Mark Corson

By N. Ford. Southern University, Shreveport-Bossier City. 2018.

Spondylotherapy system – generally buy bystolic 5mg mastercard, locally effective bystolic 5 mg, significantly or peripher- ally (Lederman 2005b) discount bystolic 5mg on line. Thiele massage for pelvic floor dysfunction There is also, of course, the undoubted impact of 26. Visceral manipulation – see also Chapter 3 manual modalities on what can be termed the psycho- 27. Neurological – where tone reduction and pain as Pilates and Alexander technique) are also dis- modulation are the desired effects cussed in Chapter 9 (Rehabilitation) and in those 3. Psychological/psychophysiological – where instances only a brief comment will be found in this the objectives include improved visceral chapter. In some descriptions – where appropriate – exercises Methodology in the use of the method have been described. As in There are various definitions of manipulation: Chapter 6 (Palpation and assessment skills) the exer- Osteopathic definition (Glossary Review Commit- cises that are described are designed to allow the tee 2005): Therapeutic application of manual force, reader an opportunity to experience an aspect of the including all techniques (e. Specific indications are listed by Gibbons & Tehan (2000a) as including joint hypomobility (Kenna & For the purposes of this chapter, the method under Murtagh 1989), motion restriction (Lewit 1999), joint consideration as the modality ‘Manipulation’ is high fixation, acute joint locking, motion loss with somatic velocity, low amplitude thrust (a. Reproduced with permission from Lederman (1997b) tous tension, or a combination of these forces (Gibbons when the area is flexed, Type 2 mechanics apply, and & Tehan 2000b, Greenman 1996). There is no universal agreement as to which seg- Major complications from cervical manipulation are ments are, and which are not, Type 1 or Type 2, apart rare (between 1 in 400 000 and 1 in 10 million; Shekelle from in the cervical region where C1 is Type 1, and C2 et al 1992) but serious (Coulter et al 1996). It is worth to T4 almost universally demonstrate Type 2 behavior acknowledging that complications resulting from – and which therefore require Type 1 positioning to most other forms of treatment of neck pain, for which create facet-locking (Penning & Wilmink 1987). Other data are available, are estimated to be higher than areas of the spine are less predictable, with coupling those for manipulation. Some artery dissection, it was not possible to identify a spe- evidence suggests (but there is no concensus) that cific neck movement, type of manipulation or trauma 216 Naturopathic Physical Medicine Side-bending left Side-bending left Rotation right Rotation left A Figure 7. Reproduced with permission from Gibbons & Tehan (2000b) that would be considered the offending activity in the • mobilization is superior to physical therapy majority of cases. This has variously been • Acute inflammatory arthritis ascribed to release of dissolved gases in the synovial • Bone infection. Gibbons P, Tehan P 2000 Manipulation of the to increase pain and compromise neural spine, thorax and pelvis: an osteopathic structures perspective. It has been also demonstrated • These events, although frequent, are usually mild and that the same manipulations may reduce the size of the transient (Ernst 2001, Senstad et al 1997) disc herniation (Mathew & Yates 1988). A report from the Canadian Stroke • 74% had disappeared within 24 hours (Senstad et al Consortium quoted Dr J. Norris, a neurologist, as 1997) saying his research indicated a risk of 1 stroke in 5000 • ‘Sympathetic storm’, fainting, syncope, palpitation, manipulations (Norris et al 2000). Dr Norris under oath nausea and perspiration occur in 1–2 cases per at an Ontario inquest into the death of a young woman 1000, lasting 1–2 days (Maigne 1972) following cervical manipulation stated the numbers he • Perspiration over trunk and axilla is common and of has quoted are ‘sheer guesswork’ and ‘way off’. He was brief duration (Maigne 1972) forced to recant his position during the inquest (Sackett • Epigastric, abdominal or pelvic pain is common and of 2002). These events, • carotid and vertebral artery dissections although frequent, are usually mild and transient (Ernst • aneurysms 2001). Manipulation of the cervical spine appears to be All of these conditions may produce central nervous associated with the possibility of cervical radiculopathy, system infarction, resulting in residual neurological myelopathy and disc herniation (Malone et al 2002b). Manipulation of the lumbar