1. 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

2. Part 1

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

4. How is treating a patient like going through the scientific method?
Come up with a hypothesis, then do an experiment with your patient (orthopaedic test, treatment), then check your results (re-evaluate your patient).

5. Why should we study the mechanisms of manual therapy?
IF you don’t know how it works, we don’t know
how it helps people
How to optimize results (promoting appropriate use of manual therapy
Who does the treatment work best for (target population)
No point on doing more RCTs if you don’t know mechanism
RCT’s are having a decreased return on investment (ROI)

6. What do we tell the patient we do?
Normalize and optimized function
Health care discipline that focuses on prevention of disease and maintenance and improvement of health related to mechanical disorders, specifically
Musckuloseklteal system
W treat aberrations of health and wellbeing that either are caused by or manifest as mechanical problems.

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

8. Part 2
View only section
Any thoughts or comments?

9. Part 3

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

11. Fill in the dysfunctional movement model.

12. 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

13. How did Hartman in 2014 demonstrate the connection between mechanotransduction and mechanotransduction disease? What experiment did he do?
Hartman loaded a spinal unit in multiple directions and measured the changes in chemical messengers, based on different loading
They found applied load (I.e. facet gapping versus compression) dictated production changes (pro-inflammatory and catabolic loss, respectively)

14. 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.

15. 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?
Acute and chronic LBP patients have different chemical mediator response to SMT

16. 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 (%)

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

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

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

20. Part 4

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

22. What 3 levels of the dysfunctional movement model does manual therapy act, based on the current evidence?
1. Local tissue stress concentration
2. Asynchronous proprioceptive and nociceptive bombardment
3. Black box between CNS and spinal cord (changes in pain (DIPM) and motor

23. 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.

24. Part 5

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

26. Does technique (applications characterisitcs) matter?
Yes, all the following have been shown to matter in muscle and afferent signal response.
Preload
Preload positioning
Peak force amplitude
Rate of rise in force (speed)

27. Do chiropractors use too much force during cervical SMT?No
ROM of neck from flexion to extension causes 200N (at extension)
SMT of cervical spine causes 90N

28. 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

29. Individual work

30. 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.

31. Questions or comments?