clinical
Adjusting Deranged Discs - Just What Are We Doing?
20/06/10 21:08 Filed in: From the Research
In our last blog post we examined the prospect of hypermobility being a common feature of many spinal pain patients. What’s more, we also suggested that it is these hypermobile segments that can benefit from the proprioceptive burst that accompanies a spinal adjustment.
But what is going on at a tissue level? And can our adjustments influence the connective tissue features of common spinal derangements?
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But what is going on at a tissue level? And can our adjustments influence the connective tissue features of common spinal derangements?
Read More...
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What Are You Adjusting? Hyper or Hypo?
03/06/10 11:22 Filed in: From the Research | Clinical Pearls
To most chiropractors quality of spinal motion is a prerequisite for spinal health. We have an intrinsic understanding that a joint must move normally to be normal - or at least to stay that way. As such, our examinations are heavily geared towards assessing and quantifying the relative motion of each segment. We then give it a rating: 'normal', 'hypermobile' or 'hypomobile'.
Most of the time chiropractors tend to focus upon finding areas of limited motion - segments of greater stiffness that would benefit from an adjustment. Indeed, the majority of definitions of joint dysfunction suggest that reduced mobility is a cardinal sign, and that we should try to stay away from any hypermobile segment.
But is this really what's going on? Is it truly the stiffer joints that are the prime source of pain in most of our patients? And is it the stiffer joints that benefit the most from manipulation? Or could it actually be the hypermobile joints that should be the target of, and beneficiaries of, the neurological effects of an adjustment?
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Most of the time chiropractors tend to focus upon finding areas of limited motion - segments of greater stiffness that would benefit from an adjustment. Indeed, the majority of definitions of joint dysfunction suggest that reduced mobility is a cardinal sign, and that we should try to stay away from any hypermobile segment.
But is this really what's going on? Is it truly the stiffer joints that are the prime source of pain in most of our patients? And is it the stiffer joints that benefit the most from manipulation? Or could it actually be the hypermobile joints that should be the target of, and beneficiaries of, the neurological effects of an adjustment?
Read More...
Proprioception Part II - It's More Complex Than You Thought
22/05/10 16:36 Filed in: From the Research
In our last blog entry (Proprioception - The Key to Chiropractic Care) we looked at the accruing evidence that chronic and recurrent spinal disorders are frequently accompanied by proprioceptive deficits. We also took the view that these deficits might actually be the 'weakness' that precedes an acute episode of pain.
So far it has been suggested that this lack of sensory feedback might exist somewhere in the peripheral structures, such as in the multifidus muscle groups, or in the muscle spindles themselves. Brumagne and colleagues (1) suggested that "it is possible that reduced proprioceptive acuity in the lumbosacral spine is a precursor to back injuries and their sequelae. Poor perception of spine orientation may lead to more frequent excursions beyond the range of mechanical stability, thereby risking mechanical injury to spinal tissues."
But could the problem be central - in the brain itself?
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So far it has been suggested that this lack of sensory feedback might exist somewhere in the peripheral structures, such as in the multifidus muscle groups, or in the muscle spindles themselves. Brumagne and colleagues (1) suggested that "it is possible that reduced proprioceptive acuity in the lumbosacral spine is a precursor to back injuries and their sequelae. Poor perception of spine orientation may lead to more frequent excursions beyond the range of mechanical stability, thereby risking mechanical injury to spinal tissues."
But could the problem be central - in the brain itself?
Read More...
Proprioception - The Key to Chiropractic Care
11/05/10 20:10 Filed in: Clinical Pearls | From the Research
Since the inception of the chiropractic profession its practitioners have struggled with models of spinal dysfunction. While early notions of structural misalignment have largely given way to ‘functional’ concepts, the average field doctor still questions the exact nature of such lesions. So the question still remains, “What exactly is going on inside the spines and nervous systems of our patients?”
Clearly there are many differing clinical diagnoses that can be made when we attempt to pick a source of pain or a ‘tissue in lesion’. These might include a meniscoid extrapment, a zygapophysial synovitis or one of the various grades of annular tear/disc herniation. However, in such instances we could view any tissue damage as the result of a functional derangement that was already in existence at the time of injury. In other words, many spinal pain syndromes are a symptom of a greater deficit underneath - not simply the unlucky result of an inappropriate movement or accident.