spine is associated with a Chapter 7 • Modalities, Methods and Techniques 219 Box 7. A similar 1988 study complications of the Canadian Memorial Chiropractic College clinic Stretching, shearing, kinking or crushing forces on the files for a 9-year period (Henderson & Cassidy 1988). An extensive 1993 often considered as possible mechanisms of injury literature review found risk of serious neurological (Gatterman 1990a, Plaugher 1993b, Terrett 1996b). A cadaver research study, looking at the biomechanical A sample of incidence of stroke in the world male strain from cervical manipulation, concluded: population: • the forces during manipulation were less than those • Finland: 310 per 100 000 persons per year (Sarti et al recorded during range of motion and diagnostic 1994) testing • Eastern Europe and former Soviet Union: 309–156 • the strains on the vertebral artery during manipulation per 100 000 persons per year were less than one-ninth of that required to achieve arterial failure • Western Europe: 100 per 100 000 persons per year • the movement of joints during cervical adjustment is • Trinidad and Tobago: 185 per 100 000 persons per done well within the normal range of motion and that year (Cinzia et al 2000). The authors acknowledge the inherent bias range of estimates as to what those risks might be. In 2001 makes this association difficult to study despite high the Canadian Medical Association Journal published volumes of chiropractic treatment’. It is also important to consider that many persons suffer spontaneous stroke from everyday activities such as • 1. A study in Stroke, based on the case while driving, holding a telephone against the shoulder, history of stroke patients (Rothwell et al 2001). A survey of California many more common activities (Rome 1999, Terrett neurologists (Lee et al 1995). A 1996 literature The wide difference in the statistics of risk of stroke review reported in Spine (Hurwitz et al 1996). A 1993 study in the spontaneous arterial dissection in the general population Journal of the Canadian Chiropractic Association raises questions as to the relationship between the two. Many observers erroneously make a connection between • 0 per 5 million manipulations. If a stroke occurred after a clinical files of the National College of Chiropractic manipulation, then according to Keating (1992), the performed between 1965 and 1980 (Jaskoviak manipulation must be the cause of the stroke: ‘To 1980). Do not continue to adjust a patient if any aggravating factor in an already compromised arterial possibility of vascular trauma has occurred. This theme is echoed repeatedly in studies evaluating It is a relative contraindication to manipulate a patient risk of manipulation. As an example, an editorial (Hill who: 2003) in the Canadian Journal of Neurological Sciences stated: • has a history of hypertension or other known risk factor for stroke or vascular disease Despite strong circumstantial reports and opinions, • has an elevated homocysteine level the quality of evidence that minor neck trauma • presents with a bruit including chiropractic neck manipulation causes • has a migraine vertebral or carotid artery dissection remains weak.

Smith Sunshine Natural Wellbeing Foundation Charitable Trust as a refection of Bill Smith’s Professorship in Chronic Fatigue Syn- exceptional vision and his desire to enhance drome and Related Disorders in Pediatrics medical excellence discount 2.5 mg bystolic free shipping. Funding provided to support a deserving fac- Alfred Sommer Professorship in Ophthal- ulty member buy 2.5mg bystolic with visa. Sutland Chair in Pediatric Funds set aside by the Department of Oph- Genetics [1991]: Ada Hamosh bystolic 5 mg with mastercard, M. Taussig Professorship [1987]: member of the class of 1947, in honor of her Jean S. Taussig’s an alumnus of the class of 1911 and the property on Cape Cod to provide support frst orthopaedic surgical resident at Johns for the Division of Pediatric Cardiology. TeLinde Distinguished Pro- The endowment will support research in brain fessorship of Gynecological Pathology disorders, especially schizophrenia and bipo- [1989]: Robert J. D lar disorders, which may be caused by infec- Funding provided by the estate of Dr. TeLinde, Director of the Department Mary Wallace Stanton Professorship for of Gynecology and Obstetrics from 1939- Education [2004]: David Nichols, M. He was an advocate of a close rela- Funds provided by donor to endow Profes- tionship between pathology and gynecology sorships in the School of Medicine. Funds provided by donor to endow Profes- Therapeutic