Comprehensive Health Services
3543 N. 7th Street, Phoenix, AZ 85014
602-263-8484 phone 602-263-3697 fax
"Manipulative Surgery"
Axial Skeleton Fixations: Diagnosis and A Method of Treatment called “Naturopathic Manipulative Surgery”
Developed by Robert L. Gear Jr., NMD, DC
Introduction
Skeletal Structure
Fixation of Joints
Result of Joint Fixation
Treatment of Joint Fixation
Gear Technique of Manipulative Surgery
Additional Considerations
Link to Saudi Arabian Lectures given by Robert Gear, Jr.
Introduction
The curved spine of scoliosis patients is functionally unbalanced and unhealthy. The intervertebral joints of the spine commonly become fixated, stiff and immobile on one side, causing the spine to curve. As a result, the intervertebral disks become dehydrated and misshapen. Doctors use manipulative surgery, which is a deep tissue manipulation under traction (that does not involve a cutting of skin or muscle), to loosen these fixated joints. This allows the misshapen intervertebral disks to become rehydrated on both sides; and as a result, there is straightening of the abnormal curvature.
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Skeletal Structure
The axial skeleton encompasses the skull, spine, ribs, and pelvis.
The appendicular skeleton is composed of the upper and the lower extremities. The lower extremity portion of the apendicular skeleton plays a significant role in the proper functionality of the axial skeleton in the bipedal or upright posture due to the effects of gravity on the righting mechanism of the body.
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Fixation of Joints
Trauma either directly or indirectly to the various motor unit joints of the skeleton may initially result in, or have a late effect of, a degree of fixation of range of motion in one or more joints of a motor unit of the skeleton.
Direct trauma results from sharp or blunt impact to joint tissues. It may also be the result of excessive range of motion of joint movement
Indirect trauma results from organ inflammation with reflex neurovascular impact, Stress from direct trauma to other joint or tissue resulting in compensatory structural repositioning, and from reactive psychological posturing of the musculoskeletal structures.
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Result of Joint Fixation
Initial fixation results in lymph flow reduction, muscular stresses, related joint aberrant motion, metabolic waste overload of ligaments, and increased neurological stimulation of muscle tone.
Later fixation results in swelling of joint capsules both diarthroidial and amphiarthroidial the pressure of which slows or stops the lymph drainage or in severe cases the capillary blood flow. The affected neurological system overloads becoming hyper-functional initially. This hyperfunctional neurological stimulation results in hypertonic muscle tissue. This results in the stockpiled nutritional supply being used up rapidly. This reduction of food supply eventually results in both local tissue atrophy and reflex target-organ tissue atrophy.
Uncorrected joint fixation results in chronic tissue changes. These manifest as excessive osteophytic production resulting in the familiar spurs seen on radiographic evaluation of joints. And as accumulation of fibrotic cells (fibroblasts) causing “scarring” within muscle, joint, and organ structures. Additionally one may see intervertebral disc degeneration develop.
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Treatment of Joint Fixation
All three phases of joint fixation are treated by return of range of motion to the joint, allowing drainage of interstitial and other fluids from the swollen or fibrosed joint(s) tissue structure(s) into the lymphatic system of vessels. The drainage may need to be augmented by appropriate physical medicine techniques.
top
“Gear Technique of Manipulative Surgery”
A technique for both preventing and disrupting accumulation of scar tissue in and around the joints of the axial skeleton and the lower extremities of the apendicular skeleton is the “Gear Technique of Manipulative Surgery”. The technique is mechanically augmented axial thrust manual traction with or without axial skeleton manually vectored force at the level(s) of joint injury or fixation. This treatment is accomplished by use of a specially designed table, based on the design of the McManus Osteopathic Table, with ergonomically correct ankle or pelvic and rib cage or head restraining orthopedic devices. Click here to see a picture.
