• Comprehensive Musculoskeletal & Nutritional History Review
• Postural, Palpatory & Orthopedic/Neurological Examination
• Imaging Studies: X-ray & MRI, CT scan, etc.
• EMG/NCV Studies
• Lab Testing: Blood Chemistry, Saliva, Urine, Stool Analysis

• Chiropractic Adjustments
• Therapeutic Modalities-Electrical Muscle Stimulation, Ultrasound, Laser therapy, etc.
• Exercise Rehabilitation
• Vitamin/Herbal Supplement & Homeopathic Therapy
• Ergonomic & Injury Prevention Education
• Deep Tissue and Myofascial Release Therapy
• Pilates, Yoga and Vibration Therapy

Treatment Solutions

Spinal Manipulation:

Manipulation is the art of moving a synovial joint suddenly beyond its normal range of movement. This accomplished by quick and careful thrust or impulse that often results in a cracking noise. The noise is simply Carbon dioxide gas pockets filing up with fluid within the joint itself.

Manipulation in North America is primarily performed by the Chiropractors and to lesser extent by Osteopaths.

Manipulation has much to offer the patient with uncomplicated acute back pain as well as the chronic back patient.

The Therapeutic Effects of Manipulation:

Reflexive Inhibition of pain

• Reflexive Relaxation of guarded or spastic muscles
• Increase in joint range of motion
• Breaking up of post injury scar tissue and adhesions
• Stimulation of joint and muscle receptors
• Reflexive autonomic nervous system stimulation resulting in vasodilation of blood vessel causing increased blow flow to the joints and visceral organ systems

The Indications for Manipulative Therapy

Facet and sacroiliac joint dysfunction

The Contra-Indications:

Relative (Meaning modification of technique or a gentler approach)

Absolute:

• Destructive lesions of the spine, ribs and pelvis (Cancer, etc,)
• Healing fracture or dislocation
• Gross instability
• Cauda equine syndrome
• Large abdominal aneurysm
• Visceral referred pain

Clinical Trials:

The scientific literature reveals that their have been more clinical trials of manipulation for low back pain than for any other treatment approach. The literature has shown the manipulation is both effective acute and chronic back pain. Patients also improved more rapidly with manipulation when compared to other treatment groups receiving alternate therapy such as mobilization within each respective study.

Cryotherapies (cold)

Cold therapy is probably one of the most effective treatments for acute musculoskeletal pain especially within first 48 hours from the onset of injury. Treatment methods include ice massage with an ice cube, cold packs and coolant sprays to immersion.

Therapeutic effects of cyrotherapy

Reduced nerve conductivity

• Analgesia (pain relief)
• Reduction cell metabolism
• Vasoconstriction of blood vessels (decreased blood flow)
• Decreased exudates (inflammatory chemicals)
• Decreased capillary pressure
• Reduction in spasm
• Increased musculature tone
• Decreased Edema (swelling)

Indications for cryotherapy:

Inhibit bleeding after acute trauma

• Pain relief through spasm reduction
• Decrease blood flow to area of acute inflammation
• Spasticity
• Burns
• Sprains/Strains

Contraindications:

Raynausd disease

• Chilbain
• Coma
• Rheumatoid or gouty arthritis
• Cryesthesuis
• Paroxysmal cold hemoglobinuria

Heat Therapy:

Heat therapy as a modality for treating pain has been around as long mankind and is applied in a variety of ways:

Superficial Heat Therapies

Electric Pads

• Fluidotherapy
• Hot moist packs
• Hot water
• Hydrocollator packs
• Incandescent lamps
• Microwaves
• Paraffin dips
• Radiant Heaters
• Sauna-like hot air
• Steam baths
• Sunlight
• Ultraviolet lamps
• Warm sand & mud
• Whirlpools

Deep Heat Therapies:

Shortwave diathermy (Diathermy means deep heating; a procedure by which body heat is elevated by passage of a high frequency current through tissue. The heat that develops in the tissue results from resistance offered by tissue constituents to the passage of the electrical current)

• Microwave (Higher frequency than Shortwave)
• Ultrasound (Ultrasound refers to acoustic vibrations that penetrate into the deeper layers of tissue)

The surface effect of heat on tissue is essentially the same but the deeper effects vary according to the type of heat modality used and vascularity of the area treated. Heat is transferred to the body through three methods: conduction-the exchange of heat between two objects; convection-the exchange of heat between a surface and a fluid moving over that surface; radiation-transfer of heat through air.

