Transcript Chiropractic - DMA Rehability Events

CHIROPRACTIC
DR. EVAN GEORGIEVSKI
BSC HON KIN, DC, ART®, GRASTON, CONTEMPORARY MEDICAL
ACUPUNCTURE
A BIT ABOUT ME
• GRADUATED IN 2010 FROM CMCC, ON MY 5TH YEAR OF PRACTICE
• CLINIC – M0DERN HEALTH & PERFORMANCE
• PERSONALLY I’M MORE INVOLVED WITH THE ACTIVE SPORT POPULATION
• BUT IN MY PRACTICE AND PREVIOUS WORK EXPERIENCE I’VE WORKED WITH ALL DEMOGRAPHICS
• CONSULTANT - TORONTO TRACK AND FIELD CLUB
• CONSULTANT – WESTERN UNIVERSITY TRACK AND FIELD
• HAVE TRAVELLED WITH ABOVE TEAMS AND ATHLETICS ONTARIO
OUTLINE
• WHAT IS CHIROPRACTIC?
• EVIDENCE BASED VS SUBLUXATION BASED CHIROPRACTIC
• CHIROPRACTIC EDUCATION – YOU CAN HAVE CONFIDENCE IN OUR DIAGNOSIS
• SCAR TISSUE
• TREATMENT METHODS
WHAT IS CHIROPRACTIC?
• GOOD QUESTION
• CHIROPRACTIC IS A VERY DIVERSE PROFESSION
• COMMUNITY BASED PRIMARY HEALTH CARE PROVIDERS
• ONE OF THE LARGEST PRIMARY CARE PROFESSIONS IN ONTARIO, CHIROPRACTIC IS A NONINVASIVE, HANDS-ON HEALTH CARE DISCIPLINE THAT FOCUSES ON THE MUSCULOSKELETAL
SYSTEM.
• BROAD SCOPE
• PROS – FREEDOM TO PRACTICE SEVERAL DIFFERENT WAYS
• CONS – DIFFICULTY IN DEFINING OUR PROFESSION
WHAT DO OUR ASSOCIATIONS SAY?
• CHIROPRACTIC AS DEFINED BY THE OCA
• CHIROPRACTORS PRACTICE A MANUAL APPROACH, PROVIDING DIAGNOSIS, TREATMENT AND
PREVENTIVE CARE FOR DISORDERS RELATED TO THE SPINE, PELVIS, NERVOUS SYSTEM AND JOINTS.
• CHIROPRACTORS USE A COMBINATION OF TREATMENTS, ALL OF WHICH ARE PREDICATED ON THE
SPECIFIC NEEDS OF THE INDIVIDUAL PATIENT. AFTER TAKING A COMPLETE HISTORY AND
DIAGNOSING A PATIENT, A CHIROPRACTOR CAN DEVELOP AND CARRY OUT A COMPREHENSIVE
TREATMENT/MANAGEMENT PLAN, RECOMMEND THERAPEUTIC EXERCISE AND OTHER NON-INVASIVE
THERAPIES, AND PROVIDE NUTRITIONAL, DIETARY AND LIFESTYLE COUNSELLING.
CHIROPRACTIC EDUCATION
WHAT TO EXPECT FROM A CHIROPRACTIC
ASSESSEMENT
• THOROUGH PATIENT HISTORY AND PHYSICAL ASSESSMENT
• GAIT AND POSTURAL ANALYSIS
• AN ACCURATE WORKING DIAGNOSIS
• REFERRAL FOR ANOTHER CONSULTATION OR IMAGING IF
NECESSARY
WHAT CAN WE TREAT?
•
BACK PAIN
•
NECK PAIN
•
HEADACHE
•
WHIPLASH
•
STRAINS AND SPRAINS
•
REPETITIVE STRAIN INJURY (RSI)
•
WORK AND SPORTS INJURIES
•
ARTHRITIS
•
LIMITED RANGE OF MOTION IN THE BACK, SHOULDER, NECK OR LIMBS
•
GENERAL HEALTH AND WELL-BEING
•
RECOGNIZE A CONDITION OUTSIDE OUR SCOPE OF MEDICINE AND REFER APPROPRIATELY
•
SEND FOR XRAYS – CAN READ AND WRITE A REPORT FOR THE XRAY OR HAVE RADIOLOGIST WRITE REPORT
WHAT KIND OF TREATMENTS DO WE DO?
NOT JUST ADJUSTING ANYMORE!
• TRADITIONAL SPINAL MANIPULATIVE THERAPY
• SOFT TISSUE THERAPY (MASSAGE, ART®, GRASTON ETC.)
