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POSTURE, PAIN, & PROPRIOCEPTORS The following information is being presented for educational purposes only. There is no intent to diagnose or treat any condition or disease. Anyone wishing to use any of this information for health improvement purposes is advised to do so under the supervision of the health care provider of their choice. The following article has been adapted from an original article by Burl Pettibon D.C. Dr.Pettibon's article was intended for professional practitioners and contained technical details that might not be immediately understood, or even of great interest to most lay readers. The following text has been designed to include other pertinent supportive and explanatory facts as well as the basic facts from Dr. Pettibon's original work. This article is intended as an introduction to the several parts of Dr. Pettibon's full structural remodeling program which serves as the Postural Molding component of the Somatics Plus structural rehabilitative procedures. A BRIEF TECHNICAL PREVIEW This "preview" outlines the points which will be made in detail in the article which follows. A bibliography at the end of the article provides a list of papers which support the points made here. All of the problems documented in the article that follows had to have a beginning. By performing digital analysis of x-rays on thousands of patients, Dr. Pettibon and his associates were able to demonstrate that sudden applied load and/or accumulative traumas (such as: whiplash and/or repetetive strain injuries) -- produce what they call -- "initiating event sub uxations" of the hard and soft tissues of the spine. The Initiating Event Subluxation (IES) The term initiating event subluxation (IES) refers to a specific problem
that happens at the joint between the skull and the top vertebra of the
neck (Atlas vertebra, also sometimes referred to as the Cl vertebra).
It has long been known that fixations involving the loss of full freedom
of motion at the head/neck junction create a whole series of problems
throughout the body.When the IES develops, the brain acts to keep
the eyes horizontal to the Earth plane.
If you suffer an IES -- which generally involves the skull being "locked" in a back-tilted position (extension-fixation) on the Atlas -- your eyes would be looking too far skyward unless, as does happen, the eyes are brought back to the horizontal under the control of visual postural reflexes. How does it do that? Quite simply by making compensatory changes in the 5 vertebrae of the lower neck. In essence, the lost ability to "flex" (go chin to chest) properly at the upper neck levels is compensated for by the lower neck going into hyper-flexion (these vertebrae "bend" into a flattened ot even a forward curve). Unfortunately, this further distorts the lordotic curve of the the neck and thrusts the head forward from its normal position. At this point you would have what is referred to as forward head posture (FHP) and you would have lost the normal anatomical curvature of the bones in the neck. Forward Head Posture (FHP) and It's Negative Effects When the skull is locked out of flexion on the atlas vertebrae, two abnormal positions and motions occur: 1).The head is forced into "forward head posture" (FHP). Note: a person has FHP when the external hole of the ear (external auditory rneatus ), as seen from the side when s/he is standing relaxed -- appears to be forward of the center line of the side of the shoulder/trunk. It looks like the head is thrust forward from the shoulder instead of sitting squarely over the trunk. 2). There is a partial or complete loss, or perhaps even a reversal
of the normal cervical lordotic curve. This is in reference to the bones
of the neck and can only be seen in a side view X-ray of the neck. The
outward appearance of the neck curve is not an indicator of the internal
bony curve arrangement.
To understand proper spinal functioning, it is necessary to understand that: spinal posture has a "normal" (ideal) configuration with measurable dimensions (just like a "normal heart rate, or visual acuity, etc.) and, that when the spinal curvature is abnormal, there will be definite and serious alteration of spinal "function" -- the seriousness of this problem is explained in the text which follows. What the Research Shows The literature shows that these normal spinal postural configurations and the functional processes they support are every bit as valid and as related to total health as are other measurable norms -- such as blood pressure, pulse rate, etc.(26,27). A bibliography at the end of this article has the list of sources for anyone interested in reading the studies themselves. A Few Facts About Pain Studies show that ninety percent of chronic pain is located in the musculoskeletal system. In individuals up to age 59, the studies further show that the most common sites of involvement include the shoulders, head, neck, low back and pelvis. (1,2,3 ) Eighty percent of individuals in the western world will be affected by some form of acute and/or chronic spinal pain at some time in their lives. Four out of every ten people under age forty-five who have chronic conditions that are limiting their activity of daily living (ADL) suffer from spine related pain. (4) Musculo-skeletal conditions have been recognized as a major health and economic problem, imposing a $126 billion dollar health care cost burden in 1998. (5) If fact, spinal related disorders are second only to the common cold as a reason for missing work. Most causes of back pain are the result of mechanical derangement of the hard and soft tissues of the spine. The derangements cause inflammation which leads to: varying degrees of pain, either at rest or during motion decreased strength and ranges of movement of one degree or another and, decreased ability to perform activities of daily living. (6) Most pain signalling comes from specialized pain sensing nerve endings called nociceptors. And, most of these receptors "signals" never reach your awareness. Local nervous system reflexes cancel out the signals until a certain amount of the pain receptors are firing. At that point, the brain becomes aware of the "pain problem" in that area. Technically, what happens when pain becomes chronic is that nerves and connections (synapses) along the pathways from these special pain sensing nerve endings (nociceptors), become hyper-sensitive (depolarized) -- they then become much more sensitive to even lower levels of insult, and the pain signaling becomes more intense and even continuous. (6)
The pain now contributes to "sickness" in a deeper way than is usually understood. (25) Because: "Most causes of back pain are the result of mechanical derangement of the hard and soft tissues of the spine" (6) -- we have to look at other effects associated with that type of "derangement". Effects of Mechanical Derangement
