sore back/OMT

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12R34Y

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I was just wondering about something....I have these "knots" in my upper back that run up and down either side of my spine. They are pretty darned painful to push on. I usually lay on a racquetball or something to kind of knead them. Could OMM help with something like this? My girlfriend and several other people I know have the same thing. thanks


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It sounds like you have some muscle spasms going on. How long have they been there? It sounds to me like some soft tissue techniques followed by some strain-counterstrain may help. If not, there's always muscle energy and HVLA. I have helped my wife with similar problems many times, and I am usually able to make the pain go away. Eventually, it always comes back though (in her case.) If it's a chronic thing, there may be deeper issues to check out. I have seen OMT to be quite beneficial when it comes to back pain (a muscle relaxant may not be a bad idea as well.) If you are concerned, go see a DO who specializes in OMT, maybe they can help. Good luck.

[This message has been edited by UHS03 (edited 05-14-2000).]
 
Can you remember doing something before you noticed these changes? Where exactly are the "knots" in relation to your spine, and at what level? Are they close in or further out? Are they symmetrical on both sides? Do you have any restricted motion?

Could be any number of factors really - muscle hypertonicity/spasm, rotated/sidebent verterbrae, posterior ribs, etc.

You would probably benefit from an OMM exam and treatment!

 
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What about your posture? Do you have an increased lumbar lordosis or thoracic kyphosis? What about your regular daily activities... do you do a lot of lifting or prolonged sitting? If so, are you maintaining a neutral spine posture (keeping your back straight) so you are minimizing the stresses placed on your back? In addition to everything mentioned previously, could be your back is weak and does not have adequate stabilization strength.
 
One more thing. Someone ought to evaluate your sacroiliac (SI) joints. Very often a simple SI joint dysfunction can lead to low back pain due to compensatory mechanisms which the low back may not be able to handle. Sometimes this pain is manifest as decreased ability to function, or more simply as tender points along your spine.
 
blah blah blah, try some heat and have a relaxing massage. This is an overuse injury.
After you have recovered, I would bet you have some muscle imbalances that have led to some overcompensation by another group of muscles.

 
Thanks for the great responses. The knots are just basically all up an down the top 1/3 of my spine (on either side) and away from spine also in the upper back area. I'm a paramedic and I life alot of big people, but I think the worst thing is that this is my first semester back in college full-time and I'm in the library all of the time with my head bent over my book for hours on end and that is really when I notice it. I wish there was a way to look straight ahead and read instead of looking down all of the time. thanks again
 
ewagner..don't be a putz. You can't minimize his problem with the info we have been given. If it is a chronic thing, heat will do no good. Don't be so condenscending dude.
 
Big words for a first year.
What I am doing is answering the question. Heat will do alot of good, it increases blood flow, which therefor decreases metabolic stasis, and also relaxes the patient allowing for easier soft tissue work. I've treated back patients daily for three years, and as an adjunct heat was perhaps the patients favorite modality and one they can utilize at home for free...while watching tv or prior to their mate rubbing their back.
Muscle imbalances are extremely common, especially in "weekend warrior" types. Upper trapezius overpowering the middle and lower trapezius causing shoulder elevation as apposed to Glenohumeral flexion or abduction therefor causing the middle and lower traps to be overworked to balance scapulothoracic rhythm and whammooooo, knots (areas of hyperactivity, spasm, and metabolic stasis!)

Now, with that scenerio, do you think heat would provide a nice adjunct uhs03???!!!
I know what you were taught in OPP, the instructors have a tendency to treat via manipulation because that is how they get paid. Once you see how other forms of rehab work, you will understand. Until then, watch who you call a PUTZ! Lets not enter into a debate regarding rehab, one that you will not win.
 
I'm not calling you a putz because of How you would treat this, I'm calling you a putz because of the tone in your post...there's no reason to be condenscending.

Now, no one would deny heat to be a good therapy in the acute patient, but how exactly would heat to any physical good in the chronic patient?? This is why I said you are minimizing this guys back pain without having all the info. If it's a "weekend warrior" thing, I wouldn't argue that some heat will help. If it's a chronic back pain, then I don't see how heat is going to help anything. It's kind of like putting ice on a broken ankle a month and a half after breaking it.

