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 By Frank M. Painter, D.C. in Education on November 21st, 2011 at 6:23 pm
The Science and Art of the Chiropractic Adjustment
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:
“Clinical Chiropractic: Upper Body Complaints”
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: The Science and Art of the Chiropractic Adjustment
THE SCIENCE OF ARTICULAR MOBILIZATION
Although adjunctive procedures have been recommended in this text, it should always be remembered that the articular adjustment is the core of chiropractic therapy. Ancillary procedures can condition tissues to receive and respond to articular therapy and enhance physiologic mechanisms, but, with rare exceptions, they should not be considered substitutes.
The sincere student of this manual will readily recognize that this author acknowledges the value of reflexology and numerous physiotherapeutic applications along with nutritional supplementation, counseling, “bloodless surgery,” and stardardized rehabilitative procedures. Yet, as explained previously, they all stand in the shadow of the basis for and the proper administration of the chiropractic adjustment. This chapter focuses on the need for the development of our unique art.
Background
The author has witnessed several practitioners who have turned an adjunctive tool into a primary therapy exclusively. We see this at times with acupuncture, physiotherapy, therapeutic nutrition, psychotherapy, and those who have made the upper cervical spine or sacroiliac joints their master rather than a servant of the patient. Such a limited viewpoint of the scope of chiropractic health care, unfortunately, does a disservice to the practitioner, his or her patients, and the public. The fault for this misdirection must be placed on improper training. No logical person would forsake a primary therapy for an ancillary therapy if he or she had confidence and skill in its application.
Continue reading …
By Frank M. Painter, D.C. in Diagnosis on November 20th, 2011 at 2:44 pm
Clinical Geriatrics: A Diagnostic Compendium
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 8 from RC’s best-selling book:
“Basic Chiropractic Procedural Manual”
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 8: Clinical Geriatrics: A Diagnostic Compendium
The objective of this chapter is to focus attention on disorders witnessed in practice by those dealing with the geriatric patient. Following neurologic disorders, heart, vascular, and blood disorders are discussed. Digestive and gastroenterologic disturbances are then followed by disorders of the urinary system, skin, endocrines, and reproductive system. Next, eye, ear, and throat conditions are followed by orthopedic and respiratory considerations. The chapter concludes with information about the sexual aspects of aging, common complaints and symptoms, and other pertinent considerations.
The topics described in this chapter are not to be considered a complete reference for all geriatric conditions seen in practice. They have been chosen as those most likely to be encountered or because they present a unique situation necessary for differentiation and/or case management.
While some described disease states may not be commonly considered within the scope of chiropractic general practice, their diagnosis is. Thus, this general knowledge will help clarify when referral should be considered, thus serving the best interests of the patient and possibly avoiding a potential accusation of professional negligence.
It is the editor’s opinion that most errors in diagnosis or judgment do not occur from a lack of clinical knowledge. They occur as the result of a hurried history and examination. A clinician must be self-disciplined to give full attention to the patient at hand, without distracting concern for those patients waiting in the reception room.
CLINICAL APPROACH
In past years, it was a frequent fault of young practitioners of all disciplines to contribute age an important etiologic factor. It is emphasized that age alone is an inadequate factor in the cause of severe illness in the elderly. Careful examination, treatment of the whole individual, and prolonged follow-up is necessary for optimal results.
Most pathologists readily admit that disease is a process, not a state, but rarely is the process defined other than to say that disease of any tissue or organ is the result of disturbed function — normal physiology gone wrong.
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By Frank M. Painter, D.C. in Diagnosis on November 18th, 2011 at 1:53 pm
Endocrine Imbalance
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 13 from RC’s best-selling book:
“Clinical Chiropractic: Upper Body Complaints”
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: Endocrine Imbalance
CLINICAL BRIEFING
The nervous and endocrine systems work hand in hand. The nervous system is design to operate body functions when rapid response is necessary. For long-term duty, the endocrines take over and simulate neural activity. These two systems can be compared to an athlete who sprints in a 100-yard dash and another who runs a marathon. They have two different roles but are not entirely independent in either role. They are integrated, synergistic, and facilitating.
Sympathetic stimulation increases the secretion of the adrenals, pancreas (including islets), pineal gland, and thyroid and parathyroids. The parasympathetics generally have a reverse or unknown effect. See Table 16.18.
