Clinical Biomechanics: Scoliosis

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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.

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 13: Scoliosis

In traditional medicine, scoliosis is commonly ignored until gross cosmetic effects or signs of structural destruction are witnessed. In chiropractic, however, even minor degrees of distortion should be considered at the time of spinal analysis because of their subtle biomechanical and neurologic consequences, and to halt potential progression at an early stage. To give a better appreciation of these points, this chapter describes the general structural, examination, and biomechanical concerns that should be considered, along with the highlights of conservative therapy.

The Spinal Curves   [1-9]

A curved column has increased resistance to compression forces. This is just as true in the spine, as for a rib or long bone. Most authorities consider the spine to have four major curves: anteriorly convex curves at the cervical and lumbar areas and, anteriorly concave curves at the thoracic and sacral levels. Cailliet considers the coccyx a curve, but this curve is usually considered an extension of the sacral curve. A few authorities consider the atlanto-occipital junction as a separate anteriorly convex curve. Regardless, the spinal curves offer the vertebral column increased inflexibility and shock-absorbing capability while still maintaining an adequate degree of stiffness and stability between vertebral segments (Fig. 13.1).

      Structural vs Functional Curves

The adult thoracic and sacral anteriorly concave curves are firm structural arcs as the result of their vertebral bodies being shorter anteriorly than posteriorly. The normal kyphosis of the adult thoracic and sacral curves is quite similar to that of the fetal spine. This is not true for the anteriorly convex cervical and lumbar regions where the curves are essentially the result of their soft tissue wedge-shaped IVDs. It is for this reason that the cervical and lumbar curves readily flatten in the supine position, while the thoracic kyphosis reduces only a slight amount.

There is a clinical correlation of disc wedging to disc disease. Most disc lesions are found in the cervical and lumbar regions where the greatest degree of physiologic wedging occurs. This appears to be true in both hyperlordosis and an exceptionally flat cervical or lumbar curve.

      Effect of Bipedism

An adult discless spine would resemble that of the newborn. Since animals that walk on four legs and infants prior to assuming the erect position do not have the physiologic curves of the erect adult, it can be assumed that these curves are the result of bipedism. In the erect position, the lower lumbar area is especially subjected to considerable shearing stress. [10, 11]

      Overall Balance

Although the spine is often considered as the central pillar of the body, this is only true when the spine is viewed from the anterior or posterior aspect. When viewed laterally, the spine lies distinctly posterior to the thoracic body mass essentially because of the space-occupying heart (Fig. 13.2), It lies much more centrally in the cervical and lumbar regions. An abundance of body mass also lies anterior to the midline in the head, which must be held by erector and check ligament strength if a thoracic “hump” or a flattened cervical curve are to be avoided.

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Source The Australian

Macquarie University has announced plans to offload its chiropractic teaching by 2015.

It said it would begin discussions with other “interested” higher education providers about taking over its chiropractic units and degrees, including academic staff and teaching facilities. Executive science dean Clive Baldock said his faculty wanted to concentrate on developing “recent major strategic investments” in research-intensive disciplines including biomedical science and engineering.

“Macquarie University has recently invested significantly in a postgraduate medical school and a state-of-the-art private hospital,” he said. “We naturally want to focus our efforts on supporting these initiatives with our teaching and research.” Professor Baldock issued a sales pitch to possible tenderers while acknowledging that the discipline didn’t meet Macquarie’s requirements “from a research-intensive perspective”.

“We believe our chiropractic degrees to be of the highest teaching quality, and they remain extremely popular with students,” he said.“We therefore believe the responsible thing to do is to begin discussions with other higher education providers who are keen to grow in this area.”

Sports Management:
Leg, Ankle, and Foot Injuries

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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.

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.

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.

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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Clinical Disorders and the Sensory System

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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.

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.

Although all pain does not have organic causes, there is no such thing as “imagined” pain. Pain that can be purely isolated as a structural, functional, or an emotional effect is rare. More likely, all three are superimposed upon and interlaced with each other in various degrees of status. This is also true for neural, vascular, lymphatic, and hormonal mechanisms.

Common Causes of Pain and Paresthesia

The Horizontal Neurologic Levels

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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.

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.

The Longitudinal Neurologic Systems

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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.

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.

Updated Reference Guide to Dr. Richard C. Schafer’s Articles

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There are now 63 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.

For CAs: The Language of the Health-Care Professions

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.

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.

The Subluxation – Historical Perspectives

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Chiropractic Journal of Australia 2009 (Dec); 39 (4): 151–164

Meridel I. Gatterman, MA, DC, MEd

Chiropractic Consultant, Florissant, Colorado

Thanks to Dr. Rolf Peters, editor of the Chiropractic Journal of Australia for permission to republish this Full Text article, exclusively at Chiro.Org!

Subluxation is a term that continues to generate controversy into the 21st Century. This paper describes the controversy surrounding terminology arrived at through consensus in the latter part of the 20th century in addition to ongoing issues surrounding the use of the term subluxation.

Introduction

A word is not a crystal, transparent and unchanged; it is the skin of a living thought and may vary greatly in color and content according to the circumstances and time in which it is used.

– Oliver Wendell Holmes, Jr.

Historically subluxation has been central to the philosophy, science, and practice of chiropractic as the primary articular lesion treated by chiropractors. A number of issues have surrounded the use of the term subluxation including: terminology, the nature of the lesion (aberrant motion versus misalignment), and clinical, economic and political issues. The complexity of these issues precludes discrete discussion, classifying them as such, however, gives focus to much of the controversy.

Aberrant Motion versus Misalignment

The controversial nature of the chiropractic subluxation began as early as 1906 with the Palmers emphasizing vertebral displacement (misalignment) [1] at the same time that Smith Langworthy and Paxson emphasized aberrant motion as the primary characteristic of subluxation [2] They stated that:

“A simple subluxed vertebra differs from a normal vertebra only in its field of motion and the center of its field of motion.” [2]

The aberrant motion concept subsequently became more popular in Europe, However in North America, Budden [3] was using the term “fixation” when referring to a subluxation at Western States Chiropractic College by 1930.

His definition described the vertebral fixation as:

“The fixation of a joint in a position of motion, usually at the extreme of motion.” [3]

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Initial Case Management Following Trauma

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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.

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Chiropractic Techniques

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Just below the following Table, you will find a brief explanation of each of these manipulative/adjustive procedure.

Every chiropractic college teaches one or more of the following techniques. Most of the rest of them may be offered as Elective Classes, which can be taken by students during their normal 15-week trimester, under the direct supervision of Technique Instructors.

Chiropractic graduates undergo a National Board examination that requires the student to demonstrate competency in the top five manipulative/ adjustive techniques, plus the techniques taught at his/her chiropractic college.

Most Frequently Used Techniques:

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