What's All the Buzz About Spinal Stability? Part One:
Biomechanics and Neurophysiology
June 3, 2004
The concepts of stability and instability are integral to modern musculoskeletal care. According to Panjabi, three subsystems work together to maintain spine stability: 1 the central nervous subsystem (control), an osteoligamentous subsystem (passive), and a muscle subsystem (active). He says: "The neural subsystem receives information from the transducers, determines specific requirements for spinal stability, and causes the active subsystem to achieve the stability goal."
What's All the Buzz About Spinal Stability? Part Two:
Assessment and Training
August 16, 2004
Reactivating spine pain patients is a key to early recovery from acute and subacute episodes, 9, 13 prevention of recurrences, 8 and treatment of chronic pain. 10 Part one of this series reviewed the biomechanics of spinal instability and simple preventive measures patients can take to spare their tissues from repetitive strain. 11 This article will present the basic stages of a spine stability "core" exercise program.
A Moment of Silence for Vladimir Janda, Dr.Sc., MD
January 14, 2003
Professor Vladimir Janda passed away November 25, 2002. His contributions to musculoskeletal health care are immeasurable. He changed our thinking - how to see beyond a muscle's strength or weakness - and to identify how the body compensates in often subtle ways to maintain stability. His teaching was a labor of love for which he sacrificed everything. Even as a devastating postpolio syndrome took its hold on him, he refused to slow down. His stature and the resonance of his message remains clearer than ever.
What to Do about "Yellow Flags"
November 30, 2002
On May 1-3, 2003, the World Federation of Chiropractic's 7th Biennial Congress will host a preeminent European leader in musculoskeletal medicine, Professor Stephen Linton. He is an expert in psychosocial aspects of back and neck pain patients, and has pioneered the identification of risk factors of chronicity and preemptive reactivation treatments with a cognitive-behavioral emphasis. This article will summarize the impact of psychosocial factors on prediction of patient prognosis, and how patients with such factors can be appropriately managed.
The Modern Report of Findings: The Role of Reactivation
December 1, 2001
Musculoskeletal pain patients in general, and LBP patients in particular, require an approach that addresses the physical (biological) and psychosocial dimensions of their problems. This modern approach is called "biopsychosocial" (BPS), in that the total patient is our subject. Rather than focusing on structural causes and cures, this new paradigm emphasizes the goal of maintaining or restoring function. Such an approach is of value, regardless of the pathoanatomic diagnosis.
How to Shift LBP Paradigms: The "Hinges" of Practice
March 26, 2001
Specialists in the management of spinal disorders have seen tremendous changes in the last decade. While the low back pain (LBP) problem has been acknowledged as an epidemic, a consensus has gradually emerged as to why this has happened and what can be done about it . An overemphasis on the simplistic biomedical approach of identifying and treating the structural cause of pain has led to excesses in diagnostic testing, bed rest, narcotic analgesics, and surgery (Waddell). Meanwhile, an underemphasis on illness behavior has led to an under-utilization of functional (re-activation advice, manipulation and exercise) and cognitive-behavorial approaches (Feuerstein).
The State of the Art: "Evidence-Based Care" From Guidelines to Practice:
What Is the New Benchmark?
August 6, 2000
"Acute low back pain" is the number one patient complaint that leads to chiropractic visits. Our treatment should have as its goal the maintenance or resumption of normal functional activities. Chiropractic appropriately emphasizes the role of manipulation in reducing activity intolerances. Other "tools of the trade" include improved psychosocial attitudes or coping skills, and stabilization training through activity modification advice or exercise.
November 30, 2000
Diagnosis of structural pathology does not adequately guide treatment decision-making. Disc bulges are present in 52% of asymptomatics.1 Surprisingly, the larger the disc herniation the more likely nerve root compression is to spontaneously resolve.2 If diagnosis of structural pathology does not consistently correlate with symptoms, what evaluation can guide our treatment decisions? Evaluation of dysfunction is essential for figuring out what is causing pain in the locomotor system. This is called the "sports medicine approach." Its main emphasis is in identifying and treating the deconditioning syndrome (see Table 1). Athletes know that functional restoration is the key to return to competition, and that diagnosis of tissue injury or pathology is only a starting point.
January 1, 2001
Active care is a proven part of the conservative care armamentarium for neuromusculoskeletal disorders. The first three parts of this series have described the importance of evidence-based care, the psychosocial aspects of care, and the biomechanical aspects of care. This fourth and final part summarizes the basic "tools of the trade" for anyone wishing to incorporate active care into their practice. These are the tools that drive the integration of active care into chiropractic.