SUBLUXATION COMPLEX HEADACE

THE SPINAL SUBLUXATION SYNDROME

Defined in Dorland's Medical Dictionary An incomplete or partial dislocation.

Defined By ACA An alteration in the normal dynamics,

anatomical or physiological relationships of contiguous osseous structures. Their positional characteristics should be described in standardized terms which depict the abnormal range or position of motion that they have manifested."

I am not even sure if there is a discrepancy.

SUBLUXATION AND THE THREE-LEGGED STOOL

1. Misalignments: May not be detectable by current technological methods.

2. Aberration of movement integrity [either deficient or excessive motion]: Reliable measurements of motion remain elusive.

3. Physiologic dysfunction: May be present with or without pain, may facilitate our understanding of [but must not be construed a priori to validate]

chiropractic subluxations.

1Rosner AL. The role of subluxation in chiropractic. Des Moines, IA: Foundation for Chiropractic Education and Research, 1997.

What is a Subluxation?

Biomechanical Basis = Abnormal (Suboptimal) Joint Position/Movement Chiropractor – Subluxation Allopath – Somatic Dysfunction Osteopath – Osteopathic Lesion

No Proof of Subluxation?What Do You Call a Sore Back?

THE SPINAL SUBLUXATION SYNDROME

A Clinical Neurologist’s Understanding - Ferezy

Acute Antalgia Away From Pain Recognized By All Who Treat/Suffer LBP▪ Radiologist – “Loss of Normal Lordosis”▪ Orthopedist – “Back Spasms”▪ Patient – “Hey Doc, I Can’t Straighten up; I’m

Crooked”

Antalgia

Why? – When a joint tells the CNS that it hurts to move, the result is an intelligent “guarding” or “splinting” response designed to minimize painful movement of that joint (nociceptor activation).

Hilton’s law - a nerve trunks which supplies a joint also supplies the joint, the muscles which move the joint and the skin over the insertions of such muscles

Splinting reaction (Hilton’s law) – protects an “injured articulation”.

Antalgia

This works to reduce/eliminate the pain. Often the original sharp, violent, stabbing,

etc. type pain (d/t instability) is replaced by a change in the character to a “tight” or “stiff” or “muscular” pain secondary to the sustained protective muscular contraction.

Patients need to be reminded that the muscle fiber is, for the most part, the slave of the neuron, controlling its every aspect.

Results in soft tissue treatment failures for secondary muscular complaints.

Antalgia

Davis’ law – if the origin and insertion of a muscle are moved further apart for some time, the muscle looses tone and becomes relaxed. If they are approximated the muscle contracts or becomes contractured.

• Chronic de-conditioning and/or “chronic antalgia” yield bad posture.

Antalgia

How? – Uses the muscles. Para Spinal Musculature (From

Superficial to Deep) Semispinales Multifidi Rotatores Muscles

PARASPINAL MUSCLES

Transversospinalis (Deep Layer 1 & Multifidi (Deep Layer 2)

Deepest Muscles

Interspinalis Intertransversarii

Deep Muscles

Variations in the Pattern of Activity During Forward Flexion, Extension, and Axial Rotation Suggest That the Transversospinal Muscles Adjust the Motion Between Individual Vertebrae.

The Experimental Evidence Confirms the Anatomical Hypothesis That the Multifidi Are Stabilizers Rather Than Prime Movers of the Whole Vertebral Column

Donisch and Basmajian, 1972

Donisch and Basmajian, 1972•All Results in Relation to the Mechanical Advantage, Center and Line of Gravity, and the Possible Axis of Movement Confirm the Idea That the Transversospinal Muscles Act As Dynamic Ligaments. •These Adjust Small Movements Between Individual Vertebrae, While Movements of the Vertebral Column Probably Are Performed by Muscles With Better Leverage and Mechanical Advantage.

THE SPINAL SUBLUXATION SYNDROME

A Clinical Neurologist’s Understanding - Ferezy

Antalgia Away From Pain Macro – Regional Subluxation▪ Cervical & Lumbar Hypolordosis w/trauma

Mirco – Intersegmental Subluxation – Intertransversarii and deeper muscles = Dynamic Ligaments

Proposed Neurobiological Action of Manipulative Therapy

What is a Headache?

The International Classification of Headache Disorders (ICHD) is a detailed hierarchical classification of all headache-related disorders published by the International Headache Society.[1] It is considered the official classification of headaches by the World Health Organization, and, in 1992, was incorporated into the 10th edition of their International Classification of Diseases (ICD-10).

Each class of headache contains explicit diagnostic criteria—meaning that the criteria includes quantities rather than vague terms like several or usually—that are based on clinical and laboratory observations.

