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 By Frank M. Painter, D.C. in Education on December 22nd, 2011 at 11:28 am
Chiropractic Perspectives On Myofascial Therapy
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 15 from RC’s best-selling book:
“Applied Physiotherapy in Chiropractic”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 15: Chiropractic Perspectives On Myofascial Therapy
The purpose of this chapter is to improve the doctor of chiropractic’s understanding of the significance of myofascial pain and dysfunction, and to improve the chiropractor’s level of competence in diagnosing the myofascial component of the subluxation complex.
The myofascial orientation in the chiropractic setting directs the doctor to look first for a myofascial source of the patient’s pain, and when found, to use numerous techniques and procedures to offer rapid relief. Lowe recommends broad spectrum therapeutics to be employed after the performance of myofascial therapy to assure maximum flexibility. [1]
Definition
Myofascial therapy may be defined in several ways. Basically, it is the treatment of the myopathophysiologic component of the vertebral subluxation complex. It is also the treatment of trigger points, areas of increased neurologic activity in muscle tissue, causing the secondary referral of pain with subsequent associated autonomic changes. [2]
The pain attributed to myofascial dysfunction is usually restricted to a certain region such as the cervical or upper thoracic area, lumbar and buttock area, or the cranial/TMJ area. A trigger point, often the cause of such pain, is always tender and palpably taut. This prevents full lengthening of the muscle and produces muscle weakening, altered proprioception, predictable referred pain patterns, and an objectively verifiable local twitch response during palpation. [3]
Historic Background
Several key figures have contributed to our understanding of the widespread cause of muscular pain syndromes, among them Travell, Rolf, and, in our own profession, Nimmo. Another chiropractor who added greatly to our understanding of the role of muscles in various pain syndromes was Gillet of Belgium. Gillet wrote, “Concerning the subluxation or misalignment, we prefer the term fixation, which describes far more accurately the actual status of the [peri]articular soft tissues, where we will find that it is the state of these tissues that actually keeps the two surfaces from moving. The osteopaths, very early on, stated that the soft tissues can vary from the simplest muscular contracture to a complete degenerative fibrosis of the muscles. The previous facts are not new ….unfortunately, x-rays, introduced early in chiropractic history, have done much to propagate the idea of the spine as a string of bones. Even today, many practitioners act as if they still believe the childish propaganda they so nimbly offer to the public, that it’s a bone out of place in the back.” [4]
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By Brett Kinsler in Podcast on April 6th, 2011 at 4:20 pm
The first time much of the public spotted kinesiology tape was during the 2008 Olympics. Kerri Walsh, half of an unbelievable American beach volleyball team, had black tape prominently stuck to her shoulder. What is that stuff, people asked? Is she mourning someone? Or hiding a tattoo? It seemed like everyone was talking about it after that and a lot of manual providers started using it — or using more of it once their patients were convinced that there must be something to kinesiology tape. And they had to have it.
In this podcast interview, Dr. Brett Kinsler interviews Dr. Kevin Jardine who created the SpiderTech line of kinesiology tape. Best known for their pre-cut tape applications, SpiderTech is also a strong advocate in the education of chiropractors.
By Frank M. Painter, D.C. in Education on March 28th, 2011 at 12:51 pm
The Art of the Chiropractic Adjustment, Part VII
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Richard C. Schafer, DC, FICC
This series has strived to define certain general principles that underlie almost all chiropractic adjustive technics. Parts I and II reviewed depth of drive, the articular snap, segmental distraction, timing, the advantages of placing the patient’s spine in an oval posture, correct table height, and patient positioning objectives.
Part III summarized the factor of time in the clinical approach and its underlying biomechanical principles of tissue viscoelasticity, fatigue, creep, and relaxation. Part IV and V reviewed the need to visualize the loading effects on articular cartilage, joint lubrication, action of the intra-articular synovial tabs, the articular planes, the fundamental types of contact, contact points and their options, securing the contact hand, and the direction of drive. Part VI offered a rationale on adjustive velocity, and this concluding column on this subject describes various types of adjustive thrusts.
