It’s happened to all of us many times. a patient comes into our office barely able to move and in excruciating pain. They have difficulty lying on the table, let alone moving through any range of motion and we want to get them into a side posture position. RIGHT!!!!!
So, in lieu of any type of chiropractic manipulative therapy, we apply a hot pack, maybe some ultra sound or motor nerve stimulation in order to reduce the muscle spasms.
That has been the traditional approach and, eventually, it has the desired result—or at least some level of the desired result. BUT….
What if we could use the body’s own neurologic and physiologic mechanisms to reduce those muscle spasms instead of using outside interventions? After all, isn’t that what we continually profess; use the body’s own healing powers? Yet, when it comes to muscle spasms, we ignore the physiologic processes that could reduce those muscle spasms. The question that comes to mind is: Why? Perhaps the answer lies in that we clinicians, to date, have not found any type of technique or equipment that could assist with these same neurological and physiological mechanisms—not until the Active Therapeutic Movements (ATM Concept) came along. But more on this unique treatment concept a little later.
Let’s look at the purpose of a muscle spasm. First of all, we know it is a protective mechanism, often elicited by the muscle spindle fibers as the stretch reflex. The stretch reflex protects the muscles and tendons against either too much of a stretch or too quick of a stretch. So, therefore, the stretch reflex is sensitive to the amount or speed of a muscle stretch. Located in the musculotendonis junction, the muscle spindle fibers protect this most vulnerable area of the muscle, the weak link of the chain, so to speak. If this area is protected, then the rest of the muscle will surely be. Unfortunately, the muscle spindle fiber is subjected to the same environmental factors as the rest of the muscles, the worst of which is inactivity.
As we have learned, when a muscle stays in a shortened state for any prolonged period of time, it becomes shorter. The same fate is assured for the muscle spindle fiber. If the muscle spindle fiber becomes shorter, then it will also become more active. This will elicit the stretch reflex when there is no need. The result is an increase in the excitation potential of a muscle, often resulting in muscles firing before they are supposed to or even when they are not supposed to fire. Because this is a protective mechanism, it often takes priority over other factors like, for example, reciprocal inhibition.
Reciprocal inhibition is the signal of relaxation that the antagonistic muscle receives when the agonist muscle contracts. This is necessary in order to allow movement to occur. This signal of reciprocal inhibition not only tells the antagonist muscle to relax, it tells it to relax at the same speed and intensity that the agonist is contracting, which helps to keep a smooth, fluid movement that can be controlled through the entire range of motion.
If these two mechanisms are functioning properly, we should get a smooth, controlled movement, as well as the protection the muscle needs if it is lengthened too far or too fast. When the muscle is injured or in a chronic shortened state, the muscle spindle fiber is in a hyper-reactive state and, thus, will activate, causing the muscle to contract or even spasm when almost any movement occurs. Again, since the stretch reflex of the muscle spindle fiber is a protective mechanism, it takes priority. So, even when the muscle is receiving the reciprocal inhibition telling it to relax, the stretch reflex overrides it. This causes the antagonistic muscle to contract when it should be relaxing. (See Figure 1) Consider, then, what happens to the path of motion of the joint when this is happening. Not Good!!!!
Figure1. is a graph of muscle activity with a symptomatic patient experiencing low back pain. These graphs were developed using sEMG technology whereby patients were asked to perform rotations showing left and right side back muscle contractions and documeting muscle spasm.
What if we could eliminate or at least dampen the stretch reflex? Only for a limited period of time of course, while the body’s own healing processes were underway, but what if we could actually do that? Medications could relax the muscles, obviously; but we are chiropractors, so we resort to the aforementioned modalities that mainly help to increase the blood supply to the muscle, which is certainly not a bad thing; but it still doesn’t address the neurological factors of the stretch reflex and the hyperactive muscle spindle fibers.