I would never argue therapies with you. I am aware you are a PT and a year ahead of me in school..all hail ewagner! My point is that in your last post you seem to do what far too many doctors in my opinion do...minimize the problem. You don't know how old the original poster is, you don't know how long the pain has been present, you just don't know enough from what he has told us to assume it's a weekend warrior thing and go throw a heat pack on it. It's nothing personal man (the putz thing was meant to be funny.) BTW, If you talk to people who know me they will tell you that I am the last person to hop on the OMT bandwagon. I believe OMT to be beneficial for back pain...so what? I believe a muscle relaxant should be used also. If it's acute, alternate heat and cold, no OMT at first, and muscle relaxant. If it's chronic, do all the OMT you want. If I don't know, I'll assume the worst and hope for the best. That way, I won't overlook anything. Lighten up dude, no one is attacking your PT manhood.

[This message has been edited by UHS03 (edited 05-15-2000).]
 
I agree. I am also a PT, and heat and massage are by no means the end-all be-all treatments for back pain... though there are many PT's out there whose main treatments are all hot pack, ultrasound, and massage.

We really can't give 12r34y any real advice until we have more details. But certainly it sounds like a postural dysfunction based on what he said about being bent over studying for hours on end. Most likely all he needs is to straighten up while studying and his problems will go away shortly.
 
1234RY:

I had a ton of upper back pain when I started sitting and studying as much as we do in school, with a book flat on the table in front of you. I finally spent the $20 bucks and bought one of those folding book stands that props up in front ofyou with a little shelf for the book to sit on. I still slump after a while, but at least every now and again having the book upright helps remind me to SIT UP STRAIGHT...does wonders for the trigger points, tender points, etc. etc tension etc etc in teh upper back! Get one - it's worth it!

Good luck!
 
Thanks smile, it is nice to actually hear advice going to a patient that is cheap, easy, educationaly, and practical.
Uhhh, uhs03, there is NO reason for you to act like a brat, and if you have a problem with me, you know what I look like and you can approach me. I take considerable offense at your "all hail ewagner" comment, considering you have no idea how much time, energy, and love I have put into rehabilitation and how frustrated I have been with our OPP department. So keep your personal sarcasm towards me to yourself, until you wish to really know me or try to understand my love for orthopedics. My "blah, blah , blah" statement was in regards to all DO students wanting to perform HVLA or some other technique as opposed to FREE patient education on posture, modalities , and movement patterns. I am very frustrated with OPP departments continually teaching techniques while patient care and education is thrown out with the garbage.
Satisfied?
Any further comments directed toward me from uhs03 can be emailed to [email protected]
so we can keep the bulletin board free of snot.
 
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12R34Y,

I read, with interest, about your back concerns. You mentioned "knots" in your upper back. Not to assume a diagnosis here, but a typical presentation of vertebral fixation, between two or more vertebral segments, can result in paraspinal muscular spasm. The spasm in this scenario, is caused by a reflex arc, which is generated at that spinal cord level. The best way to reduce the spasm would be to reduce the fixation first, at the spinal level. I would highly recommend chiropractic manipulative treatment to reduce the fixation and subsequently eliminate the spasms. You could apply heat, or even massage the area, but the relief would be short term, until the fixation is eliminated. Also, heat causes vasodialation and vasocongestion; thus drawing more fluid to the area(s). If there is any inflammatory process involved, heat would only serve to add to the inflammation. Instead, apply ice, as it will give temporary reduction of any inflammation, until which time you can get to the chiropractor.

If you would like additional information I would be happy to assist.
 
Realchiro

This fixation that you speak of (which I can only assume to be a hypomobility) can be CAUSED by muscular tightness, spasm etc. You could "rack and crack" but that may prove to be temporary and the muscle imbalace would simply "re-fixate" to use your language. The point of this discussion is this...it is a postural or movement dysfuntion with many forms of treatment...the most successful will be those that the patient can do at home and then PREVENT from happening again.
 
ewagner,

Yes, the fixation usually involves hypomobile segment(s). The muscle spasm is only secondary to the fixation process and therefore the sequence of events, following the reduction of the fixated vertebra(e), include immediate release of fixation and reduction of muscle spasm. The results are usually instantaneous. Very rarely is there any modification from the muscles in response to the CMT or even OMT; such as "balancing", which in your theory would re-trigger the fixation.

