Principles Pt. 2

Nerve compression theory (tone)

1.) subluxation results in altered nerve transmission of nerve energy, structural cause lead to altered transmission → body pathology

2.) nerve impingement includes: pressure, traction, torsion, stretch, angulation, etc

3.) still’s theory: body fluids cause somatic dysfunction

Axoplasmic aberrations theory (local)

1.) one nerve or plexus with decreased protein supply in microtubular network

2.) loss of trophic function caused by nerve compression, results in wallerian degeneration and LOCAL tissue death (hilton’s law)

Neurodystrophic (aka neuroimmunomodulation) (selye)

1.) stress → altered neuroendocrine → decreased immunity → multiple fixations T1-L1

decreased resistance, antibody, antigen, leukocyte

Korr

1.) Altered gamma gain (fixation, muscle, gait) in thoracic spine causes hypersympatheticotonia

2.) facilitation of muscle spindles based on the theory of strain and counterstrain

3.) gamma gain = steady state spindle, muscle contraction chemicals influence nerve stimulation

3.) muscle spindles are proprioceptive and maintain posture (muscle spindle helps develop muscle resistance)

Korr: during contraction

intrafusal and extrafusal fibers cancel each other out = steady state (gamma gain)

“backwards creep” can alter steady state

Korr says 2 main things can alter steady state

1.) abrupt approximation of two muscle attachments

2.) unanticipated giving way (during isometric contraction)

-both cause sudden muscle slack = spindle silence → CNS increases gamma discharge causing spasms → small trauma results in massive spasm “bracing and splinting of muscle”

-rapid stretch causes CNS to dampen gamma efferents, restoring normal gamma gain and muscle tone

Korr: if muscles do not respond appropriately, a

neuropathic pattern can result

adjustment effects = directly interrupts stimulus and resets muscle, indirectly the improved joint mechanics remove muscle dysfunction

Korr also focuses later work on:

1.) chronic (2nd order neuron from any source) segmental facilitation can alter proprioception, lead to altered sympathetic tone and perpetuate muscle and skeletal dysfunction

2.) his clinical proof is the vasomotor, sudomotor, and pilomotor changes that accompany many conditions. overburdened nerves have decreased AXT flow

note: burskirk → excessive spasm is due to nociception, not proprioception as proposed by Korr

Proprioceptive insult

1.) asymmetrical → injury misuse, overuse in a joint irritates the mechanoreceptors

2.) the irritated muscle spindle bombards the internuncial pool with message that result in spasm only currently discussed by murphy

Fixation theory (segmental facilitation or impulse theory) (Self perpetuating viscous cycle)

1.) lessened mobility: decreased motion, muscle spasm or skeletal damage causing inflammation

2.) aberrant reflexes: increase nerve transmission, excessive nociception

3.) segmental facilitation: internuncial spillover

4.) soft tissue aberrations: spasm, edema, muscle imbalance

this theory is based on adjustment providing muscle proprioception to reset pathology

Reflex theory aka somatic dysafferentation theory, somatic bombardment or dorsal horn, A. E homewood

input imbalance: increased pain, decreased mechanoreceptor input (imbalanced afferentation)

Reflex theory: somite

muscle

bone

nerve

Reflex theory: psychic

emotions

autosuggestions

Reflex theory: visceral (aka autonomic)

organ

blood

lymph

cause

afferent

result

efferent

Deafferentation is

NO sensory sensation

a scary movie leads to neuromuscular tension. which rationale makes the most sense

psychomotor response

adjusting T1 affects organ of corti to restore hearing. what best describes this

autonomic nervous system dysafferentation

Trendelenburg’s test causes the patient pain in their hip. What theory would explain this relatioship?

dysafferentation model

What theory explains chronic raynaud’s improved by biofeedback control of vasomotor tone

viscero-sympathetic response

Dysautonomia: Acute

increase, irritation, facilitation, excitation

Dysautonomia: Acute → posterior horn (sensory)

HYPEResthesia (irritated posterior horn)

