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Jay M. Trennoche
10-25-1998, 06:55 AM
Hi Mel,

It was interesting to read your queries on the post you made to the biomech
list re: manipulation.

There are many types of practitioners who utilize spinal manipulation and
also neuro-spinal adjustments. The spinal manipulation at least, is believed
to date back to the Egyptian pyramid builders on up to Aesculapius, the
Greek healer, and further on to today.

In the late 1800's at least a few people claimed that they improved upon
spinal manipulation by going to a degree of specificity in their forces put
into the spine that now included specific vectors for singular vertebra.
They claimed the difference meant that they were adjusting the spine.

One of these people is known to be A.T. Still, who claimed, I believe, that
his spinal adjustments enhanced the flow of blood, which he also claimed is
what healed the body. He was the founder of Osteopathy, which has been for
the most part absorbed into the medical broad scope practice including the
use of prescription drugs. Less and less osteopaths utilize manipulation or
adjustments in their practice. I stand corrected if this statement contains
errors in reporting.

The other person, D.D. Palmer, claimed he learned some of the principles
that he worked with and the inclusion of specific spinal adjustments from a
"Dr." Jim Atkinson who had practiced such for 50 years prior to Palmer.
Palmer claims he "adjusted" a single spinal vertebra on a maintenance worker
in the building where he had an office and this worker who had been deaf for
some years immediately got back much of his hearing. Days later it is
claimed that this worker had fully restored hearing without further spinal
adjustment.

It is said that Palmer adjusted a single thoracic vertebra that resulted in
the restored hearing. Palmer also claimed that the worker claimed that he
bent over one day and heard a pop in back and right then lost most of his
hearing. According to testimony this deaf man's wife, Mrs.. Harvey Lillard,
stated that Harvey retained his hearing for almost 2 decades but eventually
lost his hearing again before he passed.

Palmer surmised that adjusting vertebrae correctly could have a profound
effect on the central nervous system. Palmer was the founder of
Chiropractic. Most chiropractors still hold to this day this somewhat
difficult to understand and practice neuro-spinal event. Clinically the
relationship between the brain stem and spinal cord and the spine, above
musculo skeletal complaints, is seemingly made patent everyday in
chiropractic offices worldwide due to the wide ranging bi-product of
restoration of distal function subsequent to both musculo spinal
manipulation and neuro-spinal adjustments.

Up to this time all spinal manipulation and now adjustments were done
randomly, as in general manipulation; or with specificity with external
observation, examination, and palpation.

That the Egyptians, and other worldwide advanced cultures did not rely on
some degree of specificity is not known. Structural and postural observation
can carry some degree of specificity.
The big change occurred when Roentgen also in 1895 discovered x-rays.

The next Palmer, B.J., and other chiros took the x-ray as the tool to
internally observe and eventually measure displacement of vertebrae. The
x-ray was the tool which allowed the eventual and protractor and ruler
degree and millimeter measurement. The x-ray allowed the observation of
levers, fulcrums, angles, circles, hexagons, vectors and their magnitude;
and the appreciation of intrinsic and extrinsic forces, inertia and
resistance.

Manipulation vs. adjustment. Two words deserving a modern interpretation
that is held by many to be reasonable in their inherent differences..

To define these two terms one must be able to visualize the 3 ranges of
motion (ROM) found in spinal articulations and some other articulations of
the body. The explanation of same will describe the noise or popping heard
during manipulations and some adjustments.

Some describe the 3 ROM's as the spaces of motion completed during the
movement through an articulation's full excursion. Active, Passive, and
Periarticular-paraphysiological (P-p) spaces .

Active is the excursion accomplished with self induced muscle effort; next
is the Passive ROM. Passive is accomplished with stretching by a force
external to that articulation as in helping the articulation move to the
edge of the stretching "envelope".

The space beyond that is the above mentioned P-p space which continues to
the limit of joint integrity (beyond that leads to injury of the supportive
[protective] soft tissues of that articulation). It is in the P-p space
during manipulation or adjustment that the articulation allows for some
degree of separation of the joint surfaces and a suctioning of gasses from
the synovial lining and an accompanying production of a popping noise.
Others claim some deeper sounds are the discal protein gels being instantly
put into solute from the forces introduced and the friction created during
the manipulation and some adjustments.

Some report that the "resetting" of the gasses takes about 20 minutes and
the popping noise can again be demonstrated. Try it on your knuckles. No no,
not while on your knuckles... manipulate your fingers so that your digit
articulations make this sound. Try again immediately at the same
articulation and then wait the approximate 20 minutes.

A bi-product of this excursion through all 3 ROM's is that where there is
previously worn and torn or previous frank trauma to an articulation there
is already the presence of the fibrosis of repair. Fibrosis, a replacement
tissue for the original home grown strong, elastic, resilient, and cross
linkage configured supportive soft tissue of the articulation.

