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Chapter 24-1
Understanding Therapeutic Modalities
Why chiropractors use modalities?
Why are modalities used? To assist in the healing process
1. Analgesia (A deadening or absence of the sense of pain without loss of
consciousness.)
2. Promote tissue healing
3. Reduce swelling & inflammation
4. Promote neuromuscular re-education & muscle strength
5. Reduce pain
Basic Science
First we need to understand each modality is different and there is a specific reason
why the doctor chooses each modality.
What is the Doctor’s role when using therapeutic modalities?
1. Recommend based on need
2. To write an order for it
3. To monitor the affects
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What is the CA’s role when using therapeutic modalities?
1. To follow doctors’ orders
2. To never alter the treatment
3. To perform each procedure professionally and accurately
What is Electrical Muscle Stimulation?
Electric muscle stimulation (EMS) is another therapy that is useful in speeding
up the healing process of injured tissues.
This device sends an impulse into the damaged tissues, causing the muscles in
that region to contract. Ongoing contraction of these muscles will decrease
reflex inhibition and help to restore normal muscle tone, and the sensory input
of this modality will decrease pain and spasm.
Electric muscle stimulation is used for two main reasons; either to decrease
pain, or to cause a muscle to contract. When electric stimulation is used to
decrease pain, the effect of the current is to encourage the body's natural pain-
controlling mechanisms by either blocking a pain nerve's signal or by releasing
opiates (endorphins, similar to those in "runner's high".)
Endorphins reduce the sensation of pain and affect emotions.
When the doctor decides it is appropriate for a patient’s condition, muscle
stimulation is initiated. The muscle contractions caused by the electric muscle
stimulation can range from a mild twitching sensation to a strong contraction.
The treatment patients will be receiving may feel unusual at first, but should
never feel painful or very uncomfortable. Many patients describe the sensation
as tingling, like when your foot falls asleep. As the chiropractic assistant you
will ask if the treatment is tolerable; but YOU need ensure that the level of the
treatment is safe.
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Common questions
Q: What is Electro-Muscle Stimulation?
A: It is a special form of electrical current that is administered at the site of soft tissue
injury, especially muscles, for the blocking of pain.
Q: How does Electro-Muscle Stimulation work?
A: Small amounts of electrical current are induced into the tissue for the purpose of
reducing swelling. This widely used technique safely strengthens muscles and helps
reduce painful symptoms.
Q: What does Electro-Muscle Stimulation feel like?
A: Patients generally feel a slight tingling sensation at first. Since your body may
become accustomed to the initial setting, the intensity may be raised during the
course of your 10-20 minute treatment, for maximum healing effect.
Q: Why is Electro-Muscle Stimulation used?
A: Electro-Muscle Stimulation has been used as an effective form of pain relief. It is
recommended in cases in which pain is accompanied by swelling and inflammation.
Patient Benefits
Reduces pain sensation
Helps decrease swelling
Promotes general muscle tone
Speeds the healing process
Indications for EMS?
Muscle spasm
Muscle tightness
Reduced ROM
Contraindications for EMS?
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Pregnant
Excessive swelling or edema
Pace maker
Any patient suffering from loss of sensation
How do most patients respond to EMS?
Depends on their condition
Depends on their tolerance
Types of EMS
Interferential Therapy
Is delivered with two channels involving four electrodes
o One current is constant and one is variable
You can select a low or high range of frequency
Pre-modulated Therapy
Is often used for treating small areas where using four electrodes is practical
For this therapy two frequencies are mixed
Electric Muscle Stimulation Protocols
Approaching the patient
Be aware of their comfort zone
Introduce yourself
Patient education
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Tell them what the therapy does
Explain what they will experience
Patient preparation
Unveil the involved area
Make sure the area is clean
Be professional
Patient placement
Seated
Face down
Face up
Lateral recumbent
Setting up Machine
Each day run it through the set-up mode
Make sure leads are not bad
Clean all parts that touch the patient
Finding the right intensity
Select an intensity that is clinically correct
Do not turn it up because the patient wants “more”
Rechecking
After two minutes check the patient to ensure it is still comfortable
The removal process
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Do not allow patients to remove electrodes
Do not pull them off quickly
Electrodes
Small round electrode small square electrode
Non-Disposable electrodes
o
Disposable electrodes
o
o
Electrode Positioning and care
1. The patient must be comfortable
2. They need to be relaxed
3. All negative factors removed
Common problems that CA’s encounter:
Common Problem Result
Bad Patient positioning
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Incorrect electrode placement
Intensity too low
Intensity too high
Electrodes are touching
Using old or damaged electrodes
You forget the patient on therapy
Electrodes do not have good connectivity
You place the electrodes in the wrong area
FYI on muscle stimulator for building muscles:
The amount of money people spend on electric muscle-stimulation devices is
shocking. You've seen them on infomercials. They transmit mild electric shocks to
muscles to make them contract, and they've been touted to help people lose weight
and gain muscle mass. What they really do is zap money from people's wallets.
