Non-Surgical Therapeutic Approaches
(Chiropractic Services Summaries)

Clinical Nutrition
An individual's overall health and the health of specific tissues are dependent upon an adequate blood supply and the availability of nutrients. An individuals nutritional requirement vary according to numerous factors, which include age, physical activity levels, fitness level, exposure to environmental pollutants, stress levels, clinical conditions and genetic expression. There are numerous ways, which healthcare specialists use to assess the unique nutritional needs of an individual which include taking a thorough history, reviewing dietary habits, physical examination and the performance of laboratory tests such as blood, stool and urine analysis. An individualized nutritional approach will promote health and tissue recovery. Specific supplemental recommendations may be provided to help facilitate anabolic recovery of compromised tissues. Special attention may be placed on recommending neuroprotective strategies in those cases where there is neurological compromise or disease.

Physiotherapy refers to therapeutic measures, which are used to reduce inflammation, reduce pain and promote tissue recovery. It is also used to help promote normal soft tissue and joint movement patterns and to return the region of the body to a state of health. Physiotherapy has widespread applications and is typically administered by a physican, therapist or therapy assistant. Physiotherapy if often one of the earliest approaches taken in a physical medicine setting. It can be used to help an individual gain strength, improve flexibility, reduce pain, and promote greater independence. It is commonly used to treat conditions that affect muscles and nerves. One of the primary applications is the rehabilitation from stroke or injury. Physiotherapy approaches include the use of heat, cold, electric stimulation, ultrasound, iontophoresis, traction and massage.

Physical Rehabilitation
Physical rehabilitation refers to the use of procedures and techniques used to increase a patient's physical capacity or potential. The patient's response to a course of physical rehabilitation is commonly monitored by a physican experienced in the diagnosis and care of neuromuscular and orthopedic disorders. Some physicians in these fields will have additional expert skills in manipulation. The attending health care specialist will determine when spinal care must shift from a more passive approach such as physiotherapy to active care with progressive physical rehabilitation.

The implementation of a physical rehabilitation approach is preceded by a physical examination with some degree of functional assessment to ascertain the physical limitations of the individual. These limitations serve as a baseline of human performance for which to design the rehabilitative program and also serve as a baseline measurement of which to base therapeutic outcome on. During the physical rehabilitative approach, attention is placed on the health and integrity of bone and soft tissues, biomechanical function of the affected joint or joints, and the patient's psychosocial response. Physical rehabilitation may be used in conjunction with functional restoration techniques such as physical mobilization or manipulation of joints and related tissues. Adjustive techniques often help promote mobility during the healing process while also promoting quicker and more enduring results.

Weight Management
Excess body weight and increased percentage boy fat increases the risk for aquiring numerous health problems and chronic diseases. Obesity and increased body weight can contribute to mechanical pain syndromes involving the spine and may contribute to accelerating the degenerative process affecting weightbearing elements of the spine such as the intervertebral discs and facet joints. Weight management refers to the application of methods to help an individual lose weight. This may involve dietary counseling, nutritional supplementation, exercise therapy or recommendations and behavioral counseling. In some cases referral to a medical specialists in the field of bariatrics or endocrinology may be required.

Massage Therapy
Massage refers to manual soft tissue manipulation, and includes holding, causing movement, and/or applying pressure to the body. Massage therapy is usually performed with a hands on approach some techniques may involve the use of a mechanical or electrical apparatus to stimulate or soothe soft tissues of the body for therapeutic purposes. Massage therapy refers to the methodical manipulation of soft tissues to help reduce edema, increase blood flow and reduce pain while facilitating the removal of waste products in the tissues. Massage may also be applied to mobilize the soft tissues thereby reducing the negative effects of adhesion and scar. Massage therapy is often effective at reducing the pain associated with muscle spasms. Americans are turning to massage therapy for relief from injuries and certain chronic and acute conditions, to help them deal with the stresses of daily life, and to maintain good health.

Massage therapy approaches range from very gentle superficial contact to deep, forceful manipulation and mobilization of soft tissues and muscles. Massage therapy is often used to complement other forms of therapeutic intervention. The effects of therapeutic massage vary with each individual. Massage therapy promotes the reduction of soft tissue adhesions, facilitates good circulation, helps to improve range of movement, improves lymph circulation thereby increasing the local effectiveness of the immune system and generally helps to reduce stress levels leading to better mental outlook. Massage therapy has been shown to lower stress and anxiety levels, reduce blood pressure, and reduce the healing time of tissue injury. It can be helpful in overcoming the swelling and pooling of fluids at the site of tissue injury or trauma. Massage therapy is often used in conjunction with or prior to other forms of physical intervention such as joint mobilization and manipulation to help reduce muscle spasms and muscle tension.

An increasing number of research studies show that massage therapy reduces heart rate, lowers blood pressure, increases blood circulation and lymph flow, relaxes muscles, improves range of motion, and increases endorphins (enhancing medical treatment). Although therapeutic massage does not increase muscle strength, it can stimulate weak, inactive muscles and, thus, partially compensate for the lack of exercise and inactivity resulting from illness or injury. It also can hasten and lead to a more complete recovery from exercise or injury.

