Columbia Advanced Chiropractic, LLC

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Dry Needling Support Models (3 of 4): Spinal Segmental Sensitization (SSS) and Pentad Model

Dry Needling Support Models (3 of 4): Spinal Segmental Sensitization (SSS) and Pentad Model

In our last two blogs, we went over models that help explain how Dry Needling works.  These two were the Radiculopathy and the Trigger Point Models.  The topic of this blog will involve the third model, or the Spinal Segmental Sensitization and Pentad Model.  As we have with the last two discussions, we will try to explain any difficult terminology or ideas.

Spinal Segmental Sensitization and Pentad Model

The Spinal Segmental Sensitization (SSS) and Pentad Model was proposed by the late Andrew Fischer, M.D. (Physiatrist…pain management and rehabilitation medical doctor).  This is a good time to discuss this model as it really incorporates both of the first two models.  Dr. Fischer proposed that the SSS is a ‘hyperactive’ state of the dorsal horn of the spinal cord that is caused by damaged tissue sending nociceptive (pain) input into the spinal cord.  This information then causes the over-sensitivity of the associated spinal level dermatome (skin), pain sensitivity of the associated spinal level sclerotome (bone, ligaments, joints), and Myofascial Trigger Points (MTrPs) in the associated spinal level muscles.  All this occurs because the nerve coming from the spine is over sensitized, and by being in this pathological state, it stimulates these changes listed above.  In effect, we have a pretty vicious cycle of pain and dysfunction. Continue Reading →

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Dry Needling Support Models (2 of 4): The Trigger Point Model

Dry Needling Support Models (2 of 4): The Trigger Point Model

In the last blog, we discussed the first model (The Radiculopathy Model) that helps explain why Dry Needling works.  Now we will continue with the second of four models.   This one is probably the most well-known one and there is a plethora of medical literature supporting it.  Again, we will try to explain any concepts that are a little difficult to understand.  These models really shed light into how our bodies work and they are great to learn about.

The Trigger Point Model

Myofascial Trigger Points (MTrPs, or TrPs for Trigger Points) are defined as ‘hyper-irritable spots in skeletal muscle that are associated with a hypersensitive palpable nodule in a taut band’ (Travell and Simons).  The resultant pain/discomfort that one gets due to such points is referred to as myofascial pain syndrome (MPS).  Simply put, MPS is defined as ‘sensory, motor, and autonomic symptoms caused by myofascial trigger points’ (Travell and Simons).  Sensory symptoms refer to what you feel, motor symptoms refer to how the muscles work, and autonomic symptoms refer to the things that you do not realize.  This seems a little odd, but consider what happens when you bang your arm really hard.  You will feel the pain (sensory), the muscle might be painful and not contract properly (motor), and your heart rate goes up as does your respiration due to the ‘adrenaline rush’ (autonomic) of the injury. Continue Reading →

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Dry Needling Support Models (1 of 4): The Radiculopathy Model

Dry Needling Support Models (1 of 4): The Radiculopathy Model

We get a lot of questions about Dry Needling and the next few blogs will address several theories that support the treatment.  There is currently a good amount of medical literature supporting Dry Needling and this is great, but the theories behind Dry Needling are fascinating and interesting to discuss.

The 4 models are as following:

1.  The Radiculopathy Model
2.  The Trigger Point Model
3.  The Spinal Segmental Sensitization and Pentad Model
4.  The Central Model

Each of the next 4 blogs (including this one) will discuss one of these theories as it relates to Dry Needling.  We hope this gives you a better understanding as to why Dry Needling works so well.  We are aware that the models tend to use medical terminology and can be a little hard to follow, so we will try to explain things as we go to make the explanations easier to understand. Continue Reading →

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Oxidative Stress and Low Back Pain

Oxidative Stress and Low Back Pain

A new study in the high impact orthopedic journal Spine discusses what we have seen for some time with patient care but have not been able to validate in the literature: oxidative stress contributes to low back pain.

This is a topic of huge importance.  As our patients know, we use a Raman Spectrometer (Biophotonic Scanner), not unlike the one Yale uses in their studies,  to determine the oxidative stress of our patients through means of a dermal carotenoid scan.  The Raman Spectrometer (RS) has been determined in many studies to offer clinicians the optimal way to analyze oxidative stress as the test is not costly to perform, is not invasive, and it makes it easy to track changes in diet/nutrition/supplementation.  This is important for all healthcare providers.  Being a sports chiropractor, I find the RS to be an absolute necessity for all of us who work in the neuromusculoskeletal fields.  Simply put, if we cannot assess oxidative stress, we have no idea if our patients are healthy and this directly affects clinical outcomes.  This is not only limited to low back pain.  We are not what we eat, but what we absorb. Working with unhealthy patients reduces the effectiveness of our treatments and we should know this before we commence treatment.  This is only fair to the patient. They need to know if they have hindered healing ability or not.

Continue Reading →

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Hyperbaric…This Is What You Want To Breathe!

Hyperbaric…This Is What You Want To Breathe!

I recently wrote a letter to the Maryland Board of Chiropractic Examiners on the topic of allowing us to use mild Hyperbaric Oxygen Therapy (mHBOT)  in-office. I had been exposed to patients/doctors utilizing it with great results over the years when I worked at various sporting events and I wanted to add this amazing technology to my office to help my patients.  I am happy to say that at the June 2014 meeting, the Board determined that Hyperbaric Oxygen Therapy can be included under the scope of practice for chiropractors in the state of Maryland. I’m so excited my patients can now benefit from it and you should be excited too!

