Category: Techniques

CranioSacral Therapy (CST) is a manual modality that has made its way into the chiropractic clinic as an effective adjunctive therapy.  It focuses on normalizing the craniosacral system, which extends from the skull, face and mouth down to the sacrum and coccyx.

The craniosacral system consists of a compartment formed by the dura mater membrane, the cerebrospinal fluid within the membranes, the systems regulating fluid flow, the bones that attach to the membranes, and the joints and sutures interconnecting these bones.

The system operates like a semi-closed hydraulic system based on the rhythmic rise and fall of cerebrospinal fluid volume and pressure in the dura mater.  According to research^1-8 performed at Michigan State University, the bones directly relating to the dura mater must be in continual, minute motion to accommodate the constant fluid pressure changes within the membrane compartment. 

Through gentle palpation, the CST practitioner uses the craniosacral rhythm as a diagnostic and therapeutic tool.  The rhythm is produced by the craniosacral system and its attached bones as they move to accommodate the filling and emptying of cerebrospinal fluid.

The changing volume and pressure cause corresponding changes in dura mater membrane tensions, which induce small accommodative movement patterns in these membranes.  When the natural mobility of the dura mater or any of its attached bones is impaired, sensory, motor or neurological disabilities can result.

CranioSacral Therapy can effectively release those restrictions and allow the membranes and bones to assume normal mobility.

Applications of CST

My interest in CST was piqued by its ability to affect soft tissues that, when contracted, can pull on bones.  One patient came to me complaining of headaches.  I found muscle contraction in the left leg from a previous ankle sprain.  When I released the muscle and fascia, the structure easily went back into place and the headaches went away.

Another patient had sustained a mid-thigh blow.  I worked to release contraction in the belly of the muscle and fascia, which allowed the leg and pelvis to release.

The effects of CST on the dural tube is especially impressive.  Sometimes a manipulation won’t completely release a dural tube restriction.  But, if I release the dural tube first, the manipulation can become easier to achieve and more comfortable for the patient.  CST also gives me another view to consider if the vertebrae isn’t holding the manipulation.

The beauty of CST is how you can influence cranial nerves by releasing membrane restrictions inhibiting their function.  This has been helpful in addressing tic douloureux, head injuries or Bell’s palsy.

I once saw Tom, who was diagnosed with Bell’s palsy.  He woke up one morning to find his face paralyzed.  After one office visit, he reported about 50 percent relief.  About three weeks of visits later, he considered the problem solved.  His emotional outlook was better, too—he had been told he might suffer the effects of Bell’s palsy for months or more.

Other conditions that respond to CST include TMJ syndrome, chronic back pain, central nervous system disorders, migraine head-aches, orthopedic problems and chronic fatigue.  It can be used with children to address cerebral palsy, motor-coordination impair-ments, learning disabilities and attention deficit disorders.

Contraindications include conditions adversely affected by subtle changes in intracranial fluid pressure: acute intracranial aneurysm with threat of rupture, acute cerebral hemorrhage, acute subdural or subarachnoid bleeding, and situations in which increased intracranial pressure that could precipitate a medullary or brain stem herniation through the foramen magnum.

CST vs. Other Cranial Methods

While CST has been compared to Cranial Osteopathy or Sacro-Occipital Technique (SOT), the methods are quite different.

Cranial Osteopathy focuses on skull-bone sutures.  CST focuses on the motion of the dural tube and meningeal system, with the attached bones used only as “handles” to access the motion of the system.

The hand pressure used in CST is slight (about 5 grams) while other methods may use more force.  The positive effects of CST rely on the hydraulic forces within the system to contribute to the corrective process.  The CST practitioner focuses on removing obstacles that the body’s normal self-correcting abilities have been unable to overcome.

Unlike SOT, in which a specific protocol is followed, the CST practitioner follows cues from the body to determine how corrections should be made.  When the therapist uses this gentle approach, CST is extremely safe and effective.

Dr. Lisa Upledger has been a staff therapist and instructor with The Upledger Institute since 1991.  Prior to that she earned her doctor of chiropractic degree cum laude from the Palmer College of Chiropractic and ran successful private practices.  To learn more about CranioSacral Therapy call 1-800-233-5880 or visit www.upledger.com.

References

1. Retzlaff E.W., et al, Nerve Fibers And Endings In Cranial Sutures Research Report, Journal of the American Osteopathic Association, 77:474-5, 1978.
2. Retzlaff E.W., et al, Possible Functional Significance Of Cranial Bone Sutures, report, 88th Session American Association of Anatomists, 1975.
3. Retzlaff E.W., et al, Structure Of Cranial Bone Sutures, research report, Journal of the American Osteopathic Association, 75:607-8, February 1976.
4. Retzlaff E.W., et al, Sutural Collagenous And Their Innervation In Saimiri Sciurus, Anat. Rec., 187:692, April 1977.
5. Retzlaff E.W., Mitchell FL Jr., The Cranium and its Sutures, Germany: Springer-Verlag Berlin Heidelberg, 1987.
6. Upledger, John E., The Reproducibility Of Craniosacral Examination Findings: A Statistical Analysis, Journal of the American Osteopathic Association, 76:890-9, 1977.
7. Upledger, John E., Relationship Of Craniosacral Examination Findings In Grade School Children With Developmental Problems, Journal of the American Osteopathic Association, 77:760-76, 1978.
8. Upledger, John E., Mechano-Electric Patterns During Craniosacral Osteopathic Diagnosis And Treatment, Journal of the American Osteopathic Association, 1979.

