Academy of Chiropractic’s
MD Relationship Program
#11 Clinical Information, Diagnosing, MRI
Clinical Consultation
From: William J Owens Jr DC DAAMLP
EXPLAINING THE CHIROPRACTIC ADJUSTEMENT
I always explain the adjustment in two ways, that is depending on WHY we are delivering it….
1: Spinal Biomechanical Correction
OR
2: Pain Management
The biomechanical correction approach is applied when there is a specific biomechanical response to a single trauma, a series of repetitive traumas OR a manifestation of spinal compensation (which is under CNS control). The main focus of this intervention is to restore proper coupled motion in the spine (rotation and lateral bending), to remove abnormal facet and disc loading patterns and to clear out any joint adhesions if they are present (typical in chronic biomechanical spine pain patients). Specific segmental diagnosis is critical as is the precise contact point of the vertebra in question, that is what chiropractors call the Subluxation Complex. This can be done through a High Velocity Low Amplitude Thrust (HVLA), Spinal Mobilization OR by the use of a specific pneumatic device (we can adjust for amount of force into the joint, measured in Newtons)
The pain management approach is applied when biomechanical correction has reached a maximum response and the patient is stable mechanically but still in pain. This is ONLY possible with HVLA with associated cavitation as there is a sensory (afferent) input threshold that has to be met in order stimulate the CNS through the dorsal horn of the spinal cord. Once that threshold is met and the impulse reaches the thamalus, we see a increased tolerance to pain in the human body at the site of the adjustment as well as in adjacent structures.
This is how we move patients through care.
This type of explanation is quick and is perfect for Lawyers, MDs and Patients to understand.
THIS IS THE NEUROLOGY EXPLAINATION so you have it…BUT I never use it UNLESS I am challenged. It is used at STEP #2 of the conversation if it gets there.
Spinal manipulation gaps the vertebral zygapophyseal joints as proven in the 2013 MRI study, which has an excitatory affect to the local joint mechanoreceptors and the local proprioceptors which then send the electrical impulse into the lateral horn cells of the dorsal column of the spinal cord. From there, an ascending impulse goes up into the periaqualeductual grey area of the cortex, the spinal thalamic tract, and into the thalamus. The thalamus acts as the incoming clearinghouse, as the impulse is found to stimulate the amygdala, hypothalamus, the pre-frontal cortex and the motor and sensory cortexes. The impulse causes neuropeptide cascade and then stimulation is found in the efferent descending pathways and into multiple areas of the body concurrently causing autonomic responses all over such as in the heart, lung and salivary gland cells etc. Primary hyperalgesia, which changes in the area of injury, is nociception and mechanoreception, whereas secondary hyperalgesia, changes to pain thresholds in the undamaged tissue surrounding the injury, is due to the central sensitization of the spinal dorsal horn neurons.
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