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Issue 14 - October 2004 ‘Active + passive care gets results Middle-aged Americans don’t want to slow down. According to the Wall Street Journal,1 their desire to “keep going” has resulted in a 16 percent growth of the orthopedics industry, with knee replacement surgeries doubling in the 38-56 year old set from 1996-2001 and new procedures such as cartilage cell transplants, arthroscopic procedures and artificial knees, hips and discs contributing to a growing $14 billion industry.
This demographic group also has a growing interest in fitness and wellness and gets involved in programs ranging from yoga and Pilates to meditation and massage. One of the first rules of business is to provide what the market demands. Baby-Boomer demand to keep moving has given rise to a number of different providers offering various treatment modalities: • Pharmaceutical companies sell drugs. • Orthopedic surgeons sell increasingly high-tech surgery, with fast recovery times. • Retailers sell products such as beds, chairs, shoes and sports gear, all ergonomically engineered for comfort and wellness. • Physical therapists initially sell one-on-one passive care, followed up with exercise and lifestyle advice. • And we chiropractors provide spinal adjustment/manipulation, along with ancillary support procedures and health counseling. BETTER RESULTS THROUGH COMBINATION CARE Active care by itself is effective. Randomized clinical trials (RCT), a standard of research, have shown better outcomes and less disability for people with neck and back problems who receive exercise therapy than for those who don’t. 2,3 Passive therapy is also good. But some passive therapy is better than other types. Studies show that manipulative therapy, in which the ligaments of the joint are stressed (as in an adjustment) demonstrate better outcomes than passive therapies that stress primarily muscles, without sufficient force and/or velocity to affect the joint function. When you combine active and passive therapies, you see real results. Studies show the combination gives better subjective improvement on VAS and other pain and lifestyle instruments, as well as better objective improvement when measured by the ability to accurately know when the head is straight and level. 4,5 Three subsystems of tissues affect the neuro-musculoskeletal system. The muscles (contracting system), the connecting tissues (ligaments, tendons, bones and fascia) and the control system (the brain and spinal cord and peripheral receptors controlling proprioceptive and reflex interactions) all functionally choreograph every motion a person makes. On the passive therapy side, chiropractic adjustments affect the contracting, connecting and control subsystems of the neuro-musculoskeletal system on a more fundamental level than any other therapy. That’s good. Now, if you combine that with an ideal active therapy that affects all three systems and complements a chiropractic practice, you can get excellent results. The ideal active care therapy that achieves these goals is exercise with a Swiss exercise ball (gymnastic ball). These large, inexpensive but sturdy inflatable balls are available at any sporting goods or health products store, as well as online. This ball provides excellent active care because it forces the body to balance as it exercises on a labile surface. This exercise creates a high demand on the motor control system, which changes both the level of muscle activity and the way that the muscles coactivate to stabilize the body. 6,7,8 You can design an exercise and posture-awareness program that uses the ball to promote symmetrical, coupled motion and improved balance for rehab and injury prevention as well as to improve athletic form and performance. When posture exercise protocols are structured in a series of short interval encounters, they can fit very well into most chiropractic practices. Gymnastics ball rehab protocols allow you to work synergistically with other fitness professionals, who have learned that creating motion and posture consciousness helps improve a person’s form and therefore the effectives of any exercise program. The combination of active and passive care, in which passive care consists of therapies designed to maintain muscle function as well as joint motion, may ultimately prove to be the most clinically and cost effective way of initially treating and then keeping people moving as they age. Just as cholesterol, blood pressure and LDL/HDL ratios have become part of the national health consciousness, many middled-aged Americans will embrace the wisdom of keeping a body moving as it ages. And they may see chiropractic as the “magic bullet” that can help them remain supple through the manip-ulation, muscle therapies and posture exercise that chiropractic offers. The irony of chiropractic may be that the mono-causal philosophy of health — the most popular therapy of the late 19th century — may well become the vital link in 21st century wellness biomechanics for aging Baby Boomers. Steven P. Weiniger, DC, is managing partner of BodyZone.com, an online resource helping people to move naturally. His seminar on Integrating Chiropractic with Posture Rehab exercises is sponsored by the University of Bridgeport Chiropractic College. He can be reached at Dr.Weiniger@bodyzone.com. References: |
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