The specialty of acupuncture encompasses a variety of procedures involving stimulation of anatomical locations on the skin by number of techniques. There are a variety of approaches to diagnosis and treatment in American acupuncture that incorporate medical traditions from China, Japan, Korea, and other countries. The most common approach used in acupuncture refers to stimulation of acupuncture points employing the penetration of the skin by thin, solid, metallic needles, which are manipulated manually or by electrical stimulation. For patient safety acupuncture should be performed with sterile disposable needles.

During a treatment session the needles may be placed into acupuncture points, which lie along meridians. The treatment may be associated with mild discomfort during needle placement although the procedure is generally considered relatively painless. The use of acupuncture by a physician generally should follow a thorough examination. Traditional Chinese (oriental) methods of acupuncture diagnose may include palpation of the abdomen, pulse and tongue diagnosis. Acupuncture is one of World's oldest systems of medicine and it is a component of the health care system of China that can be traced back for at least 2,500 years. Dietary, lifestyle, and exercise recommendations may accompany the acupuncture approach.

The general theory of acupuncture is based on the premise that there are patterns of energy flow (Qi) through the body that are essential for health. Disruptions of this flow are believed to be responsible for various disorders. Acupuncture may correct imbalances of "energy flow" at identifiable points close to the skin. Acupuncture may contribute to increased blood flow to the region of application or stimulation. It has been proposed that acupuncture may stimulate a local immune response and also contribute to the release of special chemicals within the central nervous system referred to as endorphins and enkephalins, both, which are natural pain reducing compounds. Acupuncture has been used by millions of American patients and performed by thousands of physicians, dentists, acupuncturists, and other practitioners for relief or prevention of pain and for a variety of health conditions. After reviewing the existing body of knowledge, the U.S. Food and Drug Administration removed acupuncture needles from the category of "experimental medical devices" and now regulates them just as it does other devices, such as surgical scalpels and hypodermic syringes, under good manufacturing practices and single-use standards of sterility. Over the years, the National Institutes of Health (NIH) has funded a variety of research projects on acupuncture, including studies on the mechanisms by which acupuncture may produce its effects, as well as clinical trials and other studies. There is also a considerable body of international literature on the risks and benefits of acupuncture, and the World Health Organization lists a variety of medical conditions that may benefit from the use of acupuncture.

Foot Supports/Foot Orthotics
Orthotics can be inserted into a shoe or shoes to help relieve imbalances in the body, and to help with pelvic & spinal distortion. There are prescribed styles of custom-made foot orthotics that have been scientifically designed for the unique postural problems of the individual, and that help to improve total body wellness. Orthotics help the feet maintain their structural and functional balance in standing, walking, and running.

Orthotics are intended to correct an abnormal or irregular walking pattern. Orthotics are not just "arch supports," although some people and some physicians use these terms to describe them. Foot orthotics provide support and facilitate functions that make standing, walking, and running more comfortable and efficient, by slightly altering the angles at which the foot strikes a walking or running surface. This influences the transmission of shock bearing across the foot as well as the spine and all of the joints of the lower extremities. Proper foot and ankle biomechanics contribute to normal gait (walking patterns) which in turn can help reduce the risk for abnormal mechanical strain/stress upon the knees, hips and the spine.

Foot orthotics fall into three broad categories: those that primarily attempt to change foot function, those that are primarily protective in nature, and those that combine functional control and protection. There are three primary types of orthotics with are: the rigid orthotics, the semi-rigid orthotics and the soft orthotics. In general the rigid orthotics is primary used to influence function. The semi-rigid orthotics provide dynamic balance, influence function and help absorb shock. The soft orthotics helps to absorb shock, increased balance and take pressure off of sore regions. Your physican would decide which type of orthotics is most appropriate for your condition.

Spinal Bracing/Spinal Orthosis
Spinal orthosis refers to specialized bracing of the spine. This is typically perfomed in an attempt to reduce painful movements and reduce the risk for spinal injury. Special rigid braces are also used for the care and treatment of scoliosis. The most common area for the application of spinal bracing is the low back. The risks associated with long term or chronic bracing includes spinal muscular deconditioning or weakening. The appropriate brace applied for the right period of time may promote tissue recovery without undue risk for reinjury in some cases. Spinal bracing/support may also be used for a short period of time to help an individual develop appropriated body mechanics by limiting potentially harmfull movements. Spinal bracing is used after operations for fusion (permanent joining of the bones) of some parts of the spine.

