Category: Techniques

The Sacral Cup Test and adjustment can be an extremely important tool for the chiropractor because of its ability to help stabilize a chronic unstable sacroiliac (SI) joint, especially if it is slow to respond to traditional category two pelvic procedures. [Figure 1] In addition, it gives the doctor a tool to determine the presence of a complication in the treatment of a moderate sprain of the SI joint which might require additional time for recovery. A reoccurring sacral cup will also alert the doctor that an SI support belt and rehabilitative exercises will be required.

In essence, the Sacral Cup, or prone leg extension, tests the strength of the muscles crossing the posterior aspect of the SI joint. When a joint is unstable the adjacent musculature will often sacrifice strength and flexibility for stability, therefore weakness will be noted on straight leg extension, which is especially evident when the SI joint is so badly sprained that the sacrum has displaced posteriorly on one (or infrequently both) side(s). DeJarnette discussed this by noting that such weakness of the muscles crossing the posterior aspect of the SI joint contributes to confusing SI joint hypermobility response to treatment.

Sacral Cup Testing

Proper leg lift: When a patient’s joint is sufficiently sprained, they will adapt by recruiting other muscles to extend their straight leg. They will accomplish this by externally rotating their leg [Figure 2] and slightly abducting their thigh as they lift. [Figure 3] In addition, they will rock toward their “non lifting” side and lift their ipsilateral hip. [Figure 4] It is appropriate that the patient be instructed prior to beginning the test to:

1) Keep their hips on the table

2) Keep their leg straight

3) Attempt to keep the leg slightly turned inward and held near the midline as they lift. [Figure 5]

Determining leg/thigh extension strength:

With a severe SI joint sprain, the patient will be unable or have difficulty in lifting his/her leg(s) off the table or one side will not go up as high as the other. Possibly both legs individually might be able to be raised but, with doctor pressure upon the legs “toward the table,” the leg(s) will be obviously weaker to some degree.

Locating the Sacral Cup

Dr. DeJarnette first described the sacral cup as being located by palpation at the posterior surface of the sacrum. He divided these cups into right or left superior and inferior “cuplike” depressions. [Figure 6] Since his work, there have been studies that have found that with some adults the sacrum does not fuse completely, allowing for some slight sacral segment malposition. This necessitates greater specificity when correcting the posterior sacral segment and expands the diagnostic and treatment region beyond just a “cup” area.

Once weakness of the leg/thigh extension has been determined, the side of sacral segment or body posteriority needs to be identified. Begin by applying posterior/anterior (P/A) pressure to the superior ipsilateral region of the sacrum on the side of weakness which, 70 percent of the time, is the main area of posteriority. [Figure 7] If, upon maintaining pressure, the leg does not strengthen, then apply pressure to the ipsilateral inferior, the contralateral superior, and the inferior aspect of sacrum respectively.

Initially, it is possible that gravity alone will be sufficient to test muscle strength. Remember that this is not about muscle strength but about an SI joint injury sufficient to permit posterior displacement of the sacrum. Patients will present with varied degrees of weakness and, as they improve, they will develop greater strength. With proper P/A pressure to the sacrum in the “right place,” their leg/thigh extension weakness will eventually resolve and the muscle will appear to “lock in” appropriately.

Adjusting the Correct Segment or Sacral Cup

Once the “cup” on the sacrum is identified, the joint can be treated. Dr. DeJarnette recommended a double thumb thrust or Activator gun impulse directly into the posterior cup. For greater effectiveness, have the patient lift and slowly lower their leg while applying multiple impulses at each stage of lifting and lowering. If the ligament isn’t strong enough to hold the correction (such as chronic ligamentous compromise), sometimes the thrust, alone, will not be sufficient. In those isolated cases, you will need to apply constant P/A pressure as the patient lifts their leg and slowly lowers it to the table. Pressure must be maintained during the lowering process, since this is when the sacrum will attempt to dislodge posteriorly. Two to three leg lift attempts are generally sufficient to create some degree of improvement of function.

What does a returning positive sacral cup tell you?

Chronic sacral cup findings are commonly found with sacroiliac hypermobility syndromes (category two) presenting with a moderate to severe sprain. The patient’s recovery from this condition will not likely be rapid. Even if they have pain relief, until the posterior extensors are functioning well for one to two months, they will need to exercise caution when sitting and stressing their SI joint. The repeating positive Sacral Cup Test is indicative of two aspects of the patient’s recovery process:

(1) The need for a sacrotrochanter belt, and

(2) The need to perform leg extension rehabilitative exercises.

SI Belt

The SI belt can be worn in acute phases for twenty-four hours (while sleeping, compression can be reduced). As the patient’s condition improves, the belt may be needed just for sitting, lifting objects, or whenever weight-bearing stress of the joint might occur. For some patients, this might mean two weeks, for others six to eight weeks with a gradual tapering off. When the patient’s Sacral Cup Test shows up negative for one to two weeks, the need for the SI belt will decrease significantly.

SI Joint-Sacral Cup Rehabilitation

As the sacroiliac joint stabilizes in its acute phase, prone hip extension exercises are used to encourage strengthening of the joint tissues, ligament and cartilage. As our bodies age, the blood supply to the connective tissue diminishes. This “exercise” has the goal of increasing blood supply into the SI region without further traumatizing the joint tissues. Gentle lifting of the straight leg while prone is advised. If there is low back discomfort, a pillow under the stomach may help. If nothing relieves the discomfort enough to allow them to do this exercise, then they are not ready and should focus on slow walking with minimal sitting or lifting.

While lifting, the patient’s leg is maintained in a slightly adducted and internally rotated position to maximize forces into the SI joint (rather than the lateral pelvis). While lifting, the patient should attempt to keep his/her ipsilateral hip down, lifting just his/her leg, holding for a count of two, and alternating sides with each lift.

Usually a patient with a severe joint sprain will start with three sets of three, with thirty to sixty seconds of rest between each set. After a few days, if the exercise feels easy, then it is increased to three sets of five and, as that feels easier, increase it to three sets of seven. When the patient can perform three sets of ten and is pain free, they should continue at this level without further increase for three to six months. The patient should never do this exercise to any point of pain or exhaustion—it should always feel like he/she can do more but stops.

Treatment Protocols

The recurring failure of a sacral cup to respond to category two pelvic block treatments, sacrotrochanter support belt, and rehabilitation indicates a problem with the patient’s recovery program. The key is that posterior segment displacement can only occur if the SI joint suffers significant compromise. Sometimes patients respond with a single treatment (without the need of a support belt) and sometimes they will be responsive during the office visit but return on successive visits exhibiting the return of the leg/thigh extension weakness.

This return of leg extension weakness necessitates reevaluation, which might just be changes in lifestyle, like making sure he/she walks frequently and avoids prolonged sitting as well as evaluating the need for nutritional support. As the patient gains strength, the need for joint support will diminish. Even so, the patient will still need to maintain sacral cup exercises for three to six months.

Once the sacral cup is negative for two weeks, you can begin the process of weaning the patient from belt use. However, if the sacral cup returns, you acted prematurely and need to reevaluate.

The sacral cup test evaluates posterior SI joint integrity and is an essential part of the category two treatments and evaluation. Examination should monitor not only for the sacral cup but also the presence of iliolumbar ligament integrity or lumbar involvement piriformis tone (anterior SI instability), and hip restriction (piriformis muscle syndrome). All these factors must be eliminated prior to leg length determination, category two-block placement, and additional treatment utilizing the SOT protocol. These procedures will be discussed in the next article.

Dr. Blum will be speaking at this year’s Chiropractic ‘07 Conference in Panama City, Panama, on “Neuromuscular Specific Diagnosis and Treatment of Severe Lumbar Herniated Discs” February 22-24, 2007. Aside from Panama City being a beautiful city at this time of the year, the warmth of everyone at the conference, and the vast array of amazing speakers make this a fabulous opportunity to come learn, share, and have fun.

Sacro Occipital Technique Organization (SOTO-USA is a chiropractic organization teaching SOT and performing research to investigate its efficacy. SOTO-USA teaches SOT as strictly developed by Dr. DeJarnette yet also continually updates the teaching of SOT based on the current research evidence base. Go to www.SOTO-USA.org for information about SOTO-USA seminars and don’t miss the 8th Annual Clinical Symposium in Nashville, Tennessee, October 25-28th, 2007.

