Sj. Troyanovich et al., STRUCTURAL REHABILITATION OF THE SPINE AND POSTURE - RATIONALE FOR TREATMENT BEYOND THE RESOLUTION OF SYMPTOMS, Journal of manipulative and physiological therapeutics, 21(1), 1998, pp. 37-50
Objective: To provide a rationale for active chiropractic rehabilitati
ve treatment that extends beyond the single goal of resolution of symp
tomatic complaints. Data Collection: A manual search of available refe
rence texts and a search of MEDLINE were collected with an emphasis on
tissue healing sequelae and the role of mechanical loading on this pr
ocess. Results: The reviewed material indicates that all tissue growth
and repair is influenced by mechanical loading and body posture and i
s positively affected by body postures that normalize/minimize adverse
mechanical stresses and strains. Altered alignment of the human frame
may lead to poor healing of the body tissues and eventual pathologica
l architectural changes may occur in muscle, ligament, bone and centra
l nervous system. Minimization of altered postural/structural loading
of the human frame may take longer than resolution, or maximal reducti
on, of offensive symptoms. By itself, a patient's perception of pain i
s not a valid indicator of health. Conclusions: Because mechanical loa
ding of the neuromusculoskeletal tissues plays a vital role in influen
cing proper growth and repair, chiropractic rehabilitative care should
focus on the normalization/minimization of aberrant stresses and stra
ins acting on spinal tissues. Manipulation alone cannot restore body p
ostures or improve an altered sagittal spinal curve. Therefore, postur
al chiropractic adjustments, active exercises and stretches, resting s
pinal blocking procedures, extension traction and ergonomic education
are deemed necessary for maximal spinal rehabilitation. Chiropractic s
tudies that demonstrate structural improvements are sorely lacking and
needed. The use of passive treatment modalities as the sole means of
chiropractic intervention for the management of patients suffering wit
h neuromusculoskeletal dysfunction no longer has a place in modem chir
opractic practice after the acute phase of healing has passed.