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 By Frank M. Painter, D.C. in Chiropractic Care on April 23rd, 2013 at 11:55 am
Sports Management:
Leg, Ankle, and Foot Injuries
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 27 from RC’s best-selling book:
“Chiropractic Management of Sports and Recreational Injuries”
Second Edition ~ Wiliams & Wilkins
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 27: Leg, Ankle, and Foot Injuries
The lower leg, ankle, and foot work as a functional unit. Total body weight above is transmitted to the leg, ankle hinge, and foot in the upright position, and this force is greatly multiplied in locomotion. Thus the ankle and foot are uniquely affected by trauma and static deformities infrequently seen in other areas of the body.
Injuries of the Leg
The most common injuries in this area are bruises, muscle strains, tendon lesions, postural stress, anterior and posterior compression syndromes, and tibia and fibula fractures. Bruises of the lower leg are less frequent than those of the thigh or knee, but the incidence of intrinsic strain, sprain, and stress fractures are much greater.
A continual program of running and jogging is typical of most sports. The result is often strengthening of the antigravity muscles at the expense of the gravity muscles — producing a dynamic imbalance unless both gravity and antigravity muscles are developed simultaneously. An anatomic or physiologic short leg as little as an eighth of an inch can affect a stride and produce an overstrain in long-distance track events.
Bruises and Contusions
The most common bruise of the lower extremity is that of the shin where disability may be great as the poorly protected tibial periosteum is usually involved. Skin splits in this area can be most difficult to heal. Signs of suppuration indicate referral to guard against periostitis and osteomyelitis.
Management. Treat as any skin-bone bruise with cold packs and antibacterial procedures, and shield the area with padding during competitive activity. When long socks are worn, the incidence of shinbone injuries is reduced. An old but effective protective method in professional football that does not add weight is to place four or five sheets of slick magazine pages around the shin that are secured by a cotton sock which is covered by the conventional sock. A blow to the shin is reduced to about a third of its force as the paper slips laterally on impact.
GASTROCNEMIUS CONTUSION
This is a common and most debilitating injury in contact sports. It is characterized by severe calf tenderness, abnormal muscle firmness of the engorged muscle, and inability to raise the heel during weight bearing.
Management. Treat with cold packs, compression, and elevation for 24 hr. Follow with mild heat and contrast baths. Massage is contraindicated as it might disturb muscle repair. The danger of ossification is less in the calf than in the thigh, but management must incorporate precautions against adhesions.
TRAUMATIC PHLEBITIS
Contusion to the greater saphenous vein may lead to rupture resulting in extensive swelling, ecchymosis, redness and other signs of local phlebitis. Tenderness will be found along the course of the vascular channel. During treatment, referral should be made upon the first signs of thrombosis.
Management. Management is by rest, cold, compression, and elevation for at least 24 hr. Later, progressive ambulation, mild heat, and contrast baths should be utilized. Progressive exercises may begin in 4-6 days. When competitive activity is resumed, the area should be provided extra protection.
NERVE CONTUSIONS
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By Frank M. Painter, D.C. in Bone Injury on April 15th, 2013 at 8:35 am
Sports Management:
Bone and Joint Injuries
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:
“Chiropractic Management of Sports and Recreational Injuries”
Second Edition ~ Wiliams & Wilkins
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: Bone and Joint Injuries
In traditional general medical practice, the musculoskeletal system is the most overlooked system in the body, yet it comprises over half the body mass. The relationship between structure and function, and the interrelationship between all body systems, cannot be denied. Muscles, bones, and connective tissues are involved in both local and systemic pathology, and in a wide assortment of functional and referred disturbances. Thus, great care must be taken in eliciting the details of a complaint when any musculoskeletal disorder is suspected. This section reviews the basis of alert management of bone and joint injuries within the health care of athletic and recreational injuries.
Bone Injuries
Correlation of the history of the present complaint with musculoskeletal dysfunction must be done in detail and with care. Maintain accurate initial and progress records with repeated monitoring. Few patients can appreciate the relationship of dysfunction in one somatic part with a distant somatic part, let alone the relationship between a somatic dysfunction and a visceral dysfunction.