There is very little that a patient can do, at home, to reduce the fixation. They could only address the spasms in a temporary fashion, only to have them return. They would have no way of achieving release of the fixated vertebrae, which is the causative factor in the scenario. Again, in rare circumstances the patient may experience a reduction of the fixated joints, by some coincidental release of the fixation, which could ocur in moving about, though self manipulation is not recommended.

The fixated area creates a postural dysfunction, due to the secondary muscle reaction. Any postural dysfunctions would resolve, provided they were an end result of the fixated area(s). Naturally, postural changes, in cases of abnormal spinal curvature, may have their origin directly from muscle spasms. Their origin is yet idiopathic in nature.

[This message has been edited by Realchiro (edited 05-16-2000).]
 
You are jumping to conclusions.
The "fixation" very much may be a result of muscle imbalances causing spasm and "fixation". To use an example, hypermobile hamstrings can cause an increase in pelvic anterior rotation upon forward flexion(reaching for the toes) and a decrease in relative lumbar flexion (hence hypo mobility)...but yet you would not treat the lumbar segments becaus that is not where the primary dysfunction is.
Another example was cited by Dr. Shirley Sahrmann PhD, PT from Wash U. "when a patient undergoes a surgical fusion of vertebral segments, it is not the fused segments that later cause pain (hypomobile or fixed segments) rather, it is the HYPERmobile segments that become painful."
Not everything is reflexively associated with vertebral position. But I understand why you think that because it is a tenet of chiropractic thought. If you were to treat a shoulder that has undergone adhesive capsulitis, would the patient have normal AROM because the joint itelf has "unfixed"?? No. The muscles sourounding the joint decide what and where the movement shall occur. And if they have been shortened due to compensation, then regardless of joint "fixation" the muscles will not allow normal movement until THEY are normal.
 
here here!! Good show!

Nice thought ewagner!
 
ewagner,

I couldn't agree with you more about the benefits of having the patients do what is good for them on their own and maintain it independently. All too often patients become dependent on what they like to call "adjustments" or "maintenance manipulations." I believe all that is bogus. No one should have to go to someone regularly for adjustments... that is nothing more than a sign of very poor stabilization strength in that patient.

Patient education and awareness of all that is good and bad (ie, poor postures, proper lifting techniques, etc) are essential for any successful recovery in a rehabilitative setting.

I am not in DO school yet (will start this fall), but I hope we will be given the opportunity to incorporate patient education in our treatments in addition to our manipulative therapies.
 
ewagner,

I believe that the question posed by 12R34Y, was that of a complaint in his/her upper back. I offered that person a suggestion as to a viable treatment, given a particular scenario. This was an offering of assistance to a would-be patient. From that point you have moved to an apparent challenge of that advise, as you have applied that same scenario to the lower spine. Interesting!

Certainly if we change the parameters to a post-surgical fusion case, of which I have seen a number of, then we must consider that indeed hypermobility can and usually does result in the segments directly above and below the fusion. Those superior and inferior segments do, infact, assume greater accomodation for the lost ROM (range of motion) of the fused segments. This is nothing new.

The debate you are engaging in, as to whether the fixation or the spasm came first is one that already exists within chiropractic. Regardless of which mechanism came first, the application of CMT or OMT can reduce both the fixation and subsequently the spasm.. or.. if more appealing for you, the spasm is reduced prior to the release of the fixated joints.

With all due respect, your scenario of "hypermobile hamstrings" is a bit of a paradox, since the reverse is usually the case; ie. hypomobile hamstrings. Never the less, to entertain the potential hypermobile hamstrings idea, the area of focus would then presumably be the SI joints. Frankly, in the lower spine I would always suggest addressing the lumbar paraspinal musculature and the posterior thigh compartment, along with any fixated segments. Given every case has it's variables, it really depends on the case.

