The Omega-6/Omega-3 Ratio and Innate Neurological Function

Dan Murphy, DC—

Private Practice of Chiropractic;
Diplomate American Board of Chiropractic Orthopedist;
Faculty Life Chiropractic College West;
Vice President ICA 2003-2009;

ICA Chiropractor of the Year 2009

INTRODUCTION

Chiropractors pride themselves on improving the function of the nervous system by improving spinal mechanical integrity. However, it is also know that optimal neurological function requires a narrow, innate balance of omega-6 / omega-3 fatty acids. A recent article by physician and geneticist Artemis Simopoulos explores this relationship, and I have reviewed her article below:

Evolutionary Aspects of Diet: The Omega-6/Omega-3 Ratio and the Brain Molecular Neurobiology October, 2011; Vol. 44; No. 2; pp. 203-215

• ·      LA = linoleic acid (plant derived omega-6 fatty acid)
• ·      ALA = alpha linolenic acid (plant derived omega-3 fatty acid)

Dr. Simopoulos cites a number of sources indicating that human beings evolved on a diet that had a ratio of omega-6 to omega-3 fatty acids (FA) of about 1/1. Today, Western diets may have a ratio 25/1. Western diets are deficient in omega-3 FA compared with the diet on which humans evolved and their genetic patterns were established.

Omega-6 and omega-3 FA are important components of practically all cell membranes. The omega-3 FA docosahexaenoic acid (DHA) is essential for the normal functional development of the brain and retina. DHA accounts for 40% of the membrane phospholipid FA in the brain.

The omega-3 FAs eicosapentaenoic acid (EPA) and DHA have an effect on membrane receptor function and even neurotransmitter generation and metabolism.

The balance of omega-6 and omega-3 FA is important for homeostasis and normal development throughout the life cycle.

KEY POINTS FROM THIS STUDY INCLUDE:

1. Nutrition is an environmental factor that influences gene expression.
2. Major changes have taken place in our diet over the past 10,000 years since the beginning of the Agricultural Revolution, but our genes have not changed.
3. The major changes that have taken place in our diets in the past 10,000 years include:

a)     An increase in energy intake and decrease in energy expenditure;

b)    An increase in saturated fat;

c)     An increase in omega-6 fatty acids;

d)    An increase in trans-fatty acids;

e)     An increase in cereal grains;

f)     An increase in fruit and vegetable intake;

g)     A decrease in omega-3 fatty acid intake;

h)    A decrease in complex carbohydrate intake;

i)      A decrease in fiber intake;

j)      A decrease in protein;

k)    A decrease in antioxidants;

l)      A decrease in vitamin D;

m)   A decrease in calcium intake.

1. “The beneficial health effects of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were described first in the Greenland Eskimos who consumed a high seafood diet and had low rates of coronary heart disease, asthma, type 1 diabetes mellitus, and multiple sclerosis. Since that observation, the beneficial health effects of omega-3 fatty acids have been extended to include benefits related to cancer, inflammatory bowel disease, rheumatoid arthritis, psoriasis, and mental health.”
2. The change of omega-6/omega-3 ratio in the food supply of Western societies has occurred over the last 150 years.
3. “During evolution, omega-3 fatty acids were found in all foods consumed: meat, wild plants, eggs, fish, nuts, and berries.”
4. Today in Western societies the omega-6/omega-3 ratio is very high due to the high intake of soybean oil, corn oil, sunflower, safflower, and linseed oil.
5. The omega-6/omega-3 ratio is associated with normal “growth and development, as well as in the outcome of hypertension, cancer, arthritis, mental health, allergies and other autoimmune diseases,” as well as the “pathophysiology of atherosclerosis, inflammation, and aging.”
6. “DHA is found in high amounts in the membranes of brain and retina and is critical for proper neurogenesis, neurotransmitter metabolism, neuroprotection and vision. The consumption of high amounts of DHA has been associated with multiple health benefits including brain and retinal development, aging, memory formation, synaptic membrane function, photoreceptor biogenesis and function, and neuroprotection. DHA is essential for pre-natal brain development.”
7. Omega-3s cause apoptotic death in cancer cells whereas omega-6s allowed the cancer cells to continue to proliferate. 
8. Diets with a high omega-6/omega-3 ratio may enhance the risk for both depression and inflammatory diseases.
9. “Clinical studies show that cognitive performance improves with omega-3’s.”
10. Omega-3’s can affect not only cognitive functions, but also mood and emotional states and may act as a mood stabilizer. Omega-3’s have beneficial effects in some neurological diseases in addition to the chronic fatigue syndrome.
11. Omega-3 deficiency in childhood delays brain development, and produces irreversible effects, while the same deficiency in aging accelerates the deterioration of brain function.
12. Omega-3 intake from ALA does not provide adequate intakes of EPA and DHA.
13. “Western diets are characterized by high omega-6 and low omega-3 fatty acid intake, whereas during the Paleolithic period when human’s genetic profile was established, there was a balance between omega-6 and omega-3 fatty acids. Therefore, humans today live in a nutritional environment that differs from that for which our genetic constitution was selected.”
14. “The balance of omega-6/omega-3 fatty acids is an important determinant in maintaining homeostasis, normal development, and mental health throughout the life cycle.”
15. The AA/EPA ratio has been proposed as an index for the omega-6/omega-3 ratio.
16. Omega-3 deficiency in the brain is associated with “decreased learning ability, with a lower synaptic vesicle density in the hippocampus; whereas, chronic administration of omega-3’s improves reference memory-related learning probably due to increased neuroplasticity of the neural membranes.”
17. “Cognitive performance improves with omega-3’s supplementation possibly due to increased hippocampal acetylcholine levels, the anti-inflammatory effects of omega-3’s, decreased risk of cardiovascular disease or increased neuroplasticity.”
18. Omega-3 fatty acids have positive effects in patients with dementia, schizophrenia, depression and other central nervous systems diseases.
19. Omega-3 fatty acid supplementation could play a role in reduced hostility and violence.
20. “In carrying out clinical intervention trials, it is essential to increase the omega-3 and decrease the omega-6 fatty acid intake in order to have a balanced omega-6 to omega-3 intake.”
21. “In humans, the brain is the most outstanding organ in biological development: it follows that the priority is brain growth and development, and in the brain the balance between omega-6 and omega-3 PUFA metabolites is close to 1:1. This ratio should be the target for human nutrition.”
22. “The ratio of omega-6/omega-3 fatty acids in the brain between 1:1 and 2:1 is in agreement with the data from the evolutionary aspects of diet and genetics.”
23. “A ratio of 1:1 to 2:1 omega-6/omega-3 fatty acids should be the target ratio for health.”

