Combining Specific Chiropractic Adjusting Techniques with CBP Corrective Care Techniques: Case #2.

INTRODUCTION

            In our previous article (AJCC October 2012)¹, we suggested that the astute Chiropractor should become skilled at administering both a segmental specific adjustment technique (such as the Gonstead system) and a full spine corrective technique like Chiropractic BioPhysics (CBP). In this manner, patients will experience the benefits of segmental motion restriction improvement and the restoration of proper full body and spine alignment. The case presented herein attempts to provide further rationale for the combination of these two uniquely distinct, but complimentary full spine Chiropractic Technique systems.

CBP / Gonstead Case Study #2:

            In 2012, an 8 year old male, who had no overt symptom complaints was brought to the author's (T.P) Chiropractic clinic for postural evaluation and a spinal checkup. His parents had noticed significant posture abnormality and were concerned about underlying spinal disorders.

• Postural Analysis: Posture analysis revealed a significant left thoracic translation, a right lateral flexion of the ribcage, a right posterior pelvic rotation, a suspected left leg length inequality, a large posterior thoracic translation, and a slight forward head translation. 
• Radiographic Analysis:  

1. In April of 2012, a modified AP femur head-ferguson view was obtained. On the left of Figure 1, this x-ray is shown. The PostureRay x-ray software system was used to identify and quantify the extent of leg length inequality. A 9mm left leg length inequality was identified with consequent spine abnormality.

2. In April of 2012, a full spine lateral radiograph was obtained. While in June of 2012, a follow up full spine lateral was obtained to document the response to intervention and potential modifications that might be warranted. Figure 2 depicts these full spine radiographs

• Interventions: A total of 24 treatment sessions over the course of 2 months was utilized in this case.

            For segmental adjusting technique, the treating Chiropractor (TP) exclusively adhered to and utilized the Gonstead Technique system for identified spine subluxations including:

1. Abnormal temperature differential patterns (nervo-scope / tempo-scope).
2. Static palpation data indicating the presence of edematous tissue around the injured segment.
3. A decrease in motion of the segment in question, as compared to the surrounding area.
4. Palpable muscle spasm or splinting around the area in question.
5. Visualization of the area (looking for presence of pitting edema, asymmetry in the tissues, etc).
6. Then, consulting the 3-shot, digitally stitched, AP full spine x-ray and the lateral (2 shot) full spine x-ray to analyze the “foundation principle” and relate this to the examination findings.

            For the full spine and posture corrective care, CBP® mirror image® adjusting, exercise, traction procedures were utilized. Additionally, body weighting using the thoracic belt from Circular Traction was applied 5 times per week for 15 min walking intervals. These procedures were administered on each visit to the patient. Lastly, a full foot lift of 9 mm was administered to the patient and was placed in the left shoe.

• Mirror Image Adjustments

The patient was administered mirror image adjustments to correct posterior thoracic translation with hyper-kyphosis and anterior head translation with head flexion postures. See Figure 3.

• Mirror Image Exercises

The patient was administered mirror image® exercises to correct posterior thoracic translation with hyper-kyphosis and anterior head translation postures. See Figure 4.

• Mirror Image® Body Weighting and Denneroll Traction

      Mirror Image traction care was administered to the patient. The patient received the denneroll traction system to correct the abnormal thoracic translation posture as shown in Figure 5. In addition the patient was instructed in the use of the denneroll thoracic orthotic and was advised to do this 5 times per week at home.

• Case Outcome

            Subjectively, at the end of 2 months of corrective care, the patient's posture was remarkably improved. NRS = 1-2 / 10. According to the patient's parents, in their own words, "It’s great to see how quickly he has improved. The leveling of his shoulders and hips is apparent and how he carries himself; he is dramatically more upright and balanced".

            Objectively, the patient's follow up full spine radiographs in Figure 2 show remarkable reduction of the spinal displacements.

