Working out the kinks with naprapathy
Chicago Daily Herald - March 30, 2005
By Steve Zalusky
Treatment aids patients who are under stress
- Tight muscles and joints stand little chance against naprapath Patrick Nuzzo’s fingers.
- This army of 10 digits promises to pummel even the tensest of bodies into pleasant submission.
- During each session, Nuzzo’s hands wander along his client’s back and neck, relentlessly probing the deepest recesses of muscles and joints.
By the end of the session, you’re left with a tingling sensation, relaxed and ready once again to battle the world. Nuzzo’s medium is, indeed, the massage. But this naprapath says his treatment is more than just an expert rubdown. He bills it as an alternative health care system with a culture developed over more than a century.
Nuzzo operates Safe Waters Naprapathic Health Care, 228 W. Main St. in Lake Zurich. He also travels to an office in New Mexico. He has been in the business since the late 70’s, with a clientele that has included such sporting luminaries as the late Walter Payton. The Chicago National College of Naprapathy and Clinic, which was established in 1907 and is based in Chicago, specifically defines naprapathy as a licensed health-care system using hands-on techniques supplemented by nutritional counseling. “Connective tissue disorders is our specialty,” said naprapath Paul Maguire Jr., the college’s CEO. “That’s our scope of practice. Connective tissue disorders are basically ligaments and tendons and muscles that have a tendency to strain or tear slightly.”
During a naprapathic exam, the naprapath taps and feels different areas of the body to ferret out any pain or swelling. The naprapath’s enemies include muscle spasms and tears, inflammation, scar tissue formations, bruises and atrophied muscles. Treatment involves manipulating connective tissue, restoring proper posture and nutritional counseling. It does not involve radiology, surgery or the use of drugs. Naprapathy was developed in the late 1800’s by Dr. Oakley Smith, a trained chiropractor who abandoned his original calling to work on a technique that would cure his chronic back pain. He found the answer to his problem by attacking the soft tissue around the spine through manipulation of the muscles, ligaments and tendons. Nuzzo also discovered the naprapathic path via chiropractic. His uncle was a chiropractor. “I did not go to a doctor. I went to my uncle”, he said. “I don’t remember ever taking medication in my life. The body can and will heal itself. It’s a natural health care system.”
Nuzzo became a licensed naprapath in 1983. But it was in 1979 that he met his most famous client, Walter Payton. At the time, Nuzzo was studying at the Chicago National College of Naprapathy and earning a few bucks giving massages at the Charlie Club in downtown Chicago. “He was as flexible a man as I’ve ever met,” said Nuzzo. “He worked more on stretching than pumping iron.” Nuzzo’s goal in working with the running back was to work out the tension in his body. He continued to work with Payton through his illness and right up until the night before he died. At that point, Nuzzo said the Bears legend was in a lot of pain, and he was working to soothe him. For Nuzzo to see such a splendid physical specimen in decline at the end of his life acted as a wake up call that “we live by the grace of God. We’re not in control,” Nuzzo said. One shouldn’t get the idea that Nuzzo just works on athletes. “I work on a lot of highly motivated your stressful executives,” he said. No less an authority than Chicago White Sox trainer Herman Schneider can attest to the effectiveness of Nuzzo’s treatments. Schneider said a number of professional athletes have submitted themselves to Nuzzo’s ministrations. As for Schnieder, he visits Nuzzo regularly to take of a chronic back condition. “He may not cure the problem, but he makes it more tolerable,” Schnieder said. “This is not just deep massage. There is a real art to it. This guy is a quality person and a quality naprapath. Treatment does not necessarily mean a cure, warns Maguire of the Chicago naprapathy school. “We’re all getting over the magic bullet theory. I don’t deal in that world.
Naprapathy and Its Effect on Myofascial Tissue
The Naprapathic approach is safe, gentle and consistently effective in producing positive and lasting results. Doctors of Naprapathy use a hands on technique which provides sustained pressure into myofascial restrictions to eliminate pain, headaches and restore motion. One of the theories of Naprapathy requires an understandings of the facial system (or connective tissues).
Fascia is a tough connective tissue which spreads throughout the body in a three dimensional wed from your head to your feet, without interruption. Trauma or inflammation can create a constricting of fascia resulting in excessive pressure on nerves, muscles, blood vessels, bones and/or organs. Since all of the standard tests such as x-rays, myelograms, CAT scans, electromyography, etc., do not show the fascial constrictions, it is thought that an extremely high percentage of people suffering with pain, headaches and/or lack of motion may be having fascial problems. Most go undiagnosed.