The ICHD was first published in 1988 (now known as the ICHD-1). The second and current version, the ICHD-2, was published in 2004.

International Classification of Headache Disorders Hierarchy

1.1 The primary headaches ▪ 1.1.1 ICHD 1, ICD10 G43: Migraine▪ 1.1.2 ICHD 2, ICD10 G44.2: Tension-type headache (TTH)▪ 1.1.3 ICHD 3, ICD10 G44.0: Cluster headache and other trigeminal autonomic cephalagias▪ 1.1.4 ICHD 4, ICD10 G44.80: Other primary headaches

1.2 The secondary headaches ▪ 1.2.1 ICHD 5, ICD10 G44.88: Headache attributed to head and/or neck trauma▪ 1.2.2 ICHD 6, ICD10 G44.81: Headache attributed to cranial or cervical vascular disorder▪ 1.2.3 ICHD 7, ICD10 G44.82: Headache attributed to non-vascular intracranial disorder▪ 1.2.4 ICHD 8, ICD10 G44.4 or G44.83: Headache attributed to a substance or its

withdrawal▪ 1.2.5 ICHD 9, ICD10 G44.821 or G44.881: Headache attributed to infection▪ 1.2.6 ICHD 10, ICD10 G44.882: Headache attributed to disorder of homeostasis▪ 1.2.7 ICHD 11, ICD10 G44.84: Headache or facial pain attributed to disorder of cranium,

neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures▪ 1.2.8 ICHD 12, ICD10 R51: Headache attributed to psychiatric disorder

1.3 Cranial neuralgias, central and primary facial pain and other headaches ▪ 1.3.1 ICHD 13, ICD10 G44.847, G44.848, or G44.85: Cranial neuralgias and central causes

of facial pain▪ 1.3.2 ICHD 14, ICD10 R51: Other headache, cranial neuralgia, central or primary facial pain

Wikapedia

Muscle Tension Headaches, which were renamed tension-type headaches (TTH) by the International Headache Society in 1988, are the most common type of primary headaches. The pain can radiate from the neck, back, eyes, or other muscle groups in the body. Tension-type headaches account for nearly 90% of all headaches. Approximately 3% of the population has chronic tension-type headaches.[1]

1.Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population--a prevalence study. J Clin Epidemiol. 1991;44(11):1147-57.

MedLine Encyclopedia

A tension headache is a condition involving pain or discomfort in the head, scalp, or neck, usually associated with muscle tightness in these areas.

Tension headaches are one of the most common forms of headaches. They may occur at any age, but are most common in adults and adolescents.

If a headache occurs two or more times a week for several months or longer, the condition is considered chronic.

Tension headaches can occur when the patient also has a migraine.

MedLine Encyclopedia

Tension headaches occur when neck and scalp muscles become tense, or contract. The muscle contractions can be a response to stress, depression, a head injury, or anxiety.

Any activity that causes the head to be held in one position for a long time without moving can cause a headache. Such activities include typing or other computer work, fine work with the hands, and using a microscope. Sleeping in a cold room or sleeping with the neck in an abnormal position may also trigger a tension headache

International Classification of Headache Disorders Hierarchy

1.1 The primary headaches ▪ 1.1.1 ICHD 1, ICD10 G43: Migraine▪ 1.1.2 ICHD 2, ICD10 G44.2: Tension-type headache (TTH)▪ 1.1.3 ICHD 3, ICD10 G44.0: Cluster headache and other trigeminal autonomic cephalagias▪ 1.1.4 ICHD 4, ICD10 G44.80: Other primary headaches

1.2 The secondary headaches ▪ 1.2.1 ICHD 5, ICD10 G44.88: Headache attributed to head and/or neck trauma▪ 1.2.2 ICHD 6, ICD10 G44.81: Headache attributed to cranial or cervical vascular disorder▪ 1.2.3 ICHD 7, ICD10 G44.82: Headache attributed to non-vascular intracranial disorder▪ 1.2.4 ICHD 8, ICD10 G44.4 or G44.83: Headache attributed to a substance or its

withdrawal▪ 1.2.5 ICHD 9, ICD10 G44.821 or G44.881: Headache attributed to infection▪ 1.2.6 ICHD 10, ICD10 G44.882: Headache attributed to disorder of homeostasis▪ 1.2.7 ICHD 11, ICD10 G44.84: Headache or facial pain attributed to disorder of cranium,

neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures▪ 1.2.8 ICHD 12, ICD10 R51: Headache attributed to psychiatric disorder

1.3 Cranial neuralgias, central and primary facial pain and other headaches ▪ 1.3.1 ICHD 13, ICD10 G44.847, G44.848, or G44.85: Cranial neuralgias and central causes

of facial pain▪ 1.3.2 ICHD 14, ICD10 R51: Other headache, cranial neuralgia, central or primary facial pain

