill in context
a. Example: student is able to splint broken arm regardless of
patient position
E. Naturalization
1. Mastery level skill performance without cognition
2. Also called "muscle memory"
3. Ability to multitask effectively
4. Can perform skill perfectly during scenario, simulation, or actual
patient situation
IV. Teaching psychomotor skills
A. Whole-part-whole technique is useful
1. Requires that the skill be demonstrated 3 times as follows:
a. WHOLE: The instructor demonstrates the entire skill,
beginning to end while briefly naming each action or step
b. PART: The instructor demonstrates the skill again, step-by-
step, explaining each part in detail
c. WHOLE: The instructor demonstrates the entire skill,
beginning to end, without interruption and usually without
commentary
2. This technique provides an accurate example of the skill done in
repetition
a. If students were not completely focused on the skill
demonstration one time there are two other opportunities
for them to watch the presentation
3. This technique provides a rationale for how the skill has been
performed
a. Students may or may not be allowed to interject questions as
the demonstration is going on, but generally discussion is
allowed dur ing the middle, step-by-step “part”
demonstration
4. This technique works well for both analytic and global learners
a. Analytic learners appreciate the step-by-step presentation and
global learners appreciate the overview
b. Module 7: Learning Styles has more information on analytic
and global learners
V. Progressing through the psychomotor domain levels of skill acquisition
A. Novice to expert
1. Allow students to progress at their own pace
a. If you move students too quickly they may not understand
what they are doing and will not acquire good thinking skills
2. Although the demonstration may provide information on the
performance of the entire skill from start to finish, students
should be allowed to learn the individual parts of the skill before
pulling it all together and demonstrating the whole skill
3. Students should master individual skills before placing them in
context of a scenario or simulation
4. Students should be allowed ample time to practice a skill before
being tested
5. The need for constant direct supervision should diminish as practice
time and skill level increases
B. From novice to mastery level
1. Demonstrate the skill to students
2. Students practice using a skills check sheet
3. Students memorize the steps of the skill until they can verbalize the
sequence without error
4. Students perform the skill stating each step as they perform it
5. Students perform the skill while answering questions about their
performance
6. Students perform the skill in context of a scenario or actual patient
situation
VI. Providing feedback during psychomotor skill development
A. Interrupt and correct the wrong behavior in beginners to prevent mastery
(muscle memory) of the wrong technique
B. Practice sessions should end on a correct performance or demonstration
of the skill
C. Allow advanced students to identify and correct their own mistakes under
limited supervision
D. Adult learners need encouragement and positive feedback to reinforce
the correct behaviors
1. Adult learners need good role models of correct technique
a. Primary instructors, secondary instructors, skills
instructors, clinical faculty and preceptors are all
important in developing students and these
individuals should be carefully selected for suitability
to their individual roles
E. Allow adults to develop their own style of the standard technique after
mastery has been achieved
1. There are numerous ways to do things right
a. Focus on what is considered medically acceptable behaviors
instead of demanding rote performance or parroted skills
b. Spend time helping students develop high level thinking skills
so they can differentiate between options and adequately
solve problems
VII. Improving psychomotor skill development during a skills session
A. Have all necessary equipment set up before session begins
B. Use realistic and current equipment that is in proper working order
C. Use standardized skills sheets
D. Allow ample practice time in class, at breaks and during other times
E. Always model correct psychomotor skills behavior
F. Keep students active and involved
G. Insist students respect equipment and skills
H. Ensure competence in the individual skills before using scenarios
I. Adding realism
1. Place need for skill in context with a real life scenario or simulation
2. Limit objectives of the scenario to three learning points
a. As students become more sophisticated using critical thinking
skills you can add more dimensions to the scenarios
3. Make the scenario realistic
4. Use actual equipment
5. Consider moulage, props, background noises, etc.
VIII. Maximizing skill session time
A. Assign students in a skill group to each of the following roles according
to the size of group
1. Evaluator: uses a skill sheet or records steps as they are
performed
a. Videotape and audiotape may also be helpful in creating a
record
b. Allowing several students to critique and provide feedback will
illustrate how easy it is for observers to miss steps students
may perform
c. This technique also allows students to improve their own skill
performance as they watch the skill being repeated
2. Information provider: uses a script and supplies information as it is
requested
3. Team leader: primary patient care provider
4. Partner or assistant: performs care as directed by team leader
5. Patient: faithfully portrays signs and symptoms according to
scenario
6. Bystander #1: acts as a distractor or helper
7. Bystander #2: acts as a distractor or helper
B. Distribute a written scenario to be practiced
1. Can use real calls to create scenarios
2. Medical textbook publishing companies have books of scenarios
3. Most textbooks have scenarios in each chapter
4. EMS professional organizations websites have scenarios
C. Begin scenario with the reading of the dispatch information
D. Do not interrupt the scenario
1. Mastery of individual skills should have already been obtained
2. Can comment on timing and decision making later
3. Safety compromises may necessitate your intervention, but do not
interfere if it is not a clear safety danger
E. Group performance evaluation
1. Utilize a positive-negative-positive format
a. Begin with positive statements and general comments
b. Move into constructive feedback and areas for improvement
c. End with positive reinforcement
2. Patient care leader should comment on what he or she did
correctly, then what needs improvement
a. Remember that students are often their greatest critics;
encourage them to look for positive aspects of their
performance
3. Assistant critiques the team’s performance
4. Patient comments on how he or she was treated
5. Bystanders add their observations
6. Evaluator comments on timing, sequencing, prioritization, and skills
performance
7. Students should rotate through each role then begin another
scenario
8. This method keeps everybody active and involved in the skills
practice time
Bibliographic References
Burke, J. Ed. (1989). Competency-based Education and Training. New York: The Falmer
Press.
Kolb, D. A. (1984). Experiential Learning. (1984). New York: Simon & Schuster Trade.
Millis, B., & Cottello, P. (1998). Cooperative Learning For Higher Education Faculty.
Phoenix: Oryx Press.
Watson, A., (1980). Learning psychomotor skills in TAFE. Educational Psychology for
TAFE Teachers.
Visit us at http://www.chiropracticmentor.com and get a chance to watch our manipulation videoes
Practice Article - August 2008
Website Assisted teaching aid is going to be the main topic at the joint World Federation
of Chiropractic and Chiropractic Colleges Conference in Beijing 2008. The videos you
are studying will be part of my presentation at the conference. Finally, the benefits of
being able to see adjustments being performed and getting up-close views of the action
is being considered by the powers that be.
Every time I speak at a convention, doctors come up to me and credit the videos for
their achieving a high level of adjusting and successfully treating patients. The
functional model has served them well they say; then usually relate how they get
referrals from the M.D.s in their town and maintain a busy practice. They thank me as if
forgetting how hard they worked under my mentorship.
The following is a summary of what I will present in Beijing in November. The Chinese
Manual Medicine Association will be there as well. I will report back as to what level
they have reached in the field of joint manipulation and drugless health care.
Title: A Case for Learning Chiropractic Technique Assisted by a Web-Based Lecture Series;
Standardizing Technique Principles and Practice Aspects
By: Leonard J. Faye D.C., F.C.C.S.S. (Can.) Hon.
www.ChiropracticMentor.com
United States of America
The case for learning chiropractic technique assisted by a web-based demonstration series is
based on the assumption a common, core manipulation curriculum, would result in the
standardization of the teaching and practice of Chiropractic. One of the major criticisms of
chiropractic practice is the lack of standardization. Practitioners range from the ridiculous to the
sublime, in the level of manipulation skills.
At www.chiropracticmentor.com, core manipulation courses are available in ten, one hour
videos. Instructors can be assigned a section or sections for use in the classroom, while lab
demonstrations would be reinforced by internet access for the students. Instructors come and
go, but the semester content would remain the same for the next instructor. A core minimum
standard would be set.
The basic fundamentals of learning a psycho motor skill will be discussed. Although they are
fundamentals known by various coaches world wide, most chiropractic students are not trained
or psychologically prepared for the large task at hand. The level of “Conscious Competency”
should be the minimum level of achievement for spinal, pelvic and extremity joint manipulation.
(Note: The terms Adjusting and Manipulation are used interchangeably). Learning complex
psychomotor skills is very difficult, frustrating and time consuming. Programs need to be
followed that can be graded and the early skills developed should continue to be practiced, with
each new semester. The present programs that teach systems, don’t allow the students to
develop a basic set of skills, such as the various types of dynamic, high velocity, low amplitude
thrusts that should continue from semester to semester.
A historical perspective will be presented from Dr. Faye’s personal experience, dating from 1956
when he entered CMCC up to the present time. In Canada, in the fifties, chiropractic students
had over 1200 hours of technique labs, over a four year period. Today, the average world wide
is less than half that amount. This deficiency needs to be supplemented, by students being able
to watch demonstrations on the internet, at home or in a study hall. The lack of time spent
learning technique has reduced the average skill level of our practitioners and many can’t
produce the response to the neurobiological mechanisms in their patients. Influencing these
mechanisms is what prevents us from gravitating to the self-limiting sprain/strain symptoms of
injured joints. This ultimately results in a very narrow scope of practice.
Over the years, since Dr. Faye started teaching in 1967, at the Anglo European Chiropractic
College, Dr. Faye has taught seminars at colleges or in college towns, all around the world.
One, Scandinavian college has adopted his web-based program as their Core Manipulation
Program. Each hour of the ten hours of video demonstrations is the content of one semester,
taught by a skilled instructor. For a small college, on a limited budget, it assures continuity of
presentations from semester to semester. The clinicians are very happy, because they know the
skills the student clinicians have mastered, to a conscious, competent level. No gap between
the classroom and the clinic. A student experiences a smooth transition to the clinic and gains
confidence in what was learned in the classroom. “I know this is one of the main reasons we
became skillful” a recent graduate wrote. An instructor said “the program became stabilized
when they went to the web-based, core program. The instructor deficiencies and biases were
eliminated. Everyone knew what everyone else was teaching. The students were not getting
conflicting and confusing information.” The techniques are generic (no cook-book systems)
and cover the classic chiropractic adjustments every Chiropractor should be able to perform in
practice.
The manipulations are related to restoring the biomechanical function of joints. Every
manipulation is a rotation in a negative or positive theta direction, or in translation along the
three orthogonal axes. This approach is consistent with the basic science information students
study in anatomy, physiology of joints and biomechanics. The old model of listing the position of
a vertebra or extremity was contrary to what students learned in the basic science program. The
result was the student needed to “believe” in a technique system and its’ co-relating dogma,
often called “Chiropractic Philosophy”. The more than three hundred systems to pick from, has
made the standardization of chiropractic technique and the clinical application, impossible.
Especially, since many chiropractors graduated with poor skills, they took private post graduate
courses that were some of the three hundred available.
The achievable goal of the web-based assistance to a college technique department is to have
graduating doctors that can provide chiropractic adjustments to the spinal, pelvic and extremity
joints, with the end-result of restoring joint mobility, reversing the inflammatory process and the
neurobiological mechanisms that allow a patient to regain their health.
The web-based video presentations will be demonstrated in real time; just the way an instructor
would learn the content and the students would be able to review the instructors’ lab
presentations.
The method has one, proven successful, college integration, that has been going on for three
years. When I was visiting as a guest lecturer, I saw the clinic students all at a conscious,
competent level. Male and female alike were confident in their skills. I personally had never
seen this before or anywhere else, since.
Psychomotor skills need to be seen repeated and practiced. Students that are notified, as to
what will be demonstrated on any given day, can watch the night before the class and have
some idea, as to what will be demonstrated the next day. The drawback for introducing this core
program into an existing college program is the inabilities of instructors to willingly learn the
content of the tapes. It also requires a very confident instructor, to have a video source that the
students can judge, whether or not, their instructor is highly skilled. Technique departments in
some colleges are like fiefdoms and not easily changed by deans and administrators. For
example, if the technique head is steeped in Gonstead’s, static-listing, oriented adjustments, it is
very difficult to get his or her department teaching manipulation based on restoring inter-
segmental, dysfunctional, ranges of motion around the three axes.
Demo: www.chiropracticmentor.com
Let’s unite our technique core programs, world-wide and achieve standardization of chiropractic,
clinical procedures. De-standardization occurred, when it became necessary to increase the
basic science and diagnostic content of the college programs, without having to increase the
students’ college program to five years.
I leave with this question in your mind. What is a chiropractor who can’t adjust at a professional
level of skill? Is it like graduating dentists that can’t drill out a decayed tooth and then fill it?
Web-based assistance to a technique program is a big part of the solution. However, the college
heads must decide that reversing this decline in the average chiropractors adjusting skill level,
by graduation day, is critical. The development of our profession depends on our mastery of the
clinical application of manipulation.
If Socrates asked 100 different chiropractors “What is an adjustment?” he should not get 100
different answers, as he would today.
College programs should not be isolated and fundamentally different. The advent of web-based
support programs can solve this standardization problem in our profession.
