Chiropractic Care

Shoulder Girdle Trauma

By Frank M. Painter|May 16, 2012|Chiropractic Care, Diagnosis, Evaluation & Management, Rehabilitation, Shoulder, Spinal Manipulation, Sports|

Shoulder Girdle Trauma

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Clinical Monograph 16

By R. C. Schafer, DC, PhD, FICC

The articulations of the scapula, clavicle, and the humerus function as a biomechanical unit. Only when certain multiple segments are completely fixed can these parts possibly function independently in mechanical roles. Forces generated from or on one of the three segments influence the other two segments. Thus, they will be described here as a functional unit. Please underscore this point in your mind as you read this paper.

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Cervical Spine Trauma

By Frank M. Painter|May 15, 2012|Cervical Spine, Chiropractic Care, Evaluation & Management, Rehabilitation|

Cervical Spine Trauma

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Clinical Monograph 18

By R. C. Schafer, DC, PhD, FICC

As with most parts of the body, traumatic effects in the forearm or wrist may occur abruptly (eg, fracture, strain, sprain) or be the result of long-term microtrauma (eg, tunnel syndromes, arthritis, entrapment by scar tissue).

The cervical spine provides structural stability and support for the cranium, and a flexible and protective column for movement and balance adaptation, along with housing of the spinal cord and vertebral arteries. It also allows for directional orientation of the eyes and ears. Nowhere in the spine is the relationship between the osseous structures and the surrounding neurologic and vascular beds as intimate or subject to disturbance as it is in the cervical region.

BACKGROUND

Whether induced by trauma or not, cervical subluxation syndromes may be reflected in total body habitus. IVF insults, and the effects of articular fixations can manifest throughout the motor, sensory, and autonomic nervous systems. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the cervical spine, as may numerous brainstem disorders.

Common Injuries and Disorders of the Cervical Spine

Cervical spine injuries can be classified as

(1) mild (eg, contusions, strains);

(2) moderate (eg, subluxations, sprains, occult fractures, nerve contusions, neurapraxias);

(3) severe (eg, axonotmesis, dislocation, stable fracture without neurologic deficit); and

(4) dangerous (eg, unstable fracture-dislocation, spinal cord or nerve root injury).

Spasm of the sternocleidomastoideus and trapezius can be due to strain or irritation of the sensory fibers of the spinal accessory nerves as they exit with the C2–C4 spinal nerves. The C1 and C2 nerves are especially vulnerable because they do not have the protection of an IVF. Radicular symptoms are rarely evident unless an IVD protrusion or rupture is present.

Prevalence

Because of its great mobility, relatively small structures, and weight-bearing role, the cervical spine is a frequent site of severe spinal nerve injury and subluxation/fixations. A large variety of cervical contusions, Grade 1–3 strains and sprains, subluxations, disc syndromes, dislocations, and fractures will be seen as the result of trauma.

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Soft-Tissue Neck Trauma

By Frank M. Painter|May 12, 2012|Chiropractic Care, Evaluation & Management, Rehabilitation, Spinal Manipulation|

Soft-Tissue Neck Trauma

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Clinical Monograph 15

By R. C. Schafer, DC, PhD, FICC

The mechanical relationship between the head and neck has been crudely compared to a brick attached to a flexible rod. As the structural mass of the head is so much greater than that of the neck, it is no wonder that injuries of the neck are so prevalent. Even the person with a short neck and well-developed neck muscles and ligaments is not free of potential injury.

BACKGROUND

The viscera of the neck serve as a channel for vital vessels and nerves, the trachea, esophagus, and spinal cord, and as a site for lymph and endocrine glands. When the head is in balance, a line drawn through the nasal spine and the superior border of the external auditory meatus will be perpendicular to the ground.

Anterior injuries are more common to the head and chest as they project further forward, but a blunt blow from the front on the head or chest may cause an indirect extension or flexion injury of the cervical spine and soft tissues of the neck. In any neck injury, the injury may not be the product of a single force. For example, while extension, flexion, and lateral flexion injuries are often described separately, rotational, compressive, tensile, and shearing forces are invariably part of the picture.

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The anterior and lateral aspects of the neck contain a variety of vital structures that have no bony protection. Partial protection is provided by the cervical muscles, the mandible, and the shoulder girdle.

After neck injury, a careful neurologic evaluation must be conducted, and every examination should begin with a thorough case history. See Table 1. Note any signs of impaired consciousness, inequality of pupils, or nystagmus. Do outstretched arms drift unilaterally when the eyes are closed? Standard coordination tests such as finger-to-nose, heel-to-toe, heel-to-knee, and for Romberg s sign should be conducted, along with superficial and tendon reflex tests.

Table 1 Typical Questions Asked During the Investigation of Joint Pain

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The Foundation of Biomechanical Evaluation Following Injury

By Frank M. Painter|May 11, 2012|Chiropractic Care, Clinical Pearl, Evaluation & Management, Rehabilitation|

The Foundation of Biomechanical Evaluation Following Injury

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Clinical Monograph 9

By R. C. Schafer, DC, PhD, FICC

INTRODUCTION

The study of human biomechanics includes the mechanical principles involved, the physiologic considerations of muscle length-tension relations, and an understanding of the controlling neuromotor mechanisms and the sensory feedback apparatus, reflecting both locomotor activity and cerebral function. Applied biomechanics is the application of the practical principles of mechanics (the study of forces and their effects) to the body in movement and at rest.