Background
Musculoskeletal symptoms may be the first clues toward poor structural adaptation or stress adaptation. The most common musculoskeletal symptoms are joint stiffness, joint swelling, and joint pain. Bones, being essentially nonyielding structures, are damaged when excessive force is applied directly or indirectly. The nature of the damage depends on the direction of the applied force on the bones and the manner in which these bones are attached to other structures. The principal acute skeletal injuries are sprains, strains, subluxations, fractures, and dislocations.
Normal bone has an excellent blood supply with some exception in the metaphyseal area; but tendons, ligaments, discs, and cartilage are poorly vascularized. Yet both bone and joints challenge the host’s defensive mechanisms. The pressure of pus under hard bone blocks circulation, and emboli and thrombosis can cause additional devascularization. When circulation is deficient, local phagocytic function and nutrition are deficient, and cure is stymied.
The most accurate diagnosis can be made immediately after injury, before swelling clouds the picture. Many fracture and dislocation complications such as nerve and vessel injury occur not from the trauma itself but from poor first aid which does not provide adequate splinting prior to movement. Traumatic bone injury rarely occurs without significant soft-tissue damage. The physical examination must be gentle but thorough because soft-tissue trauma is poorly visible on roentgenograms for several days after injury. For example, a working diagnosis of stress fracture may have to be made in the absence of classic symptoms by bony tenderness alone as the fracture may not be demonstrable on x-ray films for 10-14 days or longer.
Probing the History
Symptoms of a musculoskeletal nature that cannot be linked to trauma are suspect of a chronic organic process. Unfortunately, a history of stress or strain may not be remembered. Even severe trauma is easily put out of the mind uring a game when emotions are high or forgotten once the pain and swelling have left. Whether pain is present or not, the history must be probed to determine if the dysfunction is the result of bone, the joint, or the motor apparatus involved in the joint motion.
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The Horizontal Neurologic Levels
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 4 from RC’s best-selling book:
“Basic Principles of Chiropractic Neuroscience”
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 4: The Horizontal Neurologic Levels
and Related Clinical Concerns
This chapter describes the basic functional anatomy and clinical considerations of the horizontal aspects of the supratentorial, posterior fossa, spinal, and peripheral levels of the nervous system.
OVERVIEW
The reader should keep in mind that the various aspects of the nervous system as described in this manual (eg, longitudinal and horizontal systems) are only reference guides that are visualizations of a patient’s nervous system in the upright position. They can be likened to the lines of longitude and latitude on a globe of the earth.
Such systems do not exist physically, but they do serve as excellent mental grid-like tools (viewpoints) during localization and areas in which and from which relationships can be described. For example, although the longitudinal systems take a general vertical course within the spinal column there are numerous alterations and they actually become horizontal when decussating. While the horizontal levels are spatially placed in and extend from the CNS in a general segmental manner, they soon take a widely diffuse course as they project toward their destinations. Thus, references to longitudinal and horizontal levels are just general viewpoints.
It is helpful for study purposes to isolate the body into certain systems, as described above, organize systems into organs, organs into tissues, tissues into cells, and cells into their components. However, we should keep in mind that, physically and functionally, there is only one integrated body and it is more than the sum of its parts. And even the body cannot be thought of as truly separate from its external environment. Although we may do this for study purposes, it is a limited viewpoint.
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The Longitudinal Neurologic Systems
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 3 from RC’s best-selling book:
“Basic Principles of Chiropractic Neuroscience”
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 3: The Longitudinal Neurologic Systems
This chapter succinctly describes the basic structure and function of the six major longitudinal systems; viz, the sensory, motor, visceral, vascular, consciousness, and cerebrospinal fluid systems.