Visit us at: http://www.chiropracticmentor.com to learn more and to purchase this articles
of Chiropractic and Chiropractic Colleges Conference in Beijing 2008. The videos you
are studying will be part of my presentation at the conference. Finally, the benefits of
being able to see adjustments being performed and getting up-close views of the action
is being considered by the powers that be.
Every time I speak at a convention, doctors come up to me and credit the videos for
their achieving a high level of adjusting and successfully treating patients. The
functional model has served them well they say; then usually relate how they get
referrals from the M.D.s in their town and maintain a busy practice. They thank me as if
forgetting how hard they worked under my mentorship.
The following is a summary of what I will present in Beijing in November. The Chinese
Manual Medicine Association will be there as well. I will report back as to what level
they have reached in the field of joint manipulation and drugless health care.
Title: A Case for Learning Chiropractic Technique Assisted by a Web-Based Lecture Series;
Standardizing Technique Principles and Practice Aspects
By: Leonard J. Faye D.C., F.C.C.S.S. (Can.) Hon.
www.ChiropracticMentor.com
United States of America
The case for learning chiropractic technique assisted by a web-based demonstration series is
based on the assumption a common, core manipulation curriculum, would result in the
standardization of the teaching and practice of Chiropractic. One of the major criticisms of
chiropractic practice is the lack of standardization. Practitioners range from the ridiculous to the
sublime, in the level of manipulation skills.
At www.chiropracticmentor.com, core manipulation courses are available in ten, one hour
videos. Instructors can be assigned a section or sections for use in the classroom, while lab
demonstrations would be reinforced by internet access for the students. Instructors come and
go, but the semester content would remain the same for the next instructor. A core minimum
standard would be set.
The basic fundamentals of learning a psycho motor skill will be discussed. Although they are
fundamentals known by various coaches world wide, most chiropractic students are not trained
or psychologically prepared for the large task at hand. The level of “Conscious Competency”
should be the minimum level of achievement for spinal, pelvic and extremity joint manipulation.
(Note: The terms Adjusting and Manipulation are used interchangeably). Learning complex
psychomotor skills is very difficult, frustrating and time consuming. Programs need to be
followed that can be graded and the early skills developed should continue to be practiced, with
each new semester. The present programs that teach systems, don’t allow the students to
develop a basic set of skills, such as the various types of dynamic, high velocity, low amplitude
thrusts that should continue from semester to semester.
A historical perspective will be presented from Dr. Faye’s personal experience, dating from 1956
when he entered CMCC up to the present time. In Canada, in the fifties, chiropractic students
had over 1200 hours of technique labs, over a four year period. Today, the average world wide
is less than half that amount. This deficiency needs to be supplemented, by students being able
to watch demonstrations on the internet, at home or in a study hall. The lack of time spent
learning technique has reduced the average skill level of our practitioners and many can’t
produce the response to the neurobiological mechanisms in their patients. Influencing these
mechanisms is what prevents us from gravitating to the self-limiting sprain/strain symptoms of
injured joints. This ultimately results in a very narrow scope of practice.
Over the years, since Dr. Faye started teaching in 1967, at the Anglo European Chiropractic
College, Dr. Faye has taught seminars at colleges or in college towns, all around the world.
One, Scandinavian college has adopted his web-based program as their Core Manipulation
Program. Each hour of the ten hours of video demonstrations is the content of one semester,
taught by a skilled instructor. For a small college, on a limited budget, it assures continuity of
presentations from semester to semester. The clinicians are very happy, because they know the
skills the student clinicians have mastered, to a conscious, competent level. No gap between
the classroom and the clinic. A student experiences a smooth transition to the clinic and gains
confidence in what was learned in the classroom. “I know this is one of the main reasons we
became skillful” a recent graduate wrote. An instructor said “the program became stabilized
when they went to the web-based, core program. The instructor deficiencies and biases were
eliminated. Everyone knew what everyone else was teaching. The students were not getting
conflicting and confusing information.” The techniques are generic (no cook-book systems)
and cover the classic chiropractic adjustments every Chiropractor should be able to perform in
practice.
The manipulations are related to restoring the biomechanical function of joints. Every
manipulation is a rotation in a negative or positive theta direction, or in translation along the
three orthogonal axes. This approach is consistent with the basic science information students
study in anatomy, physiology of joints and biomechanics. The old model of listing the position of
a vertebra or extremity was contrary to what students learned in the basic science program. The
result was the student needed to “believe” in a technique system and its’ co-relating dogma,
often called “Chiropractic Philosophy”. The more than three hundred systems to pick from, has
made the standardization of chiropractic technique and the clinical application, impossible.
Especially, since many chiropractors graduated with poor skills, they took private post graduate
courses that were some of the three hundred available.
The achievable goal of the web-based assistance to a college technique department is to have
graduating doctors that can provide chiropractic adjustments to the spinal, pelvic and extremity
joints, with the end-result of restoring joint mobility, reversing the inflammatory process and the
neurobiological mechanisms that allow a patient to regain their health.
The web-based video presentations will be demonstrated in real time; just the way an instructor
would learn the content and the students would be able to review the instructors’ lab
presentations.
The method has one, proven successful, college integration, that has been going on for three
years. When I was visiting as a guest lecturer, I saw the clinic students all at a conscious,
competent level. Male and female alike were confident in their skills. I personally had never
seen this before or anywhere else, since.
Psychomotor skills need to be seen repeated and practiced. Students that are notified, as to
what will be demonstrated on any given day, can watch the night before the class and have
some idea, as to what will be demonstrated the next day. The drawback for introducing this core
program into an existing college program is the inabilities of instructors to willingly learn the
content of the tapes. It also requires a very confident instructor, to have a video source that the
students can judge, whether or not, their instructor is highly skilled. Technique departments in
some colleges are like fiefdoms and not easily changed by deans and administrators. For
example, if the technique head is steeped in Gonstead’s, static-listing, oriented adjustments, it is
very difficult to get his or her department teaching manipulation based on restoring inter-
segmental, dysfunctional, ranges of motion around the three axes.
Demo: www.chiropracticmentor.com
Let’s unite our technique core programs, world-wide and achieve standardization of chiropractic,
clinical procedures. De-standardization occurred, when it became necessary to increase the
basic science and diagnostic content of the college programs, without having to increase the
students’ college program to five years.
I leave with this question in your mind. What is a chiropractor who can’t adjust at a professional
level of skill? Is it like graduating dentists that can’t drill out a decayed tooth and then fill it?
Web-based assistance to a technique program is a big part of the solution. However, the college
heads must decide that reversing this decline in the average chiropractors adjusting skill level,
by graduation day, is critical. The development of our profession depends on our mastery of the
clinical application of manipulation.
If Socrates asked 100 different chiropractors “What is an adjustment?” he should not get 100
different answers, as he would today.
College programs should not be isolated and fundamentally different. The advent of web-based
support programs can solve this standardization problem in our profession.
Visit us at: http://www.chiropracticmentor.com to learn more and to purchase this articles
Practice Article - July 2008
“Patient Compliance”
Getting patients to comply is a most important phase of the patient encounter. Doctors
that fail in practice and students that struggle as an intern, have this problem. Solving
this problem is like fixing a swing fault in golf. The fault is usually caused by lots of
other faults that accumulate into the obvious fault, you wish to correct. It is like fixing a
loose floor tile, only to discover a leaky pipe under the floor, as an example for non
golfers. The key concept, as I have mentioned before, is that “the doctor and the patient
must have the same concept of the patients’ condition.”
I have just published with Amazon; a layman’s book entitled “Goodbye Back Pain” for
patients of doctors in our paradigm. Our doctors insist on getting a diagnosis to work
from, with an understanding of the state of the tissues involved.
Is there any pathology other than the inflammation?
What is the state of the tissues that will influence the S.A.I.D. response?
What are the biomechanical insults in the closed kinematic system?
What soft tissues need to be stretched?
What muscles need to be relaxed or strengthened?
What is a reasonable treatment plan?
What is a reasonable therapeutic goal (Outcome)?
When a patient is told to order this book from www.amazon.com and they easily read it;
they will realize your diagnos is is correct and they will understand why it takes a series
of specifically oriented treatments to bring them through the healing and then the
normalizing process. As the treatments change, the patient will be happy to have a
short term goal achieved and be enthusiastic about getting to the next level. It all
makes sense to the doctor and the patient.
I even discuss the diagnosis chapter with the patient, to be sure they agree. X-ray
findings show the level of pathology.
Surface EMG can record the muscle over activity.
Posture can be viewed as abnormal muscle activity.
Springing pain that lingers can be the location of the inflammation.
The non lingering pain of joint fixation, elicited by motion palpation, can detect the joints
to be adjusted and around which axes of rotation. Remember flexion/extens ion is
rotation around the X axis. Lateral flexion is around the Z axis and rotation is rotation
around the Y axis.
Decreased passive R.O.M. can detect the tissues that need to be stretched.
Trigger points can be checked by knowing the pain patterns.
Weakness of muscles can be tested and their recruitment order observed. Etc.
By this time, the doctor and the patient are on the same page and the patient will
comply with your recommendations.
This book is a revised edition of the 20 year old, first edition. Chiropractors were not
ready for it 20 years ago. The diagnosis of ”subluxation” was dominant and rehab was
for physical therapists.
I suggest you get a copy for yourself by clicking on our Links button. If you see the
wisdom in my compliance procedure, get the patients to order online. The cost to you is
zero and the increased results for the patient and your increased visits, will more than
please both of you.
Interns have this problem in “spades” as the saying goes. Students can get their few
back pain patients to comply and the referrals will flow.
Visit us at: http://www.chiropracticmentor.com
Getting patients to comply is a most important phase of the patient encounter. Doctors
that fail in practice and students that struggle as an intern, have this problem. Solving
this problem is like fixing a swing fault in golf. The fault is usually caused by lots of
other faults that accumulate into the obvious fault, you wish to correct. It is like fixing a
loose floor tile, only to discover a leaky pipe under the floor, as an example for non
golfers. The key concept, as I have mentioned before, is that “the doctor and the patient
must have the same concept of the patients’ condition.”
I have just published with Amazon; a layman’s book entitled “Goodbye Back Pain” for
patients of doctors in our paradigm. Our doctors insist on getting a diagnosis to work
from, with an understanding of the state of the tissues involved.
Is there any pathology other than the inflammation?
What is the state of the tissues that will influence the S.A.I.D. response?
What are the biomechanical insults in the closed kinematic system?
What soft tissues need to be stretched?
What muscles need to be relaxed or strengthened?
What is a reasonable treatment plan?
What is a reasonable therapeutic goal (Outcome)?
When a patient is told to order this book from www.amazon.com and they easily read it;
they will realize your diagnos is is correct and they will understand why it takes a series
of specifically oriented treatments to bring them through the healing and then the
normalizing process. As the treatments change, the patient will be happy to have a
short term goal achieved and be enthusiastic about getting to the next level. It all
makes sense to the doctor and the patient.
I even discuss the diagnosis chapter with the patient, to be sure they agree. X-ray
findings show the level of pathology.
Surface EMG can record the muscle over activity.
Posture can be viewed as abnormal muscle activity.
Springing pain that lingers can be the location of the inflammation.
The non lingering pain of joint fixation, elicited by motion palpation, can detect the joints
to be adjusted and around which axes of rotation. Remember flexion/extens ion is
rotation around the X axis. Lateral flexion is around the Z axis and rotation is rotation
around the Y axis.
Decreased passive R.O.M. can detect the tissues that need to be stretched.
Trigger points can be checked by knowing the pain patterns.
Weakness of muscles can be tested and their recruitment order observed. Etc.
By this time, the doctor and the patient are on the same page and the patient will
comply with your recommendations.
This book is a revised edition of the 20 year old, first edition. Chiropractors were not
ready for it 20 years ago. The diagnosis of ”subluxation” was dominant and rehab was
for physical therapists.
I suggest you get a copy for yourself by clicking on our Links button. If you see the
wisdom in my compliance procedure, get the patients to order online. The cost to you is
zero and the increased results for the patient and your increased visits, will more than
please both of you.
Interns have this problem in “spades” as the saying goes. Students can get their few
back pain patients to comply and the referrals will flow.
Visit us at: http://www.chiropracticmentor.com
Practice Article - June 2008
I just got back from a very stimulating MPI Seminar in St. Louis, where six instructors
presented for 2 hours each. The 150 attending were very pleased with the presentations
and technique work shops.
I once again had the feeling that students were ready for the paradigm shift to a
dynamic, functional model. I presented a case of The Cervical Syndrome with most of
the 21 symptoms. None of the students were familiar with the text “The Cervical
Syndrome” by Ruth Jackson M.D. (I have the 4th edition).
In this old text she showed the relationship between abnormal movement of the spine
and the predictability of the degenerative and hypertrophic changes that occur
commonly at C5-C6.
She than describes the symptoms caused by irritation to the superior sympathetic
Ganglion chain. Many of the symptoms your patients complain of are in the long list.
