Sunday, April 27, 2008

 

Tonal Approach

Tonal and Functional Approach

A tonal chiropractic technique approach looks at the controlling systems of the body. Even traditional segmental and postural concerns like subluxation degeneration (also called osteoarthritis) are now being targeted as a functional (tonal) issue.

Although there are many risk factors (such as age, family history, and obesity) associated with the development of osteoarthritis (OA), only trauma is known to cause OA. The neuromuscular system, through CNS-controlled afferent-efferent programs, controls the amount and kind of movement occurring at a joint, so it is this system that is ultimately responsible for ensuring that joint tissues are not damaged to the point of developing OA during normal day-to-day activities. Tonal chiropractic techniques concern themselves with influencing the controlling systems of the body.

Most of the current research shows that a neuromuscular protective model based on central pattern generators (CPGs) can explain this clinical reality. CPGs are subconscious motor programs that run during dynamic equilibrium and movements. They control balance, static posture, and background tone in all joints and movements. These programs are developed, then remembered (recalled) as needed. These afferent/efferent programs are driven by instantaneous energy efficiency. Understanding the role of CPGs can best reconcile much heretofore ambiguous information pertaining to the development and progression of OA (subluxation degeneration) in stable and unstable joints. These CPGs (programs) can explain the continuance and maintenance of the pain in patients. Tonal chiropractic techniques concern themselves with influencing the controlling systems of the body.

The vertebral motion unit is rich in proprioceptors and nociceptors. Biomechanical alterations, from trauma or from inefficient movement patterns (chronic), may result in an alteration of normal nociception and mechanoreception. Thus, aberrant afferent input into the CNS leads to dysponesis.

Dysponesis is defined by Dorland's Medical Dictionary as follows:
A reversible physiopathologic state consisting of unnoticed, misdirected neurophysiologic reactions to various agents (environmental events, bodily sensations, emotions, and thoughts) and the repercussions of these reactions throughout the organism. These errors in energy expenditure, which are capable of producing functional disorders, consist mainly of covert errors in action-potential output from the motor and pre-motor areas of the cortex and the consequences of that output.
Dysponesis does not mechanistically describe a specific allopathic (ICD-9 labeled) condition but rather relates to human homeostasis and dis-ease. It relates to human health as a function of the whole. It is philosophically and scientifically suitable for a tonal technique chiropractor to detect a patient with dysponesis (errors in energy expenditure) secondary to vertebral subluxation complex or causing a ‘perceived misalignment’. All that is necessary are the tools for the chiropractic assessment / analysis that evaluates CNS processing and efficiency at all levels (local, regional, global) of physiology and the understanding of that processing.

D.D. Palmer emphasized the importance of “tone” in the dynamics of health and disease. Dr. Palmer in his text, The Chiropractic Adjuster, stated in 1910, “ Life is an expression of tone. Tone is the normal degree of nerve tension. Tone is expressed in function by normal elasticity, strength, and excitability...the cause of disease is any variation in tone.”

DCs must find a strategy, which is effective in disclosing these covert errors in energy expenditure caused by inefficient input and correcting them. Tonal chiropractic techniques concern themselves with influencing the controlling systems of the body that manage energy expenditure are one answer to the search for assisting the CNS in handling afferentation.

Inappropriate afferent input can lead to aberrant efferent output leading, and in the long term, to a state of dis-ease or abnormal energy expenditure. This inefficient energy expenditure leads to depressed function of other body systems as the finite energy is partitioned or mobilized to other parts of the CNS. The appropriate chiropractic adjustment adds positive physiological input into the CNS that allows resources to be saved and thus the surplus resources are able to utilized.

If this depressed functioning remains for any length of time, neuroplasticity takes over and the brain will “prune” connections to allow for a more efficient firing and ATP utilization of this depressed functional state. This pruning and efficiency is based on ATP and neurological resource utilization not on the long term effects it will have on the organism. The CNS and natural selection do not make ‘moral or rational ‘decisions on the long term consequences of increasing efficiency of deleterious programs. The drive is to save resources in the immediate short term. One ‘learns” to be sick efficiently.

These disadvantaged functional states could be a simple decreased filtering of nociception as it travels through the thalamus for filtering, integration and modification. Resources (ATP, neurotransmitters, etc are being utilized for other greater prioritized programs) rather than filtering an achy knee. Or they could be inefficient biomechanics of the sacrum and pelvis. They could indicate inefficient filtering of extraneous sensory information (auditory, kinetic, visual) and abnormal descending pre-frontal inhibition into the thalamus (or other areas) and thus lead to ADD-like symptoms.

These depressive functional states could lead to neurophysiological partitioning and mobilization of energy resources and lead to an efferent program called dysautonomia. All these outputs can be termed dis-ease or will eventually develop into an ICD-9 AMA-labeled diagnosis.

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