Chiro Theory Exam 1

Greek back walking

Widespread throughout recorded history, applied traction the pressure on spine by feet, hands, or other devices

Medieval hip manipulations

Traction was applied by suspending patient upside-down, traction applied with straps or ropes,

Antecedents to clinical chiropractic

In the 17/1800s, the ancient practice of manipulation begins to take on new significance in different forms- particularly with bonesetters

Medical manipulation in 18/19th centuries

Practiced by a few but not many physicians due to -fear of infection, tuberculosis of spine, no training in regular schools, it was considered low-class, other methods (leeching, blood-letting) were more respectable

Non-medical manipulation n 18/19th century

Practiced by a group known as bonesetters, no medical training, trained by apprenticeship many within families, popular with working class, no scientific explanation of effectiveness, like medical manipulation the methods were very general/non-specific

Sir Herbert Atkinson barker

A poplar British bonesetter, battled British medical association in English newspapers in early 1900s, autobiography ‘leaves of my life’ details the fight, was knighted by king for free health services rendered to royal army rejects and eternal of World War I

Osteopathy

Founded in 1847 by A.T. Still in Kirksville, MO, based on manipulation to restore blood flow, also used medicines and surgery, manipulation was not specific it was ‘long-lever’, today’s D.O.’s don’t manipulate as much as they did originally most don’t at all

Andrew T. Still

Founded osteopathy in 1874 and opened a school in 1892, one of his first students was homeopath Andrew P. Davis, an M.D. and future chiropractor- rival of D.D. Palmer

Chiropractic

Founded by D.D. Palmer in 1895, based on restoration of proper nerve supply not blood flow, manipulation came to be called adjustment as it was more specific than most manipulation historically, drugs and surgery were never included in the practice

Other paradigms and healing systems were emerging to challenge the dominance of ‘heroic’ medicine in the

1800s

Samuel hahnemann, M.D. (1755-1843)

Introduced homeopathy and the law of similars in Germany, ideas offered a gentle alternative to heroic medical practice and became popular in America in early 19th century

Homeopathic medicine

Principle- ‘law of similars’ may be stated as ‘like cures like’, dr. Hahnemann’s theory and practice involved administering ‘infinitesimal’ doses of substances that produced symptoms like those of the patient’s disease, a few homeopathic remedies were adopted by allopathic physicians, 19th century American homeopaths were more educated than physicians, AMA branded it as quackery in 1850s, invented the term ‘allopathy’

Franz Anton Mesmer M.D. (1734-1815)

Worked with ‘animal magnetism’, his dissertation in 177 at university of Vienna was entitled ‘the influence of the planets pion the human body by means of a magnetic fluid’, developed thriving magnetic practices in several European cities

Magnetic healing (animal magnetism)

Founded on F.A. Mesmer’s theories, theories were refuted by French scientific commission including Ben Franklin, mesmerism was introduced in North America by itinerant lecturer Charles Poyen of France in 1830s, magnetic practitioners were briefly licensed in a few American states, both A.T. Still and D.D. Palmer practiced magnetic healing

Paul caster of Burlington iowa

Built thriving magnetic practice in 1870s, may have inspired D.D. Palmer to take up healing art

Mary Baker Eddy

Offered Christian sciences as an alternative to harsh methods of mainstream ‘orthodox’ medicine

Ellen G White

Founder of 7th day adventists with her collaborator John. Harvey Kellogg, recommended prayer and healthy lifestyles

The physical culture movement

Championed by Bernard macfadden, was in full swing at the turn of the 20th century, championed physical fitness and a healthy lifestyle, “weakness is a crime; don’t be a criminal”, “sickness is a sin; don’t be a sinner”

Naturopathy

Founded by benedict Lust in 1896 (who is also recognized as M.D., D.C. and started an American school of chiropractic in NYC in 1905), first N.D. Degree offered in 1901, today is licensed in practice in 17 states and 5 Canadian providences, 7 schools

Ayurvedic medicine

Evolved in India and is the world’s oldest healthcare system, named for. Sanskrit word Ayurveda meaning ‘science of life’, is entire holistic

Traditional Chinese medicine (TCM)

A healing system of eastern medicine developed in china more than 2,000 years ago, incorporates therapies that are in some cases a millennia older, a guiding principle is to ‘dispel evil and support the good’, in addition to treating illness it focuses on **strengthening the body’s defenses and enhancing its capacity for healing and maintaining health**

