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Posted on July 1, 2020 at 9:45 PM

I hope you all are staying safe and healthy! Get ready, this is a long one, and I ask that you read the entire document - I will need for you to print it out, sign the bottom and bring it to your appointment.

On July 1, 2020, the New Mexico Governor Lujan-Grisham extended the executive order 2020-004 order until July 15, 2020.

What does that mean for my upcoming appointment?

The restrictions set forth by the Public Health Order issued March 27, 2020 which affect the health care services and procedures I am able to provide have been reinstated.

What restrictions are those?

Health care facilities, ambulatory surgical facilities, dental, orthodontic and endodontic offices in the State of New Mexico are prohibited from providing nonessential health care services, procedures, and surgeries.

Non-essential health care services, procedures, and surgeries include those which can be delayed for three (3) months without undue risk to the patient's health. Examples of criteria to consider in distinguishing between essential and nonessential actions include:

a. Threat to a patient's life

b. Threat of permanent dysfunction of an extremity, including teeth, jaws, and eyes

c. Risk of metastasis or progression of staging

d. Prenatal and postnatal care

e. Any other factors that will conserve medical resources without creating an undue risk of permanent harm to patients.


This Order's prohibition on non-essential health care services, procedures, and surgeries is not meant to apply to:

1. The provision of emergency medical care or any actions necessary to provide treatment to patients with emergency or urgent medical needs

2. Any surgery or treatment that if not performed would result in a serious condition of a patient worsening


What does that mean for me?

You warrant care in my facility and need to keep your scheduled appointment, if you meet any of the following criteria:

• Pain Level is 6 or more on the 0-10 pain scale - see The PAIN Scale in the blog post below.

• You perform Fukada's Test (the MONSTER MARCH) for 60 seconds and you: move forward more than 1 foot, and/or step to either side more than 6 inches, and/or turn either direction more than 10 degrees, and/or you move backwards more than 6 inches.

• You are having or have had seizures since your last visit.

• You are having or have had facial or extremity twitching or paralysis since your last visit.

• You are having or have had a decline in your cognitive functioning since your last visit.

• You are having or have had debilitating migraines since your last visit.

• You are having or have had any of your joints slip out/dislocate, and/or lock up/freeze since your last visit.

• You are having or have had any extremity burning, numbness, tingling or altered sensation since your last visit.

• You are having or have had any extremity weakness since your last visit.

• You are having or have had any uncontrollable tremors or shaking of your head and/or extremities since your last visit.

• You are having difficulty performing your regular activities of daily living.


If you do not meet any of the above stated criteria, then I need to reschedule your appointment for after July 15, 2020.


I take the health of each of my patients VERY SERIOUSLY and want to protect each of you the best that I can. It is my hopes you will be respectful and help protect the health of other patients, as well as my health, so I may continue to protect yours. During the COVID-19 crisis, there will be some changes to your office visit experience. In order to be open and remain open, while following the New Mexico Department of Health guidelines and restrictions, I must implement the following which are NON-NEGOTIABLE. If you feel you cannot abide by the following guidelines, I respectfully ask that you do not come in to the office at this time.


1. Only one patient will be allowed in the office at any given time.

a. If families or spouses come with the person being treated, they must remain in the vehicle during the treatment session.

b. If multiple family members are being treated on the same day, the persons not being treated must remain in the vehicle until they are given the clear to come in for their treatment session OR sit in the office with a face mask/covering on the entire time they are waiting their turn.


2. Please look at the door prior to coming in for your treatment.

a. If there is a RED Do Not Enter sign, please do not come in the office - either there is already a patient in the office being treated or the office is being decontaminated from the previous patient.

b. If there is a GREEN Safe to Enter sign, the office has been vacated by the previous patient and the office has been decontaminated.


3. When you come for your appointment, please leave any bags, purses or personal items which you will not need for your appointment in your vehicle.


4. Please have a face mask/covering on BEFORE you come into the office.

a. Face mask/covering must be worn at all times.

b. Face mask/covering must cover your nose AND mouth at all times.

c. Halloween and/or tribal masks/coverings are not considered appropriate at this time.


5. Upon entering the office:

a. Please stand by the door until I am able to take your temperature. If your temperature is at or above 99.5° F, you will be asked to leave the office immediately and call the New Mexico Department of Health for follow up for COVID-19 testing.

b. If your temperature is below 99.5° F, you are to remove your shoes – if you do not have socks on, please inform me and I will provide you with a pair.

* It is preferable you wear your own socks to your appointments.

* It is preferable that you not wear shorts or short skirts to your appointments.


6. Once in the office, go to the Restroom and place your keys, cell phone, and wallet on the designated black counter top by the sink.


7. Remove your shirt.




9. Put on the long sleeved T-shirt provided.


10. Put your face mask/covering back on if you removed it while in the bathroom.


11. When treatment is completed, remove the provided long sleeved T-shirt and socks, along with any towels you may have used, and place them in the laundry bin.


12. If you use the toilet at any time during your time in the office – WASH YOUR HANDS WITH SOAP AND WATER AFTERWARDS.

Please wash your hands PRIOR TO helping yourself to cookies, coffee or tea, AND use the disinfecting wipes to wipe down any containers, knobs, tea machine, and/or refrigerator door surface you may have touched.


I respectfully request that you delay making or reschedule your appointment if you or anyone you have come in close contact with currently meets or within the past 14 day has met any of the following:


• Has common cold or flu-like symptoms OF ANY TYPE - runny or stuffy nose, loss of smell, sneezing, chest congestion, sore throat, loss of taste, cough, fever, shaking chills, nausea, vomiting, or diarrhea. DO NOT MISTAKE THESE SYMPTOMS FOR ALLERGIES, IF YOU HAVE TAKEN AN ALLERGY MEDICATION AND STILL HAVE THE SYMPTOMS IT IS CONSIDERED A COLD OR FLU.


• Has been in person-to-person contact with someone with common cold or flu-like symptoms OF ANY TYPE


• Has been in person-to-person contact with someone who works around someone with common cold or flu-like symptoms OF ANY TYPE


• Has been diagnosed with Covid-19


• Has been in person-to-person contact with someone diagnosed with Covid-19


• Has been in person-to-person contact with someone who works around someone diagnosed with Covid-19


• Has travelled to high risk areas of COVID-19 (any area – village, town, city, county, state, country – with more than 5 confirmed cases), and/or they did not wear protective face mask/covering while in public, and/or did not practice appropriate social distancing while in public, and/or did not self-quarantine for 14 days after any of the aforementioned


• Has been in person-to-person contact with someone who has travelled to high risk areas of COVID-19 (any area – village, town, city, county, state, country – with 5 or more confirmed cases), and/or they did not wear protective face mask/covering while in public, and/or did not practice appropriate social distancing while in public, and/or did not self-quarantine for 14 days after any of the aforementioned





NOTE: Santa Fe and the surrounding counties are all high risk areas at this time.

For your safety:

• I will be wearing a face mask and scrub cap while you are in the office;


• I will wear protective glasses while you are face up on the treatment tables;


• I will be changing all linens after each patient;


• I will spray down and wipe all surfaces with a combination of ODO-BAN disinfectant (EPA-registered) and hydrogen peroxide, and 95% isopropyl alcohol – using a fresh cloth each time and on each different surface;


• I will be using UVC and Ozone Lights in each room after each treatment;

• I will be changing my scrubs, scrub hat, protective glasses, and face mask after each decontamination procedure from the previous patient;

• As always, I will be continuously cleaning my hands and arms with disinfecting wipes and isopropyl alcohol during treatment and using chlorhexidine gluconate solution when I wash up between patients and decontamination procedures.