Then you move to an adhesive capulitis case; something that is typically and incorrectly addressed by cortisone injections. Of course the shoulder has only one osseous articulation to the axial skeleton; that being the A/C (acromioclavicular)& one other the glenohumeral. Therefore, the remaining supportive structures are the rotator cuff group and deltoids. Because of this, mobilization, by manipulation, is of lessor value and a more effective treatment is utilizing trigger point therapy. Numerous cases of adhesive capsulitis respond well to this mode of care. Given the context of discussion, the fixation theory was addressing the vertebral segments and not the shoulder capsule. Again, something that I address on a regular basis after the inappropriate protocal is attempted. Back to answering 12R34Y's question; have a spinal manipulative adjustment where indicated and the complaint should resolve immediately.




[This message has been edited by Realchiro (edited 05-16-2000).]
 
Smile,

Your comment, "All too often patients become dependent on what they like to call "adjustments" or "maintenance manipulations." I believe all that is bogus."

I am curious as to what you base these opinions? Is this personal conjecture or first hand experience? thanks you

 
thanks again for all of this interesting conversation.

Once again. I'm 24y/o male who has knots in his upper back. it feel very good for me to roll on racquetball or something to kind of "knead" them out. They ONLY bother me when I am sitting down and studying for long periods of time. It's just very hard to maintain proper posture and sit straight up the whole 4-5 hours you are in the library. Is anybody proposing that if I just correct my posture that they will go away on their own? thanks to all
 
12r34y,

Reread one of my previous posts, where I said all you likely need is to sit up straight and your problems will go away. From what you describe, I am confident you are suffering from a postural dysfunction. I know it is not easy to sit up straight for hours at a time, but there are some things you can do. Either buy a commercial lumbar roll or make one yourself by rolling up two towels or folding a pillow and placing it in the curve of your low back. You will be surprised how much that will correct your posture.

Realchiro,

I base my comments from personal (professional) experience. The majority of those patients who have said such were found to have either joint dysfunctions, muscle imbalances, or poor stabilization strength. When addressed appropriately for these problems and after adequate follow-up, I have encountered few patients had to return either to me or to chiropractors for such "regular adjustments or maintenance manipulations." Of course, everyone is different and responds separately to therapy, but this has been my experience. I understand we can also get into the age-old debate of chiropractic treatment vs physical therapy, but in the end it all matters only what works best for the patient in question. I was only basing the difference in that statement people often make, not the difference between the two professions.
 
Smile,

You stated: "The majority of those patients
who have said such were found to have either joint dysfunctions, muscle imbalances, or
poor stabilization strength."

I am curious, but by what protocal and testing did you utilze to determine that adjustments were a causative factor in "muscle imbalance", "joint dysfunction" or "poor stabilization strength"? In over 12 years of practice, and of the numerous cases I have seen, I have never heard such a comment before. By what standardized testing procedure or protocal did you determine the
that the adjusting was detrimental?

12R34Y,

There is no amount of bolstering or correcting posture that will eliminate or resolve a spinal segmental dysfunction (providing that is what you have). To offer an analogy; it is akind to putting air in a tire that has a nail in it. You would merely be addressing the symptoms and not the cause. As long as there is a segmental dysfunction your problem will not be resolved.

I would like you to consider something. Allow me to locate a DC, in your area. Have that DC
examine, and if necessary treat you. If you do not achieve any relief of your complaint after one visit, by all means do as smile saya and not return. If, however, you find some relief of your complaint, continue until the complaint is resolved. I would like to see you get better. Let me know.
 
Realchiro,

I never said that adjustments were a "causative factor" in joint dysfunctions, imbalances, or poor stabilization, or even that "adjustments are detrimental". I do not believe that they LEAD to any of the above problems in patients. Rather, what I was talking about was that those patients who say they need to have such regular adjustments instead have nothing more than those problems which can be resolved long-term through an appropriate treatment plan without having to return to therapy ever again (ie, making them ultimately independent by themselves instead of dependent on someone else to get better.) Whether any of those problems arose from chiropractic adjustments or not is not the issue, and quite frankly it doesn't matter. But I do not believe they are caused by adjustments.

I hope I clarified what you were asking. Thanks for the interesting discussion.
 
