Introduction
Premise
Historical Background
Conceptual Role
Scope of Application
Physiotherapy Utilization
Common Physical Agents and Their Effects
General Considerations for All Treatments
Assisting Natural Healing Processes
The Stages of Healing
Procedural Applications Relative to Pathogenesis
Basic Rehabilitation Concerns
Closing Remarks
References
The effects of electric current on the body have stimulated profound
excitement in the field of physiologic therapeutics. Becker’s text, Body Electric,
[1] clearly elucidates the effects that electric stimulation can have on the body.
His work and that of others have flamed interest in types of modalities that
might even duplicate the body’s intrinsic electric currents. Picker demonstrated
that microcurrent stimuli could increase ATP production, increase protein
syntheses, and impact positively on membrane transport. [2] Along with this
new emphasis on duplicating the body’s energies, the chiropractic profession
holds a great interest in rehabilitating the injured patient. Recent advances in
electrotherapeutics such as the arrival of Russian stimulation and advanced
technology in rehabilitation equipment have further nurtured this concern.
It is hoped that practitioners will use adjunctive procedures as a part of a
holistic approach to total case management. Emphasis should be on those
therapies duplicating the body’s natural responses, those that alleviate
symptoms, and those that aid in restoring normal functions of the body.
INTRODUCTION
Chiropractic physiologic therapeutics encompasses the diagnosis and
treatment of disorders of the body, using the natural forces of healing such as
air, cold, electricity, rest, exercise, traction, heat, light, massage, water, and
other forces of nature. To use these forces on a rational basis, the practitioner
must have knowledge of their actions and an understanding of their
predictable effects on the tissues and pathophysiologic processes involved.
The word physiotherapy is generally considered to be a shortened form for
physiologic therapeutics: treatment by physical or mechanical means.
The term physical therapy is used in reference to the application of
specific modalities, including rehabilitative procedures, concerning the
restoration of function and prevention of disability following disease, injury, or
loss of a body part. [3] The phrase may also be considered synonymous with
the term adjunctive therapy. To improve circulation, strengthen muscles,
improve or normalize joint motion, and normalize other functional imbalances,
for example, the therapeutic properties of the natural forces of healing
described above are applied.
The Council on Physiological Therapeutics of the American Chiropractic
Association defines chiropractic physiotherapy as the therapeutic application of
forces and substances inducing a physiologic response and use and/or allow
the body’s natural processes to return to a more normal state of health. [4]
A variety of therapies has proved to be effective. The most common clinical
applications include the therapeutic use of cold, electricity, exercise, rest, heat,
light, massage, nutrition, oriental therapies, rehabilitative procedures,
supports, braces, traction, trigger-point therapy, vibration, and water. See
Table 1.1.
Table 1.1. Common Types of Physiologic Therapeutics
Application Definition
Treatment of disease by rays of light, especially actinic
(rays of short wavelength occurring in the violet and
Actinotherapy
ultraviolet parts of the electromagnetic spectrum) or
chemical light.
Treatment by means of cold; eg, the application of ice
Cryotherapy
packs to a body part to relieve swelling.
Electrotherapy The treatment of disease by means of electricity.
The treatment of disease by using water; eg, Hubbard tank,
Hydrotherapy
sitz bath.
The treatment of disorders using active and passive
exercises; eg, traction (intermittent, sustained, or
Mechanotherapy
intersegmental), braces, shoe lifts, and casts or other
supports.
Meridian therapy The evaluation and treatment of disorders using the
Oriental systems.
The use of nutritional planning, dietetics, and special food
Nutritional therapy
or nutritional supplementation.
The treatment and training of the patient that is geared
Rehabilitative therapy toward attaining maximum potential for normal living
physically, psychologically, socially, and vocationally.
The stimulation of trigger points on the body surface by
Trigger point therapy
manual or other means.
The therapeutic use of soft-tissue manipulation,
Vibration therapy
mechanical vibration, and massage.
PREMISE
As long as people have been thinking, feeling, creating, and deciding, they
have sought relief for their discomforts. Their first source and recourse were to
those natural agents and forces in their surrounding environment; viz:
1. Heat such as derived from the sun, hot mineral springs, baths,
and warm mud or clay packs.
2. Actinic rays such as the ultraviolet effects of sunlight.
3. The cleansing effects of water proper (internally and externally) and
the varieties of mineral water.
4. The force of moving or running water.
5. The benefits of massage, rubs, and stroking.
6. The reduction of dislocations.
7. The extension effect of traction.
8. The energy and nutrition of certain foods, including herbs, spices,
and supplements.
9. The encouragement and counsel of an understanding attitude and
a positive mental outlook.
