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Frank M. Painter

About Frank M. Painter

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.
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Chiropractic Perspectives On Myofascial Therapy

By |December 22, 2011|Education, Technique|

Chiropractic Perspectives On Myofascial Therapy

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 15 from RC’s best-selling book:

“Applied Physiotherapy in Chiropractic”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 15:   Chiropractic Perspectives On Myofascial Therapy

The purpose of this chapter is to improve the doctor of chiropractic’s understanding of the significance of myofascial pain and dysfunction, and to improve the chiropractor’s level of competence in diagnosing the myofascial component of the subluxation complex.

The myofascial orientation in the chiropractic setting directs the doctor to look first for a myofascial source of the patient’s pain, and when found, to use numerous techniques and procedures to offer rapid relief. Lowe recommends broad spectrum therapeutics to be employed after the performance of myofascial therapy to assure maximum flexibility. [1]

Definition

Myofascial therapy may be defined in several ways. Basically, it is the treatment of the myopathophysiologic component of the vertebral subluxation complex. It is also the treatment of trigger points, areas of increased neurologic activity in muscle tissue, causing the secondary referral of pain with subsequent associated autonomic changes. [2]

The pain attributed to myofascial dysfunction is usually restricted to a certain region such as the cervical or upper thoracic area, lumbar and buttock area, or the cranial/TMJ area. A trigger point, often the cause of such pain, is always tender and palpably taut. This prevents full lengthening of the muscle and produces muscle weakening, altered proprioception, predictable referred pain patterns, and an objectively verifiable local twitch response during palpation. [3]

Historic Background

Several key figures have contributed to our understanding of the widespread cause of muscular pain syndromes, among them Travell, Rolf, and, in our own profession, Nimmo. Another chiropractor who added greatly to our understanding of the role of muscles in various pain syndromes was Gillet of Belgium. Gillet wrote, “Concerning the subluxation or misalignment, we prefer the term fixation, which describes far more accurately the actual status of the [peri]articular soft tissues, where we will find that it is the state of these tissues that actually keeps the two surfaces from moving. The osteopaths, very early on, stated that the soft tissues can vary from the simplest muscular contracture to a complete degenerative fibrosis of the muscles. The previous facts are not new ….unfortunately, x-rays, introduced early in chiropractic history, have done much to propagate the idea of the spine as a string of bones. Even today, many practitioners act as if they still believe the childish propaganda they so nimbly offer to the public, that it’s a bone out of place in the back.” [4] (more…)

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New Research Project Demonstrates Relief Of Allodynia With Chiropractic Adjusting

By |December 18, 2011|Pain Relief, Spinal Manipulation|

New Research Project Demonstrates Relief Of Allodynia With Chiropractic Adjusting

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther 2012 (Jan); 35 (1): 18-25

Jaqueline Trierweiler, Débora Negrini Göttert,
Günther Gehlen, PhD

Academic of Chiropractic from the University Feevale,
Laboratory of Comparative Histophysiology, ICS,
University Feevale, Novo Hamburgo, RS, Brazil.
jaquetri@gmail.com

OBJECTIVE: The purpose of this study was to evaluate the mechanical allodynia in animals after immobilization and chiropractic manipulation using the Activator instrument through the Von Frey test in an animal model that had its hind limb immobilized as a form to induce mechanical allodynia.

METHOD: Eighteen adult male Wistar rats were used and divided into 3 groups:

  1. control group (C) (n = 6) that was not immobilized;
  2. immobilized group (I) (n = 6) that had its right hind limb immobilized;
  3. immobilized and adjusted group (IAA) (n = 6) that had its right hind limb immobilized and received chiropractic manipulation after.

The mechanical allodynia was induced through the right hind limb immobilization. At the end of the immobilization period, the first Von Frey test was performed, and after that, 6 chiropractic manipulations on the tibial tubercle were made using the Activator instrument. After the manipulation period, Von Frey test was performed again.

RESULTS: It was observed that after the immobilization period, groups I and IAA had an exacerbation of mechanical allodynia when compared with group C (P < .001) and that after the manipulation, group IAA had a reversion of these values (P < .001), whereas group I kept a low pain threshold when compared with group C (P < .001).

CONCLUSION: This study demonstrates that immobilization during 4 weeks was sufficient to promote mechanical allodynia. Considering the chiropractic manipulation using the Activator instrument, it was observed that group IAA had decreased levels of mechanical allodynia, obtaining similar values to group C.