Smile,

it is nice to have someone with similar experiences as myself! This is a wonderful discussion and I am enjoying the bits of time I can spend discussing it. Of course I believe this is a postural problem, and with most postural problems, reversal of the posture on a regular basis will prevent the "spasm/pain cycle". But this is very hard to advise over the internet!!

Smile, if you need any advice regarding medschool, especially for the older-professional student (PT in this case)
email me at [email protected]

realchiro,
Lets continue this debate, it is interesting.

 
Smile,

Thank you for clarifying your statements.
Do you know the forum name/webaddress for practicing DOs? Thanks
 
thanks everyone for the discussion. I did a little experiment last night and I studied for about 4 hours attempting to keep good spinal alignment and keeping my head up instead of down. I also did the same all day while I was studing for my last final. It felt a ton better!! Actually I barely noticed it. I was really suprised at the easy fix. thanks to all who helped.
 
That's what I thought.

Ewagner, thanks for offering to give me advice. I really appreciate it and will definitely email you soon. I agree, it is nice to have other people with similar backgrounds on this board.

Realchiro, I don't know off-hand any forums for practicing DO's. There is a section on this SDN site called "Gregory's Osteopathic Links" which contains links to webpages of current DO's on the Internet. Perhaps that may be of interest to you. I enjoyed our discussion... our differences in assessing 12r34y's condition seem to lie in the heart of the main difference between chiropractic vs physical therapy treatments. I cannot say which one philosophy is any better than the other, since we both know we get patients better. But it is nice to have such discussions to learn other points of view and approaches to treatment.
 
Smile, Thank you for clarifying your statement. Curious to know the web address of licensed DO forum? Thanks
 
12r34y,
I am glad you experimented and realized how beneficial some postural advice and pt education can be!

Good luck in all your goals.
 
Smile, Tried to answer twice but I guess I am being censored. Too bad. Does nayone know the address to an practicing osteopathic forum. thanks
 
Well, this forum operates a little differently than I am used to. Couldn't find page #2 until just now. Oh well....

I always find it interesting to see the challenges I sometimes encounter with offering chiropractic care. In a way, it is humorous when someone tells me it doesn't work, since it is like arguing if the moon is round or the earth is flat. Having successfully treated many patients, over the years, for me it isn't a question of whether it works or not, but to help other people and disciplines understand so. I understand that, at least in medicine, if it wasn't taught in med school, then it doesn't exist. That perception is changing, and with modes of communication, like the internet, bridges can be built and myths dispelled.

Many of my patient base works in medicine; many are doctors, nurses, lab technicians and hospital administrators. Once it is explained and once they are treated they immediately understand it's value. I have two friends who are DOs but they prefer to do less OMT and more Rx and surgery. They regularly refer to me those patients that don't respond. Likewise, they receive referrals from my office.

Interesting conversation.
smile.gif

 
Oh, I have no doubt that you have seen success, just as I have no doubt that the placing of caring hands on an individual in pain decreases their distress. The point is, placebos get results and the use of symptomatic treatment get results for short periods. But treating the CAUSE is the most beneficial. I could rack and crack till the cows come home and achieve temporary results, but if the underlying cause remains...well we have the scenerio of "well, see ya next week" cha-ching!!$$ Regardless of DC, DO,MD, or PT, the treatment of symptoms and not CAUSES (postural, movement imbalances, muscular imbalances,pathological) provides temporary, yet beneficial results...however long that may be.
Trust me realchiro, I am not pointing the finger at you, not at all (and I think you know that). I simply have the problem with theories that are incomplete and attempt to be all encompassing (is that how you spell it?)
 
ewagner,

Interesting toughts and I respect your opinion. As for philosophical tenants, I say they are as good as the philosopher. I am not a philosopher, so I guess I don't apply them.
I personally don't believe any health profession to be a pancea. If it were then rest of us wouldn't be here, now would we?

The "rack and crack" you refer to and the monetary expression that you insert may not always be so accurate, in all cases. I am familiar with the notion of laying on of hands; I don't do that. As in any health field there can be a degree of placebic affect; not in every case though, and certainly not in the majority.