TAC:  How do chiropractors generally pick the techniques that they perform?
Roth:  Chiropractors and other health professionals are drawn to techniques and theories that will help them move to the next level.  As each practitioner evolves in skill and understanding, they naturally reach for higher ground.  And, as it has been said, “When the pupil is ready, the teacher appears.”

I have consistently found, too, that it is only through this desire to provide better service, that the door to financial success is opened.  It is through the joy of helping others and experiencing the power of the self-healing process, which we support, that we become open to the positive flow assuring personal and monetary success.

TAC:  We often hear that one technique does not always work on every patient a doctor sees.  What do you think about this statement?
Roth:  There are many techniques that work, and the ones that work best are the ones that gently encourage the body’s natural ability to be restored to optimal health and well-being.

I also believe it is a question of attitude.  If the practitioner has an approach that makes sense to him or her, then they are capable of helping their patients to align with the potential to allow the healing to take place. 

TAC:  How many techniques should a chiropractor know for the best care of their patients?
Roth:  It is really not a question of the number of techniques.  It is more a question of skill combined with the ability to communicate the larger idea–the goal being to support and encourage the individual toward their potential for healing and wellness.  Various techniques may appeal, initially, to different patients; but, once inside the door, it is really their connection to these underlying principles that will make the difference.

TAC:  When does a chiropractor know enough about technique that he doesn’t need to learn anymore?
Roth:  It is never possible to stop learning.  It may be a technique or a philosophy, which helps the practitioner to become clear in his or her goals.  This is what will ultimately satisfy the desire to continue growing as a health practitioner and teacher of well-being.  This process never ends.  When it does, it is time to consider a new career.

George Roth, DC, can be reached at Wellness Systems, Inc., toll-free 1-877-905-7684; Fax: 905-880-0650; e-mail [email protected]; or visit www.matrixrepatterning.com.

Following are alphabetized descriptions of this edition’s Ten Great Techniques, with brief discussions of their evolution, theories and applications.

The Bio Cranial System

The Bio Cranial System (BCS), probably for the first time, links the spine and cranium as one complete and inseparable unit.  This is the conclusion arrived at by United Kingdom based osteopath Robert Boyd, DO, whose teachings are now being taught widely to doctors of chiropractic.  Hence, the patient suffering from low back pain, sciatica, headaches, diabetes, dysmenorrhea, chronic fatigue, etc., is, from a Bio Cranial perspective, suffering globally from a total physiological disturbance.

After many years of research, Dr. Boyd concluded that Sutherland’s Primary Respiratory Mechanism was the basis from which all function (physiology) derived.  This included not only visceral function but, crucially, also the musculoskeletal system.  His conclusions were first announced to the world in 1988 in his first book, An Introduction to Bio Cranial Therapy.   He concluded that, while segmental subluxations were certainly present, they were almost always secondary, and compensatory, to the totality of the craniosacral system’s “lesion”.

The anatomical disposition of the cranial bones is flawed with just about everyone as part of the birthing (and pre-birthing) event.  The next casualty in the chain is the dural membrane.  Since, therefore, the spine is essentially representative of the cranial disposition, Dr. Boyd believed that the need was to change the cranial (and therefore dural) status, and there was no requirement to address the spine at all–even for most extremity problems.

Unlike most, if not all, cranial approaches, The Bio Cranial System takes no more than 2-3 minutes to deliver and is relevant to almost all disorders.

The Bio Cranial Institute is dedicated to the training of both the philosophical and technical aspects of the Bio Cranial System worldwide to qualified healthcare practitioners. For more information, call 1 718-886-6056, or visit www.biocranial.com.

Bio-Kinetics Health System

1956 Palmer graduate, developer and patent holder of Bio-Kinetics Health Systems and New-Stim Stimulator, Dr. Lawrence E. Newsum, has been a seeker of health his entire career, and subscribes to the philosophy that health is a state of normal function on physical, emotional, chemical and spiritual planes of existence. 

The Bio-Kinetics approach accesses the body’s response to cellular memories of past traumas of every type:  physical, structural, organ related, mental-emotional, environmental, food toxicities, allergies, and even man-made electromagnetic frequencies.  All memories translate into energy frequencies, and have the potential of enhancing or disrupting the ideal function of the whole integrated system of the brain and body.

Dr. Newsum developed a protocol to locate and normalize, or neutralize, the body response to those memories which, when accessed, are easily demonstrated through the monitoring of changes in muscle response, structural balance, leg and arm length, change in blood pressure, physiological blind spots, bio-electrical skin response and many other tests.

He discovered that, by introducing a small amount of mechanical stimulation into the richest bed of neuro-receptor sites in the upper cervical region on precise sites and directions, powerful brain activation and normalization of feedback and memory loops was accomplished, normalizing aberrant frequencies.  Malfunction on any level indicates aberrant, abnormal frequency of firing of neurons.  With the unique stress/correct/stress/correct cycles and New-Stim stimulation, Bio-Kinetics re-educates and re-integrates neuro-receptor pathways, and restores health. 

For the past 12 years, Dr Newsum has been teaching chiropractors worldwide how to utilize Bio-Kinetics on their patients, families and even themselves through New-Stim Bio-Kinetics Seminars.  For more information, call 310-325-9122 or visit www.biokineticshealth.com. 

Body Integration

Body Integration is a diagnostic and treatment method of healthcare procedures which allows the body to reveal the underlying cause of the symptoms exhibited. The body has many complicated functions and an unfathomable data bank. Body Integration helps translate the mystery of the body and lets the body write its own instruction manual. There is no easy answer to any problem. However, Body Integration looks at the blueprint of the body, and with advanced healthcare procedures, allows the body to reveal the underlying cause of the symptoms exhibited.

