Month: May 2021

Chiropractic Treatment for Hand Numbness

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From Dr. Natalie Meiri’s Clinical Pearl Stories: Chiropractic Treatment for Hand Numbness

Author: Natalie Meiri, D.C.            Posted: 5/28/21

This was a 50 year old patient with a chief complaint of bilateral (both sides) hand numbness. To be HIPAA compliant, I will call her Margueritte instead of her real name.  Margueritte permanently lived in another state, but vacationed/worked in Florida several times a year.  On her recent visit to Florida, she injured her right hand at the gym.  

Firstly, her sports medicine doctor back home had diagnosed her with carpal tunnel in her hands a few years ago.  Secondly, she was given a brace to wear at night. Thirdly, she received physical therapy and massages. However, she still had some pain. Similarly, when it was severe it was a 8/10 -10/10 pain level.  Moreover, the type of pain she described was mostly numbness and less frequently tingling.  Margueritte also felt a clumsiness with precision gripping.

Margueritte worked out at the gym regularly and tried to eat healthy.  There was no systemic condition causing fluid retention, diabetes, and/or connective tissue disorder that was contributing to the neuropathy. She wasn’t deficient in B vitamins either.

She did work at a computer at work, but there was no trauma when her hands first started to hurt years ago.  What brought her to see me was the trauma to the already hurting right hand at the gym while hitting a punch bag without a proper boxing glove a few weeks ago.  

Margueritte presented to my office with severe pain in her right hand and mild pain in her left.

Margueritte’s Examination and X-rays

Upon examination, there were positive tests for both hands, wrists, cervical (neck) and thoracic (mid back) spine.  After that, I took some x-rays of her cervical spine, right wrist and hand. Findings on her x-rays were degenerative joint disease/ osteoarthritis (wear and tear arthritis) of her neck with a reverse lordosis.  In other words, the curve in her neck was running in the wrong direction.  The right hand/wrist x-ray was “normal” and ruled out a fracture.

Moreover, she had positive tests for the following entrapment neuropathies: in both wrists for the median nerve at the carpal tunnel(s).  Also radial nerve entrapment (Cheiraigia Paresthetica/ Wartenberg’s Syndrome) between the wrist extensor muscle tendon (extensor carparadialis longus) and the brachioradialis (muscle in forearm) in her right hand. Neurodiagnostic testing (EMG/NCV) would be ordered if there was no improvement within 12 visits. Electromyography (EMG) and nerve conduction velocity (NCV) are tests that measure the electrical activity of muscles and nerves.

 

Chiropractic Treatment for Hand Numbness

Chiropractic Treatment for Hand Numbness

due to multiple Neuropathies

Margueritte’s chiropractic treatment for neuropathy consisted of chiropractic manipulation/ adjustments of both wrists, hands, and associated regions.  Associated regions that were adjusted were her cervical (neck) and thoracic (mid back) spine which were misaligned (subluxations or intersegmental dysfunctions) due to the conditions she had. Additionally, soft tissue therapy (myofascial release, pressure point and various post isometric relaxation procedures) to the soft tissues/muscles entrapping the median and radial nerves (i.e. brachioradialis and extensor carpi radialis longus (ECRL), transverse carpal ligament) were provided. Cold/heat therapy and electric muscle stimulation were administered as necessary. Finally, home therapeutic exercises and recommendations for ergonomics/activities of daily living were given. For example,  Margueritte was given direction on using rest pads and a split keyboard to help her condition.

The outcome for Margeuritte was excellent! She felt better and much of the numbness and tingling disappeared. She treated 3 times a week for the 4 weeks before she had to leave Florida.  By the end of 4 weeks, she showed much improvement even with precision gripping. She would continue treatment back home.

 

Chiropractic Treatment for Hand Numbness: 

Carpal Tunnel and Cheiraigia Paresthetica (Wartenberg’s Syndrome)

Median Nerve entrapment at the carpal tunnel causes pain, numbness, and tingling in the palmar (palm side or grasping side) surface of the thumb and radial (toward the thumb side) two and one half fingers.  The median nerve runs through an osteofibrous tunnel created by the transverse carpal ligament and carpal (wrist) bones. Although direct compression from ganglions, fractures, and dislocations is possible, it is more common to have a history of direct external pressure on the tunnel or a history of prolonged wrist use in full flexion or extension. Pressure inside the tunnel increases in these extreme positions. In Margueritte’s case, her extensive typing at the computer at work was the culprit.

