Dr. Fred Clary's Functional Analysis Chiropractic Technique

Sensory Exercise and Clinical Decision Making

The purpose of any rehabilitation exercise, sensory therapy or regime should be to make the nervous system more efficient. When taking a functional approach the processing within the CNS becomes the primary consideration.

How mechanistic, reductionistic and allopathic thought has infected vitalistic chiropractic theory is a subject for another book and not this seminar manual, but we can look at a few clinical decision making scenarios to flesh out a few keys.

Lets us look at a right sided upper extremity contracture from a left sided CVA. The right elbow becomes flexed and the wrist flexes due to the stroke. In traditional North American physical therapy and chiropractic, the therapists will stretch out the contracture, of course, to return the joint to normal. Many hours will be spent jumping on a chronically contracted biceps. But this increases somato-sensory representation of the biceps. Is this what we want to do with an already over-contracted (over represented in the somato-sensory cortex) biceps? No thought as to the true process of the disorder.

Muscles can only contract. The biceps in our scenario above is not dysfunctional; it is contracting efficiently and vigorously, doing what it is suppose to do. The problem is lack of inhibition from the triceps. The afferentation processing from the antagonist, triceps, is damaged from the CVA. By stimulating the triceps, increasing somato-sensory representation of the triceps, magically the elbow contracture improves immediately. The biceps (elbow flexion) should be hands off unless you are stimulating the triceps while at the same time trying to reduce the biceps contracture.

Again, looking at all components of the symphony above (upper extremity movement), one would have to assess that the biceps is working and the triceps is not. The CVA has damaged the amount of “triceps” afferentation that gets to the cortex. By increasing the amount of input from the antagonist (if the program for normal upper extremity movement still exists in the CNS) the biceps contracture improves. When the program is non-existent, then the challenge is to place the program into the CNS. A subject for another manual.

Let’s look at an acute situation. The running back in a football game starts running and pulls up screaming in pain, grabbing his left hamstring. The trainer runs onto the field, grabs the hobbled elite athlete and begins to stretch out the tight ‘pulled’ hamstring.

Question: Does this increase or decrease somato-sensory representation of the spasmed hamstring? By stimulating the quadriceps (tapping, contracting), the hamstring tone is decreased. This is observed immediately.

By looking at each component/module of dynamic equilibrium, the coordination within each module of dynamic equilibrium, a global plan for rehabilitation can be attained.

One needs to look just not at antagonist and agonist relationships, but the timing of when a module or muscle group should be activated and de-activated and the proprioceptive and vestibular component. Functional processing of all the incoming information, always being weighted by efficiency, should drive all our rehabilitative (exercise therapy and sensory integrative exercises) efforts.

# posted by Fred Clary, Chiropractor @ 7:15 PM