The main objective is to find the basic underlying cause of the problem by completing a comprehensive, diagnostic workup which includes confidential consultation, a carefully taken case history and a complete examination. Muscles have electrical qualities and rely on a properly working glandular system, nervous system, circulatory system, endocrine system, acupuncture system, and many other systems of the body. Our inability to adapt to the stresses of life can be measured to a great extent by diagnosing the errors in our muscular system.  This includes a therapeutic approach to food and nutrition therapy designed especially for each individual’s needs.

Coming in late summer is a 16-volume manual and computer program with total body integration of myomeres, vertebral levels, cranial bones, foot bones, acupuncture points, extremities, organs, tissues, hand bones, nutrients, emotions, lymph nodes, the brain and an instruction manual.

Body Integration was developed by René Thomas (Espy), DC, who has taught many practitioners worldwide how to determine the primary subluxation. For more information, call 1-866-497-8273 or visit www.bodyintegration.com.

CranioSacral Therapy (CST)

CranioSacral Therapy is a gentle method of releasing restrictions in the craniosacral system—the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord, and have a vital impact on central nervous system performance. 

CST was developed by osteopathic physician John E. Upledger.  From 1975 to 1983, he led a multidisciplinary team of anatomists, physiologists, biophysicists and bioengineers at Michigan State University to test and document the influence of the craniosacral system on the body.  That research formed the basis for the modality Dr. Upledger developed and named CranioSacral Therapy. 

Essentially, the craniosacral system functions as a semi-closed hydraulic system, bathing the brain and spinal cord in cerebrospinal fluid pumped rhythmically 6-12 cycles per minute.  As fluid volume and pressure rises and falls within the craniosacral system, corresponding changes occur in dura mater membrane tensions.  These changes induce accommodative movements in the bones that attach to the dura mater compartment. 

When the natural mobility of the dura mater or any of its attached bones is impaired, the function of the craniosacral system—and the central nervous system—may be impaired as well.  Such restrictions can be detected and corrected using simple methods of palpation.  By normalizing the craniosacral system and enhancing the body’s self-corrective mechanisms, CST has proven effective for a wide variety of dysfunctions and conditions addressed in the chiropractic setting. 

More than 65,000 healthcare providers have been trained in CranioSacral Therapy.  CEU’s are widely available for doctors of chiropractic.

For more information, call 1-800-233-5880 or visit www.upledger.com.

Creed Neural Kinetic Integration Technique

The Creed Neural Kinetic Integration Technique embodies a positional relationship approach that re-orbits the musculo-skeletal structure,establishing a foundational platform for re-alignment of the head over shoulders, shoulders over hips, and hips over ankles to support the patient’s natural stance. These structural changes re-orient the facet plane angles, reduce the gravitational pulls on muscles and associated nerves, allowing for increased ranges of motion.  These changes create truer proprioceptive feedback functions to motor muscle response systems, vertebral joint motion, reflexes, and the reduction of sensory nerve stimuli that cause pain.  The outcome is a comprehensive reprogramming of the body’s structural architecture that is clearly communicated to the cerebellum via the Alpha I, II, and III neuro-fibers during the adjustment.  The patient experiences rapid relief from pain and discomfort, improved function and ranges of motion. 

Pre and post applied functional testing allows the doctor and patient to identify the aberrant conditions prior to treatment and acknowledge the positive changes afterwards.  Correcting vertebral subluxations, soft tissue and muscle concurrent with full body postural alignment is performed in various positions: standing, sitting, supine, prone or in motion. Conditions of acute and chronic pain syndrome, disc degeneration, osteophytic activity, scoliosis, failed back surgery, general fatigue as well as other degenerative conditions respond well to this comprehensive approach.

Dr Alan Creed presents a nation-wide seminar series, Boost Your Practice: Bridging Techniques, Styles & Technologies, which is approved for Continuing Education Credits.  Dr. Creed is a board eligible chiropractic neurologist and has a chiropractic practice on Key Biscayne, Florida.  For more information, call 1-305-365-7988 or visit www.dralancreed.com.

Neuro Physio Balancing

Neuro-Physio-Balancing (NPB) is a system that utilizes body reflexes for analysis and treatment.  It is a study of body reflexes. 

What are reflexes?  Most of the actions of digestion, all immune reactions and almost all muscle function are reflexive. All adjustments use body reflexes.  All neurological tests are comparing reflexes (blood pressure, heart rate, etc.)  You cannot have a change in pain level or muscle tone following an adjustment without a 100% reflexive response.  All symptoms are reflexes; all treatments and all emotions are reflexive reactions.

NPB begins by exploring the subluxation; how it influences the brain and nervous system, circulation in the body, organ function and musculoskeletal system.  The key is understanding the autonomic nervous system connection.  Various types of direct and indirect muscle tests can lead us to the lesions or subluxations.  These can identify missed reductions of a subluxation.

There are fast reflexive procedures to strengthen chronic weak muscles.  Most of these chronic weak muscles are a consequence of long-term noceciptive inhibition.  This noceciptive inhibition can be unnoticed pain due to receptor fatigue or inhibition due to the chronicity.  Stabilizing muscles can sustain a disproportional weakness regardless of therapy or exercise.  Certain fast simple procedures can reset the muscles, resulting in immediate, impressive strength increase.