The analogy is: fibrosis is the Manilla rope replacement for the bridge
jumpers bungee cords (original uninjured or non worn and torn from aging
supportive soft tissues).

Whether by manipulation or by adjustment when an articulation is forced
artistically through all 3 ROM's without going beyond the limit of joint
integrity and causing more injury, the fibrosis
is stressed from its position of inflammatory exudate (laid down like a bowl
of noodles) and is realigned towards the original cross linkage.

The fact of which indicates that supportive soft tissue injury when healed
is never 100%. It always has the fibrosis of repair and the scrambled cross
linkage pattern as seen under suitable microscope and is less effective
(elasticity and resiliency and strength) and less cross linked which is
important for the quality and strength of the joint tissues.

Thus manipulation and some adjustments re-align towards the original the
cross linkage of the fibrosis of repair...an enhancement to chronic injured
tissue.

The phases of injury healing are 1.) Inflammation when the exudate
distributes the fibrosis. Time factor: 72 hours. Tx: cold for
vasoconstriction (less inflammation and exudate), reduced ROM, compression,
and a host of other applications of medical and non medical therapies.
2.) Phase of repair. The fibrotic tissues secrete a protein collagenous glue
to bind the fibers as a repairing mechanism. Time factor: 8 weeks.
3.) Phase of remodeling. During the next 12 month window any motion to the
injured articulation helps to re-align the fibrosis of repair towards the
original cross linkage (think of a school yard fence). Active ROM like
exercise is good, Assisted passive ROM, stretching, effects more of the
fibrosis and cross linkage; and P-p ROM is most effective in re-aligning
the fibers towards the original healthy uninjured pattern of cross linkage
and all 3 ROM excursions help to break up the protein collagenous glues
resulting in greater ROM over all for that injured area.

And so manipulation and some adjustments to at least some spinal
articulations have a beneficial effect on supportive soft tissues more than
would exercise or massage due to the ROM effected.

Why do we say manipulation and SOME adjustments? Well we need to further
define what is reasonably accepted in some professional dialogue as to the
difference between manipulation and adjustment.

Manipulation is a general introduction of force to an articulation. It often
in spinal care practices includes a bilateral approach to the introduction
of force. Meaning left and right or anterior/posterior treated the same. For
instance, a general manipulation to the cervical spine would be to lay a
person on their back, cradle the head and perhaps even part of the neck to
isolate different vertebrae and then turn the head and/or neck to the left
through the active, then passive ROM's and then thrust into the P-p ROM
space artistically (without harm to the supportive soft tissues) up to the
limit of joint integrity.

Repeating this maneuver identically to the right would be considered a
general manipulation and could be done in many places along the spine using
different levers and fulcrums and different positions for the person being
manipulated.

Manipulation accomplishes excursion throughout all three ROM's without
consideration for a predetermined vector that may be begging for an actual
alignment to an articulation.

It is believed by some that joints with symphyseal attachments can be only
manipulated and not adjusted. And those which are synovial (the
sacroiliacs) or diarthrodial only (Occiput or C0, and C1 and the superior
portion of C2) can be manipulated but can better respected with adjustments.

The adjustment is made with a proper predetermined vector and magnitude of
force utilizing adequate fulcrums and levers. The vector and magnitude
necessary to re-establish juxtaposition is determined from the measurements
which can be gained by proper x-ray views and methods of measurements using
the proper tools.

The sacroiliacs are relatively simple to analyze and adjust; while the upper
cervical (upC spine: C0,C1, and C2) is considered complex due to the
combination or variations of displacement excursions allowable in the
frontal, horizontal, and sagittal planes; or x-y-z axis using the right
handed Cartesian method. I have heard of computer studies that claim that
variations in displacement of the upC spine can run as a high as 7,500
different configurations.

While any manipulation or adjustment that satisfies the 3 ROM's excursion
will benefit supportive soft tissue; a manipulation without thought for
alignment may cause greater structural displacement and initiate or cause
greater traction of neuro tissues resulting in greater aberration to distal
function or tissue regeneration.

An adjustment, if it accomplishes improved alignment may result in restored
function where there previously was less, due to the prior unattended
structural displacement.

However, whether by manipulation or adjustment in the upC spine, excursion
through all 3 ROM's may result very infrequently in CVA (cerebro-vascular
accident involving the vertebro-basilar arteries). However, while many
malfunctions caused by neuro aberration are silent to the suffering
individual, a manipulation or maladjustment may further displace the spine
and silently further traction and aberrate neuronal tissue and further
increase distal malfunctions or accelerate tissue or visceral degeneration
via different sympathetic efferent mechanisms.

The main difference between a manipulation and an adjustment is the degree
of specificity. An adjustment by nature must be unilateral along a
predetermined reduction pathway vector.