The more biomechanics are understood, the better musculoskeletal disorders in sports and the workplace can be appreciated. The same can be said of physical work and recreational activities. The athlete is constantly attempting to improve performance by applying biomechanical principles to specific movements. The same is true for ergonomics in the workplace. From the viewpoint of the doctor, knowledge of the mechanisms involved in an injury is necessary to evaluate an injury accurately.

PERTINENT BIOMECHANICS

From a pure musculoskeletal standpoint, the human body is a mechanical device. All mechanical devices are subject to wear during use that reflects their history of destructive forces. Unique to living tissue is its ability to heal, adapt, and strengthen, which provides a dialogue between catabolic and anabolic forces. While machines convert thermal or chemical energy into mechanical energy, muscle tissue transforms nutrients directly into mechanical energy without a thermal intermediary. Body energy enables it to overcome resistance to motion, to produce a physical effect, and to accomplish work.

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Practical Concepts

The body’s kinetic energy is reflected in its velocity, and its potential energy is reflected in its position. Work is the result of a force acting through a distance. Power relates to the time element and the work accomplished. There is a close association in the same unit of time between the work accomplished by a weight lifter and that of a sprinter. (more…)

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Maintaining a Vitalistic Perspective in Chiropractic in the Postmodern Era

By Frank M. Painter|April 16, 2012|Chiropractic Care, Philosophy|

Maintaining a Vitalistic Perspective in Chiropractic in the Postmodern Era

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SOURCE: J Chiropractic Humanities 2005; 12: 2-7

By Cheryl Hawk, DC, PhD, CHES

Professor and Director of Clinical Research
at Logan College of Chiropractic

Objectives: To discuss concepts of postmodernism with respect to the opposing worldviews of vitalism and mechanism, and to present an argument for a viable role for vitalism in chiropractic philosophy and research.

Discussion: Vitalism is only problematic if we begin with the assumption that a mechanist worldview or paradigm is the correct way to explain the world. In postmodern thought, a multiplicity of worldviews may coexist. One view is no more valid or correct than another and these divergent views are judged best by their utility under various circumstances. Exploring clinical practices and methodologies, such as whole systems research, arising from a vitalistic perspective could lead to innovations in both patient care and research, if pursued with flexible non-dogmatic thinking.

Conclusion: Vitalism, approached in a responsible and intelligent manner, may afford the chiropractic profession opportunities to further improve patient care and make contributions to new knowledge.

INTRODUCTION

The 2003, the World Federation of Chiropractic conference convened a panel to address this question: “Is vitalism a strong foundation or quicksand for the chiropractic profession?” As one of the panelists, in order to address what I believed this question was really asking, it was necessary to first deconstruct the question, that is, to examine its underlying assumption. [1]

This underlying assumption is that a mechanist worldview or paradigm is the correct way to explain the world. Based on this assumption, anything that does not fit this worldview would be a potential threat to our profession’s credibility and, therefore, must be modified to fit this view or jettisoned. Vitalism, which entails a different way of perceiving the world, poses such a threat.

This assumption must be examined rather than simply accepted. Only then will it be possible to make a conscious choice of which worldview we want to function within and then thoughtfully and responsibly adhere to the principles of that worldview.

DISCUSSION

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ACOEM Recognizes the Value of Chiropractic for Chronic Spinal Pain

By Frank M. Painter|April 4, 2012|Chiropractic Care, Chronic Pain, Guidelines, Spinal Manipulation|

ACOEM Recognizes the Value of Chiropractic for Chronic Spinal Pain

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SOURCE: Dynamic Chiropractic 2008 (Sep 23); 26 (20): 1

Tina Beychok, Associate Editor

Pain is the most prevalent health condition among U.S. workers and the most expensive in terms of lost productivity. Recent studies suggest more than six in 10 adults over the age of 30 experience chronic pain. Furthermore, health care expenditures for back and neck pain have risen to more than $80 billion a year in the U.S. – a dramatic increase over the past eight years, without evidence of improved health. In addition to the costs of lost productivity, an estimated $64 billion per year is lost due to workers continuing to work, even though pain reduces their job performance. This phenomenon is called “presenteeism.”

Unfortunately, workers’ comp can be a quagmire of contradictory and insufficient rules and regulations as to what treatments are and aren’t covered. The American College of Occupational and Environmental Medicine (ACOEM) has been in the process of revising its Occupational Medicine Practice Guidelines, which have not always taken a positive view of chiropractic manipulation. In fact, the second edition of the guidelines, released in 2005, was heavily criticized by some in the chiropractic community. [1]

ACOEM’s latest chronic pain guidelines (a chapter of the overall guidelines) may represent a step in the right direction in terms of recognizing the value of chiropractic care. The guidelines actually recommend manipulation for chronic, persistent low back or neck pain and cervicogenic headache. [2] This is significant because in the past, the guidelines failed to recommend manipulation, even when other treatment strategies (medication, etc.) were rated as less effective.

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