Our approach to care starts with a thorough exam. We look at not only the area of pain you may be having but all the regions of the body. Our reasoning for this is based on the principle of Regional Interdependence. This model was referenced in the Journal of Orthopedic and Sports Physical Therapy and refers to the concept that
"...seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, your primary complaint."
Once we determine what regions are affecting you, we can address the systems that are causing the region to malfunction.
This malfunction can be the result of one or a combination of the following:
- Joint dysfunction: Hypo(too little) or Hyper(too much) mobility
- Soft-Tissue Dysfunction: Trigger Points, Adhesions, tendonosis)
- Motor control issue: Weakness in muscles or muscle groups
- Structural Change: Arthritis, Torn ligament or muscle
For over 100 years, Chiropractic has been focused on maintaining the proper functioning of joints. We use joint mobilization, manipulation and stabilization strategies to maintain the proper functioning of the joints. Joints are rich with proprioceptors which are nerves that help determine position sense and pressure, When the joint is dysfunctional, this can send inappropriate signals to the nervous system and cause inappropriate signals out to the body. Investigate proprioception on yourself by standing with your eyes closed. When your eyes are closed, you are relying primarily on the proprioceptors in your body to balance.
There are many, many types of soft-tissue dysfunction that can occur. One of the most commonly used terms is a Trigger Point. There are several types of trigger points as well as theories to describe how they occur. Because there are many causes for these dysfunctions, it is important to have someone understand the mechanisms underlying these conditions to address them properly. The treatments may include stretching, strengthening, activity/technique modification, massage, bracing etc. You may have one area that can benefit from one type of massage and another that may benefit from strengthening a separate part of the body (Regional Interdependence). Addressing only one part of the equation will often result in only temporary relief of symptoms (2-3 days). One of the primary tools I use for treating soft-tissue dysfuction is Active Release Technique (ART). ART is effective at dealing with trigger points, fascial adhesions, nerve entrapments and restricted joints.
Motor Control Issues:
Weakness is not just something that occurs from not working out but it can also occur as a result of injury or training. Our joints and muscles should work in a coordinated effort but often times we have deficits that change the way we move and react to conditions. A classic example was investigated by Vladimir Janda. He recognized that people with weak or poorly activated gluteus maximus muscles would instead use their back muscles to extend their hips. The over use of the back muscles and joints would lead to back pain. If you simply massage these painful and over worked muscles, you provide more capacity for the muscles to work but never address the underlying problem. These abnormal movement patterns can occur anywhere in the body but are most commonly seen the lower back, upper back, neck, knee, and foot. I make it a priority to understand where your faulty patterns occur and you understand how to manage them.
Structural change can occur from trauma, overuse, metabolic, or other mechanisms. When the structure is changed, this can have an effect on function. I try to manage the functional changes that occur whether or not there are structural changes. Having an understanding of the structural changes that have occured helps us to understand the prognosis for your condition so you can make the right informed choices for your care. We will communicate with surgeons and other members of your medical team to make sure you have the best outcome for your condition whether that includes surgery, bracing or other therapeutic procedures.
Taking a comprehensive approach to not only your area of pain but also understanding the associated patterns that may be contributing to your condition can result in a quicker and more effective outcome.