COMMENTS FROM DAN MURPHY

The omega-6/omega-3 fatty acid ratio (AA/EPA) is innately critical for brain function, heart health, immunity, joint health, pain syndromes and more. I believe that everyone should have the AA/EPA ratio tested to see if they are in the “target ratio” of 1-2/1, AA/EPA.

Several labs offer testing of the AA/EPA ratio. The test is called Bloodspot Fatty Acids 0241. The test is a finger prick draw, not venipuncture. If you would like information on the lab I personally recommend, contact me at dan@danmurphydc.com.

Some nutritional companies offer more optimal ratios of ALA, EPA, DHA, and GLA. If you would like information on the omega-3 oils I personally recommend and take for myself, contact me at dan@danmurphydc.com.

The target ratio’s of EPA/DHA is different for children and adults. To achieve their “target ratio” most adults need to consume 3,000 mg/day of EPA+DHA

CCE: Poised to Dilute Chiropractic Education

James Musick, DC

Dr. Musick is currently Western Regional Director and on the Board of the International Chiropractors Association and serving on ICA’s CCE (watchdog) Committee. He has served on the CCE Board of Directors, as a CCE Commissioner on Accreditation and on multiple CCE site visitation teams. He is one of the founders and incorporators of Pacific States Chiropractic College (now Life West) and President of Northern California College of Chiropractic (now Palmer – West).

I had the opportunity to develop the curriculum for two different chiropractic colleges in the mid to late 1970s; first Pacific States Chiropractic College (PSCC, now Life – West) and secondly, Northern California College of Chiropractic (NCCC, now Palmer – West). 

To comply with California Law, CCE accreditation was required. CCE mandated that each college disclose whether-or-not the institution provided all necessary educational requirements for each respective state.  If an institution did not provide any necessary requirements in a given state, the college had to disclose that fact to prospective students through their college catalog. 

In order to qualify students for chiropractic licensure in all states, it was a simple task of evaluating minimal educational requirements for each state, then developing a curriculum, fulfilling the state with the highest number of hours, per subject. 

For example, in California the requirement is a minimum of 4,400 hours of chiropractic education for licensure in this state (16 CCR, Art. 4, Sec. 331.12.2).  More specifically, California requires 616 hours in anatomy.  If another state required 800 hours in anatomy, the minimum hours taught in anatomy would have to be 800 hours in order to qualify students for licensure in both states. 

Following this process, the total number of hours required of the institution, at that time, to satisfy minimal educational requirements for all states was around 4,800 hours. This would qualify a chiropractic graduate to practice in any state, regardless of the state’s slant toward a narrowed or broad scope practice. 

Both PSCC and NCCC elected not to teach minor surgery, an Oregon requirement.  In fact, chiropractors (and therefore our students) were prohibited by California law from puncturing or penetrating the skin.  So, to develop a curriculum to provide requirements for Oregon (in a different state), the college would have to include the estimate of 4,800 hours, plus those required by Oregon to do minor surgery. 

Assuming each college is meeting CCE and all respective state educational requirements, each graduate going into a state requiring a subluxation analysis or diagnosis, requiring exceptional adjusting skills, or mobilization or manipulation skills, should be well trained to do so, and should know the difference between a specific adjustment, mobilization and a manipulation. 

States requiring a strong emphasis and training in the examination and diagnosis of neuromusculoskeletal conditions, and the use of physical and manual methods, should be well educated and trained to meet the minimal requirements for that respective state.  To remind you, I graduated in 1972 from a straight college but chose to practice in California. 

Regardless, the chiropractic licentiate is well trained in approximately 4,800 hours to meet minimal licensure requirements for all states.  Therefore, a patient should have some idea of what to expect from a chiropractor when traveling from one chiropractor to another, or from one state to another. 

Chiropractic education is unique, has a long lasting tradition and has produced well trained effective scenically based, subluxation based, chiropractors.

Consider the CCE proposed standards, to remove traditional cornerstones from chiropractic education, i.e.:  the use of the word “subluxation”, and the phrase, “without the use of drugs and surgery”.  The motivation is to allow colleges to teach proprietary drugs, medicine, injectibles and/or surgery, while maintaining their accreditation through the CCE. 

