Zen and the Art of Chiropractic Adjustment and Healing

Science, Art, and Philosophy of Chiropractic


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What happens when my Low Back Pain makes Clicks and Clunks?

Recently this article came across the Gonstead Clinical Study Society database. The title was “Clicks and Clunks with Low Back Pain: What Do They Mean?” This article was a literature review by the International Musculoskeletal Medicine in April of 2009. Dr. Steve Tanaka D.C summarized this article review.

Summary of the article:

To review knowledge about noises arising from the joints of the back, which can be felt or heard by back pain patients or those undergoing treatment for back pain. Materials and methods: A literature search relating to the clicks and clunks that can be heard or felt by patients with back pain either with normal movement or during manipulation. The databases searched were Pubmed, Embase, TRIP, CINAHL, and Amed. The text terms click, clunk, and pop was used. In addition, experimental work was reviewed which aimed to elucidate the mechanism by which noises can be produced in synovial joints.

The Conclusion of the Review:

Most of the literature deals with the mechanisms of clicks in joints in general and in finger joints in particular. In the spine, there are many references to the ‘popping’ of facet joints in the spine as a result of manipulative therapy. Research has centered around an examination of cavitation and the formation of a gas bubble in the joint cavity when the joint surfaces are distracted. There was scant information about clicks and clunks in relationship to the presentation of back and neck pain. Studies have found no correlation between clicks and the typical electromyographic changes produced at manipulation, nor with therapeutic benefit. Conclusion: The significance of clicks and clunks in joints, whether occurring naturally or during treatment, remains uncertain.

Discussion of the Topic:

Unless something more finite comes along, most people accept the idea that a gas cavity or bubble of carbon dioxide forms. When it collapses or cavitates, a sound is produced. Some have brought up the concept of capsular ligament “snap-back.”

Many studies have been done on the metacarpophalangeal joints. Some studies have been done on the cervical spine, lumbar spine, and sacroiliac joints. Most agree that the sound comes from the zygapophyseal joints. In sacroiliac joint and lumbar manipulation studies, the sound has been found to come from the lumbar spine, and sometimes from multiple levels ( due to the use of “lumbar roll”?).

Comments from Gonstead Clinical Study Society:

“I wonder what actually accounts for the difference between a well-done Gonstead adjustment and the higher pitched sound of many manipulative treatments and less than effective Gonstead adjustment attempts? We say what we think it is—sound of adjusting through the disc, rather than the apophyseal joints.” Dr. Steve Tanaka D.C.

Clicks and Clunks With Low Back Pain

The last comment by Dr. Steve Tanaka mentions between adjusting through the disc rather than the apophyseal joints is a technical comment that most Gonstead chiropractors would understand.

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The apophyseal joints location in the spine is mainly a synovial joint that has fluid that can produce gas cavity or bubble from organic gases from carbon dioxide. Most people will hear this popping noise when there is a slight movement or a quick movement in the joint. These rapid movements with a popping noise are thought to be chiropractic adjustment.

A well-done Gonstead adjustment has a specific force with control into the person’s spine. The goal of the Gonstead adjustment is setting the spinal segment with the health of the disc in mind instead of restriction and movement.

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Cancer, Alzheimer’s and Cardiovascular Disease has a Link!

This is a research article review research paper from Clinical Science issue 2012 titled, “You may need the vagus nerve to understand the pathophysiology and to treat disease.” The research article writes about treating the vagus nerve, located in the upper neck, reduces the health risk of major diseases which are inflammatory reactions, increased oxidative stress, and excess stress responses. The vagus nerve activity can be measured by a non-invasive evaluation by Heart Rate Variability.

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High-Risk Diseases

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Frequent causes of death that are worldwide have been attributed to cardiovascular diseases, cancer, and Alzheimer’s disease. Another category that has been on the rise has been the Metabolic Syndrome. This syndrome includes risk factors of obesity, elevated blood lipids, elevated glucose, and blood pressure. All of these diseases and risk factors are manifested differently in clinical science and the screening process, complex treatments, prevention measures are expensive! This paper is attempting to suggest a screening process of pre-medical conditions before they start to have morbid diseases and health risks.

The hypothesis of this research paper is linking all the high-risk health factors have a common problem with the vagus nerve. The vagus nerve is a nerve that is extending from the brain stem down and front of the neck and travels down in most of the vital internal organs. (https://emedicine.medscape.com/article/1875813-overview#a1) This vagus nerve can be evaluated by Heart Rate Variability which is an in invasive and non-expensive assessment.

 

Hypothesis

The article proposes three hypothesis on how the vagus nerve is involved.

Hypothesis 1: Better Vagal Nerve Activity, Reduced Risk

Hypothesis 2: Vagus Nerve Keeps the Stress response and inflammation in check

Hypothesis 3: Poor Vagus Nerve Function means higher risk for a disease.

Solution: Heart Rate Variability Assessments:

Heart Rate Variability is an assessment that measures the beat-to-beat variation in heart rate. This natural rise and fall of heart rate are caused by several physiologic phenomena, including breathing and autonomic nervous system activity. Healthcare professionals utilize HRV for a wide variety of clinical applications. Previous blog (https://zenchiropractic.wordpress.com/2013/04/) has mentioned how this is a way to measure the performance of the vagus nerve.