of the Hard & Soft Tissues of the Spine The spine (and the spinal cord) must be considered as a single unit that has an ideal and coordinated way of moving in harmony and synchrony. There is a specific rotation and bending pattern for each vertebra relative to each other. The combination movement of tilt and rotation specific for any given vertebra is referred to as it's coupled movement pattern, or coupling. That is what is referred to as "coupled" movement. Another major factor to consider is that the spinal cord must literally move up and down within the spinal canal. That is discussed in more detail later. First let's consider "coupled" spinal movement. The actual "coupleing" combination is different in different areas of the spine. For instance, if you tilt your head to the left, the tips of the vertebrae of the neck (cervical spine) and upper back should swing to the right. It is the opposite in the low back, where bending sideways to the left should find the tips of the spinous processes of the vertebrae swinging to the left. This becomes important to our conversation here because the coupled motion always triggers signals to the brain from specialized cells called proprioceptors (the greatest concentrations of which of which are found in the capsules of spinal joints). Proprioceptors and the Central Integration of Motor Control: The signals from these special nerve cells (proprioceptors) help to tell the brain where the body is in space and how to organize muscle function for balance and movement. The signals from these cells actually help to properly integrate the brain's control of all motor activity -- including the activity of cells and organs.
How The Cervical Curve Affects Those Inflowing Signals Distortion (loss or reversal) of the bony cervical (neck) curve prevents the proper coupling movement of the cervical vertebrae when you move your head. Of course, the worst part of that is that the region of the upper three cervical vertebrae has the highest density of the specialized proprioceptive nerve endings in the whole body! So, disturbance of function in that area has a much greater effect than does disturbance anywhere else in the body. Based on their clinical observations, for many years, Chiropractors have said that proper freedom of joint motion in the upper cervical spine is necessary for good health -- it is only very recently that (non-chiropractic) scientific studies are showing why that was observed.
Dr. Alf Breig and "Adverse Mechanical Tension in the Central Nervous System" Dr. Alf Breig, a swedish neurosurgeon coined the termed adverse tension in the central nervous system to describe the mechanism by which loss of the normal cervical lordotic curve created serious health problems. His research is amazing, and his clinical results were astounding because he did surgical correction of cervical curves which actually cured such things as M.S. and ALS (Lou Gehrig's Disease), etc. What Dr. Breig showed was that as the cervical curve is lost, the tension of the meninges (covering of the brain and spinal cord) was increased in such a manner that measurable pressure was exerted on brain-stem nuclei (nerve control centers) which control our basic life functions. This in turn led to disregulation of basic metabolic control functions, and disease followed. Dr. Breig performed surgical procedures to re-establish the cervical lordotic curve and the diseases disappeared.(28)
Dr. Rene Cailliet on Forward Head Posture (FHP) and its Effects First of all , FHP refers to the head being carried forward of its proper placement over the shoulders and upper body. Ideally, the center of the external opening of the ear should lie approximately on a line dividing the lateral shoulder in half from front to back. With the head in this position, the center of mass of the skull is balanced over the body and the muscles of the neck, upper back and chest stay balanced in their activities. If the head is jutting forward of the shoulders, the weight of the skull -- about the weight of an 8-10 pound bowling ball -- is putting a strain on the muscles which are designed to pull it back. This leads to very tight and tender upper back and neck muscles and headaches where the muscles attach at the skull. Rene Cailliet M.D., director of the department of physical medicine and rehabilitation at the University of Southern California says the following regarding mechanical derangements of the hard and soft tissues of the spine:
Dr. Cailliet, explains the effects of FHP as follows:
Some Other Important Facts & Factors Disc Nutrition: Because loss of all or part of the cervical lordosis causes a loss of all or part of the normal cervical and thoracic coupling motion, the involved discs receive inadequate nutrition and oxygenation -- and, it also results in their being burdened with toxic metabolic products because the waste removal process has been slowed down. (16) Posture, Disc Compression, Nerve Entrapment,
Etc. As the head rocks backwards on the top neck vertebra (Atlas, C1) impingement into structures at the head neck junction (suboccipital triangle) is inevitable. A number of painful mechanical and muscular nerve entrapments are produced by this posture if it is allowed to persist. (15, 16, 17) The entire body becomes rigid and ranges of motion become less. Loss of these motions result in loss of disc height ('collapsed discs') along with facet pain and other spinal hard and soft tissue pathologies (such as spurs, bulges, etc.). (19) The better the posture, the better and younger one looks and feels and moves. In man, neck-spine mechano-receptors dominate the body's balancing system in combination with the inner ear balancing system (vestibular function mechanism) through reflex regulation of equilibrium (balance) in both static posture and gait. (7,8)
How Do Spinal Mechanical Derangements Come About? The actual initiating event is likely to be a trauma of some sort, a whiplash injury (aka flexion-extension injury), fall, etc. It doesn't take much if the conditions are right. The head can react like the last person in line in a game of "crack the whip" -- the acceleration at the end of the movement chain is greater than at the point where the movement started. Once the head has been subjected to a rapid acceleration-deceleration process, there is commonly an immediate localized "splinting" effect -- the local muscles lock-up to prevent further damage to the area by restricting movement of the head and cervical spine. If not corrected, this leads to many serious negative health consequences.(14)
In extreme cases, whiplash injuries can be so violent that the posterior ring of C1 (topmost cervical vertebra) is crushed between the skull and C2 (21,22). Remember, however, the trauma need not be that dramatic in order to lead to severe problems. With far less trauma, a common occurrence is the entrapment of the
greater and lesser suboccipital nerves as they pass between the base of
the skull (occiput) and C1. This can lead to:
The effects listed above develop as a result of the following mechanical problems, and then they become solidified as part of your posture.
