Innovations – The American Chiropractor

Neuropathy

:dropcap_open:N:dropcap_close:europathy, a condition where the nerves running from the brain or spinal column become damaged, is a very troublesome problem for clinicians and patients alike. Patients view the condition as incurable and the only treatment as a lifetime of cascading medications, taking one family of medications to offset the effects of another. Despite the drugs, however, many patients continue to experience burning, tingling, a loss of sensation and balance, the development of wounds from trauma or infection, and even the threat of amputation. Clinicians dislike having to tell patients this diagnosis because they feel that there is not much to offer and since they know too well the downward spiral that their patients are likely to endure. What can be done for these patients? Let’s first discuss the etiology of neuropathy.

There are three major types of neuropathy: post-chemo, diabetic related, and idiopathic. There are also other ways to get neuropathy – mono neural neuropathies that are a result of trauma, and disease-related neuropathies that are a result of other illnesses such as Guillain Barre, Charcot Marie Tooth, and multiple sclerosis. I am only going to address the more common neuropathies associated with diabetes, post-chemo, and idiopathic because of their similarity in pathology and because they are so prevalent in our society.

Peripheral neuropathy has a singular pathology that, in my opinion, is mostly overlooked. In each and every case there has been vascular embarrassment that has caused the loss of C-fibers to the tissue. The microcirculation that has been necrotized by diabetes, post-chemo or from a cause that is unknown (idiopathic), must be restored before the C-fibers can regenerate. The other nettlesome problem we have with this diagnosis is there is no way to measure C-fiber function. Currently, no reliable neurological test exists to measure these unmyelinated fibers, and therefore any improvement or further deterioration is reliant solely on patient feedback. There is the flash response from laser Doppler that claims to measure change in the vascular flow when the C-fibers fire. Unfortunately, success of this test has been spotty at best and, at present, is expensive and has no established criteria1. So, we are left with a problem that cannot be measured and with a very difficult treatment protocol.

The question then becomes: how can we improve the microcirculation in a specific area? In order to do this, we must induce angiogenesis in a specific area of the body in order to promote growth of the C-fibers. How does the body accomplish angiogenesis? The major factor of angiogenesis is nitric oxide (NO). Through activation of guanalate cyclase (GC), NO leads to cGMP formation, which then stimulates growth of the microcirculatory bed 2. By following this chain reaction back to the beginning, we can see that it would be beneficial to activate endothelium-based NO at the site of ischemia, the area damaged by the reduced blood flow.

What are the best activators of NO? There are several agents that activate NO: nitroglycerin, L-argenine, and Sildenafil, to name a few. But ingesting or injecting medications is not the answer, since the delivery is generalized. In the case of neuropathy, we need a specifically-focused NO release. The best choice in this case is near-infrared light delivered to the area of neuropathy. Near-infrared light – either collimated (laser) or non-collimated (by light-emitting diodes) – has been demonstrated to locally increase angiogenesis. The efficacy of using a laser is limited by its small area of delivery and by the need of the clinician to hold the laser-head device at the site for the entire treatment. Non-collimated near-infrared light, using LEDs, can be delivered to a large area and can be left, unattended, with no limitations such as bony prominences, etc. Whichever method is chosen, however, the development of angiogenesis and subsequent regrowth of the C-fibers will result in your patients proclaiming that they have restored sensation, diminished pain, and improved balance.

Understanding how to restore microcirculation to areas of the body damaged by restricted blood flow is a huge breakthrough for patients suffering from neuropathy, and we should no longer view neuropathy as a hopeless condition. Our ability to stimulate angiogenesis and to regrow C-fibers, along with critical improved nutrition and lifestyle changes, should result in significant improvement in this patient group.

References

Schmitz&Peterson, Neurogenic Inflammation in Human and Rodent Skin, Physiology, (Feb. 1,2001),Vol. 16 pp.33-37
Powell,Carnegie,Burke, Reversal of diabetic peripheral neuropathy and new wound incidence, Advances in Skin and Wound Care 17, 295-296, 298-300

Dr. Kirkner attended the University of Buffalo, earning a Bachelor of Science in Physical Therapy. He has worked in hospital administration, and had a private practice for 30 years, the last 10 years of which have been spent lecturing and consulting on the use of near infrared lasers in the U.S. and around the world. You may contact Dr. Kirkner for more information at leokirkner[at]frontier.com or call 330-351-3087.

New Development in Flexion/ Distraction Table

:dropcap_open:C:dropcap_close:hiropractors have been utilizing Flexion–Distraction technique for over 100 years and with good results. The first flexion-distraction table was produced by an osteopath, Dr. McManis in 1909. The chiropractic profession historically has performed flexion-distraction as a therapy, that is, a very specific form of mechanically assisted traction. Enhanced flexion-distraction conversely is performed more like an adjustment.

To appreciate the differences lets first look at how flexion-distraction is traditionally taught and performed. When a conventional FD table is flexed there is approximately one inch of additional separation between the thoracolumbar and pelvic cushions. This one inch plus any lateral flexion, is the total amount of traction available. The practitioner is traditionally taught to slowly flex the table to take out the slack then slowly flex the table a little further, hold for several seconds to deliver traction then return to neutral position. This process is often repeated in three sets of four for a total of 12 cycles.

