Category: Other Articles

Whole Body Vibration and Scoliosis Treatment

by Christian H. Reichardt, D.C.

OVER THE LAST CENTURY, CHIROPRACTORS HAVE COME UP WITH A variety of protocols for some of the milder forms of scoliosis as well as a number of stabilization therapies to prevent the catastrophic outcomes of severe scoliosis. This article will not concern itself with the discussion of the more severe form of the disorder, nor with the philosophical reasoning of whether chiropractic is the treatment of choice. However, I shall outline how Whole Body Vibration can assist the practitioner in the field and their patients in their efforts to treat scoliosis. Most doctors today agree that sensible Scoliosis treatment protocols are clearly geared towards mobilization, correction and stabilization.

The concave side of the scoliosis pattern typically presents itself with shortened, tight and connective tissue fibers, decreased ROM, osseous fixation and hypo-mobility, often leading to chronic pain. The convex side, alternatively, often presents itself as hyper-mobile, with fi bers which are overstretched and lack integrity or strength, often causing the acute pain cycles. The primary goal of treatment, thus, should be to increase motion fi rst in the fi xated areas, then stabilize the hypermobile areas. Research by Prof. Vladimir Janda, MD, showed that a patient’s awareness of their position in the 3-dimensional room is of great importance in the treatment of musculoskeletal disorders. This falls under the category of proprioceptive training and occurs in the stabilization phase.

Whole Body Vibration (WBV)

Whole Body Vibration is a modality in which a mechanical stimulation is produced by an oscillatory motion of a platform. The user is then placed on the platform. The motion of the platform creates a rapid acceleration/deceleration motion of the body part aligned with the stroke motion of the platform. Any tissue directly in line with the motion of the platform is now exposed to a rapid loading and unloading. This creates a physiologic response in those tissues equivalent to exercising. Basically, WBV produces an adaptive response in tissues and this response is both morphological as well as neurophysiological. Forty years of research has clearly demonstrated that these adaptive responses can be utilized to either loosen tissues by lengthening muscle fi bers or to strengthen muscles. WBV drastically reduces the time required to achieve these physiological outcomes; a proper WBV work out routine requires as little as 12-15 minutes training per ession, at 2 to 3 times per week intervals.

Physics of WBV

The intensity of the vibrations is determined by 3 factors: amplitude, frequency and magnitude of the motion. The height of each movement determines the amplitude, generally expressed in mm. The rate of oscillation per second determines the frequency, which is usually listed as Hertz (Hz); i.e., 10 Hz represent 10 oscillations per second. The rise of each scillation determines the magnitude, typically expressed in g-forces. Most research studies have focused on ranges from 10 to 50 Hz, which is considered low frequency, low amplitude vibration. Mechanical platforms tend to displace anywhere from 3 to 10 mm and produce acceleration factors of 1.8 to 15g, depending on the manufacturer.

WBV and Scoliosis Treatment

A number of doctors around the country have already created specialized protocols incorporating various combinations of WBV, traction and rehab exercises in the treatment of scoliosis.1 As mentioned above, the purpose of scoliosis treatment is to

a) Improve the pliability in the areas which are too rigid

b) Reposition the osseous structures via manipulation.

c) Improve strength and power in the tissues which lack strength.

d) Stabilize the structures, and

e) Improve the patient’s proprioceptive abilities.

The vibrating impulses stimulate the Golgi tendon apparatus in muscles that have become tight and constricted. This activates a stretch and release reflex similar to the mechanisms used in the PNF (Proprioceptive Neuromuscular Facilitation Technique), resulting in a high measure of muscular relaxation.2 Secondly, WBV helps to strengthen tissues. Vibration stimulates innate muscle spindle activation by increasing the load on the tissue. This rapid continual fi ring is known as the Tonic Vibratory Refl ex. It is regulated via spinal refl ex arc not unlike the Knee Jerk Refl ex. Years of  research of WBV have shown marked improvements in static, dynamic and explosive strength and power.3 Finally, the body responds to Whole.

1. Clear Institute for treatment of Scoliosis- www. Clear-Institute.org.
2. A-Acute Effects of Whole-Body Vibration on Lower Body Flexibility and Strength. Patricia A. Burns1; Kristina S. Beekhuizen1,2; Patrick L. Jacobs, FACSM1,2. University of Miami School of Medicine, Miami FL. 2) Miami VA.
3. Effects of whole-body vibration and pnf stretching on the flexibility and range of movement in elite Australian Rules football players Ben Hinton¹, John Quinn², Michael Newton¹, and Michael McGuigan¹¹Edith Cowan University, AU.
4. WILL WHOLE-BODY VIBRATION TRAINING HELP INCREASE THE RANGE OF MOTION OF THE HAMSTRINGS? ROLAND VAN DEN TILLAAR. Journal of Strength and Conditioning Research, 2006, 20(1), 192–196q 2006 National Strength & Conditioning Association.
5. Acute whole body vibration training increases vertical jump and flexibility performance in elite female field hockey players. D Cochrane and S Stannard, Massey University, Sport and Exercise, Palmerston North, New Zealand.  Br J Sports Med. 2005 November; 39(11): 860–865. doi: 10.1136/bjsm.2005.01995.
6. Effect of WBV on musclestrength and propri ception in females with knee osteoarthritis.  Trans T, Aaboe J, Henricksen M, Christensen R, Bliddal H, Lund H.  Clinical Motor Function Laboratory, The Parker Institute, Frederiksberg Hospital, Denmark.

How to Relieve a Headache in Seconds on One Patient after Another!

by Dr. Stephen Kaufman, D.C.

