Biomechanical Commonalities of manual treatments Flip Class with Dr. Simon Wang

What do you see?

Today Expected to have watched videos on the top 7 techniques that chiropractors use in practice In small groups we will list the similarities and differences of the techniques discuss and record any personal experiences that we have had with the 7 techniques As a class we will discuss what the name techniques offer the practitioner, patient and public Individually you will each add today’s small group, whole class and individual notes to your portfolio. This will account for 5% of your grade. Please sign attendance sheet

Core vs Complementary Chiropractic Procedures Core – may defined as follows 1. More common methods in use 2. Consistent with the model of care 3. Supported by theoretical foundations and mechanisms 4. Focuses on manually applied procedures with or without mechanical assistance

Core vs Complementary Chiropractic Procedures Complementary – may be defined as follows 1. Alternative approaches involving mind-body foundations 2. Mechanisms as yet undefined or outside the model of care

Most common techniques in use Diversified Activator (Arlan Fuhr) FAKTR (Tom Hyde) COX Technique (Jim Cox) Thompson Technique (John Minardi) Gonstead ART - Active Release Therapy

Break into small groups of 3

Small group work List the characteristics of Diversified technique http://blogs.babycenter.com

Diversified Technique characteristics Evidence based Difficult to define as a distinct field of practice Adaptable Treatmetns based on individual needs (patient centered) Open to interpretation (no a if this than that treatment method) HVLA with or without drop Lacks an ideology Broad scope Most popular Only method taught in Canada Constantly evolving Diverse Not standardized Both a technique system and a technique of movements FREEDOM!!!!!! To chose depending on… Steal from other techniques

Small group work List the characteristics that are common and uncommon between the 7 named techniques holykaw.alltop.com

Technique characteristics Common Uncommon All MSK interventions Passive treatments (or combo) Patient comfort? Drug free Aim to restore motion and function All have evaluation protocols (even if they’re different from each other) Hands on Practitioner comfort Believe method improves patient symptoms Work through mechanotransduction Require instruction/certification Tools/no tools Tables different Amount of force (varies) Scientific justification varies Patietn management of care different Patient exposure to radiation (x rays) Root cause of pain believed to be different Duration of treatment Purpose of intervention (intention) Some have dogmas/ideologies Velocity varies Strain & effort on doctor

Technique characteristics Common Uncommon

What is the theoretical intent of each chiropractic technique? Individually list in point form what practitioners of each technique are trying to do Refer to the videos assigned, technique websites, Google, Wikipedia, and personal knowledge thenextweb.com

Theoretical Intent Diversified Activator Restore normal joint motion or neuro function HVLA Could be scar tissue disruption Relieve pain Resetting muscle spindle fibers Reduce inflammation of joint and synovial fluid. Leg length Spinal alignment Targeting subluxations Provide patient comfort Psychological comfort (gentle, no crack) Reduce doctor effort

Theoretical Intent COX Thompson Leg length discrepancy Drop table Relieve pain Traction Decompress spine Flexion distraction Stretched tight muscles Gentle oscillation High amplitude low velocity Special table Influenced by osteopathy Leg length discrepancy Drop table Require less force Pelvic alignment Distract joint with adjustment

Theoretical Intent Gonstead ART Remove the subluxation Use xrays PA motion (Thoracic), ( rotation in cervical, sometimes lumbar) Knelling table (thoracic) Monitor temperature gradients High low tables Thrust and hold Restoring fascial interactions Breaking adhesions within fascia Stretching muscles active and passive Increase mobility Recycle/flush tissues to remove fluid Restore length and strength of muscle

Theoretical Intent FAKTR Reset muscle activation Work within painful range Brushing and tapping on muscles to activate, during exercise Reactivate inflammation process Inflammation brings the healing factors to the injury Tools (metal) – similar to graston

Personal experience In your small group, discuss and record any personal experience you have had with a named technique What technique What was the experience (does not have to be direct treatment) What did you like about the experience? What did you not like about the experience? aquaviva-munster.com

Personal experience Diversified Activator Liked combo of everything, patient specific Liked that could ask for something that seems to work. Not afraid to try and if it didn’t work, try something else. No manual SMT 5 min (not full screen) No explanation

Personal experience COX Thompson Seen it done, patients seems to like, low back pain relief from traction Dad’s experience – left on the table too long (Decmpression table) Helped mid and low back stuff, quick, didn’t mind that. Didn’t feel cavitation (liked cavitation), but felt better leaving 1st chiro experience, helped low back pain, mix of adjustments and drop table Non “Thompson” chiro, but uses drop pieces.