Technique:
The physician or therapist technician is situated either at the foot of the table or beside the caudalward flexible section. If, due to the requirements of the patient’s axial skeleton segmental dysfunction complexity, transverse vectored forces are required, up to five additional assistants are positioned around the patient. Each assistant is asked to place hands on the patient in such a manner as to apply a correctional vectored force with a constant pressure. The physician or therapist technician then extends the table to the point that resistance is first felt and asks the patient to inhale then exhale. When the patient has exhaled the “posterior leaf” of the table is flexed towards the floor. This may also be accomplished by moving the posterior leaf to the right or left, approximately 40 degrees and then asking the patient to breath in and out. When the patient has exhaled completely the physician or therapist technician, grasping the caudal section of the table, flexes it toward the floor stopping at the appropriate stretch point (learned by experience .in a preceptorship program). The action of flexion in all of the above is either slow or rapid or a combination of both. The finesse of the technique is the major part of the preceptorship program needed to become proficient. The other part is diagnosing the need for the treatment.
Motor Unit Fixation Releases:
Either at the time of the thrust, or at a future day/time of thrusting/treatment, the patient and/or the physician/therapist technician feel releases of motor unit fixation/s. These are perceived as distinctive movements, loud popping, or like a tearing of rotten cotton cloth. In the case of the first, the joint is simply moving out of fixation and into movement. The second feeling is a releasing of scar tissue or dissolved gases within the synovial fluid of the joint. And the third perception is actual tearing of the spider web fibrotic infiltrate around the joint or between the muscles of the affected motor unit that have been limiting its range of motion. In all three instances the joint is increased in its range of movement. The circulation is improved around the previously fixated joint with repetitive treatment. The joint structures are allowed to re-grow normal functional tissue with the advent of normalization of body fluid movement.
Appendicular Skeletal Considerations:
In addition to the spine one must consider the joint structures of the lower extremities. The ankles are most affected by the axial skeletal malposition/fixation segmental dysfunction. Patients will inform the physician/therapist that their ankle is “twisted” or “pulling too hard” or some other similar phrases. When this happens and a quick check of the apparatus reveals nothing out of the ordinary, the patient can be assured the ankle is simply going through the process of realigning its soft tissues and joint surfaces to a more correct alignment and functionality.
Time Needed For Correction:
Traction manipulation by the Gear Technique is to be carried out at least weekly. More frequent treatment may be needed for reduction of acute symptoms. The duration of active care may extend over days, weeks, months, or years until the swelling has been reduced and the circulation surrounding the joint structure has been restored to normal function. The normalization of circulation is noted when the joint is moved through its full range of motion without any limitation, noise, or discomfort. The physician/therapist technician simply feels a full separation of joint structures into complete anatomical extension without hindrance. The patient feels no discomfort and intuitively knows they have reached maximum medical improvement.
top
Additional Considerations
Psychological Counseling:
The patient may need psychological counseling to prepare them prior to and during the treatment. The mind set is of paramount importance. The patient must be ready and willing to recover from their ailment. They must realize and accept the effort and time it will take on their part to stay the course of treatment in spite of the various shifting of body functional balance as the structural motor units reorganize their interactions. If there is body posturing due to negative psychological thought processes they must be addressed before true healing can be accomplished.
Manual Manipulative Medicine:
One does not need a functional working knowledge of manipulative medicine diagnostic and therapeutic academia and practices to perform the axial thrust or vector a thrust to the skeletal structures. Hence, a medical assistant may perform the procedure. However, a physician specialist in the Gear Technique of axial traction manipulative surgery must oversee the training of the medical assistant and be immediately available for assistance.
Physiological State of Stress:
Additional considerations in the recovery phase of care lies in the physiological state of stress of the body in general, the related organ tissues, and the cellular structures of all aspects of the body.
· Nutrition:
The general nutrition must be considered. Food sensitivities are to be determined and diet adjusted appropriately. Nutritional supplements may be needed and other biological physiological prescriptions may be necessary to facilitate healing.
· Exercise:
The exercise level is to be evaluated. The motor units having their restricted function released need both passive and active exercise appropriate for their state of health.
· Rest:
The ability to rest the affected structures is considered. The resting of the motor unit allowing circulation to feed and drain waste products of metabolism is necessary.
· Medication:
The patient may need medication for conscious sedation or full sedation before the procedure is carried out. Or they may need anti-inflammatory medication following the initial procedural stages of spinal joint fixation release.