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Health Risk Factors

There are health risk factors that lead to major diseases like the cardiovascular disease, cancer, and Alzheimer’s diseases. The following three are the major steps that lead to major diseases:

  • Oxidative Stress
  • Inflammation
  • Excessive Stress Response

For more information about these steps, scroll further down for a more detailed summary of the article.

 

Oxidative Stress

jealousy

Oxidative stress is a condition where free radicals are flowing through your bloodstream. It is an unstable molecule that can damage cells by damaging the molecular structure of the cell. A free radical is a single person showing up to couples only dance party and stealing a partner from one of the couples thus creating a chain reaction. Simple a molecule needs even-electron ions to stabilize and a free radical is uneven and desperately wants to be even. To counter this situation it always adds antioxidants which neutralize the free radical.

Oxidative stress occurs when the free radicals are overwhelming the antioxidants and leading to damaging cellular structures such as DNA. Damaging the DNA of the cell can lead to transforming them into malignant cells. Also, oxidative stress can damage LDL, which carry cholesterol and create promotion of inflammation for plaques in the arteries in the heart and lead to cardiovascular diseases. This same process can happen in the artery of the brain and that leads to stroke and damaging nerve cells in the brain.

Inflammation

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Inflammation isn’t an evil, it is a necessary process for the body to heal. It is the amount of inflammation that causes more risks. Normally inflammation is like construction or house remodeling. Your house or building is the body and all the construction and remodeling will cause an increase of dust, extra equipment in the hallways, plastics taped on the walls and carpets, and more people in the area! This will clog up the hallway or room and often involves destruction or construction of walls. Inflammation is similar to this while the immune cells are repairing damaged artery lining, kill infected or malignant cells. Inflammation serves to prevent tumor cells to grow, infected cells to take over our body, repair damaged tissue.

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Inflammation becomes a problem when there is too much inflammation or the process goes out of control.  When the inflammation process in the artery increases too much it will start to clog up and cause elevated blood pressure and a blood clot to form which leads to cardiovascular disease. When inflammation process goes out of control and the immune cells start to attack good cells; this we call auto-immune diseases and can result in degeneration of the brain called neurodegeneration.

Excessive Stress Responses

Stress responses involve the sympathetic nervous system activity to increase fight or flight response. When this stressful state stays long term, this will fatigue and exhaust your body. This stressful state involves increased blood pressure, arteries to constrict, increased blood sugar, decrease digestive and many more! (https://www.diffen.com/difference/Parasympathetic_nervous_system_vs_Sympathetic_nervous_system) This can easily explain how increased stress response can contribute to cardiovascular diseases with increased blood pressure. During an emergency stressful state, the blood is mainly flowing toward muscles for survival. Increased adrenaline and noradrenaline, increases the opportunity for the tumor cells to grow since all the immune cells activity are slowed down to emphasize the survival state.

Conclusion:

To summarize this article, the authors were pointing out that the vagus nerve activity is vital in finding out the precursors for most common diseases that cause death worldwide. To analyze the vagus nerve, Heart Rate Variability is highly recommended due to good data from other research articles.

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Higher Heart Rate Variability is Good?

Many people would state that higher variability is better health in general. So many people make treatment plans for higher variability and state that it is the key to health! However, there is a consequence of high variability.

 

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If your physiology, such as blood pressure, heart rate, skin temperatures, etc., remain in a random unrestored state, your life trajectory will come to an end. We are to have some predictable patterns and not changing so rapidly. Having “higher HRV” is a state of more random function to a degree.

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When your brain and physiological state pass the edge of complexity and sophistication into randomness, you also have caused unhealthy conditions. This state is equal to letting a monkey steer a car. Just because there is a lot of activity at the steering wheel, does not mean that it is a coordinated function. This is past sophistication and complexity. On the other hand, there is a steering wheel lock seems stable in its activity, but that does not mean it is a healthy condition for the passengers in the back seat.

The key to understanding HRV is to be leaving the ranges of randomness and before entering a rigid physiological state is Health. Health is a well-trained chauffer who steers the car with calmness and adapting to the vehicle’s path through a timeline of life.

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HRV is an objective measurement of the physiological state of adaptation to the environment. This concept is in large, very abstract and multi-variables that need consulting and help to understand your healthy state.

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References:

  1. Le Meur, Y., Pichon, A., Schaal, K., Schmitt, L., Louis, J., Gueneron, J. and Hausswirth, C. (2013). “Evidence of parasympathetic hyperactivity in functionally overreached athletes.” Med Sci Sports Exerc, 45(11), 2061-71.
  2. Sinnott, Rob 2018, D.C. LCP, FPh.C, Lecture, PowerPoint Presentation, and Notes on Adaptability, Adaptability Research Symposium, The Center for Chiropractic Progress, September 28-29,2018
  3. Shaffer, Fred and J P Ginsberg. “An Overview of Heart Rate Variability Metrics and Norms” Frontiers in public health vol. 5 258. 28 Sep. 2017, doi:10.3389/fpubh.2017.00258

 

 


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Functional Disorder of Burn Outs, Fatigue, and Depression.