As we begin this chapter, it might be well for the reader to subjectively grasp the significance of the motor and sensory systems as far as possible. One exercise in this is to imagine that you had become unconscious and someone has placed you in a remote dark empty cellar, far beyond any source of environmental sound. The first thing you realize is that you are a total sensory and motor paralytic from the neck caudad. You are unable to move even a fingertip because your motor system is not functioning. Because there is no feeling, you do not know whether you are recumbent or tied in a chair. Your vision is normal, but there is no light. Your hearing is normal, but there is no sound. Your taste buds are functional, but there is nothing to eat or drink. Your olfactory organs are functional, but there are no detectable odors. There is little left except thought and memory.
After a time in this predicament, thoughts undoubtedly arise such as, “I wish I had really looked at the beauty of the world when I had a chance. I wish I had listened to the music of the masters and even the birds in my backyard when I had a chance. I gulped down so many delicious meals. I had a beautiful garden, but I rarely took time to appreciate its design and fragrance. I even failed to take time to appreciate the texture of my own clothes. I was in such a hurry to go nowhere that was more important. I missed so much.”
OVERVIEW
The human nervous system is a marvel in organizing and adapting to internal and external environmental changes:
(1) The receptors and afferent neurons of the visceral and somatic input systems are necessary to detect internal and external environmental changes.
(2) The visceral efferent neurons and the muscles of the motor output system must be stimulated if action is to be taken.
(3) The integrative system serves as intermediary stations via a complex arrangement of interneurons whose synapses control impulse strength and signal direction from the sensory system to the motor system.
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By Frank M. Painter, D.C. in Acupuncture on April 2nd, 2013 at 8:09 pm
Updated Reference Guide to Dr. Richard C. Schafer’s Articles
The Chiro.Org Blog
There are now 62 different Chapters from Dr. Schafer’s various best-selling textbooks for your review, available exclusively at Chiro.Org
These learned articles by Dr. Schafer can also be found again easily by selecting the EDUCATION Category, on the right-hand side of this page, just below Recent Comments. We hope you will find them of interest.
Our thanks to ACAPress for access to these materials!
Sports Management:
Introduction to Sports-related Health Care
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 Management of Sports and Recreational Injuries”
Second Edition ~ Wiliams & Wilkins
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: Introduction to Sports-related Health Care
If you were to ask the average coach about the responsibilities of an athlete, he would most likely reply that he or she was to conduct one’s self to the credit of the team, play fair, obey the officials, keep in training, be a credit to the sport, follow the rules, and enjoy the game: win or lose. This is the rhetoric commonly spooned to the naively inclined. If it were true, fewer sports injuries would be suffered.
With rare exception, even the Little Leaguer is commonly taught to WIN, drilled to disguise foul play from the eyes of the referees and umpires. Even in so-called noncontact sports, emphasis is often placed on getting the other team’s stars out of the game without causing injury to your own team. While conditioning is emphasized, the motivation is frequently on the preservation of a potential winning season rather than on prevention of a personal injury to a human being.
These words are harsh, but realistic. Yet, doctors handling athletic injuries must have a realistic appraisal of sports today if they are in good conscience to properly evaluate disability and offer professional counsel.
The Art of Evaluation
All people participating in vigorous sports should have a complete examination at the beginning of the season; and re-evaluation is often necessary at seasonal intervals. Re-evaluation is always necessary with cases where the candidate has suffered a severe injury, illness, or had surgery.
Evaluation begins with questioning. Because of drilled routine, any doctor is well schooled in the taking of a proper case history. But with an athletic injury, both obvious and subtle questions often appear. How extensive was the preseason conditioning? How much time for warm up is allowed before each game or event? What precautions are taken for heat exhaustion, heat stroke, concussion, and so forth? Does the coach make substitution immediately upon the first sign of disability for proper evaluation? How adequate is the protective gear? How many others on the team have suffered this particular injury this season?
Who, what, when, where, how, and WHY? These are the questions which must be answered before any positive course of health care can be extended. A detailed history of past illness and injury is vital. In organized sports, an outline of the regimen of training should be a part of the history, as well as a record of performance. Most sports will require a detailed locomotor evaluation of the player. Special care must be made in evaluating the preadolescent competitor because of the wide range of height, weight, conditioning, and stages of maturation. A defect may bar a candidate from one sport but not another, or it may be only a deterrent until it is corrected or compensated. Many famous athletes have become great in spite of a severe handicap.