Howard Vernon DC wrote “The Cranio-Cervical Syndrome” in 2001 Pub. Butterworth
Heinemann, it is more specific for the upper cervical facilitations.
The bottom line to getting rid of these debilitating symptoms is having the skills to adjust
the cervical joints in all rotations around the three x,y,z axes.
It turned out to be a clinic session for me. Many in attendance recognized the symptoms
in themselves and wanted the specific adjustments. It was a great opportunity to have
the students experience an adjustment that actually affected their nervous system.
Some got to experience having the upper thoracic glide improved and the resultant
cervical motion changes that occurred immediately. They were, finally understanding,
that we are treating a dynamic, closed kinematic system; NOT adjusting misalignments.
The next day we heard many reports of changes in their symptoms. The buzz was
exiting and you could see the relief on their faces having realized there really was
something to adjusting. Finding fixations by palpation and then adjusting to see how the
adjustment affected the overall spinal motion and muscles spasms became interesting.
Learning to predict the responses of your adjustments around the three axes of rotation
in a positive and negative theta direction is a challenge worth starting.
I told them my goal is for them to make a professional income by providing a rational
service that gets many patients a better quality of life.
I demonstrated a cervical flexion manipulation that is not on the videos. When more
students get more students to join our site and the paradigm shift; I will add that
manipulation. On that subject, it really saddened me to find out most of the students
there did not know of the site. If you blog on any student site, please give a review. We
need to make more videos.
There was a consensus between the presenters that the basics to practice are;
diagnosis, diagnosis of mechanical insults, palpation of fixations, adjusting skills for all
the restrictions in motion units.
Then someone needed to know when to apply stretching and rehab exercis es. Students
need to follow the workbook they print out from this site.
Practice, practice, practice by going to MPI Club or get a colleague not too far away to
practice with.
Psychomotor skills take practice to master to a professional level.
Visit us at : http://www.chiropracticmentor.com
presented for 2 hours each. The 150 attending were very pleased with the presentations
and technique work shops.
I once again had the feeling that students were ready for the paradigm shift to a
dynamic, functional model. I presented a case of The Cervical Syndrome with most of
the 21 symptoms. None of the students were familiar with the text “The Cervical
Syndrome” by Ruth Jackson M.D. (I have the 4th edition).
In this old text she showed the relationship between abnormal movement of the spine
and the predictability of the degenerative and hypertrophic changes that occur
commonly at C5-C6.
She than describes the symptoms caused by irritation to the superior sympathetic
Ganglion chain. Many of the symptoms your patients complain of are in the long list.
Howard Vernon DC wrote “The Cranio-Cervical Syndrome” in 2001 Pub. Butterworth
Heinemann, it is more specific for the upper cervical facilitations.
The bottom line to getting rid of these debilitating symptoms is having the skills to adjust
the cervical joints in all rotations around the three x,y,z axes.
It turned out to be a clinic session for me. Many in attendance recognized the symptoms
in themselves and wanted the specific adjustments. It was a great opportunity to have
the students experience an adjustment that actually affected their nervous system.
Some got to experience having the upper thoracic glide improved and the resultant
cervical motion changes that occurred immediately. They were, finally understanding,
that we are treating a dynamic, closed kinematic system; NOT adjusting misalignments.
The next day we heard many reports of changes in their symptoms. The buzz was
exiting and you could see the relief on their faces having realized there really was
something to adjusting. Finding fixations by palpation and then adjusting to see how the
adjustment affected the overall spinal motion and muscles spasms became interesting.
Learning to predict the responses of your adjustments around the three axes of rotation
in a positive and negative theta direction is a challenge worth starting.
I told them my goal is for them to make a professional income by providing a rational
service that gets many patients a better quality of life.
I demonstrated a cervical flexion manipulation that is not on the videos. When more
students get more students to join our site and the paradigm shift; I will add that
manipulation. On that subject, it really saddened me to find out most of the students
there did not know of the site. If you blog on any student site, please give a review. We
need to make more videos.
There was a consensus between the presenters that the basics to practice are;
diagnosis, diagnosis of mechanical insults, palpation of fixations, adjusting skills for all
the restrictions in motion units.
Then someone needed to know when to apply stretching and rehab exercis es. Students
need to follow the workbook they print out from this site.
Practice, practice, practice by going to MPI Club or get a colleague not too far away to
practice with.
Psychomotor skills take practice to master to a professional level.
Visit us at : http://www.chiropracticmentor.com
Practice Article - June 2008
I just got back from a very stimulating MPI Seminar in St. Louis, where six instructors
presented for 2 hours each. The 150 attending were very pleased with the presentations
and technique work shops.
I once again had the feeling that students were ready for the paradigm shift to a
dynamic, functional model. I presented a case of The Cervical Syndrome with most of
the 21 symptoms. None of the students were familiar with the text “The Cervical
Syndrome” by Ruth Jackson M.D. (I have the 4th edition).
In this old text she showed the relationship between abnormal movement of the spine
and the predictability of the degenerative and hypertrophic changes that occur
commonly at C5-C6.
She than describes the symptoms caused by irritation to the superior sympathetic
Ganglion chain. Many of the symptoms your patients complain of are in the long list.
Howard Vernon DC wrote “The Cranio-Cervical Syndrome” in 2001 Pub. Butterworth
Heinemann, it is more specific for the upper cervical facilitations.
The bottom line to getting rid of these debilitating symptoms is having the skills to adjust
the cervical joints in all rotations around the three x,y,z axes.
It turned out to be a clinic session for me. Many in attendance recognized the symptoms
in themselves and wanted the specific adjustments. It was a great opportunity to have
the students experience an adjustment that actually affected their nervous system.
Some got to experience having the upper thoracic glide improved and the resultant
cervical motion changes that occurred immediately. They were, finally understanding,
that we are treating a dynamic, closed kinematic system; NOT adjusting misalignments.
The next day we heard many reports of changes in their symptoms. The buzz was
exiting and you could see the relief on their faces having realized there really was
something to adjusting. Finding fixations by palpation and then adjusting to see how the
adjustment affected the overall spinal motion and muscles spasms became interesting.
Learning to predict the responses of your adjustments around the three axes of rotation
in a positive and negative theta direction is a challenge worth starting.
I told them my goal is for them to make a professional income by providing a rational
service that gets many patients a better quality of life.
I demonstrated a cervical flexion manipulation that is not on the videos. When more
students get more students to join our site and the paradigm shift; I will add that
manipulation. On that subject, it really saddened me to find out most of the students
there did not know of the site. If you blog on any student site, please give a review. We
need to make more videos.
There was a consensus between the presenters that the basics to practice are;
diagnosis, diagnosis of mechanical insults, palpation of fixations, adjusting skills for all
the restrictions in motion units.
Then someone needed to know when to apply stretching and rehab exercis es. Students
need to follow the workbook they print out from this site.
Practice, practice, practice by going to MPI Club or get a colleague not too far away to
practice with.
Psychomotor skills take practice to master to a professional level.
Don't forget to visit us at: http://www.chiropracticmentor.com
Thanks to Aviv M from anetonline for fixing my office network http://www.anetonline.com
I just got back from a very stimulating MPI Seminar in St. Louis, where six instructors
presented for 2 hours each. The 150 attending were very pleased with the presentations
and technique work shops.
I once again had the feeling that students were ready for the paradigm shift to a
dynamic, functional model. I presented a case of The Cervical Syndrome with most of
the 21 symptoms. None of the students were familiar with the text “The Cervical
Syndrome” by Ruth Jackson M.D. (I have the 4th edition).
In this old text she showed the relationship between abnormal movement of the spine
and the predictability of the degenerative and hypertrophic changes that occur
commonly at C5-C6.
She than describes the symptoms caused by irritation to the superior sympathetic
Ganglion chain. Many of the symptoms your patients complain of are in the long list.
Howard Vernon DC wrote “The Cranio-Cervical Syndrome” in 2001 Pub. Butterworth
Heinemann, it is more specific for the upper cervical facilitations.
The bottom line to getting rid of these debilitating symptoms is having the skills to adjust
the cervical joints in all rotations around the three x,y,z axes.
It turned out to be a clinic session for me. Many in attendance recognized the symptoms
in themselves and wanted the specific adjustments. It was a great opportunity to have
the students experience an adjustment that actually affected their nervous system.
Some got to experience having the upper thoracic glide improved and the resultant
cervical motion changes that occurred immediately. They were, finally understanding,
that we are treating a dynamic, closed kinematic system; NOT adjusting misalignments.
The next day we heard many reports of changes in their symptoms. The buzz was
exiting and you could see the relief on their faces having realized there really was
something to adjusting. Finding fixations by palpation and then adjusting to see how the
adjustment affected the overall spinal motion and muscles spasms became interesting.
Learning to predict the responses of your adjustments around the three axes of rotation
in a positive and negative theta direction is a challenge worth starting.
I told them my goal is for them to make a professional income by providing a rational
service that gets many patients a better quality of life.
I demonstrated a cervical flexion manipulation that is not on the videos. When more
students get more students to join our site and the paradigm shift; I will add that
manipulation. On that subject, it really saddened me to find out most of the students
there did not know of the site. If you blog on any student site, please give a review. We
need to make more videos.
There was a consensus between the presenters that the basics to practice are;
diagnosis, diagnosis of mechanical insults, palpation of fixations, adjusting skills for all
the restrictions in motion units.
Then someone needed to know when to apply stretching and rehab exercis es. Students
need to follow the workbook they print out from this site.
Practice, practice, practice by going to MPI Club or get a colleague not too far away to
practice with.
Psychomotor skills take practice to master to a professional level.
Don't forget to visit us at: http://www.chiropracticmentor.com
Thanks to Aviv M from anetonline for fixing my office network http://www.anetonline.com
Practice Article – May 2008
May’s article is the continuation of Dr. Faye being interviewed by Greg Green, a Palmer
College of Chiropractic student.
(Re-printed from The Triune, the Official Student Newspaper of Palmer College of Chiropractic’s Florida
Campus)
GG: Tell me about Motion Palpation. Would you describe it as a technique, like
Gonstead? What makes Motion Palpation different than other techniques?
LF: This question is like putting a red flag in front of a bull. Motion Palpation is not a
technique system. I repeat, not a technique system. It gets classified as one by all the
colleges so that the students think it is just another system, and you need to choose
one, any one it doesn’t matter.
I used to tell my students that “they had to get used to swimming in a sea of
relativity.”
The long lecture on the components of the subluxation complex and the literature
that discussed those topics was the sea of relativity. By learning to examine your
patients as individuals to determine what was occurring with all of these so-called
components and the doctor could make rational therapeutic decisions. There are co-
relations between joint dysfunction and many symptoms. There are co-relations
between joint dysfunction and faulty locomotor coordination. There are co-relations
between joint dysfunction and neural facilitation and there is a co-relation between
spinal pathology and nerve compression symptoms.
My concept of a chiropractic doctor is one who assesses all of these health reducing
factors, along with the nutritional and psychological stressors and does not follow a
system blindly, like a disciple. Needless to say, the “systems” people did not agree with
me releasing doctors and leading them to the literature and some basic science facts.
For example, bones can’t be spun into place by a “specific” adjustment. Joints can
change their function and bones can have a new range of motion. Hence the atlas can’t
be adjusted, but the atlanto-occipital and atlanto-axial joints can be influenced by our
adjustments.
To get doctors and students in touch with all these discussions I had to form MPI in
the late 70s and present seminars in all the college towns. Unfortunately I needed to
piggyback off of Dr. Henry Gillet’s reputation in order to get anyone to attend and listen
to me. He was known for teaching Motion Palpation. I should have renamed the
seminars “The Dynamic Concepts of Chiropractic.” Then it would have been more
difficult to label it a “technique system.”
Since we [The Motion Palpation Institute] have as one of our concepts, that the most
fixated joint in the closed kinematic system requires the most compensatory adaptation;
it is best to adjust this dysfunction first and observe the changes in the whole system.
This can appear to be a technique. Since this “Major” fixation varies so much in its
location, one has to palpate to find it.
The inaccuracy of palpation leads to a lot of trial and error and multiple vis its. The
intra-examiner reliability is quite good, so as individuals we can learn to recognize the
palpation feeling of the significant motion palpation findings. However, motion palpation
is only helpful in attempting to get your adjustments around the correct axes of rotation.
It provides lines of drive needed for freeing up the motion lost in a motion unit. We
demonstrate the chiropractic adjustment as being specifically around one axis or with
multiple axes, which address coupled movements.
We have motion studies that confirm joints can be hypomobile and studies that show
manipulation/adjustments cause an increase in the ranges of motion. Duh! What is the
problem with looking for hypomobility?
Static x-rays can’t show it. So how can we determine what to adjust from a static
picture?
If it is tilted and rotated does that mean it is fixated? NO.
No system can deal with all the complexities of a human patient. A holistic approach
is our strength and I am proposing we need to become de-systematized and more
comfortable examining, diagnosing and treating all the stress factors in our patients.