NPB encompasses a full spectrum approach:  Adjusting (subluxations), reflex stimulation to reduce sympathetic tone and increase parasympathetic tone to promote organ function, improve blood flow and improve function of the nervous system, musculoskeletal system, brain and emotions.
NPB is designed to be performed primarily by hand.  No expensive equipment needed.

Neuro-Physio-Balancing was developed by Richard C. Freeze, BS, DC, DACAN, DACNB.  www.drfreeze.prodigybiz.com

The NUCCA Technique

Dr. Ralph R. Gregory founded the National Upper Cervical Chiropractic Association (NUCCA), in 1966, as an orthogonally based upper cervical chiropractic technique using acceptable and predictable scientific principles, including measurement, observation and reason.  The technique measures and evaluates postural distortions, thermographic differentials and cervical spine misalignment (with pre- and post-X-rays).  Precisely aligned X-ray equipment and stringent patient placement protocols produce X-rays to be analyzed in all three planes of motion, yielding a vectored production/reduction pathway to use to correct the Atlas Subluxation Complex.

The Atlas Subluxation Complex (ASC) is the measured angular relationship between the skull and vertebrae of the cervical spine. The body moves away from a vertical axis in the standing position:  high and low pelvis in the frontal plane, twisting of the pelvis in the transverse plane, movement of the upper torso into one of the frontal planes. There is a measurable functional leg length inequality in a prone position and bilateral weight imbalance.

The body returns to frontal and transverse plane symmetry in the standing position when the upper cervical spine is corrected through proper adjustment, stabilizing the spine in a normal position, which removes the neurological interference and minimizes the need for repeated adjustments.

NUCCA has developed a sophisticated biomechanical understanding of the upper cervical misalignment, the specific neurology affected, altered centers of motion and centers of gravity of spinal vertebrae and the correction and stability of the ASC.

For more information, visit the NUCCA website at www.nucca.org.

The Pro-Adjuster Technique

The Pro-Adjuster Technique evolved from the Pierce-Stillwagon Technique combined with computer technology to form a system of patient care that is standardizing the industry.  The development of this technology was completed by Dr. Maurice A. Pisciottano, following the passing of Dr. Walter V. Pierce, Sr.
Using a c-posture chair, the patient’s spine is examined while positioned in mild flexion. Each vertebra is analyzed by evaluating the echo response of a mild six-pound percussive force that is introduced to each spinal segment.  This force is computer controlled to be exactly the same every time.

The piezoelectric sensor in the instrument records the motion characteristics of the motor units. The data is displayed on the monitor so the doctor can evaluate whether the patient needs an adjustment, and which areas are out of tolerance with regard to fixation, mobility, fluid motion and frequency.

The doctor selects the motor units to be adjusted. The computer calculates a corrective frequency of percussion based upon the analysis just performed. The instrument applies a force until the sensor determines that the harmonic balance has been restored in the area in question. The adjustment automatically stops and the patient is ready for post analysis.

The re-analysis process allows the doctor to immediately compare the original composite to the post composite reading. The specialized hardware and software eliminates the subjective variables. The result is an accurate and reliable re-analysis process. The Pro-Adjuster establishes objective analysis in the inter-examiner realm, with consistency averaging above 90%.

The technique is safe for individuals of all ages and causes no stress on the chiropractor’s body.

For more information, call 1-877-942-4284 or visit www.pro-adjuster.us.

The Test & Response System

In 1974, Herman Stoffels, D.C., made a new discovery in chiropractic. He discovered that the body’s natural circulating energy fields interfered with the clarity of all reflex-testing methods. The pioneering chiropractor experimented with a wide variety of positioning and placements of the body and limbs and found that an entirely new dimension in body response could be realized by a few unusual, but simple, modifications in body and extremity positioning.

When the body assumes this position, its usual bioelectrical flow is changed and the body’s normal strength greatly increases, often nearly doubling. This position is the Test & Response basic testing position, which makes muscular testing much clearer for all.

Therefore, when the patient is lying in the T&R position, when the doctor contacts the real or true primary vertebrae and performs the T&R test, there is a dramatic change in the patient’s strength and energy level. With the identity of the true primary segment, there is now a loss of the magnified strength of the T&R position and also of the normal strength of the body during the T&R test, making a distinct demarcation between the strength and weakness from this test.

During T&R seminars, demonstrations are performed on participants with obviously uncorrectable conditions and the clinical results have been remarkable. For instance, some old injury disabilities nearly overcome in minutes, or a doctor’s wife–a diabetic since early childhood–dropped six units off her normal 24 units of insulin.

For more information, call 805-239-9121 or visit www.testandresponse.com.

Trigenics Myoneural Medicine

Trigenics is a sensorimotor and energetic restoration system. It incorporates a neurologically-based, multimodal methodology for local or full-body assessment and treatment.  Trigenics can be applied as Western manual medicine to correct aberrant sensorimotor function or as Eastern meridian medicine to balance neurosomatic energetics.

Trigenics is used on a very wide variety of patients and conditions. In addition to being used to accelerate rehabilitation and structural correction, Trigenics can be used as an alternative no-force manipulation procedure, and specific Trigenics Sports Augmentation treatments increase athletic power and performance to greater than normal levels.

Trigenics myoneural procedures involve the synergistic, simultaneous application of 3 treatment modalities for a cumulative neurological effect. It’s mode of action works on the basis of integrating neurological convergence projection from both segmental (PNS) and suprasegmental (CNS) pathways. The multimodal stimulation approach utilized in Trigenics is consistent with the principles of neuroplasticity and enhanced corticoneural reorganization of the somatosensory and sensorimotor systems.

