CHIROPRACTIC

Chiropractic is a healing profession that treats the spine and extremity joints to improve function and health. It does this by focusing on alignment of the joints through mobilization and/or manipulation. The goal is to correct misalignment so the structure, movement and nervous system can function better.

Chiropractic can come in a wide variety of forms, similar to how there are many different types of exercise.

Some just do a roller table, electrostim, a few quick pops, and you’re done.

Some just treat the upper cervical area.

Some use a clicker device on your neck or back.

Some try to sell you a year care plan.

However, we were always interested in more complete care in a shorter time frame.

We believe in treating the whole person. This might be a big toe that won’t move which affects your running. It might be a tight IT band that affects the muscle firing in the glutes limiting your soccer game. It might be a tight diaphragm muscle that is amplifying your heartburn. It might be numbness in the fingertips from your forearm muscle that is too tight. It could be a low back pain from your SI joint that is locked on one side and too loose on the other. It could be a frozen shoulder that has stopped you from picking up your grandkids.

Part of these scenarios is treating the joints of the spine and extremities. There are other modalities to help with soft tissue restriction, flared up nerves and weak muscles, but we can’t ignore the vertebrae and other joints.

The body is an amazing creation. We still don’t understand all of it. Every year there are new discoveries and ideas on how we can allow it to heal. The idea of removing miscommunication in the body and allowing to self-heal is one of the major premises of chiropractic.

The joints in the neck, mid back and low back called vertebrae form the central column for our posture but also protect our spinal cord. The spinal cord is our central conduit for sending and receiving signals from the rest of the body. Spinal misalignment can affect your body balance and nerve firing.

The joints in the extremities of ribs, shoulder, elbow, wrist, fingers, hip, knee, ankle and toes can be misaligned, stiffened or too loose. They can affect your ability to move which affects your overall function in life. A lot of chiropractors focus on just the neck and back, so it is helpful to find a chiropractor trained and skilled in extremity chiropractic.

Nerves inside the extremity and spinal joints called proprioceptors send signals to the brain and spinal cord which affects balance, movement, pain intensity and muscle tone. One of the theories on how chiropractic is successful is the stimulation of certain proprioceptors that aren’t affected by other movement methods.

There are many different ways to move a joint. Some involve “popping,” some involving a gliding mobilization and some involve using an instrument such as an Activator or Arthrostim. We make an educated decision which ones to use depending on the individual patient. Some patients tolerate and like adjusting with a popping manipulation; some do better with a slow, low-force manual glide; some do well with trigger point holds; and some do great with an instrument-assisted adjustment like Activator. We treat a variety of patients so treatments become specific to the individual. For example, we might only use low force techniques for fibromyalgia or infant patients; whereas, we might use more intense techniques for a rugby player.

Several specialties and diplomats exist in chiropractic similar to the medical world. These include sports, radiology, neurology and internal disorders. Dr Michael Van Antwerp is one of the few Certified Chiropractic Sports Physicians (CCSP) in the state of Oklahoma.

Chiropractic is regulated in all 50 states by state Chiropractic licensing boards.

In summary, chiropractic is a natural healing art that works on the structure of the body to allow it to heal itself. It can include many other non-invasive methods including nutrition, soft tissue work and corrective exercise.

ACUPUNCTURE

Acupuncture is an ancient healing art that goes back over 2,000 years. It is being researched more and more for its healing effects including some studies at National Institutes of Health (NIH).

The theory of acupuncture works on the simple idea of increasing energy in areas of low energy, and lowering energy in areas of high energy.

Acupuncture seems to stimulate the overall healing effects of the body.

Acupuncture is a complementary medical practice that entails stimulating certain points on the body, most often with a needle penetrating the skin, to alleviate pain or to help treat various health conditions. Other methods for stimulating acupuncture points include finger pressure, rubbing, edge tools, cupping, microcurrent and laser.

Numerous recent studies conducted by scientists in Europe and the United States have found that acupuncture is at least moderately effective in treating pain and nausea.