With Cheiraigia Paresthetica (Wartenberg’s Syndrome) there is numbness or tingling over the dorsolateral (back and the sides) aspect of the wrist and hand. The superficial branch of the radial nerve is susceptible to trauma between the tendons of the extensor carpi radialis longus (ECRL is a forearm extensor muscle) and the brachioradialis (muscle of the forearm that flexes the forearm at the elbow). Repetitive movements and compression (i.e. tight watch band) are possible causes.  Or in Marguerite’s case a direct blow to the dorsolateral forearm/wrist during boxing class to a punch bag was the culprit.

There are studies indicating that chiropractic treatment including manipulation of both soft tissue and bony joints of the upper extremities and spine provide significant relief and improvement of nerve and muscle function for patients with entrapment neuropathies in the extremities (limb, feet, hands). It is important to examine other potential sites of nerve entrapment as was the case with Marguerite there was the second entrapment (radial nerve entrapment).

Contact Dr. Natalie Meiri of Meiri Chiropractic today for chiropractic treatment for Hand Numbness! Call 561-253-8984 to learn more or to schedule an appointment.

Various Soft Tissue Manipulation Techniques Along With Chiropractic Care: Part 4

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This is a follow up to the post Various Soft Tissue Manipulation Along With Chiropractic Care:  part 3.   As a review, Soft Tissue Manipulation (STM) techniques are defined as those physical methods applied to muscles, ligaments, tendons, fascia, and other connective tissues with the goal of therapeutically affecting the body. This post is about ischemic compression which is also a form of soft tissue manipulation technique. Read below about the Various Soft Tissue Manipulation Along With Chiropractic Care:  part 4 on ischemic compression practiced in our West Palm Beach office.

What is Ischemic Compression?

Ischemic compression is a procedure. All the following named techniques use it to some degree: Receptor-tonus (Nimmo), Trigger point therapy (Travell and Simons), Active release technique, ART (Leahy), and acupressure.  The difference is in the individual therapeutic approach and/or mechanism of treatment.  Each of the named procedures above have varying explanations and theories, but the application is similar for Ischemic compression. The clinical application is basically deep manual pressure applied over tender muscular nodules. 

 

 

Theories on the Mechanism of Ischemic Compression

Several theories have been suggested to explain the mechanism of ischemic compression. Travell and Simons believe that by holding pressure over a specific site, ischemia (inadequate blood supply) is induced to the sensory nerves.  Subsequently, this produces a nerve block from lack of oxygen.

Another explanation is that after the release of manual pressure, a reflex vasodilation (widening of blood vessels which enhances blood flow) and hyperemia (excess of blood in the vessels) occur.  This produces a circulatory increase capable of removing chemical irritants and metabolites. And also this brings in oxygen and adenosine triphosphates (ATP is the source of energy for use and storage at the cellular level) to the area for healing.

Finally, the last theory considers the mechanism that deep pressure produces pain that hyperstimulates interneurons (nerve cells that connect other nerve cells).  This happens in the dorsal horn (part of spinal cord) to release endorphins that block pain perception. 

The effects of ischemic compression are probably the result of a combination of mechanisms.

 

Various Soft Tissue Manipulation Techniques Along With Chiropractic Care: Part 4 – Receptor-Tonus Technique (Nimmo)

Dr. Raymond Nimmo was one of the first chiropractors to focus on the soft tissue component of dysfunction and subluxation (chiropractic joint misalignment or intersegmental joint dysfunction), advocating specific soft tissue treatment since 1950. Nimmo called the procedure for treating trigger points the receptor-tonus technique to emphasize his theory that it is a reflex technique and not a form of massage therapy.

Moreover, he suspected a neurologic explanation of treatment results because patients reported instantaneous pain relief after a treatment. He reasoned that only the nervous system was capable of creating changes in muscle tone within a few seconds. Receptor-tonus technique is therefore presented as a reflex technique that is thought to reduce muscle tonus (constant low level of activity in muscle) through reflexes mediated by the central nervous system.  The presence of these body wall reflex points are explained by a reflex pain mechanism (see previous post on body wall reflex techniques).