I HAD A CONSTANT HEADACHE FROM BIRTH UNTIL THE AGE OF TWENTY-THREE, SO I’VE HAD A LIFElong interest in this topic. My mother was also frequently incapacitated with migraines, and died at a young age, possibly of a stroke. (Female migraine sufferers with aura are seven times more likely to have a stroke than women who don’t get migraines.17)

Continue reading “How to Relieve a Headache in Seconds on One Patient after Another!”

Dear TAC,

Concerning the best strategy for dealing with an investigator whether it is from the insurance industry or the local D.A., most doctors will not have intimate knowledge and experience of dealing with the fine points of the rules and law. DJ Osborne suggests that a doctor rely on creating goodwill. By the time the insurance or D.A. investigator shows up at a doctor’s office, the most likely scenario is that the target has already been painted squarely on that doctor’s back. Trying to negotiate this mine field without proper defensive skills can easily lead to greater peril.

I always played straight down the middle when it came to insurance billing and when dealing with patients and their financial issues. Therefore I was completely taken by surprise to find my office full of people with badges and guns one day a few years ago. Since I was sure that I had done nothing wrong I figured I could explain the mistake and it would all go away. I didn’t realize that everything I said was going to be twisted to suit the job advancement opportunities of the investigator and had little or nothing to do with truth or fact finding. I was properly advised to quit talking and make them prove through legal channels that I had done something inappropriate.

What did I learn?

I had been using an electronic chart-noting system so my records were coherent and legible. Ultimately this helped make it difficult to make a case against me because those records were so clear and treatment dates, type of service and billing all matched. Had I been relying on hand-written notes, I am sure the investigation would not have gone away so easily.

Find the best lawyer you can and let him or her do the talking. A friend recommended an attorney who was very experienced with insurance and state board issues and I paid about $45,000 over three years. I consider this money well spent to have the issue go away with no charges ultimately being filed.

The system will be very impersonal and, like I said, needs to be fed. To avoid being prey, you can’t look like prey. That doesn’t mean a person needs to be rude, but politely let them know that this will not be easy for them and that, if they want to make a case, they are going to have to work for it.

Sincerely,

Daniel Schlenger, DC

January 26, 2009

Chondromalacia patellae is the term applied to the syndrome of pain and crepitus arising from the patellofemoral articulation. As a distinct entity, it was first described by Budinger in 1906. Plain film radiography is, for the most part, unrewarding and usually acts to exclude other underlying pathologic alterations.¹

Considerable confusion exists as to the actual nature and significance of the lesion in the diagnosis and delineation of its true etiology. The term chondromalacia patellae is often haphazardly used to encompass a wide variety of patellofemoral syndromes, and this has contributed greatly to the confusion. Typically, chondromalacia patellae is a disease of the adolescent and young adult. Etiologic factors include trauma, patellar dislocation, malalignment syndrome, primary cartilage vulnerability, and occupation. Many consider it a normal part of patellofemoral joint aging. It is often confused clinically with symptoms arising from a meniscal injury.

The most often used clinical criteria for applying the diagnosis of chondromalacia patellae are anteromedial knee pain associated with crepitus, buckling, locking, stiffness, swelling, and tenderness. Pain is usually aggravated by sitting in a confined space with the knee flexed (“movie sign”) and by walking up stairs. A distinctive physical sign is retropatellar pain elicited by direct patellofemoral compression with the knee slightly flexed.

Measurement of the Q angle has received attention as a method to detect patellar malalignment which may predispose to chondromalacia. It is the angle formed by the line of the quadraceps muscle and the patellar ligament. Measurement is performed clinically by assessing the angle formed by two lines: (a) from the ASIS to the center of the patella and (b) from the tibial tubercle to the center of the patella. The normal range of this angle is 15 to 20º, with greater than 20º being considered abnormal.¹

Chondromalacia literally means cartilage softening. The pathogenetic sequence is characteristic and parallels that seen in degenerative joint disease. Initial swelling and softening of the cartilage produces a blister-type of cartilage lesion. Subsequently, fissuring and fibrillation occur, predominatly involving the medial facet of the patella. Involvement of the lateral facet has also been documented but rarely occurs.1

Specific radiographic findings are characteristically absent. MR is the most accurate method of detecting focal cartilage defects. Bone changes are limited to occasional underlying osteoporosis of the patellar articular surface, particularly the medial facet. Loss of joint space denotes more advanced changes of degenerative joint disease and is usually present in advanced chondromalacia.

Malalignment of the patella can be assessed as a possible contributing factor to chondromalacia. A patella that is situated too high on the femur does not allow proper redirection of the quadriceps muscle and is termed patella alta.

Dr. Terry R. Yochum is a second generation chiropractor and a Cum Laude Graduate of National College of Chiropractic, where he subsequently completed his radiology residency. He is currently Director of the Rocky Mountain Chiropractic Radiological Center in Denver, Colorado, and Adjunct Professor of Radiology at the Southern California University of Health Sciences, as well as an instructor of skeletal radiology at the University of Colorado School of Medicine, Denver, CO. Dr. Yochum can be reached at 1-303-940-9400 or by e-mail at [email protected].

Jeffrey Fedorko graduated from the National College of Chiropractic in 1981 and has been an active member of the Ohio State Chiropractic Association (OSCA) throughout his career. He was first elected to office at the district level in 1984 and moved up through the ranks, eventually being elected President of OSCA in 1998 and Chairman of the Board in 2000. He was named Chiropractor of the Year in 1999 and 2000.

Continue reading “Interview with the President of the Congress of Chiropractic State Associations (COCSA), Jeff Fedorko, D.C.”