 

Head banging has been reported in 3.3 to 15.2 percent of “normal” children,² but is more common in children with cerebral palsy, mental retardation, schizophrenia, autism, otitis media, teething, decreased visual acuity and certain genetic syndromes.³

The medical approach

The medical profession considers head banging a relatively harmless way of releasing tension: “If the sound of your baby’s head banging bothers you, try moving the crib away from the wall. Also be sure to tighten the screws and bolts on his crib regularly.”⁴ A helmet is sometimes recommended.⁵

What causes head banging?

Medically, the etiology of head banging is unknown. The psychoanalytic school believes that head banging is a manifestation of poor ego identity⁶ and even maternal deprivation.⁷ The latter appears related to the discredited “refrigerator mother” school of autism etiology.

From a structural perspective, head banging, head rolling, thumb sucking and other repetitive behaviors may be indicative of cranial subluxations either causing or resulting from meningeal stress. These subluxations/meningeal stresses are often the result of neurological damage caused by pre-natal or birth trauma, accidents, vaccinations, chemical stress and/or emotional stress.

Anger and other extreme emotions tighten the meningeal system and increase brain pressure; consequently, head banging is sometimes associated with tantrums.⁸ Repetitive rocking appears to be an attempt to release pressure on the brain and nervous system.

How could the cranial bones subluxate? Aren’t they fused?

Do cranial bones fuse?

Italian anatomists always considered the cranial bones to remain non-fused, while the German and British anatomists believe the bones to be fused. Americans learned their anatomy from German and British texts.

Recent research reveals the Italians are correct—the skull bones do not fuse, but remain movable throughout life.

Studies of live monkeys and sections of living human skulls sutures between the ages of seven and fifty-seven demonstrated objectively that the cranium moves in a rhythmical manner and that the sutures, rather than being fused and filled with calcified tissue, contain myelinated and non-myelinated nerve fibers, nerve receptor endings, connective tissue and blood vessels.^9-12

Accommodation to pressure

Cranial movement appears to help the body adapt to changes in air pressure. If the bones of the skull are subluxated, proper accommodation cannot occur and meningeal stress on the brain and nervous system cause pain and discomfort. That’s why children become hypersensitive when a storm is on the way.

According to an osteopathic source, “Head banging is often an indicator of stresses within the head, and not simply a sign of frustration.”¹³

In Congressional testimony, John E. Upledger, DO, developer of CranioSacral Therapy, reported: Many autistic children are known to bang their heads, chew on their wrists and/or the bases of their thumbs until deep tissue (tendon sheath) is visible, and/or they may suck on their thumbs so vigorously that the front upper teeth begin to displace forward. Actually, these thumb-sucking children are pressing on the roof of the mouth as hard as they can. We have observed that, when specific corrections of the craniosacral system are successfully carried out, these behaviors spontaneously cease. It is my opinion that the head-banging child is trying to release a compressive force in the head that is quite painful. When we release this compression, head banging stops.¹⁴

It may be no coincidence that head banging in some children occurs when walking begins¹⁵ since, at that stage, the lower back or lordotic curve forms which adds length to the spinal cord and may increase meningeal tension.

What needs to be done?

Head bangers are often trying to relieve cranial/meningeal pain. When meningeal/structural stresses are relieved, head bangers have often responded favorably:

• “Alex was given osteopathic treatment…after the second treatment his chronic head banging stopped.”¹⁶

• A 3½ year-old autistic female compulsive head banger had a “50 percent reduction in head banging” under chiropractic spinal care.¹⁷ Had the child additionally received cranial adjustments, the improvement would have, no doubt, been greater.

• “In over twenty years of practice with thousands of brain-injured children, we have found brain tension due to severe cranial sacral pressure, due to the temporal bones and sphenoid basilar junction being ‘stuck’ in addition to intense myofascial strain. After Koren Specific Technique was added to our protocol, we have seen even more rapid progress in creating good cranial rhythm, reducing fascia strain and elimination of head banging symptoms.” Matt Newell, Director of Family Hope Center, Blue Bell, PA¹⁸

What to check for

All cranial bones may subluxate; however, using KST analysis procedures, we have found the following subluxations to be the most common:

1. left and right side of sphenoids anterior (sometimes inferior/superior)

2. occipital bone inferior (sometimes lateral)

3. hard palate inferior

4. left or right parietals inferior (indicative of head trauma)

5. one or both temporal bones anterior.

Please keep in mind that every skull is different. Birth trauma may subluxate a part of the skull that is not anatomically “supposed” to be subluxated. That is especially true if there are bumps, ridges, indentations and other unusual landmarks on the child’s skull.

The upper cervical spine should also be checked for subluxations. We find the following cervical subluxations to be the most common:

1. atlas/C1 right posterior arch lateral and posterior,

2. C2/C3 disc right

3. C5 posterior

Correcting cranials using KST

Koren Specific Technique was developed to easily and quickly analyze and correct or adjust the entire structural system, including the cranial bones.

In addition to being able to locate and correct subluxations to a high degree of specificity with low force on patients, KST practitioners can analyze and adjust themselves!

For information on Koren Specific Technique (KST), go to www.teddkorenseminars.com or call 800-537-3001.

 

References

1. Vinson RP, Gelina-Sorell D. Head banging in young children. American Family Physician. 1991;43(5):1625-1628.

2. Delissovoy V. Head banging in early childhood: a study of incidence. J Pediatr. 1961;58:803-5.

3. Hyman SL, Fisher W, Mercugliano M, Cataldo MF. Children with self-injurious behavior. Pediatrics. 1990;85(3 Pt 2):437-441.

4. http://www.babycenter.com/refcap/baby/babysleep/7556.html by the Baby Center editorial staff.

5. Dawson-Butterworth K. Head banging in young children. Practitioner. 1979;222:676-679.

6. Baumeister AA. Origins and control of stereotyped movements. Monogr Am Assoc Ment Defic. 1978;3:353-384.

7. Brody S. Self rocking in infancy. J Am Psychoanal Assoc. 1960;8:464-491.

8. Berkson G. Early development of stereotyped and self-injurious behaviors: II. Age trends. Am J on Mental Retardation. 2002;107(6):468-477.

9. Retzlaff EW et al. Nerve fibers and endings in cranial sutures research report. J Amer Osteopathic Assn. 1978;77:474-475.

10. Retzlaff E, Mitchell F, Upledger J, Biggert T. Aging of cranial sutures. Anat Rec. 1978;190:520.

11. Retzlaff E, Mitchell F, Upledger J, Biggert T, Vredevoogd J. Temporalis muscle action in parietotemporal suture compression. Presented at 22nd Annual Research Convention of American Osteopathic Association, Chicago, 1978.

12. Retzlaff EW, Michael D, Roppel R, Mitchell F. The structures of cranial bone sutures. J Amer Osteopathic Assn. 1976;75(6):607-608.

13. Sutherland Cranial College http://www.scc-osteopathy.co.uk/learning.php

14. Testimony of John Upledger, April 6, 2000. Gov’t Reform Committee of the U.S. House of Representatives, 106th Congress (1999-2000). http://www.upledger.com/Clinic/autism.htm

15. Silberstein RM, Blackman S, Mandell W. Autoerotic head banging: a reflection on the opportunism of infants. J Am Acad Child Psychiatry. 1966;5(2):235-242.

16. Centers S. Autism. http://www.osteopathiccenter.org/autism.html

17. Warner SP and Warner TM. Case report: autism and chronic otitis media. Today’s Chiropractic. May/June 1999.

18. Matt Newell, Director of Family Hope Center, Blue Bell, PA. Personal correspondence to author, February 6, 2006.

Accidental Discovery

I discovered Koren Specific Technique (KST) in the best tradition of empirical healthcare: by accident. D.D. Palmer had Harvey Lillard. I had a seven-foot-high piece of heavy laminated furniture. I was blindsided as it crashed down on me, almost cutting off most of three fingers. Luckily, my head was in the way or I would have lost my index, ring and middle right hand fingers. I still have the scars.

After sleeping off the concussion, I was left with chronic hand, arm and shoulder pain and burning. I couldn’t use scissors. I couldn’t pick up my ten-month-old son. My neck didn’t feel right; I heard noises from it all the time. That wasn’t even my only problem; I had been suffering from intermittent hip, leg and sciatica pain for the prior twenty years.

Here’s the kicker: I had been getting adjusted all that time.

I immediately got adjusted but the pain worsened. I had X-rays taken that revealed loss of cervical curve, degeneration at C5, C6 and C7 and disc thinning.

