At times, I could see that I was confused, not knowing how or what to choose. Some chiropractic teachers had given up adjusting altogether and had strictly embraced soft tissue techniques. Some were more closely aligned to physical therapy than chiropractic. Others would mix adjusting and physical therapies. These practices were opposed by straights, who believed in adjusting the chiropractic subluxation, period. I respected the straights and mixers but for different reasons. The straights had a strong uncompromising belief in adjusting. In general, this belief seemed to be stronger than with mixers, yet the mixers had a flexibility to see that straight adjusting did not resolve everyone's problems.
The rest of my patient experiences have shown me that I can treat problems more effectively by mixing adjusting procedures and therapies. I saw a problem, however. By mixing, one can lose sight of the chiropractic heritage of expert adjusting. So, the trick is to mix without loss of adjustive skill or purpose. Yet, if one uses therapies, there should be a high competence and skill level.
What I saw among others and myself, however, was an approach towards therapies like those used by physical therapists. Unless the problem presented as an obvious radicular problem involving a compromised nerve, there was no relationship shown between the therapies, the soft tissue problem and the adjustive chiropractic lesion.
What I am suggesting or advocating now is a better understanding of spinal mechanics, spinal dysfunction and subluxation in relation to soft tissue strains, sprains and hypertonic states. It has been my observation that many soft tissue strains/sprains result from joint dysfunction/subluxation patterns. Thus, if I use therapies to treat the soft tissue problems, I have to use a unique approach. I must recognize that the original problem may be an articular spinal or extra-spinal dysfunction or subluxation that must be corrected first. If the articular relationship is not recognized, the chiropractor has to approach the problem as a physical therapist, a muscle worker, or rehabilitation specialist. Identity as a chiropractor is then diminished.
As previously stated, my experience has led me to recognize that many soft tissue complaints result from articular lesions (dysfunction, subluxation). I was not taught this at school, nor is this reflected in continuing education seminars, unfortunately. The educational training I received, and still receive yearly, does not reflect a strong understanding or belief in the potential of a properly determined and executed analysis and adjustment (or properly executed segmental traction, if required).
My field experience, plus basics learned through school or academic study, has been the basis for my observations and practice methods. In previous published work, I have outlined some soft tissue syndromes associated with articular lesions. I have done the same in my manual (The Connection), describing and treating these related problems. As a review, I will list again some soft tissue disorders resultant from lumbar and sacroiliac subluxations and/or dysfunctions. I call them associated disorders. They are:
- groin strain
- hip strain/sprain
- knee strain/sprain
- testicular/ovarian discomfort
- gluteal strain
- sciatic radiculitis secondary to gluteal strain
- quadriceps strain
- hamstring strain
- ischial bursitis
- Osgood-Schlatter disease or syndrome
- anterior knee pain (PFPS)
- shoulder pain
Other soft tissue complaints commonly observed and resultant from articular lesions to some degrees or completely are:
- levator scapula syndrome, or strain, usually related to C-1 and/or C-2 dysfunction/subluxations;
- right-side anterior throat or SCM syndrome. The right anterior neck is sore and can be swollen, including the SCM. This is related to the anteriorly fixated and subluxated atlas on C-2, and sometimes C-2/C-3.
None of the problems listed can be appropriately treated without a proper adjustment first.
If the problem has existed long enough, the soft tissues may have developed problems of their own, which cannot be resolved by adjusting alone. Adjusting can completely solve the problems presented if performed early enough. If the adjusting is performed and the complaints still remain, then soft tissue therapies can be used. Or, adjusting and soft tissue therapies may be used simultaneously and immediately just to ensure more rapid resolution.
Chiropractic is missing a great opportunity when it comes to treating professional athletes. There are so many athletic injuries which utilize a physical medicine protocol rather than a proper chiropractic one. If proper chiropractic intervention were applied in these cases, more total care could be realized. The problem could be that there are no chiropractic protocols for hip, groin, or hamstring injuries related to spinal dysfunction. There are no protocols for treating right-sided throat and head pain.
Continuing education seminars teach us statistics and therapy protocols, but not combined chiropractic articular and soft tissue treatment protocols. The schools are doing their best, but it just isn't enough. Field doctors are not getting the practical guidance needed to diagnose and treat many common soft tissue disorders and specific articular disorders. They resort to accepting protocols from sales representatives, trainers, therapists or engineers.
Another area where meaningful protocols are lacking is the treatment of hip disorders. If hip disorders are not caught early enough, they can degenerate and result in hip replacement. Soft tissue treatment should be preceded by exacting articular analysis, showing hip-joint stress secondary to lumbar and sacroiliac dysfunction/subluxation. If this cannot be done, practitioners are left with physical therapy protocols, nutrition and exercise. Nutrition and exercise are essential and important, but they are virtually useless in the face of lumbar and SI dysfunction/ subluxation. Actually, I see hip joints worsen with exercise if proper articular correction is not made.
I would recommend:
- Study spinal and sacroiliac mechanics. Learn how to motion and static palpate.
- Relate these mechanics, or lack of, to soft tissue disorders. (I like to call joint-related soft tissue disorders "associated disorders.")
- If proper adjusting does not resolve soft tissue disorders, then consider using appropriate therapies.
- Do not look at all soft tissue lesions as independent entities. Try to identify a joint-related basis for the problem.
- Adopt a protocol that includes motion analysis, adjusting and soft tissue therapies. Soft tissue therapies in this context is rational. Without consideration of proper articular mechanics, soft tissue therapies are irrational and incomplete approaches to solutions.
We should test and refine these protocols and then apply them to our practices more effectively. We should also pioneer new and more effective treatments of lower and upper extremity problems with professional athletic teams, where we can receive due recognition, while helping others more effectively than our competitors. Researchers should base more studies on ideas presented by field practitioners, rather than making field practitioners wait until innovative and practical research data is available.
Dr. Joseph Kurnik practices in Torrance, Calif. He is a former columnist and longtime contributor to DC; previous articles are available online at www.dynamicchiropractic.com.