• ACTIVE AND PASSIVE REHABILITATION
• MODALITIES (TENS, IFC, RUSSIAN STIMULATION, LASER, SHOCKWAVE, ULTRASOUND)
• ACUPUNCTURE
• SEVERAL OTHER TECHNIQUES
FORMATION OF SCAR TISSUE
SCAR TISSUE
• LESS BLOOD FLOW TO THE TISSUE HENCE LESS OXYGEN
• THICKER SPAGHETTI LIKE TISSUE INSTEAD OF NICE PARALLEL FIBERS
• WEAK – MUSCLE DOESN’T FIRE OPTIMALLY
• TIGHT – RESTRICTS MOTION BECAUSE IT DOESN’T MOVE SMOOTHLY
SMT – SPINAL MANIPULATION THERAPY, ADJUSTMENT
• DEFINITION - AN ADJUSTMENT IS A HIGHLY SKILLED AND PRECISE MOVEMENT USUALLY
APPLIED BY HAND TO A JOINT OF THE BODY. ADJUSTMENT LOOSENS THE JOINT TO RESTORE
PROPER MOVEMENT AND OPTIMIZE FUNCTION. WHEN A JOINT IS ADJUSTED, A GAS BUBBLE
ESCAPES CAUSING THE POPPING NOISE YOU MAY HAVE HEARD ABOUT.
• SOME MAY THINK THE “CRACK” BONES MOVING BACK INTO PLACE
• THIS IS NOT TRUE WE ARE RESTORING RANGE OF MOTION WITHIN A JOINT SO IT CAN
FUNCTION OPTIMALLY, IF RANGE OF MOTION IS KEPT WITHIN A JOINT, MAKES IT MORE
DIFFICULT FOR ADHESIONS OR SCAR TISSUE TO FORM IN THE SURROUNDING TISSUES
“Non-specific low back pain has a generally favourable
prognosis, and can usually be managed with guideline-based
medical care that includes advice to stay active, self-care
options, and judicious use of NSAIDs. However, the early
addition of manual-thrust spinal manipulation appears to lead to
significantly greater reductions in pain and improved function at
four weeks. The belief in therapeutic equivalence between
manual-thrust manipulation and mechanical manipulation devices
is not supported by the current evidence. Spinal manipulation
(manual-thrust) can be a valuable treatment option in guidelinebased medical care for low back pain”
Michael Schneider is an associate professor of physical therapy
at the University of Pittsburgh, Pittsburgh, USA
References
van Tulder et al. Spine 1997; 22: 427–434
Bigos et al. AHCPR Publication No. 95-0642. 1994.
Pengel et al. BMJ 2003; 327: 323
Von Korff M, Saunders K. Spine 1996; 21:2833–2837
Chou et al. Ann Intern Med 2007; 147: 478–491 Strauss et al.
Evidence-Based Medicine 4th ed. 2011
Schneider et al. Spine 2015: 40(4): 209–217
SOFT TISSUE THERAPY
ACTIVE RELEASE TECHNIQUE ®
• ALL OF THE TISSUE BESIDES BONE – MUSCLE, FASCIA, LIGAMENTS, SKIN ETC…
• MULTIPLE TECHNIQUES – THE PREMISE IS TO BREAK UP SCAR TISSUE FORMED FROM AN ACUTE OR REPETITIVE
STRAIN INJURY
• SCAR TISSUE RESTRICTS FUNCTION IN A MUSCLE BY RESTRICTING MOTION AND/OR INHIBITING THE MUSCLE
• ART® - ART IS A PATENTED, STATE OF THE ART SOFT TISSUE SYSTEM/MOVEMENT BASED MASSAGE TECHNIQUE
THAT TREATS PROBLEMS WITH MUSCLES, TENDONS, LIGAMENTS, FASCIA AND NERVES. HEADACHES, BACK PAIN,
CARPAL TUNNEL SYNDROME, SHIN SPLINTS, SHOULDER PAIN, SCIATICA, PLANTAR FASCIITIS, KNEE PROBLEMS,
AND TENNIS ELBOW ARE JUST A FEW OF THE MANY CONDITIONS THAT CAN BE RESOLVED QUICKLY AND
PERMANENTLY WITH ART. THESE CONDITIONS ALL HAVE ONE IMPORTANT THING IN COMMON: THEY ARE
OFTEN A RESULT OF OVERUSED MUSCLES.