To enlighten you as to some of the cases I see, they are frequently those who have tried the others. Unfortunately, the patient will be sent home with muscle relaxants, NSAIDS and pain relievers. They don't work, so the patient seeks my help. As you are probably aware, one of the chiropractic tenants include the removal of neural interference.
Working closely with the structures in and around the IVF (intervertebral formamen) we focus on the positioning of those structures and how they affect neural contents and components. When such structure is effected, the adjustment re-relates the correct juxtaposition and neural interference is corrected.

A very common scenario... Patient presents with sciatica. Adjustment may be made to an involved 4th or 5th lumbar vertebra and the sciatica remits. Occaisonally an additional treatment or two is required to reestablish
positioning.

have patient will talk later.
smile.gif
 
Actually, my biggest problems ARE with the MD/DO that gives only muscle relaxants, pain meds, and NSAIDS without incorporating the musculoskeletal aspect. The same goes for the DO/DC that chooses to treat only one aspect of the problem (passive skeletal alignment or cranial therapy as examples while not treating with exercise, bracing, soft-tissue, posture etc.) This may not be your case at all...we may differ only in theoretical approaches (which is great fun to debate really).
I have been frustrated with PT's that insisted on treating the SI joint for radiating hip pain when the hip pain was caused by OA of the acetabular mechanism and was cured by THR! The same can be said for the young DO treating a patient with consistent cervical pain by manipulation. This pain recurred over and over, so when I saw them, simple postural advice prevented the pain and they were educated at the same time.

Ok I am rambling...alot!
 
ewagner,

Adjunctive protocals are very much a part of my treatment regime. It all depends on the patient and the expected compliance. Every patient receives at home instructions (tear off sheet) with outlined exercises for them to do at home. Severe cases may receive lumbosacral supporting to temporarily immobilize and enable the involved area some relief of activity. I still utilize these, even though the AHCPR report negates the effectivity of traction, tens, massage, biofeedback, acupuncture, injections, corsets or ultrasound for low back. They recommend spinal manipulation.

I also employ spray & stretch technique (using fluori methane),collars, CTS splints, lateral epicondylitis splints, taping, long axial traction, manual traction, etc. So you see, I do not rely solely on the CMT, to complete the treatment process. Still, the CMT is the most effective portion of the treatment phase; adjuncts are supportive measures.

By the way, at what point are you in your education?

smile.gif
 
<BLOCKQUOTE><font size="1" face="Verdana, Arial, Helvetica">quote:</font><HR>Originally posted by ewagner:
Ok I am rambling...alot!<HR></BLOCKQUOTE>

Yes, ewagner, you are rambling, and boring your readers. Better be careful, there are only two of you posting here, long post too. Borhani's going to get you!

Or maybe someone will suggest that "Next time you to should get each others phone numbers and just chat for a while, either that or get a room together." (as quoted by ewagner)

Ooops...some of my new found peace from my vacation must have slipped...I better go meditate.

Peace and happiness

mj



[This message has been edited by mj (edited April 04, 2001).]
 
Dear Michael Jackson (MJ),

Yep you got me, I did notice that the bulletin had become monopolized. I give my humble apology...but you gotta admit, that line you quoted was pretty funny the original time I posted it!

ps. I loved your "off the wall" album, the one with your original nose.
 
There are actually 3 people on this thread. I just didn't get around to responding till now.

MJ, I believe you should speak for yourself when you say to ewagner "you are boring your readers." Perhaps there is even one person out there who is enjoying this conversation. And truthfully, you don't have to continue reading this if you are being bored. If two (or three) people are discussing something of value to them, then let them. Just because it is not interesting to you doesn't mean it isn't interesting to others.

To Realchiro, I guess my main confusion with CMT is that how do you know you are restoring proper neural mechanisms by simply "realigning" (or, in your vocabulary, "adjusting") the patient's joints? What is to say that that spinal arrangement is not normal for that patient? I mean, we are not symmetrical beings. For example, I do have a scoliotic curve in my back which can be said to be way out of "normal alignment." But I am not symptomatic and do not have back pain.
 