The core: being able to deliver adjustments that restore function in all the lost ranges of
motion in a motion unit and the locomotor system overall.
On the website www.ChiropracticMentor.com you can see the relationship between
the palpation of lost motion and the choosing of the correct technique to restore that
movement. The adjustment is about changing the biomechanics first, and the
neurological effects change after.
Cracking joints that are already mobile is irrational. Leaving joints partially adjusted
is irrational. We try to avoid irrational behavior; that is our system.
GG: You’ve touched on a major component of the curriculum at many chiropractic
colleges: listings, and x-ray line drawing analysis. At Palmer Homecoming here in
Florida you mentioned you mentioned a personal investigation you conducted
concerning line drawings. Would you care to elaborate for the Triune readers?
LF: To answer this question, imagine my predicament in England in 1963; I was
merrily rolling along in practice seeing about 75 patients a day. Everyone had been x-
rayed and adjusted according to the listing arrived at by the marking system I was
using. Then I was lucky enough to see Dr. Fred Illi’s motion x-ray studies of before and
after manipulation and patient responses. That same weekend, I heard Dr. Henry Gillet
explain a method of palpation to aid in finding joint dysfunction.
When I got back to England, I called the patients that I had discharged as symptom
free and asked them to drop in and let me take one post treatment radiograph for a
research project.
About fifty patients responded. 12% had better listings and 67% had worse listings
and the rest looked the same. Wow! I thought Illi and Gillet had discovered a very
important piece of information.
A Danish student for his thesis for graduating from AECC, did a much bigger sample
of Gonstead’s marking system and patients of Danish chiropractors using the Gonstead
method. His results were very similar. Proving the Gonstead adjustments were the
cause of the results.
I deducted the manipulations I was performing were getting results, but not for the
reason I thought, at the time. I stopped taking x-rays to find the listings that I proved
were not significant. My new method of deciding when, where, how and how often,
became the assessment for the adjustment. I felt the hypomobility and the patient felt a
pain at the end range that was relieved as soon as I released the end-feel pressure. I
called this the pain response of the manipulable lesion. (If it is a lesion).
On corresponding with Dr. Adrian Grice at the time, he started to do x-ray studies
with the patient leaning to the left and then to the right. He demonstrated the
hypomobilities and typed the patterns that were visualized as type one, two, etc. His
papers were published in the Canadian Chiropractic Journal in the 70’s.
The listings actually limited me from attending to the faults in the patients’ complete,
closed kinematic, locomotor system. Personally, I felt literally released from following a
system and instead could start thinking my way though a patient’s problems. I became
a much smoother adjuster, with less force and very few, sore reactions to a
manipulation.
GG: So the paradigm shift for you took place in England after that serendipitous
weekend with Illi and Gillet, but when did you endeavor to bring the message to
chiropractic at large? What kind of resistance did you meet when you did?
LF: In the late 60’s I was sitting on the banks of the Seine River in Paris with another
young chiropractor who practiced the Dynamic Principles type of practice. We
fantasized; what Chiropractic could really be if all the colleges in the USA made the
paradigm shift and the American public actually got information that was rational and
not the “Spine in line feel fine.” That was advertising the concept? That chiropractors
re-aligned, mis-aligned spines?
My Belgian colleague said to me, “Unless you go back, who is going to let them
know?” I was already teaching part time at the AECC in Bournemouth, England. He
was aware of the Subluxation Complex Model I was teaching that reflected the Dynamic
Principles.
That incidence planted the seed and when we decided to leave England in 1975, I
got a job at CMCC as a clinician. I was supposed to get a class of third year students,
but that didn’t happen. I started to teach in the intern’s room in the evening. The result
was a student petition asking for my course to be put into the next semester. SOT was
dropped and I was inserted.
I was warmly received by the students that wanted to aspire to a high level of
competency and hated by those that wanted to follow a system and believed the
“Subluxation” theory of disease. That was in 1976 and nothing much has changed.
Lots have tackled the job of becoming comfortable in the sea of relativity and others
take the traditional route.
I used to get upset and angry at the situation, but on reflection I realized that I had
helped many very successful doctors stay in Chiropractic when they realized that it had
subsidence. Many of our researchers today got fired up by my MPI Seminar, Saturday
morning introduction lecture.
The lecture I presented at your college was boycotted by the traditionalists. The
students that wanted to read references and comprehend how we can provide health
care in a rational model stayed and listened and I hope asked important questions of
themselves and what they believe.
Before the dinner on the Saturday night, one student told me “It’s just a matter of
learning to sell adjustments and the philosophy.” I accept he is not my type of
chiropractor and I like to deal with the other end of the learning scale.
The sad thing is that medicine and physiotherapy is recognizing the relationship
between biomechanical function, manipulation, inflammation, stress, and the
neurobiological mechanisms involved. We are losing our position as the forefathers of
C.A.M. and we are letting others catch up. In the meantime, we stay divided, instead of
recognizing the Palmers were the best there was in 1895 to 1940. They are our history,
but because of science, we need to ask “Who Moved My Cheese?”
Don't forget to visit us at: http://www.chiropracticmentor.com
College of Chiropractic student.
(Re-printed from The Triune, the Official Student Newspaper of Palmer College of Chiropractic’s Florida
Campus)
GG: Tell me about Motion Palpation. Would you describe it as a technique, like
Gonstead? What makes Motion Palpation different than other techniques?
LF: This question is like putting a red flag in front of a bull. Motion Palpation is not a
technique system. I repeat, not a technique system. It gets classified as one by all the
colleges so that the students think it is just another system, and you need to choose
one, any one it doesn’t matter.
I used to tell my students that “they had to get used to swimming in a sea of
relativity.”
The long lecture on the components of the subluxation complex and the literature
that discussed those topics was the sea of relativity. By learning to examine your
patients as individuals to determine what was occurring with all of these so-called
components and the doctor could make rational therapeutic decisions. There are co-
relations between joint dysfunction and many symptoms. There are co-relations
between joint dysfunction and faulty locomotor coordination. There are co-relations
between joint dysfunction and neural facilitation and there is a co-relation between
spinal pathology and nerve compression symptoms.
My concept of a chiropractic doctor is one who assesses all of these health reducing
factors, along with the nutritional and psychological stressors and does not follow a
system blindly, like a disciple. Needless to say, the “systems” people did not agree with
me releasing doctors and leading them to the literature and some basic science facts.
For example, bones can’t be spun into place by a “specific” adjustment. Joints can
change their function and bones can have a new range of motion. Hence the atlas can’t
be adjusted, but the atlanto-occipital and atlanto-axial joints can be influenced by our
adjustments.
To get doctors and students in touch with all these discussions I had to form MPI in
the late 70s and present seminars in all the college towns. Unfortunately I needed to
piggyback off of Dr. Henry Gillet’s reputation in order to get anyone to attend and listen
to me. He was known for teaching Motion Palpation. I should have renamed the
seminars “The Dynamic Concepts of Chiropractic.” Then it would have been more
difficult to label it a “technique system.”
Since we [The Motion Palpation Institute] have as one of our concepts, that the most
fixated joint in the closed kinematic system requires the most compensatory adaptation;
it is best to adjust this dysfunction first and observe the changes in the whole system.
This can appear to be a technique. Since this “Major” fixation varies so much in its
location, one has to palpate to find it.
The inaccuracy of palpation leads to a lot of trial and error and multiple vis its. The
intra-examiner reliability is quite good, so as individuals we can learn to recognize the
palpation feeling of the significant motion palpation findings. However, motion palpation
is only helpful in attempting to get your adjustments around the correct axes of rotation.
It provides lines of drive needed for freeing up the motion lost in a motion unit. We
demonstrate the chiropractic adjustment as being specifically around one axis or with
multiple axes, which address coupled movements.
We have motion studies that confirm joints can be hypomobile and studies that show
manipulation/adjustments cause an increase in the ranges of motion. Duh! What is the
problem with looking for hypomobility?
Static x-rays can’t show it. So how can we determine what to adjust from a static
picture?
If it is tilted and rotated does that mean it is fixated? NO.
No system can deal with all the complexities of a human patient. A holistic approach
is our strength and I am proposing we need to become de-systematized and more
comfortable examining, diagnosing and treating all the stress factors in our patients.
The core: being able to deliver adjustments that restore function in all the lost ranges of
motion in a motion unit and the locomotor system overall.
On the website www.ChiropracticMentor.com you can see the relationship between
the palpation of lost motion and the choosing of the correct technique to restore that
movement. The adjustment is about changing the biomechanics first, and the
neurological effects change after.
Cracking joints that are already mobile is irrational. Leaving joints partially adjusted
is irrational. We try to avoid irrational behavior; that is our system.
GG: You’ve touched on a major component of the curriculum at many chiropractic
colleges: listings, and x-ray line drawing analysis. At Palmer Homecoming here in
Florida you mentioned you mentioned a personal investigation you conducted
concerning line drawings. Would you care to elaborate for the Triune readers?
LF: To answer this question, imagine my predicament in England in 1963; I was
merrily rolling along in practice seeing about 75 patients a day. Everyone had been x-
rayed and adjusted according to the listing arrived at by the marking system I was
using. Then I was lucky enough to see Dr. Fred Illi’s motion x-ray studies of before and
after manipulation and patient responses. That same weekend, I heard Dr. Henry Gillet
explain a method of palpation to aid in finding joint dysfunction.
When I got back to England, I called the patients that I had discharged as symptom
free and asked them to drop in and let me take one post treatment radiograph for a
research project.
About fifty patients responded. 12% had better listings and 67% had worse listings
and the rest looked the same. Wow! I thought Illi and Gillet had discovered a very
important piece of information.
A Danish student for his thesis for graduating from AECC, did a much bigger sample
of Gonstead’s marking system and patients of Danish chiropractors using the Gonstead
method. His results were very similar. Proving the Gonstead adjustments were the
cause of the results.
I deducted the manipulations I was performing were getting results, but not for the
reason I thought, at the time. I stopped taking x-rays to find the listings that I proved
were not significant. My new method of deciding when, where, how and how often,
became the assessment for the adjustment. I felt the hypomobility and the patient felt a
pain at the end range that was relieved as soon as I released the end-feel pressure. I
called this the pain response of the manipulable lesion. (If it is a lesion).
On corresponding with Dr. Adrian Grice at the time, he started to do x-ray studies
with the patient leaning to the left and then to the right. He demonstrated the
hypomobilities and typed the patterns that were visualized as type one, two, etc. His
papers were published in the Canadian Chiropractic Journal in the 70’s.
The listings actually limited me from attending to the faults in the patients’ complete,
closed kinematic, locomotor system. Personally, I felt literally released from following a
system and instead could start thinking my way though a patient’s problems. I became
a much smoother adjuster, with less force and very few, sore reactions to a
manipulation.
GG: So the paradigm shift for you took place in England after that serendipitous
weekend with Illi and Gillet, but when did you endeavor to bring the message to
chiropractic at large? What kind of resistance did you meet when you did?
LF: In the late 60’s I was sitting on the banks of the Seine River in Paris with another
young chiropractor who practiced the Dynamic Principles type of practice. We
fantasized; what Chiropractic could really be if all the colleges in the USA made the
paradigm shift and the American public actually got information that was rational and
not the “Spine in line feel fine.” That was advertising the concept? That chiropractors
re-aligned, mis-aligned spines?
My Belgian colleague said to me, “Unless you go back, who is going to let them
know?” I was already teaching part time at the AECC in Bournemouth, England. He
was aware of the Subluxation Complex Model I was teaching that reflected the Dynamic
Principles.
That incidence planted the seed and when we decided to leave England in 1975, I
got a job at CMCC as a clinician. I was supposed to get a class of third year students,
but that didn’t happen. I started to teach in the intern’s room in the evening. The result
was a student petition asking for my course to be put into the next semester. SOT was
dropped and I was inserted.
I was warmly received by the students that wanted to aspire to a high level of
competency and hated by those that wanted to follow a system and believed the
“Subluxation” theory of disease. That was in 1976 and nothing much has changed.
Lots have tackled the job of becoming comfortable in the sea of relativity and others
take the traditional route.
I used to get upset and angry at the situation, but on reflection I realized that I had
helped many very successful doctors stay in Chiropractic when they realized that it had
subsidence. Many of our researchers today got fired up by my MPI Seminar, Saturday
morning introduction lecture.
The lecture I presented at your college was boycotted by the traditionalists. The
students that wanted to read references and comprehend how we can provide health
care in a rational model stayed and listened and I hope asked important questions of
themselves and what they believe.
Before the dinner on the Saturday night, one student told me “It’s just a matter of
learning to sell adjustments and the philosophy.” I accept he is not my type of
chiropractor and I like to deal with the other end of the learning scale.
The sad thing is that medicine and physiotherapy is recognizing the relationship
between biomechanical function, manipulation, inflammation, stress, and the
neurobiological mechanisms involved. We are losing our position as the forefathers of
C.A.M. and we are letting others catch up. In the meantime, we stay divided, instead of
recognizing the Palmers were the best there was in 1895 to 1940. They are our history,
but because of science, we need to ask “Who Moved My Cheese?”