“How could that be?” I wondered.

Bleeding on Patients

The daytime pain was bad enough but the hand burning would awaken me nightly. I couldn’t close my hands to make a fist and the skin began cracking and bleeding. Sometimes, I’d accidentally bleed on my patients. Some days the sciatica pain was so intense, I couldn’t walk more than ten feet at a time before having to sit down. I remember looking at a photo of three old uncles, each of whom had had back or hip surgery. In spite of all my chiropractic care, was this to be my fate also?

As my problems worsened, I started seeing DC’s with expertise in various techniques. I traveled throughout the US and Canada and even to England for adjustments. My suffering continued.

I started seeing craniosacral therapists, cranial osteopaths, homeopaths, even a physical therapist.

I continued to suffer for another two years. I felt, deep down, there was a reason for my suffering. It was this: I discovered Koren Specific Technique.

Koren Specific Technique

Koren Specific Technique is based on two wonderful chiropractic techniques: Directional Non-Force Technique (DNFT), developed by Richard Van Rumpt, DC, and Spinal Column Stressology, developed by Lowell Ward, DC. When combined with a hand-held adjusting instrument and a few modifications, the results are amazing.

The Most Difficult Patients in the World

After discovering KST, I decided to approach the most difficult chiropractic patients in the world, to see if it would work:
other chiropractors.

At my regular lectures on chiropractic science, philosophy, vaccination and humor, I’d announce before the break, “Anyone who has been adjusted multiple times with many different techniques and still has a problem, please see me at the break.”

To my surprise, a long line would form.

“Some days, I am in more pain than my patients,” doctors would tell me. It wasn’t just hand, arm, back, neck, disc, arm, leg and other musculoskeletal complaints. The doctors presented with irritable bowels, anxiety, depression, heart conditions, low immune function, weakness, “hump” patterns, migraines; sinus, vision, vocal, hearing, dizziness, insomnia, and menstrual problems; “brain fog,” post-traumatic disorders, postural problems and many other conditions and disorders.

It may sound too good to be true but, after one adjustment, there was a dramatic improvement or a complete resolution in almost everyone. They were shocked and amazed! And so was I.

Doctor after doctor said, “This is the best adjustment I’ve ever had in my life.”

Self-adjustment

But, just as amazing, I discovered that I could specifically adjust myself.

Suddenly, I took a long, fulfilling deep breath, as years of subluxation pressure released. My lungs seemed to open up. My vision sharpened, my neck and shoulders shifted in relation to gravity and old muscle tension released. I felt relaxed, balanced, stronger—and wonderful!

“This is what an adjustment is supposed to feel like,” I thought to myself.

My hand, wrist and shoulder problem resolved within a few days. My twenty-five-year lumbo-sacral disc problem and sciatica disappeared in about six weeks. (It probably would have taken less time, but then I didn’t know exactly what I was doing.) Additionally, my wife’s eleven years of chronic migraines ceased after one adjustment.

This was revolutionary. I have to show others how to do it. Chiropractors no longer have to live with chronic problems—nor do their patients.

Koren Specific Technique is a quick, easy and gentle way to locate and correct subluxations anywhere in the body. For information on taking a KST seminar, go to www.teddkorenseminars.com or call 1-800-537-3001. Dr. Tedd Koren can be reached at [email protected].

When I graduated from chiro-practic college in 1978, I elected to come back to my home state of New York to practice. At the time, the law didn’t allow for chiropractors to X-ray below L2. Chiropractors couldn’t order X-rays below L2. We were reduced to hoping there were no pathologies or contraindications. Since that time, I’ve come across a couple abdominal aortic aneurysms, several bowel issues and several bone cancers. Fortunately, I had the good sense to X-ray the patient prior to treatment.

As a new graduate, I was thrust into the cold realities of practicing on the front lines in comparison to the womb-like comforts of being a student. It was a moral, ethical, clinical and legal tennis match in the mind of every practicing chiropractor in New York.

The only precedent I was able to use to assist in my decision was the memory of chiropractors in jail for defending what they believed in. I had just graduated from National College, where I had instructors such as Terry Yochum, Joseph Howe and Reed Phillips. I believed I was more trained in radiology than any other practitioner in my county. The decision to go ahead and X-ray below L2 was an easy one for me.

Today’s X-Ray Crisis

I sit here today, almost twenty-nine years later, and see our profession faced with another X-ray challenge: how to use X-ray in a chiropractic practice. To begin with, regardless of any of our individual beliefs, our differences on this point is a critical contributor to the weakness of our profession. The public is confused about us. In medicine, an X-ray is taken and interpreted, and for the most part, all interpretations are distinctly similar. In chiropractic, we’re everything but similar.

First of all, our profession has suc-cumbed to the ranks of treating people with symptoms. Despite knowing that getting adjusted on a regular basis is a good thing, we’ve not figured out how to convey this message to the masses. So, when a patient with low back pain comes into our office, all of us use different protocols. Some take X-rays; some don’t. Some order X-rays from an X-ray facility, and rely fully on their medical reports. Of those who take their own X-rays, many will only rule out pathology, and then begin a palliative approach using chiropractic adjustments as the primary modality. And, then, there are some who use some biomechanical measurements; however, due to the restraints of insurance coverage and the pre-conceived perception by the public as to what chiropractic does, the treatment only addresses the elimination of symptoms. Rarely, will a doctor utilize quality biomechanical information as seen on X-rays, interpret and communicate it effectively to the patient, and use the biomechanical defects as the objectives for care, recommending more than just the elimination of symptoms. This approach, although rare, not only improves symptoms, but changes the future of that patient and elevates the perception and quality of chiropractic.

Structural Management™ X-Ray Protocol

 

Based on the premise that human beings are architectural structures influenced by gravity and many other daily stresses, combined with the fact that all of us are continually aging and many of us have suffered with multiple neuro-musculo-skeletal injuries, it makes sense to use the status of a patient’s structure before recommendations can be made. Secondly, every other valued asset a person owns is critically managed, such as their car, their house, their finances, etc. The thought that the human structure is only considered during a time of crisis is illogical. Using symptomatic elimination as our treatment goal ignores the very laws of nature with regard to preservation and health. If members of society knew they could preserve and slow down the degenerative changes of their structures, as well as maintain a higher level of function over the course of their lifetime, most would anxiously ask “Where do I need to go and what will it cost?”

Therein lies the need for Structural Management™.

A person’s structural status is based on age, prior injuries, genetics, conditioning, job, shoes worn, mattress used, diet, height, weight and many more contributing factors. Regardless of the symptomatic picture that exists, a standard X-ray series is performed on each patient. The three reasons for X-raying each patient is to 1) rule out pathology, 2) determine biomechanical defects, and 3) to show the patient for improved communication and understanding. If additional X-rays are required, it is up to the practitioner to make that decision.

The Structural Fingerprint™ Exam (X-Ray Component)

A four-view series is taken on every patient to determine the status and biomechanical imbalances from which all people suffer. These views consist of an A-P open mouth view, a lateral cervical view, an A-P L-S view and a lateral L-S view. All are performed in the standing position with shoes off. If the patient is in a distorted postural position due to spasms or any other condition, then only the area of involvement is X-rayed, with further X-rays taken at a later, more appropriate date.

A-P Open Mouth

Biomechanical measurements and interpretation:

1) Alignment of odontoid process with sp of C2

2) Equal atlanto-axial joint spaces

3) Equal atlanto-odontoid spaces

4) Balance of occiput with the spine

The abnormal views show imbalances in the atlanto-odontoid spaces, the relationship between the occiput and the spine and the rotation of the axis relative to the atlas. Any of these findings predictably produce an elevated irritation of the spinal column at the highest level. This finding is impossible to quantify, but as chiropractors, we’ll all agree that the “normal” X-ray is preferred over the “abnormal” X-ray, and the health of the individual with the “normal” X-ray is predictably better (all other factors being equal). The goal in this case should be an improved occipital-atlanto-axial relationship.

Lateral Cervical

Biomechanical measurements and interpretation;

 

1) A lordotic curve for shock absorp-tion

2) The center of gravity (cervical gravity line) bisecting each bone so each bone can share in the distribution of the weight of the cranium (approx. 10% of body weight).