Oh, Smile, don't take things so seriously! I was merely returning a well desreved jab to ewagner, and he knew it. A little irony includes the fact that when he made a similar comment there were also three people posting. I COMPLETELY agree with what you said, but ewag. has had occassion not to. I just couldn't resist. Sorry if you were offended.

And ewag. I don't think Shoey thought your line was that funny, but I could be wrong. I'll go get my glove ironed now.
cool.gif


mj
 
I wasn't offended! I deserved that jab.
 
Smile,
Good question. To understand why and where to adjust is to first understand the mechanism that requires adjusting. There are a variety of neural receptors in tissues and around and in various joints. The more familiar receptors are pressure, temperature, sharp dull. (pacinian, meisners, ruffini's, golgi, etc etc,) The joint receptors are called mechano receptors. They register tension and motion around a joint. If, for example, a joint is taken beyond it's physiological ROM (range of motion), the mechano receptor invokes an input to trigger a response. In the case of mechano receptors located in and along the vertebrae, these receptors and other receptors send signals via nociceptors and nociceptive axons into the cord. [This is why I asked you at what point you were in your studies (or was it ewagner??)] Anyway, from the point at which nociceptive axons communicate in the gray rami of the cord, a reflex arc occurs, which elicits a sympathetic vasoconstriction and a reflex muscle spasm to any number of paraspinal muscles. The muscle spasm and vasoconstriction initiate and perpetuate what we call the subluxation complex. This can result in kinesiopathpology, neuropathophysiology, myopathology, connective tissue pathology, vascular abnormalities, inflammatory response, histopathology and biochemical abnormalities.
Aside from these direct changes there are neuronal pathways that trigger a response to the hypothalmus which sends ACTH to the adrenals resulting in cortisol output. A number of detrimental affects result from increased cortisol output. These are just a few mechanisms that can result from the subluxation complex.

Releasing the subluxation complex, through adjusting, ceases these activities as the nociceptive irritant is removed. In other cricumstances, where direct nerve pressure from subluxation affects a spinal nerve root, the removal of subluxation restores afferent and efferent nerve conduction.

My apologies to anyone who feels I am dominating this thread. I am enjoying the communication and sharing of ideas.

wink.gif


[This message has been edited by Realchiro (edited 05-18-2000).]
 
I don't think anyone has a quarrel with what you have just stated, it is spoken of on a regular basis in Osteopathic Principals and Practice class. My problems are with the many many variables that go along with HVLA manipulation. What creates the pt's subjective report of improvement? Is it the laying of hands (physical caring touch of a seasoned practioner), is it the audible "click" (well something must be better...I heard it!!), is it the reduction of a displaced facet meniscus, is it release of synovial pressure?? And, will these things actually cure the problem if the malalignment is ONLY the RESULT of spasm, muscle imbalance and postural stasis.
I also think, and this probably isn't referring to realchiro, but some DC's that I have come across follow the all-inclusive spinal pathology theories (you know, cure HTN with adjustments etc)and that just begs for an argument.


by the way Realchiro, I graduated from Indiana University's PT program, practiced in orthopedics, and now I am finishing my 2nd year in medschool. Just so you know where i am coming from.


[This message has been edited by ewagner (edited 05-18-2000).]
 
ewag, congratulations on finishing second year, good luck with boards.

I am only jumping in here, so you wont voluntarily stop writing long rambling posts that repeat themselves over and over and over and over..

I support you fully in that regard.

ps, this sounds more like a visceral somatic reflex problem in the thoracics...in addition to valium and motrin, i would send him to cardio for a cath and also to pulmonary for a complete bronchoscopy as well as radiology for an xray. This sounds reallly serious....

has anyone thought about just getting a heating pad and a more comfortable chair, or skipping classes so that you aren't in a crappy seat all day?
(oh, did ewag mention that)
Also did anyone mention EXERCISE for gods sake? along with daily stretching?

the guy is describing basic iliocostal and spinalis muscle tension, not a spasm per se as it isnt locking up, the pain is at the points of insertion, IE the ribs and the transverse processes of the vertebrae, this is similar to frontal headaches associated with nuchal and gala aponeurotic tensions...stretching, motrin, massage, heat and exercise are all acceptable...manipulation is asinine for what he is describing (for many reasons) and ice (the treatment for acute spasms) is also not called for.