According to the Federal Trade Commission, it's estimated that 18 million consumers
buy electric muscle-stimulation (EMS) devices to help them shed pounds and build
biceps. On average, Americans spend $178 for these products. That's a $3.2 billion
industry through infomercials alone.
Let’s discuss common concerns chiropractic assistants have
Patient approach
Be careful of their comfort zone for personal space
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Educate
Explain every procedure before you begin it
Place on table
Some patient will have trouble getting onto and off of the table
Position Patient
Ensure the patient is comfortable
Prepare patient area
Expose area of treatment
Be aware that some people may be uncomfortable exposing their skin
Electrode placement
Place the electrodes based on the area of treatment
Machine setup
Always set-up the machine in relation to what is safe for use
Setting the Intensity
Do not turn up the intensity just because the patient think they need more
Stay within the clinically correct settings
Monitor / recheck
Since tissue in the area of involvement may change, be sure to recheck the patient
after several minutes to ensure it does not become too intense
Take down
When removing electrodes be careful not to pull them by the wires
Use caution with elderly people who have thinner skin
Document
The area treated
Settings used
Duration of treatment
How the patient responded to the treatment
Any adverse effects from the treatment
Sensory Receptors
Through our nervous system we have sensors throughout our bodies that detect heat,
pressure, stretch, acceleration, sound, light, smells, tastes and other forms of energy
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Sensory receptors act as transducers, converting many forms of energy into action
potentials that the brain can interpret
Many receptors, such as those in the skin, are simply constructed; others, such as
the eye and ear, are very elaborate
Stimulus
When a stimulus is maintained at a constant level or intensity for a prolonged timeframe
the nerve adapts, thus becoming less sensitive.
Example: Temperature receptors
o Two types: warm & cold receptors
o If one hand is placed in warm water and the other is placed in cold water,
the temperature receptors will adapt and become less sensitive
o After adaptation, if both hands are placed in lukewarm water, the hand
originally in warm water will feel cold, and the hand originally in cold
water will feel warm
There are 2 Basic Types of Pain
There are 2 distinct types of pain, carried by 2 types of nerve fibers
o Slow, C fibers carry pain from deep within the tissues.
The pain is felt as a dull ache which is hard to localize
o Fast, A delta fibers carry sharp, well-localized pain from the surface
Tissue Response
Increase tissue temperature as a result of meeting tissue resistance
Chemical related to ion movement
Endorphin release
Physiologic
Physiologic Effects at Various Functional Levels
Cellular:
Excites nerve cells
changes in membrane permeability
Tissue:
skeletal muscle contraction
smooth muscle contraction
tissue regeneration
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Segmental:
modification of joint mobility
Methods to reduce skin/electrode resistance
use water, saline solution or some type of conducting gel
remove dirt, oil, flaky skin by washing w/alcohol
warm area w/MHP (modulated heat probe)
remove excess hair
Clinical applications
Therapeutic Uses of Electrical Currents
Controlling acute & chronic pain
Reducing Edema
Reducing and/or inhibiting Muscle Spasm
Facilitating Tissue Healing
Facilitating Muscle Reeducation
Strengthening Muscle
General Contraindications to Electrotherapy
Cardiac Disability
Pacemaker
Pregnancy
Menstruation
Cancerous Lesions
Infection Sites
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Exposed Metal Implants
Severe obesity
Levels of Stimulation
Sub sensory Level: between 0 point and point at which patient first notices
sensation
Sensory Level: stimulates only sensory nerves; intensity is increased to point at
which a slight twitch is seen then decreased
Motor Level: produces a visible muscle contraction without causing pain
Pain Control
Parameters:
Sensory Level
o
Motor Level
o
Edema Reduction:
Sensory-Level Stimulation: attempts to stop formation of edema by preventing
fluid, plasma proteins & solids from escaping into surrounding tissues
Motor-Level Stimulation: assists venous and lymphatic systems in returning
edema substances for filtering and removal
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Section 24-2
Ultra Sound
Ultrasound
Ultrasound is a treatment that can be useful in speeding up the healing process of
injured tissues. Ultrasound travels into the damaged tendons and muscles, causing
the molecules to collide, resulting in a deep heating effect. The thermal effects of
ultrasound decrease pain of the damaged tissues.
