A Sample Lecture to Healthcare Professionals Lisa K. Bloom, D.C. Diplomate of the International...

A Sample Lecture to A Sample Lecture to Healthcare Professionals Healthcare Professionals

Lisa K. Bloom, D.C.Diplomate of the International Board of Chiropractic Neurology

Diplomate in Applied Chiropractic Sciences

Associate Professor, Diagnosis and Practice Department of

New York Chiropractic College

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The Rationale for The Rationale for Chiropractic CareChiropractic Care

(Fill in your name here)

Chiropractic care centers Chiropractic care centers around the maintenance of around the maintenance of

appropriate movement of the appropriate movement of the spinal joints and optimizing spinal joints and optimizing

biomechanics throughout the biomechanics throughout the musculoskeletal system.musculoskeletal system.

Premise

WHY?WHY?

Let’s begin….

There is a distinct difference There is a distinct difference between a medical between a medical subluxationsubluxation

and a chiropractic and a chiropractic vertebral vertebral subluxation complexsubluxation complex::

A chiropractic subluxation is inherently a HYPOmobility suggesting decreased movement and no loss of stability

A medical subluxation is inherently a HYPERmobility resulting from a loss of integrity of the joint capsules and concomitant instability

The primary lesion addressed The primary lesion addressed in chiropractic is the in chiropractic is the vertebral vertebral subluxation complexsubluxation complex (VSC). (VSC).

This refers to discrete areas of hypomobilty within the spinal

column

Components of the Vertebral Components of the Vertebral Subluxation Complex (VSC)Subluxation Complex (VSC)

Dyskinesis (hypomobility) Altered biomechanics (cellular damage) Physiological and biochemical changes Altered nervous system activity Altered motor patterns...

Case management protocol Case management protocol includes…includes…

Specific spinal analysis Physical, neurological, orthopedic examinations

and consultation Specific restoration of normal biomechanics by

means of the adjustment Referral for co-management if appropriate Appropriate attention to ergonomical

considerations and other possible causes of biomechanical dysfunction

The purpose of the The purpose of the adjustment is…adjustment is…

to restore normal movement and resolve the resultant biomechanical,

physiological and neurological effects of segmental hypomobility.

What are these effects…?What are these effects…?

Biomechanical Effects of Biomechanical Effects of HypomobilityHypomobility

Altered intersegmental movement patterns Results in compensatory changes in motor

patterns, etc. Creates cellular damage in sites of

biomechanical stresses “Immobilization Degeneration…”

Loss of normal motion within a joint Loss of normal motion within a joint results in changes in every structural results in changes in every structural

component of the joint;component of the joint;subchondral bone to the synovium, from subchondral bone to the synovium, from

meninges to the ligamentum flavum.meninges to the ligamentum flavum.

Amiel D, et al. Acta Ortho Scand, 1982

Palmoski M, et al. Arth Rheum, 1979

Paine & Haung. J Neurosurgery, 1972

Lantz C. Chiro Res J, 1988

Enneking & Horowitz. J Bone Joint Surg, 1972

Evans EB, et al. J Bone Joint Surg, 1960

Current orthopedic literature Current orthopedic literature recognizes that recognizes that changes in the changes in the pattern of forces transmitted pattern of forces transmitted through joints, which occurs through joints, which occurs

during the immobilization process, during the immobilization process, is universally recognized as is universally recognized as

contributing to connective tissue contributing to connective tissue degeneration and local changes in degeneration and local changes in the chemical composition of that the chemical composition of that

tissue….tissue….

We also know that mechanical We also know that mechanical failure of ligaments, discs, failure of ligaments, discs,

capsules and other connective capsules and other connective tissue tissue can result from local can result from local

variations in chemical variations in chemical composition.composition.

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

Effects of hypomobility Effects of hypomobility on the intervertebral on the intervertebral

disc...disc...

The nucleus pulposus is the The nucleus pulposus is the the area of the disc most the area of the disc most

susceptible to dessication. susceptible to dessication.

The nucleus pulposus is dependent on movement for

nutrition and survival...

Lack of appropriate Lack of appropriate intersegmental spinal movement intersegmental spinal movement

can significantly reduce the can significantly reduce the dynamic pressure gradient dynamic pressure gradient

between the intradiscal tissues between the intradiscal tissues and the subchondral areas of and the subchondral areas of

spongiosa in the vertebral spongiosa in the vertebral bodies...bodies...

……this sacfrifices the key this sacfrifices the key mechanism by which nutrients mechanism by which nutrients and water replenish the disc and water replenish the disc

and by which metabolic waste and by which metabolic waste leaves the disc.leaves the disc.

Putting it together...Putting it together... Loss of normal movement leads to… Changes in how all tissues involved are

stressed and replenished, which causes… Chemical changes within those tissues and… Predisposes them to mechanical failure giving

us… A good reason to restore normal movement

through spinal adjustment.

NeurologicalNeurological EffectsEffectsof the Vertebral of the Vertebral

Subluxation ComplexSubluxation Complex

Spinal LearningSpinal Learning (Law of Facilitation)(Law of Facilitation)

Altered motor and sensory patterns are “learned” by the

nervous system and the musculoskeletal systems

Receptor Receptor Classifications…Classifications…

MechanoreceptorsMechanoreceptors Position sensitive Motion sensitive Vibration sensitive Pressure sensitive Provide continuous feedback about where

the body is in space...