Remember, there is already a 4,400 to 4,800 hour requirement to meet minimal state requirements for licensure.  Does this mean that additional hours are necessary to teach added courses, such as minor surgery for Oregon?  Yes it does, because you really can’t dilute minimal state requirements for licensure and be state and CCE compliant for all states.

Consider minimal educational requirements for medical physicians at the time of their graduation.  The question is, “How much addition time would a medical school graduate need, to study, learn and do what chiropractors know and do?" 

The United Nations (UN), World Health Organization (WHO) has already evaluated this question (www.wfc.org > About WFC > World Health Organization > English > Annex 3).  According to WHO, the average graduate from medical school would need an additional 2,205 hours to know and do what chiropractors are trained to do.  Assuming their education is 4,400 to 4,800 hours that would mean that the medical graduate (and medical physician with no additional training in physical medicine) would have to go to chiropractic college for two to three additional years to obtain the same education and skill level as a graduate chiropractor.

If it takes 2,205 additional hours for a medical physician to be educated and trained as a chiropractor, how many more hours would it take for a chiropractor to be legitimately educated and trained as a medical physician? 

Assuming both first professional degrees are 4,400 to 4,800 hours, and it takes an additional 2,205 hours for a medical physician to train as a chiropractor, the math is simple.  The chiropractor would, also, need 2,205 hours to train as a medical physician, assuming all other course requirements were equal. 

There is nothing wrong with being a medical physician, if you accept the use of drugs and surgery.  However, to meet minimal state requirements for licensure, a chiropractic college cannot honestly dilute their current 4,400 to 4,800 hours and substitute those hours with courses in proprietary drugs, injectibles, pharmaceuticals and surgery. Outside admitting to fraud, an institution cannot meet all state educational requirements, and would have to add hours to their current curriculum to teach these additional courses.  

If an institution wishes to train students as medical physicians, simply add 2,205 hours in addition to the D.C. program, get their medical curriculum accredited through an appropriate accreditation agency, and leave the chiropractic curriculum, intact. Otherwise, the outcome is a partially trained medic and a partially trained chiropractor. 

Chiropractic institutions should already have an educational tract to educate medical physicians in chiropractic care. If the chiropractor wishes an MD degree, count on two - three additional years, not 75 to 95 hours for a weekend credential from a chiropractic college accredited, or not, by the CCE.  It is substandard care and dilutes chiropractic education and our profession. 

Think Zinc and D3 for the Cold and Flu

The cold and flu ‘season’ is coming to an end—nearly over so to speak—as spring is here. Of course, there is really no season for these virus strains as most recent research shows that the spikes found in wintertime incidence and prevalence of these two illnesses is largely dependent on shorter days with reduced sunlight hours and colder weather; both of which impact the amount of direct skin to sunlight exposure time of human populations. Problematically, the common cold and flu are two of the most widespread illnesses our societal populations face today and are among the leading causes of visits to physicians and loss time from work and school.

During this ‘seasonal’ time of year, the pro-flu-shot-vaccination campaign increases in its aggressiveness and intensity. Some of the recent strategies can be found popping up on bill boards across the US where the marketing campaigns target human social and emotional behaviors. The taglines read:

• ·      The flu ruins date night…
• ·      The flu ruins birthdays…
• ·      Etc…
• Lack of good Evidence for Vaccination

Of interest, in 2010, a Cochrane¹ analysis was published assessing the available literature evaluating the effectiveness of the flu vaccine for influenza in adults. They included 50 studies, with 40 clinical trials assessing over 70,000 subjects. The results were enlightening:

• The flu vaccine was found to be a poor match (approx. 1%) to the actual viral strain(s) affecting the population during that specific year.
• The flu vaccine had only a modest effect on reducing time off work in adults and had no effect on hospitalization or actual complication rates (pneumonia, transmission to others, etc.).
• Importantly, the inactivated vaccines caused ‘local harms and an estimated 1.6 additional cases of Guillain-Barre Syndrome’ per million vaccinations’.¹

• Natural alternatives for Innate Immunity

In addition to providing Chiropractic adjustments and spinal rehabilitation interventions, conservative care (health/wellness) based Chiropractors have generally advised their patient populations on nutra-ceuticals to enhance innate immunity for protection against the cold and flu viruses. Here’s a brief review of recent research on two of the main nutritional supplements Chiropractors should and do recommend for enhanced immunity.

• ·      Zinc-

A recent, 2011 systematic review by Singh et al², presented information based on the available randomized, double-blind, placebo-controlled trials using zinc for at least five consecutive days to treat, or for at least five months to prevent the common cold. They identified 15 studies that met their inclusion criteria: 13 therapeutic trials (with a total of 966 total subjects) and 2 preventive trials (with 394 total subjects). This review identified that intake of zinc was associated with a statistically significant reduction in the duration (p = 0.001) and the severity of the common cold symptoms (p =0.04). Additionally it was revealed that:

• ·      There was a significant difference between the zinc and control group
  for the proportion of participants symptomatic after seven days of treatment;
• ·     
• ·     
• ·     

Note that the adverse events from zinc supplementation seem a heck of allot better than the ones from vaccination! Also, not all zinc is the same, some studies show conflicting evidence due to a reduced bioavailability of zinc from specific formulations.