• The office now has a state-of-the-art air purifier in each room which filters and cleans the air of ultrafine particulate matter down to the size of .03 microns. (The average size of the corona virus particle is 0.120 microns).

Thank you for taking the time to read through this entire message. It is my hopes you will be honest and respectful of the new office guidelines - I do not enjoy having to call the New Mexico Department of Health to report people who have put me at risk, nor do I enjoy having to be constantly tested for COVID-19 and having to shut down for 14 days after someone violates the guidelines and lied about it in order to come in.

Please let me know if you have any questions or concerns. I look forward to continuing to assisting you with your healthcare needs.

Yours for better health,

Dr. P. Nadine Gonzales – Dr.G



PS - Some may have lost their jobs and/or their health insurance because of the COVID-19 crisis. Please call Medicaid at 855-637-6574 to see if you qualify for coverage. If you do not qualify for Medicaid, you can apply for discounted premium health insurance at or call 833-862-3935. Note that I am treating established cash patients and established patients who now qualify for Medicaid PRO BONO until July 31, 2020.



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PATIENT SIGNATURE                                                                   DATE


The PAIN Scale

Posted on July 1, 2020 at 9:30 PM



0 – Pain free.


Mild Pain - Nagging, annoying, but doesn’t really interfere with daily living activities. (1-3 Pain Level)

1 – Pain is very mild, barely noticeable. Most of the time you don’t think about it.

2 – Minor pain. Annoying and may have occasional stronger twinges.

3 – Pain is noticeable and distracting, however, you can get used to it and adapt.


Moderate Pain - Interferes significantly with daily living activities. (4-6 Pain Level)

4 – Moderate pain. If you are deeply involved in an activity, it can be ignored for a period of time, but is still distracting.

5 – Moderately strong pain. It can’t be ignored for more than a few minutes, but with effort you still can manage to work or participate in some social activities.

6 – Moderately strong pain that interferes with normal daily activities. Difficulty concentrating.


Severe Pain - Disabling; unable to perform daily living activities. (7-10 Pain Level)

7 – Severe pain that dominates your senses and significantly limits your ability to perform normal daily activities or maintain social relationships. Interferes with sleep.

8 – Intense pain. Physical activity is severely limited. Conversing requires great effort.

9 – Excruciating pain. Unable to converse. Crying out and/or moaning uncontrollably.

10 – Unspeakable pain. Bedridden and possibly delirious. Very few people will ever experience this level of pain.


When rating their pain, the most common mistake people make is overstating their pain level. That generally happens one of two ways:

Saying your pain is any number greater than 10 on a scale of 0 to 10.  While you may simply be trying to convey the severity of your pain, what your doctor hears is that you are given to exaggeration and he will not take you seriously.

Smiling and conversing with your doctor, then saying that your pain level is a 10.  If you are able to carry on a normal conversation, your pain is not a 10 - nor is it even a 9.

Consider the fact that natural childbirth (no epidural or medication) is generally thought to be an 8 on the pain scale. Just as with the first example, your doctor will think you are exaggerating your pain and it is probably not nearly as bad as you say.


Chiropractic Lowers Blood Pressure

Posted on December 1, 2014 at 8:25 PM

Chiropractic Lowers Blood Pressure


Study Finds Special 'Atlas Adjustment' Lowers Blood Pressure


By Daniel J. DeNoon

WebMD Medical News

Reviewed by Louise Chang, MD


March 16, 2007 -- A special chiropractic adjustment can significantly lower high blood pressure, a placebo-controlled study suggests.


"This procedure has the effect of not one, but two blood-pressure medications given in combination," study leader George Bakris, MD, tells WebMD. "And it seems to be adverse-event free. We saw no side effects and no problems," adds Bakris, director of the University of Chicago hypertension center.


Eight weeks after undergoing the procedure, 25 patients with early-stage high blood pressure had significantly lower blood pressure than 25 similar patients who underwent a sham chiropractic adjustment. Because patients can't feel the technique, they were unable to tell which group they were in.


X-rays showed that the procedure realigned the Atlas vertebra -- the doughnut-like bone at the very top of the spine -- with the spine in the treated patients, but not in the sham-treated patients.


Compared to the sham-treated patients, those who got the real procedure saw an average 14 mm Hg greater drop in systolic blood pressure (the top number in a blood pressure count), and an average 8 mm Hg greater drop in diastolic blood pressure (the bottom blood pressure number).


None of the patients took blood pressure medicine during the eight-week study.


"When the statistician brought me the data, I actually didn't believe it. It was way too good to be true," Bakris says. "The statistician said, 'I don't even believe it.' But we checked for everything, and there it was."


Bakris and colleagues report their findings in the advance online issue of the Journal of Human Hypertension.


Atlas Adjustment and Hypertension

The procedure calls for adjustment of the C-1 vertebra. It's called the Atlas vertebra because it holds up the head, just as the titan Atlas holds up the world in Greek mythology.


Marshall Dickholtz Sr., DC, of the Chiropractic Health Center, in Chicago, is the 84-year-old chiropractor who performed all the procedures in the study. He calls the Atlas vertebra "the fuse box to the body."


"At the base of the brain are two centers that control all the muscles of the body. If you pinch the base of the brain -- if the Atlas gets locked in a position as little as a half a millimeter out of line -- it doesn't cause any pain but it upsets these centers," Dickholtz tells WebMD.


The subtle adjustment is practiced by the very small subgroup of chiropractors certified in National Upper Cervical Chiropractic (NUCCA) techniques. The procedure employs precise measurements to determine a patient's Atlas vertebra alignment. If realignment is deemed necessary, the chiropractor uses his or her hands to gently manipulate the vertebra.


"We are not doctors. We are spinal engineers," Dickholtz says. "We use mathematics, geometry, and physics to learn how to slide everything back into place."


What does this have to do with high blood pressure?

Bakris notes that some researchers have suggested that injury to the Atlas vertebra can affect blood flow in the arteries at the base of the skull. Dickholtz thinks the misaligned Atlas triggers release of signals that make the arteries contract. Whether the procedure actually fixes such injuries is unknown, Bakris says.


Bakris began the study after a fellow doctor told him that something strange was happening in his family practice. The doctor had been sending some of his patients to a chiropractor. Some of these patients had high blood pressure.


Yet after seeing the chiropractor, the patients' blood pressure had normalized -- and a few of them were able to stop taking their blood pressure medications.


So Bakris, then at Rush University, designed the pilot study with 50 patients. He's now organizing a much bigger clinical trial.


"Is it going to be for everybody with high blood pressure? No," Bakris says. "We clearly need to identify those who can benefit. It is pretty clear that some kind of head or neck trauma early in life is related to this. This is really a work in progress. It is certainly in the early stages of research."


Dickholtz has been teaching, practicing, and studying the NUCCA technique for 50 years. He says high blood pressure is far from the only thing an Atlas misalignment causes.


"On the other hand, if people have high blood pressure, there is a tremendous possibility they need an Atlas adjustment," he says.


