A Sample Lecture to Healthcare Professionals Lisa K. Bloom, D.C. Diplomate of the International Board of Chiropractic Neurology Diplomate in Applied Chiropractic.
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A Sample Lecture to A Sample Lecture to Healthcare Professionals Healthcare Professionals
Lisa K. Bloom, D.C.Diplomate of the International Board of Chiropractic Neurology
Diplomate in Applied Chiropractic Sciences
Associate Professor, Diagnosis and Practice Department of
New York Chiropractic College
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The Rationale for The Rationale for Chiropractic CareChiropractic Care
(Fill in your name here)
Chiropractic care centers Chiropractic care centers around the maintenance of around the maintenance of
appropriate movement of the appropriate movement of the spinal joints and optimizing spinal joints and optimizing
biomechanics throughout the biomechanics throughout the musculoskeletal system.musculoskeletal system.
Premise
WHY?WHY?
Let’s begin….
There is a distinct difference There is a distinct difference between a medical between a medical subluxationsubluxation
and a chiropractic and a chiropractic vertebral vertebral subluxation complexsubluxation complex::
A chiropractic subluxation is inherently a HYPOmobility suggesting decreased movement and no loss of stability
A medical subluxation is inherently a HYPERmobility resulting from a loss of integrity of the joint capsules and concomitant instability
The primary lesion addressed The primary lesion addressed in chiropractic is the in chiropractic is the vertebral vertebral subluxation complexsubluxation complex (VSC). (VSC).
This refers to discrete areas of hypomobilty within the spinal
column
Components of the Vertebral Components of the Vertebral Subluxation Complex (VSC)Subluxation Complex (VSC)
Dyskinesis (hypomobility) Altered biomechanics (cellular damage) Physiological and biochemical changes Altered nervous system activity Altered motor patterns...
Case management protocol Case management protocol includes…includes…
Specific spinal analysis Physical, neurological, orthopedic examinations
and consultation Specific restoration of normal biomechanics by
means of the adjustment Referral for co-management if appropriate Appropriate attention to ergonomical
considerations and other possible causes of biomechanical dysfunction
The purpose of the The purpose of the adjustment is…adjustment is…
to restore normal movement and resolve the resultant biomechanical,
physiological and neurological effects of segmental hypomobility.
What are these effects…?What are these effects…?
Biomechanical Effects of Biomechanical Effects of HypomobilityHypomobility
Altered intersegmental movement patterns Results in compensatory changes in motor
patterns, etc. Creates cellular damage in sites of
biomechanical stresses “Immobilization Degeneration…”
Loss of normal motion within a joint Loss of normal motion within a joint results in changes in every structural results in changes in every structural
component of the joint;component of the joint;subchondral bone to the synovium, from subchondral bone to the synovium, from
meninges to the ligamentum flavum.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 Current orthopedic literature recognizes that recognizes that changes in the changes in the pattern of forces transmitted pattern of forces transmitted through joints, which occurs through joints, which occurs
during the immobilization process, during the immobilization process, is universally recognized as is universally recognized as
contributing to connective tissue contributing to connective tissue degeneration and local changes in degeneration and local changes in the chemical composition of that the chemical composition of that
tissue….tissue….
We also know that mechanical We also know that mechanical failure of ligaments, discs, failure of ligaments, discs,
capsules and other connective capsules and other connective tissue tissue can result from local can result from local
variations in chemical variations in chemical composition.composition.
Measurable changes within Measurable changes within the joint complex occur the joint complex occur within one weekwithin one week of the of the onset of hypomobility.onset of hypomobility.
Effects of hypomobility Effects of hypomobility on the intervertebral on the intervertebral
disc...disc...
The nucleus pulposus is the The nucleus pulposus is the the area of the disc most the area of the disc most
susceptible to dessication. susceptible to dessication.
The nucleus pulposus is dependent on movement for
nutrition and survival...
Lack of appropriate Lack of appropriate intersegmental spinal movement intersegmental spinal movement
can significantly reduce the can significantly reduce the dynamic pressure gradient dynamic pressure gradient
between the intradiscal tissues between the intradiscal tissues and the subchondral areas of and the subchondral areas of
spongiosa in the vertebral spongiosa in the vertebral bodies...bodies...
……this sacfrifices the key this sacfrifices the key mechanism by which nutrients mechanism by which nutrients and water replenish the disc and water replenish the disc
and by which metabolic waste and by which metabolic waste leaves the disc.leaves the disc.
Putting it together...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 to restore normal movement
through spinal adjustment.
NeurologicalNeurological EffectsEffectsof the Vertebral of the Vertebral
Subluxation ComplexSubluxation Complex
Spinal LearningSpinal Learning (Law of Facilitation)(Law of Facilitation)
Altered motor and sensory patterns are “learned” by the
nervous system and the musculoskeletal systems
Receptor Receptor Classifications…Classifications…
MechanoreceptorsMechanoreceptors Position sensitive Motion sensitive Vibration sensitive Pressure sensitive Provide continuous feedback about where
the body is in space...
The most significant input into The most significant input into the CNS with regard to the CNS with regard to balance, posture and balance, posture and
movement comes from the movement comes from the mechanoreceptors of the mechanoreceptors of the
cervical spine.cervical spine.
Guyton, Textbook of Medical Physiology.