CONCLUSION

            The authors' opinion is that the patient's improvements were directly related to both the segmental adjusting and spinal corrective procedures applied using CBP Technique. Accordingly, for optimum patient response, traditional Chiropractic adjustments would seem to be enhanced by the addition of spinal corrective procedures as in CBP. In the end, it is the positive response of the patient that should dictate this combined approach of classical Chiropractic care, with more contemporary corrective Chiropractic systems.

References

1. http://www.chiropractic-biophysics.com/clinical_chiropractic/2012/12/18/combining-specific-chiropractic-adjusting-techniques-with-cb.html

5 Steps to Creating a Lifetime Patient

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Fred DiDomenico, DC

Practice Coach and Mentor

www.elitecoachingllc.com

INTRODUCTION        

            I receive calls from doctors all over the country asking me one of the most common questions, “How do I have MORE patients stay for a lifetime?” My answer? “5 Steps.”

            In Elite Coaching, we have a strong core value that patients should have an optimal spinal structure to attain optimal health. Isn’t that the principle of Chiropractic? We also believe each patient and family members should live their WHOLE LIFE with an optimal spine for optimal health. How do we take a patient saying, “Doc, fix my back,” to “I want to change the way I live my life for me and my family?” This is a system and this system works. Just ask the docs using it.

            First of all, if you want to change the way people act you have to change the way they think. Unfortunately, you are not going to change the way they act and think until you find out how they FEEL, NOT what they THINK. You see, Subluxation is a fact. Facts are processed in the Cerebral cortex. The cortex processes facts, language and rational thinking. There is no decision making in the cortex.

            The Limbic brain processes emotion and assigns an emotion to every experience. It does not rationalize, process facts and is TOTALLY responsible for behavior. Hence, the adage, “People buy with emotions and justify with fact.” Even a person who buys from facts and information TRUSTS information. Trust is processed in the Limbic brain. Therefore, if you are going to inspire people you MUST speak to their Limbic brain. This requires a different language, the language of emotion.

• Step #1: “Consultation focused on organs:”

            In a Consultation we address their pain and we focus on their organs. This is through system of communication discovering how they FEEL about their organ problems. EVERY person has a feeling about their health problems. When you discover they have high blood pressure and are scared of a heart attack, hypoglycemia and fear diabetes, fatigued and frustrated, and have them SAY, “I don’t want to be like this anymore,” on Day #1, you have taken a HUGE first step into their emotion. Before they know what they want, they must know what they DON’T want.

• Step #2 – “They have to know this is MINIMALY and health or disease decision, optimally a life or death decision.”

            The late Dr. Don Harrison and his son, Dr. Deed Harrison teach an overwhelming amount of research in CBP seminars proving subluxated postures lead to disease and early death. How do your patients learn this? Dr. Deed and Elite Coaching have come together to create the, “Regaining Your Youth & Vitality,” new patient workshop with a number of these studies. It handles almost every patient objection and is VERY obvious to every patient in the room their posture is affecting every area of their life, including life span. This workshop creates an emotional response (Limbic Brain).

• Step #3 – “Have the patient set 20-30 year health/life goals:”

            To me, the worst insult is finding myself trying to convince a patient into accepting care for their own good. NO MORE! Have them tell you what THEY want. When they write their 20-30 year life goals they are telling you how to speak to their emotion (Limbic Brain) by knowing their highest priority. Now get them 100% committed to that life and have the patient say they can’t live that life if they allow their subluxated posture to progress. NOW they are buying the life they want rather than your program (Limbic Brain). Then give them the recommendations, the solution to their BIGGEST problem. FYI, “Entrepreneurs solve people’s problems for a profit.” T. Harv Eker “Secrets of a Millionaire Mind.”

• Step #4 – “Remind them every 30 days.”

            Your re-exam reminds them of their original organ problems, their original level of health, shows improvement and sets short term goals on the healing of their organ problems. People forget where they came from and become unappreciative and lose the emotion. They adapt to their new state of health. Remind them and bring out their 30 year goals every 30 days to keep their attention on their vision (Limbic Brain). Next, ask them to repeat their whole corrective and maintenance program into lifetime care every 30 days. Make the transition into lifetime care seamless with your financials.

• Step #5 – “Fountain of Youth Club – Patients Committed to LIFELONG youth, Health and Vitality.”

