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Sports Management: Lumbar Spine, Pelvic, and Hip Injuries

The Chiro.Org Blog

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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 26 from RC’s best-selling book:

“Chiropractic Management of Sports and Recreational Injuries”

Second Edition ~ Wiliams & Wilkins

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.

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Chapter 26:   LUMBAR SPINE, PELVIC, AND HIP INJURIES

Facet Syndromes

The subluxation of lumbar facet structures, states Howe, is a part of all lumbar dyskinesias and must be present if a motor unit is deranged. In a three-point articular arrangement, such as at each vertebral motor unit, no disrelationship can exist that does not derange two of the three articulations. Thus, determination of the integrity or subluxation of the facets in any given motor unit is important in assessing that unit’s status.

ROENTGENOLOGIC CONSIDERATIONS

Any method of spinographic interpretation which utilizes millimetric measurements from any set of preselected points is most likely to be faulty because structural asymmetry and minor anomaly is universal in all vertebrae. However, the estimation of the integrity of facet joints is a reliable method of assessing the presence of intervertebral subluxation. An evaluation of the alignment of the articular processes comprising a facet joint may be difficult from the A-P or P-A view alone when the plane of the facet facing is other than sagittal or semisaggital. In this case, oblique views of the lumbosacral area are of great value in determining facet alignment since the joint plane and articular surfaces can nearly always be visualized.

When one cannot visually identify disrelationships of the facet articular structures, Howe suggests use of Hadley’s S curve. This is made by tracing a line along the undersurface of the transverse process at the superior and bringing it down the inferior articular surface. This line is joined by a line drawn upward from the base of the superior articular process of the inferior vertebrae of the lower edge of its articular surface. These lines should join to form a smooth S. If the S is broken, subluxation is present. This A-P procedure can be used on an oblique view.

DIFFERENTIATION

To help differentiate the low back and sciatic neuralgia of a facet syndrome to that of a disc that is protruding:

l.   With the patient standing with feet moderately apart, the doctor from behind the patient firmly wraps his arms around the patient’s pelvis and firms his lateral thigh against the back of the patients’ pelvis. The patient is asked to bend forward. If it is a facet involvement, the patient will feel relief. If it is a disc that is stressed, symptoms will be aggravated.

2.   In facet involvement, the patient seeks to find relief by sitting with feet elevated and resting upon a stool, chair, or desk. In disc involvement, the patient keeps knees flexed and sits sideways in his chair and moves first to one side and then to the other for relief. If lumbosacral and sacroiliac pain migrates from one to the other side, it is suspected to be associated with arthritic changes.

Lumbosacral Instability

Lumbosacral instability is a mechanical aberration of the spine which renders it more susceptible to fatigue and/or subsequent trauma by reason of the variance from the optimal structural weight-bearing capabilities. Hariman states that between 50% and 80% of the general population exhibit some degree of the factors which predispose to instability whether by reason of anomalous development of articular relationships or altered relationships due to trauma or disease consequences. It is the most common finding of lumbosacral roentgenography and often brought to light after an athletic strain. (more…)

Sports Management: Peripheral Nerve Injuries

The Chiro.Org Blog

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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 17 from RC’s best-selling book:

“Chiropractic Management of Sports and Recreational Injuries”

Second Edition ~ Wiliams & Wilkins

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.

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Chapter 17:   PERIPHERAL NERVE INJURIES

Neurotherapy and Spondylotherapy

Neurotherapy refers to the inhibition of overly active nerve function or the activation of sluggish function. Spondylotherapy is the treatment by physical methods applied to the spinal region. A nerve fiber may be stimulated artificially (ie, mechanically, thermally, chemically, electrically) anywhere along its course.

Certain nerve fibers function specifically for certain sensory and motor acts and may be stimulated at either their central or peripheral ends: efferent nerves are stimulated centrally and afferent nerves peripherally. The ability of sensory nerve stimulation to produce a motor or glandular response is readily demonstrated in eliciting any tendon reflex where superficial percussion produces the characteristic jerk, the muscle-spasm reflex resulting from skin exposure to a cool wind or proprioceptive excitement from strain or sprain, or the salivary response from seeing a person eat a lemon.