For example, one of the largest studies to date on acupuncture and chronic pain — a meta-analysis of 29 well-conducted studies involving nearly 18,000 patients and published in October 2012 in the Archives of Internal Medicine — found that acupuncture is effective for treating chronic pain and therefore is a reasonable referral option. The doctors wrote that "[s]ignificant differences between true and sham acupuncture indicate that acupuncture is more than a placebo.”

Another example is a 2013 review that found that acupuncture could reduce vomiting and nausea among patients receiving chemotherapy, according to Cancer Research UK.

Researchers are also conducting studies to determine if acupuncture is effective at treating depression, anxiety and a variety of cancer and cancer treatment-related symptoms. Dr. Ting Bao, an integrative medical oncologist at Memorial Sloan-Kettering Cancer Center in New York, notes that "[r]ight now acupuncture is really used to alleviate cancer treatment-induced side effects or cancer-induced symptoms, but never to directly treat cancer," Bao told Live Science.

Acupuncture treatments carried out in hospitals and other health care facilities in the West today are not based on the same principles that were established in ancient Eastern texts, according to Bao. Western scientists have been trying to study the mechanism of acupuncture for years and have come up with several hypotheses, she said.

"One major hypothesis is that acupuncture works through neurohormonal pathways. Basically, you put the needle through specific points in the body and stimulate the nerve. The nerve actually sends signals to the brain, and the brain releases neural hormones such as beta-Endorphins. By doing that, the patient may feel euphoric, or happy, and this increases the pain threshold and they feel less pain," Bao said.

Another hypothesis is that acupuncture works by reducing pro-inflammatory markers, or proteins, in the body. Some animal and human studies suggest that by doing acupuncture, you can significantly decrease these pro-inflammatory markers — including TNF and IL-1β — which decreases inflammation and reduces pain, Bao said.

Yet another hypothesis applies specifically to how acupuncture can be used to treat nerve damage, such as chemo-induced peripheral neuropathy, a condition that often causes numbness or weakness in the feet and hands.

"The idea is that by putting the needle in, you stimulate the brain to secrete some nerve growth factor, and then that helps the nerve to regenerate," Bao said.

Research is ongoing into whether acupuncture can also help with other cancer treatment-related symptoms, including hot flashes, peripheral neuropathy and lymphedema (swelling of the arm or hand).

The World Health Organization maintains an extensive list of diseases and conditions (mostly pain related) possibly treatable by acupuncture. Many doctors now do not discourage their patients from receiving acupuncture when conventional medicine fails them or when convention treatment entails too many adverse side effects.

There is a growing body of research exploring whether acupuncture also can be used to treat depression, sleep disturbances and drug addiction. In general, however, acupuncture is considered complementary to conventional treatments, and it is likely most effective when implemented along with certain healthy lifestyle habits.

"Usually, when people are more health conscious, they pay attention to diet, they exercise more, they think about a mind-body approach to decrease stress, and they might also use acupuncture. Ideally, I think these things should all come together," Bao said.

Acupuncture seems to help with a variety of conditions due to its stimulation on the healing mechanisms of the body.

Acupuncture is not regulated at the state level in Oklahoma. This is why it is important to seek out practitioners who are already other physicians, have completed proper course work and/or have passed certification tests. Dr Michael Van Antwerp studied acupuncture in Kansas City with Dr Richard Yennie and has passed the NBCE Acupuncture Examination.

DRY NEEDLING

Dry needling is a therapy for muscle or nerve pain. It can be referred to as myofascial trigger point dry needling or intramuscular stimulation. The term “dry needling” comes from the use of a needle without a liquid or medication in or on it.

Acupuncture and dry needling techniques are at times identical, depending on the style of practice of the practitioner. For example, tendinomuscular acupuncture relies on careful palpation of what are called "ah shi" points, which can be translated as “there it is” points. The ah shi points often correspond to both trigger points and/or motor points in the myofascial tissue. Acupuncture can use other theories of why to treat certain points. Thus, while some forms of acupuncture are not at all the same as dry needling, the term dry needling can refer quite specifically to what is now called Myofascial Acupuncture or some versions of Sports Acupuncture.