Cognitive Neuroscience Pro- sorships in the School of Medicine. Traystman Professorship in in making their donations in recognition of Anesthesiology and Critical Care Medi- their respect and admiration for Dr. He completed Intensive Care Medicine was renamed to his internship and residency at the Wilmer honor Dr. Welch, the frst Dean of the Johns Hopkins Thomas and Dorothy Tung Professor in School of Medicine. Income from the principal will support the Wellcome Professorship in Clinical Phar- Tung Professor. Lawson Wilkins, the father of Pedi- family, friends, colleagues, and grateful atric Endocrinology. Wagley, a 1943 gradu- William Holland Wilmer Professorship in ate of the Johns Hopkins School of Medicine, Ophthalmology [1925]: Peter J. Walsh was the founder of the sub- nician in the Department of Gynecology and specialty of neuro-ophthalmology. Walsh has been the Director of Funding provided by the Department of Oph- the Department of Urology since 1974. Fund- thalmology Unit Executive Funds to support ing was provided by an anonymous donor. Herter of New York this purpose up to the time of her death in offered to the Medical Department of the December, 1937, made it possible to offer Johns Hopkins University the sum of $25,000 prior to 1938 thirteen courses of lectures by “for the formation of a memorial lectureship distinguished scientists either from this coun- designed to promote a more intimate knowl- try or abroad. Upon her death the University edge of the researches of foreign investiga- received from her estate a legacy amounting tors in the realm of medical science. According to ment fund, the income of which is to be devot- the present terms of the gift, some eminent ed to the continuation of these lectures. The selec- the departments of pharmacology, chemistry, tion of a lecturer is to be left to a committee and medicine. This lectureship was the Johns Hopkins University to endow a lec- inaugurated in the academic year 1960-61 tureship to be known as “The William Sydney with the frst Gilman Lecture being appro- Thayer and Susan Read Thayer Lectureship priately given by Dr. Gould Lectureship in Radiol- the expenses of one or more annual lectur- ogy: In 1962 friends and former associates ers on subjects “in Clinical Medicine, Pedi- of Dr. Gould was a member of the to be made by a “Committee composed of Johns Hopkins faculty from 1947 to 1955. Gould was Professor of Radiology lishment of a lectureship in the History of at the University of Colorado. Libman’s are selected from scholars distinguished desires, the lectureship was named after the in clinical radiology or related disciplines in distinguished investigator, Hideyo Noguchi. Lawson Wilkins, it year a course of lectures in memory of her has been possible to establish a distinguished deceased husband, Charles E. Dohme, a lectureship designed to commemorate his well-known pharmaceutical chemist of Balti- great contribution to pediatric endocrinology. Stanhope Bayne-Jones, a distinguished cine for the establishment of an annual Visit- alumnus of the Johns Hopkins University ing Professorship of Clinical Pharmacology School of Medicine. In view of his long interest in infectious The purpose of the lectureship is the promo- diseases, microbiology, epidemiology, and tion of a wider appreciation of the importance preventive medicine, it has been decided to of clinical pharmacology and its scientifc orient the Bayne-Jones Memorial Lecture- base. Lecturers are selected from the Lectureship was formally established in individuals who have made important contri- 1973. The lecturers are to be selected from butions in clinical or investigative surgery and scholars distinguished in clinical or investiga- the selection is made by a committee repre- tive surgery, and the selection will be made senting the Section of Surgical Sciences. The pur- $10,000 for the establishment of a lecture- pose of this visiting professorship is to foster ship in honor of Dr. The lectures the appreciation and understanding of ethi- under this endowment are given each year by cal issues in basic and clinical research and the recipients of the Paul Ehrlich Awards and patient care. The Samuel Novey Lectureship in Psy- The Alan Coopersmith Visiting Profes- chological Medicine: The family, friends sorship: The family, colleagues, and friends and colleagues of Dr. Alan Coopersmith have established a to establish a lectureship to honor his con- lectureship (or in special circumstances, a tributions as practicing physician, and as a visiting professorship) in his memory in the teacher of psychiatry and psychoanalysis.