The Therapeutic Effects of Superficial Heat:

Pain relieving (analgesic) calming effect

• An increase in local metabolism
• Sedation of sensory nerves through the release of endorphins, natural opiates produced by the body
• Arterial & capillary dilation leading to increased oxygen, nutrients, immune response and elimination of waste products

Therapeutic Effects of Deep Heat:

Diathermy

Thermal (tissue heating)

• Stimulation of histamine and sensory nerve ending's that cause capillary dilation
• Increased capillary pressure Increased blood flow
• Increased oxygenation of damaged tissues
• Increased rate of tissue healing
• Detoxification
• Muscle relaxation
• Hormone stimulation
• Increased internal organ circulation

Microwave treatments are similar to diathermy but are less intense with less penetration into internal organ systems.

Ultrasound

Thermal effects cause an increase in peripheral circulation & metabolic rate, membrane permeability, and causes temporary block of peripheral sensory nerve endings

• Micromassage of tissue
• Scar tissue breakdown
• Increased cellular oxygenation
• Edema ( swelling) reduction
• Pain relief

Indications For Superficial Heat:

• Pain Relief
• Relaxation spastic or taught muscles
• Increase local vascular & lymphatic circulation
• Increase metabolism
• Lower blood pressure
• Increase urinary output
• Enhance nutrition
• Promote sweating

The Indications for Deep Heat Therapy for neck & back related problems:

• Facet Syndrome
• Intercostal neuralgia
• IVD syndrome (e.g., sciatica)
• Myalgia
• Trigger Points
• Osteoarthritis
• Strains/Sprains
• Spondylosis
• Spondylitis
• Neuralgia

General Contraindications:

• Infection
• Deficient blood supply
• Diminished sensation
• Cancerous Tumors
• Bleeding disorders
• Over acute inflammation or edema ( swelling)
• Over a pregnant uterus
• Tuberculosis
• Skin disorders-sunburn, rash, gangrene, etc.
• Infants, elderly, severely disabled
• Over ointment or lotions
• Recently formed scars
• Metal, rings bracelets
• Eyes
• High Fever
• Metallic implants
• Over the heart
• Over the spinal cord after laminectomy
• Acute radiculitis

Electrical Stimulation therapy:

The purpose of electrical stimulation therapy is to essentially exercise muscles after injury, develop muscular strength and tone, trigger chemical changes, alleviate pain, and break muscle spasm. There are basically four types of electrical therapy: low frequency, high voltage, interferential and micro-current.

Therapeutic effects of electrical stimulation therapy

• Develop muscular strength and tone,
• Trigger chemical changes,
• Alleviate pain,
• Break muscle spasm
• Edema reduction (Swelling)
• Tissue Healing
• Increasing circulation

Indications electrical stimulation therapy:

• Acute trauma
• Adhesions
• Arthritic complaints
• IVD Syndromes
• Joint pain
• Lumbago (Back Pain)
• Neuralgia (Nerve pain)
• Neuritis) Nerve inflammation
• Myalgia (Muscle pain)
• Myositis
• Osteoarthritis
• Pain
• Psoas Syndrome
• Sciatica
• Spasm
• Spondylitis
• Spondylosis
• Spain/Strains
• Trigger Points

Contraindications electrical stimulation therapy:

• Impaired cutaneous sensation (Skin sensation)
• Implanted pacemaker
• Metallic joint, pins or IUDs
• Near heart
• Over metallic implants
• Over Scars and Adhesions
• Over the low back or abdomen during pregnancy
• Metastatic carcinoma
• Tanscerebral application (across the skull)
• Treatment on a metallic table

Traction Therapy:

Traction therapy is the act of drawing pr pulling a body part or parts by any means. Traction can either be applied continuously or intermittently through use of mechanical pulling device or manually. Other forms of traction therapy include gravity inversion and intersegmental traction.

Fro low back or neck pain, patient is fitted with harness that attached a cable that in turn is either attached to a weight or mechanical pulling device. The angle of pull is adjusted to line up perpendicularly with the joint line of the symptomatic joint. Treatment lasts 20-30 minutes.

