Diagnosis

Clinical Disorders and the Autonomic Nervous System

By Frank M. Painter|November 29, 2011|Diagnosis, Education|

Clinical Disorders and the Autonomic Nervous System

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.

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

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Clinical Disorders of the Motor System

By Frank M. Painter|November 27, 2011|Diagnosis, Editorial|

Clinical Disorders and the Motor System

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 9 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.

Chapter 9: Clinical Disorders and the Motor System

OVERVIEW

Such clinical features as fatigue, weakness, nervousness, pain, tenderness, paralysis, sensory loss, paresthesia, and abnormalities of muscle mass or tone are the most common signs and symptoms noted in neural disorders. Fatigue, weakness, and nervousness are frequently presented together. This triune can usually be attributed to a functional disorder or appear as a complication in organic disease.

Abnormal striated muscle function has its origin in diseases of the brain, spinal cord, peripheral nerves, or muscle tissue itself. Dysfunction occurs in a variety of symptoms and signs such as:

(1) impaired movements,
(2) spontaneous movements,
(3) coordination defects,
(4) abnormal reflexes,
(5) distortions of muscle tone, and
(6) postural and movement distortions.

Weakness, wasting, and sometimes paralysis are represented in these conditions. Common types of motor lesions are shown in Table 9.1.

Basic Neuromuscular Activities

There are two fundamental types of neuromuscular activity. One type consists of reflex postural contractions, which are the basis of posture and physical attitudes and maintain muscle tone. The other type consists of phasic contractions, which produce movement. Phasic contractions may be either reflex or volitional in origin. While reflex actions are always purposeful, predictable, and involuntary, cortical activity is not.

Neurons carrying phasic and tonic impulses have distinctive characteristics. Phasic motor neurons are large, have a rapid conduction velocity, have a high threshold of physiologic excitability, present large impulses of short duration, and are electrically silent during rest. In contrast, tonic motor neurons are smaller, have a slower conduction velocity, have a lower threshold of physiologic excitability, present smaller impulses of longer duration, and are electrically active during rest.

Muscle and Joint Correlations
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Clinical Geriatrics: A Diagnostic Compendium

By Frank M. Painter|November 20, 2011|Diagnosis, Education|

Clinical Geriatrics: A Diagnostic Compendium

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 8 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.

Chapter 8: Clinical Geriatrics: A Diagnostic Compendium

The objective of this chapter is to focus attention on disorders witnessed in practice by those dealing with the geriatric patient. Following neurologic disorders, heart, vascular, and blood disorders are discussed. Digestive and gastroenterologic disturbances are then followed by disorders of the urinary system, skin, endocrines, and reproductive system. Next, eye, ear, and throat conditions are followed by orthopedic and respiratory considerations. The chapter concludes with information about the sexual aspects of aging, common complaints and symptoms, and other pertinent considerations.

The topics described in this chapter are not to be considered a complete reference for all geriatric conditions seen in practice. They have been chosen as those most likely to be encountered or because they present a unique situation necessary for differentiation and/or case management.

While some described disease states may not be commonly considered within the scope of chiropractic general practice, their diagnosis is. Thus, this general knowledge will help clarify when referral should be considered, thus serving the best interests of the patient and possibly avoiding a potential accusation of professional negligence.

It is the editor’s opinion that most errors in diagnosis or judgment do not occur from a lack of clinical knowledge. They occur as the result of a hurried history and examination. A clinician must be self-disciplined to give full attention to the patient at hand, without distracting concern for those patients waiting in the reception room.

CLINICAL APPROACH

In past years, it was a frequent fault of young practitioners of all disciplines to contribute age an important etiologic factor. It is emphasized that age alone is an inadequate factor in the cause of severe illness in the elderly. Careful examination, treatment of the whole individual, and prolonged follow-up is necessary for optimal results.

Most pathologists readily admit that disease is a process, not a state, but rarely is the process defined other than to say that disease of any tissue or organ is the result of disturbed function — normal physiology gone wrong. (more…)

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Endocrine Imbalance

By Frank M. Painter|November 18, 2011|Diagnosis, Education, Endocrine Imbalance|

Endocrine Imbalance

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 13 from RC’s best-selling book:

“Clinical Chiropractic: Upper Body Complaints”

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 13: Endocrine Imbalance

CLINICAL BRIEFING

The nervous and endocrine systems work hand in hand. The nervous system is design to operate body functions when rapid response is necessary. For long-term duty, the endocrines take over and simulate neural activity. These two systems can be compared to an athlete who sprints in a 100-yard dash and another who runs a marathon. They have two different roles but are not entirely independent in either role. They are integrated, synergistic, and facilitating.

Sympathetic stimulation increases the secretion of the adrenals, pancreas (including islets), pineal gland, and thyroid and parathyroids. The parasympathetics generally have a reverse or unknown effect. See Table 16.18.