The article is found on


Benefits of Eating Fruit

Posted on December 1, 2014 at 8:20 PM



It's a bit long but very informative



We all think eating fruits means just buying fruits, cutting it and just popping it into our mouths. It's not as easy as you think. It's important to know how and when to eat.



What is the correct way of eating fruits?






If you eat fruit like that, it will play a major role to detoxify your system, supplying you with a great deal of energy for weight loss and other life activities.



FRUIT IS THE MOST IMPORTANT FOOD. Let's say you eat two slices of bread and then a slice of fruit. The slice of fruit is ready to go straight through the stomach into the intestines, but it is prevented from doing so.



In the meantime the whole meal rots and ferments and turns to acid. The minute the fruit comes into contact with the food in the stomach and digestive juices, the entire mass of food begins to spoil.



So please eat your fruits on an empty stomach or before your meals! You have heard people complaining - every time I eat watermelon I burp, when I eat durian my stomach bloats up, when I eat a banana I feel like running to the toilet etc - actually all this will not arise if you eat the fruit on an empty stomach. The fruit mixes with the putrefying other food and produces gas and hence you will bloat!



Graying hair, balding, nervous outburst, and dark circles under the eyes all these will not happen if you take fruits on an empty stomach.



There is no such thing as some fruits, like orange and lemon are acidic, because all fruits become alkaline in our body, according to Dr. Herbert Shelton who did research on this matter. If you have mastered the correct way of eating fruits, you have the Secret of beauty, longevity, health, energy, happiness and normal weight.



When you need to drink fruit juice - drink only fresh fruit juice, NOT from the cans. Don't even drink juice that has been heated up. Don't eat cooked fruits because you don't get the nutrients at all. You only get to taste. Cooking destroys all the vitamins.



But eating a whole fruit is better than drinking the juice. If you should drink the juice, drink it mouthful by mouthful slowly, because you must let it mix with your saliva before swallowing it. You can go on a 3-day fruit fast to cleanse your body. Just eat fruits and drink fruit juice throughout the 3 days and you will be surprised when your friends tell you how radiant you look!



KIWI: Tiny but mighty. This is a good source of potassium, magnesium, vitamin E & fiber. Its vitamin C content is twice that of an orange.


APPLE: An apple a day keeps the doctor away? Although an apple has a low vitamin C content, it has antioxidants & flavonoids which enhances the activity of vitamin C thereby helping to lower the risks of colon cancer, heart attack & stroke.

STRAWBERRY: Protective Fruit. Strawberries have the highest total antioxidant power among major fruits & protect the body from cancer-causing, blood vessel-clogging free radicals.


ORANGE : Sweetest medicine. Taking 2-4 oranges a day may help keep colds away, lower cholesterol, prevent & dissolve kidney stones as well as lessens the risk of colon cancer.


WATERMELON: Coolest thirst quencher. Composed of 92% water, it is also packed with a giant dose of glutathione, which helps boost our immune system. They are also a key source of lycopene - the cancer fighting oxidant. Other nutrients found in watermelon are vitamin C & Potassium.


GUAVA & PAPAYA: Top awards for vitamin C. They are the clear winners for their high vitamin C content. Guava is also rich in fiber, which helps prevent constipation. Papaya is rich in carotene; this is good for your eyes.



Drinking Cold water after a meal = Cancer! Can u believe this?? For those who like to drink cold water, this article is applicable to you.. It is nice to have a cup of cold drink after a meal. However, the cold water will solidify the oily stuff that you have just consumed. It will slow down the digestion. Once this 'sludge' reacts with the acid, it will break down and be absorbed by the intestine faster than the solid food. It will line the intestine. Very soon, this will turn into fats and lead to cancer. It is best to drink hot soup or warm water after a meal.



A serious note about heart attacks HEART ATTACK PROCEDURE': (THIS IS NOT A JOKE!) Women should know that not every heart attack symptom is going to be the left arm hurting. Be aware of intense pain in the jaw line. You may never have the first chest pain during the course of a heart attack . Nausea and intense sweating are also common symptoms. Sixty percent of people who have a heart attack while they are asleep do not wake up. Pain in the jaw can wake you from a sound sleep. Let's be careful and be aware. The more we know the better chance we could survive...



A cardiologist says if everyone who gets this mail sends it to 10 people, you can be sure that we'll save at least one life.



Read this...It could save your life!!



Epsom Salt Bath Directions

Posted on December 1, 2014 at 8:20 PM

Epsom Salt Bath Directions:


Epsom Salt comes in 4-pound containers or packages.


Place 2 pounds (yes, pounds) of Epsom Salt in a comfortable hot bath.


2 pounds is necessary to start changing the skin’s chemistry. The temperature of a healing bath should only be about 2 degrees warmer than the temperature of your body. Test the bath water from the tub, not from the faucet, as the Epsom Salt changes the boiling point of water and the tub water will actually be hotter than the water coming from the faucet. DO NOT BURN YOURSELF!!!


Before you sit in the bath, make sure all of the salt crystals have dissolved; failure to do so may cause a skin irritation from sitting on the salt crystal.


You are going to soak in the Epsom Salt Bath for 10 minutes, changing positions if needed to soak the different body parts.


After 10 minutes, get out of the tub to urinate –

Hot bath water causes the skin to eliminate instead of absorb, therefore the minerals of the salt cannot be absorbed into the body; instead they are eliminated. Even if you do not have the urge to urinate, do the best you can to get out the concentrated toxins your blood has picked up and filtered through your kidneys so as to keep the toxins from being reabsorbed into your body. It may help to drink 1 or 2 cups of water prior to soaking in the Epsom Salt Bath.  

Get back into the Epsom Salt Bath for another 10 minutes, again changing positions if needed to soak the different body parts –

You should feel like “Jell-o” towards the end of your soak, if you do not, make sure to soak in an Epsom Salt Bath every night until you get the “Jell-o” feeling. (A “Jell-o” feeling is an extremely relaxed feeling of your muscles)



To prevent skin irritations:  

Make sure your bathtub is clean and the entire product you used to clean it is completely rinsed off of the tub’s surface.

Make sure the salt crystals are completely dissolved prior to sitting in the bathtub.



Why does Epsom Salt work where regular salt does not?

Epsom Salt is a pure mineral compound (magnesium sulfate) in crystal form that gently exfoliates skin and smoothes rough patches. Mixed with your favorite deep conditioner, Epsom Salt helps to add body to hair. Dissolved in a bath, Epsom Salt is absorbed through the skin to replenish the body's levels of magnesium and the sulfates flush out toxins from the body, thus improving the absorption of nutrients.


Studies indicate this may help to relieve stress in a number of ways, including:

• Raising the body's level of serotonin (a mood-elevating chemical within the brain that creates a feeling of well-being and relaxation), which eases stress and improves sleep and concentration.

• Offsetting excess levels of adrenaline generated by pressure and stress; magnesium ions relax and reduce irritability by lowering the affects of adrenaline.

• Helping to regulate the electrical functions that spark through miles of nerves, thus aiding with the functioning of the Nervous System – helping muscles and nerves function properly.

• Lowering blood pressure, decreasing fluid retention and helping to prevent artery hardening and blood clots.

• Aids with the production of endorphins and enkephalins, which reduce inflammation to relieve pain, muscle cramps, and prevent or ease migraine headaches.

• Aids with increasing the body’s oxygen use and metabolism, including stimulating the secretions of the intestinal tract and the liver, aiding in digestion.

