1. A Sample Lecture to 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

2. Note to the user: This presentation was designed to accommodate the student in 2 ways: 1) no pictures or graphics were used in order to reduce the size of the presentation and insure that a 3.5 disc would be sufficient to download the presentation; and 2) the text within the slides is longer than would normally be considered “most effective” in a Power Point presentation. This was done to insure that you have all the necessary words as you begin presenting this material to other health care professionals...

3. …I suggest that you add graphics as you see fit and simplify the slides as you become more comfortable with the material. The computer lab staff can help you with both. Please use and adapt this presentation as you see fit. You are always welcome to contact me at x3180. Good luck and have fun!

4. The Rationale for Chiropractic Care (Fill in your name here)

5. Chiropractic care centers around the maintenance of appropriate movement of the spinal joints and optimizing biomechanics throughout the musculoskeletal system. Premise

6. WHY? Let’s begin….

7. There is a distinct difference between a medical subluxation and a chiropractic vertebral subluxation complex: l A chiropractic subluxation is inherently a HYPOmobility suggesting decreased movement and no loss of stability l A medical subluxation is inherently a HYPERmobility resulting from a loss of integrity of the joint capsules and concomitant instability

8. The primary lesion addressed in chiropractic is the vertebral subluxation complex (VSC). This refers to discrete areas of hypomobilty within the spinal column

9. Components of the Vertebral Subluxation Complex (VSC) l Dyskinesis (hypomobility) l Altered biomechanics (cellular damage) l Physiological and biochemical changes l Altered nervous system activity l Altered motor patterns...

10. Case management protocol includes… l Specific spinal analysis l Physical, neurological, orthopedic examinations and consultation l Specific restoration of normal biomechanics by means of the adjustment l Referral for co-management if appropriate l Appropriate attention to ergonomical considerations and other possible causes of biomechanical dysfunction

11. The purpose of the adjustment is… to restore normal movement and resolve the resultant biomechanical, physiological and neurological effects of segmental hypomobility.

12. What are these effects…?

13. Biomechanical Effects of Hypomobility l Altered intersegmental movement patterns l Results in compensatory changes in motor patterns, etc. l Creates cellular damage in sites of biomechanical stresses l “Immobilization Degeneration…”

14. Loss of normal motion within a joint results in changes in every structural component of the joint; subchondral bone to the synovium, from meninges to the ligamentum flavum. l Amiel D, et al. Acta Ortho Scand, 1982 l Palmoski M, et al. Arth Rheum, 1979 l Paine & Haung. J Neurosurgery, 1972 l Lantz C. Chiro Res J, 1988 l Enneking & Horowitz. J Bone Joint Surg, 1972 l Evans EB, et al. J Bone Joint Surg, 1960

15. Current orthopedic literature recognizes that changes in the pattern of forces transmitted through joints, which occurs during the immobilization process, is universally recognized as contributing to connective tissue degeneration and local changes in the chemical composition of that tissue….

16. We also know that mechanical failure of ligaments, discs, capsules and other connective tissue can result from local variations in chemical composition.

17. Measurable changes within the joint complex occur within one week of the onset of hypomobility.

18. Effects of hypomobility on the intervertebral disc...

19. The nucleus pulposus is the the area of the disc most susceptible to dessication. The nucleus pulposus is dependent on movement for nutrition and survival...

20. Lack of appropriate intersegmental spinal movement can significantly reduce the dynamic pressure gradient between the intradiscal tissues and the subchondral areas of spongiosa in the vertebral bodies...

21. …this sacfrifices the key mechanism by which nutrients and water replenish the disc and by which metabolic waste leaves the disc.

22. Putting it together... l Loss of normal movement leads to… l Changes in how all tissues involved are stressed and replenished, which causes… l Chemical changes within those tissues and… l Predisposes them to mechanical failure giving us… l A good reason to restore normal movement through spinal adjustment.

23. Neurological Effects of the Vertebral Subluxation Complex

24. Spinal Learning (Law of Facilitation) Altered motor and sensory patterns are “learned” by the nervous system and the musculoskeletal systems

25. Receptor Classifications…

26. Mechanoreceptors l Position sensitive l Motion sensitive l Vibration sensitive l Pressure sensitive l Provide continuous feedback about where the body is in space...