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Assessing Movement…The Utter Importance of Ankle Dorsiflexion

When assessing a patient who presents with lower extremity pathology, we tend to get fixated on the chief complaint.  A person complains of knee pain, and we look at the knee…they have right calf pain, we look at the calf.  A hip is tight/sore, we look at the hip.

The longer I practice and the more well-versed I get with movement assessments, a certain pattern of dysfunction seems to dominate over others.  Now, we know that no one condition is an absolute, but this one does play in significantly, and it will throw off your entire movement.

Continue Reading →

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Dr. Manison Gets Case Study Published on Cox Flexion/Distraction Technic For Cervical Spine Disc Herniation

Dr. Manison Gets Case Study Published on Cox Flexion/Distraction Technic For Cervical Spine Disc Herniation

Dr. Manison was published in the Journal of Chiropractic Medicine (JCM), one of the two medically indexed chiropractic journals.  This is a huge accomplishment and he is very excited about this.  Writing the paper and going through the editing process took about 100 hours of time.  It was a very tough and humbling experience, and he is very happy with the end result.

Most clinicians, or field doctors, do not have the time or skill to write a paper for medical publication.  Dr. Manison feels that it is important to continue to work hard to be the best doctor he can be as well as give back to the field.  If there are no studies on the successes of chiropractic, it is hard to justify the care.  The more those in the chiropractic field publish the good work we do, the better.

Dr. Manison would like to thank his wife and editor extraordinaire, Jennifer Hepps, MD, for her help with the paper.  Dr. Hepps is very accomplished in her field and her insight and direction were critical to the success of his paper.  When they say behind every man there is a great woman, this is truly the case!

We would include the entire study here but are not allowed to do so…however, please click the link below to view the abstract.

Chiropractic management using Cox cervical flexion-distraction technique for a disk herniation with left foraminal narrowing in a 64-year-old man

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The Case Against MBTs and Sketcher’s Shape-ups

If you’re interested in a shoe to help you with toning up and you’re considering purchasing an expensive pair of one of those new and cool rounded shoes on the market, please read on.

Sketchers and MBT lead the way in this category with their ‘shaping’ shoes, or shoes that are supposed to help you tone up while you walk.  In theory, this sounds great…work on an activity that should tone you up just by doing it, and tone up because of the footwear you choose versus the activity you are performing…and, of course, there is no downside?? 

MBT (and Sketchers similarly) has set out to copy the feel of walking on soft ground…and by making the ground feel as though it is not flat.  In effect, the shoes try to  create a feeling of instability.  The makers say that by altering your gait and creating instability, your body will adapt by creating more stability. Really?  Where does this come from?

The little video on the MBT website shows a depiction of someone wearing their shoes and walking upright, while those of us who do not wear their footwear lean forward (of course, there is a disclaimer that says results will vary).  I don’t know where to start with criticism of this as I could go on for pages, so I’ll keep it simple by saying that there is a lot more to gait than simply what you wear on your feet.  There is no hard science that has shown that wearing a rounded shoe makes you walk upright while the rest of humankind is hunched over simply due to a traditional shoe…for that matter, I’ll argue that such shoes are NOT good for you.  Here are just a few of the reasons…

1.  Gait begins with heel strike, proceeds to mid-foot loading, and ends with toe off (Windlass Effect of Hicks that involves the Great Toe).  The idea of a shoe creating instability while you walk in no way contributes to helping to ensure that your gait cycle is correct.  In fact, the compensation that they are looking for may just be that…compensation…meaning, you are not functioning properly and your body will do whatever it can to just simply function…does this sound beneficial?

2.  The primary shock absorber of the body is foot pronation, followed by unlocking of the knee.  With these shoes, the emphasis is not on the PROPER biomechanics of the foot, but rather on the instability notion…do your feet properly pronate with these shoes or do you just quickly roll over the mid-stance phase?  (more likely the latter)

3.  About that instability…most of us cannot even balance on one foot on a stable surface.  Why would we want to use a shoe that effectively stresses out our body and may actually NOT help build stability, but lead to injury.  I wouldn’t take a patient who is rehabilitating from pain and dysfunction due to a two level disc herniation and start them with core balance work on a bosu ball. This simply wouldn’t make sense and further injury would likely occur.  They would start with level one exercises and proceed from there.  With these shoes, I cannot figure out why creating instability is the goal…just because you create instabiliy does not mean the body will appropriately adapt by becoming stable.  The end doesn’t justify the means.

4.  Who thinks the foot ‘rolls’ when you walk?  I’ve never seen anything that says this.  If you accelerate the foot though the gait cycle in a fashion that it is not supposed to, you will likely create more harm than good.  The foot is made to strike the ground in a particular fashion, load in a certain manner, and come off the ground in a very specific way.  Failue to do this will lead to injury.  With these shoes, you are likely bypassing critical cycles of gait that are there so that you absorb impact properly.  It is not a good idea to alter the gait cycle.

The list goes on…

The bottom line is that any footwear should be geared toward allowing your foot to work as it is programmed to do.  Those who have excessive pronation or supination should have functional orthotics to help with restoring proper gait mechanics (as much as possible).  The notion that these shoes help to tone you more than just being active has no merit.  Period!  If you feel your calves more when you walk with these shoes, it’s because you are altering your gait…and this is something you really don’t want to do.

Putting celebrity names, like Kim Kardashian and Joe Montana, on ads and in commercials does not a good product make.  We’re dealing with force transmissions through the body that can lead to potential injury all the way up your legs and into your spine.  If you want to get toned up…exercise…don’t look for a shoe without hard science to do the work for you…it’s likley not worth the injury risk.

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