What Can You Do About It Reversal of the problems must include:
A More "Technical Review" (For the reseaerch minded reader): The density of mechano-receptors in the human cervical spine is greater than at any other spinal level. (9,10) Because of that high density, and the negative effects created when the signals from these mechano-receptors are not properly balanced, cervical spine problems, such as FHP and loss of the lordotic curve can lead to symptoms in the farthest reaches of the body. Equally, correcting problems in the upper cervical spine can lead to seemingly miraculous elimination of symptoms elsewhere in the body. In fact, cervical lordosis correcting adjustments have been experimentally shown to increase people's ability to aerate their lungs, increase their vital capacity and boost their immune systems' activity. Brennen et al., documented the respiratory burst of immune system enhancing cellular activity (polymnorphonuclear neutrophils and monocytes) following these corrective adjustments. (23) In addition, a literature review in the Chiropractic Journal of Australia showed that T and B lymphocyte numbers, natural killer cell numbers, antibody levels, phagocytic activity and plasma endorphin levels are positively influenced by spinal correcting adjustments. (24) REVIEW & CONCLUSIONS: So, there is more than just cosmetic value to restoring normal posture by correcting FHP and restoring proper lordotic cervical spine curves. AND: The postural molding and corrective processes recommended for your use based upon the Pettibon System of Postural Correction when used in conjunction with the other Somatics Plus Self Help processes can definitely help you to recover from problems associated with cervical spine curve loss and FHP problems. All of the problems documented above had to have a beginning. By performing digital analysis of x-rays on thousands of patients, Dr. Pettibon and his associates were able to demonstrate that sudden applied load and/or accumulative traumas produce what they call "initiating event subluxations" of the hard and soft tissues of the spine. The "initiating event subluxation," begins when the skull stops being able to flex the expected 7.5 degrees on the first cervical vertebrae. When the skull is locked out of flexion on the atlas vertebrae, two abnormal positions and motions occur: The head is forced into "forward head posture" (FHP) with a partial or complete loss, or perhaps even a reversal of the cervical lordotic curve. Then, the weakest levels of the lower cervical spine are forced to over flex when the patient tips the head down or nod the head in the "yes" motion. This abnormal flexion motion further forces the head forward relative to the body. These abnormal postural and motion changes in turn lead to: a loss of the spinal mobility which is needed for the delivery of nutrition and metabolic waste removal from the involved tissues. In turn this leads to localized inflammation and eventually pathologies of both the hard and soft tissues associated with the spine -- eventually, pain results. In addition to the pain and health problems which are specifically caused by loss of the proper postural relation of the skull and cervical spine; nerves exiting the involved spinal areas are also adversely affected -- with disruption of both the ingoing (afferent) signals to the brain and the outgoing (efferent) signals to muscles, organs, and glands, etc. This causes dis-harmony, dis-function and dis-ease in the distant organs and parts innervated by the affected nerves. The major conclusion one should get from this paper is that form and function of the whole body are affected by events which follow the "initiating event subluxation" (IES). The problems created by the IES will not be reversed and become fully functional until the initiating event subluxations are corrected: note this includes correction of FHP and the Cervical (at least) lordotic curve as well as ensuring head flexion on Atlas. To Find out more about processes for correcting these problems please See the article: "Total Postural Rebalancing-- etc." To see a: Description of the Corrective Processes
Themselves.
The preceding information has been presented for educational purposes only. There is no intent to diagnose or treat any condition or disease. Anyone wishing to use any of this information for health improvement purposes is advised to do so under the supervision of the health care provider of their choice. REFERENCES: 1) Davis CG: Chronic cervical spine pain treated with manipulation under
anesthesia. JNMS 1996:1. 2) Anderson: Statistics of differences in age,
gender, social class, and pain localization. Clin. J Pain 1993:9:174-182. |