 

Various Soft Tissue Manipulation Techniques Along With Chiropractic Care: Part 4 –
Trigger Point Therapy (Travell and Simons)

Dr. Janet Travell, M.D., placed a significant emphasis on the role of the myofascia in health and disease. Additionally, she was the first to use the term trigger point to describe the tender nodules in the soft tissues. Travell and Simons define a trigger point as “a hyperirritable spot, usually located in a taut band of skeletal muscle, that is painful on compression and can give rise to characteristic referred pain, tenderness, and autonomic phenomena”.

Both Travell and Nimmo techniques have evaluations which consists of postural assessment to identify gross (visible to naked eye) muscle imbalances and specific palpation of the myofascia (fibrous connective tissue) and  related muscular involvement.

Myofascial trigger points (TrPs) are extremely common and affect nearly everyone’s life at one time or another.  At a pain management center, a primary diagnosis of myofascial syndrome was assigned in 85% of cases among 283 patients.  A neurosurgeon and a physiatrist made this diagnosis independently, based upon physical examination “as described by Simons and Travell.”

Soft tissue manipulation techniques along with chiropractic adjustments has many benefits for your health!  Call 561-253-8984 and make an appointment today. And find out more about Various Soft Tissue Manipulation Techniques Along With Chiropractic Care: Part 4 at our West Palm Beach office at your first appointment!

The next post will be on mobilization and manual traction/distraction techniques (i.e. cranial manipulation, manual Lumbar Flexion-Distraction, Cox Method).

 

 

References:

Bergman, Thomas. Peterson, Lawrence. Chiropractic Technique Principles and Procedures 2011. Third Edition

Hammer, Warren.  Functional Soft Tissue Examination and Treatment by Manual Methods.

Third Edition

Simons, David. Travell, Janet. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd edition

 

 

Meiri Chiropractic

561-253-8984

Chiropractic Treatment for Foot Drop Due to a Peroneal Neuropathy

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From Dr. Natalie Meiri’s Clinical Pearl Stories:

Chiropractic Treatment for Foot Drop Due to a Peroneal Neuropathy

Author: Natalie Meiri, D.C.                Posted: 5/17/21

This was a 69 year old patient who had a chief complaint of aching pain in her right leg. To be HIPAA compliant, I will call her Andrea instead of her real name. It interfered with all her daily activities and she couldn’t sleep due to the pain.  It had started about 3 months ago without any trauma.  This was the first time she ever had this problem.  And it had come on insidiously (progressed gradually). She had been seeing another doctor and came to see me when her chief complaint didn’t improve after 12 visits. Andrea was told her pain was coming from her low back (sciatica).

She presented to my office limping. Andrea had difficulty lifting the front part of her right foot.  In other words, she had a foot drop on the right. On her intake form, Andrea specifically noted pain in her right knee, leg, ankle, and foot.  Andrea had no history or symptoms of any systemic condition that could cause a neuropathy (i.e. diabetes).  She was taking over the counter drugs such as acetaminophen (for pain) and a NSAID (Non-steroidal anti-inflammatory drug for inflammation) which seemed to help very little.

Andrea’s Examination and X-rays

Upon examination, there were positive tests for her low back, right hip, right knee, right ankle and right foot.  Furthermore, she had positive tests for entrapment neuropathy in the lower right extremity (leg) of her superficial and deep peroneal nerves.  After that, I took some x-rays of her lumbar spine (low back) and right knee. Findings on her x-rays were degenerative joint disease/ osteoarthritis (wear and tear arthritis) of her low back, right hip and right knee. Neurodiagnostic testing (EMG/NCV) would be ordered if there was no improvement within 12 visits for the peroneal neuropathy.

Dr. Natalie Meiri adjusts the knee

 

Andrea’s Chiropractic Treatment

for Foot Drop Due to a Peroneal Neuropathy

Andrea’s chiropractic treatment for right peroneal neuropathy consisted of chiropractic manipulation/ adjustments of the right knee, right ankle and associated regions.  Associated regions that were adjusted were her lumbar spine and right hip, which were misaligned (subluxations or intersegmental dysfunctions) due to the condition she had. Additionally, soft tissue therapy (myofascial release, pressure point and various post isometric relaxation procedures) to the soft tissues/muscles entrapping the peroneal nerve (i.e. peroneus longus, brevis, tibialis anterior, extensor digitorum longus) were provided. And modalities (cold/heat therapy and electric muscle stimulation) were administered. Finally, she was given home therapeutic exercises and recommendations for ergonomics/activities of daily living (i.e. not crossing her legs, proper gait/posture).

