Chiropractic Theory Final

Somato-somatic

Local spinal effects of subluxation process-muscle hypertonicity/imbalance and fixation

Somato-visceral

Subluxation effects on visceral function

Viscero-somatic

visceral cause or perpetuation of subluxation

Somato-somatic reflex hypothesis

somatic dysafferentation causes somatic efferent reflex effects

Somato-somatic Reflex Model

- Korr and early researchers felt that richly innervated somatic tissues in and around the spine was the source of afferent "bombardment" of neurologic signals, leading to a state of hyperstimulation, or facilitation

- This state was considered to be self-perpetuating, leading to reflexive errors in postural muscle tone and other somatic

structures involved in posture and locomotion

Inflammatory model of facilitation

Damaged skeletal tissues associated with SDF (segmental dysfunction) release vasoneuractive substances such as bradykinin, prostaglandin E2, substance P, histamines, etc., which facilitate neural pathways, including nociceptors. This may give rise to the initial stages of segmental facilitation of the spinal cord

Somato-visceral reflex model

- Somatic dysafferentation can reflexively influence output from the lateral horn regions of the spinal cord (sympathetic preganglionic efferents); facilitation can occur ("neuroplastic" changes

- Increased sympathetic stimulation of target tissues and organs can result; this can be termed sympatheticotonia/sympathicotonia

- Visceral dysfunction can directly follow, or happen due to vasomotor effects

Viscero-somatic reflex hypothesis

Visceral afferents lead to somatic efferents

Viscero-somatic reflex model

- Visceral dysafferentation due to viscus (organ) injury/pathology can cause or predispose the spine to develop subluxation or somatic precursors

- Facilitation of the anterior horn of the cord allows visceral input to cause reflexive muscle hypertonicity and other somatic effects

- Suggests that VSC can be caused by chemical stressors and other insults to body organ

Neuroimmune/Neurodystrophic Hypothesis

- Neural dysfunction as a result of VSC is stressful to the body and lowers tissue resistance, modifying specific and nonspecific immune responses

- Specific effects of VSC are not well researched but may include alteration of the "trophic" function of nerves

- Most-accepted current concept is the modification of sympathetic nerve activity locally and globally (i.e..sympatheticotonia)

Axoplasmic Aberration Hypothesis

Neurotrophic support of body tissues can be adversely affected by VSC due to the disruption of normal axoplasmic transport mechanisms (AXT)

Vertebrobasilar Arterial Insufficiency Hypothesis

The hypothesis is that cervical VS, especially in the presence of spondylosis, can cause compression or deflection of the vertebral arteries, resulting in cerebral ischemia and neurological dysfunction with symptoms referable to the cranial structures

Intraneural Microcirculation Ischemia

An effect of mechanical compression (or torsion, traction) may be the narrowing of small blood vessels supplying the nerves themselves, causing neuroischemia, and altering nerve physiology

- Neuroischemiais associated with neurapraxia, and manifested clinically as paresthesia

Venous and Lymphatic Stasis due to compression/Traction

- Small-scale mechanical stresses (compression, traction, torsion) may be sufficient to cause localized venous congestion and/or lymphatic stasis with resulting edema or accumulation of metabolites and byproducts of inflammation

- This can cause a chain of events culminating in segmental neuropathology

Altered Cerebrospinal Fluid flow

- Improper circulation of CSF due to spinal dysfunction (particularly cranio-pelvic) can cause CNS dysfunction

- A central hypothesis of SOT as developed by DeJarnette

- Motion dysfunction and biomechanical faults inhibit normal "pumping" mechanisms of CS

Somatopsychic hypothesis

How the somatic can influence the psyche (emotions and other central states)

- Explaining clinical outcomes that: 1) involve issues usually associated with "higher" functions-alertness, personality, emotional affect, etc... 2) things we assign control over to higher centers: vision, hearing

- Merely experiencing chronic somatic pain due to nociceptive barrage from the somatic components of VSC can lead to depression

psychogenic hypothesis

Emotional state can be a factor in the cause of VSC; how the spine is affected by the "mind" ("thoughts")

Causes of subluxations

- Mechanical stressors (trauma)

- Chemical stressors (toxins)

- Emotional stressors (thoughts)

Macrotrauma

A specific, sudden episode of overload injury to a given tissue

- falls, accidents, head blows, heavy lifting, surgery, childbirth, amusement park rides, sudden unexpected movements, jarring spots