3) Healthy disc integrity

The abnormal views show a disruption (reversal) in the curvature of the neck, with the weight-bearing line falling anterior to the spine. This biomechanical imbalance predictably increases the stresses of the C5/6 and C6/7 joint space over time, encouraging increased demands and premature degenerative changes at those levels. There is also anterior bone growth with this type of biomechanical finding, which is a reflection of Wolff’s Law in action.

A-P L-S

 

Biomechanical measurements and interpretation;

1) Level iliac crests

2) Alignment between spine and symphysis pubes

3) Equal obturator foramen shape

4) Alignment of the spine

The abnormal views show an imbalance in crest heights, an unequal size of the obturator foramen, a misalignment between the spine and the symphysis pubes as well as a mass in the lower bowels potentially being a pathology.

Lateral L-S

Normal Abnormal Abnormal

Biomechanical measurements and interpretation:

1) Sacral Base Angle between 36°-42°

2) Ferguson’s Gravity Line—the center of L3 bisecting the anterior 1/3 of the sacral base (center of gravity from the side)

3) Healthy disc integrity

The abnormal views show a decrease in the sacral base angle, a posterior Ferguson’s Gravity Line and a degeneration of L4, predictably an indication of an injury with inadequate rehabilitation rather than premature wear and tear which typically causes degeneration of L5 first.

Conclusion

If the chiropractic profession would standardize this biomechanical approach, beginning with the use of X-rays in a discreet and professional manner, we would benefit in a variety of ways;

1) The public would know what to expect when they come to us as we work to standardize not only our protocols, but our identity.

2) The chiropractic profession would address a serious need in our society today, that of Structural Management™. We, as a profession, would no longer be competing with all other providers out there who only work to alleviate symptoms.

3) As a profession, we would further reduce the incidence of malpractice claims, as a more thorough evaluation will have been done on all patients before any inappropriate care might be given.

4) The profession would begin the previously unsuccessful attempt to unify, at which time chiropractic would begin to receive the long overdue recognition we deserve.

Most importantly, many people can have biomechanical lumbar distortion patterns without symptoms. Many can have cervical distortion patterns without symptoms. If we don’t examine and identify these biomechanical faults sooner rather than later, then correction becomes an impossibility. The medical model of care, authored by the medical industry, wins, and the biggest losers are all members of society. Since we have but one life to live, shouldn’t we take part in the effort to make all people’s lives more active and less painful, more joyous and less costly? The answer is to pay now or pay later and if, presented properly, most people would gladly pay now, as the value of preserving the human structure is worth more than most of us realize.

For more information on The Structural Management™ Program, contact Dr. Maggs at 1-518-393-6566 or email him at [email protected].

 

Since finding myself in the world of teaching a new adjusting protocol/technique/system (Koren Specific Technique or KST), I’ve asked many of the doctors coming to our seminars why they took the plunge to learn a new way of caring for patients. The most common reasons given may surprise you:

1. The doctor is physically damaged from years of adjusting and needs something less traumatic to his/her body.

2. The doctor has health issues and is looking for something that can help him/her.

3. The doctor is bored or dissatisfied with his/her present system.

4. The doctor wants better results with corresponding practice growth.

5. The doctor likes learning and growing.

Of course, the most powerful motivator is pain. Whether it’s physical or emotional pain, we are in some ways like amoebas: we avoid pain and seek pleasure. That is why the first three reasons on the list are in the avoidance of pain category. I’m not writing from some high horse either; it is why I was searching for something new myself. Actually, I was in all five categories, and perhaps you see yourself in a few of them as well.

Is having a pain-free, satisfying, even pleasurable, practice important?

You bet it is! Years ago an epidemiological study on the causes of death listed unhappiness at work as the number one predictor of an early death.

“Technique doesn’t matter”

There are those in our profession who say it doesn’t matter what technique is used, as long as the doctor has the correct attitude. I do not agree. Not all techniques are created equal and not all techniques work equally well. Imagine if MD’s were to say, “It doesn’t matter what drug I give people, as long as my attitude is correct?” It’s just as silly as chiropractors saying it.

I discovered KST when, after traveling the country and being adjusted by lots of people with wonderful attitudes using all kinds of different chiropractic techniques, I still had health problems. With KST I was able to adjust myself back to wellness.

“Was it really this good?” I wondered. I started making announcements at my regular philosophy/research/vaccination seminars: “Anyone with a health issue that you still have after years of chiropractic care, see me. I’ve developed a new technique that may help you.”

I expected to see one or two people—instead the line went out the door. They would then get more dramatic results from one KST adjustment than they’d had from years of regular chiropractic care. Don’t tell me that that technique doesn’t matter; it matters big-time.

Which technique is right for you?

Deciding which technique to use is like deciding which school is right for you.

Is there a good fit? What should you look for? First and foremost, is it philosophically vitalistic or mechanistic? In other words, does it treat the body like a dumb machine or a vital, living, intelligent organism that is constantly changing, adapting and adjusting to its environment?

Is it specific? Do you know exactly what needs to be corrected or are you just introducing forces?

Do you know if the subluxation/dysfunction was corrected? Just because you get an audible doesn’t mean the subluxation is fixed.

Do you get results? If so, are they long lasting? Are subluxations really corrected or do they keep coming back? Will this technique become a bore after a while or does it permit you to explore, learn and grow?

These are all important questions to ask.

What about the cost?

On one hand, I understand when a doctor complains about the costs of learning a new technique. Indeed, some techniques are very expensive to learn and implement because of investment in machinery and staff training. On the other hand, when it comes to money, it all boils down to one thing: cost/benefit.

Will the investment pay off?

 

Let’s say you go to a seminar and get a load of new patients as a result. How much is one new patient worth? The figure can vary, but I’ve heard estimates from $1,400 to $5,000. How many patients do you need to make it worthwhile?

If you spend $1,000 on a seminar and get one hundred new patients the first year as a result, then it’s a helluva investment. But there’s another benefit.

How much are you enjoying yourself?

This cannot be overlooked. If you learn a new technique and enjoy it, if you’re not bored anymore, and if you’re excited, you’ll be happier. Your staff and patients will feel it; your practice will grow naturally.

Burnt out? Variety is the spice, well, you know.

Too many doctors are burnt out with doing the same thing all the time. Sometimes just doing something different can turn on your staff and practice.

Addicted to crack?

While I am refraining from commenting on specific techniques, I must comment on so-called “diversified” adjusting. It is among the worst techniques ever used. Actually, a lot of it is old, discarded osteopathic moves. That this racking and cracking is even taught at many chiropractic colleges is an embarrassment.

However, a lot of doctors like it because it is easy, quick and can get dramatic results as old stress patterns are suddenly shifted and released. The problem is that, after the first few adjustments, there is rarely, if ever, a dramatic improvement in the patient. In fact, you can “crack” a patient’s back three times a week for life—their subluxations never seem to go away. Is that healing? Is that chiropractic? The short answer is, “No.”

The cracking sound that doctors (and patients) often expect doesn’t even mean the subluxation was even corrected. Sometimes doctors will use a little more force just to get the sound and that can be dangerous.

In my seminars, I ask doctors how many of them were hurt in chiropractic school from these diversified adjustments. Most of the attendees’ hands go up. Further, I know of four DC’s in my area who have had surgery after years of high-force techniques.

Yes, some doctors and patients are addicted to “crack.” I’m sure there’s even a release of endorphins associated with some stress release. But it is a crude, primitive form of care that is more akin to ancient tribal health practices than modern subluxation correction.

Finally, I don’t know about you, but I’m pretty tired of all the cracking jokes of which chiropractic has been the butt. It’s time we moved on to specific, scientific procedures.

Let your practice be as sophisticated as your philosophy and science

Chiropractic, with its wonderful philosophy and science based on empirical (vitalistic) principles, deserves techniques consistent with that philosophy and science.

Are you seeing miracles?

Chiropractic was founded on medical failures. We’d take people whom medicine had given up on and give them their lives back. Are you seeing miracles in your practice? If you’re not, change your technique.

Koren Specific Technique, developed by Tedd Koren, D.C., is a quick and easy way to locate and correct subluxations anywhere in the body. It is a gentle, low-force technique. Patients hold their adjustments longer. It’s easy on the doctor, too. With KST, practitioners can specifically analyze and adjust themselves. For seminar information, go to www.teddkorenseminars.com or call 800-537-3001. Write to Dr. Koren at [email protected].

 

What is the deal with this new wave of treatment called axial decompression, spinal decompression and or IDD Therapy? Is it truly the greatest thing next to sliced bread (for the treatment of back or neck pain) or is it just a passing trend?