Trigenics is often referred to as the “missing link” in neuromusculoskeletal care. In strictly using osseous manipulation to treat the vertebral subluxation complex, not correcting aberrant neurologic input (deafferentation) to the muscular holding elements will lead to the frustrating outcome of chronic, recurring intervertebral dyskinesia. In treating musculoskeletal conditions, non-treatment of aberrant neural innervation and compensatory tone imbalances (short/weak muscles) will lead to the frustrating outcome of incomplete strength rehabilitation and functional restoration. Trigenics provides the solution, by first correcting aberrant proprioceptive neurology (reafferentation). Treatment of aberrant histology (adhesions) and arthrokinetics is then subsequently addressed using soft tissue myofascial techniques and chiropractic procedures.

Trigenics was originated by Canadian-Estonian chiropractor, Dr. Allan Gary Oolo Austin, DC, DAc, CCSP, CCRD, DNM, FIAMA, FTIMM.  For more information, call 1-888-514-9355 or visit www.trigenicsinstitute.com. TAC

 

 

Q: Still no info on your favorite Technique, or one you’re curious about?  Let us know what we’re missing!  What’s your best turn-around story after using your favorite technique?  Send your story to [email protected] and win a free subscription!

 

 

 

Recently there has been much publicity surrounding the claims that neck manipulation by chiropractors can cause stroke or even death via cervical artery dissection.  This type of publicity has generated much concern for chiropractic patients and the general public.  Although, after carefully addressing the patient’s concern and informing them on the risk of neck manipulation (less than 1:500,000–1 million¹), some patients are still not fully calmed.  An alternative to the care of the neck can be provided using a combination of Trigenics Strengthening (TS), Trigenics Lengthening (TL), or Trigenics Manipulation (TM) procedures.²  TM is a non-force joint manipulation procedure performed while the patient initiates specific movements in a slow and controlled manner, which differs from the traditional high velocity adjustment.   

 

Trigenics is an interactive neurologically based soft tissue assessment and manipulation treatment system that symbiotically combines aspects of both Eastern and Western principles.  An explanation and overview of Trigenics was described in the last issue of The American Chiropractor.²

 

 

 

On the other side of the coin, rather than focusing our energy on debating the risk of stroke from neck manipulation (which is lower than the risk of NSAID’s causing more than an estimated 16,500 deaths annually³), we should put our resources into focusing on how stroke patients can benefit from chiropractic.  The chiropractic neurology diplomate program has taught many chiropractors to diagnose and treat neurological conditions chiropractically around the world.  Trigenics has also clinically displayed positive results for patients with neurologically impaired conditions, such as cerebral palsy⁴ and multiple sclerosis.  This is probably because it is a neurologically based system of muscle and joint manipulation that incorporates multiple cumulative neurological mechanisms.²   

 

The following is a case report of treatment of a stroke patient.

 

 

 

History & Observations

 

 A 90-year-old stroke patient was recently presented to me by her daughter, who is a chiropractor, at a Trigenics seminar I was teaching in Los Angeles.  She had had a stroke on her left side and she was hemiparetic on the right side with an inability to lift her right arm above horizontal.  She was also wearing a plantar lift for her right foot, which she was unable to dorsiflex.  She used a walker and dragged her right foot when the lift was removed.  She stated that she had been using sleeping pills for the past 20 years.  She also suffered from “uncontrollable high blood pressure” for which she was taking regular medication.  The patient had undergone a year of traditional physiotherapy, chiropractic, and rehabilitation with limited results. 

 

Methods 

 

Gait analysis revealed that she had an inability to easily flex her right hip.  Manual muscle testing revealed complete weakness on the hip flexors and the foot dorsiflexors and everters bilaterally.  Trigenics was applied to the muscles bilaterally to increase viability of the á-motoneuron at the spinal level via cross-over feedback, whereas Trigenics applied to the ipsilateral antagonist would help to stimulate the contralateral agonist, and vice versa.  TS procedures were applied to the iliopsoas, rectus femoris, tibialis anterior, extensor digitorum longus, fibularis brevis, and extensor hallucis longus bilaterally.  TL procedures were applied to the gluteals, hamstrings, gastrocnemius, and tibialis posterior bilaterally.  TM was applied to the talotibular joint.  In addition, TS procedures were then systematically applied to increase muscle strength to the right upper trapezius, anterior/middle deltoid, supraspinatus, coracobrachialis, biceps long/short heads, and the wrist extensors.  TL procedures were applied to increase muscle length/joint ROM to the right pectoralis major, latissimus dorsi, triceps, and the wrist flexors.  In this case, an Eastern approach was also utilized by applying Trigenics myomeridian procedures to balance her meridians points.  This included work on the bladder channel, LI11, LI4, HT3, ST34, ST36, SP6, BL62, and KI1.  (With Trigenics Myomeridian procedures, TS is used to tonify deficient meridians and TL is used to sedate overactive meridians.)

 

 

 

Results 

 

After the brief treatment, the patient was able to raise her right arm easily, lifting it fully above her head.  She was also able to walk across the room without her foot harness and without dragging her foot.  Her foot also clearly demonstrated dorsiflexion during the swing phase of her gait.  She was also able to lift her leg higher, move faster and with greater ease than prior to the treatment.  She and her daughter were quite ecstatic. 

 

The following day, her daughter called to report that her mother’s blood pressure had dropped more than normal to her usual dose of blood pressure medication.  She said, “I’m sure your treatment must have really lowered her blood pressure, as she has never had this type of reaction to her medication.”

