Universal Chiropractic            Dr. P. Nadine Gonzales 

 

Keeping the world aligned, one spine at a time. 

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Percussive/Vibrational Massage

Posted on December 1, 2014 at 7:55 PM Comments comments (0)

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 Comments comments (0)

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 Comments comments (0)

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 Comments comments (0)

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 Comments comments (0)

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 Comments comments (1)

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 Comments comments (0)

General Patient Instructions

 

DO:

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).

 

DON'T

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 Comments comments (0)

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.

 

Instructions for Acute Neck Pain

Posted on December 1, 2014 at 7:35 PM Comments comments (0)

Instructions for Acute Neck Pain

 

1. What positions are best for me?

A. Whatever provides you with relief from pain.

B. For sleeping, sleep on a soft pillow that molds to the neck and is comfortable. Positions that provide comfort may change as your condition corrects.

C. Have someone drive you to the office for treatment so you will not have to make any strenuous or sudden moves.

D. Wear your cervical collar (if one was prescribed). You can sleep with the collar on, if you take it off for sleep, follow line B. If it becomes uncomfortable during waking hours, try loosening it, or you may remove it for 10-15 minutes.

E. Do not sleep on you stomach, unless absolutely necessary for pain relief.

 

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

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

B. Initially when ice sis 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 Dr. 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 a lack of medication that caused you 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 hold you head in extreme positions, such as looking down, for extended periods.

C. Do not attempt an y exercises, unless prescribed by your doctor.

D. Do not test you neck by moving it around, twisting, bending, etc. (after an adjustment or at any other time) this only aggravates you injury.

E. Do not do any strenuous activities such as reaching, pulling, lifting, bending, etc.

F. 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.

 

Cervical Curve Restoration - Isometric Home Therapy

Posted on December 1, 2014 at 7:35 PM Comments comments (0)

Cervical Curve Restoration - Isometric Home Therapy

 

Many patients who suffer from headaches, neck aches, shoulder or arm related problems demonstrate a "loss" of the normal 35 to 45 degree uniform forward curve that must be present for maximum cervical function. This loss can be caused by a variety of situation ranging from a "whiplash type" injury to bad sleeping habits. The result is a biomechanical imbalance, predisposing a person to unseen weight bearing to discs and posterior joints, alteration of the intervertebral foramina with undue stress and pressure on the nerves and blood vessels is an open invitation to early hard and soft tissue degeneration.

 

Many times weakened posterior cervical muscles are a major part of these problem and isometric strengthening techniques assist in regaining a normal to near normal posture. These exercises are for those who still have some curve in their neck. Those who have the straight or "military" neck or reversed cureve need to be using head weights first, then proceed to do the cervical isometric exercises.

 

• have patient sit with assistant standing behind them.

• place an open hand on the upper chest to stabilize them.

• the other hand should be cupped with the wrist held 90 degrees back.

• the cupped hand should support the occiput of the patient.

• The patient should slowly but forcefully extend their head and neck to the maximum position as the assistant resists this action with the cupped hand but not enough to stop the exercise.

• this should be repeated 5 or 6 times and be preformed twice a day until desired results are accomplished.

• immediate "change" of posture should be felt by the patient after the exercise.

• caution should be taken to not over stress the tissues but enough isometric tension should be used to accomplish the desired results.

 


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