Axial decompression therapy has reached the highest level of interest ever, even though it is not a new treatment. It is a successful alternative treatment to surgery for patients with appropriate disc conditions for the cervical and lumbar spine. The way it works is by reducing pressure or creating a negative pressure inside the disc by a directed force to the desired disc level (L1-L5) and the force can be redirected by changing the vector of force. This is implemented by immobilizing both the pelvis and the thoracic spine. Axial decompression causes a negative intra-discal pressure to develop, causing oxygen, water and nutrients to be pulled into the disc. As this happens, the healing process inside the disc is facilitated by giving the chondroblasts, as well as the fibroblasts, what they need to heal.

Most readers, by now, understand that axial decompression is not traction and that traction has many limitations; one of which is related to the weight of the patient. The amount of force used in traction is limited to 50lbs and this does little more than separate the facet joints.

Lumbar axial decompression was developed by Dr. Alan Dyer, a former Canadian Deputy Minister of Health, and he was the designer of the Vax-D. The Vax-D is the predecessor to more recent axial decompression tables, such as the DRS System, the Spine-Med, Spina, DRX 9000, ABS and many others.

One thing is certain, axial decompression is a hot item and an important business, but the technology really does work. Axial decompression is the biggest innovation for the non-surgical treatment of appropriate lumbar and cervical disc conditions.

Axial decompression should not be just another trend that will go the way of any trend, craze or phase, if we know what we are doing. We must know what conditions can successfully be treated with axial decompression, how to educate the patient and how to be paid for the services rendered.

I have successfully treated thousands of patients for conditions of herniated and degenerative disc, sciatic pain, numbness and tingling in the legs, arms and hands and failed back and neck surgery pain with this technology for over ten years. These patients have generally seen multiple doctors, have had epidural injections, taken steroids, anti-inflammatory medications, pain medications, physical therapy, and failed surgeries. I can attest, based on ten years proven success, axial decompression does work! Outcomes are excellent. Results are predictable and reproducible. Patients respond exceptionally well to care, avoid surgery and achieve sustained improvement after treatment is completed!

Why are the successful results of my patients and practice so predictable and reproducible? The answer is there are procedures and protocols that must be implemented in order for axial decompression to be successful. The procedures, which are a series of steps followed in a regular order, which begin with the first new patient telephone call and continue throughout care. The procedures apply not only to staff but also to the doctor. The procedures are detailed and exact, not just visit to visit, but word to word, and by patient category. Procedures are exact, absolute and learned by consistent and continual training by both doctor and staff. These procedures are ultimately responsible for influencing the patient to begin care.

The protocol, which is a specific treatment regimen, is equally as important as procedure and must be customized and individualized for each patient. The doctor—not the manufacturer—determines each patient’s treatment plan. This is much more involved than just placing a patient on the axial decompression table.

Successful results are also determined by accepting the correct patient and condition. This decision is based on specific criteria: a review of films and examination findings, establishment of diagnosis, and evaluation of the patient type. After assessing all information, including patient type, the doctor determines if the patient is a candidate for successful axial decompression.

Now everything falls on the doctor’s ability to communicate so that the patient fully understands, believes, responds and achieves. Therefore, again, it is back to procedure. The doctor’s training on procedure of presentation will determine whether the patient begins care. If the doctor communicates successfully, purposely and makes sense about the necessity of their care, the patient has confidence, begins care and responds well.

Several times each week, I have doctors who have axial decompression tables of various makes and models call and ask the same questions: “How do you make this work?” “How do you make any money with this thing?” “Are you getting reimbursed?” “What codes are you using?” “How do you get patients to pay for it?”

My response remains the same. “Well, Doc, these are questions that you wish you had asked before investing in a table, right? You probably wish you had discussed all this with someone who was successfully treating with axial decompression. I know it was all supposed to be so easy.”

The real answer is that it takes intensity, drive and the desire to seek outside reliable resources to get to the next level. It is an investment and similar to opening another practice. It is not like the movie, Field of Dreams; if you build it, they will come. It is not just financing a table, or parking a table in your office and expecting patients to show up and hop on. You have to understand how to operate, market, and train, not only yourself but also your staff, on how to successfully run a cash and an axial decompression practice.

Axial decompression will continue to explode in this market as well as the medical market. Axial decompression is a very successful, conservative treatment for the patient, as an alternative to invasive surgery and other medical treatment options. Axial decompression can create another tier for your existing practice, allowing you to successfully treat patients that may not have responded to standard chiropractic care. The technology is safe, effective and successful. In most communities, axial decompression is well recognized by the medical profession as a viable alternative to surgery, and inter-professional referrals are standard.

Doctors, you should consider investing in axial decompression; however, learn lessons from someone else’s experience. Get counsel and investigate; do your research, because there is more to it than writing a check. Become an educated consumer and not an impulsive buyer. There are specific and correct methods, from beginning to end, for running a successful, axial decompression/cash practice.

Dr. Richard E. Busch III, President and Founder of Busch Chiropractic Center, Fort Wayne, Indiana, established what could be considered the largest single-practitioner, axial decompression cash practice in the world. Dr. Busch is co-founder of Freedom Awaits™, a program teaching exact, step-by-step procedures to establish a highly organized first-class practice, and how to implement a case fee cash program for an axial decompression practice.

To contact Dr. Busch, call 888 – DRS – BACK, or e-mail [email protected].

Using different terminology, D.D. Palmer
(chiropractic), A.T. Still (osteopathy) and Samuel Hahnemann (homeopathy) all recognized life as a triune of matter (physical), energy (emotion) and consciousness (intelligence) and viewed dis-ease as the result of disharmony amongst them.

There is no purely physical or purely mental illness—all physical illness includes emotional symptoms and all emotional illness includes physical symptoms.

Physical balance can relieve emotional disorders; emotional happiness promotes physical health; and spiritual connections can cure physical and mental illness.

Physical, mental, spiritual subluxations?

A subluxation is the physical expression of a mind/body/spirit disharmony; the three are interrelated.

Koren Specific Technique (KST) works with the body’s wisdom to locate subluxations. KST asks the body/mind, “What is the priority?” “What is the first subluxation needing correction?

The occipital drop
The body responds to properly asked questions with physiological biofeedback. Leg length shortening (Van Rumpt’s DNFT™ and Truscott), muscle weakness (Applied Kinesiology™) and autonomic tone (Toftness™) are examples of biofeedback systems.

KST uses the occipital drop (OD), wherein the occipital bone appears to drop on one side when challenged.

Discovered by Lowell Ward, DC (Spinal Column Stressology), the OD has certain advantages:

1. The patient can be checked standing, sitting or in position of subluxation, injury, etc. No table is usually needed.
2. No muscle fatigue.
3. It correlates to AK, to Van Rumpt/Truscott and to Activator™.
4. One can test oneself.
5. It responds to both physical and mental challenges.

Adjusting instrument
Some subluxations are best revealed when standing, sitting or holding a certain posture; an adjusting instrument permits us to adjust in the posture of subluxation. Less force is needed—it is much easier on doctor and patient alike.

Using biofeedback
We are limited only by the questions we ask. When we start asking about subluxations, we should be open to the answers we get.

“Where is the subluxation?” I asked one patient’s body when I first discovered this system.

I was directed to the cranium.

The cranium? Cranial subluxations?

I was also directed to the spine, discs, ribs, femur heads and other places. I noticed something very interesting.

1. The body had a priority or order in which it wanted subluxations corrected.
2. Sometimes a segment was adjusted a second time after other subluxations were released.
3. The body knew what it wanted and I shouldn’t question it because…
4. I was pretty stupid compared to the body’s wisdom.

But most importantly
Most importantly, patients were responding faster and holding their adjustments longer. People who had not responded to other techniques were responding now. Also, it was psychologically easier: Since I was learning from the body, I didn’t have the pressure of having to know all the answers; I only needed to ask and listen.

Where will this lead us?

Sometimes the body says to check for dehydration (usually a cause or contributor to disc problems, depression, etc.), scars interfering with the flow of body energy, footwear, emotional factors (we use a KST-modified version of NET) or something else. Most of the time it’s pretty simple; sometimes it’s not.
 
Subluxations are ubiquitous
People are healed by many different kinds of healers and systems because the real healer is within. The various healing modalities are merely different ways of activating that inner healer. ~ George Goodheart, from Innate intelligence is the healer, in Healers on Healing, Carlson R and Shield B (Eds.)