The highly integrated system of ductless glands in the body produces internal secretions (hormones) that discharge into circulating blood or lymph to affect remote tissues. Some of these glands also produce external secretions. The adrenals, isles of Langerhans of the pancreas, thyroid, parathyroid, pituitary (hypophysis) ovaries, and testes are true endocrine glands. The thymus and pineal body have not been shown to produce hormones.
CNS Endocrine Function
Research of recent years has shown that the brain and spinal cord also secrete many specific and nonspecific hormone-like substances into blood or lymph. Brain endorphins and enkephalins and spinal cord dynorphins and enkephalins are typical examples. Many other similar substances are likely to be discovered as investigation continues. The subtle functions of the nervous system are pioneer fields of study.
Normal Effects
The endocrine system acts similar to a chemical nervous system. Like the nervous system, self-contained positive and negative feedback mechanisms (essentially hypothalamic, pituitary, or peripheral) are crucial to proper operation and integration of body functions.
Among the physiologic processes influenced by hormones are resistance to disease; rate of systemic metabolism; rate of metabolism of specific substances; rate of growth, development, and repair processes; rate of development and function of the reproductive organs, primary and secondary sexual characteristics, and degree of libido; and the secretory activity of other endocrine glands. Hormonal processes also play an important role in the development and function of the CNS, personality formation, and how the body reacts to stress. Thus, hormones may have a specific effect on a specific organ or tissue or produce a wide systemic effect on the entire body.
General Causes of Endocrine Imbalance
Endocrine dysfunction may result from inadequate secretion or hypersecretion. Activity is under the control of the nervous system, certain circulating chemical influences, and other hormones. There is barely any pathologic process having a neurologic component that does not involve to some degree parts of the endocrine system. Because of the important role the endocrines have in maintaining homeostasis, the effects of disease, neoplasm, stress, and maladaptation can be widespread. The extent that the imbalance will have on body function depends on the severity and duration of the disturbance.
Review the complete Chapter (including sketches and Tables)
at the ACAPress website |
By Frank M. Painter, D.C. in Diagnosis on November 17th, 2011 at 6:27 pm
Clinical Chiropractic: The Wrist and Hand
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 9 from RC’s best-selling book:
“Clinical Chiropractic: Upper Body Complaints”
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 9: The Wrist and Hand
CLINICAL BRIEFING
Structural Considerations
Clinically, the most important articulation in the elbow is formed by the proximal ulna and the distal radius forms the most important articulation in the wrist. The carpals articulate with the ulna only during extreme wrist adduction.
The distal row of carpals forms a complex joint with the proximal row. Because they are loosely connected, the navicular and trapezium spread during wrist abduction and approximate during adduction. The proximal carpals rock and glide toward the ulna during wrist abduction and toward the radius during adduction. Adduction is slightly greater in pronation because the styloid process of the ulna restricts motion when the hand is supinated. During adduction, the styloid swings backward out of the way. As the A-P curve of the proximal carpals is more acute than the transverse curve, greater excursion is allowed in wrist flexion and extension than in lateral motion. The more delicate the patient’s bone structure, the greater the mobility.
The intricate anatomical architecture of the wrist allows flexion (80°), extension (70°), radial deviation (30°), ulnar deviation (20°), supination and pronation of the forearm.
Basic Wrist and Finger Biomechanics
The muscles of the wrist course obliquely to the parts to be moved. This requires coordination with other muscles whenever the wrist is moved. Wrist strength in flexion is nearly double that in extension, and the power of extension is greatly lessened when the wrist is fully flexed. During extreme flexion of the wrist, it is impossible to strongly curl the fingers in full flexion because the flexor tendons are slack. When the wrist is hyperextended, the extensors relax and the fingers cannot hyperextend fully. These are two important considerations during examination.
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By Frank M. Painter, D.C. in Diagnosis on November 15th, 2011 at 5:29 pm
Clinical Chiropractic: The Shoulder and Arm
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 7 from RC’s best-selling book:
“Clinical Chiropractic: Upper Body Complaints”
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 7: THE SHOULDER AND ARM
CLINICAL BRIEFING
Shoulder Pain
Shoulder pain can be deceiving. As in so many musculoskeletal disorders, consideration of pain in the shoulder should not give priority to sudden trauma whether it be of intrinsic or extrinsic origin. Thorough investigation of the history may reveal that trauma did not initiate the first attack or that an injury was just a precipitating event that revealed an underlying degenerative disorder. Besides trauma, shoulder pain may have an inflammatory, a neurologic, a psychologic, a vascular, a metabolic, a neoplastic, a degenerative, a congenital, an autoimmune, or a toxic origin. See Table 7.1.