 

 

 

Summary 

 

It is believed that, in restoring balance to the neuromuscular system, balance is also restored between the parasympathetic and sympathetic nervous systems.  The above stroke patient had quite obviously been in a constantly facilitated hyper-sympathetic state (hypersympatheticatonia).  Trigenics helped this patient on a local, cerebral, and systemic level.  Many doctors are already well trained in the removal of myofascial adhesions and treatment of articular dyskinesia; Trigenics provides doctors with the additional tools to treat a wider variety of conditions and to provide complete, leading edge, and highly effective care by using a neurological and synergistic approach.  TAC

 

Canadian-Estonian chiropractor, Dr. Allan Gary Oolo Austin, is the originator of Trigenics.  In March 2004, Dr. Austin will be speaking about Trigenics at the ACBSP Sports Symposium in Las Vegas.  For more information, contact the Trigenics Institute, toll free, at 1-888-514-9355 or by email: [email protected] or visit: www.trigenicsinstitute.com.

 

 

 

As a chiropractor, I have been focusing on the human nervous system and correction of related neuromusculoskeletal dysfunction for over twenty years. Although chiropractic adjustments constantly produce tremendous results, the holding elements and soft tissue components of the subluxation complex and biomechanical dysfunctions have been largely undervalued. Trigenics is a form of manual medicine that provides a solution to correcting soft tissue dysfunction and neuromuscular/neuro-energetic imbalance. A treatment such as this fits in perfectly with current chiropractic paradigms. The Trigenics Institute of Myoneural Medicine has been teaching Trigenics seminars in Canada and Australia for a number of years. The response from many notable chiropractors that have undertaken its study has been that of high acclaim. The Registered Trigenics Practitioner program and RTP designation were recently introduced to the United States. As such, this article will serve as a brief introduction.Trigenics is an interactive, neurologically based soft tissue assessment and manipulative treatment system that symbiotically combines aspects of both Eastern and Western manual medicines.

The three main components are:
It involves the simultaneous application of three components for a cumulative synergistic effect.
1) Autogenics

2) Myogenics

3) Neurogenics

Trigenics main therapeutic applications revolve around neurologically modifying muscle tone and somatic function, as well as restoring and balancing functional sensorimotor biomechanics. Although each of the three originating components in Trigenics (“genics”) could basically be used as a stand-alone therapy, the synergistic effect of combining three in a specific way provides results that are profound. This is further supported by a recent study done by Masakado Y (2001), who demonstrated that inhibition on a target muscle is significantly increased when the two stimuli (stimulation of the peripheral nervous system and central nervous system) were given together, rather than separately. Ikai (1996) also suggested that inhibition of antagonist muscles may occur at the cortical and spinal cord levels. One of the key concepts of Trigenics is to “trick” the central nervous system into super-inhibiting the target muscle. Once the muscle is put into a temporary unloaded state, it can easily and rapidly be strengthened or lengthened, using various manipulative procedures.

There are three main treatment procedures in this system:
(meridian muscle manipulation) (reflex neurology)

1) Trigenics Strengthening (TS)

2) Trigenics Lengthening (TL)

3) Trigenics Manipulation (TM)

 

Vladimir Janda has clearly delineated that many muscular and biomechanical problems develop as a result of muscle imbalance that is created by either shortened or weakened (inhibited) muscles. Imbalanced development or, more clinically, aberrant alignment and disruption of the kinetic chain integrity will inevitably lead to injuries. Traditionally, doctors and therapists have been prescribing stretching exercises for the shortened muscles and isotonic/isometric resistive exercises to strengthen weakened muscles. Although these exercises have been widely utilized, however, it takes a few months to achieve results. It will take at least the initial four-six weeks just to regain the proper neural recruitment (Moritani and Devaries, 1979; Sale, 1992). In addition, these exercises do not necessarily correct muscle spindle dysfunction. They can even be counterproductive, if a greater state of imbalance is created due to aberrant neurological input to the heavily innervated sensorimotor system. Trigenics assessment procedures provide delineated methods of locating and objectively mapping out patterns of weakness and shortening. A second key concept is the active-assisted-resisted training and interactive involvement of the patient. The patient is an active participant, rather than a passive recipient, as they actually exercise their muscles simultaneously during the treatment. This allows early training of neural recruitment to improve muscle strength, and shortens the total time for rehabilitation training. It also serves as an early stimulation of the joint mechanoreceptors and proprioception training, as well as stimulation of the muscles’ strength-building elements.

Following assessment, Trigenics TS and TL treatment procedures enable the practitioner to alter the muscle’s neurological firing pattern for a cumulative tonal “resetting” effect. (With the advent of digital muscle testing devices, such as the MicroFET III, objective results are easily recorded and shown to the patient pre- and post-treatment.) Only after the muscles’ aberrant firing patterns have been normalized will rehabilitative exercises work to enable the musculature to respond in such a way that the resetting will be held. Muscles will then respond to exercise in a way that creates balanced growth and development.

Trigenics is, generally, not hard on the doctor or the patient. It is much easier for the doctor to apply and easier for the patient to receive than regular mechanically based soft tissue techniques. The patient usually does not experience appreciable pain during the treatment, and rarely has any delayed onset of post-treatment soreness. In collectively facilitating the patient’s nervous system to reduce pain signals and inhibit the target muscle, the protocol allows for much easier and even deeper access than would otherwise be achievable.

