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Chiropractic
Biophysics Technique
By Donald D.
Harrison, D.C., Ph.D.
Steve Troyanovich, D.C., and Mark R. Payne, D.C.
Chiropractic biophysics is a system of chiropractic spinal analysis and care
developed by Donald D. Harrison, M.S., DC, M.S.E., Ph.D., and Glenn Harrison,
B.S., DC The approach to improved patient well-being, as designed by these
doctors, is a mechanistic one.
To some extent, these mechanistic concepts are justified in that the spine and
nervous system have many machinelike qualities. The spine is composed of bones,
muscles, blood vessels and neural networks which resemble beams, motors,
hydraulics and computers, respectively. Ball and Carlson1
have stated, "The use of engineering modeling in biological systems is now
commonly accepted as a logical means of approaching highly complex mechanisms."
The Rationale for CBP
CBP applies the sciences of mathematics, physics and biophysics to the practice
and theory of chiropractic. While the simple analogies of a bone "stuck" or "out
of place" may serve doctors well when communicating with patients regarding
spinal adjustments or some form of therapy, they hardly reflect the degree of
sophistication which is necessary in communicating with the rest of the
scientific community. The plight of our profession can be simply summed up in
the following statement from the report of the New Zealand Commission of Inquiry
Into Chiropractic: "The exact nature of such defects (subluxations) has not yet
been demonstrated; nor has the mechanism by which its apparent effects are
produced." The 1975 NINDS workshop on the status of spinal manipulative therapy
made the observation that "there was no quantitative or qualitative reproducible
description of subluxation."
Chiropractic biophysics is addressing these shortcomings by combining the
discipline of science, the foundational principles of chiropractic and the
application of technical skills to attempt to elucidate the truth about what we
do, how we do it and how we can do it better. CBP attempts to understand and
apply the universal laws which govern the behavior of matter and energy and
their interactions in biological systems. The result of over 12 years of
development is an ever-expanding and evolving base of work and literature
relating to the science of what chiropractic is and does. Currently, the CBP
technique represents a full spine and pelvis corrective/rehabilitative procedure
having a firm foundation in the sciences of mechanics and physics and providing
both a qualitative and quantitative model of chiropractic practice.
The overall goal of the CBP technique is to restore normal three-dimensional
human posture. Methods include "mirror image" posture adjustments,
rehabilitative exercises, cervical extension traction and manual procedures. In
CBP, the overall posture or global positioning of the spinal column is targeted
for correction, as opposed to individual spinal segments.
In CBP, the optimum static position of the upright human spine is established
with the Harrison spinal model. A subluxation is considered to be any postural
deviation from this mathematical norm. The model represents the most complete
chiropractic effort to date to establish what constitutes "normal."
Although not perfect, the
Harrison model is a starting point and a reasonable clinical objective for
corrective care. It is expected that as our knowledge expands, so too will the
model expand and evolve.
Protocol of Care
The CBP protocol of care begins with the initial patient encounter and a case
history, followed by a traditional orthopedic and neurological examination. The
patient is then analyzed for abnormal posture in every possible degree of
freedom of the skull, thoracic cage and pelvis. Next, an exacting series of
radiographs is performed which are then analyzed using geometry to obtain
information for formulating care plans and later to serve as an objective
standard against which to evaluate
the efficacy of care.
Following careful consideration of pertinent clinical findings, especially the
correlation of the patient’s three-dimensional posture with its two-dimensional
X-ray image, a patient’s case is either accepted or referred to an appropriate
specialist. Patients who are accepted for care are generally assigned to one of
two regimens (i.e., acute or corrective care). Factors, which might influence
the appropriate type of care, could be numerous, such as the nature of their
specific complaint, the magnitude of their postural distortions and the degree
of pathophysiology associated with subluxation degeneration.
Patients who are selected for acute care would receive a program of care perhaps
not unlike that of many non-CBP offices. They would undergo "diversified"-type
adjustments (both long- and short-lever) to restore segmental mobility,
cryotherapy to reduce localized inflammation, passive and active stretching and
massage as indicated to reduce spasm and myofascial involvement. Acute care
programs may also apply to corrective care patients who enter the office
symptomatic.
The CBP corrective care regimen includes the use of drop table and upper
cervical instrument-assisted adjustive procedures, as well as a variety of
corrective extension traction procedures and corrective postural exercises. It
is not the methods themselves, which are unique to CBP, but rather the rationale
behind their use and the way in which these tools are employed to accomplish
stated clinical objectives.
The following is a summary of basic methods currently in use.
Mirror Image Adjusting
In chiropractic biophysics, abnormal human posture is analyzed and corrected be
means of what is termed "mirror-image" adjustments. Basically this is done by
first analyzing the standing posture in three dimensions and then stressing the
patient’s abnormal posture into its exact opposite, or "mirror," image. Once the
patient has been pre-stressed into the mirror image, a light adjustive force is
applied.
Adjustive forces are generally applied to the atlas transverse process with
either a toggle—type adjustment or by means of a cervical adjusting instrument.
Adjustive forces may also be introduced to the lower back area by the use of a
drop table adjustment with force applied to the sacroiliac or femur head areas.