The Complexities in Treating Shoulder Complaints
Many practitioners would be happy if another patient with a shoulder complaint did not enter their offices. There are five major reasons for this:
- The shallow shoulder joint is highly unstable. Its stability is provided by muscles rather than the strong ligament straps provided in most other joints. This makes recurring disorders common. The answer is therapeutic exercise, but many patients soon get bored with such regimens and the prescribed exercises are stopped long before adequate strength is acquired. Thus thorough counseling and monitoring are required.
- The shoulder area is unique in its wide extremes in range of motion. There is abduction, adduction, downward rotation, upward rotation, and depression in the shoulder girdle. The shoulder (glenohumeral joint) expresses abduction, adduction, elevation, extension, external rotation, flexion, horizontal abduction, horizontal adduction, and internal rotation. Thus, a thorough knowledge of shoulder kinematics, neurology, angiology, myology, and kinesiology is required for proper treatment to be applied.
- Cases presenting with what initially appears to be the result of minor trauma are often misdiagnosed. The shoulder and arm are common sites of referred pain from the cervical spine, lungs, heart, mediastinum, diaphragm, liver, and gallbladder. Sometimes a lesion in the wrist or elbow will refer pain to the shoulder. As tenderness also can be referred, a thorough diagnostic workup is required in almost all cases of shoulder pain, tenderness, paresthesia, and weakness. This must incorporate a thorough knowledge of
referred pain patterns and reflexology.
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By Frank M. Painter, D.C. in Diagnosis on November 14th, 2011 at 6:39 pm
Clinical Chiropractic: The Elbow and Forearm
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 8 from RC’s best-selling book:
“Clinical Chiropractic: Upper Body Complaints”
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 8: The Elbow and Forearm
CLINICAL BRIEFING
Functional Considerations
The arm and forearm are joined by a joint that serves as both a hinge and a pivot. The semilunar notch of the ulna is hinged with the hyperboloid trochlea of the humerus. The proximal head of the radius pivots with the spherical capitulum of the humerus and glides against both the proximal and distal ends of the ulna.
The distal end of the humerus can be viewed as two columns: a larger one medially that articulates with the semilunar notch of the ulna, and a smaller one laterally that articulates with the head of the radius. The pulley-like trochlea apparatus has:
(1) a depression at the front that lodges the coronoid process of the ulna and
(2) a depression at the rear that holds the olecranon process of the ulna when the elbow is extended.
The olecranon process restricts hyperextension of the elbow and protects the ulnohumeral articulation posteriorly. The concave head of the radius glides against the spherical capitulum of the humerus. The capitulum and trochlea are separated by a bony crest that fits into the opening between the proximal ulna and the radius and serves as a fixed rudder to guide elbow motion. The elbow flexors originate from the medial epicondyle, and the extensors originate from the lateral epicondyle. This structural arrangement should be visualized during examination to discriminate normal from abnormal articular motion.
The basic range of elbow joint motion involves elbow flexion (135°) and extension (0°), and forearm supination (90°) and pronation (90°). If a motion block is found in active motion, passive motion should be checked and the type of restriction and its degree noted.
Clinical Analysis
The elbow joint was not made to be used as an organic battering ram, but it often is: purposefully in sports; by accident in falls. For this reason, the vast majority of elbow disorders has trauma as their origin or precipitating factor.
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By Frank M. Painter, D.C. in Diagnosis on November 13th, 2011 at 9:31 pm
General Factors Involved in Vitamin and Mineral Deficiencies
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 the Appendix from RC’s best-selling book:
“Symptomatology and Differential Diagnosis”
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.
General Factors Involved in Vitamin and Mineral Deficiencies
Several general factors are involved in vitamin and mineral deficiencies. For example, abnormal loss and utilization or subnormal absorption, intake, storage, or transport, singularly or in combination, may readily lead to symptoms of nutritional deficiency.
See Table A.1.
