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Pain
and your Brain To appreciate this statement, we must understand how pain is processed by the brain. Embedded throughout many tissues of the body -- especially the skin, joints, ligaments, tendons, and muscles -- we have free nerve endings acting as pain fibers. These nerve endings, called nociceptors, respond to harmful mechanical pressure and chemicals liberated from tissue damage. When nociceptors are activated, they transmit signals into the spinal cord and brainstem where the nervous system responds reflexogenically by activating sympathetic nerves. The sympathetic nervous system, which mediates the “fight-or-flight” response, has the following functions:• Increase heart rate • Increase blood pressure by increasing constriction of blood vessels • Increase respiratory rate • Increase sweating • Indirectly increase muscle tone The pain pathways ascend from the spinal cord to the brainstem and limbic system (a primitive area of our brain dealing with emotions) and to the somatosensory cortex (the area of our brain which has a map of our body to allow us to localize sensations). It’s important to understand that approximately 75% of our pain pathways direct information to our brainstem centers and limbic centers. Only 25% of these pathways actually connect to the somatosensory cortex. Therefore, it’s quite possible to have dysfunction in the tissues (subluxations, degenerative joint disease) and activation of the nociceptors and pain pathways (with resultant sympathetic changes in the nervous system) without the perception of pain. Therefore, we can’t judge health by the absence of pain or symptoms. Furthermore, blocking pain perception with drugs doesn’t decrease or eliminate the deleterious effects of nociception.Long-term activation of nociceptors causes “wind-up” in the pain-sympathetic loops and “central sensitization,” which is essentially an increased efficiency of the pathways through the growth of more nerve connections and the production of more neurotransmitters. This central sensitization results in hypersensitivity, not only at the site of injury but in many tissues of the body. It is also responsible for the overactive stress response leading to many negative widespread subsequent changes in our bodies. Ultimately, it may lead to one developing chronic pain syndromes such as sympathetically mediated pain, complex regional pain syndrome, and reflex sympathetic dysfunction. Patients with these pain syndromes and reflex sympathetic overactivity have difficulty rehabilitating themselves. That’s because the reflex sympathetic dysfunction compromises the blood delivery to muscle, resulting in rapid fatigue, the patient subsequently fatigues quickly which causes the release of further pain-activating chemicals. As a result of such dysfunction, a patient becomes predisposed to overuse-type syndromes. The Chiropractic Neurologist’s unique approach is to effectively treat these syndromes by restoring biomechanical integrity of the joints. This has two very direct benefits:
Dr. Sergio F. Azzolino is not only a Chiropractic Neurologist, but is also Board-Certified in Pain Management by the American Academy of Pain Management. He has extensive teaching and clinical experience dealing the early diagnosis, treatment, and rehabilitation of individuals suffering with a variety of pain syndromes. Posture
and your Brain The cerebellum, a small part of our lower brain in the back of the head, plays a vital role in coordinating muscles, controlling many reflexes, and keeping us erect in the earth’s gravitational field. Recent research demonstrates that the cerebellum’s contribution to control of all brain functions -- especially cognition and behavior -- may be just as great as its control over motor function. The cerebellum receives a great portion of its input from the receptors embedded in the joints and muscles. Although humans are not constantly moving, there is a continuous amount of stimulation to the cerebellum from the mechanoreceptors in the joints and muscles, due to the constant load on these structures as a result of gravity. Gravity is thus responsible for providing a source of constant stimuli to our brains. If the joints and muscles of the body, especially the spinal joints (which receive the majority of the force in the upright posture of humans), are moving correctly, then there is an optimum amount of mechanoreceptor stimulation to the cerebellum and brain, resulting in a appropriate control of the postural muscles. The postural muscles then have increased endurance, allowing them to hold an individual upright for long periods of time. If an individual has altered biomechanics/movement of a joint, then he may have a decreased amount of mechanoreceptor