• Aids with normalizing the endocrine glands and other glandular functions, which help to strengthen your immune system, make insulin levels more effective, and regulate the activity of 325+ enzymes in the body.

• Has a therapeutic effect on skin - soften skin, exfoliates, promotes the healing of wounds and other skin injuries, slows skin aging.


Researchers have found that magnesium also increases energy and stamina by encouraging the production of ATP (adenosine triphosphate), the energy packets made in the cells. Also, sulfates help form joint proteins, brain tissue and mucin proteins. Experts recommend soaking with Epsom Salt at least three times a week to look better, feel better and have more energy.


Studies show these benefits from the major components of Epsom Salt may:



• Ease stress and improves sleep and concentration

• Help muscles and nerves function properly

• Calms the nervous system

• Regulate activity of 325+ enzymes

• Help prevent artery hardening and blood clots

• Lower Blood Pressure

• Decreases fluid retention

• Make insulin more effective

• Reduce inflammation to relieve pain and muscle cramps

• Improve oxygen use

• Slows skin aging

• Create a happy, relaxed feeling

• Raise energy levels



• Therapeutic effects on skin - Soften skin, exfoliates, promotes the healing of wounds and other skin injuries.

• Affect the cellular proteins of the brain, joints and mucin, thus affecting the basic functioning of all cellular activity.


Hot Baths

• Increases hydrostatic pressure on the body, thus increasing blood circulation and cell oxygenation. The increase in blood flow also helps dissolve and eliminate toxins from the body.

• Increases the flow of oxygen-rich blood throughout the body, bringing improved nourishment to vital organs and tissues.


To purchase Epsom Salt in bulk:

1) go to - you can purchase a 50 lb bag for about $45 which makes it about $0.89 per pound. They sometimes have specials which will be much cheaper.

2) go to Sam's Club or Wal-Mart.  They now offers 8 pound bags of Epsom Salt for about $3.50 - $4.00 which is $0.44 - $0.50 per pound.

3) go to any grocery, pharmacy or stores with pharmacies (K-mart, Target, SavOn), however you will be paying up to $1.94 per pound









Intersegmental Traction (a.k.a. Spinalator)

Posted on December 1, 2014 at 8:15 PM

Intersegmental Traction (a.k.a. Spinalator)


Intersegmental Traction is a specialized procedure designed to give passive exercise to the 110 articulations or joints associated with your spine. Your normal daily activities provide "active exercise", however, "passive exercise" must be produced by an outside source. If properly done, passive exercise provides your spine with natural nutrients, circulation, and mobility that can be accomplished in no other way. Spinal injuries cause the joints of the spine to lock up and lose their ability to bend and twist normally. This loss of mobility causes the disc to lose its nutritional supply and further hinders its function, pliability and flexibility. This loss leads to degeneration of the motor units and attracts unwanted calcium which causes arthritis of the joints. This loss of youthful flexibility has been termed by lay people as an "aging spine turned to cement as it heals."


Intersegmental Traction used in conjunction with Chiropractic care loosens the locked up joints and gives passive motion exercise and therapy which feed the discs between the vertebrae. This helps to return flexibility, elasticity, and preservation to that all important disc space which protects the opening for the spinal nerve.


The feeling of the intersegmental traction has been described by patients as the "magic fingers" approach to back care. Its ability to "iron out" a crooked spine with its soothing way of stretching the yellow elastic fibers is amazing physicians and therapists with positive results wherever it is used.



Nerve Root Levels & The Body Part Affected

Posted on December 1, 2014 at 8:15 PM

There are 31 pairs of nerve roots which stem out from your spinal cord to the different organs and tissues of the body. The area of the spinal column from which they exit is called the intervertebral foramina. When the segments of the spine are out of alignment or “subluxated”, the spacing of the intervertebral foramina is decreased and thus places pressure on the nerve roots. When this happens, the specific nerve root(s) being affected will cause specific organs and tissues of the body to malfunction, as they are unable to receive the full functioning information from the brain. The continued pressure on the nerve roots and lack of information from the brain will cause the organs and tissues to malfunction, which in turn contributes to if not creates the many ailments and illnesses you may be feeling. It is also important to note that you have the vertebral artery running through the transverse processes of the cervical vertebra. Subluxations in the neck are not only pinching on the nerve roots, but decreasing the flow of blood to your brain – think about that one for a while.


Below is a breakdown of the nerve roots and the areas of the body they specifically affect. The nervous system is complex. Only the most significant relationships are shown below. Many organs and tissues have multiple nerve supplies. As the brain and spinal cord are a homologous system, meaning it is one system, there are times when certain areas of the body may have an issue and it is not related to the specific nerve root, but a malfunctioning of the nervous system as a whole – that is why when I treat you, I check you from head to toe, not just the areas you may have a complaint about. Most of you know that you may not always have a complaint/issue when you come in for your scheduled follow-ups. This has to do with the cellular activation and action potentials in your nerve cells. As you get healthier and do your home stretching and strengthening, the less frequent you have to come in.


Cervical Plexus (C1 thru C4)

C1 – brain, ears, eyes, pituitary gland (hormone function, stress hormones), scalp,

C2 – ears, eyes, head, heart, tongue

C3 – diaphragm, ears, face, neck, shoulder

C4 – chest, diaphragm, face, neck

Brachial Plexus (C5 thru T1)

C5 – upper arms, diaphragm, neck, shoulders, vocal cords

C6 – arms, shoulders, tonsils

C7 – arms, hands, shoulders, thyroid, wrists

C8 – arms, elbows, hands, shoulders, wrists

T1 – elbows, esophagus, hands, head, heart, neck, thyroid, trachea

Sympathetic Ganglia (T1 thru T12)

T1 – elbows, esophagus, hands, head, heart, neck, thyroid, trachea

T2 – upper arms, head, heart, lungs, neck

T3 – upper arms, chest, head, heart, lungs, neck

T4 – upper arms, gall bladder, head, heart, lungs, neck

T5 – upper arms, blood circulation, esophagus, head, heart, liver, neck

T6 – middle back, duodenum, esophagus, pancreas, spleen, stomach

T7 – middle back, duodenum, gall bladder, liver, pancreas, spleen, stomach

T8 – adrenal glands, middle back, gall bladder, liver, pancreas, spleen, stomach

T9 – adrenal glands, gall bladder, liver, pancreas, reproductive organs, small intestine, spleen, stomach

T10 – appendix, large intestine, legs, pancreas, reproductive organs, small intestine, spleen, stomach

T11 – adrenal glands, bladder, ileocecal valve, kidneys, large intestine, legs, reproductive organs, small intestine

T12 – upper and lower back, bladder, ileocecal valve, kidneys, large intestine, legs, reproductive organs, small intestine

Lumbar Plexus (L1 thru L5)

L1 – abdomen, bladder, feet, large intestine, legs, reproductive organs

L2 – abdomen, appendix, bladder, feet, large intestine, legs, reproductive organs

L3 – bladder, feet, large intestine, legs, prostate (in men), reproductive organs

L4 – buttocks, feet, legs, muscles of the lower back, prostate (in men)

L5 – buttocks, feet, legs, prostate (in men), toes

Sacral Plexus (S1 thru S5)

S1 – bladder, buttocks, feet, legs, prostate (in men)

S2 – bladder, buttocks, legs, prostate (in men), reproductive organs

S3 – bladder, buttocks, legs, prostate (in men), reproductive organs

S4 – anus, reproductive organs

S5 – anus, rectum

Coccygeal Plexus - anus, rectum


Posture Towel Stretch

Posted on December 1, 2014 at 8:10 PM


Posture Towel Stretch

For the posture towel stretch:

1. Take 3 towels - a regular bath towel should suffice and old ones are preferable, as you can use duct tape to keep the towels in rolled up.

