Joseph D. Kurnik, DC
Editor's note: This is a follow-up to "Irritable Bowel and the Spine," which appeared in the March 26 issue.
Having identified a potential connection between irritable bowel syndrome (IBS) and thoracolumbar hypomobile dysfunction (fixation), there are choices to make regarding how to adjust the spinal fixation(s). Here are a few of the options. A variety of methods must be considered for each situation and patient physique.
1. Prone adjusting. This method is suitable for some patients, but it can be painful, shocking and unsuitable for others. The exception is the use of instrumentation with either a single or multi-thrust capacity.
2. Wall adjusting. This can be an effective treatment choice, and I have seen this method work effectively when all else had failed. Briefly, the patient places the buttocks on the wall, feet forward so as to reduce the lumbar lordosis and take out tissue slack. The patient's fingers are interlocked behind the lower neck, with elbows forward and arms parallel at chin level or below.
The doctor's left closed hand is placed at the level of dysfunction, and their right hand/arm is placed over the elbows with the right hand grasping the patient's right forearm, controlling the tension. The patient's elbows are against the upper right part of the doctor's chest. Upon exhalation, when total tissue slack is resolved, the thrust is made A to P and I to S.
If there are cervical concerns, the patient's hands can grasp the upper trapezius muscles instead of the neck, or the patient's hands can be placed at the sides of the neck, not interlaced. This variation can be used if the patient's arms are short or their shoulders are too tight. (These methods are not appropriate if the patient has shoulder or other upper extremity injury.)
3. Incline adjusting. This is another excellent treatment method to use in adjusting the T/L region. It involves the use of an incline table in which the caudal or cephalic end raises to about 50 degrees. The patient straddles the table with their buttocks at the junction of the raised incline and the horizontal portion. The same adjusting methodology is used as in standing, and the same precautions should be taken.
Note: Both the standing and incline adjustment methods may allow a painfully afflicted low back patient to be adjusted, even when a prone or supine position is contraindicated. Pregnant women can be adjusted quite easily and safely with standing and incline adjusting methods. The previous three adjusting methods are effective for reducing extension restrictions and can resolve some rotation restriction. For more effective rotation correction, a seated patient position can be used. (See #4 below.)
4. Seated adjusting. The patient again straddles the table, as with the incline table technique, only there is no incline. The doctor sits behind the patient. For a left posterior listing, in which the segment is restricted in rotating left to right, the doctor places their left thenar or palm region over the left restricted segmental area (over the left vertebral body region).
The doctor's right hand goes under the patient's right arm and reaches to the patient's left shoulder. The patient's left arm reaches to the right and the patient's left hand grasps their or the doctor's right shoulder or upper arm. Upon exhalation, the patient rotates to the right to end-point. The patient is also slightly forward flexed. The thrust is made with a simultaneous left contact push and right doctor's hand rotational pull to the right.
This is a useful method, but it takes practice. It cannot be used with fragile patients or those with lumbar contraindications, or very stiff and unrelaxed patients who tend to resist you.
5. Supine adjusting. This is useful for T/L conditions in some patients and is familiar to most doctors. It is inappropriate if the doctor or patient has limiting low back conditions. The skill of some doctors makes this method a work of art.
6. Side-posture adjusting. This method is useful for some patient physiques and conditions, but it generally is not as useful or easy to do as the aforementioned methods. For exceptionally skilled adjustors, it can also be a fine method to remove lateral flexion restrictions, in addition to rotation and extension.If you do not have the skill or hand structure that allows this lateral flexion procedure to be successful, you may utilize instrumentation for removing lateral flexion restrictions. This includes single-action or multi-thrust instruments.