stimulation to the brain and, in turn, have decreased stimulation to the postural muscles. This could in result in and decreased efficiency of these muscles, leading to poor posture. The question often arises: What is the best way to improve or maintain postural integrity? Although exercise of the back muscles is extremely important in this process, many of these back muscles are non-consciously, reflexogenically controlled by the cerebellum; therefore, exercise has a minimal effect. The deepest muscles throughout the spine (together called the intrinsic layer) extend from one vertebra to the next, making them completely dependent on joint motion and reflexive control from the cerebellum. Therefore, maintaining appropriate joint motion (which chiropractors are trained to analyze and treat) is necessary for correct posture. As a chiropractic neurologist, Dr. Azzolino and his staff have the ability to assess not only joint motion and function, but also the function of the areas of the central nervous system. They are trained to prescribe specific treatments and exercises to maximize function, leading to optimum postural control.Repetitive
Stress Injuries Long-term neglect of symptoms and an inability to correctly diagnose the condition results in a high number of permanent disabilities. There is a lack of understanding regarding repetitive strain injuries throughout the medical community and the insurance industry. The etiology of RSIs are multifactorial. Tendonitis as the primary versus secondary/tertiary: Several Different Causes of RSI Nerve Entrapement Syndromes
Poor Ergonomics
Posture
The Chiropractic Neurologis't Approach to a patient with RSI
Sports
Injuries and Chiropractic Neurology Recent advances in the brain-based model of health have expanded our understanding of the intricate interaction of joints, muscles and the central neurological reflexes that govern balance, coordination, and muscular control. When an individual suffers a sprain or strain, the soft tissue elements will commonly heal with fibrous scar tissue, which is less elastic and weaker than healthy tissue, leaving the joint vulnerable to further damage. The trauma to the joint, along with the fibrous scar tissue, can compromise the joints biomechanics. This altered biomechanical integrity can result in a negative sequence of events leading to altered sensory input from the receptors in the joints and muscles. In turn, aberrant sensory input can alter the brain’s ability to coordinate muscles; it can also cause inhibition of certain muscle groups. This condition is called reflexogenic weakness. Reflexogenic weakness usually involves the muscle groups whose primary function is the stabilization of joints. This may present locally to the injured joint; however, due to the nature of how the left and right hemispheres of the brain coordinate muscles on each side of the body, individuals commonly develop reflexogenic weakness throughout muscle groups on one side of the body. Thousands of athletes throughout the world have greatly benefited from having these patterns addressed; however, many individuals remain short of optimum performance because such weaknesses are unidentified. When an individual has reflexogenic weakness, endless hours of physical therapy or rehabilitation can provide only minimal benefit. At Azzolino Chiropractic Neurology Group, we have an in-depth understanding of the functional aspects of the brain and its control over the musculoskeletal system, so we can examine an individual and identify his specific patterns of strengths and weaknesses. These patterns can be very successfully treated with directed, appropriate manipulation; neuromuscular exercises; and vestibular and light stimulation. How long does it take? The brain receives and conveys information to and from joints and muscles within milliseconds; therefore, many reflex centers may be reset to function appropriately within minutes of treatment. Then the doctors can prescribe appropriate stimulation and a rehabilitation program specific to individual needs to help increase the efficiency of the correct patterns of control.What is Thoracic
Outlet Syndrome (TOS)? Postural abnormalities, especially the rounding forward of the shoulders, decrease the costoclavicular space, which can cause compression of the brachial plexus and blood vessels. Trauma to the neck and/or shoulder can also cause TOS. Patients may experience pain and/or numbness or tingling in the shoulder, arm, or hand (or in all three locations). These symptoms are usually aggravated by the use of the arm/hand, or by keeping the arms outstretched or overhead. Fatigue of the arm is often prominent. How is TOS diagnosed? Is there any treatment? What is the prognosis? Attention Deficit Hyperactivity Disorder