Though to some this may seem a disadvantage bystolic 2.5mg low price, it also means that people with this profile have very low risk of alcoholism buy cheap bystolic 2.5 mg online. Janda (1994) generic bystolic 5mg mastercard, for example, discusses the fact that crisis may affect the firing of the deep, local stabilizer some muscles in the neck, the levator scapulae in par- system. Since the system is tonic, we might expect that ticular, may be used to literally ‘dump’ excessive it would become facilitated and tight (as does the neural drive from the limbic-emotional system. This pectoralis minor or the levator scapulae), but this enhanced neural drive to the levator and other pos- depends on the nature of the stimulus and whether tural muscles results in the hunched, red-light or that stimulus arrives at the cord via the alpha-afferent upper crossed posture we are all familiar with in or the beta-afferent system. The former (low threshold stressed states (whether they be emotional, physical, system) may acutely alter postural reflexes, such as thermal, etc. The common outcome of this is tension in stimulus will upregulate, while a high stimulus will the tonic muscle system and relative inhibition in the inhibit physiological processes, so the response of the phasic muscle system, though there are exceptions motor nerve at any given level will depend entirely (see Table 9. The multifidus, transversus and other deep stabi- The notion of the musculoskeletal system as a damp- lizer muscles have a lower threshold to stimulus (Sahr- ener for aberrant energies from the organ systems, mann 2002) and therefore are the first muscles to be from emotional input or from pain generators is con- affected by aberrant neural events at the cord level. Chapter 9 • Rehabilitation and Re-education (Movement) Approaches 389 Psychology of corrective exercise Box 9. Bear in mind socioeconomic effects of pain: patients about their condition as well as to offer advice and coaching as to how to make better choices, • Job performance whether this involves exercise, nutrition or other life- • Sports performance style choices. Bear in mind sexual activity being affected by pain: (1999) has described some of the following concepts • Does the pain affect libido? Any other lifestyle changes or compromises due to that 85% of patients presenting for orthopedic consul- the pain tation have an unknown causative onset of their pain. Distinguish between hurt and harm: This, of course, suggests that the problem is one of • Pain during an exercise cumulative microtrauma based on dysfunctional bio- • Pain during a stretch mechanical, biochemical or emotional patterns. Manage your patient properly by offering Movement approaches and mood comprehensive information 8. Flare-ups are not failures to manage the pain, but Depressive symptomatology is more prevalent among education as to how to better manage the pain in sedentary than physically active individuals (Berlin et future al 2006). Focus your patient on function rather than pain mental health problems account for 30% of total dura- 10. Progress should be monitored every 2–4 weeks be defined as either acute or chronic. The acute effects to give patients accurate feedback of their of exercise on mood tend to focus on state anxiety. The changes/improvements vast majority of research into the effects of exercise on 13. Assess using pain provocation tests/quantifiable psychological well-being has been conducted using testing to demonstrate gains aerobic exercise. Nevertheless, activities such as weight or strength training, yoga, and other ‘non- aerobic’ exercises have produced positive effects on psychological health (Weinberg & Gould 1999). How this occurs probably involves many mecha- Higher levels of physical activity in depressed nisms, including the fact that exercise is commonly patients have been shown to be associated with less performed in an outdoor environment which allows concurrent depression, even after controlling for exposure to sunlight, known to have antidepressant gender, age, medical problems and negative life effects and to help to re-regulate circadian rhythms. Physical activity counter- The exercise itself may also help to re-regulate a dis- acted the effects of medical conditions and negative rupted circadian rhythm, thereby aiding sleep and life events on depression. If the circadian rhythm is Exercise has been shown to have an irrefutable disrupted, this alone may be a major cause of depres- benefit in helping to optimize mood – both in those sion (Spiegel et al 2003). Other benefits of exercise on who are non-symptomatic and in those with clinically mood will be due to the ability of exercise to exert a defined depressive episodes (Warburton et al 2006). Some of this also known to increase opiate-like endorphin produc- evidence is described in Chapter 10. Governmental tion in the brain, and may contribute to a natural high physical activity guidelines are variable but com- from exercise – alongside the possibility of a feel-good monly fall within the approximate range of 20–30 factor from knowing that time has been used con- minutes’ duration of >60% of maximal heart rate three structively and to move towards a positive goal. Such Similar to antidepressants, exercise has been hypoth- guidelines are sufficient to elicit health benefits, espe- esized to increase the synthesis of new neurons in the cially in previously sedentary people. Studies on rats reveal a two- to threefold those