• DEFINITION OF ART ® PROVIDED FROM WWW.ACTIVERELEASETECHNIQUE.COM
• GRASTON – USES SAME PRINCIPLES AS ABOVE BUT USES A METAL TOOL
ACTIVE REHABILITATION
• IN MY OPINION – ONE OF THE ONLY WAYS TO MAXIMIZE THERAPEUTIC RECOVERY
• A LOT OF NEW RESEARCH/THEORIES ARISING
• FUNCTIONAL STABILIZATION AND PROPRIOCEPTION
WAD II EXAMPLE
- MULTIFIDUS MUSCLES (TINY MUSCLES RUN FROM SEGMENT TO SEGMENT OF YOUR SPINE)
• THIS MUSCLE IS SO IMPORTANT BC IT TELLS OUR BRAIN WHERE OUR SPINE IS IN SPACE FOR
EXAMPLE IF I ROTATE
• BRAIN RESPONDS TO SIGNAL AND SENDS A MESSAGE TO THE BIGGER MUSCLES
SURROUNDING THE SPINAL SEGMENT TO ACTIVATE AND STABILIZE THAT AREA FUNCTIONALLY
(WITH MOVEMENT)
• WHAT HAPPENS WITH A WHIPLASH INJURY OR INITIAL INJURY – MULTIFIDUS AT THE INJURED
SEGMENT DETERIATES 30%
• SO NOW THAT SIGNAL GOING UP FROM THE MULTIFIDUS MUSCLE TO THE BRAIN IS DELAYED
AND FUNCTIONAL STABILITY IS COMPROMISED BECAUSE NOW ALL OUR MUSCLES AREN’T
CONTRACTING AT THE SAME TIME TO STABILIZE BUT ARE COMING ON AT DIFFERENT TIMES
MODALITIES
• TENS AND IFC – HELPS WITH PAIN – GOOD FOR ACUTE SITUATIONS BUT MEH
• RUSSIAN STIMULATION – MORE THERAPEUTIC IN MY OPINION
• PLACE ELECTRICAL PADS ON CERTAIN MUSCLE GROUPS WHILE THE PATIENT PERFORMS AN ACTION
USING THE MUSCLE – RECRUIT MORE MUSCLE FIBERS – SO STRONGER RIGHT?
• WRONG – ENCOURAGES THE NERVE PATHWAY TO USE THE MUSCLE SO JUST GET BETTER AT USING
THE MUSCLE BUT THE MUSCLE HAS THE SAME STRENGTH
• SHOCKWAVE – RESTART HEALING PROCESS OF OLD CHRONIC INJURIES
• ULTRASOUND – PERSONALLY I AM NOT A FAN, NOT MUCH EVIDENCE SUPPORTING IT
•
COOK ET AL. SUBJECTIVE AND OBJECTIVE DESCRIPTION OF CLINICAL LUMBAR SPINE INSTABILITY. MANUAL THERAPY, 2006.
•
CORNWALL ET AL. THE LUMBAR SPINE MULTIFIDUS AND PATTERNS OF PAIN. MANUAL THERAPY, 2006
•
CHOLEWICKI AND MCGILL. MECHANICAL STABILITY OF THE IN-VIVO LUMBAR SPINE: IMPLICATIONS FOR INJURY AND LOW BACK PAIN. CLINICAL BIOMECHANICS, 2004.
•
HUNGERFORD ET AL. EVIDENCE OF ALTERED LUMBOPELVIC MUSCLE RECRUITMENT IN THE PRESENCE OF PRESENCE OF SI JOINT PAIN, SPINE, 2003.
•
MCGILL AND CHOLEWICKI. BIOMECHANICAL BASIS FOR STABILITY: AN EXPLANATION TO ENHANCE CLINICAL UTILITY. JOURNAL OF ORTHOPAEDIC AND SPORT PHYSICAL
THERAPY, 2001.
•
BOGDUK ET AL. A UNIVERSAL MODEL OF THE LUMBAR BACK MUSCLES IN THE UPRIGHT POSITION. SPINE, 1992
•
HODGES AND RICHARDSON. DELAYED POSTURAL CONTRACTION OF TRANSVERSE ABDOMINUS IN LOW BACK PAIN ASSOCIATED WITH MOVEMENT OF THE LOWER LIMB,
JOURNAL OF SPINAL DISORDERS, 1998.
•
HODGES AND RICHARDSON. INSUFFICIENT MUSCULAR STABILIZATION OF THE LUMBAR SPINE ASSOCIATED WITH LOW BACK PAIN. A MOTOR CONTROL EVALUATION OF
THE TRANSVERSE ABDOMINUS, SPINE, 1996.
•
YOSHIHARA ET AL. HISTOCHEMICAL CHANGES IN THE MULTIFIDUS MUSCLE IN PATIENTS WITH LUMBAR IVD HERNIATION, SPINE, 2001.
•
YOSHIHARA ET AL. ATROPHY OF THE MULTIFIDUS MUSCLE IN PATIENTS WITH LUMBAR DISC HERNIATION:HISTOCHEMICAL AND ELECTROMYOGRAPHIC STUDY.