The origin of the term “dry needling” is attributed to Janet Travell, MD. In her book, Myofascial Pain and Dysfunction: Trigger Point Manual, Dr. Travell uses the term "dry needling" to differentiate between injection of a local anesthetic and the mechanical use of a hypodermic needle without injecting a solution. The use of a hypodermic needle for dry needling was also described by Dr. Chang-Zern Hong in his research paper on "Lidocaine Injection Versus Dry Needling to Myofascial Trigger Point”. Both Travell and Hong used hypodermic needles for dry needling. However, now many healthcare practitioners who perform dry needling have found that the solid filiform (acupuncture) needles not only provides better tactile feedback but also penetrate the "dense muscle knots" better and are easier to manage and caused less discomfort to patients. For that reason both the use of hypodermic needles and the use of acupuncture needles are now accepted in dry needling practice.

Dry needling for the treatment of myofascial (muscular) trigger points is based on theories similar but not exclusive to traditional acupuncture. Both acupuncture and dry needling target the trigger points, which is a direct and palpable source of patient pain. However, dry needling theory is only beginning to describe the complex sensation referral patterns that have been documented as "channels" or “meridians” in Traditional Chinese Medicine. Dry needling, and its treatment techniques and desired effects, would be most directly comparable to the use of “ah shi” points in acupuncture. What further distinguishes dry needling from traditional acupuncture is that dry needling does not use the full range of theories of Traditional Chinese Medicine which is used to treat not only pain, but other non-musculoskeletal issues which often are the cause of pain. The distinction between trigger points and acupuncture points for the relief of pain is blurred. As reported by Melzack, et al, there is a high degree of correspondence (71% based on their analysis) between published locations of trigger points and classical acupuncture points for the relief of pain.

Dry needling can be a valuable, effective and efficient adjunct treatment in muscular pain. The purpose of this technique is to inactivate the myofascial trigger points by producing a local twitch response. This local twitch response then releases the shortened bands of muscle fibers. The result is muscle relaxation and pain relief. Eliciting this local twitch response is key for successful deactivation of the trigger point. Inactivation of the trigger points can bring immediate relief of symptoms.

The advantages of dry needling over other treatments are that we can treat parts of the muscle, and deeper layers of muscles, where our hands and fingers cannot reach. Also, this method is far superior in achieving a local twitch response over other manual techniques. In addition, there are no drugs used so we can treat many trigger points during each treatment.

Thus, results are achieved with dry needling which cannot be obtained with any other treatment.

MASSAGE

Massage has been around for millennia. Ever since people recognized aches, pains and tightness, there has been some type of massage.

Archaeological evidence of massage has been found in many ancient civilizations including Egypt, China, Mesopotamia, Greece, India, Rome, Persia, Thailand, Japan and Korea. Massage in more modern times developed in Sweden, France and Netherlands then into the United States.

There are many types of massage, but ultimately it means working on the muscular and connective tissue systems with pressure, tension, motion or vibration. The pressure can be light or heavy.

Massage can be divided into two major groups: clinical and spa massage. Clinical massage therapy is used to help treat certain defined conditions. Spa massage is usually used for relaxation. The purpose, techniques and thus the effects can be different for each.

Clinical massage therapy can include myofascial release which is designed to treat specific trigger point areas of tightened tissue that cause localized pain, referred pain and dysfunction.

Studies with fascia, the connective tissue surrounding the outer and inner parts of the body, has helped advance myofascial massage treatments.

Cranial or craniosacral therapy is a gentle, low-force type of clinical massage that works with the skull bones and circulation of the brain and spinal cord fluid.

Peer-reviewed medical research has shown that the benefits of massage include pain relief, reduced trait anxiety and depression, and temporarily reduced blood pressure, heart rate, and state of anxiety. Theories behind what massage might do include blocking nociception (gate control theory), activating the parasympathetic nervous system, which may stimulate the release of endorphins and serotonin, preventing fibrosis or scar tissue, increasing the flow of lymph, and improving sleep.