You may also find value reviewing the:
Nutrient–Drug Depletion Charts
Agents Contributing to Vitamin, Mineral, and Other Nutrient Deficiency Symptoms
Drugs and nutrients often have adverse interactions. Drugs usually interfere with normal cellular nutrition by:
(1) depressing the central appetite center,
(2) decreasing normal blood levels (eg, excessive excretion),
(3) interfering with the nutrient’s storage or metabolism,
(4) developing a chemical antagonism (eg, inactivate),
(5) increasing the action of ingested antivitamins or antiminerals, or
(6) destroying intestinal bacteria necessary to synthesize the nutrient.
See Tables A.2, A.3, and A.4.
Continue reading …
By Frank M. Painter, D.C. in Cervical Spine on November 12th, 2011 at 12:00 pm
The Posterior Neck and Cervical Spine
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 5 from RC’s best-selling book:
“Symptomatology and Differential Diagnosis”
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 5: The Posterior Neck and Cervical Spine
Introduction
With the important exception of neurologic and vertebral artery syndromes, most of the disorders witnessed in the posterior aspect of the neck are musculoskeletal conditions. Of particular significance are the symptom complexes of cervical arthritis, deformities, disorders of muscle tone, IVD syndromes, spondylosis, vertebral subluxation, tumors, and the effects of trauma. It is helpful to keep in mind that tumors of the cervical spine are usually secondary and that chronic degenerative disc disease and congenital anomalies may be asymptomatic for many years.
Functional Considerations
Nowhere in the spine is the relationship between the osseous structures and the surrounding neurologic and vascular beds as intimate or subject to disturbance as it is in the neck. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the brachial plexus and cervical spine.
The gross mechanical function of the neck is determined by analysis of joint motion and muscle strength.
EVALUATING JOINT MOTION OF THE NECK
Gross joint motion is roughly screened by inspection during active motions. When a record is helpful, it is usually measured by goniometry. The prime movers and accessories responsible for voluntary joint motion in the cervical region are shown in Table 5.1.
EVALUATING MUSCLE STRENGTH OF THE NECK
Muscle strength is recorded as from 5 to 0 or in a percentage and compared bilaterally whenever possible. The major muscles of the neck, their primary function, and their innervation are listed in Table 5.2.
Structural and Neurologic Considerations
The healthy posterior neck provides stability and support for the cranium, a flexible and protective spine for movement, balance adaptation, and housing for the spinal cord and vertebral artery. From a biomechanical viewpoint, primary cervical subluxation syndromes may reflect themselves in the total habitus; from a neurologic viewpoint, insults may manifest throughout the motor, sensory, and autonomic nervous systems. Unlike the lumbar region, cervical disc herniations are not frequently associated with severe trauma; however, traumatic nerve root or cord compression has a high incidence in this area.
A general classification of musculoskeletal disorders of the neck is shown in Tables 5.3, and the function of the nerves of the cervical plexus and the brachial plexus is shown in Tables 5.4 and 5.5.
Anomalies and Deformities
Gross anomalies are rarely seen in chiropractic practice unless well adapted to the individual’s life-style. Those cases that have biomechanical significance vary in severity from minor to severe and occur multiply or singly. The cause is purely genetic transmission in about 35% of cases, and the remainder is due to environmental factors or a mixture of genetic and environmental factors.
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By Frank M. Painter, D.C. in Education on September 14th, 2011 at 9:48 pm
Redefining the Rules: The CCE Changes Its Standards
From Quantitative to Qualitative
The Chiro.Org Blog
Todays Chiropractic
By Randy Southerland
Early next year, chiropractic colleges across the nation will adopt a new set of accreditation standards. Significantly, this will be the first wholesale rewriting of the standards in more than three decades.
Set by the Council on Chiropractic Education (CCE), these rules define what programs must do to gain or maintain CCE accreditation. In a marked departure from past years, the standards will now allow greater freedom in how D.C. programs admit and educate students, while requiring more accountability for producing competent professionals. “It’s a change in the way institutions go about delivering education,” says Dr. Brian McAulay, executive vice president and provost at Life University.
The new standards, which take effect in January 2012, are less prescriptive, with fewer demands that programs offer specific courses or use particular teaching methods such as requiring D.C. students to deliver 250 adjustments. Rather, the standards reflect an emerging focus on setting and measuring learning outcomes for students. It’s a trend that has become commonplace in higher education nationally, but is only now being adopted by the chiropractic profession, according to McAulay.