Don't forget to visit us at: http://www.chiropracticmentor.com
Thursday, June 25, 2009
Practice Article – April 2008
INTERVIEW WITH DR. FAYE
By: Greg Green, Palmer Florida Student
(re-printed from The Triune, the Official Student Newspaper of Palmer College of Chiropractic’s Florida
Campus)
Although the name Leonard Faye doesn’t typically garner the same attention or
recognition as Clarence Gonstead or BJ Palmer, many chiropractors acknowledge him
as a key figure in the world of evidence-based practice. He has being trying to “shift the
paradigm from the static, faith-based” phase of chiropractic development to the
dynamic, functional paradigm,” ever since a chance encounter with Dr. Henri Gillet and
Dr. Fred Illis in 1963 led him to the belief that although chiropractic works, the
philosophy behind it was in desperate need of an overhaul.
Dr. Faye has written hundreds of articles and chapters, and the book Goodbye Back
Pain which is currently being released as a second edition. In fifth quarter, students at
Palmer Florida became intimately aquainted with the chapter in the Gatterman text that
Dr. Faye co-wrote with Dr. Seaman. He has given over 300 lectures, and he recently
spoke at the Palmer Florida homecoming. His 10 video series, Motion Palpation and
Chiropractic Technique has been incredibly influential for developing chiropractors and
students who want to develop their adjusting skills. Many Palmer Florida students have
been introduced to the concepts of Motion Palpation in the incredibly popular club of the
same name (The club meets Wednesdays at 1:30 in both of the technique rooms in
building one).
Dr. Faye’s other career achievements include:
• The Henri Gillet Award of Excellence given by the Belgian Chiropractors Asso
• The first chiropractor to be appointed by the Canadian Track & Field Team for
the 1984 Olympics.
• The first chiropractor to present to the directors of the RAND Corporation in
Santa Monica, CA
• Co-authored chapters in well-known books: Foundations of Chiropractic, second
edition by Meridel I. Gatterman; Fundamentals of Chiropractic by Daniel
Redwood and Carl S Cleveland III; and Chiropractic Principles and Practice, by
Scott Haldeman DC, MD, Neurologist.
• Author of Goodbye Back Pain
• Founder of www.ChiropracticMentor.com
I had the opportunity to get to know Dr. Faye during homecoming, and recently
asked him if he would consider doing an interview for Triune. He was happy to oblige.
We decided that it would be best for the interview to work in a conversation format that
would take place over the course of a few weeks as opposed to a list of questions being
sent. The following is the first part of the interview, with more to follow.
GG: I am curious to ask you one thing for sure – what do you think the mechanism
was behind the adjustment “curing” your rheumatic fever as a young man? One thing
you mentioned at homecoming was the fact that many people have tried to put you in a
box by saying “Motion Palpation” is only good for low back and neck pain,” yet your own
personal introduction to chiropractic is so much more than your typical low back
complaint.
LF: The mechanism that I am sure was the reason I had a personal response to
manipulation that stopped the auto-immune disease call Rheumatic Fever was the de-
facilitation of the sympathetic nerves in my upper thoracic region. As I stated in my
introduction at PCC (Fla), I had been bedridden for three months and had all my joints
painfully swollen in spite of taking aspirin every six hours. In desperation, my Dad
called in his Chiropractor who adjusted my upper thoracic region on a portable table.
The very next day, my joints were no longer red and swollen. We all know there are no
nerves that go from the upper thoracics to all the extremities.
I spent four years from 1956 to 1960 at CMCC hoping to learn how to achieve the
same results on others. The only hit I got was in a book entitled “The Autonomics in
Chiropractic” by a Dr. Meuller DC who had been a Dean at CMCC until he committed
suicide.
Soon after graduation, I started to read a text “The Physiology and Pathology of
Exposure to STRESS” by Hans Selye M.D. of McGill University, Canada. He showed
me that when the sympathetic nervous system was activated and shut off the
parasympathetic system, inflammation and the auto-immune disease erupted. I have
hypothesized ever since that the heuristic, subluxation complex model should be
included in the list of “stressors” that promote the inflammatory process.
Dr. Irwin Korr PhD demonstrated that the sympathetics could be facilitated at the
spinal level. It is the only mechanism I can consider rational at the moment. My
Chiropractor stopped the sympathetic facilitation occurring in my upper thoracics and
the parasympathetics got back in control. The cortisol to DHEA ratio normalized and the
inflammation subsided.
I have never understood when Bausbaum and Levine published the Role of the
Sympathetic Nervous System in the Inflammatory process, why we did not do research
to show cervical/thoracic junction dysfunction causes sympathetic facilitation.
The bottom line for me is that the pathologies that have been reported anecdotally by
our fore fathers to respond to chiropractic actually caused this flip from sympathetic
facilitation to parasympathetic dominance which allowed a healing to occur.
The subluxation complex demands the doctor to conduct tests and diagnostic
procedures that remove all the stressors affecting the patient. This is a truly holistic
approach and individualizes the patient. By that I mean, the patient isn’t pre-diagnosed
even before they arrive in the office. For example, the upper cervical chiropr actor
knows it is the atlas/axis that is the etiological factor. The S.O.T. practitioner knows it is
the sacro/occipital relationships disclosed by a swaying pattern. We have over 300
systems that pre diagnose and fit patients into the system.
How do they all work when they are all so different, you may ask?
The waters are muddied by placebo, natural history of the condition, the ability of the
technique to quite the sympathetic facilitation.
The sympathetic facilitation affects the hypothalmus and that’s how it causes a
systemic affect. The concerned DC is not embarrassed by positive placebo effect as
we do no harm unlike the placebo effect of drugs and their side effects.
Healing is complex and the more informed the Chiropractor the better. As you know
from Dr. Seaman’s lectures, nutrition can be pro inflammatory and hence diet and
supplements are part of the treatment plan for the subluxation complex components
active in our patients.
So, the answer to your question as to what I think the mechanism was, is a complex
of factors with the upper thoracic adjustment being the center of the healing response
my body made.
GG: So, in effect, you’re saying that the adjustment inhibited one aspect of nervous
function- the sympathetic and this in turn allowed the parasympathetic to take over? Do
you see things like this happen often in your current practice? This seems to fly in the
face of the crowd that says your paradigm limits the scope of chiropractic to musculo-
skeletal conditions.
LF: When the sympathetics are facilitated by spinal dysfunction and inflammation,
the bodies “flight or fight” mechanism is activated. The first stage is to stop the
parasympathetic control. The old fashion chiropractic dogma used to state the
sympathetics and the parasympathetics had to be balanced. The parasympathetics are
in every day control and the sympathetics are waiting silently until an adaptation needs
to respond to a stressor. Seyle described all the stressors he was aware of but in my
opinion he was not aware that spinal dysfunction could trip up an adaptive response.
The general Adaptive Response (G.A.S.) is supposed to be a short term situation.
With chronic, continued stressors the G.A.S. fails and a fatigued response tilts the
DHEA to Cortisol ratio and disease processes commence. No matter what the stressor
is the response the body make is the same. For example, inflammation in response to
trauma is the same as an infected skin abrasion. The response is modulated by the
sympathetic nerve excitement acting on the hypothalmus which in turn causes hormonal
releases from specific tissues like the Adrenal glands. The physiology and bio-
chemistry of these responses should be covered in every chiropractic college in minute
detail.
If I am correct in interpreting Irwin Korr and others, then the sympathetics can
become activated by components of the subluxation complex. This means we can drop
the 1895, bone out of place, pinching a nerve, and shutting off the flow dogma that has
never made sense to any scholar. It was a good guess in 1895, but the facts of today,
2008 surely can sway us to recognize the former as just part of our history.
If we research the model I proposed in 1967 and co-related the reduction of
sympathetic facilitation with our adjustments we would have a strong model as to how
and why chiropractors reported such a broad scope of practice. For the traditionalists
stuck in the static model, it was much easier to suppress Motion Palpation and Dr.
Faye, rather that delve into the Dynamic Principles he spent 4 hours lecturing about at
all of the 400 seminars he presented around the world. The Subluxation Complex
model and the Dynamic Principles are the keys to a modern broad scope practice. One
limited by irreversible pathology, but willing to provide rational service to improve all
patient’s quality of life.
At your homecoming I displayed a slide of the human life span and related the typical
type of service we can provide for different age groups, however I must say that two
lumbar rolls and an anterior thoracic and two rotary cervicals do not constitute a very
rational treatment in my books.
Our failure to excite the public is a direct result of these mindless adjustments given
to all patients no matter what their problem.
Until our students learn to think in terms of the subluxation complex and understand
what therapeutic applications affect which components we will appear irrational to
educated onlookers. I address the fallacy of the so called Chiropractic Philosophy and
asked those present to read the small text by Dr. Ian Coulter PhD, entitled
‘Chiropractic.” Only three in the audience had read it. Why?
Philosophy is all about discus sion, not blind acceptance of dogma. The faith we
needed in 1895 has to be replaced with knowledge; especially since it is available.
GG: Speaking of available knowledge, you mentioned the book by Dr. Ian Coulter;
are there any other books that you would consider essential for the student of
chiropractic? You’ve written a few books yourself haven’t you?
LF: It is difficult for students to read what is necessary to learn in order to pass
college and Board exams. However “Chiropractic” by Ian Coulter and “Stress of Life” by
Hans Seyle are two essentials. One gets the philosophy discussion sorted out and the
other gives a rational explanation as to how chiropractors can treat more than neck and
back pain. Both books are quick and easy to read.
After graduation is when a doctor has time to tackle the literature and go into more
depth with the subjects connected to the subluxation complex, heuristic model, etc.
Sadly most of my colleagues do not even read J.M.P.T., our most prestigious, peer
review journal.
One’s knowledge of the inflammatory process should be very broad. You are lucky
to have Dr. Seaman as a professor, as he is truly most knowledgeable in this subject.
It has been my hope that the students would recognize the value of
www.chiropracticmentor.com @ 49.95 per year. The Dynamic Concepts are the basis
of the “Practice Articles.” Students that get the procedures and concepts, build great
practices in the college clinic. They want to do a good job, not just get the minimum
points to graduate.
Success is learned and earned and should be commenced in the college clinic. Self-
esteem comes from knowing you know what you are doing and knowing that you do it
well.
for chiropractic videos visit us at : http://www.chiropracticmentor.com
INTERVIEW WITH DR. FAYE
By: Greg Green, Palmer Florida Student
(re-printed from The Triune, the Official Student Newspaper of Palmer College of Chiropractic’s Florida
Campus)
Although the name Leonard Faye doesn’t typically garner the same attention or
recognition as Clarence Gonstead or BJ Palmer, many chiropractors acknowledge him
as a key figure in the world of evidence-based practice. He has being trying to “shift the
paradigm from the static, faith-based” phase of chiropractic development to the
dynamic, functional paradigm,” ever since a chance encounter with Dr. Henri Gillet and
Dr. Fred Illis in 1963 led him to the belief that although chiropractic works, the
philosophy behind it was in desperate need of an overhaul.
Dr. Faye has written hundreds of articles and chapters, and the book Goodbye Back
Pain which is currently being released as a second edition. In fifth quarter, students at
Palmer Florida became intimately aquainted with the chapter in the Gatterman text that
Dr. Faye co-wrote with Dr. Seaman. He has given over 300 lectures, and he recently
spoke at the Palmer Florida homecoming. His 10 video series, Motion Palpation and
Chiropractic Technique has been incredibly influential for developing chiropractors and
students who want to develop their adjusting skills. Many Palmer Florida students have
been introduced to the concepts of Motion Palpation in the incredibly popular club of the
same name (The club meets Wednesdays at 1:30 in both of the technique rooms in
building one).
Dr. Faye’s other career achievements include:
• The Henri Gillet Award of Excellence given by the Belgian Chiropractors Asso
• The first chiropractor to be appointed by the Canadian Track & Field Team for
the 1984 Olympics.
• The first chiropractor to present to the directors of the RAND Corporation in
Santa Monica, CA
• Co-authored chapters in well-known books: Foundations of Chiropractic, second
edition by Meridel I. Gatterman; Fundamentals of Chiropractic by Daniel
Redwood and Carl S Cleveland III; and Chiropractic Principles and Practice, by
Scott Haldeman DC, MD, Neurologist.
• Author of Goodbye Back Pain
• Founder of www.ChiropracticMentor.com
I had the opportunity to get to know Dr. Faye during homecoming, and recently
asked him if he would consider doing an interview for Triune. He was happy to oblige.
We decided that it would be best for the interview to work in a conversation format that
would take place over the course of a few weeks as opposed to a list of questions being
sent. The following is the first part of the interview, with more to follow.
