By viewing injured patients as architectural structures, the Structural Management program goes straight to the cause

A recent Newsweek article¹ on low back pain discussed the latest update from Harvard Medical School. The article focused on alternative therapies, which included chiropractic, and began with the admission that low back pain often mystifies not only patients, but doctors as well, as a specific diagnosis is rarely determined.

Due to the difficulty in determining a specific diagnosis, treatment can only attempt to reduce symptoms, and in that context, chiropractic becomes one of the multiple alternative therapies used for pain relief. Chiropractic has debatable benefits; some say short-term treatment offers some relief, while others say it provides minimal benefits. This, however, is only considering chiropractic as an alternative when measuring symptomatic relief, which has unfortunately become the objective of care in the back pain industry.

The Lowdown on Pain
According to another article,² “The diagnostic evaluation of low back pain with emphasis on imaging,” 97% of all low back pain is due to mechanical causes, while less than 3% is due to pathological causes. The article also states that “...a definitive diagnosis cannot be made in as many as 85% of patients because symptoms and pathologic changes are not closely associated. Many cases of uncomplicated low back pain are assumed to result from muscle sprains and strains, ligamentous injuries and spinal degenerative changes.”

The admission that 97% of all low back pain is a direct result of mechanical causes and that an accurate diagnosis is difficult because symptoms and pathologic changes are not closely associated with the condition begs the questions: Why do chiropractors see only 10% to 14% of the population? Why is it that our pathology-based specialists, the medical doctors, and osteopaths, see the majority of patients who suffer with mechanical injuries? Why are not mechanical diagnostic tests and treatments the standard in today’s industry? And what other health care provider is in a better position to be the specialist in mechanically based injuries than chiropractors?

Chiropractic, in many cases, has fallen victim of the managed care industry guidelines where the objective of the provider is to reduce symptoms only. Chiropractors should be the structural experts, using structurally-based testing and treatment to determine an accurate status of the patient and then provide structural corrective care, not just symptomatic relief.

Get With the Program
The Structural Management™ program was designed to address the needs of the mechanically injured. There are three aspects of this program; 1) the Structural Fingerprint™ exam, which quantifies structural imbalances, weaknesses, and distortion patterns in patients; 2) the Advanced Conditioning™ program, a 6-month corrective program designed to restore mobility back to the joints of the spine, while also rehabilitating and re-educating the muscles and joints of the spine; and 3) the Maggs Muscle Management™ program, designed to remove harmful toxins from repetitively used muscles, thus increasing flexibility, performance, and recoverability.

When applied to each patient, this program offers many possibilities. First, it can be incorporated prior to injuries, such as in preseason; when hiring an employee; or for the pro-active patient who wants to dramatically improve conditioning, while reducing the likelihood of injury.

Second, when working with injured patients, this program looks at the patient as an architectural structure, determining where the imbalances and stress points are. This allows the doctor to establish a corrective conditioning program using objective structural corrections as the goal, rather than just the elimination of symptoms.

Finally, those looking to dramatically improve conditioning can learn the uniqueness of their structure, so that corrective treatment and conditioning exercises can be set up. This should apply to all youth in sports today. No one performs structural evaluations on the pediatric market, especially in sports. This market blindly and aggressively trains and competes without any clinical knowledge of the status of a child’s structure. Many distortion patterns and imbalances can be determined with the Structural Fingerprint exam. Every person has many contributing factors that make up their structural strengths and weaknesses, such as heredity, prior injuries, habits, diet, sport, attitude, and more. Therefore, a detailed structural exam is imperative in determining the status of one’s structure.

Case Study
17-year-old Kaitlin Howard rows for her school crew team. She paddles only on the left side of the shell. Kaitlin came into my office with a history of low back pain. She also suffered with pains in her left neck radiating into her left trapezius. These symptoms were worsening with increased rowing.

In the Structural Fingerprint exam, I found the medial arches of her feet were equal and normal. There was no toe flare. There was an increased Q-angle of the right knee. Low back range of motion (ROM) was full and without pain, as was the cervical ROM. Toe/heel walk was negative. Cervical compression and distraction were negative. Lasegue’s, bilateral leg lowering, and Patrick-Fabere were negative. Gaenslen’s was positive bilaterally.

Trigger points were noted in the left trapezius, the left rotator cuff, the left quadratus lumborum, bilateral gluteus medius and bilateral piriformis muscles.

Anterior-posterior open mouth.

A structural x-ray series was taken; an anterior-posterior (A-P) open mouth, a lateral cervical, an A-P lumbo-sacral (L-S) and a lateral L-S, all in the standing position. As noted on the A-P open mouth (Figure 1, page 18), there is a rotation of the spinous process of the axis, and there is an imbalance in alignment with the odontoid process, as compared to the normal A-P open mouth (Figure 2, page 18). On the lateral cervical (Figure 3, page 18), there is a reversal of the normal lordotic curve with the gravity line falling anterior to the spine, as compared to the normal lateral cervical (Figure 4, page 18). Keeping in mind the head is approximately 10% of the body weight, an abnormal weight distribution will lead to premature injury, difficult recovery, and accelerated degeneration.

Lateral cervical.

On the A-P L-S (Figure 5, page 18) there is a significant elevation of the left crest over the right crest, as compared to the normal A-P L-S (Figure 6, page 18). The lateral L-S (Figure 7) showed a posterior gravity line with a 33° sacral base angle (normal SBA is 36° to 42°), as compared to the normal lateral L-S (Figure 8).

Anterior-posterior lumbo-sacral.

Recommendations. Improve the structural positioning seen on the x-rays; the status of the noncompliant, over-used muscles harboring trigger points in Kaitlin’s structure; and patient compliance in managing her structure on a daily basis.

Lateral lumbo-sacral.

Improvement of structural positioning began with recommendations of custom orthotics due to the elevation of one crest, as seen on the x-ray, in the absence of an anatomical short leg (both legs measured 29½ inches), combined with an increased Q-angle on the right.

With the Advanced Conditioning program, I treated Kaitlin with a combination of adjustments, 40 during a 6-month time frame (3 times per week for 6 weeks; 2 times per week for 6 weeks; once per week for 12 weeks) to restore mobility back to all joints of the spine; a specific exercise program designed and taught by a personal trainer to re-educate the involved muscles and joints; and a re-education of habit patterns that may have affected Kaitlin adversely. I also performed 2 re-exams during this 6-month period and took x-rays at the completion of the program.

Using the Maggs Muscle Management program, removing the harmful toxins accelerated recovery and relaxation of Kaitlin’s injured, taut muscles.

Kaitlin is just entering her second month of care. Since her treatment will result in lifetime benefits, not just short-term symptomatic relief.

When chiropractors can bind together to become the structural management specialists, we can then hope for a significant portion of the 97% of mechanical injuries that exist in our country today, as well as many uninjured athletes and employees looking to prevent injuries.

Tim Maggs, DC, specializes in sports and industrial medicine. He has authored and lectured on biomechanics and produces a talk radio show. He can be reached via his website: www.runningdr.com. 

References
1. Cherkin D, Sherman K, Eisenberg D. Beyond the backache. Newsweek. 2002;32:56.
2. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. 2002;18:586–597.