 

Outcome for Chiropractic Treatment

for Foot Drop Due to a Peroneal Neuropathy

The outcome for Andrea was excellent! She started feeling better after the 2nd visit and gradually got better.  Chiropractic adjustments restore joint mobility and function, resolves joint inflammation and reduces the patient’s pain. Anatomically, the kinetic chain describes the interrelated groups of body segments, connecting joints, and muscles working together to perform movements. Andrea’s lower right kinetic chain (ankle, lower leg, knee, hip, lumbar spine) needed realigning. 

Injury to the common peroneal nerve results in a foot drop described as slapping or tripping. Pain and parethesia (pins and needles) may occur at the site of compression as well as distally into the lateral leg. At times there may be a radiation of pain into the thigh. Numbness and tingling can occur along the lateral leg and dorsum (upper surface) of the foot. Peroneal neuropathies occurring at the fibular (outer of two bones of the lower leg) neck (upper part of fibula) affect the DPN (deep peroneal nerve).  The SPN (superficial peroneal nerve) entrapment occurs in the lower leg at the ankle frequently due to a twisting of the ankle.

Do you know someone who needs Chiropractic Treatment for Foot Drop Due to a Peroneal Nerve Neuropathy? Contact Meiri Chiropractic serving West Palm Beach, Jupiter, North Palm Beach, and Palm Beach Gardens today at 561-253-8984 for this or some other ailment.

 

Meiri Chiropractic

561-253-8984

 

Various Soft Tissue Manipulation Techniques Along With Chiropractic Care: Part 3

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This is a follow up to the post Various Soft Tissue Manipulation Along With Chiropractic Care:  part 2.   As a review, soft tissue manipulation (STM) techniques are defined as those physical methods applied to muscles, ligaments, tendons, fascia, and other connective tissues with the goal of therapeutically affecting the body. This post is about body wall reflex techniques which are also a form of soft tissue manipulation technique. Read below about the Various Soft Tissue Manipulation Techniques Along With Chiropractic Care:  part 3 on Body WALL REFLEX TECHNIQUES (acupressure, chapman reflexes) practiced in our West Palm Beach office.

 

BODY WALL REFLEX TECHNIQUES

Body wall reflex techniques incorporate a number of different procedures for identifying a wide variety of different types of soft tissue points that are sensitive to palpation. Palpation is the process of using one’s hand or fingers to identify a disease or injury of the body or the location of pain. Basically, the soft tissue point is found via palpation  for treatment.

 

The presence of these body wall reflex points are explained by a reflex pain mechanism.  So if you’re in pain, your neurons (nerve cells) send a signal or impulse.  This impulse travels to your spinal cord, your thalamus and then your brain. Then you recognize the pain.  And with prolonged pain there are many impulses creating a vicious cycle which spreads through your spinal cord to your brain.   This is called the internuncial pool connection (internuncial neuron connects two other neurons). These connections go upward, downward, and across the spinal cord, potentially reaching the thalamus. Your thalamus relays motor and sensory signals to the cerebral cortex.

 

Presence of Pain at a Distance from the Site of Injury

Finally, depending on the extent of these connections, it is possible to detect the presence of pain at a distance from the site of injury and sometimes on the other side of the body. Moreover, even sympathetic disturbance can be present at this distant site.  Sympathetic disturbance is when your sympathetic nervous system directs the body’s rapid involuntary response to dangerous or stressful situations. For instance, a flash flood of hormones boosts the body’s alertness and heart rate, sending extra blood to the muscles.

 

These reflex points are in fascial tissue (thin connective tissue that surrounds organs, blood vessels, bones, nerve fibers and muscles). Similarly, these reflex points seem to be responses to a variety of types and degrees of tissue injury, including physical trauma, infection, degeneration, and chemical injury.