Physical Medicine Procedures:
Physical medicine procedures using the physiological effects of the various modalities of physical medicine in their appropriate manner may be needed for their pain reducing anti-inflammatory effects. These include but are not limited to electromagnetic energy (diathermy, infrared, etc.), electrical muscle stimulation, ultrasound, motorized intersegmental and long axis traction, and applications of hot fomentations or cryotherapy.
top
Developed by Robert L. Gear Jr., NMD, DC
Introduction
Skeletal Structure
Fixation of Joints
Result of Joint Fixation
Treatment of Joint Fixation
Gear Technique of Manipulative Surgery
Additional Considerations
Link to Saudi Arabian Lectures given by Robert Gear, Jr.
Introduction
The curved spine of scoliosis patients is functionally unbalanced and unhealthy. The intervertebral joints of the spine commonly become fixated, stiff and immobile on one side, causing the spine to curve. As a result, the intervertebral disks become dehydrated and misshapen. Doctors use manipulative surgery, which is a deep tissue manipulation under traction (that does not involve a cutting of skin or muscle), to loosen these fixated joints. This allows the misshapen intervertebral disks to become rehydrated on both sides; and as a result, there is straightening of the abnormal curvature.
top
Skeletal Structure
The axial skeleton encompasses the skull, spine, ribs, and pelvis.
The appendicular skeleton is composed of the upper and the lower extremities. The lower extremity portion of the apendicular skeleton plays a significant role in the proper functionality of the axial skeleton in the bipedal or upright posture due to the effects of gravity on the righting mechanism of the body.
top
Fixation of Joints
Trauma either directly or indirectly to the various motor unit joints of the skeleton may initially result in, or have a late effect of, a degree of fixation of range of motion in one or more joints of a motor unit of the skeleton.
Direct trauma results from sharp or blunt impact to joint tissues. It may also be the result of excessive range of motion of joint movement
Indirect trauma results from organ inflammation with reflex neurovascular impact, Stress from direct trauma to other joint or tissue resulting in compensatory structural repositioning, and from reactive psychological posturing of the musculoskeletal structures.
top
Result of Joint Fixation
Initial fixation results in lymph flow reduction, muscular stresses, related joint aberrant motion, metabolic waste overload of ligaments, and increased neurological stimulation of muscle tone.
Later fixation results in swelling of joint capsules both diarthroidial and amphiarthroidial the pressure of which slows or stops the lymph drainage or in severe cases the capillary blood flow. The affected neurological system overloads becoming hyper-functional initially. This hyperfunctional neurological stimulation results in hypertonic muscle tissue. This results in the stockpiled nutritional supply being used up rapidly. This reduction of food supply eventually results in both local tissue atrophy and reflex target-organ tissue atrophy.
Uncorrected joint fixation results in chronic tissue changes. These manifest as excessive osteophytic production resulting in the familiar spurs seen on radiographic evaluation of joints. And as accumulation of fibrotic cells (fibroblasts) causing “scarring” within muscle, joint, and organ structures. Additionally one may see intervertebral disc degeneration develop.
top
Treatment of Joint Fixation
All three phases of joint fixation are treated by return of range of motion to the joint, allowing drainage of interstitial and other fluids from the swollen or fibrosed joint(s) tissue structure(s) into the lymphatic system of vessels. The drainage may need to be augmented by appropriate physical medicine techniques.
top
“Gear Technique of Manipulative Surgery”
A technique for both preventing and disrupting accumulation of scar tissue in and around the joints of the axial skeleton and the lower extremities of the apendicular skeleton is the “Gear Technique of Manipulative Surgery”. The technique is mechanically augmented axial thrust manual traction with or without axial skeleton manually vectored force at the level(s) of joint injury or fixation. This treatment is accomplished by use of a specially designed table, based on the design of the McManus Osteopathic Table, with ergonomically correct ankle or pelvic and rib cage or head restraining orthopedic devices. Click here to see a picture.
Technique:
The physician or therapist technician is situated either at the foot of the table or beside the caudalward flexible section. If, due to the requirements of the patient’s axial skeleton segmental dysfunction complexity, transverse vectored forces are required, up to five additional assistants are positioned around the patient. Each assistant is asked to place hands on the patient in such a manner as to apply a correctional vectored force with a constant pressure. The physician or therapist technician then extends the table to the point that resistance is first felt and asks the patient to inhale then exhale. When the patient has exhaled the “posterior leaf” of the table is flexed towards the floor. This may also be accomplished by moving the posterior leaf to the right or left, approximately 40 degrees and then asking the patient to breath in and out. When the patient has exhaled completely the physician or therapist technician, grasping the caudal section of the table, flexes it toward the floor stopping at the appropriate stretch point (learned by experience .in a preceptorship program). The action of flexion in all of the above is either slow or rapid or a combination of both. The finesse of the technique is the major part of the preceptorship program needed to become proficient. The other part is diagnosing the need for the treatment.