Microtrauma

Causing small unseen openings in the skin that allow for the entry of pathogens

- pillow/mattress, worn or ill-fitting shoes, poor posture, phones, sleeping position, prolonged driving, obesity

Macrotoxins

- Ingestion/inhalation of poisonous substances

- Smoking, tobacco use

- Alcohol abuse

Microtoxins

- Poor diet (pro-inflammatory)

- Improper removal of metabolic byproducts/inflammatory neurochemicals

- Low level envrionmental exposure to toxins

Macro-emotional stress

Amount of emotional stress

- Life-changing events (job loss, family death, divorce, financial stresses)

Micro-emotional stress

- Chronic anxiety

- Relationship problems

- Suppressed hostility/anger

- Post traumatic stress

Loeser Pain Hierarchy

Nociception (injury, with tissue damage) --> pain --> suffering --> pain behavior

Pain behaviors

Can include depression and inactivity

- postures disadvantageous to the spine

- mechanoreceptor deafferentation due to hypomobility of the spine

- an acceleration of facet joint and disc aging/degeneration

Health

The state of optimal physical, mental, and social well-being, and not merely the absence of disease and infirmity

Physical ease

balance, alignment, poise, and freedom of movement

Mental ease

Confidence, harmony, creativity, peace of mind

Social ease

Comfort around others, fearlessness, and generosity

Subluxation prevention

- Exercise

- Avoid patterns of behavior, or repetitive motions, including asymmetry in postures and loading

- Live more the way we're designed (more Naturally, be active)

Subluxation

the natural outcome of unnatural living

Innate Inteligence

-mind and body connection at cellular level; self awareness and self healing

-spiritual

-above-->down-->inside-->out

Educated intelligence

what your mind and body learn to do over time

Hadley

intervertebral subluxations could cause foraminal encroachment in the thoracic spine, but determined nerve root compression unlikely, due to smaller diameter of nerve roots

Spinal cord compression/traction

- Cervical subluxations can cause sufficient neural canal stenosis to mechanically compress the spinal cord, with subsequent injury and neural dysfunction; particularly when spondylosis/degeneration is present; and in those with congenitally small canals

- Dorsal columns particularly sensitive (kinesthesia, fine touch, fine pressure, vibration)

Meylopathy

disease of the spinal cord

Symptoms

- headache

- numbness and paresthesia

- quadriplegia

- transient paraplegia

Neurothlipsis

pressure on a nerve, direct or indirect

Nerve and nerve root compression, traction, and torsion

- IVF distortion due to VSC can cause mechanical compression of spinal nerves ("neural complex") with resulting neurological injury and dysfunction

- Other mechanical changes can cause traction and torsion injuries to the neural complex

Nerve compression factors

- Subluxations can cause spinal nerve root compression and injury

- Cervical and lumbar regions are most susceptible to nerve compression with subluxation

- Nerve roots are most sensitive to compression

- Nerve roots lack the connective tissue and sheath of peripheral nerves

Transforaminal Ligaments

- "accessory ligaments"; found to be normal occurrences throughout the spine; locations variable in the IVF

- Especially common in lumbar spine-several at each level; L5-S1 very prevalent

- They compartmentalize the IVF into a lattice that vessels and nerves must thread through

- May decrease the functional S to I diameter of the IVF by one-third

Ectopic Impulse Hypothesis

- Deformation sites (as in the case of neurologic compression in the IVF) can be sites where ectopic nerve impulses are generated

- These are spontaneous depolarizations that give rise to both orthodromic (proper direction) and antidromic (wrong direction) impulses

- These have different effects if the involved nerves are sensory or motor

Dorsal Root Ganglion compression

- Mechanical stresses due to VSC can cause injury to the highly sensitive DRG

- DRG are far more sensitive to mechanical stimulation than peripheral nerves (5X more sensitive to compressive forces)

- When inflamed, DRG become hyperexcitable, and can give rise to spontaneous discharges

- A significant irritating factor can be injury/inflammation/swelling in Z-joints

Spinal cord compression/tractions

- Cervical subluxations can cause sufficient neural canal stenosis to mechanically compress the spinal cord, with subsequent injury and neural dysfunction; particularly when spondylosis/degeneration is present; and in those with congenitally small canals

- Dorsal columns particularly sensitive (kinesthesia, fine touch, fine pressure, vibration)