2. Roll each towel to be between 4 and 6 inches in diameter (as you will be using the towels on a regular basis, use old towels and use duct tape to hold their shape). The length of the rolled towel which will be used vertically up your back should be from the middle of your neck to just below your waist/hips (the length of your spine). The length of the rolled towels which will be used horizontally should be able to support your body’s width in the area being used – the neck towel may be smaller in diameter and length but should be comfortable in supporting your neck in extension.

3. You are going to lie on the towels (use a firm surface or if you are going to lay on your bed, make the diameter of the towels larger).

4. When lying on the towels, there are 4 different stretching positions:

    A. you will have one going vertically down the middle of your spine - from the middle of your neck to just below your waist/hips.

    B. you will have one going horizontally under your neck. NOTE: this stretch can be skipped if you position the towels described in A correctly

    C. you will have one going horizontally across your low back, just above your waist/hip bones.


    D. you will have one going horizontally across your mid back, just below your shoulder blades.

5. Lay on the towels for for 2 – 5 minutes in each position for a total of 15 - 20 minutes. No one position should be done for more than 15 minutes (we are allowing a 5 minute leeway since beyond the 20 minute mark you will be getting very sore). If any of the positions are causing too much discomfort, STOP!

6. Once you are done, remove the towels.

The best time to do the stretch is before going to sleep (don't fall asleep on them; put a timer to go off in 15 minutes if you think you will fall asleep).

Also, after you have done strenuous activity, lay on the towels. As your muscles cool down if they cool down in an improper position, while lounging on the couch or chair, you will have the "locking up", pain and stiffness. Laying on the posture towels after the strenuous activity prevents the ”locking up", pain and stiffness or at least keeps it at a minimum. Further, if you place a towel horizontally across your low back, just above your waist/hip bones while lounging on the couch or chair, it will help prevent the "locking up", pain and stiffness.

You may also purchase styrofoam fulcrums specifically designed to do the above stretches, the total cost for a set can be up to $110.00, but check on or Google Shopping for the Pettibon Fulcrum Foams to keep your costs down to a minimum, towels with duct tape at home are the cheapest way to accomplish the same goal.



Research Supports Chiropractic

Posted on December 1, 2014 at 8:10 PM

Research Supports Chiropractic


Although empirical evidence suggests that chiropractics a safe and effective means of natural healing, a growing body of scientific data supports chiropractic’s effectiveness. The studies listed below are a TINY FRACTION of the studies published on the efficacy of chiropractic.


The RAND Study


The RAND Corporation, one of the most prestigious centers for research in public policy and health, released a study in 1991 which found that spinal manipulation is appropriate for specific kinds of low back pain. (Reference Shekelle PG, Adams A, et al. The Appropriateness of Spinal Manipulation for Low Back Pain: Indications and Ratings by a MULTIDISCIPLINARY EXPERT Panel. RAND Corporation, Santa Monica, CA; 1991)



The Koes Clinical Trial


A 1992 Dutch project compared manipulative therapy (chiropractic) and physiotherapy for the treatment of persistent back and neck complaints. After 12 months, the manipulative therapy group showed greater improvement in the primary complaint as well as in physical function, with fewer visits. (Reference Koes BW, Bouter LM, et al. British Medical Journal. March 7, 1992; Vol 304, No. 6827, pp. 601 – 605)



The AHCPR Guideline


In 1994, the Agency for Health Care policy and Research (AHCPR), now the Agency on Health Research and Quality (AHRQ), an arm of the U.S. Department of HEALTH AND Human Services, released a clnical practice guideline for the treatment of acute low back problems. The guidelines recommend the use of spinal manipulation as an effective method of symptom control. The researchers developing the guideline found that “manipulation…is safe and effective for patients in the first month of acute low back symptoms without radiculopathy [disease of the spinal nerve roots].” (Reference Bigos S, Bowyer O, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline, Number 14, Rockville, Maryland: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR Pub. No. 95-0642; December 1994)



The Manga Study


This study researched both the effectiveness and cost-effectiveness of the chiropractic management of low-back pain. Dr. Pran Manga, the study’s author, found “on the evidience, particularly the most scientifically valid clnical studies, spinal manipulation applied by chiropractors Is shown to be more effective than alternative treatment for LBP [low-back pain]. Many medical therapies are of questionable validity or are clearly inadequate.” (Reference Manga P, Angus D, et al. The effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back pain. The Ontario MINISTRY OF Health, Ottawa, Ontario, Canada; August 1993)



The Duke Study


Based on a literature review of several headache treatment options, a panel of 19 multidisciplinary experts concluded that spinal manipulation resulted in almost immediate improvement for cervicogenic headachesand had significantly fewer side effects and losnger lasting relief of tension-type headache than a commonly-prescribed medication. Researchers conclude the following: “Manipulation appeared to result in immediate improvement in headache severity when used to treat episodes of cervicogenic headache when compared with an attention-placebo control. Furthermore, when compared to soft-tissue therapies (massage), a course of manipulation treatments resulted in sustained improvement in headache frequency and severity.” (Reference McCrory DC, et al. Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache. Duke Unversity Evidence-Based Practice Center, Durham, North Carolna, January 2001)



The Boline Study


This randomized controlled trial compared six weeks of spinal manipulative treatment of tension-type headache by chiropractors to six weeks of medical treatment with amitriptyline, a medication often prescribed for the treatment of severe tension headache pain. Researchers found that chiropractic patients experienced fewer side-effects (4.3%) than the amitryptyline group (82.1%) and while both were effective during the treatment phase of the study, on they chiropractic patients continued to report fewer headaches when treatment ended. (Reference Boline PD, Kassak K, et al. Journal of Manipulative and Physiological Therapeutics. March/April 1995; Vol 18, No. 3, pp. 148 – 154.)



The Nelson Migraine Study


This study compared chiropractic spinal manipulation to amytriptyline (a medication often prescribed for the treatment of headache) for the treatment of migraine headache. The researchers found that “spinal manipulation seemed to be as effective as well-established and efficacious treatment (amitryptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches.” The researchers also found that in the weeks immediately following treatment, patients who had received spinal manipulation had a 42% reduction in headache frequency, compared to only 24% of those who took amitryptyline. (Reference Nelson CF, et al. Journal of Manipulative and Physiological Therapeutics. October 1998; Vol. 21, No. 8, pp. 511 – 519.)



The Colic Study


When researchers compared spinal manipulation for the treatment of infantile colic to dimethicone (a medication for colic), they came to a simple conclusion: “Spinal manipulation is effective in relieving infantile colic.” (Reference Wiberg JMM, et al. Journal of Manipulative and Physiological Therapeutics. October 1999; Vol. 22, No. 8, pp. 517 – 522.)


Supplement Companies I Recommend

Posted on December 1, 2014 at 8:00 PM

This list is always a work in progress.