            Have a club they enter when they have completed postural correction. Make a BIG DEAL about it. Stencil it on a wall with their picture to give them a visual goal (Limbic Brain). Take their picture in the middle of the adjusting area at your busiest time. Present them with a membership plaque in front of other patients and watch how many patients will inquire and make that their goal (Limbic Brain). Set a goal for how many patients enter the club and watch your practice go through the ROOF!

SUMMARY

            We are teaching these principles of how to create lifetime patients and MUCH more at our Elite Coaching Las Vegas seminar, August 25^th/26^th, 2012. Dr. Deed Harrison is one of our phenomenal speakers. Please call us today to attend at 253-851-5899, or call me, Dr. Fred DiDomenico, personally at 253-851-8353 for any questions.

Upper Cervical Concepts

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Dan Murphy, DC

Private Practice of Chiropractic;
Diplomate American Board of Chiropractic Orthopedist;
Faculty Life Chiropractic College West;
Vice President ICA 2003-2009;

ICA Chiropractor of the Year 2009

INTRODUCTION

            A key component to understanding the upper cervical spine is to understand the Trigeminal-Cervical Nucleus. In his 1995 article Nikolai Bogduk, MD, PhD¹ makes these points:

            The point is that the trigeminal nerve afferents and the upper cervical afferents are neuro-mechanically linked. Upper cervical spine afferent mechanoreceptors arising from the capsules, ligaments, and discs are well documented. Importantly, the sub-occipital muscles are documented to be the most densely innervated (by far) with muscle spindle mechanoreceptors.²

• Neuroanatomical Pathways

            “Our first conscious muscular act is nursing at the breast. The neuronal pathways mediating and stipulated by nursing from the beginnings of our awareness of ‘self’ as well as the neuronal substratum upon which all future emotional and mental experience is interpreted and recorded. The tactile and oral sensations that accompany this extremely important act, namely pleasure, warmth and security, are conveyed centrally primarily by the trigeminal nerve, the trigeminal sensory nuclei in the brain stem, the trigeminal tracts, the nucleus VPM [ventral posterior medial] in the thalamus and its myriad connections.”

            “Conceivably whether a person is basically happy and content in life, whether he or she is trusting of others human beings, and whether he or she is capable of loving another human being may all depend upon the sufficient stimulation, activation and persistence of these neurons, their connections and their neurotransmitters.”

• The Brain and Behavior:

            There are monosynaptic inputs to the hypothalamus that arise from within the trigeminal spinal nucleus. “These fibers project directly to many areas of the hypothalamus. The monosynaptic pathways provide a route for reflex autonomic and endocrine behaviors.” 

• Integration

            The central nervous system (spinal cord, brain stem and brain) is built upon the quality of its afferent (sensory) stimulation. Apparently the first and most important sensory afferent input for the development of the synaptic array of the spinal cord, brain stem, and brain is to the trigeminocervical nucleus. The quality of the input into the trigeminocervical nucleus is ultimately linked to the following:

• Headache perception
• Emotional and mental experience
• Happiness and being content in life
• Trusting of other human beings
• Being capable of loving another human being
• Autonomic (visceral) nervous system function
• Endocrine hormonal function

DISCUSSION

            The KEY is the understanding that the sensory afferent input into the trigeminocervical nucleus originates from two primary sources:

1)    Mouth/temporomandibular function (TMJ)

2)    Upper cervical spinal mechanical afferentation

These concepts are well supported by German physician Heiner Biedermann, MD.^3-5 

SUMMARY

            The powerful systemic influences of upper cervical chiropractic improvement of mechanical afferentation is linked to the most important mechanical (not to mention nutritional) influences on central neurological development: breast feeding.

 

References

1)    Nikolai Bogduk, MD, PhD Anatomy and Physiology of Headache Biomedicine and Pharmacotherapy; 1995, Vol. 49, No. 10, 435-445.

2)    Boyd-Clark et. al., Quantitative Study of Muscle Spindles in Suboccipital Muscles of Human Foetuses; Neurology India, 2001, 49, 355-359.