The Physician’s Responsibilities
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By Frank M. Painter, D.C. in Chiropractic Care on January 6th, 2013 at 1:54 pm
Clinical Biomechanics: Mechanical Concepts and Terms
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:
“Clinical Biomechanics:
Musculoskeletal Actions and Reactions”
Second Edition ~ Wiliams & Wilkins
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: Mechanical Concepts and Terms
All motor activities such as walking, running, jumping, squatting, pushing, pulling, lifting, and throwing are examples of dynamic musculoskeletal mechanics. To better appreciate the sometimes simple and often complex factors involved, this chapter reviews the basic concepts and terms involved in maintaining static equilibrium. Static equilibrium is the starting point for all dynamic activities.
Energy and Mass
Biomechanics is constantly concerned with a quantity of matter (whatever occupies space, a mass) to which a force has been applied. Such a mass is often the body as a whole, a part of the body such as a limb or segment, or an object such as a load to be lifted or an exercise weight. By the same token, the word “body” refers to any mass; ie, the human body, a body part, or any object.
Energy
Energy is the power to work or to act. Body energy is that force which enables it to overcome resistance to motion, to produce a physical effect, and to accomplish work. The body’s kinetic energy, the energy level of the body due to its motion, is reflected solely in its velocity, and its potential energy is reflected solely in its position. Mathematically, kinetic energy is half the mass times the square of the velocity: m/2 X V524. In a closed system where there are no external forces being applied, the law of conservation of mechanical energy states that the sum of kinetic energy and potential energy is equal to a constant for that system.
Potential energy (PE), measured in newton meters or joules, is also stored in the body as a result of tissue displacement or deformation, like a wound spring or a stretched bowstring or tendon. It is expressed mathematically in the equation PE = mass X gravitational acceleration X height of the mass relative to a chosen reference level (eg, the earth’s surface). Thus, a 100-lb upper body balanced on L5 of a 6-ft person has a potential energy of about 300 ft-lb relative the ground.
The Center of Mass
The exact center of an object’s mass is sometimes referred to as the object’s center of gravity. When an object’s mass is evenly distributed throughout, the center of mass is located at the object’s geometric center. In the human body, however, this is infrequently true, and the center of mass is located towards the heavier, often larger, aspect. When considering the body as a whole, the center of mass in the anatomic position, for instance, is constantly shifted during activity when weight is shifted from one area to another during locomotion or when weight is added to or subtracted from the body.
The term weight is not synonymous with the word mass. Body weight refers to the pull of gravity on body mass. Mass is the quotient obtained by dividing the weight of a body by the acceleration due to gravity (32 ft/sec524). Each of these terms has a different unit of measurement. Weight is measured in pounds or kilograms, while mass is measured by a body’s weight divided by the gravitational constant. The potential energy of gravity can be simply visualized as an invisible spring attached between the body’s center of mass and the center of the earth. The pull is always straight downward so that more work is required to move the body upward than horizontally (Fig. 2.1).
Newton’s Laws of Mechanics
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By Frank M. Painter, D.C. in Chiropractic Care on January 3rd, 2013 at 3:22 pm
Clinical Biomechanics: General Spinal Biomechanics
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 6 from RC’s best-selling book:
“Clinical Biomechanics:
Musculoskeletal Actions and Reactions”
Second Edition ~ Wiliams & Wilkins
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 6: General Spinal Biomechanics
This chapter discusses the vertebral column as a whole and serves as a foundation for the following three chapters that consider the regional aspects of the spine and pelvis. Emphasis here is on gross structure, function, spinal kinematics, and other general biomechanical implications.
Background
The vertebral column is a mechanical marvel in that it must afford both rigidity and flexibility.