“I am not as young as I used to be.”both-kids-finally-napping-and-im-like

“I just don’t have the energy anymore.”

“I can’t keep up.”

“I don’t feel like doing anything.”

 

Sounds familiar? Have family members annoyed with you because you can’t be productive or participate in activities? Some people are really trying and yet there is no energy left in the tank. No emotional motivation to make the first step or to get back up. Burnout, fatigue, and depression are symptoms that are just the tip of the iceberg.

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Symptoms are events but Health is a Process

North American’s health care is medical medicine based on symptomatic control. The signs & symptoms are indicators for medical professions to measure the outcome of each case is under control and to observe the survival of the person’s overall condition. Most people who have survived the medical condition simply assumed that their condition is stable and have no need for any further health care.

snow-ball

As we all know that health care is not an episode but a process. Assuming that after a visit to the dentist there is no need for brushing teeth is not what the dentist recommends. Our health is a process of growth and decay at a rapid pace. There are billions of chemical molecules that are being interchanged, modified, consumed, processed, and wasted as a resource for our body to maintain its brain activity.

Brain Budget

As we focus our topic to our brain, it is the most sensitive to disturbances in energy generation. The adequate supply of ATP which is a sub-unit of the organic compound for cells to utilize for energy metabolism is essential for life. For the brain, even the short-term interruption of this process can lead to long-lasting and irreversible damage(1). The large cost of energy in neural processing suggests that efficiency will be critical for an organism’s survival (2) A great majority of the energy used by the Central Nervous System (Brain and Spinal Cord) cells is for processes that subserve physiological functioning. Energy requirements may increase many-fold with increasing activity (3). Economizing our energy for the brain is essential for our health care.

survival

Your Phone is Burning You Out

The usage of electronic devices and its complexity has increased since the invention of the smartphone and many other electronic devices. Virtual reality is a full integration of the brain and getting close to a fiction movie called “Matrix.” The multitasking is an addiction that creates a dopamine-addiction feedback loop and increases stress hormone cortisol(4,5). This is the fight-or-flight hormone adrenaline, that can overstimulate your brain and cause over-expenditure of energy consumption of the brain. To have such a lifestyle with electronics, it is vital to have maximal physiological activity and not have any energy limitation. Otherwise, it can be a problem for the normal activity of the brain (3).phone-addiction

More Brain Activity=Higher Energy Costs

Most of our electronics require us to use our eyes and hands. This will include sensory and motor control for the brain to expend energy and communicate with the brain for thinking, responding, interpreting, etc for a post on a facebook page. The higher the brain activity, the higher the energy expenditure and faster the fatigue(6). The nerve in the eyes, which interpret the information on the electronic devices, can have a large impact on the energy supply (7).

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The lack of supply in energy resources from increased demands leads to many diseases. It is obvious that our brain and the nervous system are becoming maladaptive in the context of modern environment changes. As people get in fight-or-flight mode constantly and become infected or have trauma, the demands for energy resources will be diminished even more (8). A typical example of depression is a result of the brain that is exhausted in neurotransmitters to keep the brain active and productive to adapt to the stressful environment.

Conditions that Cause More Energy Expenditure

Energy expenditure is a well-known topic in neurophysiological science. When this energy expenditure is causing more problems than it should, they start to suspect Dysponesis, Dysautonomia, and Dyskinesia.

Dysponesis is a functional disorder that makes you sensitive to stress and you do not respond well. You do not adapt well, energy efficiency goes down, and you are completely unaware of this situation. “It is basically a reversible physiopathologic state composed of errors in energy expenditure that interfere with nervous system function and thus with control of organ function….. Among the numerous clinical manifestations are fatigue and exhaustion, insomnia, headache, backache, hyperventilation, anxiety and depression, “indigestion,” impotence, frigidity, and spastic colon.” (10)

Dysautonomia refers to an abnormality of the function of the autonomic nervous system. In people suffering from dysautonomia, the autonomic nervous system loses that balance, and at various times the parasympathetic or sympathetic systems inappropriately predominate. Symptoms can include frequent vague but disturbing aches and pains, faintness (or even actual fainting spells), fatigue and inertia, severe anxiety attacks, tachycardia (fast heart rate), hypotension (low blood pressure), poor exercise tolerance, gastrointestinal symptoms, sweating, dizziness, blurred vision, numbness and tingling, pain, and (quite understandably) anxiety and depression (11,12).

Dyskinesia refers to distortion or impairment of voluntary movement. Spinal segmental dyskinesis is a joint misalignment throughout the entire range of motion of the involved joint. It is well known with Parkinson’s disease of increased muscular rigidity and involuntary movements of dyskinesia increase energy requirements(13). Even if we are not diagnosed with Parkinson’s disease we can still have dyskinesia in a different form.

Knowing what kind of neurological activity that might be occurring, we will address all of these conditions and processes on how it happens, how to see the signs, and what would be the solutions in the future articles.

Brain Energy

You can not increase your brain’s capacity of how much energy you have. You can economize them, you can save them, and continue intake of nutrients to continue brain activity but you can not have more or keep your brain cells at a rapid activity at a constant rate. You will run out of resources before you know what is going on. People are commonly ignoring signs and symptoms of seemingly minor problems when there are so many things that need attention, such as your baby needs a diaper change or paying the bills.