GG: I am curious to ask you one thing for sure – what do you think the mechanism
was behind the adjustment “curing” your rheumatic fever as a young man? One thing
you mentioned at homecoming was the fact that many people have tried to put you in a
box by saying “Motion Palpation” is only good for low back and neck pain,” yet your own
personal introduction to chiropractic is so much more than your typical low back
complaint.
LF: The mechanism that I am sure was the reason I had a personal response to
manipulation that stopped the auto-immune disease call Rheumatic Fever was the de-
facilitation of the sympathetic nerves in my upper thoracic region. As I stated in my
introduction at PCC (Fla), I had been bedridden for three months and had all my joints
painfully swollen in spite of taking aspirin every six hours. In desperation, my Dad
called in his Chiropractor who adjusted my upper thoracic region on a portable table.
The very next day, my joints were no longer red and swollen. We all know there are no
nerves that go from the upper thoracics to all the extremities.
I spent four years from 1956 to 1960 at CMCC hoping to learn how to achieve the
same results on others. The only hit I got was in a book entitled “The Autonomics in
Chiropractic” by a Dr. Meuller DC who had been a Dean at CMCC until he committed
suicide.
Soon after graduation, I started to read a text “The Physiology and Pathology of
Exposure to STRESS” by Hans Selye M.D. of McGill University, Canada. He showed
me that when the sympathetic nervous system was activated and shut off the
parasympathetic system, inflammation and the auto-immune disease erupted. I have
hypothesized ever since that the heuristic, subluxation complex model should be
included in the list of “stressors” that promote the inflammatory process.
Dr. Irwin Korr PhD demonstrated that the sympathetics could be facilitated at the
spinal level. It is the only mechanism I can consider rational at the moment. My
Chiropractor stopped the sympathetic facilitation occurring in my upper thoracics and
the parasympathetics got back in control. The cortisol to DHEA ratio normalized and the
inflammation subsided.
I have never understood when Bausbaum and Levine published the Role of the
Sympathetic Nervous System in the Inflammatory process, why we did not do research
to show cervical/thoracic junction dysfunction causes sympathetic facilitation.
The bottom line for me is that the pathologies that have been reported anecdotally by
our fore fathers to respond to chiropractic actually caused this flip from sympathetic
facilitation to parasympathetic dominance which allowed a healing to occur.
The subluxation complex demands the doctor to conduct tests and diagnostic
procedures that remove all the stressors affecting the patient. This is a truly holistic
approach and individualizes the patient. By that I mean, the patient isn’t pre-diagnosed
even before they arrive in the office. For example, the upper cervical chiropr actor
knows it is the atlas/axis that is the etiological factor. The S.O.T. practitioner knows it is
the sacro/occipital relationships disclosed by a swaying pattern. We have over 300
systems that pre diagnose and fit patients into the system.
How do they all work when they are all so different, you may ask?
The waters are muddied by placebo, natural history of the condition, the ability of the
technique to quite the sympathetic facilitation.
The sympathetic facilitation affects the hypothalmus and that’s how it causes a
systemic affect. The concerned DC is not embarrassed by positive placebo effect as
we do no harm unlike the placebo effect of drugs and their side effects.
Healing is complex and the more informed the Chiropractor the better. As you know
from Dr. Seaman’s lectures, nutrition can be pro inflammatory and hence diet and
supplements are part of the treatment plan for the subluxation complex components
active in our patients.
So, the answer to your question as to what I think the mechanism was, is a complex
of factors with the upper thoracic adjustment being the center of the healing response
my body made.
GG: So, in effect, you’re saying that the adjustment inhibited one aspect of nervous
function- the sympathetic and this in turn allowed the parasympathetic to take over? Do
you see things like this happen often in your current practice? This seems to fly in the
face of the crowd that says your paradigm limits the scope of chiropractic to musculo-
skeletal conditions.
LF: When the sympathetics are facilitated by spinal dysfunction and inflammation,
the bodies “flight or fight” mechanism is activated. The first stage is to stop the
parasympathetic control. The old fashion chiropractic dogma used to state the
sympathetics and the parasympathetics had to be balanced. The parasympathetics are
in every day control and the sympathetics are waiting silently until an adaptation needs
to respond to a stressor. Seyle described all the stressors he was aware of but in my
opinion he was not aware that spinal dysfunction could trip up an adaptive response.
The general Adaptive Response (G.A.S.) is supposed to be a short term situation.
With chronic, continued stressors the G.A.S. fails and a fatigued response tilts the
DHEA to Cortisol ratio and disease processes commence. No matter what the stressor
is the response the body make is the same. For example, inflammation in response to
trauma is the same as an infected skin abrasion. The response is modulated by the
sympathetic nerve excitement acting on the hypothalmus which in turn causes hormonal
releases from specific tissues like the Adrenal glands. The physiology and bio-
chemistry of these responses should be covered in every chiropractic college in minute
detail.
If I am correct in interpreting Irwin Korr and others, then the sympathetics can
become activated by components of the subluxation complex. This means we can drop
the 1895, bone out of place, pinching a nerve, and shutting off the flow dogma that has
never made sense to any scholar. It was a good guess in 1895, but the facts of today,
2008 surely can sway us to recognize the former as just part of our history.
If we research the model I proposed in 1967 and co-related the reduction of
sympathetic facilitation with our adjustments we would have a strong model as to how
and why chiropractors reported such a broad scope of practice. For the traditionalists
stuck in the static model, it was much easier to suppress Motion Palpation and Dr.
Faye, rather that delve into the Dynamic Principles he spent 4 hours lecturing about at
all of the 400 seminars he presented around the world. The Subluxation Complex
model and the Dynamic Principles are the keys to a modern broad scope practice. One
limited by irreversible pathology, but willing to provide rational service to improve all
patient’s quality of life.
At your homecoming I displayed a slide of the human life span and related the typical
type of service we can provide for different age groups, however I must say that two
lumbar rolls and an anterior thoracic and two rotary cervicals do not constitute a very
rational treatment in my books.
Our failure to excite the public is a direct result of these mindless adjustments given
to all patients no matter what their problem.
Until our students learn to think in terms of the subluxation complex and understand
what therapeutic applications affect which components we will appear irrational to
educated onlookers. I address the fallacy of the so called Chiropractic Philosophy and
asked those present to read the small text by Dr. Ian Coulter PhD, entitled
‘Chiropractic.” Only three in the audience had read it. Why?
Philosophy is all about discus sion, not blind acceptance of dogma. The faith we
needed in 1895 has to be replaced with knowledge; especially since it is available.
GG: Speaking of available knowledge, you mentioned the book by Dr. Ian Coulter;
are there any other books that you would consider essential for the student of
chiropractic? You’ve written a few books yourself haven’t you?
LF: It is difficult for students to read what is necessary to learn in order to pass
college and Board exams. However “Chiropractic” by Ian Coulter and “Stress of Life” by
Hans Seyle are two essentials. One gets the philosophy discussion sorted out and the
other gives a rational explanation as to how chiropractors can treat more than neck and
back pain. Both books are quick and easy to read.
After graduation is when a doctor has time to tackle the literature and go into more
depth with the subjects connected to the subluxation complex, heuristic model, etc.
Sadly most of my colleagues do not even read J.M.P.T., our most prestigious, peer
review journal.
One’s knowledge of the inflammatory process should be very broad. You are lucky
to have Dr. Seaman as a professor, as he is truly most knowledgeable in this subject.
It has been my hope that the students would recognize the value of
www.chiropracticmentor.com @ 49.95 per year. The Dynamic Concepts are the basis
of the “Practice Articles.” Students that get the procedures and concepts, build great
practices in the college clinic. They want to do a good job, not just get the minimum
points to graduate.
Success is learned and earned and should be commenced in the college clinic. Self-
esteem comes from knowing you know what you are doing and knowing that you do it
well.
for chiropractic videos visit us at : http://www.chiropracticmentor.com
Website Article March 2008
The following is a summary of what the Task Force on Neck Pain and its Associated
Disorders. It quotes a very significant study done on VBA stroke. Dr. Scott Haldeman is
a D.C as well as a medical neurologist. Dr. David Cassidy is also a chiropractor.
I wish to make a reminder that a lot of cervical dysfunction and pain is caused by
adaptation to dysfunction lower in the kinematic chain. Adjusting the cause of the
adaptation is the key to stopping episodal neck pain and headaches. Please note even
though the articles look similar they are slanted differently depending upon the media
and medical communities. Please read all the information presented.
FINAL – Health Trade Publications
Seven-Year Neck Pain Study Focuses Clinical Directions
TORONTO, February 15, 2008 — A seven-year, international multidisciplinary study
published in the journal Spine today could signal a shift in clinical best practices for the
treatment of neck pain.
The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated
Disorders considered almost 32,000 citations and performed critical appraisals of more
than 1,000 studies in developing its 236-page report. The years 2000-2010 have been
designated the Decade of the Bone and Joint by the United Nations and the World
Health Organization. The Task Force is an independent research group recognized by
the UN and the WHO.
“Neck pain is widespread, and is a persistent and recurrent condition for most sufferers,”
says Task Force president, Dr. Scott Haldeman, clinical professor, department of
neurology at the University of California, Irvine; and adjunct professor, department of
epidemiology University of California Los Angeles. “Our work was designed to help neck
pain sufferers and health professionals to apply the best available evidence to prevent,
diagnose and manage neck pain.”
A key recommendation of the Task Force is that neck pain, including whiplash-
associated disorders (WAD), be classified and treated in a common system of 4 grades:
Grade 1: neck pain with little or no interference with daily activities
Grade 2: neck pain that limits daily activities
Grade 3: neck pain accompanied by radiculopathy
Grade 4: neck pain with serious pathology, such as tumour, fracture, infection or
systemic disease
The published report, which synthesizes the best available scientific and clinical
evidence on the onset, course and prognosis, assessment and management of neck
pain, concludes that there is sufficient evidence to support education, exercise, neck
mobilization, neck manipulation, acupuncture, analgesics, massage and low-level laser
therapy in the treatment of Grades 1 or 2 neck pain.
The study found that many commonly prescribed treatments are unlikely to be effective
for sufferers of Grades 1 or 2 neck pain. These include: cervical collars, ultrasound,
electrical muscle stimulation, transcutaneous electrical nerve stimulation (TENS), most
injection therapies (such as corticosteroid injections in cervical facet joints) and surgery.
For the minority of neck pain sufferers who may experience Grade 3 neck pain,
corticosteroid injections may provide temporary relief, according to the Task Force study.
Surgery should only be considered if accompanied by radiculopathy or if the person is
experiencing Grade 4 neck pain due to fracture, tumor, infection or systemic disease
“There is typically no single cause and no single effective treatment for Grades 1 and 2
neck pain,” says Task Force member, Dr. Linda Carroll, Associate Professor, School of
Public Health at the University of Alberta, and Associated Scientist, Alberta Centre for
Injury Control and Research (ACICR). “But effective treatment options that have been
cited in the study are all low risk and may provide short-term relief when provided in
moderation. A variety of treatments may need to be tried and, ultimately, an informed
patient’s preferences are key to treatment decisions.”
Significantly, the Task Force study found that routine diagnostic imaging does little to
increase understanding of causation in Grades 1 and 2 neck pain. The Task Force does
recommend that patients with acute neck injuries may need radiographic examination to
rule out fracture or dislocation if they have ‘red flag’ signs and symptoms.
In addition to its comprehensive review of the existing body of research on neck pain,
the Task Force also initiated a new population-based, case-control and case-crossover
study into the association between chiropractic care and vertebrobasilar artery (VBA)
stroke. This Canadian study investigated associations between chiropractic visits and
vertebrobasilar artery stroke and compared this with visits to primary care physicians
and the occurrence of VBA stroke.
The study — which analyzed a total of 818 VBA strokes that met the inclusion/exclusion
criteria over the 9-year inception period in Ontario — concludes that VBA stroke is a very
rare event and that the risk of VBA stroke associated with a visit to a chiropractor’s office
appears to be no different from the risk of VBA stroke following a visit to a family
physician’s office.
“Our research has led us to believe that the association between VBA stroke and
chiropractic care is likely due to patients with headache and/or neck pain from a VBA
dissection seeking care in the prodrome of a stroke,” explains the study’s lead author,
Dr. David Cassidy, professor of epidemiology at the University of Toronto and senior
scientist at the University Health Network at Toronto Western Hospital.
“We found no evidence of excess risk of VBA stroke associated with chiropractic care
beyond that associated with primary physician care,” says Dr. Cassidy. He added that
these rare strokes have also been reported after ordinary neck movements such as
looking up at the sky or shoulder checking when backing up a car, and that they are
often reported as spontaneous and without known cause.
“This is an important body of research that we anticipate will help to improve the quality of
patient care by incorporating the best evidence into practice and patient education,”
concludes Dr. Carroll. “Neck pain can be a stubborn problem – we hope this
comprehensive analysis of the evidence will help both sufferers and health care providers
better manage this widespread complaint.”