Ultrasound also has a mechanical effect on the tissues that possibly causes the
breakdown of scar tissue.
Indications for Ultra Sound
Acute pain
Muscle tightness or spasm
Contraindications for Ultra Sound
Lesions
Swelling
How do most patients respond to Ultra Sound?
Feel relief of symptoms
Feel relaxed
Positioning and care
Use paper towels
Support the feet
Use a gown if possible
Common problems that CA’s encounter:
Common Problem Result
Bad Patient positioning
Incorrect gel usage
Intensity too low
Intensity too high
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Ultra Sound Patient Process:
Patient approach
Educate
Place on table
Position Patient
Prepare patient area
Topical gel application
Machine setup
Setting Intensity
Monitor patient
Document
ULTRASOUND
Deep penetrating modality
Capable of producing changes through both thermal and mechanical
mechanisms
Most frequently used are 1 MHz and 3 MHz
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Terms
Effective Radiating Area (ERA)
Frequency
Intensity
Treatment Duration
Purpose
Transfers of US Through the Tissues
US passes through tissues in the form of longitudinal wave until it hits bone,
when some energy is reflected and the rest is converted into transverse waves
Passage of US through the body causes the tissues to acquire kinetic energy,
resulting in cellular vibration
Transfer of US Through the Tissues
US is reflected or refracted when the energy travels through different density
of tissue
If wave is reflected straight back and meets the incoming wave the intensity of
the wave in that area is increased
Keep sound head moving
US that is reflected off bone can produce periosteal pain
Coupling Agents and Methods
Direct Coupling
Use of US gel
Use enough gel
Body hair can limit US delivery
Try not to have air bubbles
Use slight pressure on sound head
Biophysical Effects
Both thermal and non-thermal effects occur in the body
Non-thermal Effects
May stimulate the healing process
Effects on the Injury Response Cycle
Tissue Healing
US accelerates the inflammatory phase
This may be helpful in the later stages of healing
May also be helpful over superficial wounds in the later stages of healing
Effects on the Injury Response Cycle
Tissue Stretching
Increased extensibility in collagen-rich tissues, including scar tissue
Must be used with passive stretching
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Tissue must be elevated 5°C and then stretched within 3 minutes
May want to place tissue on stretch during the treatment
Pain Control
May have some direct effect to the nerves or as a result of other effects
Direct effects are through eliciting changes within the nerve fiber themselves
Deep penetrating modality
Capable of producing changes through both thermal and mechanical
mechanisms
US waves are capable of:
Reflection
Refraction
Absorption
The area exposed to the sound waves is limited to the size of the sound head
Treatment Duration
Depends on:
The size of the area treated
The output intensity
Therapeutic goals
Coupling Agents and Methods
Direct Coupling
Use of US gel
Use enough gel
Body hair can limit US delivery
Try not to have air bubbles
Use slight pressure on sound head
Combo-therapy
Combo therapy combines ultrasound and electric muscle stimulation as a single
treatment device. Based on some clinical experience, combo therapy is a more
effective treatment than just using ultrasound or muscle stimulation separately.
Ultrasound and electric muscle stimulation are useful treatment modalities for
creating a more favorable environment for the body to heal itself.