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To Conserve and economize energy by stopping all activities is impossible for a busy lifestyle or when you have kids, work, multiple jobs, and etc. Unless you live in a timeless world that allows you to slow down or stop all activities. Trying to limit the amount of brain activity such as fasting from electronics or turning off all phones while driving will be simple things that will help to economize brain activities (16). Simpler tasks instead of multi-tasking all the time will help you from overloading your brain with too many activities. Many monasteries start with very simple tasks and meditation to help in processing, interpreting, detoxing, and rest from the busy world. We can do similar things in our daily activities of living. Keep it simple.

5-Types-Of-Meditation-Techniques-And-Their-BenefitsFiltering unnecessary brain activity will be an impossible task. In this modern age of electronics and high-speed internet, we are trying to go faster in getting information and more quantity of information. Unplugging yourself from all this information is what we do when we sleep to regenerate resources. Our brain needs to cut down activities to regenerate and restock resources for the next period of activities. Temporary shut down may be needed for high-stress individuals and constant high brain activities (17). People can take short naps or sessions to meditate and regenerate resources as you reduce the fight or flight response by slowing down to rest and digest. Slow and grow.

brain food

Intake of nutrients to continue brain activity in which most people do by taking stimulants such as coffee, eating lunch for energy resources, taking supplements to keep your brain activity to a high level. When your brain is deficient in much needed organic biochemicals for the billions of processing in a split second, this will create a problem so your body will start to take necessary chemicals from other parts of the body. Your body will start to break down muscle, fats, and carbohydrates from all over of your body to fulfill the brain’s needs (14). As the condition gets worse, people develop symptoms that result in prescribed medication. Keeping a good biochemical balance is to provide enough nutrient sources in your meals and supplements. Another way to get more chemicals for brain activity is exercise. This is well known for wellness enthusiasts because by using physical exercises we stimulate hormones and brain chemicals for more motor function stimulation. When we have more motor function stimulation of your muscles, we focus our frontal premotor cortex for muscle function and cognitive function (15). This will help counter the limbic system which causes larger stress response and unstable mood control. Eat well, move well, think well.

Conclusion:

BrainGarden

Your brain is like a garden. You need to nurture and give good nutrients to the plants. The brain producing complex abstract cognitive thought process is like the garden producing fruits and vegetables that are produced in the garden. The more you try to superficially handle it, or leave it alone, your garden will not be successful. Your brain is the same way and highly functional but vulnerable to problems and disorders.

Functional disorders may confuse people and conventional medical care might just be treating the symptoms but not the cause. High stress and continuous lifestyles stimulation from electronics are usually the stressors. Our brain will decline and degenerate from constant brain activity with no regeneration and rest. To help you allocate your brain’s activity efficiently, chiropractor or other practitioners that understand functional disorders and monitors them is essential. Healthy lifestyles are the key. Keep it simple, slow and grow, eat well, move well, and think well.

References:

  1. M Erecinska et al./Progress in Neurobiology 73 (2004) 434
  2. http://www.cnbc.cmu.edu/~gotts/thesis/gottsThesisCh1.pdf
  3. A. Ames / Brain Research Reviews 34 (2000) 62
  4. Reinecke, Leonard, et al. “Digital stress over the lifespan: The effects of communication load and internet multitasking on perceived stress and psychological health impairments in a German probability sample.” Media Psychology 20.1 (2017): 90-115.
  5. Paridon, Hiltraut M., and Marlen Kaufmann. “Multitasking in work-related situations and its relevance for occupational health and safety: Effects on performance, subjective strain and physiological parameters.” Europe’s Journal of Psychology 6.4 (2010): 110-124.
  6. Korf, Jakob., and Gramsbergen Jan B. “Timing of potential and metabolic brain energy.” Journal of Neurochemistry (2007), 103, 1697-1708
  7. Laughlin, Simon B. “Energy as a constraint on the coding and processing of sensory information.” Current Opinion in Neurobiology (2001), 11:475
  8. Yun, J Anthoney, Lee Y. Patric, Doux, D, John, Conley, R. Buford, “A general theory of evolution based on energy efficiency: its implication for diseases.” Medical Hypothesis (2006) 66, 667.
  9. https://www.webmd.com/balance/stress-management/stress-symptoms-effects_of-stress-on-the-body#2
  10. Whatmore G.B., Kohli D.R. (1979) Dysponesis: A Neurophysiologic Factor in Functional Disorders. In: Peper E., Ancoli S., Quinn M. (eds) Mind/Body Integration. Springer, Boston, MA
  11. Reichgott MJ. Clinical Evidence of Dysautonomia. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 76. Available from: https://www.ncbi.nlm.nih.gov/books/NBK400/
  12. Dysautonomia, A family of misunderstood disorders. Richard N. Fogoros, M.D., About.com Guide Updated November 13, 201q
  13. Bachmann, C. G., and Trenkwalder, C. (2006), Body weight in patients with Parkinson’s disease. Mov. Disord., 21: 1824-1830. doi:10.1002/mds.21068
  14. Gómez-Pinilla, Fernando. “Brain Foods: The Effects of Nutrients on Brain Function.” Nature reviews. Neuroscience 9.7 (2008): 568–578. PMC. Web. 3 Oct. 2018.
  15. Gomez-Pinilla, F. Zhuoang, Y., Feng Z., Ying G. Fan, “Exercises impacts brain-derived neurotrophic factor plasticity by engaging mechanisms of epigenetic regulation.” European Journal of Neuroscience. (2010) Vol. 33, 3, 383-390
  16. Brewer, Judson A. et al. “Meditation Experience Is Associated with Differences in Default Mode Network Activity and Connectivity.” Proceedings of the National Academy of Sciences of the United States of America 108.50 (2011): 20254–20259. PMC. Web. 4 Oct. 2018.


