He further stated, "It is well-known that loss of function in one joint may have widespread effects on the normal functioning of much of the rest of the musculoskeletal system. Many a late-developing symptom of musculoskeletal pain could be easily avoided if one knew better how to care for current joint problems."
And so it with these basic thoughts that I devote this article to the late Dr. Mennell as my friend, mentor and logical thinker. It is my job, I believe, to add to these thoughts and demonstrate to you that what he said more than 30 years ago is as true today as it was then. I will at times state his writings and then expand on them, so that you can use these ideas almost instantly in your practice. So, if you're ready for the challenge of learning and adding logic and common sense in what you do, please read on. You may find the answers that you've been looking for.
There appears to be a lot of frustration in the ability of individual chiropractors to fully understand a (or any) mechanism of adaptation within the human body. As a result, there has been a tremendous drive to get into more testing to validate any and all problems which must be present in the patient.
It has always been my belief that malingering tests were to weed out the bad apples, but many of the people that were so-called "faking" were suffering from some joint and spinal problems. This led me to believe that it was not the criteria used but rather the doctor's ability to understand and recognize what is before him.
In my many years of studying and training under many of the best doctors in the world, including Drs. Mennell, Travell, Kohr, Faye, Gillet, and Pletain, I believe that I have developed a strong foundation for understanding any alteration in the (at least theoretically) normal range of movement, joint function and paraphysiological space.
This brings us back to the understanding of what we think normal should be, whatever that is! And when we begin to use such figures and criteria, we must also realize that certain laws and rules apply to them, which must be predictable and repeatable.
Dr. John McM. Mennell's thoughts and theories were based around the concept of joint dysfunction:
"This condition I call joint dysfunction signifies a loss of joint-play movement that cannot be produced by the action of voluntary muscles, in contradistinction to the loss of voluntary action of a joint which, together with pain, results from this condition. Having recognized joint dysfunction as a pain-producing pathological condition that causes loss of movement. I intend to show that restoration of normal joint play by manipulation is the logical and only reasonable treatment to relieve pain from it and to resolve normal voluntary movement. The recognition of dysfunction can only be achieved by clinical means.
"It is only by knowing what should be present in the way of movement in a normal joint that it is possible to detect its loss and, when appropriate, to know how to restore that which is lost. Commonly, joint disease is the cause of secondary muscle changes, particularly atrophy and spasm, the latter being protective and Nature's attempt reflexly to prevent painful joint movement. Yet, sparse attention is given in treatment to the joint itself unless there are gross clinical and radiographic changes in it, and no attention is paid to the muscles.
"There can be no doubt that there is a vicious circle of effects in any musculoskeletal problem, but, usually, the prime fault lies in the synovial joint. It is the detection of the prime fault in the synovial joints which present work is concerned. If the prime fault can be corrected, the secondary abnormalities resulting from it can usually be readily corrected, too.
"The loss of these movements of joint play may be primary, in which case it is usually the result if minor trauma, often caused by some unguarded, and therefore abnormal, movement being inflicted upon the joint during the performance of an otherwise normal voluntary movement. In this case, the loss of joint play, that is, dysfunction, is a diagnosis of the cause of pain and limitation of voluntary movement. In a case of primary dysfunction the treatment to relieve the pain and loss of function is to restore those movements of joint play that have been lost."
Mennell's Concept: A Simple Review
The understanding of these rules have been the greatest reasons between success and failure for getting results:
- When a joint is not free to move, the muscles that move it cannot be free to move it.
- Muscles cannot be restored to normal if the joints which they move are not free to move.
- Normal muscle function is dependent on normal joint movement.
- Impaired muscles function perpetuates and may cause deterioration in abnormal joints.
Now, let's take these and expand them using the dispersive factor, as I formulated it while working with the '88 Olympic Greco-Roman Wrestling Team as their consultant.
