What is Chiropractic Neurology or Functional Neurology?
Some chiropractic doctors have chosen to advance their study beyond the general, and may specialize in various curricula that will deepen their understanding of the optimization of human function; should they take the board examinations after study (and pass), this will lead to board-certification. All board-certified doctors (Diplomates) have successfully completed an intense science-based study of their chosen specialty field of interest. One such field of study is that of chiropractic and functional neurology.
Chiropractic neurologists are trained in the latest and most advanced diagnostic and therapeutic applications of neurological modalities to maximize human performance. The procedures of chiropractic neurology center on the recognition that there is an intimate interaction between the nervous system – both central and peripheral – and the musculoskeletal system, mediated by all types of sensory receptors, which are found throughout the body in the special senses (eyes, ears, nose), skin, soft tissues, balance system, joints and muscles. By understanding that the brain (including the thalamus, basal ganglia, brainstem and cerebellum) is a “central processor” for the information relayed by all of your body’s systems, chiropractic neurologists are able to assess – and then access – those information pathways in an attempt to effect a change in the brain’s output via control or alteration of the sensory or even motor input (afferentation).
In order to become a board-certified functional neurologist, the Doctor of Chiropractic or the equivalent must take a minimum of 300 post-doctoral hours of coursework in functional neurology and pass the rigorous written and performance exams required for certification by the American Chiropractic Neurology Board (A.C.N.B.). We call these doctors “Diplomates of the American Chiropractic Neurology Board (D.A.C.N.B.)”.
What is “fascia”?
Fascia is a specialized connective tissue layer surrounding muscles, bones and joints and gives support and protection to the body. It consists of three layers – the superficial fascia, the deep fascia and the subserous fascia. Fascia is one of the 3 types of dense connective tissue (the others being ligaments and tendons) and it extends without interruption from the top of the head to the tip of the toes.
Fascia is usually seen as having a passive role in the body, transmitting mechanical tension, which is generated by muscle activity or external forces. Recently, however some evidence suggests that fascia may be able to actively contract in a smooth muscle-like manner and consequently influence musculoskeletal dynamics.
Obviously, if this is verified by future research, any changes in the tone or structure of the fascia could have significant implications for athletic movements and performance. This research notwithstanding, the occurrence of trigger points within dense connective tissue sheets is thought to be correlated with subsequent injury.
What are trigger points, and why does Dr. Kevala assess for them?
Trigger points have been defined as areas of muscle that are painful to palpation and are characterized by the presence of taut bands. Tissue can become thick, tough and knotted. They can occur in muscle, the muscle-tendon junctions, bursa, or fat pad. Trigger points might be accompanied by inflammation and if they remain long enough, what was once healthy fascia is replaced with inelastic scar tissue.
Trigger points in the fascia can restrict or alter the motion about a joint resulting in a change in the normal neural feedback loop to – and from – the central nervous system. Eventually, this will make the neuromuscular system become less efficient, leading to premature fatigue, chronic pain and injury and less efficient motor skill performance.
All muscle stretching, then, is actually stretching of the fascia and the muscle, the myofascial unit. When muscle fibers are injured, the fibers and the fascia which surrounds them become short and tight. This may result in adhesions and uneven local stress in the surrounding fascia and structures, including the myofascial unit and even the nearby joints. This uneven stress can also be transmitted through the fascia to other parts of the body, causing pain and a variety of other symptoms in areas you often wouldn’t expect. Myofascial Release treats these symptoms by releasing the uneven tightness in the injured or adhesed fascia.
Myofascial release and neuromuscular re-education…what are they?
Dr. Kevala utilizes a variety of Myofascial Release and neuromuscular re-education techniques in conjunction with other neuroscience-based modalities to address the equally various myofascial restrictions/adhesions, muscle imbalances and trigger points of her patients.
Neither myofascial release nor neuromuscular re-education are forms of massage. They are used to equalize muscle tension throughout the body. Unequal muscle tension can compress nerves and muscles causing pain. Progress is measured by a decrease in the patient’s pain and by a holistic/centrally modulated improvement in joint movement ability and the patient’s overall posture and balance.
Myofascial release and/or neuromuscular re-education – when used in conjunction with chiropractic neurology and functional treatment – is highly effective in treating patients with the following diagnoses:
- Back strain, chronic back pain, low back pain, thoracic back pain
- Carpal tunnel syndrome
- Chronic cervical pain
- Complex pain complaints
- Disc derangement
- Radicular symptoms
- Dizziness, vertigo
- Myofascial pain dysfunction
- Plantar fasciitis
- Post-Polio symptoms
- Thoracic outlet syndrome
- TMJ dysfunction
- Trigger points, tender points *
* Trigger Points and tender points cause different types of pain. For example, a Trigger Point in the neck muscles can cause headaches, the sensation of your throat closing or eye pain. Pressure on a Trigger Point causes increased pain at the site and radiating pain in other apparently unrelated parts of the body. Pressure on a tender point causes increased pain only at the tender point itself.
What is inflammation and how does Dr. Kevala treat it?