11.2.1 [G44.841] Cervicogenic headache [M99]

A. Pain, referred from a source in the neck and perceived in one or more regions of the head and/or face, fulfilling criteria C–D

B.Clinical, laboratory and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck known to be, or generally accepted as, a valid cause of headache

C. Evidence that the pain can be attributed to the neck disorder or lesion based on at least 1 of the following:1. demonstration of clinical signs that implicate a source of pain

in the neck2. abolition of headache following diagnostic blockade of a

cervical structure or its nerve supply using placebo- or other adequate controls

D. Pain resolves within 3 months after successful treatment of the causative disorder or lesion

Cervicogenic or (TENSION-TYPE)HEADACHE

Muscle Contraction Little Evidence of Importance in Majority of Sufferers

Cervico-genic Mounting Evidence

Ferezy’s TTH = Cervicogenic

Common HAAssociated With

Fatigue Stress Prolonged Reading Will Respond to a Simple Analgesic Begins in an Episodic Form Progresses Into a Chronic

Cervico-genic (TENSION-TYPE)HEADACHE

Almost Daily Do Not Appear to Be Associated With Any Obvious Psychological Factors

About 90% of All Headaches 15% of Patients Are Likely to Experience Their First Attack Before Age 10

Intractable and Persist Throughout Life

Cervico-genic (TENSION-TYPE)HEADACHE

Headaches Almost Every Day for up to 30 Years

75% of Patients Are WomenNo Genetic Explanation40% of Sufferers Appear to Have a Family History of Some Form of Headache

BilateralDull and Persistent, Variable

Cervico-genic (TENSION-TYPE)HEADACHE

Described As a Feeling of Pressure, Heaviness or Tightness

About 10% Sufferers Also Have Migraine Symptoms May Become Superimposed to Give a Very Complex Headache Picture

Cervico-genic (TENSION-TYPE)HEADACHE

In Mild Cases, the Headache Develops During Recognizable Stress

May Appear in Anticipation of an Unpleasant Event

In Chronic Form Headache at the Start of the Day, Remains As Dull Ache Throughout the Course of the Day

Cervico-genic (TENSION-TYPE)HEADACHE

Last From 30 Minutes to 7 DaysBy Definition, Occur Less Than 15 Times a Month = Episodic

Chronic Headache Diagnosed When Headache Is Present for More Than 15 Days Per Month

Cervico-genic (TENSION-TYPE)HEADACHE

Seriously Affected Patients Experience Headaches All Day Every Day

Not Normally Accompanied by Distinctive Characteristics of Migraine, Although Mild Photophobia or Phonophobia May Occur in Severe Attacks

Mild Nausea From Anxiety May Accompany HA

Cervico-genic (TENSION-TYPE)HEADACHE

Vomiting Is Not a Feature Depression and Anxiety Are Common

Psychological Disorder? Emotional Disturbances?

Headache Is Result of Physical Process

Now Outdated Term, Muscle Contraction Headache

Cervico-genic (TENSION-TYPE)HEADACHE

Greater Occipital Nerve Anatomic Trespasses

Cervical Afferents and Cranial Nerve V Convergence

Connective Tissue Bridge Between Rectus Capitis Posterior Minor (RCPM) and Spinal Dura at C0-C1

Cervical Plexus Afferents

Syndrome of the Greater Occipital Nerve

Cervical Afferents and Cranial Nerve V Convergence

Connective Tissue Bridge Between Rectus Capitis Posterior Minor (RCPM) and Spinal Dura at C0-C1

Reproduced Dozens of Times Since Discovery by Hack and Associates in Maryland

Cervico-genic (TENSION-TYPE)HEADACHE

Rarely SevereCharacteristic Pressing/tightening Quality

BilateralDoes Not Worsen With Physical Activity

Lack of Associated SymptomsGeneral Physical and Neurological Are Normal

Cervico-genic (TENSION-TYPE)HEADACHE

ReassureBodily RelaxationChiropractic ApproachPharmacological Approach

Chiropractic Treatment

Reduction of Cervicothoracic Subluxations

Active and Passive Stretching of Cervical and Shoulder Musculature

Reduce Cervicothoracic Trigger Points Treat Emotional Problems Diet Rest Exercise

Chiropractic Treatment

Relaxation ExercisesBiofeedbackAcupuncture/meridian Therapy

Medical Treatment

Simple Analgesics (NSAID's)TranquilizersAntidepressantBarbiturates (Sleep)Psychiatric Exam (May Require Referral)

CaffeineWatch for Rebound HA's