Personal experience Gonstead ART Liked grab trigger point and stretched out (specific) Painful, but only thing that helped knee pain

Personal experience FAKTR

Whole class discussion

Dr. Wickes - How we look at the body, where research takes us Dr. Wickes Inaugural Address clip – 7:00 research http://cmcc.ca/inauguration

Advantage Disadvantage What are the advantages and disadvantages of thinking about science and health through a reductionist view? MSK problems, joint problems, etc. Advantage Disadvantage

Advantage Disadvantage What are the advantages and disadvantages of thinking about science and health through a systems biology view? Viewing the body as a whole integrating all systems. Advantage Disadvantage

Whole class discussion: CMCC Model of Care Chiropractic is a primary contact health care profession with expert knowledge in spinal and musculoskeletal health, emphasizing differential diagnosis, patient centered care and research. How well does each named technique fit into the CMCC Model of Care? What can we learn from the named techniques?

How well does each named technique fit into the CMCC Model of Care? primary contact expert knowledge in spinal & MSK health differential diagnosis patient centered care and research

What can we (practitioner) learn from the named techniques?

Translating into practice Understanding that it is difficult to have an informed opinion without having personal experience I encourage you to shadow and talk to practitioners who practice a specific technique From the videos and your small group discussions can you think of a time when Utilizing 1 technique would benefit the patient? Utilizing more than 1 technique would benefit the patient? irisexecutives.com

Translating into practice – Benefits of Utilizing 1 Utilizing more than 1

Applications to practice What factors might influence: technique selection? Patient configurations/positions for treatment? Chiropractor configurations/positions for treatment? https://www.youtube.com/watch?v=JufugJdU9Ok

What factors might influence: technique selection?

What factors might influence: Patient configurations/positions for treatment?

What factors might influence: Chiropractor configurations/positions for treatment?

Scenario 45 year old female walks into a chiropractic office with an acute onset of low back pain (3 days ago). Lets assume this patient walked into 7 different clinics, all utilizing different techniques. Lets assume this patients’ pain and disability reduces to zero after a series of visits over 4 weeks. What commonalities do all these visits/encounters have that might explain why this patient improved? topadjustablebed.com

What commonalities do all these visits/encounters have that might explain why this patient improved? Actual time line of low back pain was expected to resolve in 4 weeks Going and being proactive about health may make you feel better Some sort of proprioceptive input (touch and movement of tissues) Elicted mechanotransduction Someone is there caring for you, your doctor patient interaction Patient education

What if the patient only got better with one type of treatment What if the patient only got better with one type of treatment? Why could this be?

Therapeutic factors Survey of mechanotransduction disorders (Chap 6, Triano) The Science and Clinical Application of Manual Therapy (King 2011) Exercise’s usual intension is to: increase compliance of tissues (fascia, ligament, tendon, muscle), increase ROM and functional motion Increase strength, stabilize joints/whole body Manual therapies (may have different theoretical constructs) are all designed to Alter tissue strain Promote normal function Permit symptom resolution and healing

Translating techniques to patient understanding What would you say when someone asks you “does Activator work” “should I try Thompson technique?” “my last chiropractor used ART, and it hurt, do you believe in ART?”

“does Activator work” reinerchiropractic.chiromatrixbase.com

“should I try Thompson technique?” williamshealthcare.com

“my last chiropractor used ART, and it hurt, do you believe in ART?”

Translating techniques to public understanding What might the public gain? What might the public lose?

Translating techniques to public understanding We will be revisiting this more later in the course My hope is that you will keep you mind open to what you hear, read and see about techniques to begin to form a “working opinion”

What do you see?

Individual work

Please grow your portfolio Reflection assignment: Please take some time and reflect on this class discussion Answer this question: How could it be possible that people with back pain get better seeing different chiropractors that use different techniques? Also add this to your portfolio: small group notes whole class notes Any individual notes or thoughts that you made (in class) Please submit your link via KIRO assignments by September 20, 2016 This will account for 5% of your grade.

Cook vs Chef If we say that a cook follows a recipe and a chef creates recipes, how could this statement relate to chiropractic techniques? Please reflect on this. Please reflect on the entire flip class and what you got out of it. foodclipart.com