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Chronic Pain and the Brain

Written by: Brooke Preston-Chiropractic Intern at Zen Chiropractic Inc. DBA Zen Healing Center

Most of us are totally different people today than we were five years ago. Why is that? Today, we’re going to dive in and talk about a concept known as neuroplasticity.

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What is neuroplasticity?
Neuroplasticity is the idea that the brain and nervous system (neuro) can remodel(plasticity) itself to reflect the experiences we have in our daily lives(5). This means that our nervous system can learn, which is an important concept.
An example of neuroplasticity in our bodies would be our motor (voluntary muscle control and coordination) development. We definitely don’t have the same motor function as when we were babies. We’ve learned to roll over, crawl, sit, stand, walk, and even do more complex things such as type, play sports, write, and play musical instruments.

How does neuroplasticity work?
Think about a set of railroad tracks(5). You’re born with a specific set of railroad tracks. These railroad tracks get messages from Grand Central Station, which in this case refers to your brain. As you learn to do new things- whether they are physical or mental, you lay down new railroad tracks. Some of these tracks get used a lot- they’re heavily developed and polished.

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Change happens through a process called long-term potentiation or LTP or long-term depression or LTD. LTP and LTD function similar to a dimmer switch. LTP is when you’re turning up the dimmer switch and LTD is when you’re turning down the dimmer switch. The lights are still on, but in one scenario more light is shining than the other.

light-bulb-and-dimmer-switch

What is Long-Term Potentiation (LTP)?
LTP is a pathway that is being stimulated or turned on. Think of it like positive feedback. The more you get, the more you want. So the more a railroad track is used, the more you want to use it and the easier it becomes to use. You polish it, and it becomes well traveled.

Structure of a typical chemical synapse. neurotransmitter release mechanisms
You have messengers in your body called neurons that help the brain and body communicate using chemical substances called neurotransmitters. The more a pathway is stimulated, the more neurotransmitter is produced. What does this mean? Think of it in this way: the more a railroad track is used, more cargo can be transported along its path.

If you’re more economically minded, a principle similar to this is the law of supply and demand. The more a consumer (your body) uses something (a pathway) then the more of that product (the neurotransmitter) needs to be produced.

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What is Long-Term Depression (LTD)?
LTD is the result of a pathway that isn’t being stimulated and is being muted or turned off. Think of it in the sense “if you don’t use it, you lose it”. The less a railroad track is used, the harder it becomes to access that pathway. It’s still available, but not as readily available. It’s like the rickety old mineshaft railway with old abandoned carts everywhere. It could be restored to its former glory, but it’s going to take a lot of work and practice. These tracks are harder to utilize.

Neuroplasticity and pain.. is it good or bad?

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In normal development, the nervous system uses pain as a warning sign. Think about it like using a smoke alarm. Just like that alarm, pain is telling us “Something is wrong, fix it!” This is known as eudynia or “good” pain. This system is used as security against threats like injury, infection, and tumor. In some people, though, this wiring somehow gets mixed up and a system that once worked to protect the body produces long-term effects. The pain tracks are getting an increasing amount of cargo and are being utilized more often. This is known as maldynia or “bad” pain.

What are examples of conditions that may be caused by maldynia?
Some examples of dysfunctional neuroplasticity include when our bodies rewire themselves for pain like was discussed in the last point. Specific examples of conditions include limbically augmented pain syndrome, fibromyalgia, phantom pain, complex regional pain syndrome, visceral (organ) pain, headache, and postsurgical pain.

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What does this have to do with chiropractic?

Premise 1: Chronic pain and altered movement

Recent papers have shown that in patients with a history of long-term or recurring neck pain and/or stiffness, episodes of short-term pain with injury may be what induce long-term changes in the brain. Basically, the wrong train track is being laid down, and this disrupts how the brain processes sensation and carries out motor function. If this change in how your body moves is not corrected, long-term altered movement occurs and new train tracks continue to develop and be polished. These new train tracks tell the brain that this is the body’s new normal function and the short term protection that was previously discussed becomes a long-term problem.
The representations of muscles near a site of pain are altered in both the sensory and motor areas of the brain and these areas of the brain are then reorganized to show the new normal. The extent of change is correlated with the level of motor function and/or deficit.

