The title of this article represents a statement which is difficult to fathom. If it "didn't hold" then possibly the glue was not adequate, indicating that it was too loose to begin with. If we pursue the fixation concept, then "didn't hold" might represent a beneficial result. We can tell our patients that as soon as they reach the "didn't hold" phase, they will feel marked improvement.
In all seriousness, an adjustment that doesn't hold really represents a chronicity or continuation of a problem that the adjustment did not correct. Many assume that the adjustment did not "hold" because something else was necessary such as an orthotic, improved nutrition, another technique, or possibly the wrong area was adjusted. All of the above may be true, but in order of importance, next to the joint, the most probably reason for "not holding" is the muscle.
Chiropractors have always been slightly prejudiced in incriminating the spinal segment. Treat the joint and the adjoining muscle will respond; treat the sacroiliac joint and the hypofunctioning gluteus maximus will increase its tone. While this is true, adjusting a vertebral segment will not restore a chronically shortened muscle to its original flexibility. A chronically shortened muscle has been defined by Janda1 as a muscle that is not in spasm, that is short at rest, and has decreased elasticity due to proliferation of hypertrophied connective tissue. A short muscle must eventually affect the biomechanics of the joint which will eventually lead to secondary changes. One of the main changes will be an altered pattern of movement. A prime example could be a chronically shortened psoas muscle creating a permanent weakness of its antagonistic gluteus maximus. A weak gluteus maximus will alter the normal sequence of hip extension. According to EMG studies conducted by Janda1, if the gluteus maximus is weakened there will be an alteration in the normal sequence of hip extension. The normal sequence is activation of the hamstrings, gluteus maximus, contralateral lumbar, ipsilateral lumbar, contralateral thoracolumbar, and ipsilateral thoracolumbar. An inhibited (weak) gluteus maximus can result in an abnormal hip extension pattern: hamstrings, ipsilateral lumbar, ipsilateral thoracolumbar, contralateral thoracolumbar, contralateral lumbar, and ipsilateral upper trapezius. This pattern will result in an unstable lower lumbar spine and probable cervical stress. Abnormal patterns of motion can be visualized by the doctor.
It is extremely doubtful that a lumbar or pelvic adjustment would normalize a chronically shortened hypertrophic iliopsoas. The work of Vladimir Janda offers an exciting method of analyzing and treating the muscular system which offers us an essential part of the puzzle in the elimination of chronic pain.
If you are interested, look for the new MPI course: "Subluxation Complex-Myopathology."
References
Janda V, Jull GA: Muscles and motor control in low back pain: assessment and management. In Twomey LT, Taylor JR: Physical Therapy of the Low Back, New York: Churchill Livingstone, 1987.
Warren Hammer, MS, DC, DABCO
Norwalk, Connecticut
Editor's Note:
Dr. Hammer will conduct his next soft tissue seminar on June 26-27, 1993, in Chicago, Illinois. You may call 1-800-359-2289 to register.
Dr. Hammer's book, Functional Soft Tissue Examination and Treatment by Manual Methods: The Extremities, is now available. Please see the Preferred Reading and Viewing List on pages xx, Part #T-126 to order your copy.