Ultimately, massage can make you feel better.

Massage in Oklahoma is not certified at the state level but is often regulated at the city level. This is why it is helpful to go to someone who has attended a certified school and passed an evaluation like The National Certification Board for Therapeutic Massage & Bodywork (NCBTMB).

CRANIOSACRAL THERAPY

Cranial or craniosacral therapy is a low-force therapy that is often placed under the massage therapy category. However, it was also developed in the osteopathic discipline.

The concept behind craniosacral therapy is that the head and the tail influence the spine and thus the rest of the body. The central nervous system (CNS) is heavily influenced by the craniosacral system including the membranes and fluids that surround, protect and nourish the brain and spinal cord.

Everyday our bodies endures stresses and strains that they must compensate for. These changes often cause body tissues such as the craniosacral system to tighten and distort. These distortions can then cause tension to form around the brain and spinal cord resulting in restrictions. This can create a barrier to the healthy performance of the central nervous system and potentially every other system it interacts with.

In craniosacral therapy, the goal is to detect and correct these restrictions using simple methods of touch. The craniosacral practitioner feels various locations of the body to test for the ease of motion and rhythm of the cerebrospinal fluid pulsing around the brain and spinal cord. Low-force techniques are then used to release restrictions in any tissues influencing the craniosacral system.

By normalizing the environment around the brain and spinal cord and enhancing the body’s ability to self-correct, craniosacral therapy is theorized to alleviate a wide variety of dysfunctions, from chronic pain and sports injuries to stroke and neurological impairment.

Cranial therapy can work on the inner movement, vibration and energy of the body and is thus subtle and deeper type of manual therapy. It is this release of the deep tensions of the body that can lead to improved whole-body health and performance.

THERAPEUTIC EXERCISES

Therapeutic exercise can reduce pain and improve muscular strength, balance and range of motion.

One of the key therapies to improving low back pain has been shown to be movement. There are a lot of ideas about core exercises and low back pain, but the key seems to be applying some focused movement to your rehab.

Shoulders can have limited motion in which case we use certain exercises to help regain mobility. Shoulders are often unstable and need therapeutic exercises to retrain the muscles and nervous system to help stabilize the affected shoulder.

A key to a lot of low back and lower extremity problems are the hips. If our hips are tight they can cause the low back and sacroiliac (SI) joints to move more to make up for the loss of movement. This can lead to a host of repetitive injuries. Hips can be weak which can lead to problems in the knees when running.

SI joints can be restricted or hypermobile. If restricted we often use mobilization and manipulation therapies. However if they are hypermobile, which is often the case in chronic SI joint problems, then they need a focused stabilizing exercise program.

Sprained ankles often have ligament and proprioceptive nerve injuries. These often need help stabilizing the muscles and ligaments but also retraining the proprioceptive nerves.

Feet are often weak due to wearing shoes on hard surfaces. We can “wake up” the feet with barefoot exercises and gain a surprising amount of input, mobility and function.

The jaw (TMJ) has a large amount of nerve endings which can affect balance issues, neck tightness and painful jaw. There are certain maneuvers and exercises for the TMJ that can help TMJ syndrome problems.

The body does not develop repetitive stress syndromes or postural distortions in a single day. Thus, it takes educated, focused exercise and other therapies over the long term to help these conditions out.

One of our goals in providing exercise was to provide the adjunct of mobility, stability and strength after we worked on joint and muscle alignment. We found patients gained more benefit from their treatments, we could shorten treatment plan times from around 20 to 30 visits to 8 to 12, and patients were able to use the exercises later to help if their problem flared up.

Therapeutic exercises help patients have an active role in their own care.

There are many ways to describe physical rehabilitation including functional movement, corrective exercises, rehab exercises, e-cise, therapeutic movement, movement therapy, mechanotherapy and medicomechanical.

We have drawn on many ideas for our exercise therapy and are constantly adding to, developing new and altering previous exercises for focus on the particular patient and problem.