NociceptorsNociceptors
Thermo-, mechano- and chemosensitive Spinal nociceptors are almost exclusively
chemosensitive Estimated that half of all dorsal afferents
are nociceptors (M. Zimmermann, 1979) Fire with harmful or potentially harmful
stimuli …
PainPain
Is not carried by nociceptors Occurs in the cerebral cortex 90% of all nociceptive activity never
reaches the cortex and the patient will remain symptom-free
Factors that influence the Factors that influence the perception of painperception of pain
Intensity of the stimulus Duration of the stimulus Descending inhibition
Nociceptor SitesNociceptor SitesGrieve G. Common Vertebral Joint Problems, Grieve G. Common Vertebral Joint Problems,
19881988
Skin Subcutaneous tissue Adipose Joint capsules All spinal ligaments Blood vessels Cancellous bone
Periosteum Muscles Tendons Fascia Aponeurosis Dura mater Epidural tissue
Nociceptor activity Nociceptor activity reflexively activates the reflexively activates the
sympathetic nervous sympathetic nervous system.system.
The dorsal horn is a central focal The dorsal horn is a central focal point for mediating autonomic point for mediating autonomic
and somatomotor reflexesand somatomotor reflexesinitiated by nociceptive initiated by nociceptive
stimulation.stimulation.
Price D. Psychological and Neural Mechanisms Price D. Psychological and Neural Mechanisms of Pain, 1988; Raven Press, NY.of Pain, 1988; Raven Press, NY.
The Effects of Nociceptive The Effects of Nociceptive ActivityActivity
Segmental responses of muscle spasm and sympathetic hyperactivity.
J. Bonica, 1990 & 1992H. Hooshmand, 1993
Noxious chemical stimulation of specific spinal structures produce measurable changes in sympathetic nerve activity...
Budgell B, et al. J NMS Syst, 1995
Nociceptive input normally Nociceptive input normally triggers sympathetic activity.triggers sympathetic activity.
Cabell J. Sympathetically maintained pain. In: Willis W, Cabell J. Sympathetically maintained pain. In: Willis W, ed. Hyperalgesia and Allodynia. Raven Press, NY; ed. Hyperalgesia and Allodynia. Raven Press, NY;
1992.1992.
Effects of Spinal NociceptorEffects of Spinal Nociceptor Stimulation of the Hypothalamus Stimulation of the Hypothalamus
and Reticular Formationand Reticular Formation
Nausea Pallor Dizziness Faintness Syncope
Changes in blood pressure
Changes in respiration Changes in heart rate No pain
In the presence of irritation to spinal In the presence of irritation to spinal structures manifestations were pallor, structures manifestations were pallor,
sweating,changes in heart rate, changes in sweating,changes in heart rate, changes in blood pressure, nausea and syncope.blood pressure, nausea and syncope.
These features were not proportional to the These features were not proportional to the severity of pain perceived; on the contrary, severity of pain perceived; on the contrary,
they seemed to dominate experience of they seemed to dominate experience of subjects who complained little of pain but subjects who complained little of pain but who were overwhelmed by the symptoms who were overwhelmed by the symptoms
listed above...listed above...
Feinstein B. J Bone Joint Surg, 1954Feinstein B. J Bone Joint Surg, 1954
There is good evidence to There is good evidence to support the importance of support the importance of input from spinal afferents input from spinal afferents
in reflex activity of the in reflex activity of the sympathetic nervous sympathetic nervous
system.system. D. Jordan, 1997 Schramm and Poree, 1991 Hayes, et al, 1991 Weaver and Stein, 1988 Stein, et al, 1989
Qu, et al, 1988 Meckler and Weaver,
1988 Taylor and Schramm,
1987 Stjernberg, et al, 1986
SO...SO...
It is possible for nociceptors to It is possible for nociceptors to fire secondary to the tissue fire secondary to the tissue
damage caused by abnormal damage caused by abnormal biomechanics...biomechanics...
This nociceptor activity can This nociceptor activity can cause reflexive stimulation of cause reflexive stimulation of
the sympathetic nervous the sympathetic nervous system...system...
This may occur and and become chronic without the presence of
pain or any other symptom.
How is chiropractic inherently How is chiropractic inherently different from other healthcare different from other healthcare
professions who chose to professions who chose to utilize manipulation?utilize manipulation?
Application of immobilization as it relates to the joint complex
Kinetic chain principle and basic neurology allows full spine vs symptom based management...
Thorough understanding of the neurological and physiological implications of faulty biomechanics
Purpose of the adjustment: to restore normal biomechanical, neurological and physiological activity
Extensive and focused study in the art of adjusting using multiple techniques to best adapt to the individual needs of the patient
TodayToday
The public has widely embraced many forms of wellness care and alternative therapies
Other healthcare professions have embarked on a paradigm shift to include alternative therapies, including spinal manipulation
Many conditions respond best with a multidisciplinary approach
HEALTHHEALTH
“A state of optimal physical, mental and social well-being, and not
merely the absence of disease and infirmity.”
Dorland’s Medical Dictionary, 28th ed., 1994
ENTERING THE NEW ENTERING THE NEW MILLENIUMMILLENIUM
“The Wellness Model”“The Wellness Model”
Potentiating treatment protocols Patient-centered paradigm Improving interdisciplinary communication Maximizing the benefits of healthcare from
all perspectives
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