Education

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

 

Clinical Geriatrics: A Diagnostic Compendium

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 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.

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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…)

Clinical Chiropractic: The Wrist and Hand

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 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.

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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…)