“Rather than focusing on credit hours and the amount of time a student spends in a seat, an outcomes approach asks ‘What has a student actually learned?’” he explains. “This approach is about holding institutions accountable for being very clear on what the student is expected to learn, and then being very good at measuring and assessing whether that learning has taken place.”
The U.S. Department of Education charges accrediting agencies such as the CCE with periodically reviewing standards to ensure they reflect best practices in the profession and in the broader field of education. A team comprising personnel from CCE-accredited programs began this process in the summer of 2006. Its mission was to look at every aspect of the agency’s accrediting standards, and then bring them more in line with current thinking and practices in higher education.
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By Frank M. Painter, D.C. in Education on July 15th, 2011 at 2:27 pm
Fundamentals of Initial Case Management Following Trauma
The Chiro.Org Blog
By Richard C. Schafer, DC, PhD, FICC
The following 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.
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. Taber1 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.
Taber1 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.
Other authors define rehabilitation strictly in terms of exercise and restorative therapeutic modalities and regimens. Some limit the term to preventing or reversing the noxious effects of the inactivity or lessened activity associated with the healing process. While it is true that these definitions hold significant components of clinical reconditioning and restoration, the scope of rehabilitation means much more to the chiropractic physician.
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By Frank M. Painter, D.C. in Diagnosis on June 14th, 2011 at 7:16 pm
Introduction to the Dynamic Chiropractic Paradigm
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.
The following is Chapter 1 from RC’s best-selling:
“Motion Palpation”
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 THE DYNAMIC CHIROPRACTIC PARADIGM
Overview of the Dynamic Chiropractic Approach
This chapter presents an overview of the background and basic concepts of Dynamic Chiropractic. The normal motions of spinal and related articulations, general considerations of spinal fixations, the different types of fixations, the significant physiologic mechanisms associated, a comparison of traditional and modern definitions of the vertebral subluxation complex, and other basic concepts are summarized.
In 1936, a small group of Belgium chiropractors began what was to be a long research project. Its aim was to study what chiropractors refer to as a subluxation, which is traditionally defined as an incomplete dislocation, a displacement in which the articular surfaces have not lost contact, or a partially reduced (spontaneously) dislocation.
Outstanding within the Belgium group were Drs. H. Gillet and M. Liekens. These investigators, who have been involved in this study for more than half a century, soon found that the clinical phenomenon of subluxation was a great deal more complicated than the effects of the oversimplified picture of “a bone out of place” that has been commonly proposed since the turn of the century. Their findings reported in the Belgium Research Notes are a testimony to their skillful observations. Although the theory of “a displaced vertebra” contained enough truth within it to constitute a basic therapeutic approach that could be justified by large numbers of positive benefits witnessed empirically, it was not sufficient to serve as a scientific hypothesis.
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By John in Education on May 6th, 2011 at 2:47 pm
Source Dynamic Chiropractic
by Kent Greenawalt
The future is a topic that is top of mind to everyone. When the future comes up in conversations, words that are generally associated with it are technology, improvement and growth.
But as we look into the future of chiropractic, one of those important words is missing: growth. Among chiropractic colleges, the enrollment trend has declined or flat lined over the past 10 years. The economy has been difficult, but we cannot place the blame there. A successful profession cannot last long when its college enrollment isn’t strong. As a chiropractic community, we need to make an impact to grow the profession and invest in our future – the students.
I strongly believe there is a need for action to be taken to assist in enrollment efforts. Obviously what is being done now needs to be tweaked or even fundamentally changed. To fill this need, I felt it was essential to create a nonprofit organization, the Chiropractic Education Foundation. The foundation was founded in order to develop chiropractic education and support the Association of Chiropractic Colleges (ACC) as it decides what actions need to be taken.
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Advising on Prevention in Chiropractic:
A Look at Public Health Promotion
The Chiro.Org Blog
SOURCE: Topics in Integrative Health Care 2011: 2 (1)
There are more articles like this at the:
Health Promotion & Wellness Page
Harrison Ndetan, M.Sc., MPH, DrPH, Michael Ramcharan, DC, Marion Willard Evans, Jr., DC, PhD, MCHES, CWP
The Abstract:
Chiropractic care is among the more commonly used Complementary and Alternative Medical (CAM) therapies. Spinal co-morbidities include many of the most common causes of premature death and disability. Health promotion and disease prevention have been used in the profession and taught in educational settings but not yet fully embraced in usual practice. This manuscript reviews areas in which health promotion has been emphasized in chiropractic education along with instances in which health behavior theories (HBTs) have been applied. Chiropractic clinical and educational programs should consider application of HBTs to move clinicians and interns forward regarding better advising roles with patients related to prevention and health promotion.