Dysautonomia: acute → lateral horn (sympathetics / ANS)

irritate or excite sympathetic T1-L1/L2

vasodilation/vasconstriction

Bronchodilation and tachycardia

increased sympathetic = decreased parasympathetic (decrease GI motility)

Dysautonomia: Acute → anterior horn (motor)

Hypertrophy, spasm, spasticity (irritate or excite muscle)

Dysautonomia: chronic

Decrease

pressure, compression

inhibition

degeneration

Dysautonmia: Chronic → posterior horn (sensory)

Anesthesia and hypoesthesia

Inhibit posterior horn

Dysautonmia: chronic → Lateral horn (sympathetics)

inhibit sympathetics T1-L2/L2

gastric secretion

bronchoconstriction and bradycardia

decreased sympathetic = increased parasympathetic

Dysautonomia: Chronic → anterior horn (motor)

atonia, flaccid, weak, paresis

degeneration of posterior horn causes

decreases sensory symptoms

Bronchodilation is caused y an

acute subluxation affecting the lateral horn

facilitation of the anterior horn could cause

increased motor response

tachycardia is associated with

lateral horn. It is caused by inhibition of parasympathetics or irritation of sympathetic NS

Cord compression (compressive myelopathy)

severe subluxation and ligament laxity C1-C2 causes it

dentate traction causes direct mechanical irritation to the cord

lateral translation can irritate cord (esp during distrction)

Cord traction (major dejernette, craniosacral meningeal tnsion)

“cranio-pelvic manipulation to restore CSF flow”

CSF pump: sphenobasilar (top), sacral (bottom)

Vertebral artery insufficiency

cervical rotation causes symptoms (nausea, nystagmus, numbness)

Dural torque, dentate cord distortion (grostic)

dentate ligament aka denticulate, cross bridges stabilizing the cord, rotational stress (torque), attachments from pia to dura

ligament is made of pia mater

Intervertebral encroachment theory (IET)

IET/IVF → DRG → substance P → destroys me and my IVD

DRG is most sensitive neurological structure to compression

environmental forces → disruption of the DRG, direct stimulation of DRG causes pain

irritation of DRG releases neuropeptides substance P (very acidic), causing disc degeneration, VIP and calcitonin

DRG facts

1.) very vascular, very sensitive, not upper cervical because no IVF)

2.) DRG is located in the middle of the IVF, in the cervical spine

3.) it migrates medialward in the thoracic and lumbar spine

4.) substance P normally inhibits pain in CNS

5.) increase pain in PNS with inflammation

6.) DRG may or may not be in the IVF, depending on level of spine

7.) 10 mmhg alters DEG output

Chiropractic subluxations are diagnosed by

joint play (poor inter-examiner reliability)

Subluxation adjusted by instrumentation

poor inter-instrument reliability for use

systemic effects of adjustment

not proven to make systemic change but proven to change cells and fluid concentration that can effect entire body

increased TNF, decreased dysmenorrhea signs and symptoms, decreased pain, decreased PMN, increased CSF flow

motion segmental buckling (buckling event)

uncontrolled response to spinal loading

ICPA (international chiropractic pediatric association)

evaluation specifies webster technique is specific assessment and diversified adjustment for weight bearing dynamics

not recommended for fetal malposition

Cerebral dysfunction theory (terret’s)

reduced cranial blood flow reversible, non-lethal ischemia

Stroke

must be ruled out when adult has neck pain and headache (FAST)

-rothwell study possible relationship of adjustment to stroke

-cassidy study same risk with medical and DC visits for stroke

-Connecticut board finds no causal relationship between adjustment and stroke

Harvard business

recommends “focused factories” = increased volume = increased outcome = decreased cost

research associates upper cervical subluxation with the following

tensiocephalgia, upper respiratory infections, grisel syndrome, SIDS, bradycardia (0-3 mo)

Hippocrates

father of medicine and rachiothearpy (long axis distrction) to fix “hump in spine”