There are so many ways we can disconnect from our wholeness. Using KST we do not make assumptions about what a person needs—we ask, and learn to respect their inner wisdom.

In conclusion
Chiropractic links the spiritual with the material. ~ D.D. Palmer

From the earliest days of chiropractic, D.D. Palmer saw the subluxation as a disconnection between body, mind and spirit. The subluxation has an intangible component (intelligence or consciousness) that can and should be addressed.

Physically, mentally and spiritually we are far healthier than we think we are. Each person’s innate wisdom is constantly trying its best to communicate to us. We have to learn to ask the right questions and to respectfully listen to the answers.

Koren Specific Technique, developed by Tedd Koren, D.C., is a quick and easy way to locate and correct subluxations anywhere in the body. It is a gentle, low-force technique. Patients hold their adjustments longer. It’s easy on the doctor, too. With KST, practitioners can specifically analyze and adjust themselves. For seminar information, go to www.teddkorenseminars.com or call 800-537-3001. Write to Dr. Koren at [email protected]. 

Trauma, especially motor vehicle crashes (MVC), can change an individual’s posture. This will, in turn, affect the victim’s stance and gait, due to soft and hard tissue injuries which cause abnormal function.

Humans adapt in time and need to their environment. The human body must adapt when external forces damage the internal environment. This induced aberrant posture causes the body to function in a minimum, although abnormal, energy state.

The lordotic curves of the spine give the spine strength and stability. Ligament damage to the posterior ligaments found after whiplash causes a loss of the cervical lordosis and forward head posture. This ligament damage is diagnosed as a loss of motion segment integrity.

In a study of motor vehicle patients, Burl Pettibon, DC, and Ray Wiegand, DC, found an abnormal extension malposition of the occiput (C0) on the Atlas (C1).1 This abnormal spinal displacement subluxation results in a loss of cervical lordosis and Forward Head Posture (FHP).

Forward Head Posture is better acknowledged as “Forward Head Syndrome,” and can cause many symptoms, including back pain, headaches, depression, emphysema, intestinal problems, hemorrhoids, varicose veins, osteoporosis, hip and leg deformities, poor health, decreased quality of life, shortened life span, breathing difficulties, hormonal imbalances, spinal pain, headaches, mood swings, high blood pressure, lung and pulse problems, decreased lung capacity and bone changes.2

George Ehni, MD, states, “Ligaments are made of collagen. Collagen fibers can only elongate four percent before they rupture.”3

Ruth Jackson, MD, states, “Ligaments heal with fibrous tissue in an irregular pattern, which is less elastic and less functional. It is different from the origin tissue.”4

When a fractured bone heals, it heals through osteoblastic activity with new bone cells, in four to six weeks. When ligaments are torn, they heal though fibroblastic activity with fibrous or scar tissue. John Kellet said, “The organization of normal ligament tissue has not been approached by the remodeled scar tissue even after forty weeks of healing.”5

In MVC, the cervical spine does not simply go through extension and flexion. The initial phase is compression of the cervical spine followed by traction, with flexion of the upper cervical spine and extension of the lower cervical spine. This produces a kyphotic S-Curve. This is a non-physiological motion of the vertebral segments.6,7

The average car accident occurs in 200 milliseconds. The nervous system reacts in 350 milliseconds. The nervous system does not have enough time to adapt a neuro-muscular protection, and injuries result.

The head experiences initial flexion BEFORE it touches the headrest. The entire spine experiences straightening and compression. At 9.5 km/h or 6 mph, the cervical spine experiences a compressive load of fifty pounds. At the same time, the spine’s shear strain is twenty-two pounds. When the cervical spine is compressed, it loses its ability to withstand shear forces. A forty-pound load reduces facet stiffness by 73%.”7

Calliet explains that, for every inch of forward head posture, the apparent weight of the head increases by ten pounds.8 There also may be serious ligament damage to the posterior longitudinal ligament. This is clearly explained in the AMA’s Guides to the Evaluation of Permanent Impairment, 5th edition, November 2000.9

It is not disputed that many healthy-appearing individuals may have herniated or bulging discs and degenerative changes. The Guides state, “Several reports indicate approximately 30% of persons who have never had back pain will have an imaging study that can be interpreted as positive for herniated disks, and 50% or more will have bulging disks. Further, the prevalence of degenerative changes, bulges and herniations increases with advancing age.” (Page 378)

“While disc problems and degenerative changes are common in the general population, loss of motion segment integrity is rare, unless accompanied by trauma.” Chronic areas will show associated degenerative changes while acute areas will not.

The Guides further state, “When routine X-rays are normal and severe trauma is absent, motion segment alteration is rare; thus flexion and extension X-rays are indicated only when the physician suspects motion alteration from history or findings on routine X-rays.” (Page 379)

“Motion Segment Integrity is defined as two adjacent vertebra, the intervertebral disk, the apophyseal or facet joints, and ligamentous structures between the vertebra. Alteration of motion segment integrity can be either loss of motion segment integrity (increased translation or angular motion) or decreased motion.” (Page 378)

A line is drawn along the posterior bodies of the vertebra below and above the motion segment in question in dynamic (flexion and extension) lateral roentgenograms of the spine. The distance between lines A and B and the distance between lines B and C at the level of the posterio-inferior corner of the upper vertebral body are summed. A value of greater than 3.5 in the cervical spine qualifies as a loss of structural integrity. (See Figure A)

Lines are drawn along the inferior borders of the two vertebral bodies adjacent to the level in question and of the vertebral bodies above and below those two vertebrae. Angles A, B, and C are measured on both flexion and extension X-rays and the measurements subtracted from one another. Note that lordosis (extension) is represented by a negative angle and kyphosis (flexion) is represented by a positive angle. Loss of motion segment integrity is defined as motion at the level in question that is more than eleven degrees greater than at either adjacent level. (See Figure B)

Loss of motion segment integrity (MSI) is defined as “an anteroposterior motion of one vertebra over another that is greater than 3.5 mm in the cervical spine.” (Page 379)

A study published in Spine indicates that angular displacement should be less than seven degrees and that translation (MSI) should be less than .06 mm.10
The Guides further state that this may not show up on a standard examination: “Motion of the individual spine segments cannot be determined by a physical examination but is evaluated with flexion and extension roentgenograms.” (Page 379)

The Guides place a high impairment rating on a loss of motion segment integrity. In the cervical spine, 3.5mm equals 25-28% impairment. This is so important and severe that the Guides equate this damage as equal to a vertebra that has a compression fracture greater than 50%. The reason is that this type of damage to the soft tissue causes abnormal function of the spine and posture!

This ligament instability can lead to a loss of cervical and/or lumbar lordosis. This kyphotic spine is an abnormal form and leads to abnormal function. Abnormal anatomy causes abnormal physiology, which results in pathology. This adverse mechanical tension on the central nervous system can lead to a chronic central mediated pain syndrome.

The lordotic curves of the spine give the spine strength and flexibility. Kapandji states that the # curves + 1 = resistance. With the loss of the lordosis, the body loses strength and flexibility.10 Oktenoglu, et al., state, “It is concluded that a loss of lordosis increases the risk of injury to the cervical spine following axial loading.”11

This loss of lordosis has ramifications with regard to health. Shimizu states that progressive kyphosis of the cervical spine results in demyelination of nerve fibers in the funiculi and neuronal loss in the anterior horn due to chronic compression of the spinal cord.12

Previous studies have suggested that spinal cord compression by the vertebral bodies and intervertebral discs during neck flexion causes cervical flexion myelopathy (CFM). Axial MRI/CTM demonstrated flattening of the spinal cord with the posterior surface of the dura mater shifting anteriorly. The findings of this study suggest that degenerative changes of the dura mater may be a characteristic pathology of CFM.13

Giuliano, et al., compared 100 trauma patients with 100 normal subjects, using flexion and extension MRI.14 The ages varied from 18-53, with an average of 35. The patients were 12-14 weeks post injury. In the normal subjects, hypolordosis was found in 4%.

In the trauma patients, hypolordosis with a loss of normal segmental motion pattern was found in 98%. There were 2% asymptomatic disc herniations in the normal group and 28% disc herniations in the trauma patients. “In no instance was disk herniation and spinal stenosis observed in the absence of hypolordosis and segmental motion restriction.”