Types of Adjustive Thrusts
Test Thrusts
Test thrusts are mild preliminary thrusts applied before an actual corrective thrust is delivered. They have a twofold purpose: first, to acquaint the adjuster with the structural resistance present and patient response to the pressure applied; second, to acquaint the patient with what to expect. Surprise lowers a patient’s pain threshold.
Leverage Thrusts
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By Frank M. Painter, D.C. in Education on March 27th, 2011 at 10:50 am
The Art of the Chiropractic Adjustment: Part VI
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Richard C. Schafer, DC, FICC
The aim of this series is to define certain general principles that underlie almost all chiropractic adjustive technics. Parts I and II reviewed depth of drive, the articular snap, segmental distraction, timing the advantages of placing the patient’s spine in an oval posture, correct table height, and patient positioning objectives. Part III summarized the factor of time in the clinical approach and its underlying biomechanical principles of tissue viscoelasticity, fatigue, creep, and relaxation. Parts IV and V reviewed the need to visualize the loading effects on articular cartilage, joint lubrication, action of the intra-articular synovial tabs, the articular planes to deliver a corrective thrust most effectively. The fundamental types of contact, contact points and their options, securing the contact hand, and direction of drive were described. This column summarizes the rationale of adjustive velocity.
Background
One’s preference in technic can be clinically justified as long as biophysical and physiologic principles are followed. In health care, however, we are not dealing with purely mechanical principles. We are dealing with patients, sensitive human beings, who are often already in pain, and we should not wish to induce any more discomfort during a correction than is necessary.
Thrust technics applied to an articulation can be divided into two categories: low-velocity technics (LVTs) and high-velocity technics (HVTs), and each has various subdivisions depending on the joint being treated, its structural-functional state, and the primary and secondary objectives to be obtained. The term adjustment velocity refers to the speed at which the adjustive force is delivered. In either low-velocity or high-velocity technics:
Continue reading …
By Frank M. Painter, D.C. in Education on March 20th, 2011 at 10:31 am
The Art of the Chiropractic Adjustment: Part V
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Richard C. Schafer, DC, FICC
This series of articles has strived to define certain general principles that underlie almost all chiropractic adjustive technics. Parts I and II reviewed depth of drive, the articular snap, segmental distraction, timing the adjustment, the advantages of placing the patient’s spine in an oval posture, correct table height, and patient positioning objectives. Part III summarized the factor of time in the clinical approach and its underlying biomechanical principles of tissue viscoelasticity, fatigue, creep, and relaxation. Part IV reviewed the need to visualize the loading effects on articular cartilage, joint lubrication, action of the intra-articular synovial tabs, and the articular planes to deliver a corrective thrust most effectively. Here we shall describe the fundamental types of contact, contact points and their options, securing the contact hand and direction of drive.
Types of Contact
The type of contact used in applying a chiropractic adjustment is optional in most situations. The broadest contact that is efficient should be used, because the force will be directed through a larger surface area. For example, a force applied by a fairly open palm against the skin is perceived by the patient far differently than a force applied by a pointed finger against the skin. Thus, a palm-heel, thenar or knife-edge (medial edge of the hand) contact produces less patient discomfort than a pisiform or thumb contact. There are times, however, when a pisiform or thumb contract on a spinous process is necessary to get the job done quickly and efficiently.
Contact Points and Their Options
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By Frank M. Painter, D.C. in Education on March 16th, 2011 at 11:51 am
The Art of the Chiropractic Adjustment: Part IV
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Richard C. Schafer, DC, FICC
The aim of this series is to define certain general principles that underlie almost all chiropractic adjustive techniques. Parts I and II of this series reviewed depth of drive, the articular snap, segmental distraction, timing, the advantages of placing the patient’s spine in an oval posture, correct table height, and patient positioning objectives. Part III summarized the factor of time in the clinical approach and its underlying biomechanical principles of tissue viscoelasticity, fatigue, creep, and relaxation. This column reviews the need to visualize the loading effects on articular cartilage, joint lubrication, action of the intra-articular synovial tabs, and the articular planes to deliver a corrective thrust most effectively.
