CHIROPRACTIC THERAPY

The Rationale for Chiropractic Care.

Premise: Chiropractic therapy centers around the maintenance of appropriate movement of the spinal joints and optimizing biomechanics throughout the musculoskeletal system.

Components of the Vertebral Subluxation Complex (VSC).

• Dyskinesis (hypomobility)

• Altered biomechanics (cellular damage)

• Physiological and biochemical changes

• Altered nervous system activity

• Altered motor patterns...

CHIROPRACTIC THERAPY

So what does that mean in English?

For one reason or another, a joint becomes fixated. It's less mobile, or HYPOmobile. That could be due to sitting too long, sleeping on your stomach, a leg length inequality, an injury ... we could go on. And on ...

Take this lady's foot for example. She fell down the stairs and subluxated in the cuboid bone in her right foot. Compare it with the left - can you see that:

1. The calcaneo-cuboid joint is reduced and the cuboid is displaced? Believe me, it's less mobile, or hypomobile.

2. That changes the way the whole foot works, altered biomechanics. What's more these changes work their way up the kinetic change - it has knock-on effects in the knee, hip, sacroiliac joints, and all the way up to her skull. Just watching her walk and you can see it.

3. This brings about biochemical changes: can you see the whiteness along the edges of the bones, in that joint, compared to the normal left foot? That's hyaline cartilage dying, starved of normal nutrients.

4. Within this little joint are dozens of tiny mechano- and chemoreceptors. They are detecting these changes and bombarding the spinal cord. The spinal cord starts firing off via a tract called the STT to the parietal lobe of the brain (pain), to the limbic system (emotion) and . What's more, they bombard the autonomic system, it's been proved that they particular affect blood flow.

5. Pain and fixations in the foot change the gait. That's what will usually bring the patient to the Chiropractor - change of gait starts to cause pain elsewhere, often in the pelvis.

Case management protocol includes…..

• Specific spinal analysis before Chiropractic Therapy:

• Physical, neurological, orthopedic examinations and consultation

• Specific restoration of normal biomechanics by means of the adjustment

• Specific rehabilitation program

• Referral for co-management if appropriate

• Appropriate attention to ergonomical considerations and other possible causes of biomechanical dysfunction.

The purpose of the chiropractic therapy (the "adjustment") is…

"... to restore normal movement and resolve the resultant biomechanical, physiological and neurological effects of segmental hypomobility."

NEUROLOGICAL Effects of Hypomobility

Other adverse neurological effects

1. HYPOMOBILITY >>> DECREASED PROPRIOCEPTOR activity >>> DECREASED IBHIBITION OF THE PAIN (and other) NOCICEPTOR ACTIVITY firing via C fibres into the Dorsal Horn.
   
   Simultaneously,

2. BREAKING DOWN OF CELLS in the Hypomobile Joint >>> INCREASED firing of SPINAL CHEMOSENSITIVE NOCICEPTORS >>> Inflammation AND Increased input into the Dorsal Horn.
   
   

Double wammy: Increased noxious input into the dorsal horn + Decreased inhibition from Proprioceptors.

Nett result: Greatly increased input into the Spinal Thalamic Tract >>> Thalamus >>> Parietal brain where pain is perceived.

Biomechanical Effects of Hypomobility

• Altered intersegmental movement patterns

• Results in compensatory changes in motor patterns, etc.

• Creates cellular damage in sites of biomechanical stresses
  
  
• “ Immobilisation Arthritis…”
  
  

  ---

"Loss of normal motion within a joint results in changes in every structural component of the joint; subchondral bone to the synovium, from meninges to the ligamentum flavum."

• Amiel D, et al. Acta Ortho Scand, 1982

• Palmoski M, et al. Arth Rheum, 1979

• Paine & Haung. J Neurosurgery, 1972

• Lantz C. Chiro Res J, 1988

• Enneking & Horowitz. J Bone Joint Surg, 1972

• Evans EB, et al. J Bone Joint Surg, 1960

Current orthopedic literature recognizes that changes in the pattern of forces transmitted through joints, which occurs during the immobilization process, is universally recognized as contributing to connective tissue degeneration and local changes in the chemical composition of that tissue…

We also know that mechanical failure of ligaments, discs, capsules and other connective tissue can result from local variations in chemical composition.

"Measurable changes within the joint complex occur within one week of the onset of hypomobility."

Effects of hypomobility on the intervertebral disc....

Lack of appropriate intersegmental spinal movement can significantly reduce the dynamic pressure gradient between the intradiscal tissues and the subchondral areas of spongiosa in the vertebral bodies...

This sacrifices the key mechanism by which nutrients and water replenish the disc and by which metabolic waste leaves the disc...

Putting it together...

• Loss of normal movement leads to…

• Changes in how all tissues involved are stressed and replenished, which causes…

• Chemical changes within those tissues and…

• Predisposes them to mechanical failure giving us…

• A good reason justifying chiropractic therapy to restore normal movement through spinal adjustments.

ANTI INFLAMMATORY DRUGS and CHIROPRACTIC THERAPY

LINKS @ CHIROPRACTIC THERAPY