Neuroinhibition.   Abnormal reflexes appear to be inhibited more by pressure and cold than by any other methods. For example, a painful splinting erectormuscle spasm can be relaxed by placing the muscle in a position of functional rest and then applying mild continuous stretching or pressure. Cold is an excellent neuroinhibitor, especially with nerves which are located not too deep. Functional inhibition can be gained by stimulating a nerve whose chief function is inhibitory. Pressure may be applied digitally or with a pressor instrument at or near the paravertebral spaces. Steady pressure on the surface of the body, usually applied digitally, over the course of a nerve tends to be a restraining influence. There also appears to be a reflex influence upon vessels and glandular secretions. Certain skin areas (eg, suboccipital, paraspinal, parasacral, perianal, peripheral-meridian) are highly responsive to mild pressure from which reflexes of vasodilation and muscle relaxation can be initiated. (more…)

General Principles of Clinical Neurology

The Chiro.Org Blog

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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 2 from RC’s best-selling book:

“Basic Principles of Chiropractic Neuroscience”

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.

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Chapter 2:   General Principles of Clinical Neurology

The nervous system and the endocrine system work as partners to provide the majority of functional control for body processes. Guyton, the renowned physiologist, describes the basic function of the nervous system to be the controlling factor for rapid activities such are necessary for muscle contraction, rapidly changing visceral events, and the rate of endocrine secretions.

The dominant action of the nervous system over the physical processes of the body is called neurarchy. In contrast to the nervous system, the endocrine system principally regulates the metabolic functions of the body and controls prolonged physiologic activities.

OVERVIEW

The demanding role of the nervous system of the human body can be appreciated by recognizing that during every minute of life the nervous system must receive thousands of signals from a countless variety of sensory organs, integrate the data, prepare necessary responses, and effect the responses via a multitude of motor and/or autonomic efferent mechanisms. Thus, a specialized network of nerve tissue permeates the body in such a manner that some parts receive and respond to stimuli from the external or internal environments, some parts transmit signals to and from integrating and coordinating centers, and some parts conduct messages from centers peripherally to muscles, vessels, or glands to effect an action. (more…)

Clinical Disorders and the Autonomic Nervous System

The Chiro.Org Blog

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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 10 from RC’s best-selling book:

“Basic Chiropractic Procedural Manual”

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.

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Chapter 10:   Clinical Disorders and the Autonomic Nervous System

This chapter is an overview of the clinical aspects of autonomic dysfunction that emphasizes the clinical aspects of sympathetic and parasympathetic disorders. Such topics as stress and the neurodystrophies, the evaluation of visceral function, and reflexology are described. A review of the section titled “The Visceral System” within Chapter 3 will be beneficial to the reader of this chapter.

Wiles has stated that “Visceromotor articles made up 14% of the ACA Journal of Chiropractic articles in 1977. They made up 8.9% in 1985. If we wanted to, this could be extrapolated out and this type of article would die out by 1992.” If this occurs, a great injustice would be done to the potential of the profession as well as the public it serves. It appears that some in the profession have lost sight of the fact that it was the successful management of visceral and systemic conditions that sustained chiropractic during its early years.

It was the opinion of James Firth, then president of Lincoln Chiropractic College, that chiropractic was a dying profession around the period of World War I. He stated, “There is no question in my mind that it was the successful results of chiropractic during the great influenza epidemic following the war that saved it. Hundreds of thousands of people were dying, and medicine had no solution to the problem. Chiropractors got results, and the word quickly spread throughout the nation. Chiropractic offices that had been nearly empty became filled, and state legislators began to take the chiropractic profession seriously in spite of the opposition of the AMA.”

