CP 2203 FLIP CLASS Dr. Simon Wang Foundations of Chiropractic Practice: Updating Ourselves by Dr. John J. Triano. CP 2203 FLIP CLASS Dr. Simon Wang

Part 1

Part 1 - 2 minutes each Take 2 minutes each to discuss with a partner what you got from part 1 of Dr. Triano’s talk

How is treating a patient like going through the scientific method? Hypothesis of what’s wrong experiment (ortho tests) on patient to determine what’s wrong and then treat

Why should we study the mechanisms of manual therapy? if you don’t know how it works don’t know how it helps people then can’t say it works; can’t identify people and optimize Every person is an RCT but don’t know how or why it works If know mechanism then we can match population then we can predict and see who gets better

What do we tell the patient we do? Normalize and optimize function A health care discipline that focuses on prevention of disease, maintenance and improvement of health related to mechanotransduction disorders, primarily of MSK system  Mechanotransduction disorders are aberrations of health and well being that either are caused by or manifest as mechanical problems (but harder to tell patient) We treat aberrations of health and well being that either are caused by manifestation of movement problems

Where is our entry to health? Where do chiropractors fit in? Normalization of movement

Part 2 View only section Any thoughts or comments?

Part 3

Part 3 - 2 minutes each Take 2 minutes each to discuss with a partner what you got from part 3 of Dr. Triano’s talk

Fill in the dysfunctional movement model   .

Dysfunctional Movement: Local and Remote Dashed lines represent assumed pathways. Overload event 1. Cortex: Volitional task commands  2. Cerebellar & ? Coordination 3. Spinal Cord: Asynchronous feedforward/feedback neuromotor control 7. Asynchronous proprioceptive & nociceptive bombardment 6. Local tissue stress concentration 5. Asynchronous motion 4. Asynchronous intrinsic & extrinsic spinal muscle stabilizers Pain, swelling, cytokine release 3a. Motor, sensory, autonomic responses. 3b. Neurohumoral responses Local Effects Remote Effects Copyright JTriano DC, PhD January 2016 Draft

How did Hartman in 2014 demonstrate the connection between mechanotransduction and mechanotransduction disease? What experiment did he do?

Hartman RA. MECHANOBIOLOGY OF COMPLEX LOADING IN FUNCTIONAL SPINAL UNITS. PhD Thesis 2014 University of Pittsburgh The objective of this study was to determine the effect of spinal F/E on catabolism and inflammation simultaneously in all types of spinal tissue—AF, NP, FC, and LF—in viable FSUs.

What did the studies by Drs What did the studies by Drs. Stephen Injeyan and Julieta Teodorczyk-Injeyan on SMT’s effects on chemical mediators (immunoregulatory, pro-inflammatory, anti-inflamatory) in LBP patients find, regarding acute and chronic LBP group responses? Depending on acute or chronic LBP there were different inflammatory markers React differently to the same treatment

Demography, pain and functional outcomes Asymptomatic (n=20) Acute (n=15) Chronic (n=19) Age 32 (22-45) 41 (23-48) 45 (26-59) Gender (m/f) 14/6 11/4 10/9 VAS 1 __ 6.1 5.2 VAS 2 2.4 2.7 OS 1 51 27.6 OS 2 13 17 VAS: 10 point visual analogue scale OS: Oswestry (%)

Effect of SMT on the production of pro-inflammatory mediators * * * * * P<0.05 *

Effect of SMT on the production of anti-inflammatory mediators *

Effect of SMT on the production of immunoregulatory mediators * * P<0.05 *

Part 4

Part 4 - 1 minute each Take 1 minute each to discuss with a partner what you got from part 4 of Dr. Triano’s talk

What 3 levels of the dysfunctional movement model does manual therapy act, based on the current evidence?

Dysfunctional Movement: Overload event Cortex: Volitional task commands   2. Cerebellar & brainstem Modulation 3. Spinal Cord: Asynchronous feedforward/feedback neuromotor control 7. Asynchronous proprioceptive & nociceptive bombardment 6. Local tissue stress concentration 5. Asynchronous motion 4. Asynchronous intrinsic & extrinsic spinal muscle stabilizers Pain, swelling, cytokine release 3a. Motor, sensory, autonomic responses.

Part 5

Part 4 - 1 minute each Take 1 minute each to discuss with a partner what you got from part 5 of Dr. Triano’s talk

Does technique matter? Yes , different reaction when we change force, rate, and load

Do chiropractors use too much force during cervical SMT? no

Cervical HVLA Force amplitudes Neck loads during movement Force matters! Triano PhD Thesis, University of Michigan 1998 Anderst et al. Subject-Specific Inverse Dynamics of the Head and Cervical Spine During in Vivo Dynamic Flexion-Extension. J Biom Eng 2013

Individual work

Please grow your portfolio Reflection assignment: 1. Please take some time and reflect on this class discussion 2. Answer this question in plain language (for your patient): Why has my back pain not improved on it’s own? Use the dysfunctional movement model as the basis for you explanation Also add this to your portfolio: 3. All pre-work questions & answers 4. All class discussion notes (this lecture will be re-posted on KIRO) Please submit your link via KIRO assignments by February 2nd, 2017 This will account for 5% of your grade.

Questions or comments?