September 2009

The intersection of rehab and technique

by Dr. Mark Payne

Chiropractic has traditionally been concerned with various methods of adjusting misaligned or dysfunctional spinal segments. During the adjustment process, the patient is generally a passive recipient of the thrust administered by the doctor. Hence the term, "passive care." Rehabilitation on the other hand, typically requires patients to do more than just relax while receiving treatment.

Whether the activity is spinal strengthening, cardiovascular exercise, or neuromuscular reeducation, most rehab requires active participation ("active care") by the patient with the doctor functioning more as a coach or facilitator. Consequently, spinal adjusting and rehab have traditionally been viewed as completely separate subjects.

But where do we draw the line of distinction between the two when active care procedures such as exercise, or stretching, both traditionally seen as "rehab" activities, are employed for the purpose of correcting spinal subluxation? When it comes to postural imbalance, we are reaching a point where rehab and technique are beginning to overlap.

Consider this example.

The first two photos (Figs. 1 and 2) show a common postural imbalance and the profound effect on the cervical lordosis. Many doctors are familiar with a common drop table adjustment for restoring the cervical lordosis. The patient is placed prone in the reversed or opposite of their subluxated posture (Fig. 3). The idea here is to pre stress the spine into extension to maximize correction of the cervical lordosis before the thrust is delivered into the mid cervical area. This is a manual thrust delivered with the intent of correcting spinal misalignment/subluxation. I think it's fair to say most readers would probably agree this falls clearly under the heading of "technique." (Note: This method of adjusting actually isn't very effective at restoring the lordosis but it serves well for this example.)

The doctor might also choose to address the same loss of lordosis with traditional rehab procedures instead. In Fig. 4, the patient performs extension exercise to help restore the lordosis. Here's a classic rehab procedure, therapeutic exercise, employed for the specific purpose of correcting spinal subluxation. So is this rehab or technique? On the one hand, it's certainly active care. On the other hand, our therapeutic goal is now the structural correction of postural subluxation/misalignment. See how the lines become blurred?

Here's another example.

In Fig. 5, the patient performs extension traction of the neck to restore the cervical curve. While not exactly active care, the process still requires a level of participation by the patient. Certainly, most doctors wouldn't classify traction as an adjusting technique and yet, the purpose here is exactly the same as that of the adjustment -- to correct subluxation of the neck.

In fact, some procedures might be better defined by the therapeutic goal. When patients perform therapeutic exercise to improve muscular function, it's obviously rehab. But, when therapeutic exercise is done to correct spinal misalignment, the goal becomes identical to that of many adjusting techniques. Similarly, when patients perform spinal traction for pain relief, most of us probably wouldn't consider it to be part of our technique. On the other hand, 20 minutes of extension traction to correct postural subluxation starts to look like more of a slow, sustained adjustment once you consider the real purpose.

Semantics aside, the bottom line on how you view various procedures will ultimately hinge on your chiropractic paradigm. Once you consider subluxation from a postural perspective, it opens the door for new applications of old, standard therapeutic procedures. Try considering other treatment methods from the perspective of improving your patient's posture as well. How might that change your application of methods like PNF stretching, active release, or even perhaps electro therapies like EMS if you happen to use those in your practice? What about patient education regarding activities of daily living? Or why not even posture-based massage?!

By just stretching your paradigm a bit, you may well find the opportunity to add valuable new tools to your arsenal of corrective care procedures.

(A 1979 graduate of Life Chiropractic College, Dr. Mark Payne is the president of Matlin Mfg., a manufacturer and distributor of postural rehabilitation products since 1988. For more information regarding issues, products or methods discussed in this column and to learn more about implementing postural rehab into your practice, call 334-448-1210 or link to www.MatlinMfg.com for the FREE REPORT, "The Best Corrections of Your Career.")

Fig. 1 Patient with typical head forward/neck flexed posture.

Fig. 2 X-ray of patient with flexed neck posture and cervical hypolordosis.

Fig. 3 Reverse posture adjusting attempting to restore cervical lordosis.

Fig. 4 Cervical extension exercise to restore normal lordosis.

Fig. 5 Extension traction to restore the lordosis: Rehab or technique?