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TENS Units
Help between visits
Good for chronic conditions
Increases functional capacity
Massage Therapy
Massage therapy is a hands-on manipulation of the soft tissue and joints of the
body.
The soft tissues include muscle, skin, tendons and associated fascia, ligaments
and joint capsules.
Massage has many diverse physiological effects, which are primarily due to the
therapist's hands moving over the body.
The different movements can physically stretch muscles, ligaments, tendons
and fascia, encourage the circulation through the tissue, inhibit muscular spasms
and be either sedating or stimulating to the nervous system.
Massage Therapy
The therapeutic use of massage by a registered massage therapist affects all the
systems of the body- in particular, the muscular, circulatory, lymphatic
(immune) and nervous systems.
Many of today's health problems can benefit from massage therapy because
the manipulation of soft tissues affects so many of our bodily systems.
The benefits of massage are extensive. Massage therapy treatments will have a
therapeutic affect and improve health by acting directly on the muscular,
nervous, circulatory and lymphatic (immune) systems.
Massage treatments aim to:
Develop, maintain, rehabilitate or augment physical function.
Relieve or prevent physical dysfunction and pain.
Relax tight and tense muscles.
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Improve circulation, recovery time and immune system function.
Reduce overall stress
Massage therapy is also effective in the control of pain chronic or acute, in
stress reduction, and in creating a sense of relaxation and well-being.
With a therapeutic massage, stress can be significantly reduced. This, in turn,
will increase energy, improve your outlook on life, and in the process boost
your immune system function.
Active Release Techniques
ART provides a way to diagnose and treat the underlying causes of cumulative
trauma disorders that result in symptoms of numbness, tingling, burning and
aching.
ART is a type of manual hands-on therapy that corrects muscular and soft
tissue problems caused by adhesion formation as a result of injury, overuse or
cumulative trauma.
The ART provider uses their hands to evaluate the texture, tightness, and
movement of muscles, fascia, tendons, ligaments, and nerves. Abnormal tissues
are treated by combining precisely directed tension with very specific patient
movements.
Acupressure
A non-intrusive precursor of acupuncture, acupressure stimulates the flow of
vital energy - known as "chi" - that circulates along the body's meridians and
influences the functioning of certain internal organs.
By applying thumb and fingertip pressure, specific symptoms are relieved and
balance is restored to the entire body.
Cranio-Sacral Therapy
CST is a gentle, hands-on method of evaluating and enhancing the functioning
of a physiological body system called the Cranio-sacral system, comprised of
the membranes and cerebrospinal fluid that surround and protect the
brain and spinal cord.
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Using a soft touch generally no greater than 5 grams - or about the weight of a
nickel - practitioners release restrictions in the Cranio-sacral system to improve
the functioning of the central nervous system.
By complementing the body's natural healing processes, CST is increasingly
used as a preventive health measure for its ability to bolster resistance to
disease, and is effective for a wide range of medical problems associated with
pain and dysfunction.
Deep Connective Tissue Massage
This deep form of bodywork helps to release myofascial restrictions in the
body. It relieves chronic tension, increases range of motion, improves
posture and enhances self-awareness.
Connective tissue massage restores length and flexibility to the fascia,
normalizing the tissue and bringing greater health through the fascial system.
This deep form of bodywork helps to release myofascial restrictions in the
body. It relieves chronic tension, increases range of motion, improves posture
and enhances self-awareness.
Connective tissue massage restores length and flexibility to the fascia,
normalizing the tissue and bringing greater health through the fascial system.
Kinesiology
A "muscle testing" form of chiropractic introduced in 1964, practitioners also
examine structural factors such as posture and gait and make recommendations
about lifestyle changes.
Kinesiology is also a non-invasive therapy, in which applied kinesiologists
apply light finger-tip massage to pressure points on the body or head in order
to stimulate or relax key muscles.
Neuromuscular therapy also includes muscle test for diagnosis, then emphasizes
the role of the brain, spine, and nerves to assess and restore balance of the
body's skeletal structure.
Kinesiology is used to improve digestion, energy, and sports performance and
to ease back and joint pain, allergies, asthma, depression and headaches.