unaccustomed to exercise use their lack of exer- increase in hippocampal neurogenesis with regular cise history as an excuse for not taking on the advice access to a running wheel when compared with of the clinician to do an exercise program; however, control animals (Ernst et al 2006). Recent rat studies the less conditioned they are, the greater the benefits also show that exercise (in this instance swimming) they will receive (Warburton et al 2006). Many people who suffer with depression are focused In one study (Berlin et al 2006), 40 regular exercisers on one or multiple earlier life experiences (such as were deliberately deprived of exercise across just 2 a bereavement, a divorce, or a time(s) they have felt weeks and assessed using multiple profiles and testing cheated). Alternatively, such individuals may be procedures to measure fatigue and somatic depres- focused on a kind of hopelessness about the future sive symptoms. Both fatigue and depressive symp- and how certain past (or anticipated future) events toms emerged after just 1 week of exercise withdrawal may impact the potential for future happiness. Exercise withdrawal also resulted future events that may never happen (Tolle 2001). Depressed mood and fatigue are commonly engagement in exercise encourages the participant observed in individuals deprived of usual exercise into the present, into the now, potentially decreasing activities, and the increase in fatigue may be partially pain, increasing endorphins, and enhancing self- mediated by reduced fitness levels. This is of particular psy- While effective motor control and sequencing is far chosocial importance for those whose careers, identi- more important to biomechanical function than body ties or social activities are built around a given sport fat levels, it is a general trend that if body fat is high, or activity (see Liebenson’s recommendations in Box muscle activation and sequencing may be compro- 9. This can be attributed to a number of physio- Physical activity is associated with reduced concur- logical cascades – such as the ingestion of allergenic rent depression. In addition, it appears that physical foods resulting in weight gain (Deitsch & Rivera activity may be especially helpful in the context of 2002) and concomitantly disrupting activation of the medical problems and major life stressors. Clinically, abdominal wall musculature (see ‘Viscerosomatic encouraging depressed patients to engage in physical reflexes’ below).

Another study found that all addictive substances including nicotine into between eight and 16 percent of people who had standard treatment protocols generic 5mg bystolic amex. Negative Public Attitudes and Behaviors Toward People with Addiction The most frequently-mentioned barrier to accessing treatment for addiction involving Related to widespread misunderstanding of the alcohol and drugs other than nicotine is not disease of addiction is the stigma attached to it-- ‡ 99 being ready to stop using these substances cheap 5 mg bystolic with mastercard. A the well documented cheap bystolic 5 mg without a prescription, strong disapproval of or study of current smokers in Wisconsin found discrimination against those with the disease-- that the main barriers to quitting that participants and the fear of repercussions which prevent reported were not being ready to stop smoking 103 people with addiction from getting help. Another way of people looking for needed addiction national survey found that two-thirds (67 102 treatment. These estimates are from combined This survey excluded addiction involving nicotine. Stigma was defined for respondents as “something § Met clinical diagnostic criteria for addiction that detracts from the character or reputation of a involving alcohol or drugs other than nicotine. The analyses conducted for the study, Defined in this study as including services delivered which controlled for other factors that predict in an inpatient ward, outpatient clinic, rehabilitation employment outcomes, suggest that employer program, halfway house, emergency room or crisis discrimination may be an important contributing center or by a private physician, psychiatrist, psychologist, social worker or other professional; factor to job instability in this population. The alcohol or other drug detoxification; and self- authors speculate that while the Americans with help/mutual support programs (e. N) control that can be remedied with a simple change of mind, stigma and Figure 7. N discrimination against addicted Participants Reporting They Would Be Less Likely* individuals are all too common. Privacy Concerns Discrimination against those with addiction is manifested on the governmental and institutional Because of negative public attitudes toward levels as well. Insurance companies generally addiction and the consequent potential for provide less coverage for addiction treatment stigma and discrimination, prospective patients 119 services than for other medical services. This populations where patients may fear a lack of perception was true across income levels: 67 anonymity due to relatively smaller and more percent of adults with annual incomes under 125 close-knit communities. In one study a high school degree or less (65 percent), those of individuals with addiction, 36. Approximately 50 million With the current funding stream, you must be Americans, or 16. Twenty-nine million insured people are --Johnny Allem † 131 Founder and President underinsured perhaps