Posture-and-Your-Brain

Premise 2: Pain changes your brain
We’ve talked a lot about train tracks in how your body learns, but it turns out that your brain, Grand Central Station, is changed by pain input as well.
One paper concluded that pain can alter activation of the neurons in brain regions associated with the central processing of pain and showed that chronic pain can actually lead to reorganization of the brain(6, 7). This was shown as a reduction in grey matter in patients with chronic low back pain(8). The grey matter is the area that houses the neurons. When we talked about neurons earlier we talked about them as messengers and they were the cargo containers. Fewer cargo containers mean less communication between the brain and body or between different areas of the brain. Unfortunately, the areas that are losing communication are those that decrease and stop pain sensation, so this actually makes the patient more sensitive to pain.

Differences in the “resting” brain have also been documented. This means that brain activity may be different in patients with chronic back pain even when the brain is not processing painful inputs. Significant impairments in memory, language skills, mental flexibility, deficits in cognitive function, and changes in decision-making have been noted in chronic back pain patients.

Chiropractic adjustments have been found to improve how the brain processes sensation and motor information

Research has shown that chiropractic adjustments in the neck can change the processing of sensation and movement within the brain. This contributes to pain relief and restoration of functional ability. The authors conclude that spinal manipulation of dysfunctional joints may modify transmission in neuronal circuits not only at a spinal level but in the brain as well. Imaging was used to draw these conclusions.
Research showed that after a single chiropractic adjustment to dysfunctional neck joints, improved sensory responses in the brain occurred in patients with recurring neck pain and stiffness. Their results indicate an improvement in discrimination and filtering of sensory information from the upper limb for at least 20 minutes after the adjustment.
In addition, the study concludes that these results are not simply due to altered input to the brain from balance, changes in muscle or changes in skin sensors as a result of the chiropractor’s touch or due to movement of the patient’s head because no changes were found after passive neck movement. This implies that results are likely specific to the delivery of the high-velocity, low-amplitude thrust of a chiropractic adjustment. (2,3,4)

(1) Boudreau SA, Farina D, Falla D. The role of motor learning and neuroplasticity in designing rehabilitation approaches for musculoskeletal pain disorders. Manual Ther, 2010:1-5. Epub ahead of print.

(2) Haavik-Taylor H, Murphy B. Cervical spine manipulation alters sensorimotor integration: a somatosensory evoked potential study. Clin Neurophysiol, 2007;118:391-402.

(3) Haavik-Taylor H, Murphy B. Altered sensorimotor integration with cervical spine manipulation. JMPT, 2008;31:115-26.

(4) Haavik-Taylor H, Murphy B. ACC-RAC Award Winning Paper. Altered central integration of dual somatosensory input after cervical spine manipulation. JMPT, 2010;33:178-88.

(5) Ray, AA. Treatment of Chronic Pain by Integrative Approaches: The American Academy of Pain Medicine Textbook on Patient Management. Springer. 2015. P52 ISBN: 978-1-4939-1820-1

(6) Strutton P, Theodorou S, Catley M, et al. Corticospinal excitability in patients with chronic low back pain. J Spinal Disord Tech, 2005;18:420-4.

(7) Tsao H, Galea M, Hodges P, et al. Driving plasticity in the motor cortex in recurrent low back pain. Eur J Pain, 2010;14:832-9.

(8) Wand BM, et al. Cortical changes in chronic low back pain: current state of the art and implications for clinical practice. Manual Therapy, 2010:1-6. Epub ahead of print.


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Nervoscope

 

Written by: Brooke Preston-Chiropractic Intern at Zen Chiropractic Inc. DBA Zen Healing Center

What is the nervoscope?EDL100_dd.jpg

The nervoscope is a thermal device that provides a comparative measure of small differences in temperature from one side of the skin of the back and paraspinal musculature to the other. Thermocouple instruments such as the nervoscope and delta T consist of two thermal sensors and a housing unit(8). When the sensors are at different temperatures, this causes a movement of the needle on the screen of the device, allowing for objective or measurable heat findings. These objective findings can be used as a part of the chiropractic exam and also reviewed at the end of the visit to show objective, numerical evidence of a change in local body temperature.

Why would this change in heat occur in our patient?
thermal-before1Thermography findings are largely accepted as resulting from changes in underlying blood vascularity(10, 11). There are two main mechanisms that are thought to cause these changes. The first being the production of inflammation and release of inflammatory mediators. Many know the signs of inflammation as swelling, heat, altered movement, redness, and pain. The chiropractor is looking for a combination of these in their exam. In this case, the heat produced by local inflammation is what is being measured by the nervoscope. The second mechanism being the cutaneous axon reflex. This reflex occurs as a result of increased activity of recurrent meningeal, or sinuvertebral, nerve. This nerve innervates the intervertebral disc(8). The intervertebral disc is a piece of fibrocartilage that helps distribute loads to the spine. Due to the cutaneous axon reflex, sweat glands and blood vessels in the skin have altered function at one single level and side of the spine which results in a temperature difference(3, 4, 7, 8, 13).