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Myofascial Release
This slow and subtle technique can be used to release fascia and muscle
throughout the body. The therapist uses light to moderate traction and a
twisting approach to achieve biomechanical and reflex change through an
appropriate tension on the soft tissue.
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Section 24-3
Understanding the Healing Process
Phases of the Healing Process
Inflammatory Response Phase
Fibroblastic Repair Phase
Maturation/Remodeling Phase
Understanding the Healing Process
Inflammatory Response Phase
A series of events occurring in vascular tissues in response to injury or antigen,
pathogen or allergen which causes infection, illness or allergic reaction
Characteristics of Inflammation
Swelling:
Redness:
Heat:
Pain:
Loss of Function:
What is the purpose of the inflammatory phase?
Control effects of injury
Return tissue to normal state by localizing & disposing of injury by-products to
set stage for repair
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Factors Which Impede Healing
Extent of Injury
Edema
Poor Vascular Supply
Tissue Separation
Muscle Spasm
Atrophy
Health
Age
Nutrition
Infection
Climate
Healing Process of Various Body Tissues
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Section 24-4
Understanding Pain
What is pain?
There is no universally accepted definition of pain, or agreement on its causes. However,
for those experiencing pain, there is no confusion at all as they say “It hurts!”
Many patients have heard horror stories about pain and that a previously treating doctor
told them nothing could be done to relieve their pain. In recent years, the techniques
and treatments chiropractors use for pain management have come a long way. Today
patients can have their pain well-managed or removed thus greatly improving their
quality of life. Each patient experiences pain differently and their emotional responses
will vary.
Thought:
The side effects from pain medication are worse than the pain.
Fact:
Side effects from pain medication can be severe; this is why more patients
was chiropractic care that is drug-free
Thought: Many patients entering your office may have used or still be using
prescription drugs
from their previous treating doctor.
Facts:
Your health care team needs to understand the pain related to their
condition and realize they do need relief of their specific pain. As a health
care professional, your doctor will most likely recommend they discontinue
the use of any pain relievers or muscles relaxers. However, as the
chiropractic assistant you are not allowed to give this advice.
When a patient comes in pain their perception of that pain is conveyed to the brain
or central nervous system by the sensory nerves. Pain can be described as either
sensory or motor pain in relation to which branch of the autonomic nervous system is
conveying the nerve impulses. Specifically musculoskeletal pain tends to be constant
at a certain level of sensation. It can be present all the time or only on movement
and no matter what kind of pain is present in the body both sensory and motor
nerves are involved. You must acknowledge their pain as that is normally their
presenting complaint upon entering your office for care.
Mechanism of Pain Control
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Pain: “unpleasant sensory & emotional experience associated with actual or potential
tissue damage” (International Association for Study of Pain)
Types of Pain
Acute:
o Injury just occurred
o usually sharp
Chronic:
o more than a 6 month duration
o may be a disease in itself
Referred:
o acute or chronic pain perceived to be in an area with little relation to
existing condition
Radiating:
o pain that starts at one point and spreads out from there
Two types of pain scales:
1. Numerical Scale
o rate pain on a scale of 1-10
2. VAS scales
o which utilizes photos
Visual Analogue Scales:
Used to ask a patient to mark on a diagram where pain lies
Or
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Numerical Scale
On a scale of 0-10 rate your pain with “0” reflecting no pain and “10” the worst pain
possible
0 1 2 3 4 5 6 7 8 9 10
Since pain is the one of the most frequent complaints of a patient and an extremely
difficult symptom to measure, you need to ask specific questions to get the answers you
need. These include:
1. How intense has the pain been for you?
no pain
mild
discomforting
distressing
horrible
excruciating
2. Can you sit in a chair without discomfort?
Common responses:
Pain prevents me from sitting
I avoid sitting because it increases the pain
3. What makes it better?
Need to know what they have tried
o did it work
o how long it helped
4. What makes it worse?
You must know what aggravates a condition
Sensory Receptors:
Thermoreceptors: temperature & temperature change (cold & hot)
Mechanoreceptors: pressure, touch, skin stretch
Proprioceptors: changes in muscle length and tension, changes in joint position
Nociceptors: pain
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Response to Stimulus:
Phasic: produce an impulse when stimulus is increased or decreased but not
sustained/adapt to constant stimulus
Tonic: produce impulse as long as stimulus is present
Neural Transmission
Afferent Nerve Fibers: transmit signals from sensory receptors to brain
First Order Afferents: transmit impulses from receptor to dorsal horn of spinal
cord
Second Order Afferents: synapse w/first order afferents in dorsal horn and
carry message to brain
Third Order Afferents: carry impulse to various brain centers to be interpreted
and acted on
Fourth Order Afferents: between various centers in brain
Types of Pain:
Fast: brief, well localized, well-matched to stimulus; originates in skin & carried
on A(d) fibers
Slow: aching, throbbing, poorly localized, less related to stimulus; carried on
C fibers
Neurophysiologic Methods of Pain Control
3 Models of Analgesic Mechanisms:
1. Ascending Input: stimulation of ascending A (b) afferents block impulses on A and
C Fibers
2. Descending Control: stimulation of descending (efferent) pathways at dorsal horn
of spinal cord blocks impulses of A & C fibers
3. B-Endorphin Release: long-term
Descending Pain Control Mechanisms: Pain is gated by higher levels of CNS
Pain stimulus reaches midbrain
Impulses are sent down efferent tract which inhibit pain transmission at dorsal
horn of spinal cord through release of enkephalins
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Cognitive Influences:
way pain is perceived and responded to may facilitate or inhibit pain
perception
Chronic Pain:
Pain Management:
Identify the source of pain: may come from serious underlying disorder
Recognize pain is real to patient even if its psychosomatic
Match therapeutic agent to each specific situation
No one best way “trial & error”
Never apply a modality without having a rationale for its use
Therapist must approach with confidence/believe in what doing
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Section 24-5
Spinal Traction
Spinal Traction
Definition: separation of spinal elements through the process of pulling. Therapeutic
spinal traction uses manually or mechanically created forces to stretch and mobilize the
spine. Traction may alleviate back pain by stretching tight spinal muscles that result from
spasm and widen intervertebral foramen to relieve nerve root impingement.
Effects:
Muscles:
Joints:
Ligaments:
Nerves:
Disk:
Mechanical-Cervical:
Most mechanical traction devices used to treat the cervical spine are
comprised of a head halter with over-the-door pulley system.
Manual Cervical:
Is a minimal impact, hands-on approach where the patient lies in a
relaxed and comfortable position as the doctor or therapist applies
gentle and controlled pressure.
Position:
supine with head very near edge of table
Patient must remain totally relaxed, dead weight
Support head and neck at mastoid process
Tx Time: 3-10 minutes
Mechanical-Lumbar:
Position:
o supine with legs extended
o Patient should remain totally relaxed
o Grasp patient just superior to ankles
o Pull gently-using body weight-lean back
o Requires a lot of strength, more effective mechanically
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Manual Lumbar
Manual Lumbar traction involves distracting the body's weight by
pulling at the ankles with again using controlled force.