Fascia is a specialized system of the body which has an appearance similar to a spider’s web or a sweater. Fascia is a densely woven layer that attaches to every structure of our body. The facial system is not just a system of separated coverings; it is actually one uninterrupted structure which exists from your head to your feet. In this way you can begin to see each part of the entire body is connected to every other part by the fascia, like the yarn in a sweater.
In the normal healthy state the fascia is relaxed and wavy in configuration. It has the ability to stretch and move without restriction. When we experience physical trauma, emotional trauma or inflammation, the fascia loses its flexibility. It becomes very tight and can be a source of tension to the rest of the body. Trauma, such as a fall, whiplash, emotional stress, surgery or just habitual poor posture over time has a cumulative effect. The fascia can exert excessive pressure producing pain, headaches and/or restriction of motion.
Naprapathy allows us to look at each patient as a unique individual. Our treatment sessions are hands on treatments during which our physicians use a multitude of Naprapathic techniques and movement therapy. The goal of Naprapathy is to restore the individual’s myofascial freedom, so they may return to a pain free, active lifestyle.
Clinical Journal of Pain
By Stina Lilje DN
Objectives: Traditionally, orthopedic outpatient waiting lists are long, and many referrals are for conditions that do not respond to interventions at an orthopedic outpatient department. The overall objective of this trial was to investigate whether it is possible to reduce orthopedic waiting lists through integrative medicine. Specific aims were to compare the effects of Naprapathic manual therapy to conventional orthopedic care for outpatients with nonurgent musculoskeletal disorders unlikely to benefit from surgery regarding pain, physical function, and perceived recovery.
Methods: Seventy-eight patients referred to an orthopedic outpatient department in Sweden were included in this pragmatic randomized controlled trial. The 2 interventions compared were Naprapathic manual therapy (index group) and conventional orthopedic care (control group). Pain, physical function, and perceived recovery were measured by questionnaires at baseline and after 12, 24, and 52 weeks. The number of patients being discharged between the naprapath and the orthopedist were also estimated.
Results: After 52 weeks, statistically significant differences between the groups were found regarding impairment in pain, increased physical function, and regarding perceived recovery, favoring the index group. Sixty-two percent of the patients in the index group agreed to be discharged from the waiting list. The level of agreement concerning the management decisions was 80%.
Discussion: The trial suggest that Naprapathic manual therapy may be an alternative to consider for orthopedic outpatients with disorders unlikely to benefit from surgery.
|Dynamic Chiropractic – July 1, 2011|
It's the Fascia, Stupid
By Warren Hammer, MS, DC, DABCO
Bill Clinton used the campaign slogan, "It's the economy, stupid," to help defeat George H.W. Bush in the 1992 presidential election. The sooner the chiropractic profession recognizes the importance of fascia and its treatment in the world of soft tissue, the sooner will we receive the recognition we rightly deserve.
No need to hash over the value of the chiropractic adjustment, but when will we open our eyes and recognize the world of soft tissue and especially the most ubiquitous of all soft tissue, the fascial system? Maybe I should say the fascial organ, which one day it will be designated as. The fascial system is a neurosensory organ that must be considered along with chiropractic neurology. Why depend on one modality with our hands when we can have an even greater effect by including soft tissue?
Most chiropractic colleges still do not pay enough attention to the soft-tissue world. I feel sorry for their graduates, our profession and most of all, our patients. I have seen too many patients over the years treated with spinal manipulation for extremity and spinal lesions, to no avail. I have written about studies that repeatedly show spinal manipulation plus soft-tissue treatment is more effective than spinal manipulation alone.
I recently viewed a DVD on fascia "research pioneers" that includes lectures by Carla Stecco, Helene Langevin, Serge Gracovetsky, Tom Myers, Andree Vleeming and Robert Schleip. I recommend this DVD for anyone interested in an introduction to the fascial system or anyone who has benefited their patients by using soft-tissue methods that have a fascial effect. Much of what this article is about is derived from this DVD, especially the lecture by Robert Schleip, PhD.
It seems that the rebirth of fascial inquiry occurred at the First International Fascia Research Congress at Harvard Medical School in Boston in 2007. Over the past few years, there has been a tremendous increase in the number of MEDLINE-indexed publications with the term fascia in their title or abstract.