FINAL – Consumer media
Seven-Year Neck Pain Study Sheds Light on Best Care
Toronto – February 15, 2008 – A seven-year, international study published today finds
that some alternative therapies such as acupuncture, neck manipulation and massage
are better choices for managing most common neck pain than many current practices.
Also included in the short-list of best options for relief are exercises, education, neck
mobilization, low level laser therapy and pain relievers.
Therapies such as neck collars and ultrasound are not recommended. The study found
that corticosteroid injections and surgery should only be considered if there is associated
pain, weakness or numbness in the arm, fracture or serious disease.
The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated
Disorders 236 page review of the current research on neck pain is published in the
journal Spine. The multi-national and inter-disciplinary study team included Canadian,
American, South American, Australasian and European researchers. The Task Force
was created to help neck pain sufferers and health professionals use the best research
evidence to prevent, diagnose and manage neck pain.
“Neck pain is not a trivial condition for many people,” says Task Force president Dr.
Scott Haldeman, clinical professor, department of neurology at the University of
California, Irvine; and adjunct professor, department of epidemiology University of
California Los Angeles. “It can be associated with headaches, arm and upper back pain
and depression. Whether it arises from sports injuries, car collisions, workplace issues
or stress, it can be incapacitating. Understanding the best way to diagnose and manage
this problem is of high importance for those who are suffering and for those who manage
and pay for its care.”
The study found that neck pain is a widespread experience that is a persistent and
recurrent condition for the majority of sufferers. It is disabling for approximately two out
of every 20 people who experience neck pain and affects their ability to carry on with
daily activities says the Task Force.
A key recommendation of the Task Force is that neck pain, including whiplash-related
pain, be classified and treated in a common system of 4 grades:
Grade 1: neck pain with little or no interference with daily activities
Grade 2: neck pain that limits daily activities
Grade 3: neck pain accompanied by radiculopathy (“pinched nerve” – pain weakness
and/or numbness in the arm)
Grade 4: neck pain with serious pathology, such as tumor, fracture, infection, or
systemic disease.
“The majority of neck pain falls into Grades 1 or 2,” says Task Force member, Dr. Linda
Carroll, Associate Professor, School of Public Health at the University of Alberta, and
Associated Scientist, Alberta Centre for Injury Control and Research (ACICR). “Many
sufferers manage to carry on with their daily activities. Others find their pain interferes
with their ability to carry out daily chores, participate in favorite activities or be effective
at work. For these people, the evidence shows there are a relatively small number of
therapies that provide some relief for a while, but there is no one best option for
everyone.”
In addition to its comprehensive review of the existing body of research on neck pain,
the Task Force also initiated a new study into the association between chiropractic care
of the neck and stroke. This innovative piece of research found that patients who visit a
chiropractor are no more likely to experience a stroke than are patients who visit their
family physician. The study concludes that this type of stroke commonly begins with
neck pain and/or headache which causes the patient to seek care from their chiropractor
or family physician before the stroke fully develops.
“This type of stroke is extremely rare and has been known to occur spontaneously or
after ordinary neck movements such as looking up at the sky or shoulder-checking when
backing up a car,” noted the study’s lead author, Dr. David Cassidy, professor of
epidemiology at the University of Toronto and senior scientist at the University Health
Network at Toronto Western Hospital.
For the minority of neck pain sufferers who experience Grade 3 neck pain – that is neck pain
accompanied by pain, weakness and/or numbness in the arm, also referred to as a “pinched
nerve”, corticosteroid injections may provide temporary relief says the study. Surgery is a
last resort according to the findings and should only be considered if accompanying arm
pain is persistent or if the person is experiencing Grade 4 pain due to serious injury or
systemic disease.
Top findings for neck pain suffers:
Stay as active as you can, exercise and reduce mental stress.
Don’t expect to find a single “cause” for your neck pain.
Be cautious of treatments that make “big” claims for relief of neck pain.
Trying a variety of therapies or combinations of therapies may be needed to find relief –
see the therapies for which the Task Force found evidence of benefits.
Once you have experienced neck pain, it may come back or remain persistent.
Lengthy treatment is not associated with greater improvements; you should see
improvement after 2-4 weeks, if the treatment is the right one for you.
There is relatively little research on what does or does not prevent neck pain;
ergonomics, cervical pillows, postural improvements etc. may or may not help.
“This is an important body of research that will help to improve the quality of patient care by
incorporating the best evidence into practice and patient education,” says Dr. Carroll. “Neck
pain can be a stubborn problem – we hope this comprehensive analysis of the evidence will
help both sufferers and health care providers better manage this widespread complaint.”
Neck pain task force collars best treatments
February 05, 2008 Andrew Skelly
LOS ANGELES An international task force with major Canadian involvement has developed a
new system of classifying neck pain;
analyzed the literature to determine which treatments may work and which ones don’t; and
conducted original research showing patients are no more likely to suffer a stroke after
visiting a chiropractor than they are after visiting a family doctor.
The findings of the Bone and Joint Decade Task Force on Neck Pain and Its Associated
Disorders were released here at the World Congress on Neck Pain last month and posted on
the website of the journal Spine. The report will appear in print as a supplement to the
journal’s February 15 issue.
Dr. Scott Haldeman, the task force president and a neurologist and clinical professor at the
University of California at Irvine, discussed the report’s key messages with the Medical Post
in advance of the congress.
“Most people develop neck pain, and 5% to 10% of the population actually find the pain
disabling. We’re talking about a huge problem, and so far we don’t treat it very well,” said Dr.
Haldeman, a Saskatchewan native who trained as a chiropractor before obtaining a PhD and
MD from the University of British Columbia.
“What is particularly interesting is once we have an episode of neck pain . . . about 50% of
people will still have neck pain one to five years later. So this is something that is a persistent
or recurrent condition in a larger number of people.”
The task force categorized neck pain into four grades:
• Grade 1: Little or no interference with daily activities;
•Grade 2: Limits daily activities;
• Grade 3: Accompanied by radiculopathy;
•Grade 4: Serious pathology such as tumour, fracture, infection, systemic disease.
The task force, whose members represented 19 clinical and scientific disciplines, screened
nearly 32,000 citations, finding 1,203 relevant articles and deeming 552 scientifically
acceptable for a synthesis of the best evidence.
They concluded that treatments worth considering for Grades 1 and 2 neck pain, which
account for most cases, include: education, exercise, mobilization, manipulation,
acupuncture, analgesics, massage and low-level laser therapy. But there was no evidence
that any one treatment was better than any other.
Treatments found unlikely to help Grades 1 and 2 neck pain were collars, ultrasound,
electrical muscle stimulation, transcutaneous electrical nerve stimulation, most injection
therapies, including corticosteroid injections in cervical facet joints, radiofrequency
neurotomies and surgery.
“Most people who know the literature will not find this a surprise,” Dr. Haldeman said. “But
those who . . . make their living with one particular technique are likely to become quite
upset.”
Patients considering chiropractic treatment may be reassured by the task force’s Ontario-
based study suggesting earlier reports of an increased risk of vertebrobasilar artery (VBA)
stroke following visits to a chiropractor were instances of “confounding by indication.”
“The increased risks of VBA stroke associated with chiropractic and (primary-care physician)
visits is likely due to patients with headache and neck pain from VBA dissection seeking care
before their stroke. We found no evidence of excess risk of VBA stroke associated with
chiropractic care compared to primary care,” concluded a team led by Dr. J. David Cassidy
(DC, PhD), a senior scientist in the Division of Health Care and Outcomes Research at the
Toronto Western Research Institute.
An earlier analysis of Ontario administrative data by the Institute for Clinical Evaluative
Sciences in Toronto, published in Stroke in October 2001, showed people under age 45
years who had suffered a VBA stroke were five times more likely than controls with no stroke
history to have visited a chiropractor within one week of the stroke. Unlike that report, the
new study also looked at stroke incidence after visits to primary-care physicians.
The researchers found 818 cases of VBA stroke admitted to Ontario hospitals from April 1,
1993 to March 31, 2002 (more than 100 million person-years of observation). Four controls
were age- and gender-matched to each case; and case and control exposures to
chiropractors and primary-care physicians were determined from health billing records.
In those younger than 45 years, cases were about three times more likely to have seen a
chiropractor or a primary-care physician in the month before their stroke than controls. There
was no increased association between chiropractic visits and VBA stroke in those older than
45, however the association remained for primary-care visits.
“It should put the controversy to rest,” said Dr. Haldeman. “Dissections appear to be an
issue, but . . . all the concerns about this being a chiropractic issue probably are not valid.”
Other key messages from the task force report:
• Conduct a thorough patient history, physical examination and patient self-assessment
questionnaire to identify or rule out Grades 3 or 4 neck pain.
• Routine imaging in Grades 1 or 2 neck pain will not increase understanding of causation.
• Patients with Grades 1 or 2 neck pain should be advised to stay as active as they can. A
variety of therapies or combinations of therapies may be needed to find pain relief, which is
often modest and short-lived.
• Be cautious of treatments that make impressive claims for relief of neck pain, and
discontinue treatments that don’t provide improvement within two to four weeks.
• Epidural corticosteroid injections may provide temporary relief of radiculopathy in Grade 3
neck pain. Consider surgery in the presence of serious pathology or persistent radiculopathy.
• In the case of emergency department visits involving neck pain, the Canadian Cervical
Spine Rule and the NEXUS Low Risk Criteria are effective at identifying patients who do not
require imaging.
• Use of MRI as a screening tool in the emergency setting is not supported by evidence; CT
scan is more sensitive than X-ray in high-risk patients (e.g. intoxicated, unconscious and/or
obtunded); and five-view X-rays are no more effective than three in identifying fractures
• In Grade 3 neck pain, there is no evidence that any one type of decompression or fusion
surgery is superior to the others.
Payment recommendations
The task force also called on public and private insurers to adopt evidence-based treatment
guidelines when paying for services.
“A physician who does multiple procedures, rightly or wrongly, is going to be paid
considerably higher than a person who sits down and talks to the patient and examines the
patient,” Dr. Haldeman said. “And the feeling is that since the evidence suggests that sitting
down and examining and talking to the patient is more likely to improve patient outcomes
than these invasive procedures, then the payers should encourage it.”
The Task Force on Neck Pain and Its Associated Disorders was established in 2000 and
was given official status by the steering committee of the United Nations/World Health
Organization Bone and Joint Decade project in 2002.
Visit us at:
http://www.chiropracticmentor.com
The following is a summary of what the Task Force on Neck Pain and its Associated
Disorders. It quotes a very significant study done on VBA stroke. Dr. Scott Haldeman is
a D.C as well as a medical neurologist. Dr. David Cassidy is also a chiropractor.
I wish to make a reminder that a lot of cervical dysfunction and pain is caused by
adaptation to dysfunction lower in the kinematic chain. Adjusting the cause of the
adaptation is the key to stopping episodal neck pain and headaches. Please note even
though the articles look similar they are slanted differently depending upon the media
and medical communities. Please read all the information presented.
FINAL – Health Trade Publications
Seven-Year Neck Pain Study Focuses Clinical Directions
TORONTO, February 15, 2008 — A seven-year, international multidisciplinary study
published in the journal Spine today could signal a shift in clinical best practices for the
treatment of neck pain.
The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated
Disorders considered almost 32,000 citations and performed critical appraisals of more
than 1,000 studies in developing its 236-page report. The years 2000-2010 have been
designated the Decade of the Bone and Joint by the United Nations and the World
Health Organization. The Task Force is an independent research group recognized by
the UN and the WHO.
“Neck pain is widespread, and is a persistent and recurrent condition for most sufferers,”
says Task Force president, Dr. Scott Haldeman, clinical professor, department of
neurology at the University of California, Irvine; and adjunct professor, department of
epidemiology University of California Los Angeles. “Our work was designed to help neck
pain sufferers and health professionals to apply the best available evidence to prevent,
diagnose and manage neck pain.”
A key recommendation of the Task Force is that neck pain, including whiplash-
associated disorders (WAD), be classified and treated in a common system of 4 grades:
Grade 1: neck pain with little or no interference with daily activities
Grade 2: neck pain that limits daily activities
Grade 3: neck pain accompanied by radiculopathy
Grade 4: neck pain with serious pathology, such as tumour, fracture, infection or
systemic disease
The published report, which synthesizes the best available scientific and clinical
evidence on the onset, course and prognosis, assessment and management of neck
pain, concludes that there is sufficient evidence to support education, exercise, neck
mobilization, neck manipulation, acupuncture, analgesics, massage and low-level laser
therapy in the treatment of Grades 1 or 2 neck pain.
The study found that many commonly prescribed treatments are unlikely to be effective
for sufferers of Grades 1 or 2 neck pain. These include: cervical collars, ultrasound,
electrical muscle stimulation, transcutaneous electrical nerve stimulation (TENS), most
injection therapies (such as corticosteroid injections in cervical facet joints) and surgery.
For the minority of neck pain sufferers who may experience Grade 3 neck pain,
corticosteroid injections may provide temporary relief, according to the Task Force study.