10. The privileges of rest, relaxation, and support.
The application of physiologic therapeutics thus predates all schools of
healing. Its use is generic in the healing arts; thus, such natural methods and
forces are the common property of all practitioners who are duly recognized by
society and its laws to treat human ailments.
HISTORICAL BACKGROUND
The application of physiologic therapeutics in chiropractic was firmly
established at the National College of Chiropractic in 1914 approximately.
However, the forces of nature have been used throughout history as a means of
facilitating the body’s healing processes.
During early recorded civilization, both Eastern and Western cultures had
much to do with building the foundation of the healing arts. The Babylonians
gave the first key to the nature and prevention of communicable diseases. The
early Hebrews originated public hygiene and developed a weekly day of rest for
recuperation.
In the Chinese Kong-Fou, written almost 4700 years ago, the popularity of
massage is well documented. The Chinese, as far back as 2838 B.C., offered
advances with their development of manipulation, massage, anthropometry,
acupuncture, moxa, pulse diagnosis, and herbs. Records are also clear that
manipulation, massage, and acupuncture were practiced by the Japanese at
least as early as 600 B.C. Early Chinese and Hindu writings also included
exercise therapies.
The Egyptians developed skill in manipulation and the use of natural
forces as far back as 2500 B.C. There is evidence that heliotherapy in the form
of light and water sunbathes in the temple of Aesculapus (the sun god) were
used to treat rheumatism and muscle wasting in 1400 B.C. By 770 B.C.,
treatment in Aesculapion sanctuaries was essentially based on bathing,
fasting, drugs, and suggestion. The temple priests also stressed the importance
of massage (amid an atmosphere of hypnotic-like suggestion and incantations)
in the treatment of epilepsy, dizziness, and headaches.
The early Greeks used a multitude of mechanical devices for stretching the
spine and setting dislocations. A wide variety of crude traction devices were
invented. Hippocrates, in 450 B.C., contributed to physiologic therapeutics by
recording his observations of the effect of heat and cooling on the body. Among
his many recordings, he also wrote Manipulation and Importance to Good
Health and On Setting Joints by Leverage.
Herodicus, a contemporary of Hippocrates, is often called the first great
drugless healer: “The one who laughed at the use of tonics.” He was a great
athlete who achieved wide fame by curing diseases by correcting abnormalities
in the spine, which he did in the relatively healthy through therapeutic exercise
and in the weak by manipulation with his hands. [5] He was criticized by
Aristotle because “He made old men young and thus prolonged their lives too
greatly.”
In later Greece, Claudium Galen (130—200 A.D.) became the most
distinguished practitioner of his time. He was the first to teach the proper
positions and relationships of the vertebrae and the spinal column, the
examination of urine in certain diseases, the value of specific foods during
illness, the critical days of fever, the significance of the pulse and arteries, and
many other features of health and disease. Among his many recordings, Galen
is attributed with 16 books on exercise and massage, and his many findings
influenced physicians for centuries.
Documents disclose that heat and hydrotherapy (eg, hot springs) were
used in America as a general body heating technique in 1706. It was not until
1745, however, that the first book on electrotherapy was published —wherein
it suggested the use of torpedo fish to treat gout. By 1870, the practice of
electrotherapy had greatly advanced. Galvanism and ultraviolet light were
commonly used as therapeutic measures before 1900.
For centuries, the use of sun rays, mineral spas, therapeutic exercise, and
massage have been popular in both Eastern and Western Europe. The use of
physiologic therapeutic devices was initiated and developed in America by the
nonallopathic professions, with pioneer chiropractors offering some leadership
in both application and development. [6] The various applications were
originally described as actino-therapy, electro-therapy, hydro-therapy,
mechano-therapy, etc.
Spinal analysis and adjustment have always been emphasized in the
practice of chiropractic, but they have never constituted the sole scope of
therapy used by the majority of practitioners. A chiropractor patented an
automated “traction couch” in 1914, and Drs. A. L. Foster and W. C. Schultz of
the National College wrote extensively on the physiology of the nervous system
and reflex therapies during the early part of this century. In the 1920s, Dr. J.
S. Riley made frequent mention of various peripheral reflex techniques in vogue
in chiropractic at that time.
Physical therapy and the many modalities we know today did not become
generally accepted by the allopathic medical community at large until 1914—
1918, when their use was demanded by the Armed Services during World War
I.