ORTHOPAEDICS, 2003.
•
MACDONALD ET AL . THE LUMBAR MULTIFIDUS: DOES THE EVIDENCE SUPPORT CLINICAL BELIEFS? MANUAL THERAPY, 2006.
•
HIDES ET AL. EVIDENCE OF LUMBAR MULTIFIDUS MUSCLE WASTING IPSILATERAL TO SYMPTOMS IN PATIENTS WITH ACUTE/SUBACUTE LOW BACK PAIN, SPINE, 1994
•
HIDES, RICHARDSON, JULL. MULTIFIDUS RECOVERY IS NOT AUTOMATIC AFTER RESOLUTION OF ACUTE, FIRST EPISODIC LOW BACK PAIN, 1995.
WHAT IS CONTEMPORARY MEDICAL ACUPUNCTURE
• TAUGHT BY DR. ALEJANDRO ELORRIAGA CIARACO MD (SPAIN) AT MCMASTER UNIVERSITY
• IT IS A PRECISE PERIPHERAL NERVE STIMULATION TECHNIQUE IN WHICH FINE SOLID NEEDLES ARE INSERTED INTO
NEURO-ACTIVE ANATOMICAL LOCATIONS AND STIMULATED MANUALLY OR WITH ELECTRICITY FOR THE THERAPEUTIC
PURPOSE OF MODULATING ABNORMAL ACTIVITY OF THE NERVOUS SYSTEM AND/OR OF ITS ASSOCIATED EFFECTORS.
IE IMMUNE SYSTEM
• WHAT DOES THAT MEAN?
• TRIGGER POINTS ARE FORMED BY DECREASED BLOOD FLOW AND HENCE OXYGEN TO THAT PART OF THE MUSCLE
FORMING A “KNOT”. ACUPUNCTURE IS IDEAL FOR THIS, IT IS VERY PRECISE BY INSERTING THE NEEDLE DIRECTLY INTO
THE TRIGGER POINT INSULTING THE TISSUE, DIRECTING BLOOD FLOW (HENCE OXYGEN) TO THE AREA, ULTIMATELY
DISSIPATING THE TRIGGER POINT! ELECTRO ACUPUNCTURE IS USED TO AMPLIFY THE EFFECTS OF ACUPUNCTURE AND
TO ENHANCE STIMULATION OF NEURAL PATHWAYS OF INHIBITED MUSCLES. THROUGH BAD HABITS, CERTAIN MUSCLES
CAN BECOME INHIBITED, AND THE BRAIN CAN “FORGET” THEY ARE THERE, SO DOES NOT USE THEM WHEN THEY
SHOULD BE. ELECTRO ACUPUNCTURE STIMULATES THESE NEURAL PATHWAYS OF IN INHIBITED MUSCLES TO HELP THE
BRAIN “KNOW” THEY ARE THERE.
VIDEO OF ELECTROACUPUNCTURE
• HTTPS://YOUTU.BE/5LBHOXQFRUC
ACUPUNCTURE CONTINUED
• PAIN IS A COMPLICATED MULTILAYERED SYSTEM
• IMMEDIATE EFFECTS OF DRY NEEDLING AND ACUPUNCTURE AT DISTANT POINTS IN CHRONIC
NECK PAIN: RESULTS OF A RANDOMIZED, DOUBLE BLIND, SHAM CONTROLLED CROSSOVER
TRIAL IRNICH ET AL PAIN 99 (2002) 83-89
• ACUPUNCTURE IS SUPERIOR TO SHAM ACUPUNCTURE IN IMPROVING MOTION-RELATED PAIN AND
ROM FOLLOWING A SINGLE SESSION OF TREATMENT IN CHRONIC NECK PAIN PATIENTS
• ACUPUNCTURE AT DISTANT POINTS IMPROVES ROM MORE THAN DRY NEEDLING
• DRY NEEDLING WAS INEFFECTIVE FOR MOTION RELATED PAIN
NECK PAIN
• ACUPUNCTURE ENHANCES GENERATION OF NITRIC OXIDE AND INCREASES LOCAL
CIRCULATION AND WERE NOT OBSERVED IN SHAM-ACUPUNCTURE NEEDLE GROUP
• TSUCHIYA ET AL ANESTH ANALG 2007;104:301-307
• SUBCUTANEOUS TISSUE FIBROBLAST CYTOSKELETAL REMODELING INDUCED BY
ACUPUNCTURE:EVIDENCE FOR A MECHANOCTRANSDUCTION-BASED MECHANISM
• LANGEVIN ET AL JOURNAL OF CELLULAR PHYSIOLOGY 207:767-774 (2006)
THANK YOU