Enhanced Flexion-Distraction utilizes a modified FD table that is capable of producing over 4 inches of separation between the thoracolumbar and pelvic cushions plus the amount of traction added by lateral flexion. Practitioners of enhanced flexion-distraction also employ a significantly different type of table movement. The entire flexion movement of the table is completed over a one to two second duration which is much faster than traditionally taught. Three sets of four cycles can again be performed. The inherent movement of the modified FD table is such that the weight of the patient’s lower extremities act on a longer physical arm as the table is progressively flexed. This change in weight/arm length causes the table to flex at a rapidly increasing velocity. High speed photographic analysis (60 FPS) of the modified FD table demonstrated the short duration and rapidly increasing velocity of the flexion movement. The same high speed photographic analysis of a conventional table demonstrated flexion at a constant velocity.

Applying a force to a joint over a short duration, at an increasing velocity is the hallmark of a chiropractic adjustment. Enhanced flexion-distraction produces movement that is much more like an adjustment than just a passive therapy, resulting in frequent audible releases and subluxation correction.

For more information on the Axial Trac innovation, visit : www.axialtrac.com or call 866-998-3428.

Innovator’s Interview

Chiropractic America, LLC:

Delivering the Chiropractic Message in a Professional and Credible Manner

by Herb Newborg, D.C.

TAC: Could you tell our readers about how you became involved in Chiropractic America?

NEWBORG: I discovered chiropractic care through a very serendipitous route. I took a much needed vacation at a holistic resort. Spending several weeks eating healthy, organic foods and hearing from a leader in the raw food movement prompted me to embark on some research of my own into how my diet and that of my family might be causing some of the health challenges we faced. At the time, my wife was on 5 different prescription drugs, my 15-year-old was on 4 different medications for asthma. Doctors wanted to put my 8-year-old on medicine for “pre asthma” and my oldest son had just been prescribed Prozac. And all of these prescriptions were for drugs they were told they would need to take for the rest of their lives. I knew something was wrong with the advice we were receiving.

So, after much investigation, I found out that there was a third discipline of health care beyond the MD’s and DO’s (that until that time I had trusted for health care advice) called DC’s.

After several months of chiropractic care, they were off all medications and I felt better than I had in years. I wanted everyone to know the amazing turnaround my family and I experienced and began to share my story with everyone I knew. But I found out that there was so much misinformation and negative information in the public arena, it was difficult for me to convince others to get under care.

So, I contacted my neighbor in the business park where my computer company had been located who headed up a company called Chiropractic America. Within 2 weeks, I reached an agreement to buy the company. I then spent the next three years building and refining a program to finally take the chiropractic message to the public in a professional and credible manner. The result is Chiropractic America 2.0 and the YourSpine.com initiative.

TAC: So could you tell us a bit more about what Chiropractic America is offering DC’s today, in getting their message out there?

NEWBORG: The simple fact is chiropractic has no representation in the main stream media and no organized plan of action to properly present chiropractic to consumers on the Internet. We address both of these deficits with one integrated solution.

We engaged the top health care public relations firm in the country and worked with them to formulate a plan to reach consumers with the chiropractic message. They developed a thought leadership campaign to present Chiropractic America’s Advisory Council members to major media outlets to provide commentary and leadership on key trends in healthcare—drug safety, sleep habits, reimbursement and drug pricing, nutrition and obesity, etc.—where the perspective of the chiropractic community is relevant and will call attention to the value of chiropractic in addressing key health system issues. Every media opportunity is a chance to promote chiropractic and this high profile publicity drives consumers to the web site for additional information.

It turns out there are 10 million Internet users searching for health information each day in the US. We know exactly how they conduct their searches. We also know that there is absolutely nothing currently being done to reach them. So, the PR firm designed our site and the Internet advertising plan that supports it to put the chiropractic message in front of these 10 million consumers at the exact moment they are in need of care.

We have the top heath care PR firm in the country, the same firm that represents all of the major drug houses, poised to promote chiropractic with the same media savvy and professionalism that our health care competitors enjoy. We have the top web site developers, Internet and search engine marketing experts and pay-per-click campaign managers in place and ready to do what has never before been possible, to reach those in need of care at the exact moment they are deciding where to go for that care.

TAC: How will doctors be able to track the results associated with signing up for the new Chiropractic America program?

NEWBORG: We can track everything, from the ad text that draws them into the page they land at to the wording and images on the page through to the call to the doctor’s office. We, then, continually test and refine as we go to optimize our effectiveness. We give the doctor a report each month with the exact number of calls they received into their office. The whole process is completely scientific and will only get more efficient with time. The only thing left is to find the lucky doctor in each zip code that gets to participate, as we can only represent one doctor per zip code. We do this because there has to be a direct benefit to those that fund the program, or there is no incentive to participate.

Herb Newborg is president of Chiropractic America. Chiropractic America and Ogilvy PR Worldwide firm, Feinstein Kean Healthcare (FKH) have developed a national marketing communications program centered on www.YourSpine.com a website designed to educate patients about the importance of spinal health. You can reach him at 1-215-310-1735 or 1-877-846-8544.