Loading Effects on Articular Cartilage
When articular cartilage is subjected to weight bearing, deformation develops instantaneously according to the tissue’s stiffness property. This initial stage of rapid deformation has a negligible matrix fluid flow, and the contour of the tissue changes but not its volume. This stage is followed by a slower time dependent creep (see previous column) related to the flow of water through the matrix according to the magnitude of the load, the fiber elasticity, the quantity of surface area loaded, the uniformity of force distribution, the matrix permeability (which is low even when unloaded), the osmotic pressure of the matrix colloid, and the length of the flow path.
When articular load is decreased during rest, stressed cartilages begin to return to their original thickness — quickly at first (90 percent) because of the elastic recoil of the collagen fibers, and then slowly after that from the absorption of water governed by the Donnan osmotic pressure of the proteoglycans in the matrix gel. This recovery by absorption is enhanced by oscillation of the unloaded joint and limited by the collagen fiber’s stiffness and strength that are subjected to increasing tensile forces as the swelling develops.
Continue reading …
By Frank M. Painter, D.C. in Education on March 15th, 2011 at 11:38 am
The Art of the Chiropractic Adjustment: Part III
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Richard C. Schafer, DC, FICC
As described in the previous two columns, all adjunctive procedures stand in the shadow of the basis for and the proper administration of the chiropractic adjustment. The goal of this series is to define briefly certain general principles that underlie almost all chiropractic adjustive technics. Some may be new to the reader, yet their basis is as old as chiropractic itself.
Parts I and II of this series reviewed depth of drive, the articular snap, segmental distraction, timing the thrust, the disadvantage of some drop-support tables, the advantages of placing the patient’s spine in an oval posture, correct table height, and patient positioning objectives. This column very briefly describes the factor of time in the clinical approach and its underlying biomechanical principles: viz, tissue viscoelasticity, fatigue, creep, and relaxation.
The Factor of Time in the Clinical Approach
To produce an effective articular adjustment, it is first necessary to evaluate the degree of joint motions and end plays present. Whatever corrective procedure is used, Hooke’s law should be remembered: The stress applied to stretch or compress a tissue is proportional to the strain, or change in length thus produced, if the limit of elasticity of the tissue is not exceeded. Adjustive ojectives are generally achieved by dynamic manual articular mobilization unless such a technic is contraindicated in a specific situation. Obviously, one would not apply a dynamic force over extremely porotic bone, a fracture, an abscess, a tubercular cyst, or a malignancy, for example; nor would it be applied over acutely inflamed tissue or splinted muscles if the doctor expects the patient to return.
Continue reading …
By Frank M. Painter, D.C. in Education on March 12th, 2011 at 8:42 pm
The Art of Chiropractic Adjustment: Part II
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Richard C. Schafer, DC, FICC
The two most important instruments for chiropractors are their hands and a well-designed adjusting table. Some graduates in recent years have not been taught the optimal applications of either. The following suggested procedures, regarding the art of articular correction, are based on established biomechanical principles. They are not new. They are the teachings of pioneer chiropractic.
Background
Seven cardinal rules are suggested for the application of any adjustive technic. They concern:
(1) preadjustment tissue relaxation;
(2) preadjustment patient positioning;
(3) directing the impulse drive carefully in line with the facets’ plane of articulation;
(4) applying the active contact on the strongest logical point of the segment;
(5) using the mechanical advantage of leverage;
(6) applying segmental distraction before the thrust; and
(7) timing the thrust.
The well-designed adjusting tables available today contain a multitude of potential adjustments to help achieve these goals. It is unfortunate that many DCs practice for years with little knowledge of why these many position and tension variables are available or when they should be used. This column will attempt to solve this apparently widespread mystery.
Continue reading …
By Frank M. Painter, D.C. in Education on March 10th, 2011 at 7:26 pm
The Art of the Chiropractic Adjustment: Part I
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Richard C. Schafer, DC, FICC
This author acknowledges the value of reflexology and numerous physiotherapeutic applications (along with nutritional supplementation, counseling, “bloodless surgery,” and standardized rehabilitative procedures) in chiropractic case management.
Yet, they all stand in the shadow of the basis for and the proper administration of the chiropractic adjustment. This column and others throughout the year will focus on the need for the development of our unique art. Certain basics seem to have become lost in the teaching of “technic” during the last decade or so.