Products I always recommend: Traumeel (tablets and cream), Spasm-Pain, Sinus, Zeel

These can usually be found at Whole Foods, Vitamin Cottage, Wild Oats, but the web site has a store finder.



Kool Fit America, Inc.

Products I always recommend: Sports Spray & Regular Spray

P.O. Box 22786

San Diego, CA 92192

Phone: 619/336-7820


Fax: 619/336-7826




Products I always recommend: Myocalm, Myocalm P.M., CalApatite with Magnesium

100 Avenida La Pata

San Clemente, CA 92673

(949) 366-0818

(800) 692-9400 (Metagenics)

(800) 668-8743 (Ethical Nutrients)

(800) 621-6070 (Unipro)

fax: (949) 366-0853

fax: (949) 366-2859


NATR Health

Products I always recommend: Pitch/PAV Products

PO Box 5600, Eureka, CA 95502

(800) 422-4716



NOW Supplements

Products I always recommend:  Eco-Multi (multivitamin), Super Omega 3-6-9, Black Cherry Fruit Extract, Quercetin, Glucosamine & MSM, Triphala, St. John’s Wort, Peppermint Gels, Ginger Root, Potassium Chloride, RememBRAIN, L-Proline, Rhodeola, 5-HTP, L-Carnosine, Alpha Lipoic Acid

These can usually be found at Whole Foods, Vitamin Cottage, Wild Oats, but the web site has a store finder.

They are cheap in price but very high in quality



Progena Professional Formulations

Products I always recommend: ProTrauma, DHEA25

Albuquerque, NM 87111

(505) 292-0700



Tahitian Noni

Products I always recommend: Noni Juice, HOA Supplements, Face Products, Gourmet Jams, Lip Balm



Transformation Enzyme Corp.

Products I always recommend: The whole line, depending on the health of the patient & our goals.

2900 Wilcrest Blvd.

Suite 220

Houston, TX, 77042

(800) 777-1474

(888) 777-1474


Fax (713) 266-2339


Himalaya Pure Herbs

Products I always recommend:  The whole line, depending on the health of the patient & our goals.  Of special note are Mind Care, Stress Care, Bacopa, Holy Basil, and Neem.

1101 Gillingham Land

Sugarland, TX 77478

(800) 869-4640






What Causes a Dysfunctional Cranial-Sacral (CS) System?

Posted on December 1, 2014 at 7:55 PM

What Causes a Dysfunctional Cranial-Sacral (CS) System?


Dysfunction may occur with head, neck, back, or more global somatic trauma, leaving scar tissue and/or traumatic tissue memory. Emotional shock and trauma may also contribute to, or be contained within, these events. This may restrict the CS system's ability to respond freely to its inherent rhythm. Damage can also be caused by a traumatic head injuries (concussions), traumatic birth, extensive dental work, a bite imbalance, or chronic bruxing.


The CS system can be released through specific gentle techniques which are directed at restricted areas, using diagnostic methods akin to "motion palpation" concepts applied to CS dysfunction. Because the body is designed to support a normal functioning CS system, it tends to remain movable once it has been "released." Without this help, not only is the body often unable to resolve these restrictions, it adapts to abnormal movement potentially leading to neurological, vascular, and/or biomechanical and organic complications.


What is Cranial Work?

Posted on December 1, 2014 at 7:55 PM

What is Cranial Work?


There is a measureable rhythmic pulsation (approximately 6-12 cycles/minute) within, and throughout, the central nervous system contained by the spine, sacrum, and skull, which is accompanied by other longer and slower wave patterns. When the mobility of the cranial-sacral (CS) system is restricted, altered, or disrupted because of injury, symptoms may appear. These can include jaw, tooth, facial, back, and neck pain; visual disturbances, hearing loss, tinnitus, sinus trouble, anosmia, insomnia, Bell's palsy, trigeminal neuralgia, nystagmus, strabismus, and other cranial nerve dysfunctions, various emotional and thought disturbances, etc. Some of these dysfunctions may result from consequent neurological and/or vascular alterations.


Percussive/Vibrational Massage

Posted on December 1, 2014 at 7:55 PM

Percussive/Vibrational Massage penetrate through all the muscle layers even the thickest muscles releasing tension and fatigue. Massage is always helpful if it is done in a way that is appropriate for that particular individual. The reason we say that is because massage enhances two of the main functions of the body, which are the delivery of nutrients to the trillions of cells in the body, and the elimination of waste products from the trillions of cells in the body. The blood and lymph fluid systems facilitate this crucial delivery and elimination activity, upon which all of life depends.


Massage aids this process by dilating blood vessels and relaxing muscles, which improves the flow of life-giving blood, and the flow of cleansing lymph fluids throughout the body.


As a result, many good things start to happen. "Fatigue" products like lactic acid and other harmful deposits are eliminated from the muscles and joints. Recovery time is dramatically reduced. Inflammation and swelling can be lessened. The body is more limber and supple. Muscle tone is improved because of better nutrient delivery. The nervous system is relaxed. For people or animals that are forced to remain inactive because of injury, illness or age, massage can be a mild form of exercise for their muscles and joints.


This all happens because of better nutrient delivery and better waste elimination from all the cells of the body.


The Proprioceptive Neuromuscular Facilitation Techniques

Posted on December 1, 2014 at 7:55 PM

The Proprioceptive Neuromuscular Facilitation Techniques include:


Hold Relax: most familiar. Also called Contract-Relax Involves the therapist asking the patient to fire the tight muscle isometrically against the therapist's hand for roughly 20 seconds. Then, the patient relaxes and the therapist lengthens the tight muscle and applies a stretch at the newly found end range. This technique utilizes the golgi-tendon organ, which relaxes a muscle after a sustained contraction has been applied to it for longer than 6 seconds. Verbal cues for the patient performing this exercise would include, "Hold. Hold. Don't let me move you."


Contract-Relax with Agonist Contract (CRAC): Also called Hold-Relax Contract. Same as Hold-Relax, patient isometrically contracts the tight muscle against the therapist's resistance. After a 20 second hold has been achieved, the therapist removes his/her hand and the patient concentrically contracts the antagonist muscle (the muscle opposite the tight muscle, the non-tight muscle) in order to gain increased range of motion. At the end of this new range, the therapist applies a static stretch before repeating the process again.


Hold-Relax-Swing/Hold-Relax Bounce: These are similar techniques to the Hold-Relax and CRAC. They start with a passive stretching by the therapist followed by an isometric contraction. The difference is that at the end, instead of an agonist muscle contraction or a passive stretching, involves the use of dynamic stretching and ballistic stretching. It is very risky, and is successfully used only by people that have managed to achieve a high level of control over their muscle stretch reflex.


Rhythmic Initiation: Developed to help patients with Parkinsonism overcome their rigidity. Begins with the therapist moving the patient through the desired movement using passive range of motion, followed by active-assistive, active, and finally active-resisted range of motion.


Rhythmic Stabilization: Also known as Alternating Isometrics, this technique encourages stability of the trunk, hip, and shoulder girdle. With this technique, the patient holds a position while the therapist applies manual resistance. No motion should occur from the patient. The patient should simply resist the therapist's movements. For example, the patient can be in a sitting, kneeling, half-kneeling, or standing position when the therapist applies manual resistance to the shoulders. Usually, the therapist applies simultaneous resistance to the anterior left shoulder and posterior right shoulder for 2-3 seconds before switching the resistance to the posterior left shoulder and the anterior right shoulder. The therapist's movements should be smooth, fluid, and continuous.


