Wisdom Wednesday: Treatment Before the Diagnosis?

This is an abbreviated case history to illustrate some of the unique features of the QA (Quintessential Applications) protocol.

A 34 four-year-old female came to my office with a chief complaint of severe pain under her left jaw. She had been to her primary care physician who thought it was a salivary gland but found no evidence of infection.

On palpation I could elicit pain but not from the salivary gland but actually from a small area just adjacent to a salivary gland. The area did not feel inflamed or abnormal in any sense, except she reacted to the pain.

Chiropractors are very good at palpation. It’s skill that is honed in school by palpating a hair through pages of Gray’s Anatomy. With practice, you can feel the distortion through about 80 pages of text. Now add 38 years of practice, palpating spines all day long.

So I was just as confused as her PCP. I could not identify the tissue from palpation.

Using the QA protocol, I looked for an injury reflex. However, Autogenic Facilitation was intact (any weak muscle strengthened when the nerve supply to that muscle was stimulated) eliminating an injury.

TL (therapy localization) to the jaw was active – if she placed her hand on the location of pain, any weak muscle became strong. Now I had a tool to evaluate her symptoms.

Next I checked to see what inflammatory pathway might be active. She was negative for prostaglandins but positive for both leukotrienes and cytokines. These pathways stimulate the immune system and when both are active can be autoimmune in nature. Typically, such cases will not respond favorably to ginger or boswellia, requiring a supplement that modulates the immune system.

Wisdom Wednesday: Chasing Chemistry

Quintessential Applications (QA) is the format I use to evaluate all patients. It is a form of manual muscle testing based on excitation and inhibition of neural pathways. It uses the nervous system as a window to view the status of the human body.

However, the majority of the testing involves “chasing the chemistry” of the body.

The first pathways that are evaluated are all associated with inflammation. I frequently tell new patients, “If you can eliminate inflammation, 80% of your symptoms will resolve, regardless of the cause.” However, if you cannot reduce inflammation, you cannot properly evaluate or treat the underlying causes that are the ultimate goal of nutritional therapy.

Prostaglandins are the most common inflammatory pathway I find, accounting for 60% of my patient population. PG2 (prostaglandin 2) is released by damaged tissues and is magnified by the liver. While PG2 can be reduced by NSAIDS, like Advil, aspirin, or Aleve, I prefer to use omega 3 fatty acids, like fish oil or flax seed oil that form PG3 in the body. PG1 precursors (omega 6 fatty acids) like black current seed oil, borage oil, or evening primrose oil can also reduce PG2. The beauty of QA is that I can actually determine which one(s) will be most effective in reducing inflammation.

Fish oil is the most common anti-inflammatory supplement that will reduce PG2 inflammation. However, the better the patient’s diet (think fresh fruits and vegetables) the more likely that flax seed oil will work better than fish oil. Virtually all Americans are deficient in omega 3 fatty acids, unless they are supplementing their diet.

Wisdom Wednesday: TMJ Syndrome

Temporomandibular joint (TMJ) syndrome is typically characterized as pain in the jaw joint. Conventional medicine considers the syndrome a biomechanical issue caused by trauma. Often grinding or clenching the teeth is blamed.

There are a variety of treatments – night guards, filing of the teeth, orthodontics, and even surgical intervention. Over 40 symptoms are associated with TMJ syndrome including headaches, radiating pain in the neck and shoulder, and tinnitus (ringing in the ears).

Applied Kinesiology (AK) evaluates the TMJ as a cranial fault – a subtle misalignment between the mandible (lower jaw bone) and the cranial bones that make up the socket that articulates with the mandible. Muscle testing pinpoints the mechanical flaw, then cranial manipulation is performed in rhythm with breathing to restore normal movement of the cranial bones involved. This is very similar to Cranial Sacral Therapy, an osteopathic technique now practiced by very well trained massage therapists.

Balancing the strength of the supporting muscles of mastication (chewing muscles) is also important. If a muscle imbalance remains, the TMJ syndrome will quickly return.

Over the course of 38 years of practice, I have treated a number of TMJ syndrome cases successfully. However, many of the cases would recur within a matter of weeks or months. Even collaboration with dentists specializing in TMJ syndrome often met with limited or temporary success.

Implementing Quintessential Applications (QA) in my practice radically changed the way in which I evaluate and treat TMJ syndrome. QA creates a flow chart for step-by-step evaluation using AK procedures. Please review any of the Wisdom Wednesday blogs written during the first quarter of 2014 on the steps in QA.

Wisdom Wednesday: Visceral Referred Pain

Visceral referred pain (VRP) is an important concept in the evaluation and treatment of patients. In brief, it is a location on the skin of referred pain from an internal organ. Virtually all organs have VRP locations. Even though you may not realize it, you are familiar with some of them.

When someone is having coronary insufficiency or a heart attack, their heart does not hurt. The referred pain (angina) is generally into the left arm but can also include the left chest, mid-back and into the jaw and teeth. In appendicitis, the pain is referred to the skin over the pancreas. Gallbladder problems often refer pain into the right shoulder. When the kidneys are inflamed (think kidney stone) the pain is referred down the sides into the outer aspect of the thighs.