But what ‘deficit’ might precede a spinal injury? And how would we know it was present if our patients are asymptomatic?
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Clearly there are many differing clinical diagnoses that can be made when we attempt to pick a source of pain or a ‘tissue in lesion’. These might include a meniscoid extrapment, a zygapophysial synovitis or one of the various grades of annular tear/disc herniation. However, in such instances we could view any tissue damage as the result of a functional derangement that was already in existence at the time of injury. In other words, many spinal pain syndromes are a symptom of a greater deficit underneath - not simply the unlucky result of an inappropriate movement or accident.
But what ‘deficit’ might precede a spinal injury? And how would we know it was present if our patients are asymptomatic?
Read More...
The Neck - A Sensory Organ for Balance
06/05/10 12:38 Filed in: Clinical Pearls | From the Research
When we operate as clinicians in the mechanical realm there is a tendency to view the neck simply as a series of linkages that enable the head to move around on top of the trunk. But it’s really so much more than that. The extraordinary repertoire of movements available to the human neck is only made possible by an exquisite neurology that ensures precise neuromuscular control over the joint segments.
To really appreciate this level of neural control, just focus your attention on your fingers for a moment. Feel how finely you can control their movements and how accurately you can perceive their position. Much of this sensory-motor prowess over your fingers is due to the sheer number of muscle spindles in the musculature - all providing a rich stream of proprioceptive information. And 16 muscle spindles per gram of muscle in the lumbricals certainly sounds like a lot...
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To really appreciate this level of neural control, just focus your attention on your fingers for a moment. Feel how finely you can control their movements and how accurately you can perceive their position. Much of this sensory-motor prowess over your fingers is due to the sheer number of muscle spindles in the musculature - all providing a rich stream of proprioceptive information. And 16 muscle spindles per gram of muscle in the lumbricals certainly sounds like a lot...
Read More...
The Vagaries of the Clinical Exam - Who Can You Trust?
29/04/10 21:27 Filed in: Clinical Pearls
It is unfortunate that the art of clinical diagnosis is exactly that - an art.
While we are fortunate to have the tools of science available to help us, the ultimate assembly of clinical data to construct a diagnosis is as much an art form as it is a science. However, the clinical decisions that we make on a daily basis must be based upon something concrete or we would be paralysed by indecision. So in the end our experience is often called upon to help us decide which of our examination procedures are really trustworthy. The trouble is, sometimes our most cherished practices may not be as reliable as we'd like.
Take, for example, the humble palpatory examination...
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While we are fortunate to have the tools of science available to help us, the ultimate assembly of clinical data to construct a diagnosis is as much an art form as it is a science. However, the clinical decisions that we make on a daily basis must be based upon something concrete or we would be paralysed by indecision. So in the end our experience is often called upon to help us decide which of our examination procedures are really trustworthy. The trouble is, sometimes our most cherished practices may not be as reliable as we'd like.
Take, for example, the humble palpatory examination...
Read More...
Nerve Root Sedimentation Sign in Lumbar Stenosis
27/04/10 21:08 Filed in: Clinical Pearls
One of the great challenges facing the front-line clinician is to decide whether a radiological finding is actually relevant.
I’m sure that you are all too aware that many ‘abnormalities’ seen on imaging studies are present in an asymptomatic population (for example, 52% of asymptomatic individuals have at least one disc bulge evident on MRI(1)).
So what about lumbar spinal stenosis? When a patient complains of leg pain while walking (claudication), how can we tell whether the stenosis visualised on their MRI scan is relevant and demonstrates the cause of their symptoms? Or should we keep looking for another source of pain? Perhaps their complaint is vascular in origin?
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I’m sure that you are all too aware that many ‘abnormalities’ seen on imaging studies are present in an asymptomatic population (for example, 52% of asymptomatic individuals have at least one disc bulge evident on MRI(1)).
So what about lumbar spinal stenosis? When a patient complains of leg pain while walking (claudication), how can we tell whether the stenosis visualised on their MRI scan is relevant and demonstrates the cause of their symptoms? Or should we keep looking for another source of pain? Perhaps their complaint is vascular in origin?
Read More...