Therapeutic effects of traction

To separate or stretch spinal segment and/or extra-spinal joint surfaces

• To promote distraction and gliding of joint facets
• To relieve muscle spasm
• To dissipate edema (swelling)
• To stretch fibrotic tissue
• To trigger proprioceptive reflexes
• To temporarily immobilize or splint parts

Indications for Continuous Traction:

• Articular/Facet Jamming
• Brachial Neuritis
• Compression Fracture
• Degenerative disc Disease
• Intervertebral disc syndrome
• Intervertbral foramen narrowing
• Kyphosis
• Lordosis
• Occipital Neuralgia
• Osteoarthritis
• Per-vertebral adhesions, contractures and fixations
• Scalenus anticus syndrome
• Scoliosis
• Spasticity
• Spinal nerve root impingement
• Spondylolisthesis
• Sprains
• Stimulation of mechnoreceptors
• Torticollis
• Whiplash syndrome

Intermittent Traction:

• Deficient intervertebral hydration
• Joint hypomobility
• Kyphosis
• Lordosis
• Occipital Neuralgia
• Osteoarthritis
• Perivertebral adhesions, contractures and fixations
• Perivertebral congestion
• Perivertebral hypotonicity
• Post traumatic edema
• Scoliosis
• Stimulation of mechnoreceptors
• Vascular & lymphatic stasis

Contraindications Traction Therapy:

• Dizziness
• Nausea
• Undue discomfort
• Other adverse sensory changes (e.g. numbness)

Therapeutic Exercise:

The goal of therapeutic exercise in the rehabilitation of neck & low back pain is to achieve symptom free movement and function. This is achieved through improving low back & neck strength, endurance & cardiovascular fitness, mobility & flexibility, relaxation, coordination and skill. This improvement also takes place in a positive, progressive & appropriately planned manner to allow the individual to return fully to the demands of daily living.

Therapeutic effects of exercise:

Strength is improved through movement of a load that exceeds the metabolic capacity of muscle during exercise. This leads to muscle hypertrophy and the recruitment of additional muscles leading to increased strength. (22) In order to achieve an adaptive change in strength, the muscle is exercised to the point of fatigue. (17) An increase in strength is inversely associated with decrease in pain.

Endurance & Cardiovascular fitness is necessary for performing repeated repetitive tasks in daily living and carrying on a sustained level of functional activity, such as walking or climbing stairs.

Endurance work leads to increased blood flow due to the muscles need for more oxygen, heart rate, arterial pressure & rate and depth of respiration and adaptive changes that includes increased vascualrization of the muscle, cardiac output & stroke volume and decrease in resting heart rate.

Mobility & Flexibility in addition to strength and endurance is necessary for the performance of normal functional joints. Soft tissues (muscles, ligaments, tendons, and fascia) and joints continually elongate and/or shorten. If this normal movement is restricted it can lead to adaptive shortening (tightness) of soft tissue and joints. This can occur as a result of disease or trauma, which can cause pain, weakness, or inflammation, and lead to impaired mobility caused by muscles contracture, scar tissue or joint capsule restriction.

Type's of mobility exercises:

• Passive stretching that is accomplished either by manual techniques such massage or myofascial release; mechanical stretching applied by a machine such as spinal traction; or positional stretching where the stretch is applied opposite to the shortened muscle.
• Reflex inhibition using the shortened muscle to contract or shorten first that is followed by stretching in the opposite direction of shortening
• Flexibility exercises performed by the individual to elongate shortened tissue.
• Joint mobilization applied passively to restore normal joint movement.
• Relaxation is a conscious effort to relieve tension in muscles. Prolonged tension can lead to pain that in turn can lead to spasm and more pain. This relaxation is accomplished through reciprocal inhibition in which the muscle is tightened as much as possible followed by a deep exhalation and relaxation or through biofeedback and transcendental meditation.
• Coordination & Skills form the basis of smooth efficient movement, which often occurs simultaneously. This accomplished through stimulation of the sensory system, which includes is touch pressure, heat, cold, vibration, auditory, visual and body position awareness senses to stimulate the neuromuscular system & constant repetition with increase in speed of activity over time. Various techniques have been developed to accomplish these goals such proprioceptive neuromuscular facilitation (PNF).

Indications for therapeutic exercise:

• Pain
• Muscular atrophy
• Soft tissue inflexibility
• Joint hypomobility & dysfunction
• Scar tissue adhesions and muscle contractures
• Cardiovascular reconditioning
• Lack of coordination
• Chronic muscle tension

Contra-indications:

• Infectious disease
• Destructive lesions of the spine, ribs and pelvis (Cancer, etc,)
• Healing fracture or dislocation
• Gross instability
• Cauda equine syndrome
• Large abdominal aneurysm
• Visceral referred pain

Orthopedic Aids, Analgesic Creams, Supplements, Ergonomic Accessories & Furniture.