Non-Surgical Therapeutic Approaches
(Chiropractic Services Summaries)
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 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.
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.
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 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.
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.
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.