Surgery should only be considered if accompanied by radiculopathy or if the person is
experiencing Grade 4 neck pain due to fracture, tumor, infection or systemic disease
“There is typically no single cause and no single effective treatment for Grades 1 and 2
neck pain,” says Task Force member, Dr. Linda Carroll, Associate Professor, School of
Public Health at the University of Alberta, and Associated Scientist, Alberta Centre for
Injury Control and Research (ACICR). “But effective treatment options that have been
cited in the study are all low risk and may provide short-term relief when provided in
moderation. A variety of treatments may need to be tried and, ultimately, an informed
patient’s preferences are key to treatment decisions.”
Significantly, the Task Force study found that routine diagnostic imaging does little to
increase understanding of causation in Grades 1 and 2 neck pain. The Task Force does
recommend that patients with acute neck injuries may need radiographic examination to
rule out fracture or dislocation if they have ‘red flag’ signs and symptoms.
In addition to its comprehensive review of the existing body of research on neck pain,
the Task Force also initiated a new population-based, case-control and case-crossover
study into the association between chiropractic care and vertebrobasilar artery (VBA)
stroke. This Canadian study investigated associations between chiropractic visits and
vertebrobasilar artery stroke and compared this with visits to primary care physicians
and the occurrence of VBA stroke.
The study — which analyzed a total of 818 VBA strokes that met the inclusion/exclusion
criteria over the 9-year inception period in Ontario — concludes that VBA stroke is a very
rare event and that the risk of VBA stroke associated with a visit to a chiropractor’s office
appears to be no different from the risk of VBA stroke following a visit to a family
physician’s office.
“Our research has led us to believe that the association between VBA stroke and
chiropractic care is likely due to patients with headache and/or neck pain from a VBA
dissection seeking care in the prodrome of a stroke,” explains the study’s lead author,
Dr. David Cassidy, professor of epidemiology at the University of Toronto and senior
scientist at the University Health Network at Toronto Western Hospital.
“We found no evidence of excess risk of VBA stroke associated with chiropractic care
beyond that associated with primary physician care,” says Dr. Cassidy. He added that
these rare strokes have also been reported after ordinary neck movements such as
looking up at the sky or shoulder checking when backing up a car, and that they are
often reported as spontaneous and without known cause.
“This is an important body of research that we anticipate will help to improve the quality of
patient care by incorporating the best evidence into practice and patient education,”
concludes Dr. Carroll. “Neck pain can be a stubborn problem – we hope this
comprehensive analysis of the evidence will help both sufferers and health care providers
better manage this widespread complaint.”
FINAL – Consumer media
Seven-Year Neck Pain Study Sheds Light on Best Care
Toronto – February 15, 2008 – A seven-year, international study published today finds
that some alternative therapies such as acupuncture, neck manipulation and massage
are better choices for managing most common neck pain than many current practices.
Also included in the short-list of best options for relief are exercises, education, neck
mobilization, low level laser therapy and pain relievers.
Therapies such as neck collars and ultrasound are not recommended. The study found
that corticosteroid injections and surgery should only be considered if there is associated
pain, weakness or numbness in the arm, fracture or serious disease.
The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated
Disorders 236 page review of the current research on neck pain is published in the
journal Spine. The multi-national and inter-disciplinary study team included Canadian,
American, South American, Australasian and European researchers. The Task Force
was created to help neck pain sufferers and health professionals use the best research
evidence to prevent, diagnose and manage neck pain.
“Neck pain is not a trivial condition for many people,” says Task Force president Dr.
Scott Haldeman, clinical professor, department of neurology at the University of
California, Irvine; and adjunct professor, department of epidemiology University of
California Los Angeles. “It can be associated with headaches, arm and upper back pain
and depression. Whether it arises from sports injuries, car collisions, workplace issues
or stress, it can be incapacitating. Understanding the best way to diagnose and manage
this problem is of high importance for those who are suffering and for those who manage
and pay for its care.”
The study found that neck pain is a widespread experience that is a persistent and
recurrent condition for the majority of sufferers. It is disabling for approximately two out
of every 20 people who experience neck pain and affects their ability to carry on with
daily activities says the Task Force.
A key recommendation of the Task Force is that neck pain, including whiplash-related
pain, be classified and treated in a common system of 4 grades:
Grade 1: neck pain with little or no interference with daily activities
Grade 2: neck pain that limits daily activities
Grade 3: neck pain accompanied by radiculopathy (“pinched nerve” – pain weakness
and/or numbness in the arm)
Grade 4: neck pain with serious pathology, such as tumor, fracture, infection, or
systemic disease.
“The majority of neck pain falls into Grades 1 or 2,” says Task Force member, Dr. Linda
Carroll, Associate Professor, School of Public Health at the University of Alberta, and
Associated Scientist, Alberta Centre for Injury Control and Research (ACICR). “Many
sufferers manage to carry on with their daily activities. Others find their pain interferes
with their ability to carry out daily chores, participate in favorite activities or be effective
at work. For these people, the evidence shows there are a relatively small number of
therapies that provide some relief for a while, but there is no one best option for
everyone.”
In addition to its comprehensive review of the existing body of research on neck pain,
the Task Force also initiated a new study into the association between chiropractic care
of the neck and stroke. This innovative piece of research found that patients who visit a
chiropractor are no more likely to experience a stroke than are patients who visit their
family physician. The study concludes that this type of stroke commonly begins with
neck pain and/or headache which causes the patient to seek care from their chiropractor
or family physician before the stroke fully develops.
“This type of stroke is extremely rare and has been known to occur spontaneously or
after ordinary neck movements such as looking up at the sky or shoulder-checking when
backing up a car,” noted the study’s lead author, Dr. David Cassidy, professor of
epidemiology at the University of Toronto and senior scientist at the University Health
Network at Toronto Western Hospital.
For the minority of neck pain sufferers who experience Grade 3 neck pain – that is neck pain
accompanied by pain, weakness and/or numbness in the arm, also referred to as a “pinched
nerve”, corticosteroid injections may provide temporary relief says the study. Surgery is a
last resort according to the findings and should only be considered if accompanying arm
pain is persistent or if the person is experiencing Grade 4 pain due to serious injury or
systemic disease.
Top findings for neck pain suffers:
Stay as active as you can, exercise and reduce mental stress.
Don’t expect to find a single “cause” for your neck pain.
Be cautious of treatments that make “big” claims for relief of neck pain.
Trying a variety of therapies or combinations of therapies may be needed to find relief –
see the therapies for which the Task Force found evidence of benefits.
Once you have experienced neck pain, it may come back or remain persistent.
Lengthy treatment is not associated with greater improvements; you should see
improvement after 2-4 weeks, if the treatment is the right one for you.
There is relatively little research on what does or does not prevent neck pain;
ergonomics, cervical pillows, postural improvements etc. may or may not help.
“This is an important body of research that will help to improve the quality of patient care by
incorporating the best evidence into practice and patient education,” says Dr. Carroll. “Neck
pain can be a stubborn problem – we hope this comprehensive analysis of the evidence will
help both sufferers and health care providers better manage this widespread complaint.”
Neck pain task force collars best treatments
February 05, 2008 Andrew Skelly
LOS ANGELES An international task force with major Canadian involvement has developed a
new system of classifying neck pain;
analyzed the literature to determine which treatments may work and which ones don’t; and
conducted original research showing patients are no more likely to suffer a stroke after
visiting a chiropractor than they are after visiting a family doctor.
The findings of the Bone and Joint Decade Task Force on Neck Pain and Its Associated
Disorders were released here at the World Congress on Neck Pain last month and posted on
the website of the journal Spine. The report will appear in print as a supplement to the
journal’s February 15 issue.
Dr. Scott Haldeman, the task force president and a neurologist and clinical professor at the
University of California at Irvine, discussed the report’s key messages with the Medical Post
in advance of the congress.
“Most people develop neck pain, and 5% to 10% of the population actually find the pain
disabling. We’re talking about a huge problem, and so far we don’t treat it very well,” said Dr.
Haldeman, a Saskatchewan native who trained as a chiropractor before obtaining a PhD and
MD from the University of British Columbia.
“What is particularly interesting is once we have an episode of neck pain . . . about 50% of
people will still have neck pain one to five years later. So this is something that is a persistent
or recurrent condition in a larger number of people.”
The task force categorized neck pain into four grades:
• Grade 1: Little or no interference with daily activities;
•Grade 2: Limits daily activities;
• Grade 3: Accompanied by radiculopathy;
•Grade 4: Serious pathology such as tumour, fracture, infection, systemic disease.
The task force, whose members represented 19 clinical and scientific disciplines, screened
nearly 32,000 citations, finding 1,203 relevant articles and deeming 552 scientifically
acceptable for a synthesis of the best evidence.
They concluded that treatments worth considering for Grades 1 and 2 neck pain, which
account for most cases, include: education, exercise, mobilization, manipulation,
acupuncture, analgesics, massage and low-level laser therapy. But there was no evidence
that any one treatment was better than any other.
Treatments found unlikely to help Grades 1 and 2 neck pain were collars, ultrasound,
electrical muscle stimulation, transcutaneous electrical nerve stimulation, most injection
therapies, including corticosteroid injections in cervical facet joints, radiofrequency
neurotomies and surgery.
“Most people who know the literature will not find this a surprise,” Dr. Haldeman said. “But
those who . . . make their living with one particular technique are likely to become quite
upset.”
Patients considering chiropractic treatment may be reassured by the task force’s Ontario-
based study suggesting earlier reports of an increased risk of vertebrobasilar artery (VBA)
stroke following visits to a chiropractor were instances of “confounding by indication.”
“The increased risks of VBA stroke associated with chiropractic and (primary-care physician)
visits is likely due to patients with headache and neck pain from VBA dissection seeking care
before their stroke. We found no evidence of excess risk of VBA stroke associated with
chiropractic care compared to primary care,” concluded a team led by Dr. J. David Cassidy
(DC, PhD), a senior scientist in the Division of Health Care and Outcomes Research at the
Toronto Western Research Institute.
An earlier analysis of Ontario administrative data by the Institute for Clinical Evaluative
Sciences in Toronto, published in Stroke in October 2001, showed people under age 45
years who had suffered a VBA stroke were five times more likely than controls with no stroke
history to have visited a chiropractor within one week of the stroke. Unlike that report, the
new study also looked at stroke incidence after visits to primary-care physicians.
The researchers found 818 cases of VBA stroke admitted to Ontario hospitals from April 1,
1993 to March 31, 2002 (more than 100 million person-years of observation). Four controls
were age- and gender-matched to each case; and case and control exposures to
chiropractors and primary-care physicians were determined from health billing records.
In those younger than 45 years, cases were about three times more likely to have seen a
chiropractor or a primary-care physician in the month before their stroke than controls. There
was no increased association between chiropractic visits and VBA stroke in those older than
45, however the association remained for primary-care visits.
“It should put the controversy to rest,” said Dr. Haldeman. “Dissections appear to be an
issue, but . . . all the concerns about this being a chiropractic issue probably are not valid.”
Other key messages from the task force report:
• Conduct a thorough patient history, physical examination and patient self-assessment
questionnaire to identify or rule out Grades 3 or 4 neck pain.
• Routine imaging in Grades 1 or 2 neck pain will not increase understanding of causation.
• Patients with Grades 1 or 2 neck pain should be advised to stay as active as they can. A
variety of therapies or combinations of therapies may be needed to find pain relief, which is
often modest and short-lived.
• Be cautious of treatments that make impressive claims for relief of neck pain, and
discontinue treatments that don’t provide improvement within two to four weeks.
• Epidural corticosteroid injections may provide temporary relief of radiculopathy in Grade 3
neck pain. Consider surgery in the presence of serious pathology or persistent radiculopathy.
• In the case of emergency department visits involving neck pain, the Canadian Cervical
Spine Rule and the NEXUS Low Risk Criteria are effective at identifying patients who do not
require imaging.
• Use of MRI as a screening tool in the emergency setting is not supported by evidence; CT
scan is more sensitive than X-ray in high-risk patients (e.g. intoxicated, unconscious and/or
obtunded); and five-view X-rays are no more effective than three in identifying fractures
• In Grade 3 neck pain, there is no evidence that any one type of decompression or fusion
surgery is superior to the others.
Payment recommendations
The task force also called on public and private insurers to adopt evidence-based treatment
guidelines when paying for services.
“A physician who does multiple procedures, rightly or wrongly, is going to be paid
considerably higher than a person who sits down and talks to the patient and examines the
patient,” Dr. Haldeman said. “And the feeling is that since the evidence suggests that sitting
down and examining and talking to the patient is more likely to improve patient outcomes
than these invasive procedures, then the payers should encourage it.”
The Task Force on Neck Pain and Its Associated Disorders was established in 2000 and
was given official status by the steering committee of the United Nations/World Health
Organization Bone and Joint Decade project in 2002.
Visit us at:
http://www.chiropracticmentor.com
Subscribe to:
Posts (Atom)