The most significant input into The most significant input into the CNS with regard to the CNS with regard to balance, posture and balance, posture and

movement comes from the movement comes from the mechanoreceptors of the mechanoreceptors of the

cervical spine.cervical spine.

Guyton, Textbook of Medical Physiology.

NociceptorsNociceptors

Thermo-, mechano- and chemosensitive Spinal nociceptors are almost exclusively

chemosensitive Estimated that half of all dorsal afferents

are nociceptors (M. Zimmermann, 1979) Fire with harmful or potentially harmful

stimuli …

PainPain

Is not carried by nociceptors Occurs in the cerebral cortex 90% of all nociceptive activity never

reaches the cortex and the patient will remain symptom-free

Factors that influence the Factors that influence the perception of painperception of pain

Intensity of the stimulus Duration of the stimulus Descending inhibition

Nociceptor SitesNociceptor SitesGrieve G. Common Vertebral Joint Problems, Grieve G. Common Vertebral Joint Problems,

19881988

Skin Subcutaneous tissue Adipose Joint capsules All spinal ligaments Blood vessels Cancellous bone

Periosteum Muscles Tendons Fascia Aponeurosis Dura mater Epidural tissue

Nociceptor activity Nociceptor activity reflexively activates the reflexively activates the

sympathetic nervous sympathetic nervous system.system.

The dorsal horn is a central focal The dorsal horn is a central focal point for mediating autonomic point for mediating autonomic

and somatomotor reflexesand somatomotor reflexesinitiated by nociceptive initiated by nociceptive

stimulation.stimulation.

Price D. Psychological and Neural Mechanisms Price D. Psychological and Neural Mechanisms of Pain, 1988; Raven Press, NY.of Pain, 1988; Raven Press, NY.

The Effects of Nociceptive The Effects of Nociceptive ActivityActivity

Segmental responses of muscle spasm and sympathetic hyperactivity.

J. Bonica, 1990 & 1992H. Hooshmand, 1993

Noxious chemical stimulation of specific spinal structures produce measurable changes in sympathetic nerve activity...

Budgell B, et al. J NMS Syst, 1995

Nociceptive input normally Nociceptive input normally triggers sympathetic activity.triggers sympathetic activity.

Cabell J. Sympathetically maintained pain. In: Willis W, Cabell J. Sympathetically maintained pain. In: Willis W, ed. Hyperalgesia and Allodynia. Raven Press, NY; ed. Hyperalgesia and Allodynia. Raven Press, NY;

1992.1992.

Effects of Spinal NociceptorEffects of Spinal Nociceptor Stimulation of the Hypothalamus Stimulation of the Hypothalamus

and Reticular Formationand Reticular Formation

Nausea Pallor Dizziness Faintness Syncope

Changes in blood pressure

Changes in respiration Changes in heart rate No pain

In the presence of irritation to spinal In the presence of irritation to spinal structures manifestations were pallor, structures manifestations were pallor,

sweating,changes in heart rate, changes in sweating,changes in heart rate, changes in blood pressure, nausea and syncope.blood pressure, nausea and syncope.

These features were not proportional to the These features were not proportional to the severity of pain perceived; on the contrary, severity of pain perceived; on the contrary,

they seemed to dominate experience of they seemed to dominate experience of subjects who complained little of pain but subjects who complained little of pain but who were overwhelmed by the symptoms who were overwhelmed by the symptoms

listed above...listed above...

Feinstein B. J Bone Joint Surg, 1954Feinstein B. J Bone Joint Surg, 1954

There is good evidence to There is good evidence to support the importance of support the importance of input from spinal afferents input from spinal afferents

in reflex activity of the in reflex activity of the sympathetic nervous sympathetic nervous

system.system. D. Jordan, 1997 Schramm and Poree, 1991 Hayes, et al, 1991 Weaver and Stein, 1988 Stein, et al, 1989

Qu, et al, 1988 Meckler and Weaver,

1988 Taylor and Schramm,

1987 Stjernberg, et al, 1986

SO...SO...

It is possible for nociceptors to It is possible for nociceptors to fire secondary to the tissue fire secondary to the tissue

damage caused by abnormal damage caused by abnormal biomechanics...biomechanics...

This nociceptor activity can This nociceptor activity can cause reflexive stimulation of cause reflexive stimulation of

the sympathetic nervous the sympathetic nervous system...system...

This may occur and and become chronic without the presence of

pain or any other symptom.

How is chiropractic inherently How is chiropractic inherently different from other healthcare different from other healthcare

professions who chose to professions who chose to utilize manipulation?utilize manipulation?

Application of immobilization as it relates to the joint complex

Kinetic chain principle and basic neurology allows full spine vs symptom based management...

Thorough understanding of the neurological and physiological implications of faulty biomechanics

Purpose of the adjustment: to restore normal biomechanical, neurological and physiological activity

Extensive and focused study in the art of adjusting using multiple techniques to best adapt to the individual needs of the patient

TodayToday

The public has widely embraced many forms of wellness care and alternative therapies

Other healthcare professions have embarked on a paradigm shift to include alternative therapies, including spinal manipulation

Many conditions respond best with a multidisciplinary approach

HEALTHHEALTH

“A state of optimal physical, mental and social well-being, and not

merely the absence of disease and infirmity.”

Dorland’s Medical Dictionary, 28th ed., 1994

ENTERING THE NEW ENTERING THE NEW MILLENIUMMILLENIUM

“The Wellness Model”“The Wellness Model”

Potentiating treatment protocols Patient-centered paradigm Improving interdisciplinary communication Maximizing the benefits of healthcare from

all perspectives