Bonesetters

europe and england (1800s) used manual procedures

DD (discoverer)

short levers, nerve compression

TONE: 3 causes → chemical, mechanical, mental

magnetism

used jim atkinson’s procedures for adjusting, not stills

BJ (developer)

HIO

cord compression, meric chard (pottinger), founded UCA

short lever = decreased absorption in soft tissues, high force creates elastic deformation, low force creates plastic deformation

weed

named “chiro (by hand) practic”

still

father of osteopathy based on circulation and fused with MDs (allopathic medicine)

Logan

sacrum is key, heel lifts, buttock’s lifts, x-ray distortion (pedicle rotation)

McManis

flexion distraction

Langworthy

1st textbook, subluxation

kirkaldy-willis

SI and posterior joint/side posture

dysfunction (muscle, gait, inflammation) → unstable (ligament laxity) → stable (DJD)

hypomobility leads to hypermobility somewhere (compensation)

Sandoz

episodic fixations that are manipulable

chronic fixations that are non-manipulable

Mennell

motion palpation, poor inter-examiner reliability

Universal intelligence

universal laws, can be constructive or destructive, living and non-living

innate intelligence

in living bodies only, the intrinsic ability to maintain a healthy environment (homeostasis and tone)

Educated intelligence

every educated decision has as consequence for innate choices

allopathy

therapies antagonistic to disease

homeopathy

small dose (primer)

naprapathy

adjust lig-a-tights (ligaments)

therapeutic conservatism

do no harm (primum non nocere) use least invasive forms of care

vitalism

life force, interconnectedness, tone

Mechanism

independent systems

holism

all parts of a system act together (not independently)

reductionism

opposite of holism

humanism

empathy, compassion, discussion, respect, etc

naturalism

natural laws and forces govern everything (no supernatural power)

spiritualism

monotheistic belief (supernatural power exits)

materialism

devotion and belief in things, greed

mesmerism

hypnotic, spell binding power (DD based magnetic healing practice on this principle)

Surface EMG

myoelectric activity used to evaluate nerve and muscle

Nervoscope

dual probe, heat sensitive, break

Thermography

evaluates “vasomotor tone” (compares temp bilaterally)

Fluroscopy

segmental and total ROM on x-ray

Stress xrays

segmental dysfunction on x-ray (ligaments)

anatometer

bilateral weight scales to evaluate postural distortion

inclinometer

ROM of spine

Goniometer

ROM of extremities

Spinograph

chiropractic xray

mensuration

muscle girth

spinolator

rollers, intersegmental traction

scanogram

xray series for leg length

Purpose of x-rays

diagnose

biomechanics and postures

anomalies

screen contraindications

monitor progression

Reasons to x-ray

>50 years old

corticosteroids

history of cancer

unexplained weight loss

neuromotor deficits

no improvement

persistent instability

Cervical spine rule

flexion-extension exam study reveals excessive movement of 3mm of translation = instability = contraindication to adjustment

Functional x-rays

aberrant motion can be identified (biplanar radiographic techniques)

Subluxation complexes: kinesio pathophysiology

altered movement (deranged motoricity) affected by thrust

hypo (gillet), hyper (illi), decreased joint play (mennel)

Subluxation complex: histo pathophysiology

edema, inflammation, cellular flow, histamines, prostaglandins, stress (Selye)

Subluxation complex: neuropathophysiological

degeneration, facilitation, horn cell activity

Subluxation complex: myopathophysiolical

muscle alterations, atonia, spasm, hilton’s law, vsiceromotor reflex

Patho physiologoical

end result of joint (arthropathology) and body impairment

Subluxation is a process not a lesion

Complex = components

syndrome = signs and symptoms of patient

subluxation has 3 components

misalignment

decreased motion

dysfunction

Soft tissue techniques

activator

cranial

distraction → flexion cox and axial eckard (slight extension), flex-ext marky

massage

nimmo

CT massage

trigger points

lymphatic reflexes

logan basic

spondylotherapy (electrical over spine)