Metaphysics

Study of fundamental mature of reality and existence and of the essence of things, often subdivided into ontogeny (the study of being and cosmology) and the study of physical universe

Epistemology

Study of nature, basis, and extent of knowledge (priori and empirical)

Logic definition

Study of principles and methods of reasoning (inductive and deductive)

Ethics definition

Study of human conduct, character, and values (relativism, objectivism, deductive)

Aesthetics

Study of creation and principles of art and beauty and of thoughts, feelings, and attitudes

Principles

The existence of universal intelligence, presence of an inborn innate intelligence in all living things, health is the expression of the innate intelligence through innate matter via innate intelligence, dis-ease is the result of the interference with the transmission of innate energy causing a decrease in the expression of innate intelligence

Conceptual definition of subluxation

Philosophically, vertebral subluxation is a metaphor concerning what we see as a possible source of interference to the maintenance of homeostasis

Operational definition of subluxation

Scientifically vertebral subluxation is a phenomenon with studying and investigating through research

MOPI

Misalignment/malposition, occlusion/narrowing, pressure/impingement, interference

What subluxation leads to

Subluxation (structural disre;Latinos hip with associated neurological dysfunction) → dis-ease/incoordination (alteration of homeostatic balance of body organs and systems)- may contribute to the onset or perpetuation of → disease/pathology

patient-centered chiropractic paradigm

traditional approach to patients, observed by non-doctors of chiropractic

educational chiropractic paradigm

developed in 1996 by consensus of the presidents of all existing north american chiropractic colleges

6 doctrines of chiropractic

vitalism, holism, naturalism, humanism, conservatism, rationalism

vitalism

nervous system’s function in the “self-healing” human organism, physical vitalism or that vital functioning of each individual was referred to by Palmer as the body’s innate intelligence, “the organism is a vital reactive entity, which is itself the first physician in disease”

holism

the whole is greater than the sum of its parts, mind-body-spirit, health education and self care/self-healing, a relatively open, equal, and reciprocal relationship between the patient and practitioner, this approach views the patient as a whole person not a symptom-bearing organism

naturalsim

preference for natural therapies and avoiding drugs and surgery, wellness and health promotion are encouraged through natural means (diet, exercise, behavior modifications), the body was built on nature’s order and thereby obeys nature’s laws

humanism

compassionate manner that requires empathy, nonjudgemental acceptance, congruence, and genuineness, chiropractor is oriented to the patient not the illness, D.C.’s legitimize their patient’s health problems often after the patients have been rejected as “malingerers” or as “having psychosomatic illnesses”

conservatism

built on “primum non nocere” (first do no harm) from hippocrates, minimal intervention from the chiropractor will promote active participation of the patient in the healing process, economically this approach is the best path to a sustainable health care system

rationalism

invokes logic and evidence as a basis for clinical reasoning, “good doctors use both individual clinical expertise and the best available external evidence and neither alone is good enough”, even the best evidence may not be appropriate/applicable to a specific patient

clinical approaches in chiropractic

segmental, postural/structural, tonal

5 component model of vertebral subluxation complex (VSC) (dishman/faye/flesia)

1- kinesiopathology (abnormal motion/position of spine)

2- myopathology (abnormal muscle function)

3- histopathology (abnormal soft tissue function)

4- neuropathophysiology (abnormal nervous system function)

5- pathophysiology/biochemical changes (abnormal function of spine and body)

kinesiopathology

abnormal motion/position of spine, can restrict ability to turn and bend, sets in motion other 4 components of VSC

myopathology

abnormal muscle function, muscles can weaken/atropy/tighten and go into spasm, can result in scar tissue that changes muscle tone, requires repeated correction

histopathology

abnormal soft tissue function, changes in blood or lymph flow can result in swelling and inflammation, discs can bulge/herniate/tear/degenerate, ligaments may be permanently damaged

neuropathophysiology

abnormal nervous system function, improper spinal function can compress/stretch/irritate delicate nervous tissue (spinal cord or nerves), can cause symptoms elsewhere in body

pathophysiology

abnormal function of spine and body, bone spurs and other abnormal bony growths attempt to fuse causing malfunctions in spinal joints, spinal decay/scar tissue/long-term nerve dysfunction can cause other body systems to be affected