 

In mapping out where these body wall reflexes exist, there is much overlap of the various body wall reflexes.  This suggests that each developer recognized a similar characteristic, but explained it differently. Examples of these are acupuncture points, Travell (trigger points), Chapman (lymphatic reflexes), and Bennett (vascular reflexes).   Although there are a number of different names with different philosophical views, many procedures are very similar in application.

 

Acupressure Point Stimulation

Acupressure is a method of manual point pressure applied to acupunture points for producing analgesia (insensibility to pain). Acupuncture points are organized along meridians that have no known neurologic or vascular pattern. There appears to be a measurable change in electrical potential in acupunture points.  Treatment is by electrical stimulation, needle application, or manual (by hand/finger) pressure. In theory, blockage or other dysfunction in the meridian causes illness.

 

In one study acupressure was studied for effectiveness in reducing nausea and vomiting of pregnancy. The results indicated that acupressure was effective in reducing symptoms of nausea but not frequency of vomiting in pregnant women. However, promising results exist demonstrating efficacy of acupuncture/ acupressure in adult postoperative and chemotherapy nausea and vomiting.

 

Firstly, acupressure has an effect on pain reduction through the modulation of endorphin (hormones for pain relief) levels. Secondly, through stimulus-produced analgesia by working on local mechanoreceptors (sensory cell that responds to mechanical pressure or distortion) and nociceptors (sensory receptor for painful stimuli). Thirdly, the nerve reflex theory of acupuncture says that when an abnormal condition occurs in an internal organ, alterations will take place in the skin and muscles related to that organ by means of the nervous system. Interestingly, there is a 70% correlation between trigger point maps and acupuncture point charts.

 

Chapman (Neurolymphatic) Reflexes

Chapman reflex points are found in the deep fascia and are associated with specific viscera (organs).  These reflex points can be used as a diagnostic aid (diagnosis of illness) to locate a pathologic (indicative of disease) change.  Also, these reflexes influence visceral function through nervous system input. Finally, these reflexes are useful for influencing the motion of fluids, mostly lymph. And for influencing visceral function through the nervous system.

 

There was a study determining whether stimulation of a chapman reflex point could reduce blood pressure. They found while there was no effect on blood pressure, there was an alteration in aldosterone levels. Aldosterone affects the body’s ability to regulate blood pressure. Many hypertensive patients have high aldosterone and low renin levels affecting the renal tubules and causing sodium retention. Hypertensive patients have shown abnormalities in aldosterone levels. Stimulation of chapman reflexes caused a consistent lowering of aldosterone levels. It was suggested  not enough time was allowed, because even with drugs that lower aldosterone, it takes 5 to 7 days for the blood pressure to lower.

 

 

 

 

Soft tissue manipulation techniques along with chiropractic adjustments has many benefits for your health! Call your West Palm Beach chiropractor at 561-253-8984 to make an appointment today.


Find out more about Various Soft Tissue Manipulation Techniques Along With Chiropractic Care: Part 3 in the next post (part 4) on BODY WALL REFLEX TECHNIQUES (ischemic compression). 

 

 

References:

Bergman, Thomas. Peterson, Lawrence. Chiropractic Technique Principles and Procedures

  1. Third Edition

Hammer, Warren.  Functional Soft Tissue Examination and Treatment by Manual Methods.

Third Edition

 

Meiri Chiropractic

561-253-8984

Various Soft Tissue Manipulation Techniques Along With Chiropractic Care: Part 2

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This is a follow up to the post Various Soft Tissue Manipulation Versus Massage Along With Chiropractic Care:  part I.   As a review, soft tissue manipulation (STM) techniques are defined as those physical methods applied to muscles, ligaments, tendons, fascia, and other connective tissues with the goal of therapeutically affecting the body. Generally, STM  enhances proper tone and/or extensibility (ability of a muscle to be stretched) through a number of proposed mechanisms. Read below about the Various Soft Tissue Manipulation Techniques Along With Chiropractic Care: part 2 in our West Palm Beach office.

 

 

Functional Techniques

Functional techniques focus on structure and function and this interrelationship in the body. Additionally, they focus on the tendency of the body toward self-regulation. Functional techniques restore normal ease of movement and reduction of abnormal afferent (inward) input (signals) into your nervous system by correcting the problematic muscles. Certainly, this restores joint mobility and muscle tone. Two examples of functional techniques are MRT and PRT described below.