• Vitamin D

Vitamin D is fast becoming, if not already, the ‘Vitamin C’ of the current generation. It is a known fact that Vitamin D levels in the human body have an inverse trend to the cold and flu virus incidence and prevalence. It is currently accepted that vitamin D supplementation reduces the incidence of viral respiratory infections in children and adults.³ Recent evidence has been found that vitamin D has anti-viral and anti-microbial roles in the immune regulating system.⁴ One of the more compelling pieces of evidence for vitamin D’s role in protection against the flu comes from the 2010 randomized, double-blind, placebo-controlled trial by Urashima and colleagues.⁵ They⁵ found that vitamin D(3) supplementation during the winter months reduces the incidence of influenza A:

Summary

            Let’s face it, we’re all going to get run down, stressed out, and sick from time to time. Instead of running to the local cold and flu needle sticking shop, why not supplement with appropriate nutra-ceuticals to aid in the prevention of and lessening the severity/duration of the cold and flu. It appears to be just as effective, if not more, and safer to think zinc and vitamin D

References

PostureRay®: Better Software Based on the Best Structural Science!

This year we have released many exciting updates to our PostureRay® Radiographic EMR system.  In addition to its already exhaustive list of features geared to stimulate patient referrals and bullet proof your documentation, we have again added EVEN MORE requested features.  Here is a glimpse of the latest additions.

Pediatric Age-Related Segmental and Global Analysis:  Yes, you heard correct, we have released our modeling research findings in our software for inclusion of age-related specific normal for the pediatric/adolescent populations.  Earlier this year, Deed Harrison, DC, Tad Janik, PhD, and myself revisited our ideal and normal modeling studies to extrapolate age related normal using our published modeling for the Harrison Posterior Tangent Methods.  This again, is available nowhere else but in the PostureRay® CBP® module.

Updates Instability Analysis: We have included an optional upgrade to the Endplate (Cobb) analysis for instability pioneered originally by White and Panajbi – which was adopted by the AMA Guides.  In addition, we have also added Penning’s Analysis to better evaluate total instability within total range of motion.  This is crucial for doctors that work on patients involved in MVC’s and other injuries where cervical instability is to be assessed.

Lateral Full Spine Analysis:  Now available in PostureRay® you can digitize a lateral fullspine view and overlay the copyrighted CBP® elliptical fullspine model allowing much more accurate assessment of a patient’s true sagittal plane balance.  This has never been possible, and obviously is not available in any other software package on the market.

Phrase Builder – Since our system is geared as a Structural Based Radiographic Specific EMR, this unique addition will drastically reduce reporting by doctors to both educate patients as well as add impressions to a pathology report using our state of the art macro phrase builder/reporting system.

Nasium Analysis – New to PostureRay® is inclusion of the CBP® Nasium analysis, adding the completion of upper cervical analysis specific to CBP® Methods.

Support for 3^rd Party EMRs / PACs– We are currently partnering with all major vendors of documentation EMRs as well as 3^rd party PACs systems to allow tighter integration with patient demographic implementation and calling up of our QuickView Module.

Updated QuickView and Image Exporting: Doctors now have ability to display and export different variations of our analysis, especially for scoliosis cases.  This allows for adding overlay of annotated findings with impression report lines (such as Risser-Ferguson/Cobb Analysis/ or “patient  friendly” assessment lines 

Impression Report Updates with citations:  Since CBP® originally authored countless index medicus papers on x-ray reliability, validity, as well as the modeling studies, we have used this expertise, to generate specific reports and references to aid your documentation of your x-ray findings.  Again, this available no where else.

If you would like to learn on how the PostureRay® radiographic analysis EMR solution can benefit your practice, please call 866.577.7297, email sales@postureco.com or visit www.postureco.com

 

October AJCC Issue Print DOWNLOAD link

This is the direct download of the print version to our most recent American Journal of Clinical Chiropractic.

Download the October 2011 AJCC now.

CT Chiropractors "Say No" To Drugs

George B. Curry DC, DACS,FICA,LCP(hon)
Chairman CCC
ICA Northeast Regional Director
Private practice Windsor, CT 28 years

A recent Internet poll utilizing Survey Monkey ^TM, sponsored by the Connecticut Chiropractic Council revealed that 82.5% of the respondents indicated that they are against the expansion of Chiropractic in CT to allow prescription drugs, 8.8% were in favor and 8.6% were not sure. 

"The issue of practice scope expansion to include pharmaceuticals” has created a firestorm of controversy and I'm happy to see that the majority of our respondents want to keep Chiropractic a "drug-free profession" commented Dr. George Curry the CCC chairman of the board.

The sixteen question survey was sent to 300 licensed CT Chiropractors as part of the online poll.

FSCO Denounces ACC's Use of the Term "Chiropractic Medicine."