Spinal Manipulation
Joint manipulation is a method used to mobilize joint and surrounding soft (periarticular) tissues in a manner that is not possible through other means, such as joint or soft tissue mobilization. For example chiropractic physicians carefully apply specific manipulative forces, utilizing the bones as levers in order to place the desired motion into the joint and periarticular tissues. The resulting forces influence the axis of rotation and other movement patterns of restricted (hypomobile) joints. Proper joint and soft tissue motion is essential for proper alignment and healing of tissue. The absence of proper joint movement during the tissue repair process may lead to the development of more restrictive tissue, which can limit joint and soft tissue movement. Joint manipulation influences neurological input from the densely innervated joint linings and surrounding joint tissues through the peripheral and central nervous system thus influencing muscle firing patterns around the spine, autonomic function and modulating of pain thresholds. The physician makes the determination as to what joints may benefit by the use of manipulation by performing a regional examination. The examination may include diagnostic imaging and palpatory assessment of the quality of the joint play (joint movement) and of the muscle around the joint. Regions with abnormal resistive barriers to motion or joint play can often be detected. A manipulative thrust may be carefully and gently delivered to the spinal region with a resistive barrier to motion.

Spinal joint manipulation may be associated with regional and more distant physiological effects. The relationship between structure and function in the human body is a significant factor in health and disease. The relationships are highly significant because of the influence of structure and function on the nervous system control of bodily functions.

Joint manipulation is used to help promote an optimum the tissue repair process through the various stages of healing. Tissues tend to recover and remodel consistent with the stresses placed upon them during the healing process. Some movement is required for the tissues to heal strong and flexible enough to allow normal joint movement and to adequately withstand physical loads placed upon the tissue. In each stage of repair, methods are used to lessen pain, reduce extent of injury, aid in remodeling of granulation tissue, break adhesions as they develop, and most important, attempt to prevent chronic joint stiffness and /or a potential chronic pain syndrome from developing. Spinal manipulation is most effective if it is used in combination with muscle therapy, correction and maintenance of proper posture, home and in-office exercises and stretching, and proper work and home ergonomics.

There are numerous techniques available for spinal manipulation. Studies have shown that spinal joint manipulation may help reduce spinal degenerative disease and related disability. Adequate joint mobility is required to help sustain nutritional and fluid exchange in joint tissues and the intervertebral disc of the spine. This process greatly influences the health of joint cartilage. Increasing joint stiffness leads to global stiffness and accelerated degeneration of joint tissues.

Exercise Therapy
Exercise therapy refers to the implementation of exercise with a specific goal in mind. An exercise therapy program may be supervised or unsupervised. Supervised exercise is usually part of a physical rehabilitative program. Patients may be provided with simple exercises, which they can perform at home. Home exercises are often provided to help improve flexibility and restore the strength required to stabilize a joint region. Some exercises are provided to help reduce the risk for injury or re-injury. A spinal stabilization exercise program is often used to strengthen muscles around the spine to reduce excessive or abnormal joint and spinal region movement patterns.

Physical Therapy
Physical therapy often includes the application of modalities such as ultrasound, electrical stimulation, heat, cold and iontophoresis in an attempt to reduce pain and inflammation. In some cases a combination of these approaches may be used. Manual approaches such as joint mobilization or joint manipulation may be applied during the course of physical therapy. The patient may be entered into a progressive exercise program to improve flexibility, muscular strength and endurance. The patient may be referred to an outside facility for aquatic therapy.

Occupational Therapy
The primary goal of occupational therapy is to prepare the patient to return to a working environment. The therapeutic plan is generally tailored to the job responsibilities the patient will be exposed to. In this division custom bracing and splint fabrication may be performed to help reduce the risk of reinjury. Functional training (ADL) will also be performed to improve occupational skill levels the skill level. Visual perceptual assessment and training may be applied.

Work Injury Rehabilitation
Evaluation of the injured worker may require a functional capacity evaluation (FCE). The findings serve as a baseline of physical performance capacity at the workplace. If significant deficits are found a course of work conditioning/work hardening may be implemented. This involves the implementation of postural retraining and a course of specific exercises. Onsite or simulated job analysis may be recommended to help design the best therapeutic approach. An ergonomic or workplace assessment may be implemented to provide further insight into the rehabilitative requirements and to assist in the implementation of preventive measures.

Neurorehabiliation refers to a specialized rehabilitative approach, which integrates physical performance with higher more complex nervous system functions. The focus of the neurorehabilitative approach may be placed upon improvement of muscle firing patterns, gait retraining, coordination enhancement, and the improvement of reaction time and complex task performance. Neurorehabilitation may also involve cognitive exercises requiring the application of short-term memory, long-term memory, application of communication skills, decision-making and reaction based activities.

TENS (Transcutaneous Nerve Stimulation)
The TENS unit is a battery-operated portable device used for relief, control, and management of pain. Many TENS units have fully adjustable parameters include frequency, pulse duration, various modulation modes and a timer. The TENS unit is hooked up to electrodes which are adhesive and stick to the skin. They are generally placed around the region of pain. The TENS unit can be hooked onto a belt or special strap. In some cases the use of a TENS unit may take the place of pain medication or may allow for the reduction of the dosage or a change of the type of pain medication required, thus reducing the exposure to medication related side effects.

September 21, 2004


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