 

Myofascial Release Technique (MRT)

The goal of myofascial release treatment (MRT) is to establish functional three-dimensional whole-body symmetry and motion by removing fascial (thin casing of connective tissue that surrounds bone, nerve fiber and muscle) restrictions and restoring the body’s equilibrium. Consequently, MRT reduces muscle spasm and fascial restrictions.  This eliminates irritation to these pain-sensitive structures and so increases range of motion.

 

Positional Release Therapy (PRT)

PRTs major characteristics include specific body positioning and the use of tender points (areas of pain). PRT works by the positional release of abnormal neural reflexive activities (a neural reflex is an involuntary response to a stimulus). This is accomplished by placing the involved soft tissues in an “ideal position of comfort“.  Irritability of the tender points are reduced as PRT normalizes function. In short, a return to normal length of the muscle is ultimately achieved.

Manual Resistance Techniques

 

Manual resistance techniques includes those procedures that have varying degrees of contact pressure and joint movement or positioning. In other words, the doctor contacts with varying pressure and positions the patient and/or the joint. MRT also uses varying degrees of muscle contraction from none to strong sustained contractions from the patient. And the corrective process requires active patient participation. This encourages the patient to assume responsibility for self-care.  Two examples of manual resistance techniques are MET and PIR.

 

Muscle Energy Technique (MET)

MET incorporates the use of the patient’s muscular effort in the application of the procedure. The primary effect of MET is to influence joint function.  But, there will be effects on the muscles. Similarly, the aim of MET is to restore normal joint position and function while influencing proper posture. And to be effective, the soft tissue restrictive barrier must be found, accurately engaged and manipulated. Moreover, engaging the restrictive barrier is what distinguishes soft tissue manipulation (STM) from massage.

 

Postisometric Relaxation (PIR)

Postisometric relaxation (PIR) achieves results through neurologic mediation of neural pathways (nervous system pathways). PIR techniques focuses on the muscular system and on inducing muscle lengthening. So it lengthens the muscle by influencing the nervous system.   Firstly, PIR refers to the effect of subsequent relaxation experienced by the muscle after brief periods of isometric contraction. Isometric contraction occurs when muscle length remains relatively constant as tension is produced. Secondly, by relaxing the active elements within the muscle, the lengthening procedure may be more effective at stretching the connective tissue elements.  Thirdly, this normalizes the function of the contractile and noncontractile elements in the muscle. Lastly, PIR tends to be simplistic and gentle.  Above all, you can also carry out many useful types of self-administered PIR as home treatment between your visits.

 

Soft tissue manipulation techniques along with chiropractic adjustments has many benefits for your health! 

Call your West Palm Beach Chiropractor at 561-253-8984 to find out more about Various Soft Tissue Manipulation Techniques Along With Chiropractic Care: Part 2 or to make an appointment.

Various Soft Tissue Manipulation Techniques Along With Chiropractic Care: Part 2 will be  followed up with a post (part 3) on BODY WALL REFLEX TECHNIQUES (ischemic compression, acupressure, chapmans reflex points). 

 

 

References:

Bergman, Thomas. Peterson, Lawrence. Chiropractic Technique Principles and Procedures

  1. Third Edition

Hammer, Warren.  Functional Soft Tissue Examination and Treatment by Manual Methods.

Third Edition

 

Meiri Chiropractic

561-253-8984

 

Various Soft Tissue Manipulation Versus Massage Along With Chiropractic Care: Part 1

Posted on by Natalie Meiri

 

A common source of pain and disability is soft tissue injury with its resultant fibrosis and loss of elasticity and strength. Soft tissue injury and fibrosis may result from acute or repetitive trauma to muscular, tendinous, myofascial, or ligamentous tissue.  Therefore,  adjustments of the joint without attention to the supporting and controlling effects of the soft tissues (i.e. muscles, tendons, ligaments, fascia) will likely result in recurrence of joint dysfunction (misalignment of joint).  The reason being, abnormal soft tissue patterns and presentations may persist after joint function has been restored.  Accordingly, any soft tissue problems need to be treated along with the joint dysfunction. 