On February 24, 2011, Shane Walker, D.C., President of the Federation of Straight Chiropractors and Organizations (FSCO) sent the following letter to Frank Nicchi, DC, President of the Association of Chiropractic Colleges (ACC) and the other ACC Officers and Directors, as well as to the presidents
of all US chiropractic colleges.
Dear Dr. Nicci,
It has come to our attention that the Association of Chiropractic Colleges (ACC) has adopted and begun to promote the term "chiropractic medicine" within their programming.  Most notably, this term has appeared in announcement of an ACC program titled, "Integration of Chiropractic Medicine in the Workers' Compensation Industry."
As the ACC is presumably a representative affiliation of chiropractic colleges, we at the Federation of Straight Chiropractors and Organizations (FSCO) object to the ACC's utilization of terminology which has been flatly rejected by the majority of the chiropractic profession.  We note that there has been a covert movement by a small but vocal minority within the profession who have actively pursued the expansion of accepted chiropractic practice to include medical modalities and procedures associated with the promotion of the term, "chiropractic medicine."  It would appear that adoption by the ACC would serve as an attempt to infiltrate the academic community within the profession with expansive terminology that will increase the scope of chiropractic into an infringement on the practices of medicine by fiat.  We do not believe that the intent, purpose or direction of the ACC should be in the pursuit of expansion of scope.
The term "medicine" is not permissible in most, if not all states and jurisdictions as part of a chiropractic practice designation.  As the principles and tenets of chiropractic are antithetical to the practice of medicine, the term chiropractic medicine is an oxymoron and, at best, inappropriate and deceiving to the public.  The FSCO encourages the leadership of the ACC to act in proper accord with the majority in the chiropractic profession and not to serve as a vehicle for the dilution or destruction of the founding principles of our unique profession.

We will be in communication with the administrations of the ACC affiliated schools and seek to clarify their position in regard to this issue in the interest of professional conformity in the educational process.

The FSCO will remain vigilant in protecting and preserving chiropractic from all infringements so that it will be available for the benefit of this and future generations.
Respectfully submitted,

Shane Walker, D.C.,

President of the FSCO

Ligament Hysteresis, Creep, Recovery and Plastic Deformation

Don Meyer, DC

Private Practice Huntington Beach, CA

President Circular Traction Supply

CBP Instructor

INTRODUCTION

Structural/postural corrective based Chiropractors endeavor to return the abnormal spine back towards an accepted normal via the physiological process of ligamentous re-modeling. Ligamentous re-modeling is based on the fact that the resting length of a ligament can be altered by the application of a structurally specific traction or exercise. But how does this process really work?

In this article, I will discuss four main viscoelastic properties of spinal ligaments and their importance in the therapeutic rehabilitation of human spinal structure and global posture.

Visco-elastic Properties of Ligaments

The general response of ligaments to a traction load or a repetitive structural/postural corrective exercise is influenced by several phenomena which are time-dependent, such as hysteresis, creep, recovery and plastic deformation.

• Hysteresis

Ligamentous hysteresis is defined as the energy lost (as heat) within the tissue between loading and unloading. When the ligament is stimulated repetitively with constant peak load, hysteresis develops and the ligament length limits increase with each cycle. Thus the repetitive use of the same force produces greater and greater ligamentous deformation (creep). This is why postural/structural corrective exercises work and should always be done first, before the patient is adjusted or has any traction performed. The exercises “heat-up” the ligaments, increase their length and reduce their internal tension. This “sets-up” the spine to better receive any corrective spinal manipulation or traction. Also, if you can increase the peak load during the patients corrective exercise session you will increase tissue hysteresis. The use of a device such as the Pro-Lordotic Neck Exerciser™ provides 20-50 pounds of force into the lower, middle and/or upper anterior neck structures while the patient performs their corrective neck extension exercises. See Figure 1.

It is important the peak force be delivered into the region of the spine that most needs re-modeling. If the patient has a lower cervical kyphosis, that is the region that should receive most of the structural corrective exercise.

Figure 1. Pro-Lordotic Neck Exercise.

• Ligament Creep

Ligament creep is defined as the time dependent elongation of a ligament when subjected to a constant stress. Ligament creep is not linear in nature. Most of the ligament elongation occurs during the first 15-20 minutes of a traction load. This is why at least 10-20 minutes of structural corrective traction is usual recommended. But how long does is take the ligament to recover from the elongating force and return to its original length?

In a human in vivo study, following 20 minutes of deep flexion, a 25-minute rest period was required in order to achieve 50% recovery and a 50-minute rest period was required to achieve 70% recovery from the resulting creep.¹ Recent evidence demonstrate that both creep and tension-relaxation induced in 20-50 minutes of loading or stretching a ligament, respectively, demonstrated 40-60% recovery in the first hour of rest, whereas full recovery is a very slow process which may require 24-48 hours.¹ Also, hysteresis recovery following creep deformation was more prolonged and less complete in older subjects.² From these studies, we can see that performing corrective procedures on your patients (in-office) three times per week with 48 hours or more between sessions will not be very successful if the patient is not also performing some type of ligamentous rehabilitation at home on a daily basis. Having them re-stretch the soft tissues in-between the in-office therapy sessions with postural/structural corrective exercises and devices like the Pro-Lordotic Neck Exerciser™, the Cervical Remodeling Collar™ (Figure 2.) and/or a Denneroll™ (Figure 3.) are essential for a good structural corrective outcome.

Figure 2. Cervical Remodeling Collar.

Figure 3. Cervical Denneroll.

• Frequency or Time-History

Ligament behavior is also dependent on the frequency of load application and unloading or strain rate. Cyclic loading of a ligament with the same peak load, but at a higher frequency, results in larger creep development and longer time for the full recovery of the creep to occur.¹ So having your patient perform their corrective exercises in a slightly faster, but still controlled, manner is better than a slow methodical fashion.