3)    Kinematic Imbalances Due To Suboccipital Strain In Newborns. Journal of Manual Medicine; June (No. 6) 1992, pp151-156.

4)    Manual Therapy in Children, Churchill Livingstone; 2004.

5)    Manual medicine of functional disorders in children. Medical Veritas: The Journal of Medical Truth; 2006; Vol. 3; pp. 803-814.

New Chiropractic BioPhysics® Training Institute and Spinal Health Center will Open in Boise-Eagle, ID

 

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            On June 22, Drs. Deed and Shirlene Harrison, of CBP® Seminars, procured an 11,000 sq. ft. class A professional building in down town Eagle, Idaho; just outside of Boise, ID. The purpose of this building is twofold:

1. To operate a Chiropractic BioPhysics (CBP) training facility where Chiropractors around the world, interested in learning all aspects of CBP Technique, will come to acquire the knowledge and skills necessary to practice CBP and become CBP Certified Chiropractors. Thus, part of the new facility will be a state of the art 2,000 sq. foot conference room capable of running 2-sessions simultaneously; and
2. To operate a full scale, multi-doctor, CBP patient spine rehabilitation and health center. Currently, the Chiropractors chosen to run this CBP patient center are Drs. Deed and Shirlene Harrison, Dr. Todd Pickman, and Dr. Joe Betz.

            For Dr. Deed Harrison, this is a dream come to fruition. It has always been challenging to train Chiropractors in the technicalities and nuances of CBP Technique in a hotel conference setting without the necessary equipment (adjusting tables and instruments, traction equipment, exercise and rehabilitation equipment, and radiographic facilities). Also, the perspective of how a full scale CBP office looks, feels, functions, and operates is lost in the 'hotel convention center' environment. This new facility will solve these dilemmas. Also, CBP will launch its new Chiropractic Assistant (CA) training certification program out of this facility.

            The new CBP facility is just west of Boise in Eagle, ID and is approximately 20 minutes from the Boise international airport. The facility is located in Eagle's premiere business complex: The Eagle River Business park and is at 950 E. Riverside Drive in Eagle, ID. The amenities of this business complex are outstanding with a Hilton hotel, local favorite restaurants, parks, and a paved-maintained trail system for walking and biking along the Boise river.

            The CBP patient center is scheduled to open in October of this year (2012) while the CBP training institute will open its doors in January of 2013. Watch CBP's website (www.idealspine.com) for the 2013 conference schedule and for further details.

CBP Lumbar Extension Traction Evidenced in Two Recent RCT's

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            In the last couple of months, two new randomized controlled trials have been published having strong impact on CBP Technique protocols and procedures. These two randomized trials were authored by Ibrahim Moustafa, PhD and Aliaa Diab PhD; both from the Basic Science Department, Faculty of Physical Therapy, Cairo University, in Egypt.^1,2 The two trials built on and expanded the knowledge of a previous non-randomized trial on supine lumbar extension (3-point bending) traction published by Deed E. Harrison, DC and colleagues.³

            Moustafa and Alia's trials demonstrated that lumbar extension traction increases the lordosis and improves pain, disability, and nerve function in patients with chronic low back pain¹ and chronic discogenic lumbo-sacral radiculopathy² and concomitant lumbar hypo-lordosis. For complete study abstracts see the CBP NonProfit, Inc. research update in this issue by Dr. Oakley.

1. Moustafa IM, Diab AA. Rehabilitation for Pain and Lumbar Segmental Motion in Chronic Mechanical Low Back Pain: A Randomized Trial. Journal of Manipulative and Physiological Therapeutics Volume 35, Issue 4 , Pages 246-253, May 2012.
2. Moustafa IM, Diab AA. Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial. Clin Rehabil June 8, 2012 Published online before print June 8, 2012.
3. Harrison DE, Harrison DD, Cailliet R, Janik TJ, Holland B. Changes in Sagittal Lumbar Configuration with a New Method of Extension Traction: Non-randomized Clinical Control Trial. Arch Phys Med Rehab 2002; 83(11): 1585-1591.