Discussion

The present study investigated the effects of instrumented assisted spinal manipulation therapy on mechanical allodynia produced by the immobilization of the right hind limb in a small animal model through the Von Frey test. Our group observed that the immobilization of the right hind limb, for a period of 4 weeks, might produce an exacerbation of the local mechanical allodynia and that the manipulation applied to the tibial tubercle, using the Activator instrument, might reduce the severity of local allodynia induced by the immobilization. (more…)

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Insurers Announce New Reimbursement Policy for Multiple Therapies

By |December 17, 2011|Announcement|

Insurers Announce New Reimbursement Policy for Multiple Therapies

The Chiro.Org Blog

SOURCE:   The American Chiropractic Association

By: Bobby Gibson, Director of Operations

United Healthcare (UHC) and Aetna recently sent out notices to providers detailing their new Multiple Therapy Reduction policies. These policies reduce the reimbursement for the practice expense portion of the relative value units (RVUs) for certain therapies beyond the first therapy billed. The rationale is that there is duplication of the practice expense portion of the RVU.

UHC and Aetna are following the lead of the Centers for Medicare and Medicaid Services (CMS) after it initiated a similar policy on Jan. 1, 2011. CMS originally proposed a reduction of the second and any subsequent therapy practice expense portions by 50 percent. When that policy was proposed, ACA partnered with other provider organizations to contact Congress to oppose the policy. Due to the large amount of opposition, CMS decided to lessen the reduction to 20 percent rather than the proposed 50 percent.

UHC’s policy will affect claims with a date of service on or after March 1, 2012 and will affect claims paid by United. It will not affect claims on any plans in which Optum processes or pays the claims or plans in which providers are paid a flat per diem visit fee. Aetna’s policy took effect November 14, 2011, and to the best of our knowledge affects all Aetna plans. To illustrate how this policy will play out, we have created the following hypothetical example: (more…)

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Motion Palpation of the Pelvis

By |December 12, 2011|Diagnosis, Education|

Motion Palpation of the Pelvis

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 6 from RC’s best-selling book:

“Motion Palpation”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 6:   Motion Palpation of the Pelvis

Differentiating Sacroiliac from Lumbar Fixations

To differentiate sacroiliac from lumbar fixations, Faye offers the following comments for consideration.

With the patient sitting and their hands placed behind their head, rotate the patient’s trunk first to the right and then to the left. Special care should be taken not to lift the patient’s pelvis. Motion restriction of the patient’s left lumbar facets or left sacroiliac joint will reduce rotation to the left (positive theta Y). Motion restriction of the patient’s right lumbar facets or right sacroiliac joint will inhibit rotation of the patient’s trunk to the right (negative theta Y).

To discern between a lumbosacral or sacroiliac lesion, the patient is allowed to relax against the doctor (patient’s hands are still behind their head). In this position, the lumbosacral joint is relatively stress free. Next, twist the patient’s trunk into posterior rotation on the right until the patient’s left ischial tuberosity lifts slightly (buttocks remaining on palpation stool). In this position, there is a marked posterior torsion strain on the right sacroiliac joint. If pain arises in the right sacroiliac that can be relieved by pushing the left ilium posteriorly, then the pain can be assumed to arise from the right sacroiliac joint. Reverse the doctor-patient positions to differentiate fixations on the left. This is Mennell’s modified Kemp’s test for the lumbosacral area.

Here are some helpful clues: The patient suffering from sacroiliac dysfunction gets up in the morning with stiffness that improves with activity. The patient suffering with facet inflammation and/or an IVD lesion arises improved, but the condition worsens as the day goes on. Fixation produces a sharp pain on certain movements that is relieved when the site is not stressed. Other points characteristic of a sacroiliac lesion are:

  1. There is usually unilateral pain in the sacroiliac joint.
  2. The patient may describe an onset involving a lifting or twisting maneuver upon which a “catch” in the back is felt.
  3. The patient has difficulty rising from bed, and the disability is worse in the morning, improving with activity. (more…)
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Motion Palpation of the Lumbar Spine

By |December 11, 2011|Diagnosis, Education|

Motion Palpation of the Lumbar Spine

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 5 from RC’s best-selling book:

“Motion Palpation”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 5:   The Lumbar Spine

This chapter describes the dynamic chiropractic approach to the correction of fixations of the lumbar spine and related tissues. Emphasis is on biomechanical, fixation, and therapeutic considerations. Some significant points in differential diagnosis are also described.

According to Faye, the three most common types of low back pain are:

(1) the lumbar facet syndrome,

(2) the sacroiliac syndrome, and

(3) the lumbar radicular syndrome, which may be discogenic or biomechanical in origin.

Each of these types can be acute or chronic, traumatic or nontraumatic, and have varying degrees of concomitant pathomechanics. The syndromes are named according to the level of inflammation or pain-producing structures and more than likely not the area in need of adjustments. Their typical cause may be due to:

sprain/strain,
overuse,
poor posture,
disuse,
joint dysfunction (fixation/hypermobility),
development abnormality,
degenerative changes,
or various combinations of these origins.

In addition, the possibility of viscerosomatic and somatosomatic reflexes should not be overlooked. (more…)

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