Scientists have traditionally ignored fascia, possibly because of its extensive expansion throughout the body. Anatomists usually just cut away the "white stuff." Recently, ultrasound has been used to determine in vivo its thickness, sliding and motion; and histological studies have proven that fascia is a sensory organ.
Fascia was defined at the First Fascia Research Congress as "the soft-tissue component of the connective tissue system that permeates the human body, forming a whole-body continuous three-dimensional matrix of structural support. It interpenetrates and surrounds all organs, muscles, bones and nerve fibers, creating a unique environment for body systems functioning."
"Fascia serves both global, generalized functions and local, specialized functions"1 As far back as 1964, Dittrich2 referred to "rupture of the lumbodorsal fascia, with subsequent fibrosis of the subfascial tissues and adhesions between these structures." And as recently as 2009,3-4 connective tissue fibrosis has shown to be causative. Just go to www.pubmed.com, the Web site of the National Library of Medicine, and put in Stecco, fascia; and at least 43 studies on fascia will appear.
Fascia has the ability to move; it can contract and relax on its own. The myofibroblasts originate from normal fibroblasts stimulated by mechanical tension and specific cytokines such as TGFß-1. Myofibroblasts are composed of alpha smooth-muscle actin, allowing these cells to maintain a contractile force over long periods with little energy expenditure. They are increased normally in dense connective tissues like joint ligaments, menisci, and tendons; and abnormally increased in Dupuytren's contracture, plantar fibromatosis, excessive scar formation, frozen shoulder, and lumbar fascia.
So, the frozen shoulder may be similar to a "frozen back," in that the causative restriction is due to increased myofibroblasts in the fascia rather than the muscle. The density of myofibroblasts correlates with tissue stiffness. A high density of myofibroblasts is often found in the perimyceum that separates muscle bundles from each other, which may be a reason why the upper trapezius is often tight, since this muscle tends to have a thicker perimyceum. Fascial adhesions occur due to inflammation, immobility and micro-injuries caused by overloading.
Fascia is also a sensory organ that responds to mechanical stimulation. Schleip discussed the fascial mechanoreceptors and their role in deep-tissue manipulation,5 and the influence of fascial manipulation on mechanoreceptors such as Pacini, Paciniform and Ruffini (Type II), interstitial Type III and IV, and proprioceptives such as Golgi (Type Ib), and spindle cells. Increasing receptor stimulation input strongly inhibits spinal cord processing of myofascial nociception. Receptor stimulation has shown its effectiveness in pain reduction with elastic taping and apparel that mimic the skin.
High velocity stimulates Pacini, located in spinal ligaments and facet joints of spine. The tangential angle of direction, rather than a perpendicular or longitudinal directed force, is more effective than the amount or duration of force in creating a global inhibition of sympathetic tone. Sympathetic activation (stress) can cause increased TGFß-1, resulting in increased myofibroblastic activity and fascial stiffness due to the manufacture of stiffer collagen matrix over time.
Treatment involving slow, gradual fascial release (Barnes) or lighter "melting" techniques stimulates Ruffini receptors that inhibit sympathetic activity, reducing a global sympathetic state to a global parasympathetic (relaxing) tone. Other methods such as friction massage or fascial manipulation also affect receptors, of course, but work on the premise of amount and duration of force and particular locations based on functional testing. Depending on how you use Graston Technique, both light and more forceful technique can be used.
A recent study points to fascia as the painful mechanism in delayed-onset muscle soreness.6 Another recent (unpublished) study by Franklyn-Miller studied strain transmission during straight leg raising. One would think that the hamstrings would present with the most tension during this maneuver, but with the hamstring tension rated at 100 percent stretch, the iliotibial tract (ITB) percentage reached 240 percent the ipsilateral lumbar fascia was 145 percent, lateral crural compartment was 103 percent, the Achilles tendon was 100 percent, and the plantar fascia was 26 percent. The collagen covering epimyceum on the lateral ITB was parallel and dense, while the posterior fascia on the hamstring was more criss-cross, allowing more freedom.
Based on the study of the connective tissue, it may be more important to stretch and treat with soft-tissue methods the lateral extremity structures and ipsilateral lumbar fascia, rather than the posterior connective-tissue fascia of the hamstrings.
- Findley TW, Schleip R (editors). Fascia Research: Basic Science and Implications for Conventional and Complementary Health Care. Elsevier / Urban & Fischer, 2007:2-9.