The Spine as a Whole
The segmental design of the vetebral column allows adequate motion among the head, trunk, and pelvis; affords protection of the spinal cord; transfers weight forces and bending moments of the upper body to the pelvis; offers a shockabsorbing apparatus; and serves as a pivot for the head. Without stabilization from the spine, the head and upper limbs could not move evenly, smoothly, or support the loads imposed upon them (Fig. 6.1).
Essentially because of its various adult curvatures, the bony spine is anatomically divided into the seven cervical vertebrae, the twelve thoracic vertebrae, the five lumbar vertebrae, and the ossified five sacral and four coccygeal segments. From C1 to S1, the articulating parts of these vertebrae are the vertebral bodies, which are separated by intervertebral discs (IVD’s), and the posterior facet joints. The IVD’s tend to be static weight-bearing joints, while the facets function as dynamic sliding and gliding joints.
WEIGHT DISTRIBUTION
The flexible vertebral column is balanced upon its base, the sacrum. In the erect position, weight is transferred across the sacroiliac joints to the ilia, then to the hips, and then to the lower extremities. In the sitting position, weight is transferred from the sacroiliac joints to the ilia, and then to the ischial tuberosities.
SPINAL LENGTH
About 75% of spinal length is contributed by the vertebral bodies, while 25% of its length is composed of disc material. The contribution by the discs, however, is not spread evenly throughout the spine. About 20% of cervical and thoracic length is from disc height, while approximately 30% of lumbar length is from disc height. In all regions, the contribution by the discs diminishes with age.
Development of the Spine
In brief, development occurs in three stages: mesenchymal, chondrification, and ossification.
MESENCHYMAL AND CHONDRIFICATION ORIGINS
Just prior to the 4th week of embryonic development, a vertebral segment begins to develop as paired condensations of mesenchyme (somites) around the longitudinal notochord and dorsal neural tube. One or usually two chondrification centers appear (6 weeks) in the centrum and begin to form a cartilaginous model surrounded by anterior and posterior longitudinal ligaments which are complete by 7-8 weeks. Chondrification centers also form in the neural arches and costal processes. A thick ring of nonchrondrous cells establishes the model IVD around the longitudinal string of beaded notochordal segments (Fig. 6.2).
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“No Offense, Doctor, But I Want a Referral for My Pain”
The Chiro.Org Blog
SOURCE: Medscape Education Community CME
NOTE: Establish your free account with Medscape to participate
Charles P. Vega, MD
Case Presentation
You are seeing a 42-year-old woman whom you diagnosed with fibromyalgia 4 weeks ago. Her main complaint continues to be diffuse, dull body pain, but she also reports occasional numbness in both hands. She says that she has felt fatigue for the past several years, and she blames poor sleep for this. She denies depression but says that she gets tearful when she thinks about her chronic symptoms and how they have limited her from what she has wanted to accomplish.
The patient was treated initially with some education regarding fibromyalgia and its manifestations, followed by several supporting phone calls from your staff. She was given a prescription for an exercise program, which she tried twice but could not continue due to exacerbation of her symptoms. She was also given a prescription for amitriptyline 50 mg at bedtime, which she stopped after 2 days due to dry mouth and increased fatigue.
Two weeks ago, you prescribed duloxetine 20 mg daily. She comes to your clinic today to tell you that this medication has had no effect on her symptoms. She tells you that she likes you as a person, but she requests that she be referred to someone who can treat her illness more effectively.
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A Practical Guide to Avoiding Drug-Induced Nutrient Depletion
The Chiro.Org Blog
SOURCE: Nutrition Review ~ October 2011
By Hyla Cass, MD
A little known, but potentially life-saving fact is that common medications deplete your body of a host of vital nutrients essential to your health. This practical guide will show you how to avoid drug-induced nutrient depletion and discuss options for replacing nutrient-robbing medications with natural supplements.
America has been called a pill-popping society, and the statistics bear this out. Nearly 50 percent of all American adults regularly take at least one prescription drug, and 20 percent take three or more. [1] Our increasing reliance on prescription medications has contributed to the growing problem with nutrient depletion. The truth is that every medication, including over-the-counter drugs, depletes your body of specific, vital nutrients. This is especially concerning when you consider that most Americans are already suffering from nutrient depletion. Additionally, many of the conditions physicians see in their everyday practice may actually be related to nutrient depletion. The good news is that, armed with information and the right supplements, you can avoid the side effects of nutrient depletion, and even better, you may be able to control and prevent chronic diseases, such as diabetes, cardiovascular disease and osteoporosis.
