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How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Treating the Terrain of Chronic Sinus Infections
Chronic sinus infections can be stubborn to treat, but the therapeutic path forward can be simplified when utilizing three distinct treatment principles which take into account the terrain of the body, and the way in which microbes grow.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
January, 2016, Vol. 16, Issue 01
Positional Release Techniques: What are the Mechanisms?
By Leon Chaitow, ND, DO
At its simplest, positional release techniques as used in manual therapy settings, involve the unloading of tissues, placing them into less-stressed, "ease" positions. In such a comfort state, a number of beneficial changes may emerge including reduced pain perception and reduced inflammation,15 greater local muscular strength, reduced fascial stiffness,1,2 reduced pain-medication use and number of days of hospitalization, as well as enhanced peripheral circulation, post-surgically.11
There are four main forms of PRT methods:3
The benefits of reduced stimulation, applied to the whole body may help us to understand the effects of PRT. For example, time spent in a flotation tank, immersed in neutral temperature water, of high salt concentration to increase buoyancy - described as Restricted Environmental Stimulation Technique (REST) – reduces anxiety, depression and pain in individuals suffering chronic pain.
In 2001, Kjellgren et al, described 37 patients suffering from chronic pain who were randomly assigned to either a control group (17) or an experimental group (20) who received nine REST treatments over a 3-week period. The most severe pain intensity was significantly reduced, but low perceived pain intensity was not influenced. REST treatment elevated optimism, reduced the degree of anxiety or depression, and improved sleep.
In another study, Edebol et al (2008) reported the benefits of the REST method in the management of the chronic effects of whiplash injuries. And of course, relaxation, mindfulness, meditation approaches – are all known to be useful as means of reducing general over-sensitive states, whether mental, or physical. Here are some suggested mechanisms for manually induced stimulus reduction.
Neurolophysiological changes might involve muscle, fascial and joint mechanoreceptors (e.g. Ruffini corpuscles, Golgi tendon organs, muscle spindles),10 as well as pain receptors. To explore the role of muscle spindles, and the hypothesis that sensitivity of the deep tendon stretch reflex contributes to range-of-motion restrictions, Howell et al. (2006) measured stretch and H-reflex latency and amplitude before and after strain counterstrain treatment. The results suggest that SCS affected the sensitivity of the muscle spindle, thought to be heightened by the existence of tendonitis.
Proprioceptive theory is probably the most commonly discussed explanation for the efficacy of SCS. It is suggested that when a disturbed relationship exists between muscles and their antagonists, following strain, the positioning of these tissues into an unloaded, ease, position, may allow spindle resetting and partial or total resolution of inappropriate motor impairment.9
Mechanotransduction: Altered fibroblast responses resulting from changes in the shape and architecture of cells through mechanotransduction can be anti-inflammatory. Meltzer et al.14, observed that traumatized fascia disrupts the normal functions of the body, causing myofascial pain and reducing ranges of motion. Resulting inflammatory responses - involving fibroblasts - can be reversed in as little as 60 seconds by changes in load on the tissues, delivered either by counterstrain or myofascial release. In 2007, Standley & Meltzer observed that "fibroblast proliferation and expression/secretion of pro-inflammatory and anti-inflammatory interleukins may contribute to the clinical efficacy of indirect osteopathic manipulative techniques..." such as SCS. Standley and Meltzer (2008) also reported that "it is clear that strain direction, frequency and duration, impact important fibroblast physiological functions known to mediate pain, inflammation and range of motion."
Ligamentous reflexes: Solomonow13 identified the sensory potential and major ligamento-muscular reflexes that have inhibitory effects on associated muscles. He states, "If you apply only 60 to 90 seconds of relaxing compression on a joint... an hour+ of relaxation of muscles may result. This may come not only from ligaments, but also from capsules and tendon" (personal communication 2009). A possible clinical application of this ligamentous feature may be seen when joint "crowding" is induced as part of Facilitated Positional Release and/or SCS protocols. Such effects would be temporary – 20 to 30 minutes – but this would be sufficient time to allow an enhanced ability to mobilize or exercise previously restricted structures.
Wong16 summarizes current thinking regarding ligamento-muscular reflexes and SCS: Ligamentous strain inhibits muscle contractions that increase strain, or stimulates muscles that reduce strain, to protect the ligament.7 For instance, anterior cruciate ligament strain inhibits quadriceps and stimulates hamstring contractions to reduce anterior tibial distraction.7
Hydration: Crowding (compression) of soft tissues – as used in SCS and Facilitated Positional Release (FPR), has an effect on the water content of fascia, leading to temporary (20 to 30 minutes) of reduced stiffness of fascial structures – with the potential for enhanced mobility during that period. This window of opportunity can be usefully employed to enhance function and for the individual to experience less painful movement.
Hysteresis: In a study at the Philadelphia College of Osteopathic Medicine (Barnes 2012), 240 subjects were palpated for cervical articular somatic dysfunction. This was followed by use of a durometer to objectively measure soft-tissues overlying each cervical segment pre- and post-intervention, using a single consistent piezoelectric impulse, quantifying hysteresis (tissue stiffness/densification). Various soft-tissue techniques, including SCS, myofascial release, muscle energy technique and high velocity manipulation were tested. The results showed that all methods - but not the sham intervention - improved symptoms and stiffness of tissues but that SCS resulted in the most significant beneficil changes.
To what degree all, or any, of these mechanisms are operating during application of PRT in general, and StrainCounterstrain (SCS) in particular, remains to be more definitively established. Meanwhile positional release methods are among the safest and most effective ways of easing painful symptoms and inducing a healing response.3
Click here for more information about Leon Chaitow, ND, DO.
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