• Temperature

Ligament length-tension (strain-stress) behavior is also temperature-dependent, exhibiting reduced capability and therefore increased deformation at higher temperatures.¹ The main point to understand from this statement is to not perform corrective procedures in a cold room or with a cold patient. It also re-iterates the importance of heating-up the tissues with exercise before other corrective procedures are performed.

Clinical Relevance

So a person could ask: How do you get the ligaments to stay elongated if they recover so quickly? This is accomplished by getting the ligament stretched out to a length that moves it out of its elastic capability and into its plastic (viscous) range. Plastic deformation of a ligament can occur all at once, such as in athletic injuries where an extremely large force is applied, or through what is called “repetitive overwhelm”. Repetitive overwhelm is when a sub-maximal physical stress is applied so often, that it causes a micro-failure of the ligamentous cross-links, resulting in permanent deformation of the ligament. The main factors that affect plastic deformation are the amount, duration and frequency of the applied force.³ In one reference involving the posterior cruciate ligament of the knee, it was found that “Slow stretching of the ligament results in elongation up to 30% before any plastic deformation”.⁴

CONCLUSION

Understanding ligament physiology is essential to achieving consistent positive changes in your patient’s posture and structure. This information presented above emphasizes the importance of giving the patient a “home rehab kit” that includes the Pro-Lordotic Neck Exerciser™ and some form of corrective home traction (Denneroll or Cervical Remodeling Collar).

I hope this information helps you improve your patient's corrective care and health outcomes.

References

1. Solomonow, M. Ligaments: A source of musculoskeletal disorders. Anatomy, physiology, pathophysiology review. Journal of Bodywork and Movement Therapies 2009 (13):136-154.

2. Twomey L, Taylor J. Flexion creep deformation and hysteresis in the lumbar vertebral column. Spine. 1982 Mar-Apr; 7(2):116-22.

3. Christensen, K. Plastic deformation and long-term support. Dynamic Chiropractic. December 15, 1999 (17).

Chow JCY. Advanced Arthroscopy. Springer-Verlag Publishing, New York, 2001: pg. 522.

Chiropractic United: “Bringing the Roots of Chiropractic Principle into Today’s Chiropractic Practice.”

Fred DiDomenico, DC

Practice Coach and Mentor

www.elitecoachingllc.com

&

Deed E. Harrison, DC

President CBP Seminars, Inc.

Vice President CBP Non-Profit, Inc.

Chair PCCRP Guidelines

Editor—AJCC

INTRODUCTION

Chiropractic was founded on the principle that the nervous system controls ALL functions of the body and spinal subluxations, individual of vertebrae out of place, impede nervous system function and can break down the body and cause disease. This is the TENET that early chiropractors risked their lives to teach. It was a segmental approach to full spine correction with B.J. Palmer leading the crusade using full spine pre and post x-rays.

Segmental Subluxation vs. Regional/Global Subluxation

After over a century of research and increased understanding of this TENET of a spinal subluxation, research now suggests that individual vertebrae do NOT readily subluxate as individual components---obviously there are exceptions to this statement (atlas laterality, retro's, spondy's, etc..). In contrast, when vertebra do displace, they subluxate within a displaced REGION of the spine or as groups of vertebra where one specific vertebra may have a greater displacement than the others.^1,2

This means a whole curve or sections of the spine is displaced and is generally understood using buckling theories from graduate level courses in mechanical engineering.^3-7 We now also know if one area of the spine displaces the WHOLE spine will adapt and displace to adapt to its environment, gravity. The REAL truth of spinal subluxation is REGIONS of the spine displace causing the brain to adapt the whole body structure to gravity displacing the rest of the spine to attempt to achieve balance. What does this mean? Thus, it is our perspective that nearly EVERY spinal problem is likely a FULL SPINE problem causing WHOLE spinal cord stress and strain weakening the WHOLE body? This statement is EXTENSIVELY documented in medical and chiropractic research, as well as supported in proven principles in engineering and laws of physics.

Two Questions for You to Consider

1. “With this knowledge, do you think B.J. Palmer would be treating patients the same way today as he did 50-70 years ago?”
2. “If the TRUTH of spinal function and subluxation is expanded today, do you think he would be correcting the spine and teaching the principle of chiropractic the same way?”

The answer to these questions is probably “NO!” If B.J. wouldn’t be doing the same thing decade after decade, then maybe today’s chiropractors should adapt their model, keeping the TRUTH of chiropractic principle alive today applied to the TRUTH of spinal function and dysfunction, subluxation, and how it relates to human health. Where do we find this TRUTH? This answer is www.chiropracticunited.com.

WWW.CHIROPRACTICUNITED.COM

Chiropractic United contains extensive and up-to-date research validating spinal function and subluxation and its affect on biomechanical function of the body, overall health, quality of life as well as life span. You may be SHOCKED to learn that with the history of medicine vs. chiropractic, many of the studies are MEDICAL research where these subluxation principles are validated. Yes, we are in the midst of a transformational evolution in the chiropractic profession. In fact, with all the intra-professional battles chiropractic creates, we ALL have the RESPONSIBILITY to know this information. Let’s begin with Chiropractors!

Purpose and Mission

The purpose and mission of www.chiropracticunited.com is to educate and unite subluxation-based chiropractors and arm them with the information and technical skill that will add power, credibility and TRUTH to the very principles that began this great profession.

Corrective care grounded Chiropractors need to teach their patients to know EVERY spinal problem is a FULL SPINE, OVERALL health problem in order to shift the consciousness of the general public toward spinal subluxation and health with consistency and predictability.