Motor Unit Fixation Releases:
Either at the time of the thrust, or at a future day/time of thrusting/treatment, the patient and/or the physician/therapist technician feel releases of motor unit fixation/s. These are perceived as distinctive movements, loud popping, or like a tearing of rotten cotton cloth. In the case of the first, the joint is simply moving out of fixation and into movement. The second feeling is a releasing of scar tissue or dissolved gases within the synovial fluid of the joint. And the third perception is actual tearing of the spider web fibrotic infiltrate around the joint or between the muscles of the affected motor unit that have been limiting its range of motion. In all three instances the joint is increased in its range of movement. The circulation is improved around the previously fixated joint with repetitive treatment. The joint structures are allowed to re-grow normal functional tissue with the advent of normalization of body fluid movement.
Appendicular Skeletal Considerations:
In addition to the spine one must consider the joint structures of the lower extremities. The ankles are most affected by the axial skeletal malposition/fixation segmental dysfunction. Patients will inform the physician/therapist that their ankle is “twisted” or “pulling too hard” or some other similar phrases. When this happens and a quick check of the apparatus reveals nothing out of the ordinary, the patient can be assured the ankle is simply going through the process of realigning its soft tissues and joint surfaces to a more correct alignment and functionality.
Time Needed For Correction:
Traction manipulation by the Gear Technique is to be carried out at least weekly. More frequent treatment may be needed for reduction of acute symptoms. The duration of active care may extend over days, weeks, months, or years until the swelling has been reduced and the circulation surrounding the joint structure has been restored to normal function. The normalization of circulation is noted when the joint is moved through its full range of motion without any limitation, noise, or discomfort. The physician/therapist technician simply feels a full separation of joint structures into complete anatomical extension without hindrance. The patient feels no discomfort and intuitively knows they have reached maximum medical improvement.
top
Additional Considerations
Psychological Counseling:
The patient may need psychological counseling to prepare them prior to and during the treatment. The mind set is of paramount importance. The patient must be ready and willing to recover from their ailment. They must realize and accept the effort and time it will take on their part to stay the course of treatment in spite of the various shifting of body functional balance as the structural motor units reorganize their interactions. If there is body posturing due to negative psychological thought processes they must be addressed before true healing can be accomplished.
Manual Manipulative Medicine:
One does not need a functional working knowledge of manipulative medicine diagnostic and therapeutic academia and practices to perform the axial thrust or vector a thrust to the skeletal structures. Hence, a medical assistant may perform the procedure. However, a physician specialist in the Gear Technique of axial traction manipulative surgery must oversee the training of the medical assistant and be immediately available for assistance.
Physiological State of Stress:
Additional considerations in the recovery phase of care lies in the physiological state of stress of the body in general, the related organ tissues, and the cellular structures of all aspects of the body.
· Nutrition:
The general nutrition must be considered. Food sensitivities are to be determined and diet adjusted appropriately. Nutritional supplements may be needed and other biological physiological prescriptions may be necessary to facilitate healing.
· Exercise:
The exercise level is to be evaluated. The motor units having their restricted function released need both passive and active exercise appropriate for their state of health.
· Rest:
The ability to rest the affected structures is considered. The resting of the motor unit allowing circulation to feed and drain waste products of metabolism is necessary.
· Medication:
The patient may need medication for conscious sedation or full sedation before the procedure is carried out. Or they may need anti-inflammatory medication following the initial procedural stages of spinal joint fixation release.
Physical Medicine Procedures:
Physical medicine procedures using the physiological effects of the various modalities of physical medicine in their appropriate manner may be needed for their pain reducing anti-inflammatory effects. These include but are not limited to electromagnetic energy (diathermy, infrared, etc.), electrical muscle stimulation, ultrasound, motorized intersegmental and long axis traction, and applications of hot fomentations or cryotherapy.
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