Indication for lumbar traction:
Impingement of a Nerve Root
Disk Hernia ion
Spondylolisthesis
Narrowing within intervertebral foramen
Degenerative Joint diseases
Sub-acute Pain
Joint Hypo mobility
Disco genic Pain
Muscle Spasm or guarding
Muscle Strain
Spinal ligament or connective tissue contractures
Contraindications:
Acute sprains/strains
Acute inflammation
Vertebral Joint instability
Any condition in which movement exacerbates the problem
Tumors
Bone Diseases
Infection
Pregnant Females
General Considerations:
Reassess after treatment
Will know after first several treatments whether it will be effective or not
Minimize compressive forces post treatment
Lumbar: no sitting, standing
Cervical: soft collar
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Section 25-6
Heat and Cold Therapy
Cryotherapy
Effects of Cold
Local Tissue Temperature Decrease
Baseline Muscle Temp: 97.5 F
Analgesia @ 58 F
Therapeutic Benefits @ 57 F
Analgesia
Decreased nerve conduction velocity
Decreased excitability of nerve endings
Gate Control Theory
Indications
Acute inflammation or injury
Acute or chronic pain
Post-surgical pain/edema
Acute or chronic muscle spasm
In conjunction w/rehabilitation
Contraindications
Cardiac or respiratory involvement
Uncovered open wounds
Circulatory insufficiency
Anesthetic Skin
Advanced Diabetes
4 Stages of Cold
Uncomfortable Cold
Burning
Aching
Numbness
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Cold Spray
Fluoro-Methane or Ethyl chloride
Used to decrease spasm
Heat Applications
Most heat used in a chiropractic office is from using a heated pad
**Pictured above is standard cervical hot pack that is placed in a hydroculator (shown
below)
Indications for using Hot Packs
Muscle spasms
Muscle tightness
Pain
Tenderness
Reduced range of motion
Contraindications
Swelling or edema in involved area
Lesions
Infection
Safety Precautions for Hydroculator
Clean once per month
o Turn off tank
o Unplug from electrical outlet
o Drain entire tank
o Clean with non-abrasive solution
o Clean actual hot packs with a soft toothbrush
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Keep children away from the hydroculator
Place on a sturdy table to avoid spillage
Use tongs or potholder to remove pads from the tank
Safety Precautions using hot packs
Cover pack before placing on the patient
o Make sure the open end is not towards the patients head if using in
the cervical spine
Recheck the patient as all patients have a different tolerance to heat
Comparison of Hot & Cold Modalities
Deciding Between Heat & Cold?
Is the area warm to touch?
Is the area sensitive to light/mod touch?
Is the amount of swelling increasing?
Does swelling increase w/activity?
Does pain limit ROM?
Is the inflammatory process still active?
Is the patient improving w/ the use of cold?
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Section 25-7
Therapeutic Terminology
Acupressure- applied finger pressure on muscle or tissue.
Acupuncture- needle piercing of the connective tissues to release blockages and pain.
Alexander Technique- Aligns the spine and improves biomechanics
Applied Kinesiology- Test muscles for weakness and strengths
Chakra- Even centers of energy in the body.
Connective Tissue Massage- massages layers of tissue between the skin and the
muscles.
Craniosacral Therapy- Gentle noninvasive pressure on the skull and the tailbone to
release restrictions and balance spinal fluid flow.
Deep Tissue massages Myofasical connective tissue release through deep
manipulations.
Energy Balancing- Balancing energy auras with crystals, herbs, oils or by visualizations.
Homeopathy- Administration of minute doses of natural substances to rid the body of
toxins or diseases.
Hydrotherapy- uses heat or water to stimulate healing.
Lymp Drainage Massage- this is light slow repetitive strokes to remove toxins and
bacteria from the body.
Myofascial Release- A connective tissue release using gliding stokes to stretch and
move the fascia.
Myotherapy- trigger Point therapy
Neuromuscular Therapy- trigger point therapy-
Reflexology- is a massage type technique on the feet. Relexology is based on the
areas of the foot which all body parts and organs are associated to certain points in
the feet. These areas are worked by rubbing pressure to release tension or pain and
increase circulation or flow of energy.
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Reiki- Is a form of energy work in which the therapist taps into the life forces of
healing to assist others in pain. Rolfing- is a deep manipulation of the myofascial
muscle system.
Shiatsu- Finger pressure massage.
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26-1
Rehabilitation
There are many types of Rehabilitation. Let’s start with the feet
1. Statistics
a. By the age of 20, nearly 80% of us have some kind of foot problem, and by
age forty almost all of us do.
2. Your Body
a. Your body is an interconnected system of specialized parts, and the
support structure which holds everything together is made up of bones,
muscles, tendons, and ligaments.
b. Even if your feet don’t hurt, they may be contributing to your overall
postural balance. If you’re having pain or discomfort in a specific area of
your body.
c. This can occur anywhere from your feet to your neck
3. What Causes Foot Problems?
a. From the time you learn to walk, your feet assume three crucial functions
as they support your body whenever you;
1. Stand
2. Walk
3. Run
4. Your feet assist you in achieving movement from one place to another
a. They protect your bones and soft tissues from damaging shock stress
as you move.
b. Being overweight, having minor structural defects in the feet, or
injuries can contribute to additional foot and body stress.
Pronation
Is considered the most common foot problem.