It is for these 2 intentions that CBP^® and Elite Coaching have come together to bring you systems to achieve these results in your practice; the research, clinical certainty achieving spinal correction from full and elevated patient commitment and retention living a chiropractic, optimal spine/optimal health lifestyle. These systems have been proven and will give you the ability to move your practice into today’s current model for the transformation of the profession now and into the future. If you are not keeping up with the times, you may be getting left behind.

In addition, tune in to www.ChiropracticUnited.com podcasts to hear Dr.’s Deed Harrison, Joe Ferrantelli and Fred DiDomenico interview the leading personalities in subluxation-based chiropractic, speak about philosophy, current issues in chiropractic politics, research and management tools that readily apply in your practice. It is the #1 and most downloaded podcast in the chiropractic profession today.

References

1. Harrison DE, Harrison DD, Troyanovich SJ. Three-Dimensional Spinal Coupling Mechanics. Part I: A Review of the Literature. J Manipulative Physiol Ther 1998;21(2): 101-113.
2. Harrison DE, Harrison DD, Troyanovich SJ. Three-Dimensional Spinal Coupling Mechanics. Part II: Implications for Chiropractic Theories and Practice. J Manipulative Physiol Ther 1998; 21(3): 177-86.
3. Gilmore R. Cartastrophe theory for scientists and engineers. New York, Dover Publoications, 1981.

4. Nightingale RW, Camacho DL, Armstrong, Robinette JJ, Myers BS. J Biomechanics 2000;33:191-197.

5. Nightingale RW, McElhaney JH, Richardson WJ, Myers BS. J Biomechanics 1996;29:307-318.

6. Nightingale et al. J Bone and Joint Surgery Am 1996;78-A:412-421.

1. Myers BS, Nightingale RW. J Crash Prevention and Injury Control 1999;1(1):67-82

Rehabilitation of Thoracic Hyper-Kyphosis: The Thoracic Denneroll

Deed E. Harrison, DC

President CBP Seminars, Inc.

Vice President CBP Non-Profit, Inc.

Chair PCCRP Guidelines

Editor—AJCC

&

Adrian Dennewald, DC

President / CEO Denneroll Industries

Private Practice of Chiropractic Sydney, Australia

INTRODUCTION

The thoracic spine as viewed from the side, should have a natural elliptical or ‘oval’-shaped curve; where slightly more curvature per segment occurs in the mid and upper thoracic segments.^1,2 Lifting injuries, falls, poor posture, de-conditioned supporting muscles of the trunk and lower extremity, and poor ergonomics all may contribute to abnormal increased thoracic kyphosis (hyper-kyphosis). Figures 1-4 depict abnormal types of thoracic kyphosis and the proposed elliptical shape that should be present (Figure 5.)

In the past decade, research into the detrimental effects of thoracic hyper-kyphosis on patient populations has become quite prolific.^3-14 In fact, studies have identified that hyper-kyphosis places a person at greater risk of adverse nerve, ligament, and muscle function. Ultimately, abnormal thoracic hyper-kyphosis has been found to contribute to a number of health related disorders including: lower self image, depression, lack of motivation, increased potential for back pain, injuries-falls, vertebral fracture, deformity progression, and even shortened life span.^3-14

While there has been increased awareness of and studies on proposed effective treatments for thoracic hyper-kyphosis, these studies are based on small case series and trials with few reporting long-term results.⁶ Of the proposed interventions for rehabilitation of thoracic hyper-kyphosis, only spinal extension based exercise programs and spinal corrective orthoses have been found to have a corrective effect aimed at reducing curve magnitude. ^6,15

THORACIC DENNEROLL

Due to the paucity of existing methods to effectively improve thoracic hyper-kyphosis and the general lack of a simple but effective home-based corrective orthotic, my colleague (Adrian Dennewald, DC) and I, sought to develop such a spinal orthotic. The idea was to design a unique spinal orthotic to be used with the patient in a supine position where lying over the apex of such device would provide a tolerable but effective stretch that assists in the correction of abnormal thoracic hyper-kyphosis (Figures 6-8 below).

The main features of this Denneroll Thoracic Orthotic as seen in Figure 9 include:

· Contoured thoracic elliptical shape based on the CBP evidence based Elliptical model.^1,2 This shape provides stability and effective passive forces specific to the thoracic spine.

· The denneroll’s fulcrum peak located at the top of the orthotic creates localized 2-4 segment extension specificity at the proximity of the fulcrum peak.

· The width is designed to allow stability whilst not impacting the scapula.

· Tolerable and impactful spinal extension moment-bending- and slightly compressible peak for patient tolerance with a firm base for support so the unit will not collapse or tilt to maximize the effects.

· Note that changing the apex of the thoracic spine segmental contact with the peak of the thoracic denneroll allows customized fit to the individual patient’s needs and their spinal abnormality.

· Ultra light weight, extremely portable, effective, and user friendly.

· Cost effective!

Figure 9. Thoracic denneroll sitting centered on top of the thoracic support block. The taper of the denneroll and design was cut from the CBP evidence based thoracic kyphosis elliptical model.^1,2

The Recommended Types of Patient Cases and Spine Presentation for Denneroll Orthotic Application:

· Hyper-kyphosis with or without posterior thoracic translation relative to the pelvis;

· Allows for specificity in correcting an increased lower, mid, or upper thoracic kyphosis;

· Anterior head posture greater than 25mm (approximately);

· Rounded-protracted shoulder girdle and scapular region. The size of the denneroll allows for support while simultaneously being narrow enough to allow the scapula to retract over the unit;

· The addition of different sizes of the support block under the thoracic denneroll allow correction of internal flexion-extension of the ribcage while simultaneously reducing kyphosis.