CONCEPTUAL ROLE
The role of physiologic therapeutics in the practice of chiropractic can best be
appreciated by the answers to four basic questions:
1. What role and place does physiologic therapeutics play in the practice
of chiropractic? The agents and forces of nature in their basic state, but
controlled, represent therapeutic aids and privileges that belong to all the
healing arts. When adjunctive procedures are used, it should be in such a way
that the body’s innate natural responses are duplicated; eg, the use of
microcurrent stimuli to promote healing. Therapies might also be used
preparatory to a chiropractic adjustment such as relieving muscle spasm,
dispersing edema, or alleviating pain. It also seems reasonable that
rehabilitative procedures should be used in the restorative phase of soft-tissue
injury.
2. What is the relationship between physiologic therapeutics and the
chiropractic adjustment? The answer to this question is fourfold:
First, solely the structural adjustment of a patient cannot
always be considered to effect adequate case management by
itself. Rest, exercise, diet, temperature control, sensory
stimulation, circulation enhancement, and proper
elimination are a few of the other important factors of health
that must be addressed.
Second, physiotherapeutic procedures often enhance and
augment the structural adjustment by means of physical
agents and forces. Heat tends to relax tense muscles, thus
making them more receptive to adjustment. Certain forms of
diathermy and galvanism often soften indurated tissue,
allowing a corrective adjustment to hold a more favorable
position for a longer period. When applicable, joint traction
applied before and an orthopedic support applied after
structural manipulation takes advantage of the
biomechanical forces of intrinsic stress relaxation and creep.
Both of these properties are a function of time that is
difficult to achieve manually. [7]
Third, when physiologic therapeutics are properly applied,
the humeral, chemical, and cellular elements of the body are
more competently readied and conditioned to allow for a
more effective response to the structural adjustment.
Fourth, total body function is enhanced. Physiotherapy aids
proper elimination, promotes proper nutrition, and affects
the mental and emotional status of the patient in a
constructive manner.
3. What is the major objective in the use of physiologic therapeutics? At
all times, the primary purpose is to bring the body to homeostasis, to health,
as effectively as possible. A secondary objective is to help the body normalize or
adapt to the abnormal processes of a diseased state. An incorrectly applied
physiotherapeutic measure, however, may worsen the condition. Another
significant factor is strengthening a weakened area following injury.
4. What are the general actions of physiotherapy and, basically, how do
they work? Any form of energy applied to human tissue exerts a primary
physical (physiochemical) action. This action, in turn, initiates secondary
physiologic or cellular alterations, either locally or systematically, that lead to
therapeutic changes.
The efficiency of physical therapy in the treatment of injury and disease
depends largely to: (1) the direct reflex effects of the stimulating agent
employed and (2) the influence of these agents exerted through the autonomic
centers. The typical procedure and the force of a physical modality are applied
through the skin. Besides protection, the skin is the greatest neural sensorium
of the body —being responsible for perception, absorption, excretion, and
temperature regulation functions. Stimulation of cutaneous receptors brings
about numerous vascular changes; eg, dilation, increased permeability of
vascular walls, and increased circulation. Sundry reflexes are also initiated
that have numerous nociceptive and autonomic implications.
SCOPE OF APPLICATION
The scope of clinical application of physiologic therapeutics in chiropractic
is directed by customary use based on scientific and empiric evidence, the
physiologic effects of the agent or modality applied, and the individual patient
and pathophysiologic needs at hand.
Physiotherapy Utilization
Most basically, the common procedures of physical therapy on a clinical
level may be classified into several categories. Typical considerations include
cryotherapy, diathermy, exercise, hydrotherapy, interferential current, low-
frequency current, microcurrents, meridian therapy, thermotherapy, and
rehabilitative therapies. See Table 1.2.
Table 1.2. Basic Forms of Physiotherapeutic Applications
1. Thermotherapy
a. Hot moist packs
b. Infrared
c. Heating pads
d. Ultraviolet
e. Paraffin
f. Fluidotherapy
2. Cryotherapy
a. Ice
b. Cold packs
c. Vapocoolant sprays
d. Clay compresses
e. Cold therapy
f. Cold immersions
g. Cryokinetics
h. Alternating heat and cold
3. Diathermy (high-frequency)
a. Short wave
(1) Induction or coil field
(2) Condenser field
b. Microwave
c. Ultrasound
4. Interferential current (medium frequency)
5. Low-frequency currents
a. Direct current, eg, low-volt galvanism
b. High voltage current
c. Alternating current
(1) Sine wave and other muscle stimulating currents
(2) Faradic current
d. TENS
e. Microcurrent
f. H-wave
6. Hydrotherapy
7. Exercise therapy
8. Rehabilitative therapy
9. Meridian therapy
a. Pressure techniques
b. Acupuncture
c. Auriculotherapy
d. Ryodoraku
10. Vibratory therapy
11. Traction and Stretching
12. Bracing and Supports