If we could just use the reciprocal inhibition to relax the muscle but somehow prevent the tight or spasmodic muscle from moving, we could get our patient’s own body to tell those muscles to relax. But, to do this, we would have to use an isometric contraction of the muscles that are opposing the tight or spasmodic muscles. By contracting these opposing muscles without movement, we could avoid activating the hyperactive muscle spindle fibers and receive the full benefit of the reciprocal inhibition, resulting in the body’s own mechanisms giving us the results that we want instead of using medications. This is a perfect example and illustration of how the ATM Concept works and works so wonderfully within this same interesting, dynamic and very complex neurological mechanism.
The ATM2 system is a vertical treatment table that can immobilize, support and stabilize the patient all at the same time. The ATM2 uses a series of adjustable stabilization straps against a positional pad to create a safe and stabilized environment for the patient, who can then perform isometric contractions in the opposite direction of the muscle spasms. The straps allow a forceful contraction, giving a strong message of reciprocal inhibition and, since there is no movement, it overrides the stretch reflex and helps the muscle to relax. (See Figure 2) Furthermore, the straps can be tightened in any configuration to isolate almost any of the spinal stabilizer muscles, to reduce muscle spasms. It can be used for movements in the frontal, sagital, or horizontal planes or any combination thereof, making it infinitely versatile for any movement pattern that you could imagine.
Figure 2. shows the muscle activity after 1 treatment on the ATM2 system. Notice the distinct left side and right side muscle contractions showing their increased strength and their distinct muscle separations. This is reciprocal inhibition. Notice muscles, even in the neutralor resting position and after one 6-minute treatment intervention. Notice these same muscles contracting in a much lower intensity and in unison and at rest.
The question then becomes, how do we know the process is having the desired effect?
Actually, a very simple protocol of tightening the straps to make the patient feel safe, supported and comfortable lets you know you are isolating the proper areas. A series of short, yet forceful contractions (Active Therapeutic Movements or isometric exercises) that the patient is now able to perform, yet without discomfort or pain, also tells you that you are on the right track. The patient will be very surprised to be able to perform isometric exercises (a very conservative number of ten isometric repetitions is always recommended on the first visit) with that much force without feeling any pain. Then, after performing the contractions and being unstrapped, the patient will be amazed at the increased, pain free range of motion. (See Figure 3) You, also, will be amazed at how quickly they are able to move pain free, easily perform isometric exercises, and the increased flexibility, ROM and significant decrease in pain they exhibit on that first visit.
Figure 3. This patient is being treated for lumbar flexion movement impairments. We see the patient doing the Active Therapeutic Movements or Isometric flexion exercises.
Just like most other conditions that we face as chiropractors, the cause of the muscle spasm will most likely not disappear after the first treatment. Although, I have heard and read instances of patients that, on their very first visit, using the ATM2 system, the muscle spasm condition was changed or rectified completely. It can obviously vary from patient to patient. I also know that many of these spasm problems are deep rooted and so, just like the manufacturer recommends, continuing along the treatment path with further ATM’s can provide the correct stimulus to change these deep rooted muscle spasm conditions. The environmental factors that cause the tight or spasmodic muscle are probably still present, whether it is from an injury or from prolonged positioning and/or poor posture. Thus, these factors also need to be addressed and can easily be identified and corrected when the right assessment and treatment protocol is in place.
Most of us, as chiropractors, now deal with patients who are very inactive, both at their jobs and at home. This has created an epidemic of spinal instability. We see more and more patients everyday that possess low back injuries as a result of some ridiculously simple task or movement.
As a developer and instructor of the personal training program for the largest fitness chain in the country, I believe I have found an easy to implement a Core Stabilization program for chiropractors that can overcome these factors and restore spinal strength and stability to our patients who suffer from the effects of prolonged sitting and poor posture. The ATM2 can greatly enhance this Core Stabilization protocol and help us, as chiropractors, completely overcome the common muscle spasm, an all too familiar nemesis in our practices—thus, making us more effective as health care providers in obtaining faster, longer lasting results for our patients.
For more information on Dr. Meier’s Core Stabilization program, visit www.drkirkmdc.com or call 1-510- 713-7117. For more information on the ATM Concept, visit www.BackProject.com or call 1- 888-470-8100.