Sunday, October 14, 2007
Safety of Cervical Manipulation
Safety of chiropractic manipulation of the cervical spine: a prospective national survey.
Thiel HW, Bolton JE, Docherty S, Portlock JC.
Department of Research and Professional Development, Anglo-European College of Chiropractic, Bournemouth, United Kingdom. firstname.lastname@example.org
STUDY DESIGN: Prospective national survey. OBJECTIVE: To estimate the risk of serious and relatively minor adverse events following chiropractic manipulation of the cervical spine by a sample of U.K. chiropractors. SUMMARY OF BACKGROUND DATA: The risk of a serious adverse event following chiropractic manipulation of the cervical spine is largely unknown. Estimates range from 1 in 200,000 to 1 in several million cervical spine manipulations. METHODS: We studied treatment outcomes obtained from 19,722 patients. Manipulation was defined as the application of a high-velocity/low-amplitude or mechanically assisted thrust to the cervical spine. Serious adverse events, defined as "referred to hospital A&E and/or severe onset/worsening of symptoms immediately after treatment and/or resulted in persistent or significant disability/incapacity," and minor adverse events reported by patients as a worsening of presenting symptoms or onset of new symptoms, were recorded immediately, and up to 7 days, after treatment. RESULTS: Data were obtained from 28,807 treatment consultations and 50,276 cervical spine manipulations. There were no reports of serious adverse events. This translates to an estimated risk of a serious adverse event of, at worse approximately 1 per 10,000 treatment consultations immediately after cervical spine manipulation, approximately 2 per 10,000 treatment consultations up to 7 days after treatment and approximately 6 per 100,000 cervical spine manipulations. Minor side effects with a possible neurologic involvement were more common. The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse approximately 16 per 1000 treatment consultations. Up to 7 days after treatment, these risks were headache in, at worse approximately 4 per 100, numbness/tingling in upper limbs in, at worse approximately 15 per 1000 and fainting/dizziness/light-headedness in, at worse approximately 13 per 1000 treatment consultations. CONCLUSION: Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.
Tuesday, October 09, 2007
Normal Physiological Breathing Wave
· Initiates at coccyx – sacrum
· Moves inferior to superior
Initiation of breathing mechanics is the most important sensory-motor program in the CNS. An inefficient program here can lead to partitioning (sapping off) of CNS resources to maintain a breathing program. Again, since energy is a limited resource and evolutionary adaptive processes drive neuroplasticity towards efficiency, the breathing mechanics take priority in energy and significance in the thalamus.
The Chiropractor observes which region moves FIRST on inhalation. Be careful not to be misled by regions that have the most movement. It is the region that moves first that is the location of Initiation.
IT MUST BE UNDERSTOOD THAT LABELS (NAMED DISEASES) CAN BE PRESENT WITH ANY ABERRANT BREATHING PATTERN.
Aberrant Initiation in the thoracics or a cycle that initiates in the lumbars can reveal:
· Brain Stem Issues
· Chemical Dependencies
· Hormonal Imbalances
· SIDS Potential
· Bipolar Disorder
· Chronic Pain
Aberrant Initiation that is focused more superiorly than the pelvis:
· Loss of initiation of pelvic movement will cause a degree of visceral circulatory stasis and pelvic diaphragm weakness will develop, as will an imbalance between increasingly weakening abdominal muscles versus hypertonic spinal stabilizers.
· The upper ribs will be fixated superiorly on the chronic motion palpation and there will be dysafferentation costal cartilage tension on palpation.
· The thoracic spine will have intersegmental glide fixations caused by lack of normal motion of the articulation with the ribs.
· Thoracic breathing wastes large amounts of energy. In this form of paradoxical respiration, the chest and abdominals function oppose each other.
· Normal effort produces inadequate tidal volume; more energy (ATP) and increased cervical and thoracic thalamic/cortical representation must be accessed to maintain a minimal tidal volume.
· Accessory respiration muscles of the upper chest must come into play, including scalenes, upper trapezius and levator scapula. The muscles overwork to exchange sufficient air. Accessory muscle hypertonia will be palpable and observable. Hypertonic scalenes can entrap lymphatic structures mechanically, which has been shown to reflexively suppress lymphatic duct peristaltic contraction in the affected extremity.
· Fibrosis (regional myofascial pain) will occur in these overworked muscles.
· Trigger points in the pectoralis, subscapularis, teres major and latissimus dorsi caused by thoracic breathing patterns negatively influence lymphatic drainage.
· The neurological overload (increased thalamic integration and priority given to secondary respiratory muscles) changes the thalamic relays to give priority to respiratory function. Other visceral afferents are simply filtered. Thus the connection to other visceral afferents is “lost.”
· Cardiovascular dysfunction and high blood pressure can result as the CNS fights for a minimal functional tidal volume.
Aberrant Initiation that is focused in the lumbars is a common presentation as the first sign of interference and inefficiency in the CNS.
1) Lack of proper proprioception leads to aberrant local and global movement patterns (dysponesis) including inefficient breathing mechanics.
a) Improper sensory integration leads to inefficient/ imbalanced efferent yield, local/global efferent dysfunction, disability, disease states, symptoms and loss of human potential.
b) Aberrant local and global movement patterns habituate (pathological neuroplasticity) unless adjusted, attenuated and eliminated from the input side. Physiological filtering and integration through the thalamus.
2) The top two dominant reflexes in the hierarchy of adult human survival are the Breathing Reflex and the Righting Reflex (Dynamic Equilibrium).
a) The two most important reflexes that can be observed (for function) and corrected are the Breathing Reflex and the Righting Reflex.
b) If the Breathing Reflex or the Righting Reflex are not corrected properly, all other input/output system adjustments (chiropractic adjustments, physical rehabilitation, diet therapy, psychological therapy) become less effective at best and iatrogenic at worst.
Inefficient breathing patterns shift the nervous system to a negative state of utilizing all conserved energy for appropriate oxygen exchange. The Breathing Reflex is the driving reflex of all physiological processes. It is the first step and the controlling factor to all physiological processes.
Physiopathology – clinicians have long been aware of structural pathology and the ability of these anatomical or biochemical abnormalities to produce malfunction. Malfunctions produced in this manner are termed pathophysiology by the health care community. Malfunction resulting from processing or signaling errors within the circuitry of nervous system is termed physiopathology. Because of the presence of both inborn and acquired neuronal interconnections (acquired because of efficiency driven neuroplasticity), processing and signaling errors can be produced and maintained.
Signals traveling along sensory afferent pathways and entering various neuronal circuits within the CNS or signals in from the PNS but entering the CNS will affect individuals differently. They can also affect the same individual differently on different occasions. In the presence of one set of variables, a migraine headache develops. With another set of variables, gastrointestinal or cardiac malfunction of one form occurs. In the presence of still another set of variables, the individual becomes chronically fatigued or clinically depressed. Acute or chronic anxiety, mental illness and amplified pain are a common result. Alterations in endocrine function can also occur. All of these consequences result from sub-cortical processing errors (signaling malfunction) that affect physiological mechanisms in a manner detrimental to the organism. In this paradigm, inappropriate emotions or amplified bodily pain or a diagnosable disease is just a symptom from processing and signaling errors and is not the primary diagnosis. Physiopathology causes Dysponesis. The dis-ease is a result not the cause.
Physiopathology (Nervous System processing errors) can accompany structural pathology and it can also exist alone and be the sole cause of a given patient’s symptoms.
For optimal patient care it is essential to examine and estimate the extent to which Pathophysiology and Physiopathology is contributing to the patient’s illness.