Dr. Shewmaker, signing off.
 
Sorry MJ, I guess I did take you too seriously. I missed the thread about ewagners's comments so I didn't pick up on your sarcasm
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My apologies for jumping on you.

Realchiro, what you described does make sense. However, not that I don't take your word for it, but I have not heard of those mechanisms taking place from other sources so I guess I will fully understand your theoretical basis once I hear it again from other reputable sources (not that you aren't one, I just want to hear it from others who have demonstrated that all you say does indeed happen.)

As for my background, I graduated from PT school 3 years ago and have been working in outpatient orthopedics/sports medicine. I have been trained in manual therapy techniques for the spine but I do treat all diagnoses, orthopedic and neurologic. I will begin DO school this fall.

p.s. You are not dominating this thread. I believe we are getting a sound discussion by various people from different backgrounds. It is certainly nice to hear and learn about other points of view to patient management. We may not always agree on everything, but at least we become more aware of what else is out there aside from our own professions.
 
ADRIANSHOE,

You stated: "manipulation is asinine for what he is describing (for many reasons) and ice (the treatment for acute spasms) is also not called for."

Is this statement personal opinion or do you have supporting documentation?

["The physiologic effects of local application of cold are many. Cold therapy has the following advantages: it relieves muscle spasm and pain, it reduces swelling, combines effectively with muscle reeducation that utilizes proprioceptive neuromuscular facilitation techniques, diminishes spasticity and fatigue." Handbook of Physical Therapy, Robert Shestack, Ph.G.R.P.,P.T.R. Springer Publishing Co. pp.56-57.

ewagner,

Is that Indiana, Pa, or Indiana, IN? You are right. There is a small faction, within our profession, that considers CMT the end all to all. As the profession has evolved, this attitude is slowly dissolving. By the way, this attitute is not mine. I believe that the old time DOs held some of their principles too, whereby they had a belief system that most health issues could be resolved by osteopathy. Please correct me if I am wrong.

In my previous description of the mechno receptor and proprioceptive involvement, it is here where one issue can be helped by manipulation. The fixated segment(s) are shown to be caused, as a result of proprioceptive input. Adjusting/manipulating the joint immediately breaks the cycle of input and the factors return to normal. This has been proven and is already understood by the process I described previously. As for the audible click; I too questioned this concept early on in my career. The issue is negated with first time patients, as they do not know to equate audible sounds with relief. I would assume that after a period of time, as an established patient do so, since the effect of operant conditioning comes into effect; ie, audible is assoicated to improved feeling.

Smile,

The mechanism I have outlined is readily available. Don't take my word for it. Look in Guytons textbook of physiology (in the library). It may take some decifering if yoou are not acustomed to the terminology, however, all of what I described is there. It only takes understanding the concepts; once related.

interesting dialogue
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Indiana University, that would be in Indiana. Great school! (after that I took classes at U. of St.Augustine to pursue my DPT while still practicing).

I think the Pennsylvania school is U of Indiana(PA) or something.

Thought I would clear that up.
Now, I am content on listening others debate this for the moment.
 
Yes I have plenty of documentation stating that PURELY muscle problems shouldn't be treated with manipulation, its one of the many central principles to OMM to treat the disease (APPROPRIATELY)

Would you SCAN him? he may have a viscero somatic reflex!!!! oh my...
manipulation is overkill if the problem isn't a primary skeletal dysfunction, which in this case the HISTORY clearly shows that it is not.
 
ADRIANSHOE,

Nothing personal but you seem to be continuing to debate from personal conjecture. I welcome any documentation that demonstrates that what I said is invalid or not applicable, and any documentation that supports your claims. Afterall, this is something that I do on a daily basis, and I would be enlightened to find evidence that the successes I reach are to the contrary....

If the patient resolution, that I achieve on a daily basis, should not be happening, as you say, then I need to better understand why as it is very perplexing....

Also, I sense some animosity by your previous postings here and have to wonder why? I am not here to cause battles for you, but to merely discuss and have understanding...

Thanks for the discussion everyone.
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