Is this test reliable?
Handheld devices, common to the chiropractic profession, have been evaluated and shown to give moderate to excellent inter-examiner reliability over short time durations(2, 12). Good intra and inter-rater reliability have been found when scanning the thoracic spine, or middle back, in studies done on the nervoscope, however, these results did not extend to the cervical spine, or neck (1).Scope-1-C7.jpg

In Plaugher’s study to determine the reliability of the practitioner in comparison to themselves and other practitioners, found fair-to-moderate reliability in one area and substantial in another(9). All of the patients in this study were asymptomatic or without symptoms. With the mechanism of heat changes described above it is reasonable to assume that with a test group of symptomatic patients there would be even greater reliability results, however, further testing needs to be done with dual probe instrument thermography to extrapolate any sort of conclusions. In this authors opinion, this particular study’s design would be the model to follow for further studies(9).

Is there controversy with the equipment?
Some have reservations about the utilization of the nervoscope and seek to discredit it, however, it is important to understand the credibility and motives of such voices. One man is Stephen Barrett. The US court system declared that “Stephen Barrett is biased and unworthy of credibility” in the NCAHF v. King case. Originally a psychologist, he was forced to give up his medical license in 1993. However, due to Barrett’s degree, people trust him whether his license was revoked or not. Barrett makes money off of posting inflammatory content tearing down anything that doesn’t match his specific beliefs to his blog, Quackwatch and the blog that he co-authors with a Doctor of Chiropractic, Samuel Homola, Chirobase. There are many websites that question the validity and motives of Dr. Stephen Barrett(5, 6).

Homola, another voice against nervoscope utilization, receives money from traffic to chirobase. Homola’s books are readily advertised on the site and the more traffic these posts get, the greater chance he has of padding his retirement fund(5). It is important to consider the financial gain these two stand to make as a potential bias and to not discount or discredit instrumentation based on the opinion of few where research encouraging its utilization is available.

References:

(1) Chang L, Abernathy M, O’Rourke D, Dittberner MK, Robinson C. The evaluation of posterior thoracic temperatures by telethermography, thermocouple, thermistor, and liquid crystal thermography. Thermocouple 1985;1:95-101

(2) DeBoer KF, Harmon RO, Chambers R, Swank L. Inter and Intraexaminer reliability study of paraspinal infrared temperature measurements in normal students. Research Forum 1985; Autumn:4-11

(3) Guyton, AC. Textbook of medical physiology. Sixth ed. Philadelphia: W.B. Saunders Co., 1981:710

(4) Hamilton BL. An overview of proposed mechanisms underlying thermal dysfunction. Thermocouple 1985: 1:81-7.

(5) https://www.chirobase.org. Web. 2018.

(6) https://www.quackwatch.org. Web. 2018.

(7) Mitchell GAG. Anatomy of the autonomic nervous system. London: E and S Livingstone Ltd, 1955:116-118.

(8) Plaugher, G. Textbook of Clinical Chiropractic. P93-97

(9) Plaugher G., Lopes M., Melch P., Cremata E., The Inter and Intraexaminer Reliability of a Paraspinal Skin Temperature Differential Instrument

(10) Plaugher G. Skin temperature assessment for neuromusculoskeletal abnormalities of the spinal column: a review of the literature. J. Manipulative Physiol Ther 1992;15:July/Aug

(11) Rademacher, WJ. A Premise for Instrumentation.

(12) Spector B., Fukuoka F, Kanner L., Thorschmidt E. Dynamic thermography: a reliability study. J Manipulative Physiol Ther 1981;4:5-10

(13) Wall PD, Devor M. Sensory afferent impulses originate from dorsal root ganglia as well as from the periphery in normal and injured rats. Pain 1983;17:321-339.

Note: This blog article is written by an intern that has a bright future in Chiropractic. She is eventually going to lead her practice in her community and hopefully the Gonstead Clinical Study Society as well.  Dr. Zen Matsuda D.C. G.C.S.S. Diplomate, C.C.W.P


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Stressed? How do we know?

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Stress is a reaction to a stimulus that disturbs our physical or mental equilibrium. This stimulus comes from various sources. How do we measure this reaction? By symptoms? Blood pressure? Pulse? Blood tests? All of which can be expensive after a while. Heart Rate Variability used to be one of the expensive tests that needed heavy electronic machines but with newer technology, this made the test more accessible. We know from research that there is all kinds of stress and states that we go through on a daily basis. By using Heart Rate Variability we can find out more about our stress and states of our physical and mental conditioning.

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In the world of wellness and longevity healthcare, the topic of heart rate variability is a focus for optimal function. Many physical fitness trainers, psychologists, acupuncturists, osteopaths, chiropractors, and more are utilizing this by analyzing stress and ability to adapt. Heart rate variability is not just monitoring the heart rate but the rhythm and intervals between each heartbeat. Each individual has a specific heart rate variability and for an assessing that norm and comparing it to daily activity and lifestyle is the best indicator of how we are adapting to our environment.

Eustress vs Distress

Eustress is a stress when an individual perceived the event or incident as beneficial to them. Motivates and focuses energy on tasks and goals. Individuals feel excited, performances improve and are within their coping abilities. Eustress is often short-term stress.

Distress is too much stress that can cause anxiety, sorrow, pain, trouble falling asleep. When you had too much eustress and overload yourself with too much can cause distress.