Neuromuscular Re-education

Posted on December 1, 2014 at 7:50 PM

Neuromuscular Re-education


Neuromuscular reeducation is a therapeutic technique that is used to improve balance, coordination, posture, kinesthetic sense and proprioception. Neurologically the patient may be asked to use different eye and/or head movements to facilitate the proper functioning of the cerebral hemispheres, cerebellum and/ vestibular system. The spindle cell aspect of neuromuscular re-education is a technique used by rehabilitation therapists to restore normal movement. Together, your nerves and muscles work to produce movements. Nerves send signals between your muscles and your brain about when, where, and how fast to move. It is a complex process. Theorists believe that over time, nerve tracts are reinforced and muscle movement (motor) patterns are learned and stored in your memory. For example, this explains why you remember how to go up steps and automatically know how to adjust your movements for tall or short steps.


Muscle movement patterns are affected when nerves or muscles experience damage or injury. This can result from trauma, medical conditions, and neurological conditions, such as stroke and traumatic brain injury. Neuromuscular re-education is one method used by rehabilitation therapists to facilitate the return of normal movement in persons with neuromuscular impairments.


What is Chiropractic Neurology?

Posted on December 1, 2014 at 7:50 PM

What is Chiropractic Neurology?


As in medicine and dentistry, the chiropractic profession has individual specialties and specialists. Some of these specialties include radiology, orthopedics, physical rehabilitation and neurology.



The chiropractic neurologist serves as a primary treatment doctor and in a consulting manner as does a medical neurologist. The difference is that the treatment application the chiropractor employs does not include drugs or surgery. As a result, certain conditions are more customarily seen by chiropractic neurologists than medical neurologists.



More specifically, the chiropractic neurologist sees a wide variety of movement disorders such as dystonia, post stroke rehabilitation, radiculopathy/nerve entrapments as a consequence of peripheral or central type of soft lesions (brain) and chronic pain to patients.



The medical neurologist is faced with primarily looking for ablative lesions such as stokes, tumors in which visible compression of brain/spinal cord tissue is seen and extensive loss of function for the individual is present. In these types of cases, the medical neurologist is the perfect specialist to be evaluating these types of patients.



Chiropractic neurologists can also provide council to patients whenever the diagnostic dilemma or question at hand becomes difficult to understand.



Hemispherisity is a key concept in the practice of Chiropractic Neurology.



This term is used to indicate a functional imbalance between the two halves of the brain. If one of the hemispheres is functioning lower than the other, there is a great probability that it will be expressed in the body. These expressions can take the form of high blood pressure, tightened or laxity in muscle, dizziness, double vision and many other possibilities.


Why might Vestibular Rehabilitation be useful ?

Posted on December 1, 2014 at 7:50 PM

Why might Vestibular Rehabilitation be useful ?


Here we will consider the "generic" type of vestibular rehabilitation in which ataxic or vertiginous individuals are provided with a series of tasks to perform that require them to use their eyes while their head is moving, and possibly when their body is also moving. There are many processes that might be usefully influenced by experience and motion:


1. Plasticity -- changes in central connections to compensate for peripheral disturbances. It would be nice if plasticity could handle everything. Unfortunately, there appear to be limits on how much the brain can compensate. Although conventional wisdom holds that older persons adapt less well than younger, a recent study suggests that there is no difference in benefit of vestibular rehabilitation according to age (Wriseley et al, 2002)


2. Formation of internal models -- a cognitive process where one learns what to expect from ones actions. Internal models are critical for predictive motor control, which is essential when one is controlling systems that have delays.


3. Learning of limits -- another cognitive process involved with learning what is safe and what is not. Someone who does not know their limits may be overly cautious and avoid dangerous situations. Someone who does not realize that, for example, they can't figure out which way is up, may drown in a swimming pool.


4. Sensory weighting -- a cognitive process in which one of several redundant senses is selected and favored over another. Classically, selection occurs between vision, vestibular and somatosensation inputs when one is attempting to balance. People with unreliable vestibular systems, such as those in Meniere's disease, sometimes seem to unable to switch off their visual reliance, causing them distress in certain situations where vision is an incorrect reflection of body movement (i.e. in the movies). (Lacour et al, 1997)


Indications for therapy


There are five reasonable indications for vestibular rehabilitation:


• Specific interventions for BPPV (Benign Paroxysmal Positional Vertigo)

o The Epley maneuver and the Semont maneuver ( see following and BPPV page)

o The Brandt-Daroff exercises (also see following section and BPPV page for details)

o Log roll exercises (for lateral canal BPPV)


• General interventions for vestibular loss

o Unilateral loss, such as for vestibular neuritis or acoustic neuroma

o Bilateral loss, such as for gentamicin toxicity and related conditions


• Persons with fluctuating vestibular problems, not necessarily dizzy at the time of the therapy. The objective here is to prepare the person for anticipated dizziness rather than to make any permanent change in their present vestibular situation.

o Meniere's syndrome

o Perilymphatic fistula


• Empirical treatment for situations where the diagnosis is unclear.

o Post-traumatic vertigo

o Multifactorial disequilibrium of the elderly


• Psychogenic vertigo for desensitization

o Brandt-Daroff exercises for phobic postural vertigo

o Other situations where there is irrational fear of situations in which balance is challenged


Individuals not likely to benefit from vestibular therapy include mainly persons without a vestibular problem, for example:

• low blood pressure

• medication reactions (other than ototoxicity)

• Migraine associated vertigo (although it has been reported to be helpful nonetheless, e.g. Whitney et al, 2000)

• Transient ischemic attack -- TIA


There are some conditions where it is not clear whether rehabilitation is helpful, but it seems likely at this writing that it is not helpful, or if beneficial, it might be a minor effect.

• Mal de debarquement (MDD)

• Cerebellar degenerations

• Basal ganglia syndromes such as PSP (There is some evidence that rehab helps in Parkinsonism)

• Idiopathic motion intolerance (except if psychogenic, see above)


Descriptions of the type of therapy applicable to each diagnosis can be found under pages that related to the condition itself.


Vestibular Rehabilitation Treatments

Posted on December 1, 2014 at 7:45 PM

Treatments that may be offered in Vestibular Rehabilitation


As an overview, we have listed various procedures that can be offered as part of vestibular rehabilitation. Excepting for treatment of BPPV, in general, the outcome of these procedures have not been studied to a great extent, and a recurring theme is that more research is needed.


Treatments for BPPV are dealt with in detail under the BPPV pages.


Gaze Stabilization Exercises

This is an exercise especially appropriate for persons with bilateral vestibular loss(Krebs, 1991) as well as being a reasonable procedure for persons with unilateral vestibular disturbances such as vestibular neuritis or persons who have had tumors of the 8th nerve removed. This exercise should be "progressed" to a more difficult one as it is mastered. We have only shown a part of the exercises here.


Visual Dependence Exercises

It is not unusual for vestibular therapists to propose other treatment maneuvers. For example, therapists might have patients smear their glasses with Vaseline. The rationale is to reduce "visual dependency", which is an inappropriate reliance on visual input, in situations where it might be better to use somatosensory or vestibular inputs. In certain situations, this seems like a good idea. Does smearing vaseline on glasses reduce visual dependency ? Nobody knows. If we had a reliable method of measuring visual dependence, perhaps we could relate it to interventions. At this writing, posturography seems to be the closest to being a measure of visual dependency.


