Physical Medicine is a broad field poorly understood in the U.S. and I want to give the reader a brief explanation for a basic understanding of these treatment modalities offered in this office that are both safe and effective.
Spinal Manipulation (SM): When most people think of chiropractors, SM is what comes to mind and with good reason because it is the one thing all chiropractors have in common. SM is usually done by hand, but there are mechanical adjusting instruments that are also commonly employed. The Activator mechanical instrument and the Impulse electrical unit are two used in this office, which provide an adjustable power of impulse from very light for neck or sensitive areas to quite heavy for the thoracic, lumbar and hip areas, where there are strong muscle overlay of the joints.
How does Manipulation work to reduce pain? Joint manipulation is the quickest and best way to fix joint subluxation, which is simply joint "lock." Joints were designed to move freely through their normal range of motion. Patients sometimes refer to this as a "cric," a "kink" or a "catch" that prevents their normal range of neck or back movement. It is usually described as causes a sharp pain, restricting function. A joint in the spine is where a bony flat plat about the size of a half penny articulates with another above or below it. There is one on the left and one on the right at each the 24 segments of the spine, plus 2 much larger sacroiliac joints. They must all mesh and glide smoothly for proper function. Occasionally one or more joints can "jam" together, locking that segment. The solution to this problem is to bring motion back into this dysfunctional joint by applying manipulation to it, breaking the "jam", returning full motion to that joint.
Why does it take sometimes more that one, sometimes multiple visits to correct the subluxation? The usual cause of subluxation is a quick unexpected motion. Sometimes, it is a low force subluxation that one visit is all that is needed. Other times there is a strong force (falls, auto accidents) that not only subluxates the joint, but also sprains the ligaments that support the joint and strains the muscles and tendons that attach to the bone of the joint. These soft tissue injuries complicate the subluxated joint and is the reason why other modality treatments precede or follow the adjustment of the joint.
Risks of Manipulation: Manipulation is low risk (proof is the low cost of malpractice insurance for chiropractors), never-the-less, some risks still exist. One notable, but rare, is stroke when the cervical spine is adjusted. In normal individuals there is no risk at all. But in people with a weakness in the vertebral artery causing a ballooning of the arterial wall, sudden rotational and extension stretching delivered simultaneously may cause the the weakened wall to break. If bringing your head back and turning it to the right or left causes some dizziness, you need to make this know to your chiropractor so that type of adjustment is not done. In 38 years of adjusting the cervical spine, no patient has ever had such a side effect. Another potential side effect is fracture. Elderly women with osteoporosis are must vulnerable and need to be adjusted gently, perhaps with adjustable mechanical instruments.
The 1st Adjustment: Following manipulation, there should be some relief from the sharp, catching pain, but often there will be ongoing soreness of the soft tissues for reasons explained above.
Other Modalities of Treatment:
Ultra Sound (US): US gets deep down to the bone and joint where the injury is located.
It has long been used as an anti-inflammatory agent by breaking down the exudates of injury into tiny molecules that can be absorbed by the body, cleaning up the injured area, speeding the healing process. Healing agents placed on the skin can be carried through the skin to also speed the healing process. This process is called "phonophoresis." Our office has a number of US units with different size heads to accommodate the various sites of injury.
Electrical Muscle Stimulation (EMS): Many patients are familiar with TENS units for home use. How does EMS of the office differ from TENS. Their are similarities, to be sure, but there are vast differences. A TENS unit can be bought for less than $100. The office units ofter cost over $2000. The office unit is more sophisticated offering a variety of currents: Interferential, High and Low Volt Galvanic, Russian, etc. They are also computer driven to constantly vary the pulse frequency through the treatment. TENS is typically used for chronic pain conditions to reduce the pain while they are worn on the person throughout the day. When it is removed, the pain returns usually within minutes. They are used to control pain, not heal. The office units are used to reduce inflammation and to make manipulation more effective. "Iontophoresis" can be used with office units and is similar to "phonophoresis" described above with US.
Medical Acupuncture: EKG and EEG prove the existance of electrical energy within the body. Body energy can be in certain parts either too much or too little and the results of this can produce disease states. Acupuncture seeks to balance these states and assist the body in healing itself. An acupuncture point can be stimulated in a variety of ways. Needles are one way most people associate with acupuncture, but not the only. Point pressure, laser, US, electric stim are other effective ways to stimulate acupuncture points. There are many systems of acupuncture: Chinese, Korean, Japanese, French Auricular, and Medical. Chinese is the most common form practiced in the United States by non-medical acupuncturists. The Chinese system relies heavily on pulse diagnosis and the 5 element theory for treatment. To feel a pulse at 3 places along the wrists and identify each of these 6 pulses as one of 28 possible categories requires more skill and time than I possess and is not used in my practice. Also treating with 5 element (Fire, Earth, Metal, Water,and Wood) is to trust in a complex Eastern theory that has yet to be validated by Western research and is not used in my practice of acupuncture.
The Chinese have established over the centuries acupuncture points on the body and meridians or pathways of the energy that flow through a connection of each of these pathways. While much of this still remains theoretical, we, as well as all those practicing Medical acupuncture, use these accepted points and meridians in our practice because they work clinically to balance the excess or deficient energies of the body.
There is, however, objective and medically researched evidence for one reason for the efficacy of acupuncture that is accepted by all medical associations the world over. That huge body of evidence was performed by a team headed by Dr. Bruce Pomeranz in Canada. His work documented that the stimulation of the acupuncture points increased the body's production of neurotransmitter chemicals by the brain and cord. Arming these chemicals were powerful anti-inflammatory agents such as cortisone and powerful pain mediators such as endorphins and enkephalins that mitigate pain.
Acupuncture around the world is used to treat many disease states that include most of the medical specialties in the U.S. In this office, I limit the practice of acupuncture to orthopedic and neurological problems.
Auricular Acupuncture (AA): Specific mention should be made of this French development, by Dr. Nogier. He charted points on the ear according to the 3 levels of embryological tissues that are found in the ear and correlate through those tissues and nerves to the brain and body parts. These points are commonly used today in the treatment of chronic pain, weight and alcoholism. Because these problems require daily treatment over long period of time, we could not offer treatment because of prohibitive cost and unrealistic compliance by the patients in a non-institutional setting. But with the development of the Semi-Permanent Needle (SPN), it is possible for this office to treat these problems with reasonable cost. Instead of a 15 minute treatment, the patient can now receive in one visit a treatment that will continue 24/7 until the needles fall out on there one in days later. AA treated with semi-permanents holds promise for a number of chronic medical problems.