The Trigenics Practitioner, or Trigenist, may use manual or instrument contact in the application of the treatment.  Contact is made with the tissue in such a way as to distort the fibres to stimulate local mechanoreceptor activity, and to increase the mechanical load on the tissue in order to stimulate proliferation of fibroblasts at a cellular level (Eastwood, 1998 & Galen, 1999).  This form of manual contact is referred to as Proprioceptive Distortional Myomanipulation (PDM).  (Direct ischemic compression pressure and longitudinal traction pressure are not to be used with Trigenics, as they are often painful to the patients, causing reflexogenic contraction of the muscle.)  The application of PDM often results in a Myoneural Reduction (MNR), wherein a muscular or articular cavitation is notably felt.

Processes involved in a Trigenics treatment:

nitial cerebral pathways induce voluntary muscle contraction activity of specific vector forces to cause firing of pre-programmed proprioceptive and sensorimotor feedback signals from within the
muscle or tissue.

+

The controlled generation and convergent neurologic bombardment of existing and recently uncovered, reflex feedback mechanisms such as the inverse resistance loading reflex (aka “The Austin Response”*), generate sustainable changes in the firing pattern of the targeted musculature.
(*Application of a measured light resistance load to the agonist will facilitate an increased level of reciprocal innervation to the antagonist.)

+

Localized monosynaptic pathways are further generated and added to the converging neural signal pool via simultaneous distortional manipulation of the tissue mechanoreceptors during muscle exercise activity.

=

A cumulative “myoneural” response that is significantly greater on multiple levels than one could attain with application of mechanically based techniques.

Many doctors who have studied Trigenics have commented that Trigenics “puts it all together”.  They see it as an effective treatment formulation, which includes key aspects of many singular treatment and exercise modalities already known to be effective.  The Trigenics treatment combination, with the incorporation of recently researched neurophysiological reflexes, provides results that are not linear, but exponential.
Trigenics treatment protocols can be used in close succession for optimal results with multiple treatment plans.  Adjunctive laser applications and topical post-treatment homeoceuticals such as Trigel® are also used in certain cases.  (Trigenics treatments average ten-to-twenty minutes, with fees standardized at $75-$150/tx.)  There are four application levels for the TS and TL procedures, with four types of PDM techniques, depending upon muscle size and design.

Examples of Conditions, Protocols, and Application Levels

1. Ultra-light application (UA)
· Acute inflammatory conditions (TS, TM)
· Acute sprain/strain injuries (TS, TM)
· Pediatrics (i.e., infantile torticollis, hip dysplasia) (TS)
·  Severe fibromyalgia, severe osteoporotic patients (TS, TM)

2. Light Application (LA)
· Acute torticollis (TL), disc herniation and canal stenosis (TS), fibromyalgia (TS, TL), geriatrics patients (TS, TL, TM)
· Major neurological impairment from conditions such as trigeminal neuralgia, cerebral palsy, multiple sclerosis, Bell’s palsy (TS)
· Patients with conditions in which integrity of the vasculature is in question, such as chronic diabetic and rheumatoid arthritis patients (TS)

3. Moderate Application (MA) &
4. Heavy Application (HA)
· Most musculoskeletal or musculotendinous conditions, such as: tendinitis/tenosynovitis/tendonosis, frozen shoulder, sciatica, headaches, chondromalacia patella, plantar fasciitis, disc protrusion (TS, TL, TM)
· Post-surgical/post-joint-replacement rehabilitation (TS, TL)
· Athletic strength and power augmentation (TS, TL)
· Neurological conditions, such as cerebral palsy & stroke (TS, TL).

Canadian-Estonian Chiropractor, Dr. Allan Gary Oolo Austin is the originator of Trigenics. He is a Certified Chiropractic Sports Physician, Certified Chiropractic Rehabilitation Doctor, Doctor of Natural Medicine, Doctor of Acupuncture, Fellow of the International Academy of Medical Acupuncture, and Fellow of the Trigenics Institute of Myoneural Medicine. Dr Austin began developing Trigenics in the early 1980s.  In 1994, Dr. Austin began to write the current procedural and theory manuals and commenced upon forming The Trigenics Institute. In 2004, Dr. Austin will be speaking about Trigenics at the ABCSP Sports Symposium and the SWIS Symposium.
For more information, contact the Trigenics Institute of Myoneural Medicine, toll free at 1-888-514-9355 or by email: [email protected],or visit www.trigenicsinstitute.com.

When selecting a software package for your office, take your time and know exactly what you are looking for.  There are many applications on the market today to choose from and the search can be intimidating for someone who is not savvy on the latest technologies.  However, without having the technical knowledge, there are ways that you can make good decisions.

Obviously, technology is the way of the world now and we must join in or be left behind.  After researching many products out there, the most important feature to a software application is the ease at which data may be entered and the ability to adapt to your own office workflows.  Many times, end users will manipulate the software in ways to fit an office workflow that may actually make data entry more difficult, rather than easy and efficient.

Windows based applications are the appropriate choice today.  If you are not familiar with the latest technologies in hardware, networking, and internet connectivity, you should consider hiring a technical person to guide you in making those decisions.  Selecting the right hardware and networking system for your software is critical.

To begin your search for software, first make a wish list of what you would like to have in your system.  Review your current practice systems and imagine ways that would enhance your overall ability to render service, if certain processes could be automated.  Create a list of the current reports that you use on a regular basis.  Identify information that you are not able to obtain and would like to have in order to better manage your business.  Knowing exactly what your needs are gives you power and confidence to begin your search.   

