November 2014 Newsletter

What is Instrument Adjusting? One of Ott Chiropractic NW's Most Common Questions Instrument adjusting separates us from other doctors in the area and is frequently requested by our patients. We are the only clinic in downtown Portland that uses one of the three main instruments used for adjusting, the Impulse iQ Adjusting Instrument®; the others are instrument assisted soft tissue manipulation (IASTM) and the Activator Method Chiropractic Technique®. Instrument adjusting may be useful for treating a wide range of conditions from sports related injuries to osteoporosis.  They may be used as a supplement to manual adjusting or they may be used individually.  Some patients prefer the more gentle adjustments provided by instruments because they are in either too much pain or they tend to resist during manual adjustments. How is instrument adjusting different from manual adjustments, i.e. Diversified technique? Instruments may be a more gentle, controlled, specific, and in some cases more effective therapies.  While they don’t provide the audible “popping” noise that manual adjustments do, the “popping” noise is not necessarily what makes an adjustment effective.

Impulse iQ Adjusting Instrument® When your  joints are out of alignment or not moving properly they may irritate delicate nerves.  This may affect your health.  When nerves are irritated they send a message to your brain that something is wrong.  The result of these messages are symptoms such as pain and stiffness.  Stiffness is your brains way of stabilizing and protecting the area from further injury.  You may also feel sore and even tired.  As opposed to taking pain masking drugs, which can be dangerous to your health, chiropractic care seeks to locate the source of your symptoms and address the underlying cause, so the problem doesn’t keep recurring.  Chiropractic adjusting with the Impulse iQ Adjusting Instrument® aims to restore your body’s balance and function with treatments that are as painless as possible. Using a controlled force technique, there are three settings that apply the same amount of force every time.  The first setting applies a trust of 100 Newtons which is the equivalent of 17 lbs. of pressure.  The second setting delivers 200 Newtons or 34 lbs. of pressure and the third setting applies 400 Newtons or 67 lbs.  It is 100x faster than manual chiropractic adjustments, therefore, the gentle thrust is faster than the body’s tendency to tighten up and resist adjustments. The Impulse Adjusting Instrument® is twice as fast as other adjusting instruments such as the Activator Method(1). It also has a micro-computer inside of it which provides feedback to the doctor using it. The Arthrostim™ is another similar instrument, that doesn't provide feedback like the Impulse Adjusting Instrument®. A high-tech sensor that provides information from your body’s response to chiropractic adjustments. A single beep indicates that the acceleration response has been maximized during the adjustment. Maximizing mobility is the Impulse iQ Adjusting Instrument’s® equivalent to a manual chiropractic adjustment. A double beep denotes that the acceleration response has not yet been maximized and either further adjustments may be indicated or there is operator error. No beep means that no increase in acceleration response has been sensed. In this case, either the segmental contact point is wrong, the line of drive is off, or the given area is not receptive to changing its mobility. "Provides gentle and precise computer-aided chiropractic adjustments to relieve pain and restore function." Instrument assisted adjustments are often useful for treating patients within various special populations, like osteoporosis. Osteoporosis is a disease of the bones that happens when you either lose too much bone, make too little bone, or a combination of both. As a result, your bones become weak and may break from a minor fall or, in serious cases, from sneezing or bumping into furniture. If and when a doctor decides that a patient with osteoporosis needs an adjustment and the patient agrees, instrument assisted adjustments may be optimal.  Instruments can deliver precisely targeted adjustments so only the joints that need to be adjusted are affected. In addition to the focus that instrument adjustments allow, they also deliver adjustments through a controlled amount of force. What does it feel like? Chiropractic adjustments with the Impulse iQ Adjusting Instrument feel like a light tapping sensation on the area that is being treated.  In most cases the treatment is painless and after the adjustment many patients feel relief of pain and improved mobility.  Others report a sense of well-being or a soothing calm feeling.