Introduction
The actual causes of death in the United States include many chronic diseases that are attributable to modifiable behavioral risk factors such as tobacco use, physical inactivity or sedentary lifestyle, alcohol consumption, poor nutrition or eating habits. [1] An increased emphasis on prevention, health promotion (HP), and education has been recommended for decades but has failed to reduce many of the threats related to premature morbidity and mortality. [2,3] Complementary and alternative medicine (CAM) use has also increased; in many cases aimed at chronic disease management. [4-7]
Chiropractic care is one of the most frequently used professional CAM health care systems in the U.S. [4,5,7] Musculoskeletal conditions such as low back and neck pain, which are among the most common reasons patients visit medical physicians in the U.S., [8] are also among the conditions most frequently treated with chiropractic care. [7-9] The relative efficacy and cost effectiveness of chiropractic and medical care have emerged as important issues in the broader debate on evidence-based healthcare. [10,11]
Chiropractors and health promotion
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By Brett Kinsler in Education on March 31st, 2011 at 11:20 am
It was called House Bill 127 (HB 127) and with it, the New Mexico State Senate considered legislation to permit limited prescription drug rights to a group of “Advanced Practice” Chiropractors. The bill passed the house but not the full senate. The chiropractic formulary was to include some anti-inflammatories, a common muscle relaxer, and several other topical and internal substances. Proponents said this law would permit chiropractors to help with the drastic shortage of PCP’s in NM and also help patients reduce their medication usage. Opponents said this law flew in the face of our chiropractic forefathers who fought hard to preserve our drugless profession.
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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:
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By Frank M. Painter, D.C. in Education on March 25th, 2011 at 10:19 am
Is the Spinal Subluxation a Risk Factor?
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Meridel I. Gatterman, MA, DC, MEd
Risk factors come in a variety of distinctions, from those for cardiovascular disease and some forms of cancer to those less than life-threatening but nonetheless undesirable conditions affecting the quality of a person’s life. A risk factor causes a person to be particularly vulnerable to an unwanted, unpleasant or unhealthful event. Risk factors predispose individuals to developing specific conditions. It has been suggested spinal subluxation could be considered such a risk factor. [1]
Subluxation As a Risk Factor
The following questions should be examined if the concept of subluxation as a risk factor is considered:
- Is subluxation of one region of the spine a risk factor for different signs and symptoms as opposed to a subluxation in another spinal area?
- If so, does a subluxation in one area create a different syndrome than when it occurs in a different region?
- Does clinical observation suggest there are different subluxation syndromes associated with different spinal areas? [2]
- Does a subluxation in the upper cervical region cause a different syndrome than a subluxation in the lower cervical region, and does a subluxation of the sacroiliac joint cause a different syndrome than one at a costovertebral joint? Does a patient’s symptomatic complaints and observable signs lead you to suspect a subluxation of one spinal region as opposed to another?
Subluxation Syndromes
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By Frank M. Painter, D.C. in Education on March 24th, 2011 at 9:06 am
The Vertebral Subluxation Syndrome
The Chiro.Org Blog
SOURCE: Dynamic Chiropractic
By Meridel I. Gatterman, MA, DC, MEd
The term subluxation has been used to describe the lesion treated by chiropractors since its inception. D.D. Palmer [1] described it in 1910 as “a partial or incomplete separation, one in which the articulating surfaces remain in partial contact.” Because of confusion by other professions, some within the chiropractic profession would have us abandon the term.
Others have promoted a teaching paradigm: the vertebral subluxation complex (VSC), which has grouped various components in a model focused around the dynamic component of the subluxation. Based on the works of Homewood, [2] Janse, [3] and Faye, [4] this model began being taught at CMCC in the mid-1970s and was later popularizing through the Motion Palpation Institute. [5] Other authors have revised Faye’s early model. The vertebral subluxation complex forms a paradigm for teaching the basic principles of chiropractic theory. By taking the VSC model one step further, the vertebral subluxation syndrome can be used to describe the primary clinical entity treated by chiropractors.
