proprioception
What Does an Adjustment Do?
05/05/11 12:03 Filed in: From the Research
One of the most common questions that we are asked is, "What does an adjustment actually do?"
Every chiropractor would be aware of the most common theories regarding spinal manipulation and how it exerts its effects upon the human body. However, the detail is often somewhat sketchy. Fortunately the research literature is increasingly building a body of evidence as to the mechanics of manual treatment and how it is transduced into neurological effects. Some of these seem well understood; the analgesic effects occurring at the dorsal horn, the increased sympathetic activity following mobilisation, changes in joint perception and proprioception, and altered patterns of muscle recruitment. We have discussed this last item recently, specifically the changes to multifidus muscle activity that arise following a spinal adjustment, and it has returned again as the subject of a new study published in Journal of Orthopaedic & Sports Physical Therapy...
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Every chiropractor would be aware of the most common theories regarding spinal manipulation and how it exerts its effects upon the human body. However, the detail is often somewhat sketchy. Fortunately the research literature is increasingly building a body of evidence as to the mechanics of manual treatment and how it is transduced into neurological effects. Some of these seem well understood; the analgesic effects occurring at the dorsal horn, the increased sympathetic activity following mobilisation, changes in joint perception and proprioception, and altered patterns of muscle recruitment. We have discussed this last item recently, specifically the changes to multifidus muscle activity that arise following a spinal adjustment, and it has returned again as the subject of a new study published in Journal of Orthopaedic & Sports Physical Therapy...
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...