We have appreciated the ideas of Stuart McGill, Gray Cook, Gary Gray, Geoff Maitland, Brian Mulligan, Robin McKenzie, Vladimir Janda, Karel Lewit, Craig Liebensen, Pete Egoscue, Don Harrison, Prague school of Rehab, Ida Rolf, Ido Portal, Nick Tumminello, Kelly Starrett, Naudi Augilar, Bret Contreras, Rafe Kelley, CrossFit, MovNat, Darkside Strength, Juggernaut Training Systems, Breaking Muscle, Mark Cheng, Mike Reinold, Charlie Weingroff, Eric Cressey, Katy Bowman, Tom Myers, Jean-Pierre Barral, BKS Iyengar and many others.

Using therapeutic exercise is not new for treating multiple types of health conditions. Egypt, Greece, Rome, China, India and Japan, for example, developed different systems of movement for health benefits. Different individuals have developed other systems as time has gone on. Per Henrik Ling developed Swedish Medical Gymnastics, Joseph Pilates developed a system of physical fitness called Contrology, Rudolf von Laban developed a dance methodology, Irmgard Bartenieff advanced this dance methodology with a rehab background, BJ Palmer experimented with exercise equipment at his chiropractic school, Florence Kendall advanced physical therapy, Frederick Alexander developed posture exercises for actors and singers, Moshe Feldenkrais contributed slow controlled movement exercises, BKS Iyengar systemized yoga, Pete Egoscue developed new ideas in rehab and Vladimir Janda greatly advanced balance rehab, Karel Lewit enabled further work from manual therapy and Jack LaLanne popularized fitness.

Dr Michael Van Antwerp is a Certified Strength and Conditioning Specialist.

YOGA THERAPY

Yoga therapy is using yoga exercises as rehab and corrective exercises. It is a useful method for movement therapy.

It can help an individual regain certain movements that have been lost due to injury or lack of use. It can help with postural alignment and balance. Breathing exercises can help with back pain, muscle control or relaxation.

If you have found certain positions have had pain or have been difficult, yoga therapy can provide cues and solutions to gain those postures.

“Yoga is beneficial for the health in ways that modern science is just beginning to understand. Even though it has been applied with therapeutic intention for thousands of years, yoga therapy is only just now emerging as a discipline in itself. More health care practitioners are starting to include yogic techniques in their approach to healing – and more yoga teachers give a therapeutic intention to their teaching. People who have never tried yoga before are starting to consider including yoga in their treatment plan.” – Yoga Therapy Conference

“Yoga therapy treats the whole person, seeking to change attitudes and actions that inhibit the natural healing process, and cultivate attitudes and actions that support it." – Gary Kraftsow of Viniyoga that has been researched at NIH

“Medical research shows that yoga therapy is among the most effective complementary therapies for several common ailments. The challenges may be an illness, a temporary condition like pregnancy or childbirth, or a chronic condition associated with old age or infirmity.” – Robin Monro, PhD

“Yoga therapy is of modern coinage and represents a first effort to integrate traditional yogic concepts and techniques with western medical and psychological knowledge. Whereas, traditional yoga is primarily concerned with personal transcendence on the part of a "normal" or healthy individual, yoga therapy aims at the holistic treatment of various kinds of psychological or somatic dysfunctions ranging from back problems to emotional distress. Both approaches, however, share an understanding of the human being as an integrated body-mind system, which can function optimally only when there is a state of dynamic balance.” – Georg Feuerstein, PhD

Dr Michael Van Antwerp is a Certified Strength and Conditioning Specialist as well as acroyoga instructor.

SPINAL DECOMPRESSION

Nonsurgical spinal decompression is a method of traction using a specialized table with the goal of decompressing the vertebral discs in the neck or low back.

The discs are gel-like cushions between the bones in your spine and normally should have good water content. They have a tougher outer layer called the annulus and gel-like inner core called the nucleus. The outer layer can be thought of as a radial tire, the inner part as a jelly-filled donut.