The Dispersive Factor
I had just walked into the Pensacola Civic Center for the final qualifier to determine the team members of the 1988 Olympic Greco-Roman and Freestyle Wrestling teams. I watched many of the athletes I had worked on win their matches and earn their respective spot to travel to Seoul, Korea and compete for their country. Thinking about it even 10 years later still gives me the chills!
As I walked in a hand grabbed me by the back of the neck, "We've been waiting for you, one of your athletes is hurt. We haven't been able to do anything for him and he's been asking for you!" What a nice feeling, but even better when it was coming from one of the two head Olympic orthopedic doctors.
As Todd G. explained what had happened and what already been done, several thoughts came to my mind: I obviously can't repeat what they've already done (two MDs, two Olympic trainers and two PTs); second, the position of his arm is more compensatory than an actual injury (since I had worked with him in the past); third, I had to be thorough. I was now on stage with six other professionals watching to see what the chiropractor could do, if anything, that could make a difference when they could not!
Todd explained that he had been picked up and dumped onto his right shoulder. He could not move the shoulder at all. When I examined him, his arm was tightly wrapped around his abdomen and his hand wrapped around his ribs. The strange thing was how far posterior his scapula was protruding.
The rules that Dr. Mennell had taught me flashed before my eyes. One thought dominated my mind: "When a joint is not free to move, the muscles that move it cannot be free to move. With that in mind I proceeded to apply this rule. By observation and listening to the description of the onset of the injury and understanding Dr. Mennell's rule, a careful examination led me to the lower extremities. I came to the conclusion that the problem was in the subclavius muscle, and that the other restrictions were only compensations.
I placed my left thumb under his clavicle and began to release this small muscle, all the while being stared at by all the other doctors. It didn't take long to please them, yet baffle them, too. After about 15-20 seconds of applying pressure, I asked Todd to go ahead and raise his arm. He argued at first, then followed my direction and to his (actually everyone's) amazement, he was able to. What happened, exactly what I thought would happen, was that he was able to finally move his arm back to almost 95 percent of the normal range of motion and with no pain.
You could almost hear the thoughts of the other professionals, "How did he do that?" But I was more interested in rechecking Todd to see if every other joint had freed up; most of them had. Within 30 minutes, even his strength was back up to 80 percent of his norm, but he had already been eliminated from making the team.
What I realized from this event changed my life, because it expanded my thinking and caused me to never accept what I see or hear on the surface and/or chase symptoms and pain.
Let me describe the dispersive factor. Picture the ripple effect from a stone being dropped into the water. Now imagine an injury to the shoulder from a fall. If we were to have a ripple effect from the shoulder, what structures would be or begin to be affected? (The reason I said "begin to be affected" is because most of the time this line of thinking is never used, resulting in an incomplete treatment protocol and planting the seeds of greater problems that may not develop in the months, years or even decades to come. This alone is a reason not to accept the treatment time dictated by insurance companies.)
Take the shoulder as the epicenter of the shock wave. Where else do you suppose this protective mechanism will strike next? I say protective mechanism because the body is always trying to protect itself from further injury by dispersing as much of the shock wave as possible away from the original injury site to reduce the amount of injury to that one area.
This is why people usually complain of additional problems, hindrances, loss of range of motion, decreased performance, and increased symptoms, all for no apparent reasons or recall of a specific injury. This leads to a big problem in history taking and asking specific questions about an injury. There may be other nonsymptomatic areas involved that get missed because they don't hurt yet. Sometimes you'll get fortunate and find the right spot without ever knowing any of this, but wouldn't it be nice if you were able to solve these problem without getting lucky?
Visualize the shoulder and go in all directions away from it; further visualize what other joint, muscle, ligament and other soft tissues may be in line in this chain of events. The next key is not to stop at just the next joint, but continue as far down the chain as possible: shoulder, elbow, wrist, hand and fingers; shoulder, cervicals, thoracics, scapula, low back, hip, knee, ankle, foot, toes and every muscle, ligament and soft tissue in between. No muscle, joint, ligament or soft tissue is too big or too small to overlook: none, not one. Please understand that.