3 Ds of 3-component model

dyskenesia, dysponesis, dysautonomia

dyskenesia

distortion of, difficulty with, or impairment of voluntary movement, can consider global and segmental range of motion

dysponesis

a reversible physiopathologic state consisting of unnoticed, misdirected, neurophysiologic reaction to various agents and the repercussions of these reactions throughout the organism, covert errors in action-potential output from motor and pre-motor areas of cortex and consequences of that output, body is no longer on safety pin cycle

dysautonomia

a neurophysiologic state reflecting abnormal balance between or tone of sympathetic/parasympathetic divisions of ANS, current hypothesis is that it may dis-inhibit sympathetic division leading to increased tone of SNS

subluxation leads to __ which then leads to __

dis-ease/incoordination; disease/pathology

complex organisms depend on the…

bidirectional flow of information between CNS and peripheral cells in order to adapt to a changing environment in a coordinated manner

palmer propose what mechanism and when?

relieving nerve compression in 1910

major subluxation theories

IVF encroachment, altered sensory input (dysafferentation), spinal cord distortion

step 1 in mechanism of action of adjustments/corrective procedures

an adjustment/corrective procedure leads to change in organ dysfunction, tissue pathology, or symptom complex

step 2 in mechanism of action of adjustments/corrective procedures

an adjustment/corrective procedure leads to change in musculoskeletal system

step 3 in mechanism of action of adjustments/corrective procedures

a change in musculoskeletal system leads to a change in the nervous system

step 4 in mechanism of action of adjustments/corrective procedures

a change in nervous system lead to a change in organ dysfunction or tissue pathology or symptom complex

how do chiropractors evaluate individuals clinically to determine the appropriateness of chiropractic care?

biomechanical evaluation, neurologic evaluation, trophic assessment, psychosocial assessment

biomechanical evaluation

mechanical etiologies (trauma), static asymmetries, dynamic asymmetries (gait), passive and active individual joint ROM (static/motion palpation), imaging procedures (x-ray, videoflouroscopy)

neurologic evaluation

symptoms, palpatory tenderness, altered muscle tone, vasomotor findings, sudomotor findings

trophic assessment

altered tissue fixture, edema, metabolic disturbances, nutritional imbalances

psychosocial assessment

mental attitude/outlook, social interactions, lifestyle habits, stress

theories/models of subluxations

biomechanical, neurologic, trophic, physchosocial

biomechanical models of subluxation

vertebral/spinal misalignment → spinal fixation → abnormal motion kinetics (hypermobility, compensation reaction, joint dysfunction progressing to spinal degeneration) → subluxation degeneration → conceptual models of degeneration

neurological models of subluxation

neurologic compression/traction/torsion- affects nerves/roots/cord, neurologic irritation, aberrant reflexes, deafferation/dysafferentation, neurodystrophic/neuroimmune effects

trophic models of subluxation

axoplasmic flow mechanisms, vertebrobasilar arterial insufficiency, neurologic ischemia (macro and micro), lymphatic/venous stasis, csf flow dynamics

psychosocial models of subluxation

psychogenic concepts- how mental/emotional state influences structure; somatopsychic concepts- how structure (VSC) influences mental/emotional states

hypothesis of mechanical causes of subluxation

the opinion that the human spine is incompletely adapted to upright bipedal configuration

grisel syndrome

any C1-C2 subluxation associated with inflammatory ligamentous laxity

spinal/vertebral misalignment outline

intervertebral subluxation, statics- basic and compensatory distortion

statics

the branch of mechanics that deals with the equilibrium of bodies at rest, or in motion with zero acceleration

spinal fixation hypotheses

cross-linking in periarticular ligaments or post-traumatic ligament shortening, meniscoid entrapment, disc (IVD) mechanism, postural muscle hypertonicity/spasm, swelling and edema in joint spaces

3 categories of spinal fixation mechanisms

periarticular mechanisms, intraarticular mechanisms, disc (IVD) mechanisms

periarticular fixation mechanisms

intermolecular ligaments cross-linking within ligaments due immobilization without trauma (loss of GAG and water affects the extensibility of ligaments); periarticular muscles acting as impediment to motion- facilitation of muscle spindle/gamma motor neuron pathway, ‘nociceptive spasm’ (facilitation of nociceptor afferents, reflexively stimulating a-motor neurons)

intraarticular fixation mechanisms

degeneration with prolonged immobilization, intraarticular fluid (edema/blood), meniscoid entrapment

meniscoids

intraarticular synovial fold inclusions which can become entrapped between the superior and inferior articular processes, producing acute ‘locked back syndrome’ which occurs after motions involving flexion of trunk with rotation