Inflammation is a natural process utilized by your body to heal itself. Inflammation per se is not a bad thing, but “inflammation gone wild” can wreak havoc upon many different systems within your body. You may have heard, for example, that inflammation as a response to arterial damage is at the root of the symptoms of heart disease. The same line of reasoning applies to other disease processes, like diabetes, rheumatoid arthritis, and it has even been postulated for Alzheimer’s and other, less grave situations. Interestingly, did you know that often, the first overt symptom of heart disease is…a heart attack? (!!!). Similarly, many disease complexes often have no overt signs and symptoms…until your body has reached the point of “This is just the last straw! I cry uncle!”
For the most part, we are concerned with inflammation that has gone beyond the normal control processes that your body innately possesses. The body is a beautiful, elegant system…but when one or more of those systems exceeds its (very large) capacity to adapt to insult or injury, problems will arise…and it can then become a vicious cycle.
The problem is that when soft tissues are stressed they produce a group of chemicals called inflammatories. These include histamine, bradykinin, and prostaglandin. These chemicals are designed to provoke specific physiological responses – which are supposed to be part of the healing process. Ideally, these chemicals are broken down as soon as they are produced by enzyme action as they come in contact with the blood. If the blood supply is inadequate and these chemicals are allowed to build up sufficiently, they produce adverse reactions that may not only slow healing but also increase soft tissue stress. In such circumstances, histamine increases swelling, bradykinin increases tissue sensitivity, and prostaglandin increases pain.
Histamine changes circulation in the soft tissues affected by inflammation by opening the arterioles, which lead to the capillaries, while simultaneously closing the venules leading away from the capillaries. This has the effect of promoting swelling, while at the same time – if deep tissues are affected (tendons, ligaments, joint capsules, or fascial layers) – increasing skin resistance right over the inflamed deeper tissues. When the capillaries are engorged and open up around and in inflamed tissues the capillaries in the skin just over those deep tissues reciprocally constrict, increasing surface skin resistance to the passage of electrical current. Dr. Kevala may use a skin resistance meter to detect these particular changes.
Bradykinin does not hurt overtly, but it does have the effect of making the involved tissues sensitive. This sensitivity increases and can affect adjacent tissues as the bradykinin builds up and spreads out. By rule of thumb, the tissues will remain sensitive (easily irritated) for two weeks after all of the pain is gone. In that period, the tissues remain tender and easy to irritate and re-inflame.
Prostaglandin is an organic acid that burns the tissues it comes in contact with. Prostaglandins are also several different molecules that are responsible for things such as blood clotting, in addition to pain and burning the tissues. Prostaglandins are the molecules whose formation aspirin prevents (you know how they say to take your aspirin a day?). Did you know that omega-3s work upon the identical pathway that aspirin and cox-2 inhibitors work on? (There’s a clue: ask Dr. Kevala about omega 3s!).
Continuing on…if prostaglandin is allowed to remain in the area long enough its burning action causes the body to respond as if it has been burned. The body, responding normally, tries to heal the burn; it floods the area with collagen in the form of collagen fibrils, which would ordinarily collect to form a scar matrix. There is no scar matrix to reasonably form, so these fibrils start sticking tissue layers together, becoming what are called adhesions. These adhesions cause these tissue layers to “catch” as they try to slide over one another. This increases tissue stress and provokes more inflammation, thereby becoming a self-perpetuating process. Adhesions are one source of many chronic problems seen in orthopedics, physical medicine and the chiropractic field.
The first step in “fixing” the problem is to precisely determine the location of the inflammation(s).
The second step in the process is to break whatever adhesions exist in the involved tissues. This involves mobilizing the tissue layers in such a manner that a shearing force is exerted on the individual collagen fibrils, which is sufficient to cause the fibrils to break – thus reducing the adhesion. This is generally accomplished by picking up the tissues and forcefully rolling (or pinching) them between the fingers. Another method utilized by Dr. Kevala is the Graston Technique. These processes are generally uncomfortable, but do afford the advantage of giving almost instantaneous, albeit (sometimes) temporary, relief of some or almost all of the constant chronic pain. High intensity electrical stimulation may be used to facilitate this procedure. In the long term, adhesion breaking, in conjunction with precise chiropractic neurology modalities, gives you the chance of permanently getting back normal ranges of motion and comfort that other procedures may only temporarily provide you. If the adhesions remain unbroken, the pain will eventually come back.
The third step is to induce your own deep circulation to come into the inflamed area so that the waste products of this cycle can be carried away. In our setting, we utilize ultrasound and laser. The effect is generally immediate with a general decrease in the degree of overt pain. In some cases, the desired decrease in pain has occurred over night or (in a few cases) over the course of a few days. Dr. Kevala will also instruct you in home anti-inflammatory measures that you can take.
The fourth step is directed at increasing capillary circulation in the involved tissues. This is usually accomplished through judicious use of various forms of electrical stimulation, laser and/or vibration. If we can improve capillary circulation, enzyme action will complete the destruction of the inflammatory chemicals and relief will come a good deal faster than otherwise. Indeed, some forms of electrical stimulation will not only increase capillary circulation, but will also inhibit the formation of adhesions in the involved tissues.