Most chiropractic adjustive techniques (adjustments) impart a thrust to move a joint into proper alignment of the body to normalize function.  In contrast, many manual therapy procedures (joint mobilization, traction, and soft tissue techniques) are designed to affect physiologic processes to normalize function without using a thrust. This post will focus on soft tissue manipulation (STM) techniques. STM techniques are defined as those physical methods applied to muscles, ligaments, tendons, fascia, and other connective tissues with the goal of therapeutically affecting the body.

Indeed, various and numerous forms of STM exist within the profession of chiropractic. Firstly, all STM techniques are not equivalent. Secondly, while all are often recommended for the relief of pain, all STM techniques are not interchangeable.  Thirdly, although all STM techniques have some effect on the soft tissues, one may be more appropriate or effective for a particular condition.

 

Various Soft Tissue Manipulation Versus Massage Along With Chiropractic Care: the Restrictive Barrier Concept

Probably the most well known soft tissue technique is massage (methodical, friction and kneading of the body upon bare skin). Subsequently, some chiropractors do not use manual therapy (non thrust techniques) and refer their patients for massage (i.e. deep tissue) because of the exclusiveness of  adjustments (thrust techniques). And in the chiropractic practice, one of the functions of massage is to relax your muscles.  This prepares the irritated region for adjustments. 

So massage is great for pain reduction, relaxation, improved circulation and even softens superficial fascia. However, massage is not soft tissue manipulation therapy which crosses the restrictive barrier. Many conditions require the restrictive barrier to be found and accurately engaged to provide  functional improvement.  The barrier concept provides an important distinction between massage procedures and other STM techniques.

You cannot get whichever therapy (massage) you prefer and expect the same  outcome.  Some soft tissue injuries/conditions may require a soft tissue manipulation technique beyond massage for restoration of full functional and/or structural improvement.  Furthermore, when considering the use of treatment of certain soft tissue conditions a working knowledge of the fundamental principles behind them is necessary and helpful. 

 

 

Education

Chiropractors have far more education than a massage therapist. A chiropractor has to complete a four-year undergraduate degree and then must finish a four-year doctorate of chiropractic program. All chiropractic programs teach a comprehensive program incorporating elements of basic science (e.g., physiology, anatomy, and biochemistry), clinical science (e.g., laboratory diagnosis, radiographic diagnosis, orthopedics, neurology, and nutrition), and clinical intern experience.

During their education, chiropractors also have to complete a residency program that includes hands-on training, pass several board exams, and pass certification tests. In conclusion, government inquiries and comparative evaluations have determined that the coursework and hours of instruction in the basic sciences are very similar between chiropractic and medical schools. Chiropractic students on average spend more hours in anatomy and physiology and fewer hours in public health. In the clinical arena chiropractic students have very limited training in pharmacology and critical care, but have significantly more training in clinical biomechanics, neuromusculoskeletal diagnosis, manual therapy, and exercise rehabilitation.

 

Part II of this post will discuss some various soft tissue manipulation techniques utilized at Meiri Chiropractic such as:

 

 FUNCTIONAL TECHNIQUES

Strain-counterstrain

Positional release technique

MRT, Myofascial release technique

 

MANUAL RESISTANCE TECHNIQUES

MET, Muscle energy technique

PIR, post isometric relaxation

PNF, proprioceptive neuromusculoskeletal facilitation

Ischemic compression

Trigger point therapy

Receptor-tonus technique

 

BODY WALL REFLEX TECHNIQUES

Acupressure point stimulation

Chapman lymphatic reflexes

Bennett vascular reflexes

 

If you just need to relax and treat yourself, you should head to a massage therapist. However, if you have more serious complaints, such as back/neck pain, frequent headaches, TMJ pain or even arm and leg pain, you may get more benefits from chiropractic soft tissue manipulation techniques. Call Meiri Chiropractic today at 561-253-8984 to make an appointment or to learn more about various soft tissue manipulation versus massage along with chiropractic care: Part 1 in West Palm Beach.

 

 

References:

Bergman, Thomas. Peterson, Lawrence. Chiropractic Technique Principles and Procedures

2011. Third Edition

Hammer, Warren.  Functional Soft Tissue Examination and Treatment by Manual Methods.

Third Edition

 

 

 

        Video on same post

https://youtu.be/O4RILYTswVA

 

Meiri Chiropractic

561-253-8984