A Sample Lecture to Healthcare Professionals

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A Sample Lecture to Healthcare Professionals

• Lisa K. Bloom, D.C.
• Diplomate of the International Board of
  Chiropractic Neurology
• Diplomate in Applied Chiropractic Sciences
• Associate Professor, Diagnosis and Practice
  Department of
• New York Chiropractic College

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• Note to the user
• This presentation was designed to accommodate the
  student in 2 ways 1) no pictures or graphics
  were used in order to reduce the size of the
  presentation and insure that a 3.5 disc would be
  sufficient to download the presentation and 2)
  the text within the slides is longer than would
  normally be considered most effective in a
  Power Point presentation. This was done to
  insure that you have all the necessary words as
  you begin presenting this material to other
  health care professionals...

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• I suggest that you add graphics as you see fit
  and simplify the slides as you become more
  comfortable with the material. The computer lab
  staff can help you with both.
• Please use and adapt this presentation as you see
  fit. You are always welcome to contact me at
  x3180.
• Good luck and have fun!

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The Rationale for Chiropractic Care

• (Fill in your name here)

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Chiropractic care centers around the maintenance
of appropriate movement of the spinal joints and
optimizing biomechanics throughout the
musculoskeletal system.

• Premise

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WHY?

• Lets begin.

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There is a distinct difference between a medical
subluxation and a chiropractic vertebral
subluxation complex

• A chiropractic subluxation is inherently a
  HYPOmobility suggesting decreased movement and no
  loss of stability
• A medical subluxation is inherently a
  HYPERmobility resulting from a loss of integrity
  of the joint capsules and concomitant instability

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The primary lesion addressed in chiropractic is
the vertebral subluxation complex (VSC).

• This refers to discrete areas of hypomobilty
  within the spinal column

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Components of the Vertebral Subluxation Complex
(VSC)

• Dyskinesis (hypomobility)
• Altered biomechanics (cellular damage)
• Physiological and biochemical changes
• Altered nervous system activity
• Altered motor patterns...

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Case management protocol includes

• Specific spinal analysis
• Physical, neurological, orthopedic examinations
  and consultation
• Specific restoration of normal biomechanics by
  means of the adjustment
• Referral for co-management if appropriate
• Appropriate attention to ergonomical
  considerations and other possible causes of
  biomechanical dysfunction

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The purpose of the adjustment is

• to restore normal movement and resolve the
  resultant biomechanical, physiological and
  neurological effects of segmental hypomobility.

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What are these effects?
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Biomechanical Effects of Hypomobility

• Altered intersegmental movement patterns
• Results in compensatory changes in motor
  patterns, etc.
• Creates cellular damage in sites of biomechanical
  stresses
• Immobilization Degeneration

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Loss of normal motion within a joint results in
changes in every structural component of the
jointsubchondral bone to the synovium, from
meninges to the ligamentum flavum.

• Amiel D, et al. Acta Ortho Scand, 1982
• Palmoski M, et al. Arth Rheum, 1979
• Paine Haung. J Neurosurgery, 1972

• Lantz C. Chiro Res J, 1988
• Enneking Horowitz. J Bone Joint Surg, 1972
• Evans EB, et al. J Bone Joint Surg, 1960

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Current orthopedic literature recognizes that
changes in the pattern of forces transmitted
through joints, which occurs during the
immobilization process, is universally recognized
as contributing to connective tissue degeneration
and local changes in the chemical composition of
that tissue.
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We also know that mechanical failure of
ligaments, discs, capsules and other connective
tissue can result from local variations in
chemical composition.
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Measurable changes within the joint complex occur
within one week of the onset of hypomobility.
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Effects of hypomobility on the intervertebral
disc...
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The nucleus pulposus is the the area of the disc
most susceptible to dessication.

• The nucleus pulposus is dependent on movement
  for nutrition and survival...

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Lack of appropriate intersegmental spinal
movement can significantly reduce the dynamic
pressure gradient between the intradiscal tissues
and the subchondral areas of spongiosa in the
vertebral bodies...
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this sacfrifices the key mechanism by which
nutrients and water replenish the disc and by
which metabolic waste leaves the disc.
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Putting it together...

• Loss of normal movement leads to
• Changes in how all tissues involved are stressed
  and replenished, which causes
• Chemical changes within those tissues and
• Predisposes them to mechanical failure giving us
• A good reason to restore normal movement through
  spinal adjustment.

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Neurological Effectsof the Vertebral Subluxation
Complex
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Spinal Learning (Law of Facilitation)

• Altered motor and sensory patterns are learned
  by the nervous system and the musculoskeletal
  systems

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Receptor Classifications
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Mechanoreceptors

• Position sensitive
• Motion sensitive
• Vibration sensitive
• Pressure sensitive
• Provide continuous feedback about where the body
  is in space...