Depth of Drive
Besides patient positioning, the type of contact selected, and direction of drive, the depth of drive also must be accurate. It is sometimes taught that it should be to the anatomical limit, but this is not always true. Adjusting a strong ligament fixation immediately to the anatomical limit may rupture degenerated tissues — resulting in the development of even tougher scar tissue. The object is to progressively stretch but not rupture shortened fibers. Adaptation takes time.
The opposite should also be recognized. An attempt to mobilize further after a fixation has been released will produce a new defensive contraction and inflammation, and therefore predispose the development of a new fixation. Over-adjusting is not beneficial; it is trauma.
The Articular Snap
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on October 15th, 2009 at 8:14 am
Upper Extremity Technique: Adjustment of Upper Extremity Joint Subluxations-Fixations
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 2 from RC’s best-selling book:
“Upper Extremity Technique”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 2: Adjustment of Upper Extremity Joint Subluxations-Fixations
This chapter describes adjustive therapy as it applies to articular malpositions of the lateral clavicle, shoulder, elbow, wrist, and hand. Manipulations to free areas of fixation are also covered.
Screening Tests for the Upper Extremity as a Whole
The Shoulder Girdle
As with other areas of the body, it is good procedure during observation to first note the general characteristics and then inspect for details. Visualize the anatomy involved while observing the overall bilateral symmetry, rhythm of motion, swing during gait, smoothness in reach, patterns of pain, and general circulatory and neurologic signs. Inspect for gross abnormal limb rotation or adduction. Note skin discolorations, masses, scars, blebs, swellings and lumps, abrasions, and overt signs of underlying pathology. Carefully note the biomechanical relationship of the neck with the shoulder girdle and both with the thorax. Observation should be conducted on all sides.
With the patient sitting, inspect the anterior aspect of the shoulder girdle starting with the clavicle. A fracture or dislocation at either the medial or lateral end of the clavicle is usually quite obvious by the apparent change in contour and exaggerated round shoulders to protect movement. Note the normally symmetrical fullness and roundness of the anterior aspect of the deltoid as it drapes from the acromion over the greater tuberosity of the humerus. Unusual prominence of the greater tuberosity of the humerus suggests deltoid atrophy, while a sharp change in contour unilaterally suggests dislocation. A forward displacement of the tuberosity exhibits an indentation under the point of the shoulder and a loss of normal lateral contour. The most common points of abnormal tenderness are at the acromioclavicular joint and in the rotator cuff.
To test the general integrity of the shoulders, have the patient place the hands on top of the head and pull the elbows backward. This will be painful, if not impossible, in shoulder bursitis, arthritis, and rotator-cuff strains. Apley’s scratch test is another good screening procedure. Note if the scapula and humerus move in harmony.
Branch points out that spasm above or over the scapula will be readily recognized if the examiner observes the patient from the back during horizontal abduction. If such spasm exists (eg, from cervical radiculitis), horizontal abduction of the arm will occur with little motion of the scapula. However, if the origin of pain is within the shoulder, a “shrugging” motion occurs, in which the apex of the scapula sharply swings laterally but glenohumeral motion is restricted.
The Elbow and Forearm
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on October 6th, 2009 at 12:33 pm
Posttraumatic Rehabilitation: The Rationale of Rehabilitative Therapy
The Chiro.Org Blog
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 1 from RC’s best-selling book:
“Chiropractic Posttraumatic Rehabilitation”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 1: The Rationale of Rehabilitative Therapy
Preface
For many centuries, therapeutic rehabilitation was a product of personal experience passed on from clinician to clinician. In the last 20 years, however, it has become an applied science. In its application, of course, much empiricism remains that can be called an intuitive art –and this is true for all forms of professional health care.
The word trauma means more than the injuries so common with falls, accidents, and collision sports. Taber* defines it as “A physical injury or wound often caused by an external force or violence” or “an emotional or psychologic shock that may produce disordered feelings or behavior.” This is an extremely narrow definition for trauma can also be caused by intrinsic forces as seen in common strain. In addition to its cause being extrinsic or intrinsic, with a physical and emotional aspect, it also can be the result of either a strong overt force or repetitive microforces. This latter factor, so important in treating a unique patient’s specific pathophysiology, is too often neglected outside the chiropractic profession.
Continue reading …
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