From this study, it can be stated that individuals with a normal cervical lordosis do not have symptomatic disc herniations. Therefore, the way to correct disc herniations is to restore a normal lordotic curve in the spine.

Ligament damage results in FHP and a loss of the cervical lordosis. Through proper protocols, it is possible to restore the normal lordotic curves of the spine. (See Fig. 1)

A loss of the lordosis causes a stretching of the spinal cord. The diagonal fibers of the dura mater cause a pincer effect when lengthened. Yuan & Marguiles state, “Between a neutral posture and full flexion, the entire cord (C2-C7) elongated linearly with head flexion, increasing 10% and 6% of its initial length along the posterior and anterior surfaces respectively.” Average displacement was 1-3 mm. The upper cord moved caudal and the lower cord cephalad with larger movements on the posterior surface.15

The European Spine Journal, in 2001, indicates a relationship between a loss of lordosis and scoliosis: “A short, unforgiving spinal cord could produce the abnormal rotatory anatomy observed at the apex in scoliosis with, first, lordosis, then lateral deviation and, finally, a rotation of the vertebral column, with the rotation occurring between the canal and the vertebral body, around the axis of the cord.”16 Based upon this, it would also be possible to correct and/or improve scoliosis without bracing and surgery. (See Fig. 2)

These abnormal findings can also be substantiated through the utilization of Myologic computerized muscle testing and range of motion evaluation. This objective outcome assessment is a diagnostic tool that objectively verifies abnormal function as well as determines proper treatment. These changes can be also be verified by CROM, Neck Disability Index, and the Rand 36 activities of daily living / quality of life.

Based on the above, it would appear that rehabilitation and restoration of the cervical lordosis is necessary as a contribution to the health of the individual. The question is then asked, how may this be accomplished?

Standard medical military traction is performed to open the intervertebal foramina (IVF’s), with no regard to the lordosis. This may actually be detrimental in the long run.

In the chiropractic profession, there has been little research as to what is the best way to rehabilitate the cervical lordosis. Current treatment consists of cervical pillows, cervical roll for spinal molding, Posture Pump, fulcrums, head weights, circular traction, Extension Compression Traction, cervical collar brace, limited vision glasses and specific adjusting procedures.

One of the newest procedures is cervical Vibrating Traction (VT)™. The premise behind the Vibrating Traction™ is simple. Research done by top scientists has suggested that occupational drivers tend to suffer from a higher-than-average incidence of low back pain, due to the effect of the engine’s vibration upon the spinal discs.¹ When the vertebrae of the spine are compressed, as in a sitting position, this vibration “grinds down” the discs, reducing their effectiveness in absorbing the force of gravity. But, if the discs and ligaments are vibrated while they are in an uncompressed, relaxed state, it turns out that the exact same frequency has highly beneficial effects in relaxing ligaments and discs, as well as rehabilitating the spine.17,18,19 (See Fig. 3)

The loss of cervical lordosis and resulting forward head posture is detrimental to the health of the individual. Proper treatment should focus on the restoration of the lordosis. There is much to learn with regard to the spinal rehabilitation of the curves of the spine.

The purpose of CLEAR Institute is to empower the DC who wants to specialize with the patients who have scoliosis and the doctors who treats them.
For Seminar information contact Parker College of Chiropractic at www.parkerseminars.com, or call 1- 800-266-4723.
For information on The Vibe or Vibrating Traction (VT), contact Williams Healthcare Systems at www.williamshealthcare.com or call 1-800-441-4967.
For further information, contact Dr. Dennis Woggon at www.clear-institute.com

1. Burl Pettibon DC. Private Practice Garland Texas, 1994 (anecdotal reference)
2. Dennis Woggon, BSc, DC, CLEAR Institute, Posture, Vol. 1, #1, Dec. 2002
3. George Ehni, MD. Cervical Arthrosis, 1984
4. Ruth Jackson, MD. The Cervical Syndrome
5. John Kellet, Acute Soft Tissue Injuries
6. Grauer, Panjabi et al, Spine, 1997
7. Ono, et al. Society of Automotive Engineers, Strapp Car Crash Conference, 1998
8. Rene Calliet, MD. Neck and Arm Pain.
9. AMA Guides to the Evaluation of Permanent Impairment, 5th edition, November 2000, Chapter 15, pages 378-392
10. Kapandji. Physiology of the Joints, Vol. 3
11. Effects of Cervical Spine Posture on Axial Load Bearing Ability: A Biomechanical Study, Oktenoglu et al, Dept. of Neurosurgery, VKV American Hospital, Instanbul, Turkey, The Cleveland REFERENCES
Clinic Foundation, Cleveland, Ohio, J. Neurosurgey: Spine, Vol. 94, January, 2001
12. A New Model of Kyphotic Deformity Using Juvenile Japanese Small Game Fowls. Spine. 30(21):2388-2392, November 1, 2005. Shimizu, Kentaro MD *; Nakamura, Masaya MD *; Nishikawa, Yuji MD +; Hijikata, Sadahisa MD +; Chiba, Kazuhiro MD *; Toyama, Yoshiaki MD * Abstract:
13. Pathophysiology and treatment for Cervical Flexion Myelopathy. Fujimoto Y, Oka S, Tanaka N, Nishikawa K, Kawagoe H, Baba I. Department of Orthopaedic Surgery, Hiroshima University School of Medicine, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551 Japan. [email protected]
14. The Use of Flexion and Extension MRI in the Evaluation of Cervical Spine Trauma: Initial Experience in 100 Trauma Patients Compared with 100 Normal Subjects” Giuliano et al. Emergency Radiology (October 2002) 9: 249-253
15. In Vivo Human Cervical Spinal Cord Deformation and Displacement in Flexion, Yuan & Marguiles, Spine 1998: 23:1677-83
16. Can a short spinal cord produce scoliosis? Eur Spine J 2001 Feb;10(1):2-9
17. The biomechanics of lumbar disc herniation and the effect of overload and instability, Wilder, Pope, Frymoyer. Journal of Spinal Disorders 1988;1(1):p16-32, Univ. of Vermont, Burlington.
18. Energy Medicine: The Scientific Basis, Oschman. Churchill Livingston Publishing, 2001.
19. Neck muscle vibration induces lasting recovery in spatial neglect, Schindler et al. Clinical Neuropsychology Research Group, City Hospital Bogenhausen, Munich, Germany.

 

An alternative to spinal surgery

Sometimes the most difficult cases are not due to subluxations of the vertebrae but to subluxations of the disks. As Richard Van Rumpt, DC, developer of directional non-force technique (DNFT) said decades ago, “If the disks are subluxated, the vertebrae won’t hold.”

Is it possible to adjust disks? Yes, it is possible to easily and quickly locate and adjust subluxated disks.

Do herniated disks require surgery? Rarely. In most cases, even a herniated or ruptured disk can heal without surgery. Most heal spontaneously.

As Jerome Groopman, MD, writes: “A recent study of CT scans showed that twenty-seven percent of healthy people over the age of forty had a herniated disk, ten percent had an abnormality of the vertebral facet joints and fifty percent had other anatomical changes that were judged significant. And yet, none of these people had nagging back pain. Another study using MRI scanning, showed that thirty-six percent of people over sixty had a herniated disk, and some eighty to ninety percent of them had significant disk degeneration.  Even patients with acute ruptured disks have a good prognosis, though their recovery is usually slower; some ninety percent will feel significantly better within six weeks, without surgery. Over time, the disk gradually retracts, so that it is no longer pressing on the nerves and the inflammation subsides.”1

Back surgery

Back surgery is perhaps the most dangerous and useless surgery ever developed. “Spinal medicine, unfortunately, is producing patients with failed back surgery syndrome at an alarming rate.”2

According to Norma Shealy, MD: “It was obvious to me that vast majorities of people suffering from chronic pain were actually the result of unnecessary back surgery. In one study, I demonstrated that at least eighty percent of those who had had lumbar surgery for a presumed ruptured disk had not had a ruptured disk before their first surgery. But, by the time they had had between five and seven unsuccessful back operations, they certainly were invalids.”3

No one knows how many of the over 150,000 spinal fusion operations and the 500,000 total spinal surgeries performed each year in the United States are unnecessary. I would guess the number to be over ninety-five percent.  Chronic pain clinics are filled with back surgery failures. Can the disk be addressed without surgery?

How can you adjust the disk?

Years ago, when I studied Van Rumpt’s work with Drs. Pat and Mike McLean, I was instructed as follows: In order to adjust a disk, you must find a tight fiber a few inches lateral to the spine and adjust into it.