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The most significant input into the CNS with
regard to balance, posture and movement comes
from the mechanoreceptors of the cervical spine.

• Guyton, Textbook of Medical Physiology.

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Nociceptors

• Thermo-, mechano- and chemosensitive
• Spinal nociceptors are almost exclusively
  chemosensitive
• Estimated that half of all dorsal afferents are
  nociceptors (M. Zimmermann, 1979)
• Fire with harmful or potentially harmful stimuli

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Pain

• Is not carried by nociceptors
• Occurs in the cerebral cortex
• 90 of all nociceptive activity never reaches the
  cortex and the patient will remain symptom-free

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Factors that influence the perception of pain

• Intensity of the stimulus
• Duration of the stimulus
• Descending inhibition

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Nociceptor SitesGrieve G. Common Vertebral Joint
Problems, 1988

• Skin
• Subcutaneous tissue
• Adipose
• Joint capsules
• All spinal ligaments
• Blood vessels
• Cancellous bone

• Periosteum
• Muscles
• Tendons
• Fascia
• Aponeurosis
• Dura mater
• Epidural tissue

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Nociceptor activity reflexively activates the
sympathetic nervous system.
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The dorsal horn is a central focal point for
mediating autonomic and somatomotor
reflexesinitiated by nociceptive
stimulation.Price D. Psychological and Neural
Mechanisms of Pain, 1988 Raven Press, NY.
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The Effects of Nociceptive Activity

• Segmental responses of muscle spasm and
  sympathetic hyperactivity. J. Bonica,
  1990 1992 H. Hooshmand, 1993

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• Noxious chemical stimulation of specific spinal
  structures produce measurable changes in
  sympathetic nerve activity...
  
  Budgell B, et al. J NMS Syst, 1995
  

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Nociceptive input normally triggers sympathetic
activity.Cabell J. Sympathetically maintained
pain. In Willis W, ed. Hyperalgesia and
Allodynia. Raven Press, NY 1992.
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Effects of Spinal Nociceptor Stimulation of
the Hypothalamus and Reticular Formation

• Nausea
• Pallor
• Dizziness
• Faintness
• Syncope

• Changes in blood pressure
• Changes in respiration
• Changes in heart rate
• No pain

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In the presence of irritation to spinal
structures manifestations were pallor,
sweating,changes in heart rate, changes in blood
pressure, nausea and syncope.These features
were not proportional to the severity of pain
perceived on the contrary, they seemed to
dominate experience of subjects who complained
little of pain but who were overwhelmed by the
symptoms listed above...Feinstein B. J Bone
Joint Surg, 1954
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There is good evidence to support the importance
of input from spinal afferents in reflex activity
of the sympathetic nervous system.

• Qu, et al, 1988
• Meckler and Weaver, 1988
• Taylor and Schramm, 1987
• Stjernberg, et al, 1986

• D. Jordan, 1997
• Schramm and Poree, 1991
• Hayes, et al, 1991
• Weaver and Stein, 1988
• Stein, et al, 1989

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SO...
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It is possible for nociceptors to fire secondary
to the tissue damage caused by abnormal
biomechanics...
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This nociceptor activity can cause reflexive
stimulation of the sympathetic nervous system...

• This may occur and and become chronic without the
  presence of pain or any other symptom.

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How is chiropractic inherently different from
other healthcare professions who chose to utilize
manipulation?

• Application of immobilization as it relates to
  the joint complex
• Kinetic chain principle and basic neurology
  allows full spine vs symptom based management...

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• Thorough understanding of the neurological and
  physiological implications of faulty biomechanics
• Purpose of the adjustment to restore normal
  biomechanical, neurological and physiological
  activity
• Extensive and focused study in the art of
  adjusting using multiple techniques to best adapt
  to the individual needs of the patient

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Today

• The public has widely embraced many forms of
  wellness care and alternative therapies
• Other healthcare professions have embarked on a
  paradigm shift to include alternative therapies,
  including spinal manipulation
• Many conditions respond best with a
  multidisciplinary approach

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HEALTH

• A state of optimal physical, mental and social
  well-being, and not merely the absence of disease
  and infirmity.
• Dorlands Medical Dictionary, 28th ed., 1994

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ENTERING THE NEW MILLENIUMThe Wellness Model

• Potentiating treatment protocols
• Patient-centered paradigm
• Improving interdisciplinary communication
• Maximizing the benefits of healthcare from all
  perspectives