In pronation, some of the bones of the foot drop to a less stable position
because the foot arches are too weak to keep them in proper alignment.
The arches themselves may be unnaturally stretched ("flat feet"), and
stress on the entire foot increases.
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Feet can become "tired and achy" or experience a burning pain, and
walking can begin to feel "clumsy" as you try to move your foot in a way
that avoids further pain.
Supination
This is when a patient has excessively high arches
This makes the patient have problems with knees, ankle and low back as
their feet turn outward.
Children
A child is a unique individual, of course, so the specifics of his or her care can
only be determined by a health care professional like a chiropractor.
In general terms, a chiropractor may recommend a postural evaluation,
examination of the feet, testing of any painful areas, X-rays (to rule out more
serious conditions), adjustments or manipulation where needed, spinal/pelvic
stabilizers (foot orthotics), and rehabilitative exercise.
Child Evaluation
Your family chiropractor is best qualified to evaluate your child's postural
health.
Given all the natural growth developments and potentially serious conditions
which can affect a child, it is not surprising that a recent study indicated
children need chiropractic care for low back pain nearly twice as much as
their parents
Just like the adult the child should have periodic postural evaluations; every
six months to one year is usually sufficient.
Heel Spurs
Heel spurs are small deposits of bone-like calcium on the heel bone
(calcaneus
Usually there are located on or near the bottom of the foot.
What causes heel spurs?
Some experts believe that a spur is the body's attempt to strengthen its
foundation.
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Being overweight, having abnormal foot biomechanics, or running regularly
on hard surfaces can cause excessive stress on the foot, which may lead to the
production of a spur.
Other authorities contend that spurs are a normal part of the aging process:
some studies have shown that calcaneal spurs are more frequently found in
people after age 50.
The best data currently available projects that between 11% and 16% of the
population have heel spurs. It is also interesting to note that spurs occur
almost twice as often in adult females as they do in adult males.
Treatment of Heel Spurs
The treatment you receive will probably focus in general on reducing
swelling, relieving pain, restoring functional movement and position through
joint mobilization, protecting your foot from additional stress, and
strengthening your foundation.
Depending on your specific condition, your healthcare professional may
instruct you to do some or all of the following items after you leave the clinic:
Rest: a decrease or stoppage of running and jumping exercises is often
indicated.
Ice the heel, to help bring down any swelling.
Exercise, to help build muscle strength and joint stability.
A therapeutic Exercise System is often recommended by healthcare
professionals for heel spur conditions.
Wearing foot orthotics to protect the heel and to help the adjustments hold
better.
Stabilizers for this condition can be designed to provide a protective "cushion"
around the heel area, and also change your foot's posture to help take
pressure off the spurs and make you more comfortable.
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How would spinal/pelvic stabilizers help my back? My feet don't hurt!
Your feet are the foundation of your body, and if your feet are not properly
supported, you can have problems anywhere from your ankles on up through
your neck.
Orthotic therapy is essential in restoring structural and functional balance
and developing the strength and flexibility to keep your body stable as you
stand, walk, or run.
Depending on a variety of factors (lifestyle, health, age, weight, sex), your
healthcare professional will select the stabilizers best suited for you.
Because it is very important to wear your stabilizers all day long, and
because most people wear at least two styles of shoes each day, your
healthcare professional may decide that a stabilizer Combo (two pairs) would
be best for your low back condition.
Orthopedic supports-Understanding Your Feet?
Did you Know?
Leg Length Inequality
1. ANATOMICAL
o
o
o
o
o
2. FUNCTIONAL
o
o
o
o
o
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The 3 arches of the foot
1.
2.
3.
Common Conditions Associated with Pronation and LLI
1.
2.
3.
4.
5.
6.
Orthotics - Goal #1
Create a symmetrical foundation by blocking excessive pronation or
supporting Supination within the established normal angulation
ranges.
Orthotics - Goal #2
Provide heel strike shock protection
o The natural heel strike shock absorption mechanisms are
compromised with faulty pedal biomechanics making the
individual more susceptible to bone marrow edema and stress
fractures.
Orthotic - Goal #3
Enhance sensory - motor reflexes
o The sensory information from the feet affects muscular efficiency, balance, gait,
and posture.