Spinal decompression works by gently stretching the spine. This traction changes the force and position of the spine with the goal of taking pressure off the discs by creating a negative pressure. As a result, bulging or herniated discs may retract, taking pressure off nerves and other structures in your spine. This in turn, over several visits, helps promote movement of water, oxygen, and nutrient-rich fluids into the discs so they can heal.

Doctors have used nonsurgical spinal decompression in an attempt to treat:

Back pain, neck pain, sciatica, radiating pain and radiating numbness/tingling

Bulging or herniated discs or degenerative disc disease

Worn spinal joints (called posterior facet syndrome)

Injured or diseased spinal nerve roots

Surgical decompression is a completely different procedure that involves a surgeon removing a piece of bone and/or disc material from pressing on a nerve. Surgical decompression has its own risks and percentage of success rates like most surgeries.

KINESIO TAPING

Therapeutic elastic taping has become very popular in the last few years. With Kerri Walsh and Misty May showing off the tape in the 2008 Olympic beach volleyball games, the tape has become very well-known.

The tape seems to work on three major areas: 1. Muscle support. 2. Skin-nerve feedback. 3. Reducing superficial swelling.

There are many different brands now due to its popularity. They include: Rocktape, Strength Tape, Kinesio Tape, KT Tape and Theraband Kinesiology Tape.

The tape is made to be thin so you don’t notice very much. It is made to be wearable during the day, sport or activity. It is made to shower and bathe with it on. Most are latex-free.

Tape is safe for populations ranging from pediatric to geriatric, and successfully treats a variety of orthopedic, neuromuscular, neurological and other medical conditions. It has been proven to have positive physiological effects on the skin, lymphatic and circulatory system, fascia, muscles, ligaments, tendons and joints.

At ZOVA, we have been using Rocktape H2O lately due to its hold and ability to last in water sports.

The British Journal of Sports Medicine recently found that “kinesio taping is superior to minimal intervention for pain relief.”

Dr Michael Van Antwerp has used therapeutic elastic taping for over 17 years. He did his Certified Kinesio Taping Practitioner (CKTP) training over a decade ago. He uses it along with other styles of taping such as McConnell and SPRT taping.

FOOT ORTHOTICS

There is a difference between shoe inserts and custom-made orthotics. Shoe inserts are any kind of non-prescription foot support designed to be worn inside a shoe. Pre-packaged arch supports are shoe inserts. So are the “custom-sized” insoles and foot supports that you can order online or at retail stores. Unless the device has been prescribed by a doctor and crafted for your specific foot, it's a shoe insert, not a custom orthotic device, despite what the ads might say.

Shoe inserts can be very helpful for a variety of foot ailments, including flat arches and foot and leg pain. They can cushion your feet, provide comfort, and support your arches, but they can't correct biomechanical foot problems or cure long-standing foot issues.

Custom foot orthotics are specially-made devices designed to support and comfort your feet. Prescription orthotics are crafted for you and no one else. They match the contours of your feet precisely and are designed for the way you move. Orthotics are only manufactured after a doctor has conducted a complete evaluation of your feet, ankles, and legs, so the orthotic can accommodate your unique foot structure and pathology.

Doctors use orthotics to treat foot problems such as plantar fasciitis, bursitis, tendinitis, diabetic foot ulcers, and foot, ankle and heel pain.

Orthotics typically cost more than shoe inserts purchased in a retail store, but the additional cost is usually well worth it. Unlike shoe inserts, orthotics are molded to fit each individual foot, so you can be sure that your orthotics fit and do what they're supposed to do. Prescription orthotics are also made of top-notch materials and last many years when cared for properly.

Foot orthotics can help with foot pain but also knee, hip and low back pain, dysfunction and alignment.

Dr Michael Van Antwerp is a certified pedorthist (CPed) in addition to a sports chiropractor (CCSP). A CPed is a separate profession that specializes in making custom foot orthotics and footwear. The nice thing about having your pedorthist also be a treating physician is that they understand the treatment and rehab of the foot.

Dr Van Antwerp started the orthotic company ArchMed and continues to provide his own skill and use of specialty labs in developing a custom foot orthotic.