Although musculoskeletal pain is composed of many factors, certainly joint dysfunction is a significant contributor. Seaman, et al., (1998) described a theoretical model by which joint dysfunction alters the afferent feedback to the central nervous system at the segmental and suprasegmental levels. This is based on the idea that a loss of mechanical or positional information from a joint will result in increased information from the nociceptors that sense tissue damage. Seaman, et al., (1998) used the term dysafferentation to describe this situation.
As clinicians, we need to decide how to get proper movement and position information to the central nervous system. Once serious pathology is ruled out, joint function can be broken down into a few basic concepts. A joint should have proper movement and proper compression to control movement. A joint can lack movement (fixation); a joint can have too much movement (instability) and lack appropriate compression; or a joint can have fixation and still be unstable, due to reflex effects on the surrounding musculature inhibiting proper compression. Any one of these situations can cause nociceptive input to be sent to the central nervous system.
As clinicians, our job is to select which category our patient is in and tailor our treatment to their needs. If a joint is stuck, it needs increased movement to supply the central nervous system with the proper movement and position information. If a joint lacks compression, this too produces poor mechanical and position information. Think about all the receptor pools in a joint, and the need to be stimulated by pressure. This pressure needs to be symmetrical and to be adequate to reach threshold.
Pain from an unstable joint can be relieved by proper stabilization exercises rather quickly (Hodges 2001). Incidentally, stabilization exercises should not hurt. The "no pain, no gain" slogan is not applicable here. Pain can inhibit proper muscle activity (Simons 1993). Proper compression of a joint increases mechanoreceptor input (Hodges 2001). If a joint lacks movement and lacks proper compression, the clinician should increase joint movement via adjustment, and follow the procedure with proper stabilization exercises.
If we can properly categorize our patients, it will increase the effectiveness of our care substantially.
References
Mark King DC
Cincinnati, Ohio
When I graduated from chiropractic college in 1981 and started practice, I heard it all, and very little was positive. “You are a quack; you do not know what a subluxation is; you couldn’t get into a real health care program, so you chose the one that is slightly above a mail-order degree; you have no proof that chiropractic works; Are you really licensed?”, and so much more.
| Digital Exclusive
A central challenge in creating our identity is that chiropractic is a method of care, not a technique or procedure. This is an important concept for us to promote. Our patients are treated with lifestyle modification, exercise, nutritional supplements, diet and a whole-body approach to accelerate the natural healing process. We are not simply CMT providers.
The results of a global survey released late last year (2023) unveiled some startling findings among medical and nursing students. The “Clinician of the Future: 2023 Education Edition” surveyed 2,212 students, of which 446 were in the United States, from 91 countries.