Contact other providers and find out which software packages they are currently using.  Ask the doctor and staff what their likes and dislikes are with regard to their system.  After, you have identified the various packages to consider, contact each company and request a demo of their product.  During the demo, have prepared a list of questions of desired functionality that you would like to see.  A good way to find out how a system would work for your office is to create scenarios that you would like to see handled with that software.  For instance, request that the vendor demonstrate entering a new patient that has both a primary and secondary insurance and has a 20% co-pay.  Ask them to demonstrate charge entry and entering a patient payment. 

Create scenarios that would encompass your entire system, from entering a new patient, and scheduling multiple appointments, to ledger functionality.  Pay close attention to the number of screens and flow of the data entry through each scenario.  Make sure that the system is not too difficult or cumbersome to handle the easiest tasks.
Reporting is a very important feature in a system.  You want to look for a system that has good reporting capabilities.  Many vendors have integrated the technology for Open Database Connectivity (ODBC), which allows the user to capture their data and implement other reporting software in order to create custom reports.  This technology is also important for cleaning up data, if necessary, and fixing problems without having to contact technical-support.

A software application should be one that you can expand and grow with.  Many packages offer “bells and whistles” that you may not think are necessary for your practice.  Our industry is one that is constantly changing and, as your practice grows, these features may become important to you later down the road.  Choosing a basic package to begin with may result in more expense later when your needs begin to expand. 
When choosing the right company to enter into this important relationship with, you must understand the aspects of this company that will affect you.  First, every company has a support department.  Find out if the support is 24/7. 

How many times per month, can you call for help?  In addition, many companies offer different levels of support from very costly to relatively inexpensive.  Your first year with a new software company is a time of growth and, sometimes, frustration.  Good technical support is important and should be readily available.  Many companies will also tailor a support contract that fits your budget.  Support contracts normally include updates to the product that add additional features free. 

Training is another major aspect when selecting a new software company.  Most companies offer different packages for training that include onsite or modem training.  Investing in extensive training will save money in the long run and relieves staff anxiety during the implementation phase. 

Components to Practice Management Software:
Scheduler:  When looking at automating your scheduling, make sure that the software is flexible.  The software should be able to handle multiple work hours for multiple providers, with different days and times.  The ability to create your own appointment types and set specific time limits to each can be important.  Scheduling a patient should be simple and fast.  A nice feature in a scheduler is the ability to block book multiple appointments and or cancel multiple appointments with out having to switch from day to day to enter each appointment.  The ability to customize the views is also a plus.  The system should allow you to create views that will display multiple doctors, single doctors, and daily and weekly views.
A good scheduler program should also possess the functionality to flag appointments to track cancellations and reschedules, print patient’s appointments, and generate statistics.

Billing:  The most important part of the billing system is the ability to generate clean patient statements, enter charges easily and accurately, and post payments per line item.  Make sure that the system maintains a payor history for the patient and can handle multiple injuries or incidents for each without having to create separate patient accounts.  When posting payments, make sure that you have the flexibility to create appropriate write- offs or adjustments.  Payments should be able to link back to the specific payor who made the payment.  All accounting reports are generated from the patient ledgers and, many times, how the reports are created can be confusing.  During training, be sure that you understand exactly how the information is reported, to insure that you are getting accurate figures.
Make sure that the system has the capability to file electronically.  Even if you are not currently filing claims this way today, it is likely to happen in the future.  When generating bills, either electronically or on paper, the system should have a process to review all claims and check for missing information before sending out the claim.  The process for fixing those errors should be user friendly.  In addition, there should be a good way to track collection attempts and add notes to the system for follow up information. 

Documentation:  It is recommended that the software have both a practice management package and a fully integrated documentation package.  As hard as it is to get rid of those paper charts, it is almost becoming a necessity with today’s requirements for providers to prove medical necessity.  An all-in-one package saves everyone time and money.  There are very good systems with touch screen and voice recognition to simplify this process.  Handheld devices have also improved this process for reasonably low costs.
Security:  This is a very important factor in today’s world with the HIPAA regulations.  Advanced security features can add value to any system.  The ability to control and user-functionality is extremely important.  In addition, with electronic documentation, most systems can track who and when accessed any record.  This feature is especially important to compliance with the new regulations. 

Customization:  Customization is the ability to change the program to meet your practice needs.  When purchasing software, inquire about the flexibility for customization on both the practice management package and documentation package.  Be aware that customization will result in additional fees. 

Pricing and Costs:  Software applications usually price the software with a base price that includes one-to-five users.  Additional user licenses will add to the cost of the software.  Purchase the amount of users you currently have and add a couple more to leave room for growth.  Purchasing licenses later can result in higher costs, so it is better to plan now than pay later.  Support contracts can vary.  Structure a support contract that works for you.  Make sure that there is a true value to their contract, such as upgrades.  Training is one area that you do not want to skimp on.  The more training your staff has, the better they will adapt to a new way of doing things.  New systems can be very intimidating to staff who are not comfortable with change.
In summary, when selecting a new software vendor, choose a reputable company and gather references.  Know what you want and educate yourself on all of the many options available.  Make sure that the software is user friendly.  Always remember to purchase a software that will grow with your practice and enhance your overall service delivery and profitability.

Ms. Munroe was an Executive Director and Practice Manager for a successful multidisciplinary practice for over 6 years.  Her experience and proficiency lead her to the position of Implementation Manager with a large practice management software company for 5 years.  She is currently the Vice President of Development Services at Practice Perfect.  Contact her at [email protected].