Instrument Assisted Soft Tissue Mobilization (IASTM)   A.K.A. Instrument assisted cross fiber massage (IACFM), this type of therapy utilizes a variety of tools that go by the names Graston®, Tiger tail, Scimitar, Gua sha, The Edge, HawkGrips, and many more.  Athletes get injured, instrument adjustments can help Soft tissue injuries are common across all sports.  Tendons and ligaments are prone to wear and tear and overuse.  Unfortunately, once an athlete sustains such an injury, he or she is prone to re-injury.  Researchers have determined that may be due to the fact that ligaments, in particular, heal through the formation of scar tissue, which leaves the athlete with mechanical deficiencies.  Soft tissue mobilization (STM) breaks up the formation of scar tissue and appears to accelerate healing(2). What is a soft tissue injury? A soft-tissue injury involves damage to the muscles, ligaments, tendons and/or myofascia. Sprains and strains are the most common soft-tissue injuries and are the result of either a trauma, such as falling or twisting an ankle, or repetitive use, such as a person who plays tennis five times a week and develops pain in his or her shoulder. It’s either misuse (i.e., the wrong muscles are used to complete an action) or over-use (i.e., using a muscle too often without proper recovery time). What is IASTM? IASTM has two main functions: to break up abnormal densities in tissue, such as scar tissue, and to re-initiate first-stage healing in the body. When a body is injured, it sends healing substances found in white blood cells to the wounded area, i.e. inflammation.  The body then lays down new collagen tissues which results in  the formation of scar tissue. Microtrauma caused by IASTM initiates re-absorption of inappropriate fibrosis or excessive scar tissue and facilitates a cascade of healing activities resulting in remodeling of affected soft tissue structures. IASTM is similar to a mild injury to the tissue which starts this process over again and helps the body to heal itself. It also effectively breaks down fascial restrictions and scar tissue allowing full functional restoration to occur. Adhesions within the soft tissue may have developed as a result of surgery, immobilization, repeated strain, or other mechanisms. Though scar tissue is essentially a “patch” at the site of an injury, helping it to heal, it is much less flexible than normal tissue. In the long run, scar tissue can cause restricted motion, which leads to pain when, for example, a patient with a sprained ankle tries to return to running. Typically, patients with soft-tissue injuries do not seek out a DC until the injuries have become chronic, usually months post-injury. By this point, the body has completed most of its self-healing process where scar tissue has built up and motion is restricted. This is when it may be necessary for the doctor to restart the curative process. The injuries that respond best to IASTM include acute and chronic spinal and extremity problems, such as tendinopathies, Achilles tendinosis, rotator cuff injuries, IT band syndrome, and plantar fasciitis, among others. Studies have addressed the benefits of IASTM at the cellular level such as increased fibroblast proliferation, reduction in scar tissue, increased vascular response, and the remodeling of unorganized collagen fiber matrix following IASTM application. What to Expect: Treatment generally consists of the doctor rubbing the affected area(s) with eh handheld stainless steel instruments using very specific, calculated massage techniques.  Treatment time is usually 30 - 60 seconds per area treated.  It is common for patients to experience some discomfort during the procedure. Patients are advised they may be sore, bruised, or exhibit small red dots over the area treated.  Many patients have reported increased range of motion and reduced pain after just one treatment.

Activator Method® The Activator Method is one of the most widely-researched chiropractic techniques(3). Activator Method® has published hundreds of clinical and scientific peer-reviewed papers, worked with major academic research institutions, and received grants from recognized entities like the National Institutes of Health. The Activator Method® uses a small, hand-held instrument called the Activator Adjusting Instrument to deliver a gentle impulse force to the spine with the goal of restoring motion to the targeted spinal vertebra or joint. The spring-loaded, hand-held mechanical instrument instrument provides a quick, low-force impulse at specific points. It is an alternative to the traditional manual form of spinal manipulation, known as the high velocity low amplitude (HVLA) thrust. There are two theoretical advantages of an Activator instrument-assisted treatment. The first is based on the speed of the device. The instrument is so quick that the body's muscles are less likely to become tense and resist the treatment. The lack of muscle resistance may facilitate the effectiveness of the treatment. The second advantage is that the applied force is localized and does not add any additional torque or bending movement to the joint. What to expect: A typical treatment will be done while the patient lies face down on the adjustment table. The treatment typically begins with the low back and progresses toward the head, targeting each vertebral segment individually. During a typical adjustment with the Activator, the chiropractor applies the Activator device to the tissues at or near the affected joint. An initial pressure is followed by a quick thrust from the device, which feels much like having one's reflex tested by tapping your knee. The patient remains still, with no twisting or turning as there often is for a traditional chiropractic adjustment. Examples when the Activator method may be more superior to other forms of adjusting include: sensitive areas such as the temporomandibular joint (TMJ), extremity joints, patients preference, and for stubborn spinal segments that fail to adjust with the first attempt of manual manipulative therapy.

References 1. Keller T, Colloca C, Moore R, Gunzberg R, Harrison D, Harrison D. Three-Dimensional Vertebra Motions Produced By Mechanical Force Spinal Manipulation. Journal of Manipulative and Physiological Therapeutics. 206;29(6):425-36. 2. Loghmani MT, Warden SJ. Instrument-Assisted Cross-Fiber Massage Accelerates Knee Ligament Healing. Journal of Orthopaedic & Sports Physical Therapy. 2009;39(7):506-514. 3. Huggins T, Boras AL, Gleberzon BJ, et al. Clinical effectiveness of the activator adjusting instrument in the management of musculoskeletal disorders: a systematic review of the literature. Journal of the Canadian Chiropractic Association. 2012;56(1):49-57.