The highly integrated system of ductless glands in the body produces internal secretions (hormones) that discharge into circulating blood or lymph to affect remote tissues. Some of these glands also produce external secretions. The adrenals, isles of Langerhans of the pancreas, thyroid, parathyroid, pituitary (hypophysis) ovaries, and testes are true endocrine glands. The thymus and pineal body have not been shown to produce hormones.

CNS Endocrine Function

Research of recent years has shown that the brain and spinal cord also secrete many specific and nonspecific hormone-like substances into blood or lymph. Brain endorphins and enkephalins and spinal cord dynorphins and enkephalins are typical examples. Many other similar substances are likely to be discovered as investigation continues. The subtle functions of the nervous system are pioneer fields of study.

Normal Effects

The endocrine system acts similar to a chemical nervous system. Like the nervous system, self-contained positive and negative feedback mechanisms (essentially hypothalamic, pituitary, or peripheral) are crucial to proper operation and integration of body functions.

Among the physiologic processes influenced by hormones are resistance to disease; rate of systemic metabolism; rate of metabolism of specific substances; rate of growth, development, and repair processes; rate of development and function of the reproductive organs, primary and secondary sexual characteristics, and degree of libido; and the secretory activity of other endocrine glands. Hormonal processes also play an important role in the development and function of the CNS, personality formation, and how the body reacts to stress. Thus, hormones may have a specific effect on a specific organ or tissue or produce a wide systemic effect on the entire body.

General Causes of Endocrine Imbalance

Endocrine dysfunction may result from inadequate secretion or hypersecretion. Activity is under the control of the nervous system, certain circulating chemical influences, and other hormones. There is barely any pathologic process having a neurologic component that does not involve to some degree parts of the endocrine system. Because of the important role the endocrines have in maintaining homeostasis, the effects of disease, neoplasm, stress, and maladaptation can be widespread. The extent that the imbalance will have on body function depends on the severity and duration of the disturbance.

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

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Clinical Chiropractic: The Wrist and Hand

By Frank M. Painter|November 17, 2011|Diagnosis, Education|

Clinical Chiropractic: The Wrist and Hand

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 9 from RC’s best-selling book:

“Clinical Chiropractic: Upper Body Complaints”

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 9: The Wrist and Hand

CLINICAL BRIEFING

Structural Considerations

Clinically, the most important articulation in the elbow is formed by the proximal ulna and the distal radius forms the most important articulation in the wrist. The carpals articulate with the ulna only during extreme wrist adduction.

The distal row of carpals forms a complex joint with the proximal row. Because they are loosely connected, the navicular and trapezium spread during wrist abduction and approximate during adduction. The proximal carpals rock and glide toward the ulna during wrist abduction and toward the radius during adduction. Adduction is slightly greater in pronation because the styloid process of the ulna restricts motion when the hand is supinated. During adduction, the styloid swings backward out of the way. As the A-P curve of the proximal carpals is more acute than the transverse curve, greater excursion is allowed in wrist flexion and extension than in lateral motion. The more delicate the patient’s bone structure, the greater the mobility.

The intricate anatomical architecture of the wrist allows flexion (80°), extension (70°), radial deviation (30°), ulnar deviation (20°), supination and pronation of the forearm.

Basic Wrist and Finger Biomechanics

The muscles of the wrist course obliquely to the parts to be moved. This requires coordination with other muscles whenever the wrist is moved. Wrist strength in flexion is nearly double that in extension, and the power of extension is greatly lessened when the wrist is fully flexed. During extreme flexion of the wrist, it is impossible to strongly curl the fingers in full flexion because the flexor tendons are slack. When the wrist is hyperextended, the extensors relax and the fingers cannot hyperextend fully. These are two important considerations during examination. (more…)

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Clinical Chiropractic: The Shoulder and Arm

By Frank M. Painter|November 15, 2011|Diagnosis, Education, Shoulder|

Clinical Chiropractic: The Shoulder and Arm

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 7 from RC’s best-selling book:

“Clinical Chiropractic: Upper Body Complaints”

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 7: THE SHOULDER AND ARM

CLINICAL BRIEFING

Shoulder Pain

Shoulder pain can be deceiving. As in so many musculoskeletal disorders, consideration of pain in the shoulder should not give priority to sudden trauma whether it be of intrinsic or extrinsic origin. Thorough investigation of the history may reveal that trauma did not initiate the first attack or that an injury was just a precipitating event that revealed an underlying degenerative disorder. Besides trauma, shoulder pain may have an inflammatory, a neurologic, a psychologic, a vascular, a metabolic, a neoplastic, a degenerative, a congenital, an autoimmune, or a toxic origin. See Table 7.1.

The Complexities in Treating Shoulder Complaints

Many practitioners would be happy if another patient with a shoulder complaint did not enter their offices. There are five major reasons for this:

1. The shallow shoulder joint is highly unstable. Its stability is provided by muscles rather than the strong ligament straps provided in most other joints. This makes recurring disorders common. The answer is therapeutic exercise, but many patients soon get bored with such regimens and the prescribed exercises are stopped long before adequate strength is acquired. Thus thorough counseling and monitoring are required.

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