DENNEROLL PLACEMENT

There are three primary types of thoracic corrective setups appropriate for thoracic denneroll application:

1. Lower thoracic,

2. Mid-Thoracic, and

3. Upper-Thoracic..

However, in each of these three spinal placement categories there exists the possible need for both a translation component of the whole ribcage as well as a mild flexion-extension component of the top of the curve relative to the bottom of the curve. Review Figures 1-4 for identifying that the thoracic kyphosis can exist with the top of the ribcage 'flexed' relative to the bottom of the ribcage; alternatively, it can exist with the top of the ribcage extended relative to the bottom of the ribcage. See Figures 10-13 below for detailed setup alterations using various sizes of translation support blocks underneath the thoracic denneroll.

Only a radiographic and postural analysis can determine which denneroll placement is right for the individual patient. The denneroll device should only be used on a firm surface such as the floor, or a bench so that an effective stretch can be applied to the thoracic tissues.

Figure 10. Thoracic denneroll turned around so the peak contacts the lower thoracic spine (T10) while the tapered end supports the mid thoracic region. This setup is for hyper-kyphosis in the T9-T12 region with upper thoracic flexion relative to the lower.

Figure 11. Thoracic denneroll placed in the mid thoracic spine (T6-T7). This setup is for mid-thoracic hyper-kyphosis with T1-anterior to T12—or upper thoracic flexion relative to the lowers.

Figure 12. Thoracic denneroll sitting centered on top of the small 20mm block in the Thoracic Support Block System. This setup assist correction of mild posterior thoracic translation postures with upper thoracic kyphosis and anterior head translation.

Figure 13. Thoracic denneroll sitting centered on top of the Thoracic Support Block. This setup assist correction of moderate-severe posterior thoracic translation postures with upper thoracic hyper-kyphosis and anterior head translation. This is for deformities where the T1 vertebra is posterior to T12.

SUMMARY

In future articles, my colleagues and I will report on selective case studies where the effectiveness of the thoracic denneroll is shown in properly selected and managed patient cases. Also, formal clinical trials into the effect of the denneroll on hyper-kyphosis and patient outcomes is planned; these results will be reported as they are completed.

References

1. Harrison DE, Janik TJ, Harrison DD, Cailliet R, Harmon S. Can the Thoracic Kyphosis be Modeled with a Simple Geometric Shape? The Results of Circular and Elliptical Modeling in 80 Asymptomatic Subjects. J Spinal Disord Tech 2002; 15(3): 213-220.
2. Harrison DD, Harrison DE, Janik TJ, Cailliet R, Haas JW. Do Alterations in Vertebral and Disc Dimensions Affect an Elliptical Model of the Thoracic Kyphosis? Spine 2003;463-469.

3. Katzman WB, et al. Age-related hyperkyphosis, independent of spinal osteoporosis, is associated with impaired mobility in older community-dwelling women. Osteo Int 2011 Jan;22(1):85-90.

4. Katzman WB, et al. Increasing kyphosis predicts worsening mobility in older community-dwelling women: a prospective cohort study. J Am Geriatr Soc. 2011 Jan;59(1):96-100.

5. Kasukawa Y, et al. Relationships between falls, spinal curvature, spinal mobility and back extensor strength in elderly people. J Bone Miner Metab 2010;28(1):82-7.

1. Kado DM. The rehabilitation of hyperkyphotic posture in the elderly. Eur J Phys Rehabil Med 2009;45(4):583-593.
2. Peetcharaporn M, et al. The relationship between thoracic hyperkyphosis and the Scoliosis Research Society outcomes instrument. Spine. 2007 Sep 15;32(20):2226-31.
3. Kado DM, et al. Hyperkyphotic posture and risk of injurious falls in older persons: the Rancho Bernardo Study. J Gerontol A Biol Sci Med Sci 2007;62(6):652-657.
4. Huang MH, et al. Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo study. J Bone Miner Res 2006;21(3):419-423.
5. Kado DM, et al. Hyperkyphotic posture and poor physical functional ability in older community-dwelling men and women: the Rancho Bernardo study. J Gerontol A Biol Sci Med Sci 2005;60(5):633-637.
6. Mika A, et al. Differences in thoracic kyphosis and in back muscle strength in women with bone loss due to osteoporosis. Spine 2005;30(2):241-246.
7. Miyakoshi N, et al. Impact of postural deformities and spinal mobility on quality of life in postmenopausal osteoporosis. Osteoporosis Int 2003;14(12):1007-1012.
8. Keller TS, Colloca CJ, Harrison DE, Harrison DD, Janik TJ. Prediction of Osteoporotic Spinal Deformity. Spine 2003; 28(5): 455-462.
9. Kado DM, et al. Hyperkyphosis predicts mortality independent of vertebral osteoporosis in older women. Ann Intern Med. 2009 May 19; 150(10): 681–687.
10. Katzman WB. Changes in Flexed Posture, Musculoskeletal Impairments, and Physical Performance After Group Exercise in Community-Dwelling Older Women. Arch Phys Med Rehabil 2007;88:192