prompting them to postpone needed treatment. Those with public insurance focus more on accessibility A 2009 national survey found that nearly half issues (waiting times, eligibility) as barriers to (49 percent) of U. This disparity may be due to the not be able to afford treatment for addiction fact that some private insurance companies do ‡ involving alcohol or other drugs if they or not cover addiction treatment and some employers do not extend their benefit plans to 140 * include addiction treatment coverage. One study treatment providers in New York State found found that people randomly assigned to receive that a significant proportion of the respondents free methadone maintenance therapy stayed in said that a lack of conveniently located treatment their treatment programs longer than those programs “somewhat” (62. A significant barrier to obtaining addiction Some individuals who need addiction treatment treatment is the lack of knowledge about where face eligibility criteria for program entry that are to go for help and the limited ability of too stringent--including a patient’s ability to pay physicians, parents and other family members, and a required agreement to comply with all teachers, coaches, employers, clergy and law rules and treatment protocols regardless of 150 enforcement to identify the signs of addiction in individual goals. In contrast, the main others and know how to help patients access criterion for treatment access in mainstream 144 medicine is the principle of medical necessity, effective treatment. This barrier can undermine an they need to treat their disease are those who 154 individual’s fragile resolve to enter treatment. Such a belief may favor of those most likely to succeed with derive from a misperception of what symptoms 155 treatment, as a longer wait time to enter a and what level of symptom severity constitute program is associated with pretreatment the disease of addiction and require professional 156 attrition. One study found that the longer assistance, or it may derive from the belief that patients have to wait between clinical treatment simply is not effective and will not assessment and the first treatment session, the 164 help. Some of this concern may be warranted less likely they are to complete subsequent given the nature of the services offered. Treatment providers providers) stand in the way of people accessing see this as a barrier to treatment access as well: 158 needed addiction treatment. Even among those who may Some individuals with addiction have negative otherwise seek treatment, continued substance perceptions or a fear of treatment providers and use in an addicted individual’s family or social programs that may keep them from seeking and network can increase the risk of continued use, 167 accessing treatment. These perceptions can reduce the likelihood of treatment entry and be based on an individual’s prior negative 160 derail treatment efforts. While individuals with co- Legal Barriers occurring addiction and mental health disorders such as anxiety and depression access treatment Unlike other chronic health conditions, addiction at higher rates than individuals in the general involving illicit drugs, by definition, marks a population (although most treatment facilities do person as having engaged in illegal activity. Many of people looking for needed addiction barriers stand in the way of treatment for people 171 with disabilities, such as erroneous attitudes or treatment. People with disabilities who have The barriers to treatment outlined above apply to addiction also may be deterred by most individuals with addiction; however, accommodation barriers to treatment, such as certain populations face additional barriers that lack of personal or public transportation to a exacerbate the difficulty of accessing needed 179 * treatment center and facilities that do not have treatment. Likewise, not all special populations that have additional or unique barriers to treatment access necessarily require specialized screening or treatment protocols (e. Few diseases affecting adolescents are as extensively under-treated as addiction, even Some pregnant smokers report reluctance to quit though addiction is a disease with firm roots in 186 196 smoking due to fear of weight gain, not adolescence. The significant treatment gap in believing in the harmful effects of smoking to the adolescent population--which is particularly 197 themselves or their fetus due to prior acute among black and Hispanic youth --is due pregnancies with no observable harm and a in large part to the failure to understand the social environment where smoking is developmental nature of addiction and the 187 prevalent. Unfortunately, systems fear that entering treatment may result in losing responsible for the welfare of young people-- 190 custody of their children; they may be schools, juvenile justice, child welfare-- too apprehensive of the involvement of child often miss opportunities to intervene with young protective services if they were to be identified people in need of treatment and continue to 191 as having addiction. Yet, effective evidence-based interventions for smoking cessation to older 202 213 treatment approaches for adolescents do exist. One or other medical problems common in the 214 national survey found that adolescents frame elderly. Other barriers drugs, only one percent identified a substance include insufficient research on the safety and use problem as a likely diagnosis.