(ADHD) Chiropractors Offer Hope and Help to Children with Attention Deficit Hyperactivity Disorder (ADHD). In the past decade, prescriptions for Ritalin, a stimulant medication commonly used for attention deficit hyperactivity disorder (ADHD), increased five-fold, with 90 percent of all prescriptions worldwide consumed in the United States. As many parents grow leery of the traditional medical approach to ADHD, doctors of chiropractic are offering promising results with non-drug treatments that focus on postural muscles, nutrition and lifestyle changes that affect brain activity. Some children may simply have difficulty learning certain subjects, but the current system—in a sense—prompts school officials to encourage their parents to have the children diagnosed with ADHD, says Dr. Scott Bautch, past president of the American Chiropractic Association (ACA) Council on Occupational Health. "The higher the number of disabled kids in the school, the more funding the school can apply for," says Dr. Bautch. Some teachers might also have difficulty with students who have a different style of learning, according to Dr. Bautch. If the child is a visual learner—and the teacher is not—perhaps the child is not being taught in a way he or she can learn. Before diagnosing the child with ADHD, Dr. Bautch recommends doctors talk to the child and the parents: "Is the child too active? Bored? Has dyslexia or a different learning pattern? It can be a behavior problem, problems at home, or frustrations with the teacher's style," explains Dr. Bautch. "If we went to a conference where the speakers taught in a way we can't learn, we would be frustrated and would misbehave—we'd get up and leave or chat to the person sitting next to us." The traditional medical model, however, seems to follow the cookie-cutter principle. The diagnosis of ADHD is based on a questionnaire. But this is not enough, says Dr. Robert Melillo, a chiropractic neurologist. "True ADHD patients have other signs — tics, tremors, balance or postural problems, or unusual sensitivity to touch, movement, sights, or sounds." Unfortunately, although medications can keep ADHD under control, they don't cure it. Eighty percent of patients have ADHD features in adolescence, and up to 65 percent maintain them in adulthood. Doctors of chiropractic and chiropractic neurologists offer a non-drug and non-invasive treatment alternative for ADHD patients that targets the underlying problems, not just symptoms. "Motor activity—especially development of the postural muscles—is the baseline function of brain activity. Anything affecting postural muscles will influence brain development. Musculoskeletal imbalance will create imbalance of brain activity, and one part of the brain will develop faster than the other, and that's what's happening in ADHD patients," says Dr. Melillo. Chiropractic neurologists are trained to identify the underfunctioning part of the brain and find treatments to correct the problem, to help that hemisphere grow. "On every patient, we perform a brain function exam," says Dr. Frederick Carrick, president of the ACA Council on Neurology. "We test visual and auditory reflexes through, for example, flashing light in the eye, or asking patients to listen to music in one or the other ear." When the problem is identified, patients are placed on a treatment program—and most of the therapies can be done at home. "Patients are asked to smell certain things several times a day ... or wear special glasses," says Dr. Mark S. Smith, a chiropractic neurologist. "We also focus on their individual problems. Some children, for example, have difficulty with planning, organization, and coordination—so they benefit from timing therapies. They learn to clap or tap to the metronome, perform spinning and balancing exercises." Although currently no studies comparing chiropractic neurological and medical treatment for ADHD are available, chiropractic neurologists are compiling the data. "We test children before they start the treatment and then every three months," says Dr. Melillo. "Within the first three months, the children get a two-grade-level increase on average—which is pretty dramatic. With children on medications, the improvement in academic performance is short term and lasts only as long as they take the medication. Our programs change the brain function and the improvement doesn't go away." While chiropractic neurologists have found success
in treating ADHD and learning disabilities by providing the necessary
brain stimulation, they also recommend nutrition and lifestyle changes
that may help correct or prevent biochemical imbalances that cause
ADHD. Parents are encouraged to: Chiropractic Care Can Help... Chiropractic in Cyberspace...
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