“How can that be?” I asked.

“We don’t know the mechanism, but it works,” they said.

The answer may be found in a fascinating phenomenon known as myofascial gelosis, discovered by Janet Travell, MD (discoverer of trigger points).4  Myofascial means relating to the fascia connective tissue, and gelosis means an extremely firm mass in a tissue.

Adjusting the bands

It appears that, when a disk is subluxated, the normally soft, pliable connective tissues surrounding it transform into relatively taut bands. These bands help anchor and stabilize the disk, as guy wires, to protect it from further injury. They are easily palpated as thin bands emanating laterally from the disk—often reaching many inches away.

These bands can be exquisitely sensitive along their length. Dr. Van Rumpt used wooden dowels and a deep thumb toggle—the adjustments could sting.

The results? Three case histories

The technique I developed for adjusting disks is one that applies concepts from Van Rumpt, Lowell Ward and others, using an adjusting instrument. Using the negative (index) finger, the doctor locates a “hot” disk and taut fibers. A body biofeedback device (such as the occipital drop) is used as a “yes-no” indicator. We can then introduce a relatively light force anywhere along the length of the fiber using an adjusting instrument. The results are often amazing.

Case #1. Forty-nine year old male, bedridden with severe back and leg pain. Not able to stand. Had an MRI. By third adjustment, he was able to walk with crutches. By the sixth adjustment, he could stand without pain for about thirty seconds—first time in five days he was pain free.

After ten days he was completely pain free with eighty percent strength in leg. Neurosurgeon was at a loss to explain his recovery. He told patient, “Your MRI is the second worse disk herniation I’ve seen in my career. I would recommend immediate surgery. I cannot believe you are pain free.”5

Case #2. Patient hurt his low back in an accident and was making very slow progress after six weeks of three-times-a-week of diversified adjusting. I had guessed his problem was a disk, and my history with disks was it takes a while to mend. After one adjustment (to the disk) he stated he was fifty percent better; after the second, no more pain, and is bringing in the wife.6

Case #3. I had seen a patient years prior for low back pain with radiating leg pain and numbness/tingling down the leg. Poor response. She discontinued care and, eventually, had surgery to “repair” her disc. She still had numbness/tingling in her foot, even months after the surgery.

She returned to the office. I started adjusting her with KST. After a few adjustments, the numbness/tingling was gone and whatever remaining LPB she had went as well. She was amazed and very pleased. On a follow up with her surgeon, she told him her symptoms were gone because she was back under chiropractic care.7

One final note: dehydration

I have never seen a disk patient who was not dehydrated. Most disk sufferers are moderately to severely dried-out and that may be a major reason why their disks start weakening and compressing in the first place.

The earliest sign of disk herniation is decreased signal on a T-2 weighted image due to desiccation and dehydration of the disk. This is usually associated with a loss of height and a bulging of the annulus fibrosis circumferentially.8

Putting patients on an aggressive hydration plan (a glass of water every hour—not iced or distilled) for one to two weeks can often result in dramatic improvements.

It is gratifying to see that simply drinking water (rehydrating) and adjusting the disk and/or vertebra can help the patient at a fraction of the cost of medical and mechanical traction devices.

Dr. Tedd Koren is the founder of Koren Publications and developer of Koren Specific Technique (KST), an Empirical/Vitalistic method of locating and correcting subluxations anywhere in the body that is easy to learn and is revolutionizing chiropractic practices.. For information on KST seminars, go to www.teddkorenseminars.com or call 1-800-537-3001.  Write to Dr. Koren at [email protected]

References
1. Groopman J. A knife in the back (Is surgery the best approach to chronic pain?). The New Yorker. April 8, 2002.
2. The BackLetter. Philadelphia: Lippincott Williams and Wilkins. 2004;12(7):79.
3. Shealy CN. Chronic pain management. The Townsend Letter for Doctors & Patients. January 2005.
4. Simons DG, Travell JG and Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1; The Upper Half of Body (2nd Edition). Philadelphia: Lippincott Williams & Wilkins. 2nd edition (October 1998).
5. Tedd Koren, DC. Conversation with patient. September 12, 2006.
6. Brad Miller, DC. Personal correspondence with author. September 6, 2006.
7. Warren Silver, DC. Personal correspondence with author. September 13, 2006.
8. Bradley WG. MRI of degenerative disease of the lumbar spine. https://e-edcredits.com/XrayCredits/article.asp?TestID=12

You try all your regular approaches and the patient reports that “it’s a little better,” but your adjustment doesn’t seem to hold. If you’re like most chiropractors, this has happened in your office, too.  You could keep adjusting the patient every week, but what if you could address the patient’s “emotional physiology of thought” and then your adjustments would hold?  This has actually happened, to the delight of thousands of chiropractors around the world and the many thousands of their patients who have received relief with the correction of their dreaded chronic subluxations and associated conditions.

How does this happen? 

Practitioners trained in helping patients who have an emotional/physiological component to their subluxation generally use a combination of the following dynamics:

1. Muscle Testing.  Applied Kinesiologists have traditionally used muscle testing as an indicator of impaired physiological function (Goodheart, 1964).  Chiropractors who use muscle testing often work with the premise that the muscle will be less able to resist outside force when there is some non-congruency in the function of the nervous system.  This premise has been validated by Monti.1

2. Emotions are physiologically based.  Much of the neurophysiology of emotion is based on various chains of amino acids, called peptides, which travel throughout the entire body via extra-cellular fluids to distant “catcher” amino acid chains called receptors. “This is one reason,” Pert says, “we contend that this ‘whole body’ system—the system of neuropeptides, the system of emotion —can play a critical part in matters of health and disease.”2

3. Pavlovian Responses.  Humans, as well as animals, can be conditioned.  Often, events in our surroundings (like a ringing bell!) can trigger a physiological reaction in our body.  Sometimes we’re aware of it, and sometimes it happens without our conscious awareness.  Of course, much study has been done on this, including the original work by Pavlov.

4. Physiology and the Meridian System.  This is a 1,500- to 4,000-year-old principle.  Acupuncture theory has clinically validated that specific emotional responses are linked with specific meridians.  Classic examples are how “anger” is associated with the liver meridian and “fear” is associated with the kidney. 

5. Repetition Compulsion.  One of Freud’s contributions was the concept of repetition compulsion, which essentially expresses that, once we have been emotionally traumatized, we tend to unconsciously seek to repeat a similar pattern in the future.  The physiology of the body may work in a similar manner. 

6. The Role of Thought and Physiology.  By remembering an emotional event, important somatic and visceral modifications can take place in the body.  Hassan and Ward write, “The recollection of perceptions, which implicates neocortical processes, may evoke (through descending connections via ‘limbic system,’ hypothalamus, brain stem, and spinal cord) the somatic and visceral motor changes which occurred in the original situation.”3

7. Semantic Responses.  A person whose physiology is reactive to the sight of a spider can also be reactive to a picture of a spider, the thought of a spider, or even react to verbal communication.  Monti found this to be true in his Muscle Test Comparison paper, stating, “Overall, significant differences were found in muscle test responses between congruent and incongruent semantic stimuli.”4

8. Homeopathy.  A scientific system of health care that is known to activate the body’s own healing processes and help the body detoxify.  Thousands of research studies support the effectiveness of homeopathy in detoxifying the physiological chemistry of the body.

How can you identify if a chronic subluxation has an emotional/physiological reactivation factor?  Traditionally, using the science and art of muscle testing, the chiropractor can two-point a chronic subluxation to the Emotional Points to discover if there is an emotional/physiological component. The Emotional Points, which were discovered by Bennett (in the 1930’s), are located bilaterally on the forehead, directly above the pupils and halfway between the eyebrows and the natural hairline.

Using the above two steps (See Pg.30) doesn’t correct the situation, but it does help identify a possible component of why your patient’s adjustment is failing to hold.  If the above testing indicates that there may be an emotional/physiological pattern, you can take a different approach in stabilizing the chronic subluxation, rather than continuing to adjust your patient over and over again with the same result of little to no relief. Nowadays, there are many wonderful techniques available to address the emotional/physiological component, and you may even want to refer the patient to a trained professional who deals with this factor if you don’t have such a tool in your present “tool box of techniques.”  The extinguishment of the emotional/physiological conditioned response associated with chronic subluxations offers great relief for our patients who fail to respond to our traditional approaches.