Virtual reality training (see below) might offer a better method of reducing visual dependency. This promising technology is in it's infancy right now, and research studies are needed to validate it.


Somatosensory Dependence Exercises

Following the same train of thought as the visual dependency exercises, perhaps it might be of benefit for someone to practice maintaining their balance in situations where somatosensory (ankle and pressure) input is either reliable or just not there. Somatosensory input can be distorted using tilt-boards, rails, slabs of foam, or just by walking on the beach. Forcing someone to do this might encourage them to recalibrate and rely to a greater extent on their vestibular or visual sensory inputs. Is this a good idea ? Based on experience, it probably is -- more studies are needed though.


Otolithic Recalibration Exercises

Bouncing on Swiss balls or mini-tramps may be advocated to build up the otolith-ocular reflex as well as otolith-postural reflexes. Again, this might be a good idea, but we are presently lacking any reasonable way to measure the otolith-ocular reflex and also we have little idea as to it's significance in daily life. There are essentially no situations in which otolith function is selectively elimianted in humans. Thus, there are no "experiments of nature" with which one might decide whether this protocol is useful. It would be interesting to see if this procedure is associated with improved outcome, as compared to another activity (such as perhaps weight-lifting).


Ocular Tracking Exercises

Patients may be urged to track objects that are moving in counterphase to their heads, generally moved by themselves. This procedure might encourage patients to use both visual tracking and vestibular stabilization in tandem. There is no natural situation that this exercise might help them with. Similarly, patients may be asked to track objects that are moving with their heads. This procedure might encourage patients to turn off their vestibular system. This might, in theory, be useful for persons with vestibular imbalance such as those with Meniere's disease. It would be unlikely to be helpful in persons who already have their vestibular system turned off (i.e. persons with bilateral vestibular loss).


Posturography Training

Little outcome information is available about posturography training. These procedures involves a moving platform coupled to a computer monitor. The patient is asked to keep their center of pressure within a box on the screen or to track a visual target by shifting their weight on the platform. Typically two sessions are given per week over several weeks. In our opinion, this procedure seems unlikely to promote neuroplasticity or adaptation (because it is too short), but it might assist individuals in forming internal models of their body and the outside world. Forming and recalibrating internal models is certainly a worthwhile endeavor, critical to recovery from lesions. It seems likely to occur in time whether or not a device like this is available, but the progress of revising an internal model might be accelerated through guided practice.


Regarding data, two recent studies suggested that there is no benefit from the Smart Balance-master training paradigm over conventional PT for acute stroke balance rehabilitation (Walker et al, 2000; Geiger et al, 2001). In our opinion, these studies are flawed because in this situation, it would seem to us that the effects of the training might be obscured by natural time dependent neural processes involved in stroke recovery that would progress with or without a daily 30 minute exposure to a training device. Also, study of strokes seems to us a poor choice of model as it is very difficult to find a large number of people with stroke who have exactly the same size, and location of their neurological lesion.


Nevertheless, as noted above, there are some theoretical reasons to suspect that such devices might be helpful in accelerating the pace of recovery even though the exposure time is short. Additional studies are needed to determine the utility of these devices in other contexts than acute stroke such as vestibular imbalance or loss. One interesting question would be to see whether these devices have utility in more static clinical situations (such as a person who has had imbalance for several years). Another would be to examine the utility of these devices in contexts where the lesion perturbing balance is well understood, standardized and acute.


Virtual Realty Training

Virtual reality seems like a particularly promising method of treating people with inappropriate visual dependence. It seems a lot more likely to work than smearing vasoline on ones glasses (see above). Perons with visual dependence are the people who get sick from looking at ceiling fans, or going to the Omnimax. Virtual reality is new, and at present, there are few studies that bear on this intervention. There has been some preliminary work done by Viirre, suggesting that virtual reality may help assist in increasing abnormally low vestibular ocular reflex gain (Virre and Sitarz, 2002)


General Patient Instructions - Do's & Don'ts

Posted on December 1, 2014 at 7:40 PM

General Patient Instructions



1. Drink plenty of water 4 to 8, 12oz glasses per day.

2. Eat a balanced diet.

3. Stand on both feet (don't prop up on counters, etc.).

4. Sleep on a firm mattress.

5. Naps - no more than one hour at a time, during the daytime, only in bed.

6. Use medium size pillows (foam or fiber filled). Use small pillows between knee's when on sides or under knees when lying on back.

7. Sit and walk intermittently throughout your day.

8. Hot showers (neck and shoulder area; twice daily first 5 days).

9. Towel Roll: Fifteen to twenty minutes before bedtime (Do in bed or on the floor).

10. Ice 15-20 minutes every 1.5 hours as needed for pain (at least 3 times a day). DO NOT GO OVER 20 MINUTES AT A TIME!

11. Men: STOP wearing wallet in back pocket (put in front pocket).



1. Do not lie on stomach now, or in the future.

2. Do not use your head for turning in bed.

3. Do not sleep with two or more pillows.

4. Do not sit in recliner for more than thirty minutes at one time, Stay out of recliner for the first 5 days.

5. Do not lie on the sofa now, or in the future.

6. For the first 5 days do no lifting over 10 pounds, vacuuming, changing bed linen's, carrying groceries, etc.

7. Do not sit with legs crossed at knee's, cross at ankle's.


Instructions for Acute Low Back Pain

Posted on December 1, 2014 at 7:40 PM

Instructions for Acute Low Back Pain


1. What positions are best for me?

A. Lay down on a firm surface on your side with knees bent (fetal position).

B. Lay down on a firm surface on you back with knees bent. (use pillows to support your knees to make you more comfortable)

C. Have someone drive you to the office for treatment so you can lie down on the back seat.

D. Do not sit unless absolutely necessary. If you must sit, keep it to a minimum and sit only on a firm, straight back chair.

E. Wear your low back brace (if one was prescribed). If the brace becomes uncomfortable, you may remove it for 10-15 minutes but you must stay in one of the above positions while you have it off.

F. Do not sleep on you stomach, it strains the low back.


2. What should I do to relieve the pain and inflammation?

A. Apply ice in a plastic bag or re-freezable ice pack over the painful area for twenty minutes on, one hour off. Do this continuously while awake, until the doctor tells you otherwise.

B. Initially when ice is applied to skin there will be a burning sensation, this should change to a deeper feeling of cold and or numbness after about 2-3 minutes. If you have sensitive skin or if the skin has a burning sensation after 3-5 minutes when ice is applied directly; wrap with a thin cloth, the thickness of a pillowcase or a thin t-shirt, this will allow the cold to penetrate without irritation.

C. If you have to take medication let the doctor. know. Please follow the instructions carefully and make sure you understand the side effects, especially whether or not you should drive. Keep in mind that all drugs are toxic and do not correct anything. It's not lack of medication that caused your problem and makes you hurt.


3. What would be the wrong thing for me to do?

A. Do not apply heat. It will increase the swelling.

B. Do not bend, lift, or twist you body.

C. Do not attempt any exercises, except those prescribed by your doctor.

D. Do not test your back by moving it around (after an adjustment or at any other time) this only aggravates your injury.

E. Do not give up hope. Healing takes time. Remember, we are here to help. If you have any questions, please ask us. We'll listen. We care. 24 hours a day.