Syndrome has been traditionally used to describe the aggregate of signs and symptoms associated with any morbid process and constituting together the picture of disease. [10] The focus for chiropractors today should not remain the terminology used to describe the vertebral subluxation syndrome, but rather the specific mechanisms whereby this complex aggregate of signs and symptoms is produced by altered spinal joint motion.
Recently, the primary fibromyalgia syndrome has replaced the controversial term fibrositis used to describe a condition that has been written off as psychological at best, with the physiological manifestations either denied or ignored. [11] When the multiple complaints and varied systemic complaints of this condition were recognized as a syndrome, objective investigation was fostered to the benefit of the many patients suffering from the condition.
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By Frank M. Painter, D.C. in Education on March 20th, 2011 at 10:54 pm
Recognizing Subdural Hemorrhage in Older Adults
The Chiro.Org Blog
Topics in Integrative Health Care 2010; 1 (2)
By: Mark T. Pfefer, RN, MS, DC and Richard Strunk MS, DC
The Abstract:
A subdural hematoma, also known as a subdural hemorrhage (SDH) is caused by a post-traumatic accumulation of blood within the potential space between the dura mater and the arachnoid layer covering the brain. Chronic SDH is much more common in the elderly. Patients can have a good outcome with neurosurgical management if the conditions is promptly recognized. All health care providers, as well as nursing home staff, should be aware of this condition because older patients presenting with headache and/or other neurologic complaints need careful assessment to identify SDH.
Keywords: subdural hematoma; subdural hemorrhage; chronic subdural hemorrhage; headache
Definition and Etiology
A subdural hematoma, also known as a subdural hemorrhage (SDH) is caused by a post-traumatic accumulation of blood within the potential space between the dura mater and the arachnoid layer covering the brain. All health care providers, especially those who frequently treat patients with musculoskeletal complaints, as well as nursing home staff, should be aware of this condition because older patients presenting with headache and/or other neurologic complaints need careful assessment. SDH should be considered in the differential assessment of any older patient presenting for care following trauma as it has been associated with minor head injury or falls, even those not involving direct trauma to the head. [1] In fact, absence of direct trauma to the head is associated with up to half of all cases of SDH, and a case has been reported in an adult following a roller coaster ride. [2] Based upon this it should be assumed that motor vehicle collisions could generate forces sufficient to cause SDH in older patients.
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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.
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By Frank M. Painter, D.C. in Education on March 15th, 2011 at 4:26 pm
8 drugs doctors wouldn’t take
If your physician would skip these, maybe you should, too
The Chiro.Org Blog
Source:  ~ updated 6/22/2008
By Morgan Lord
With 3,480 pages of fine print, the Physicians’ Desk Reference (a.k.a. PDR) is not a quick read. That’s because it contains every iota of information on more than 4,000 prescription medications. Heck, the PDR is medication — a humongous sleeping pill.
Doctors count on this compendium to help them make smart prescribing decisions — in other words, to choose drugs that will solve their patients’ medical problems without creating new ones. Unfortunately, it seems some doctors rarely pull the PDR off the shelf. Or if they do crack it open, they don’t stay versed on emerging research that may suddenly make a once-trusted treatment one to avoid. Worst case: You swallow something that has no business being inside your body.
Of course, plenty of M.D.’s do know which prescription and over-the-counter drugs are duds, dangers, or both. So we asked them, “Which medications would you skip?” Their list is your second opinion. If you’re on any of these meds, talk to your doctor. Maybe he or she will finally open that big red book with all the dust on it.
Advair
It’s asthma medicine … that could make your asthma deadly. Advair contains the long-acting beta-agonist (LABA) salmeterol. A 2006 analysis of 19 trials, published in the Annals of Internal Medicine, found that regular use of LABAs can increase the severity of an asthma attack. Because salmeterol is more widely prescribed than other LABAs, the danger is greater — the researchers estimate that salmeterol may contribute to as many as 5,000 asthma-related deaths in the United States each year. In 2006, similarly disturbing findings from an earlier salmeterol study prompted the FDA to tag Advair with a “black box” warning — the agency’s highest caution level.
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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.
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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.
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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
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