But some claim to adjust into the P-p ROM, while others claim to adjust
within the Active ROM only, ignoring the benefit of remodeling soft tissue
and cross linkage pattern but trying to replace the head and spine to the
vertical axis and all segments to an orthogonal position on the x-y-z- axis.
This must be appreciated as a major difference within the term adjustment.

Where manipulation can be delivered with as much as 100 lbs. of force; some
adjustments utilize only ounces of delivered force. Some have evolved to
using non-excursion percussion force to replace vertebrae in the upC spine.

Adjustments require x-ray measurement, for to see is to know and not to see
is to guess. Some methods require immediate re-x-raying after the first
day's adjustment(s) to verify the re-positioning of the upC spine,
specifically the C0, C1, and C2 segments.

Manipulation is awesome for supportive soft tissue.

Precision adjustments can be incredible for restoration of health and
maintenance of same.

In some areas of the spine manipulation can be repeated indefinitely on a
reasonable time schedule without harm and with supportive soft tissue
benefit.

An adjustment can only be delivered in the presence of neuro disturbing
vertebral displacement. You cannot adjust what is in alignment; that would
be a maladjustment An adjustment can only be given in the presence of
neuro-aberration.

A neuro-spinal adjuster needs to know not only how to artistically and
scientifically adjust the neuro-spine but also when not to adjust or when to
stop adjusting upon accomplishing the endeavor at hand.

For greater precision, the art of adjusting the spine has evolved into the
use of floor mounted instruments upon which an alignee lays and is adjusted.
X and Y axis vectors can be introduced as a co-sine of eachother
simultaneously. The instrument has different calibration settings for the X
and Y axis.

Some adjusters claim to only deliver their service for the allowance of the
complete expression of the human experience by way of full expression of
neuro-integrity.

Others for restoration and maintenance of health and its contribution to
longevity.

While others merely maneuver the spine for the relief of pain, symptoms,
sickness, injury, or disease.

No matter, there is a difficult to deny overlap of all the theories and
philosophies.

The trouble is there is not enough people serving others in either
manipulating without harm or adjusting with accuracy the column of the human
frame which daily must at least withstand the compressive forces of
gravity....and "other misdemeanors of daily living".

It is claimed that spinal displacement, spinal stress, or subluxations can
cause neuro aberration. Still yet difficult to prove or disprove. However
the clinical deductions of results by those practicing this ancient art and
modern science cannot be ignored.

Frankly, the experts in biomechanics may holds the answers to many questions
begging revelation.

We notice many notices on the biomechanics list indicating jobs and
research, etc. that promotes radical and remote or distal therapy.

An effort of cooperation by the biomechanics towards the phenomenal neuro
upC spinal area and its proximity to the brain stem is long overdue or ready
to roll.

Thank you,

Trennoche

-----Original Message-----
From: Mel Siff
Newsgroups: bit.listserv.biomch-l
To: BIOMCH-L@NIC.SURFNET.NL
Date: Saturday, October 24, 1998 10:49 AM
Subject: SPINAL MANIPULATION


>This article was sent to me recently. Does anyone have a scanned copy of
the
>article which could be sent out via email? It would be interesting to read
it.
>If anyone else has read the full article, any views? Any comments by other
>therapists or researchers on the last sentence, especially the entire
>philosophy of mechanical manipulation of the spine to relieve alleged
>subluxations or other stresses accumulated by the misdemeanours of daily
life?
>
>Have any models or studies been devised which adequately explain the
allegedly
>beneficial effects of regular spinal manipulation. Theories are bandied
about
>which attribute the 'popping' sound sometimes elicited during manipulation
to
>the release of nirogen bubbles in the joints, others talk about sudden
release
>of accumulated tension in soft tissues, yet others refer to the reduction
of
>subluxations, but few seem to establish a causal link between specific
>ailments and subtle mechanical stresses and pressures.
>
>The article follows below:
>
>Dr Mel C Siff
>Littleton, Colorado, USA
>mcsiff@aol.com
>
>---------------------------------------------------------------
>
>Magazine Readers Warned About Chiropractors
>
>The January issue of Smart Money informed readers of "Ten Things Your
>Chiropractor Won't Tell You." Writer John Protos explores the "nutty
theories"
>of many chiropractors, the absurdity and expense of repeated (if not
>indefinite) visits for "adjustments," the availability of physical medicine
>from other professionals, the risks of chiropractic manipulation
(particularly
>of forceful maneuvers of the cervical spine), the spotty insurance coverage
of
>chiropractic, and the profit-driven efforts of many chiropractors to draw
in
>children (the manipulation is whom can be dangerous), sell vitamins, and
take
>X-rays.
>
>Finally, he notes that scientific studies have repeatedly found that, no
>matter what is done about low back pain, most people will get better on
their
>own with over-the-counter analgesics and the use of heat and cold
>applications.
>------------------------------------------------------------
>
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