- Dittrich RJ. Soft tissue lesions as cause of low back pain; anatomic study. Am J Surg, 1956 Jan;91(1):80-5.
- Langevin HM, Stevens-Tuttle D, Fox JR, Badger GT, et al. Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain. BMC Musculoskeletal Disorders, 2009;10:151.
- Langevin HM, Sherman KJ. Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms. Medical Hypotheses, 2007;68:74-80.
- Schleip R. Fascial plasticity- a new neurobiological explanation. J Body Mov Ther, 2003;7(1):11-19. Also in 7(2):104-116.
- Gibson W, Arendt-Nielsen L, Taguchi T, Mizumura K, et al. Increased pain from muscle fascia following eccentric exercise: animal and human findings. Exp Brain Res,2009;194(2):299-308.
Dr. Hammer's third edition of Functional Soft-Tissue Examination and Treatment by Manual Methods is available from Jones & Bartlett publishers. He writes a regular column for Dynamic Chiropractic and has written articles for prominent journals such as Chiropractic Sports Medicine, the Journal of Manipulative and Physiological Therapeutics, Chiropractic Technique and the Journal of Bodywork and Movement Therapies.
Dr. Hammer has lectured for the Motion Palpation Institute since 1987, and has lectured nationally and internationally on the examination and treatment of soft-tissue lesions.
The Web of Life
Just beneath your skin lies a complex network of connective tissue called fascia. It helps you move well, stand straight and play hard. Keeping it healthy might be one of the fastest – and most overlooked – ways to improve your health and fitness.
Please follow this like to continue reading: http://experiencelife.com/article/the-web-of-life/
WHAT IS NAPRAPATHY?
Naprapath Petted Koski, U.N.
Naprapathy is a treatment method, which concentrates on
studying, treating and preventing locomotor disorders. Passive
treatment methods are manipulation, mobilization and soft-
tissue methods and active ones include medical training
therapy and ergonomical guidance.
FREQUENCY OF LOCOMOTOR DISORDERS
Locomotor disorders are the most common pain and disability-causing group of long-
term diseases amongst the populations of industrial countries. Resources are limited and
the number of patients is increasing because of changes in the population's age structure,
hence it is important to attend to the treatment of locomotor disorders. The proportion of
spinal disorders amongst disabled persons is estimated to be 9, when the effect of other
spinal patients' diseases is noted (Heliovaara, 1992).
Intervertebral disks, zygapofyseal joints and spinal muscles have been indicated as the
most significant anatomical reasons for back pains (Bogduk, 1995). For example
zygapofyseal-based pain have been shown to be the cause for chronic neck pains in over
50 of whiplash injury patients (Barnsley. 19(5).
In many studies manipulative treatment methods such as naprapathy have been noticed to
be an effective and recommendable treatment for chronic back pain (Bigos /Clinical Practice
Guideline No.14. 1994: Spitzer! The Quebec Task Force on Whiplash Associated Disorders 19(5).
Many of the modern treatment methods for locomotor disorders have been shown to be
useless or even hazardous. Because preventive actions have not been effective enough in
decreasing the amount of locomotor disorders, one should make use of multi-professional
evaluation and effective treatment methods. Lumbar spine pains are expected to become
an increasing problem in the future. That is why treatment of locomotor disorders should
change together with reorganization of the health care system (Waddell 1(95).
The starting point for naprapathic treatment is to define a patient's case history. When and
how the first symptoms appeared. their character and behavior and other noteworthy
factors of medical history are part of this process. At the same time the significance of
other possible diseases and other factors affecting the treatment are also defined. A
preliminary form including personal details. questions concerning the general health and
patient's own estimation about pains and detrimental factors caused by the disease are
part of anamnesis too. Pain graphs and drawings are used as indicators.
CLINICAL PRELIMINARY EXAMINATION
The origin of the symptoms are examined with help of anamnesis, inspection, different
orthopedic, neurologic and vascular tests, specific joint level mobility studies and using
palpation of soft tissues. A need for radiology and laboratory tests is notified in this stage.
Special attention is drawn to the patient's posture and possible postural anomalies. The
naprapath can amongst other things analyze walking; measure muscular balance and
strength; and estimate the patient's ability to work and need for rehabilitation.
After the necessary examinations, the naprapath diagnoses the patient's condition and
makes an independent decision about starting the treatment or not. Those diseases and
problems not belonging to the naprapathic treatment must be diagnosed separately and
the patient must be guided to the appropriate medical specialist afterwards.