We use these VRPs initially as diagnostic tools. When a new patient comes in with right shoulder pain, the gallbladder is in the differential diagnosis. If they also note right sided abdominal pain late at night, especially after a heavy evening meal, gallbladder moves to the top of the list. Treating the right shoulder as a mechanical issue with manipulation and therapy will often provide good temporary relief. However, the pain will always return if the gallbladder is the real issue.

VRPs are also used in muscle testing challenges. Pinching a VRP stimulates the nociceptors (pain receptors in the nervous system) and stimulates the sympathetic system (fight or flight). Rubbing a VRP stimulates the parasympathetic system (increases digestion, calms everything else).

Challenging a VRP helps locate the source of a health issue. It can also be used to temporarily negate a reflex. If, for example, I find a histamine response to wheat sensitivity has an active VRP to the small intestine, I can stimulate the VRP, temporarily shutting the reflex off. This allows me to move forward in the QA (Quintessential Applications) protocol. Otherwise, I would have to wait weeks or even months until the histamine issue was resolved to test further.

Wisdom Wednesday: GAIT MECHANISMS

The last step in the QA protocol is the evaluation for gait. The neurological organization required to walk upright is very complex. (Please review my blog “Did Walking Upright Make Humans Smart” posted on Friday, June 6, 2014) It takes most of us about a year to learn the process as infants. These neurological patterns develop from the “cross crawl” human babies use prior to walking.

Gait evaluation examines these patterns looking for distortion as it relates to structural issues. I commonly test the latissimus dorsi or “lat” bilaterally as my last step during an office visit. With the patient standing, feet even, I test for a strong latissimus dorsi with the left arm. Then the patient takes one step backward with the left foot. Now they are in a gaited position, as if they were walking. The left latissimus dorsi should now become weak if there are no abnormal gait patterns at work. The procedure is repeated on the right, looking for the muscle to weaken with the right foot back.

Wisdom Wednesday: Ilio-Transverse Ligaments

The last six steps in the QA protocol involve assessment and treatment of the spine and extremities. This is the cornerstone of chiropractic care and most of you are familiar with spinal and extremity manipulation. However, the evaluation and treatment sequence of QA are what revolutionized my musculoskeletal practice.

Virtually every chiropractor has a core of patients with chronic low back problems. We treat these patients monthly, weekly, or sometimes even daily. In most cases, we are able to provide some measure of temporary relief. The patients are pleased because their pain has been reduced, but they are always vulnerable, seemingly going from one episode of back pain to the next.

My practice had that core. It was the most dissatisfying aspect of my job. All of that changed with QA. As soon as I learned how to reset the neurological patterns that drive most low back pain cases, my chronic patients began to stabilize. With their vulnerability resolved, activities of daily living – arising from bed, walking, sitting, bending and lifting no longer stimulated episodic low back pain.

The key is a pair of ligaments that attach the transverse processes of the L5 vertebra to the inner crest of the ileum bilaterally. Forty years ago, when I was a student, we were taught that the ilio-lumbar ligaments were comprised of proprioceptive fibers. That is, they sense position, and send that information to the brain. So if you are swinging a golf club, those ligaments tell your brain how the pelvis is rotating. However, we now know that only half of the fibers of the ilio-lumbar ligament are proprioceptors. The remainder are nociceptors – they elicit pain.

When stimulated, the ilio-lumbar ligaments send pain signals to the brain that result in low back spasm, restricted range of motion, and, of course, a sense of back pain. This is a protective reflex designed to prevent low back injury. However, when stimulated repeatedly, these ligaments fire spontaneously creating ongoing chronic low back pain and instability.

In my clinical experience, this neurological pattern of pain stimulation is the key factor in almost all cases of chronic low back pain.

Thirty-eight years ago, during my first year in practice, I quickly learned that if I could elicit pain on palpation of the ilio-lumbar ligament, that patient was not stable. Even if they were pain free at the time of examination, they would soon be back with another episode. Unfortunately, I just didn’t know how to correct the problem.

Four years ago, when I began to test and treat the ilio-lumbar ligaments, 95% of my chronic low back patients stabilized within 3-4 visits and no longer required constant care. The remaining 5% are victims of FBSS (failed back surgery syndrome) or have significant neuropathy that limits healing.

When patients have acute low back pain, these ligaments are typically firing constantly. However, in more chronic cases, the ligaments often fire only when the patient is seated as sitting increases weight bearing on the low back ten fold. In the worst case scenario, I can reboot this reflex with the patient lying on their stomach and it will fire again as soon as they sit up. Unless rebooted again while seated, the reflex will continue to fire and create low back instability. This is the patient that “never holds an adjustment” and returns repeatedly for treatment. However, when treated over the course of 3-4 visits, the threshold continues to rise, the ligaments fire less and less often, and eventually the low back stabilizes.

Clinically, I find little or no correlation between the degree of disc damage (herniation, protrusion, prolapse, or rupture) and the response to treatment. As noted previously, nerve damage and previous low back surgery are the significant limiting factors.

THE BOTTOM LINE:
If you suffer from chronic low back pain, please seek the help of a qualified QA practitioner. You can visit QuintessentialApplications.com to find a physician in your area.