OVERVIEW

Embryologically, the somatic structures appear late in development as compared to the vegetative nervous system, which serves as the chief integrating and correlating system of the visceral structures. The voluntary and vegetative nervous systems are intimately connected and brought into reflex connection so that visceral stimulation has skeletal and somatic expression and skeletal muscle messages are expressed in visceral tissues: The body is a whole.

Vegetative action is slow when compared to voluntary action. In addition, human will, at least for normal consciousness without specialized training (eg, biofeedback), has little power to direct visceral effects as one would direct a skeletal muscle because vegetative functions must be conducted whether one is awake or asleep. In certain acts, however, voluntary and vegetative nerves supplement one another such as in swallowing, breathing, defecation, urination, and seminal ejaculation.

Sympathetic Distribution

The sympathetics are widespread in their distribution. Through their innervation of blood vessels, sympathetic fibers reach every tissue of the body. They control blood vessel diameter, subdermal structures, heart muscle, the sphincter system of the gut and urinary apparatus, and parts of the bladder and reproductive organs; they inhibit many structures in the head and chest; and they reach the enteral system’s muscles and glands.

While it is widely recognized that the cervical sympathetic chain communicates with the lower cranial nerves, Parkinson and associates have confirmed that the sympathetic nerve running with the carotid artery gives off a multitude of fine branches at irregular intervals as the nerve travels cephally. The largest residual component joins the cranial VI (abducens) and leaves to join the cranial V (trigeminal) nerve. Similar fibers have not been found to join the cranial III (oculomotor) or IV (trochlear) nerves.

Parasympathetic Distribution

The parasympathetics activate the intrinsic eye muscles, glands of the peripheral head, bronchi muscles and glands, entire enteral system, body of the bladder; they inhibit the heart; and they provide vasodilation in many structures (especially the head and penis).

STRESS AND THE NEURODYSTROPHIES

An autonomic efferent nerve has two major functions:

(1) impulse conduction and(2) a trophic influence on receptor organ growth, repair, immunity, and cellular alterations in disease.

While these conduction and trophic functions are of equal importance and separate actions, trophic functions have unfortunately received secondary interest by most research neurologists. Because interference with trophic function serves an important role within chiropractic concepts, several pertinent findings are described in this section.

Research on nonimpulse initiated communication between the neuron and its end structures has increased in recent years. Singer relates that despite considerable controversy modern consensus accepts the role of neurotrophic and impulse stimulation in the maintenance of muscle tissue. He feels that, experimentally, it has been difficult to report these two mechanisms for individual study because most information has been obtained in model systems.

Autoadaptation and Immunity

Guth, Gutmann, and Gurkalo/Zabezhinski show that there should be no question that the autonomic nervous system regulates directly and indirectly the functions of all organs and tissues and influences even biochemical processes at the cellular and subcellular level.

After observing more than 15,000 patients with infectious diseases and studying the host-parasitic relation in infectious disease, Sato found that the adaptation of the human body to the internal environment is maintained by an autoadaptation mechanism operating upon the biological binary digit. That is, the autoadaptation mechanism has two antagonistic systems (sympathetic and parasympathetic divisions) that are composed of many antagonistic links:

(1) the two reciprocal nerves of the autonomic nervous system;(2) two phases (rise and fall) of mitosis of the neurotrophic system in bone marrow; and

(3) two defense reactions (the cell-stimulant factor reaction and the antibody-antigen reaction).

These binary antagonistic links are interconnected into two systems that are controlled by the two antagonistically functioning nerves (sympathetic and parasympathetic) of the autonomic nervous system.

In a following study, Sato found that the autoadaptation mechanism of the human body loses its rationality and purposefulness by an imbalance of the autonomic nervous system, and the host body falls into adaptational disturbances. He reports that hosts with sympathicotonia often fall into acute adaptational disturbances in the acme to the convalescent stage by stimuli of the second-phase factors (the factors lowering mitosis of the neurotrophic system in the bone marrow), resulting sometimes in death.

Review the complete Chapter (including sketches and Tables) at the ACAPress website