IVD fixation model

immobilization of disc inhibits imbibition of fluids and removal of wastes from central 2/3 of IVD and predisposes it to degeneration, disc injury/degeneration causes nucleus pulposus to fragment, decentralized nucleus fragments become sequestered and further limit motion of segment

cribiform endlplate

where diffusion of water, nutrients, and waste occurs to central 2/3 of IVD

compression of IVD

forces wastes out of IVD, occurs when normally weight bearing

decompression of IVD

decreased pressure in disc space allows nutrients to flow into IVD, occurs due to recumbency or shifting loads during normal whole-body activities and movement

spinal fixation

hypomobility, soft-tissue changes, aberrent neural reflexes, and neurological facilitation

postural stress is associated with

evolution of the spine and axial skeleton, with inherent susceptibility to gravitational insults and trauma

kinetics

branch of mechanics that studies the relationship between the forces acting on a body and the changes they produce in the motion of the body, Dr. Fred Illi is chiropractic biomechanics pioneer

compensation reaction quote

a lack of mobility in any segment due to cause will result in compensatory hypermobility in the segments above and/or below…if the factors are noted in time the osseous changes can be avoided

positions of rest

the positions assumed by bones while the body maintains certain postures, positions of rest will also be changed from the normal

simple vertebral subluxation

the exact relation between the articulating surfaces of bones has been altered from normal; differs from a normal vertebra only in its field of motion and the center of it’s field of motion, has various positions of rest but is not lodged in a fixed and permanent abnormal position

modernized chiropractice

chiropractic manual/textbook written in 1906 by langworthy, paxson, and smith

loss of joint play

concept attributed to mennell, hypothesis that z-joints of affected segments demonstrate a loss of joint play, represents amount of capsular laxity within a joint, associated with reduced active or passive ROM/muscle hypertonicity/muscle and articular pain, can be corrected with high-velocity, low-amplitude thrust associated with adjustment

positional dyskinesia

suh, plaugher; concept that vertebral malposition and aberrant motion are almost always concomitant findings; a misaligned segment will have improper motion in at least one plane and a segment not moving properly will be found in wrong place at some point

4 phase subluxation degeneration model

chart progression of hypothesized biomechanical effects of uncorrected VS and offer empirical biomechanical responses to adjustments, assumption is made that there is a “near-perfect” ideal spine which can be maintained or regained if correction is made in a timely fashion

phase 1 of 4 phase subluxation degeneration model

occurs chronologically very early in life or after occurrence (0-20y/o), motion dysfunction and possible misalignment, bony architecture of spine is intact, initially only soft-tissue changes, biomechanical response to care- return to near normal with care in weeks-months

phase 2 of 4 phase subluxation degeneration model

occurs chronologically in young adults typically 20-40, motion dysfunction and possible misalignment, fibrosis occurs in soft-tissues, early bone changes seen (exostosis, sclerosis), biomechanical response to care- significant improvement, but longer-term care over several years required to halt degeneration, reversal of some changes may be possible

phase 3 of 4 phase subluxation degeneration model

occurs chronologically in mature adults typically 40-60, motion dysfunction and possible misalignments, chronic soft-tissues effects, major bone and joint changes seen- beginnings of ankylosis or fusion, biomechanical response to care- minimal, care may slow or retard progression, lifetime care required

phase 4 of 4 phase subluxation degeneration model

occurs chronologically in elderly patients typically 60+ or earlier with significant trauma, all changes of earlier phases, major bone and joint changes seen (fusion or ankylosis complete), biomechanical response to care- none, care is directed to segments in earlier phases or those subject to compensation reaction

3 phase unified VSC model

described by Kirkaldy-Willis and Sandoz in 1989, outlined in Leach’s text ‘the chiropractic theories’

phase3 of 3 phase unified VSC model

1- segmental dysfunction featuring “pre-radiologic” kinesiopatholgoy → 2- instability featuring cartilage and ligament histopathology showing “true” subluxation → 3- stabilization featuring significant DJD ankylosis

version 1 of 3 phase unified VSC model

phase 1 (segmental dysfunction) has significant trauma involved with resulting articular overstess proceeds to phase 2 (instability) → cartilage/ligament histopathology shows ture subluxation- radiographically demonstarable with episodic fixations proceed to phase 3 (stabilization) → significant DJD ankylosis occurs

version 2 of 3 phase unified VSC model

immobilization is the primary initiating factor of phase 1 (segmental dysfunction) so a facilitative lesion involving chronic muscle contracture and impaired circulation to joint and muscle and hypomobility occurs and proceeds straight to phase 3 (stabilization) → severe DJD without significant displacement occurs