There is more info like this at our:
Nutrient Depletion Page
A Common Scenario
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Initial Case Management Following Trauma
The Chiro.Org Blog
Clinical Monograph 2
By R. C. Schafer, DC, PhD, FICC
Without a doubt, no other health-care approach equals the efficacy of chiropractic in the general field of conservative neuromusculoskeletal rehabilitation.
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.
INTRODUCTION
The word trauma means more than the injuries so common with falls, accidents, and contact sports. Taber [1] 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.
Taber [1] states rehabilitation is “The process of treatment and education that lead the disabled individual to attainment of maximum function, a sense of well being, and a personally satisfying level of independence. The person requiring rehabilitation may be disabled from a birth defect or from an illness. The combined effects of the individual, family, friends, medical, nursing, allied health personnel, and community resources make rehabilitation possible.” It is surprising that Taber excludes trauma as a prerequisite for rehabilitation for it is the most common factor involved.
You may also enjoy our page on:
Chiropractic Rehabilitation
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A Basic Rehabilitative Template
The Chiro.Org Blog
Clinical Monograph 1
By R. C. Schafer, DC, PhD, FICC
INTRODUCTION
Injuries can be classified into 13 types: abrasions, contusions, strains, ruptures, sprains, subluxations, dislocations, fractures, incisions, lacerations, penetrations, perforations, and punctures. This paper will not detail the management of burns or injuries requiring referral for operative correction, suturing, or restricted chemotherapy.
Objectives
Except for the most minor injuries, traumatized neuromusculoskeletal tissues are benefited by alert restorative procedures. The more serious the injury, the more prolonged is and the greater the need for professionally guided rehabilitation. The first step in rehabilitation is to explain to the patient that rehabilitation is just as important as the initial care of the injury. The goal is not only to restore the injured part to normal activity or as near normal as possible in the shortest possible time but also to prevent posttraumatic deterioration. It is an individualized process that requires patient dedication. The author recognizes that it is easier to write about comprehensive planning than to motivate some patients to follow prescriptions after pain has subsided.
You may also enjoy our page on:
Chiropractic Rehabilitation
Most authorities would agree with Harrelson when he lists the goals of rehabilitation as:
- decreased pain;
- decreased inflammatory response to trauma;
- return of full pain-free active joint ROM;
- decreased effusion;
- return of muscle strength, power, and endurance; and
- regain of full asymptomatic functional activities at the preinjury level (or better).
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By Frank M. Painter, D.C. in Chiropractic Care on March 15th, 2012 at 11:13 am
Clinical Decision-making to Facilitate Appropriate Patient Management in Chiropractic Practice: ‘The 3-questions Model’
The Chiro.Org Blog
Chiropractic & Manual Therapies 2012 (Mar 14); 20: 6
Lyndon G Amorin-Woods and Gregory F Parkin-Smith
Murdoch University, School of Chiropractic and Sports Science, South Street, Murdoch, 6150 Perth, Western Australia. L.Woods@murdoch.edu.au.
Background: A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis.
Discussion: This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called ’3-Questions Model’;
Summary: Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.
From the FULL TEXT Article:
Development of the 3-questions Model
The chiropractic profession, particularly in Western countries, finds itself in a rapidly evolving healthcare landscape, with ‘modernisation’ being a consequence of escalating costs, an aging population, and an ever-diminishing relative resource base [9]. With a view to rationalising resources health system decision-makers are increasingly vigilant about the delivery of safe, evidence-based, cost-effective care, summarised as “the right care at the right time in the right place” [10, 11]. With this imperative in mind, the authors propose three straightforward questions that frame clinical decision-making within the context of diagnostic uncertainty.
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Introduction to Sports-related Health Care