You have to become an efficient detective who can interpret, decipher and understand all of these events, and with a plan of action. You must know what to look for and predict the results before you even lay hands on the person. You must be certain of what you'll find, just by the brief description of what the person has told you happened.
You must be able to visualize what the injury looked like and what happened as a result. Now you follow the Dr. Mennell's basic rules, on which I will now expand.
There are only two laws to the dispersive factor: both involve the amount of force that is involved in an injury, fall or accident.
Rule one: The body will adapt the force the best it can by spreading the force out and sharing the impact with the rest of the body to minimize the forces to one area.
Rule two: If the force is greater than the body can handle, the body will give way to the force (e.g., fractures, torn ligaments, muscle tears, or even death).
New Rules and Expansion of the Dispersive Factor
Since 1988, I have made many new distinctions in this work and understanding of specifically predicting how the body will respond under stress and injury. I have added and refined these distinctions:
- Every joint in the body has a specific set of functions and when it cannot express its set of functions it must therefore express a state of dysfunction.
- To each joint is attached a specific set of muscles, ligaments and other soft tissues, therefore if a joint is not able to perform its function, these tissues must also express dysfunctional patterns.
- Since each joint in the body must rely on other joints for structure and support, if a joint cannot move freely, then other joints which rely on it for their proper innate movement cannot move freely either, causing additional areas of dysfunction often referred to as adaptation or compensations.
- If secondary or tertiary joints become involved in this chain of joint dysfunction, they will create their own subsequent joint dysfunctions, leading to reactions in other distant or proximal joints, soft tissues, muscles and ligaments. Any joint which is involved in coupled motion becomes susceptible to joint dysfunction.
- These additional joint dysfunctional areas that create their own chains of joint dysfunctional areas will most always be in areas that are totally unrelated to the original site of injury.
- You must be able to understand the chain of events, maintain an open mind and discern the original point of dysfunction. If you are truly able to attain such mastery and find the original offensive joint dysfunction, then by removing the original joint dysfunctional pattern, the remainder should instantly disappear.
- The laws of limitation also state that if an injury has taken root in an area long enough to begin to cause damage and degeneration, then it will more than likely not release and must be taken care of separately, even though it had nothing to do with the original injury.
- Never accept that the whole injury is only in one joint without thoroughly excluding any and all other joints down the path, and even crossing over whether or not you think any other joints may be or may not be involved as a direct or indirect result of a new or existing injury.
- Every injury has its own patterns of development, detection, involvement and resolution. When you begin to understand them, you can see signs of their impending development. Therefore, you can actually predict what is going to happen, what has happened and why.
- When you understand this predictable mechanism, you can develop a preventive plan based on similar situations that have caused similar injuries in the past. Because injuries leave clues and each sport or injury has certain repetitive actions that involve specific joint components, if weaknesses can be found before a full blown injury occurs, the weak areas can be strengthened to avoid injury. I have done this numerous times with many top professional, Olympic and amateur athletes in different sports.
If you truly understand the power of these rules, you can begin to analyze any sport. From 1986 to 1993, I was unofficially involved with taking care of 37 Miami Dolphin players and spent many hours at their training camp. I began to notice several common patterns that, if left unchecked, would lead to injuries. I presented these concerns to the trainers. I got no response and nothing was done. My conclusions were 99 percent correct. Almost every single injury that I anticipated occurred. When it was accepted that I knew what I was talking about, they changed trainers.
Since then I have made even more distinctions and continue to see easily solvable patterns in the prevention of injuries. You just have to understand what to look for. This is why I have begun to teach these principles. I believe they will forever get rid of the frustrations suffered by trainers, doctors and all others involved in working with top athletes and the public.
There is no reason to allow injuries to take place when there is a way of determining their patterns and resolving them before they strike.
William Moyal, DC, CCSP
Miami Beach, Florida
tel: (305) 531-2933
e-mail: DrMKiro4u2-aol.com