The purpose of mirror image adjustment is to introduce mechanical stimulation to
proprioceptors and encourage the brain to reconsider the faulty postural
patterns which have become habituated overtime. It is precisely these habituated
postural patterns which are a major source of chronic spinal dysfunction and
which result in spinal resistance to correction which all practitioners have
experienced. Mirror image adjustments may be performed with the patient in
either the prone, supine, side posture or standing positions. Correction to
normal posture is then verified by pre- and post-adjustment postural
examinations.
Rehabilitative Exercise
Since adaptation of muscular structures is a process that takes place over an
extended period of time, repetition of positive forces into the affected tissues
is necessary to effectively achieve and maintain postural correction. These
simple techniques alone can often be quite effective, as demonstrated in a 1986
study by Klein and Sobel of neck pain patients, in which 59 percent received
significant long-term relief from performing postural exercises for their
conditions.
Harrison’s mirror image
exercises are set up individually, based on the patient’s particular abnormal
posture configuration, unlike many generic, "one-size-fits-all" exercise
programs. Mirror image exercise procedures effectively reeducate the body by
targeting those muscle groups and their associated global movements, which
effect a more permanent correction of the patient’s subluxated posture.
Extension Traction
One of the most common postures, which presents in the chiropractic office is
that of cervical hypolordosis/kyphosis with the patient’s head in an anterior
weight-bearing position. In chronic cases, ligaments will have creeped shorter
and adapted to the abnormal postures. Due to their specific mechanical
properties, ligamentous tissues do not often respond well to the rapid loading
forces which constitute the chiropractic adjustment. Anyone familiar with the
sigmoid-shaped load-deformation curves obtained from testing spinal ligaments
realizes that rapid loading forces affect only the elastic range of the
ligaments. Loads must be applied over 20 to 30 minutes to affect the viscous and
plastic regions of the load-deformation curves.
Consequently, the
primary purpose of cervical extension traction is to provide a long duration or
slow adjusting force to those soft tissues that have contracted over time and
therefore tend to perpetuate the patient’s subluxated state.
A variety of traction methods are currently being employed by CBP practitioners.
Performed in the office, these methods may require times that range from
10 to 20
minutes, according to the doctor’s discretion and patient tolerance. Many
patients also receive a home traction device so that they may actively
participate in their recovery program.
By use of these methods, CBP field practitioners are experiencing great success
in restoring cervical curves. As evidence of the success of this approach, a
recent controlled clinical trial demonstrated an average increase of the
cervical lordosis of 13.5 degrees versus no statistically significant change in
the control group.
Conclusion
The chiropractic biophysics technique is unique for several reasons. It provides
a specific therapeutic goal (the Harrison model of ideal upright posture). It
correlates the patient’s three-dimensional posture with precise radiographic
analysis to help eliminate much of the false data, which are inherent in
analysis based on X-rays alone. It effectively addresses the overall posture of
the patient by means of mirror image adjustive procedures, and it seeks to
rectify long-term soft tissue changes by means of extension tractioning and
rehabilitative exercise programs which are tailored individually for each
patient. Through the application of knowledge borrowed from the fields of
physics and mathematics and university biophysics, we are bringing clinical
results into line with our philosophical tenets.
About the authors
Donald D.
Harrison, D.C., is the developer of the CBP technique. He holds BS and MS
degrees in mathematics, masters in mechanical engineering, and also holds a PhD
in math in addition to his Doctor of Chiropractic degree. He is the publisher of
the American Journal of Clinical Chiropractic, which is published quarterly.
Steve Troyanovich, D.C., who maintains a full-time practice in Normal, Ill., is
a certified CBP seminar instructor and is a contributing author to several CBP
textbooks.
Mark R. Payne, DC, is a contributing author to two CBP textbooks and is a CBP
seminar instructor. In addition, he maintains a full-time private practice in
Hartselle,Ala., where he and his wife, Kathy, also own and operate Matlin
Manufacturing, Inc., a chiropractic supply company whose products are geared
toward the CBP practice. For more information on the CBP technique, call (800)
346-5146.
References
1.Ball, L.D., and Carlson, L.E., Experimental Mechanics of the Spine, 6th Annual
Biomechanics Conference on the Spine, Boulder, Cob.t Univ. of Colorado, 1975.
2.Harrison, D.D., "Abnormal Postural Permutations Calculated as Rotations and
Translations From an Ideal Normal Upright Static Spine," chapter 6,
In:Chiropractic Family Practice, J. Sweere, Ed., Gaitherburg, Md.: Aspen
Publishers, 1992.
3. Cochran, C., A Primer of Orthopedics Biomechanics, Churchill Livingstone,
1982.
4. White, A.A., and Panjabi, M.M., Clinical Biomechanics of the
Spine, Philadelphia:
1.8.Lippincott Co., 1978.
5. Chasal, J., Tanguy, A., Bourges, M., Caurel, C., Escande,
G., Cuilbot, M., and Vameuville, C., "Biomechanical Properties of Spinal
Ligaments and a Histological Study of the Supraspinal Ligament in Traction," I.
Biomechanics 3:167-176,1985.
6. Chow, D.H.K., Luk, K.D.K., Leong, J.C.Y., and Woo, C.W., "Torsional Stability
of the Lumbosacral Junction: Significance of the Iliol Ligament,"
Spine 14:611 -615, 1989.
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