27. The most significant input into the CNS with regard to balance, posture and movement comes from the mechanoreceptors of the cervical spine. Guyton, Textbook of Medical Physiology.

28. Nociceptors l Thermo-, mechano- and chemosensitive l Spinal nociceptors are almost exclusively chemosensitive l Estimated that half of all dorsal afferents are nociceptors ( M. Zimmermann, 1979 ) l Fire with harmful or potentially harmful stimuli …

29. Pain l Is not carried by nociceptors l Occurs in the cerebral cortex l 90% of all nociceptive activity never reaches the cortex and the patient will remain symptom-free

30. Factors that influence the perception of pain l Intensity of the stimulus l Duration of the stimulus l Descending inhibition

31. Nociceptor Sites Grieve G. Common Vertebral Joint Problems, 1988 l Skin l Subcutaneous tissue l Adipose l Joint capsules l All spinal ligaments l Blood vessels l Cancellous bone l Periosteum l Muscles l Tendons l Fascia l Aponeurosis l Dura mater l Epidural tissue

32. Nociceptor activity reflexively activates the sympathetic nervous system.

33. The dorsal horn is a central focal point for mediating autonomic and somatomotor reflexes initiated by nociceptive stimulation. Price D. Psychological and Neural Mechanisms of Pain, 1988; Raven Press, NY.

34. The Effects of Nociceptive Activity l Segmental responses of muscle spasm and sympathetic hyperactivity. J. Bonica, 1990 & 1992 H. Hooshmand, 1993

35. l Noxious chemical stimulation of specific spinal structures produce measurable changes in sympathetic nerve activity... Budgell B, et al. J NMS Syst, 1995

36. Nociceptive input normally triggers sympathetic activity. Cabell J. Sympathetically maintained pain. In: Willis W, ed. Hyperalgesia and Allodynia. Raven Press, NY; 1992.

37. Effects of Spinal Nociceptor Stimulation of the Hypothalamus and Reticular Formation l Nausea l Pallor l Dizziness l Faintness l Syncope l Changes in blood pressure l Changes in respiration l Changes in heart rate l No pain

38. In the presence of irritation to spinal structures manifestations were pallor, sweating,changes in heart rate, changes in blood pressure, nausea and syncope. These features were not proportional to the severity of pain perceived; on the contrary, they seemed to dominate experience of subjects who complained little of pain but who were overwhelmed by the symptoms listed above... Feinstein B. J Bone Joint Surg, 1954

39. There is good evidence to support the importance of input from spinal afferents in reflex activity of the sympathetic nervous system. l D. Jordan, 1997 l Schramm and Poree, 1991 l Hayes, et al, 1991 l Weaver and Stein, 1988 l Stein, et al, 1989 l Qu, et al, 1988 l Meckler and Weaver, 1988 l Taylor and Schramm, 1987 l Stjernberg, et al, 1986

40. SO...

41. It is possible for nociceptors to fire secondary to the tissue damage caused by abnormal biomechanics...

42. This nociceptor activity can cause reflexive stimulation of the sympathetic nervous system... This may occur and and become chronic without the presence of pain or any other symptom.

43. How is chiropractic inherently different from other healthcare professions who chose to utilize manipulation? l Application of immobilization as it relates to the joint complex l Kinetic chain principle and basic neurology allows full spine vs symptom based management...

44. l Thorough understanding of the neurological and physiological implications of faulty biomechanics l Purpose of the adjustment: to restore normal biomechanical, neurological and physiological activity l Extensive and focused study in the art of adjusting using multiple techniques to best adapt to the individual needs of the patient

45. Today l The public has widely embraced many forms of wellness care and alternative therapies l Other healthcare professions have embarked on a paradigm shift to include alternative therapies, including spinal manipulation l Many conditions respond best with a multidisciplinary approach

46. HEALTH “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

47. ENTERING THE NEW MILLENIUM “The Wellness Model” l Potentiating treatment protocols l Patient-centered paradigm l Improving interdisciplinary communication l Maximizing the benefits of healthcare from all perspectives