Eustress-and-Distress

Homeostasis and Allostasis

Homeostasis as a definition:

“….the tendency toward a relatively stable equilibrium between interdependent elements, especially as maintained by physiological processes.”

Homeostasis sounds like a complicated word in the medical word but it is simply putting it as all body chemical process is in balance and harmony to regulate and adapt to the environment.  Homeostasis is a situation where we have established during our healthy and vibrant time in our body. To establish homeostasis can be difficult or simple depending on your health condition. To measure homeostasis has been typically by measuring several parameters of blood laboratory tests, neurological examinations, and cardiovascular measurements.

Allostasis as a definition:

“…the process by which the body responds to stressors in order to regain homeostasis.”

When there is a environmental stress is introduced to a human, the body responds by regaining homeostasis. This is the adaptive component of our body to self-regulate and adapt to the stimulant. The signs of allostasis in our body are when stress hormones, cytokines, and catecholamines are present. When these stressors are constantly stimulating us for a long time, then our ability to adapt starts to fail. This is called allostatic load.

allostasis

Stressors are anything that challenges homeostasis and constantly disrupt the process of homeostasis will indicate a stress load. Maintaining homeostasis efficiently will help us have better health, better performances, and better resilience to our environment. Our goal is to maintain this stable environment for the body. Usually, unfamiliar stress causes greater stress response because this process requires greater resources to overcome stress and more recovery time.

When stress is accumulated over time, this becomes the allostatic load. When the allostatic load is too much, the ability to tolerate the load decreases. The wear and tear of the body experience repeated cycles of inefficient regulation of the stress response. Poor performance and increased recovery time will eventually lead to chronic diseases, a higher rate of injury, and higher susceptibility to illness.

Heart Rate Variability

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It is not just a heart rate but it is the inner-beat variability between successive heart contractions. In each heartbeat, there is an electronic signal that is produced and measured by the ECG/EKG representing the ventricular depolarization during a heart contraction. It is called the QRS complex. With the Heart Rate Variability, we are measuring the interval between RR. This is called the RR intervals or inter-beat intervals (IBI). By measuring Heart Rate Variability, we are measuring the change in time or variability between successive heartbeats.

Why is there a variability?

The variability in the heart rate is the result of the allostatic (adaptive) processes of the bodies response to stimulus and other regulatory processes within the body. Having variability is beneficial for the biological system that is complex like our body. There are many regulatory systems that regulate and affect the heart. In the short-term, there is the respiratory system, cardiovascular system, and autonomic nervous system. For long-term, there is circadian rhythm, body temperature, hormonal patterns, cumulative stressors.

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Clinical Indicators of Health!

When we have reduced health, we have decreased adaptability. Which means heart rate variability can significantly decline with decreased health. Changes in Heart Rate Variability have been correlated to 9 out of 10 leading causes of death in the United States.

  • Heart Diseases
  • Cancer
  • Chronic lower respiratory diseases
  • Stroke (Cerebrovascular diseases)
  • Alzheimer’s diseases
  • Diabetes
  • Influenza and Pneumonia
  • Nephritis, nephrotic syndrome & nephrosis
  • Intentional self-harm (suicide)

Heart Rate Variability is also linked to many of the risk factors associated with these diseases such as hypertension, obesity, glucose intolerance, insulin sensitivity, and stress. It is also known for an accurate and objective monitor for progression or regression of the disease and health.

Presnological Assessments

Heart Rate Variability is not a diagnosis of diseases listed above.  It is a prenosological assessment that determines that direction of our health is going towards. Prenosological is the determination of potentiality for the failure of the adaptive state. This determination is before the advent of the disease states or symptoms will occur. There are levels of adaptive states in the prenosological assessments.

  1. Proper Adaptive Function
    1. Optimal adaptability of the stressor, and therefore health exists-Not Diagnosable
  2. Prenosological State
    1. Tension on the ability for adaptive response via stressors-Not Diagnosable
  3. Premorbid State
    1. Subpar adaptation begins to occur, possible symptoms-Not Diagnosable
  4. Pathological State
    1. Adaptive failure-Improving diagnostic certainty

There was a large study that assessed the prenosological state of various individuals. With the first proper adaptive functional state was 30% of the public. People with tension on the adaptive system and subpar adaptation together were 40-70% of the population. For the final state of adaptive failure and pathological state were 10-30%. This means there are between 70-90% of individuals that have undiagnosable states of adaptability. (Baevskii, R.M. et al. “Use of principles of prenosological diagnosis for assessing the functional state of the body under stress conditions as exemplified by bus drivers.” Human Physiology 35.1 (2009):34-42. These researchers concluded that people that are in the tension or subpar adaptive states need assessment of the level of health rather than the diagnosis of diseases.

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Conclusion:

Many conditions may need a medical diagnosis because the person may have progressed their condition beyond adaptive capabilities. Stress is something elusive and people may think they need a medical assessment with blood tests and MRI taken to confirm local or physical manifestation of ill health. Sometimes it is a condition where we need to boost the persons’ adaptive capability and they will do fine. Having an HRV analysis helps us to find out what is our pre-medical condition. HRV is one of them and there are many others that are known. Stay tuned for more presnological assessment for functional and adaptive capabilities!