A functional locomotor disorder is a common treatment indication. Pains, symptoms or
detrimental factors caused by this disorder can be affected mechanically. either increasing
the symptom or decreasing it (provocation tests) during the treatment. Motional restrictions for
a joint or joints are used as an indication for manipulation treatment. These can be
expected to be in connection with the patient's symptoms. Counter-indications concerning
the patient's health or other condition can be an obstacle for naprapathic treatment.
The purpose of treatment is to cure functional locomotor disorders. The main treatment
methods are manipulation or mobilization treatments for joints and different kinds of soft
tissue methods (ifnecessary). Other scientifically effective physical medicine treatments can
be also used as preliminary treatments. The most common of these are ultrasonic,
cry-zthermotherapy, electro-irritation and electrical pain-relieving treatments.
A naprapath can apply indicated medical training therapy to the patient. This can be used
while treating, for example, joint hyperrnobility or instability. or while attempting to
affect joint mobility and muscular strength by training.
Different kinds of accessories such as back braces, neckbands, joint supports and taping
can be used to assist naprapathic treatment.
PRECAUTIONS / ABILITY TO WORK
A naprapath guides his/her patients to lead an active lifestyle including strengthening,
stretching, mobilizing and relaxing exercises. A naprapath also supports his/her patients
in other necessary changes in their lifestyle in order to prevent locomotor disorders and
achieve long-standing treatment results. It is also important to emphasize the importance
of a patient's own responsibility concerning his/her own health.
A naprapath gives ergonomical guidance and his/her work can be part of an occupational
health service. A naprapath's work supports working capacity, emphasizes a patient's own
responsibility and strives for decreasing dependence on therapy.
While treating locomotor disorders, a naprapath is part of the therapy group consisting of
professionals from different fields of health care.
PATIENT SAFETY / QUALITY CONTROL
Attending to the patient's safety is an essential part of a naprapath's work. Naprapaths are
educated to make independent examinations and treat locomotor disorders. They also
have responsibility for attending to the patient's safety, filling out the necessary patient
documents and retaining them, maintaining and improving his/her proficiency and being
aware of patient rights.
A naprapath studies and treats all joint, intervertebral disk and soft tissue-based diseases
and pains located to the spinal and extremity joint areas, as long as these are not
counterindicated for naprapathic treatment. Treatment can be concentrated directly on the
diseases or it can be based on symptoms. Typical diseases / symptoms are:
- locomotor disorders including e.g. pain, motional restriction, radiculative
symptom, neurological deficiency symptom, sensation or some other
hindrance such as -
cervical spine-based tinnitus, cephalalgia and vertigo, tension neck,
WAD ("whiplash"), torticollis, myofascial pain syndrome, thoracic outlet-
syndrome, cervical spine-syndrome and other disc-based pains;
- upper extremity pains like frozen shoulder, different tendinitis and wrist
- thoracal spine facet-syndrome, costo-transversal joint pains;
- lumbal facet-syndrome, disc-based pains, sciatica-syndrome,
insufficientia dorsi, spondylqlysis and spondylolistesis, muscular
- lumbal facet-syndrome, disc-based pains, sciatica-syndrome,
- piriformis-syndrome, bursitis, ligament injuries, etc.
Naprapaths are educated in Sweden or the United States. In Sweden full-time university
education lasts four years. This four-year period consists of] 60 study weeks (6.400
hours). Experts from different medical fields take care of the education. After four years
of studying, a naprapath completes one year training in a hospital, health center or private
practice. The purpose of the Swedish Doctor of Naprapathy examination is to give
accreditation as an independent professional naprapath, especially in the Scandinavian
health care system.
INTERNATIONAL FEDERATION OF NAPRAPATHIC ASSOCIATIONS-
IFONA is an organization made up of naprapathic associations from different countries.
IFONA's primary function is to co-ordinate and improves communication between these
associations. IFONA is also committed to representing naprapathy globally as well as
supervising research and development within the naprapathic field. IFONA has
nominated an independent qualification committee, whose task is (together with each country's
own health administration) to control and improve naprapaths' education and professional
qualifications. Its task is also to create annual placement tests, which are used to evaluate
and improve naprapaths' professional qualification levels.
Chicago. IL., USA.
Naprapath Petter; Koski. D.N.
Fysioterapia Ergo - Back CI inic
Keskuskatu 10 C. 48 100 KOlka