Wednesday 27 August 2014

Care for Athletes who have had impacts to the head or concussion

Dr. Sabrina Chen-See

Vancouver's Pediatric & Family Wellness Chiropractor

I have been very fortunate to have attended Palmer College of Chiropractic for my Chiropractic education.  Not only is it the "Fountainhead" of chiropractic and second largest chiropractic college (by enrollment), but it is the recipient of the most research grants from the National Institutes of Health in the U.S.  I had the opportunity to learn 5 techniques in the core curriculum, called "Palmer Package", then to choose electives from an array of more than 10 other techniques.  From Davenport, Iowa, and neighbouring states, I was able to attend a multitude of seminars on technique and philosophy.  This broad immersion in all things chiropractic gave me awareness of the types of chiropractic techniques available, and the chance to specialize in the techniques that best-suited me.   I continue to take seminars to broaden and deepen my knowledge base and provide better service and care to my patients and community.
 
Atlas Orthogonal Technique


Atlas Orthogonal Technique is the most specific, safest and effective technique I've come across to help people who have had any type of head or neck trauma.  In terms of your nervous system. the area that controls the most crucial systems for survival is located just below the skull.  This includes nerve centres for breathing, heart function, balance, hormones, sleep/wake, digestions, plus controls the blood flow to all parts of the brain.  The "atlas" is the name for small vertebra at the top of the neck, balancing the skull. "Orthog onal" refers to the  optimal alignment of the atlas bone, which is at right angles (aka "orthogonal") to the centre of the skull and to the centre of the neck.  When the atlas is not orthogonal, (aka "subluxated" or misaligned), it can potentially affect any of those crucial functions.  Some conditions which respond very well to Atlas Orthogonal care include headaches and migraines, TMJ, tinnitus, lethargy, poor concentration, ADHD, poor balance, and anxiety.* 
The atlas is a particularly vulnerable bone which can easily misalign.  To begin with, the atlas is a tiny bone, weighing 2 ounces, and it supports the weight of the skull and brain which can weigh as much as 12-15 lbs.  Next, the atlas is the most movable bone of the spine, since it is not held to the adjacent bones by intervertebral discs.  Forces which can cause subluxation of the atlas can be head or neck trauma (ie. whiplash, ball hitting the head), severe or prolonged mental or emotional stress, chemical stress (ie. intoxication or reaction to strong medication), or even the birth process (C-section, vacuum, forceps, too slow/fast, overly forceful pull on neck). 
The Atlas Orthogonal Technique is unique in that the direction and magnitude of the atlas subluxation is measured on x-rays taken in all 3 dimensions, then adjusted accordingly with an instrument (Atlas Orthogonal Percussion Instrument).  The AO Instrument transmits percussion waves (a type of vibration) through a metal stylus placed on the skin, and this moves the atlas in the prescribed direction.  The use of the instrument ensures the adjustment is light enough (6 lbs of force versus over 40 lbs of force with most hand adjusting), precise enough (down to 1 degree of rotation), and repeatable.  On occasion, x-rays are taken post-adjustment, and the changes to the atlas alignment can be measured as well.  At no point in time with an AO adjustment is there any twisting of the neck, or moving the neck out of a neutral position.

 
The power of the atlas adjustment was first realized by Dr. B.J. Palmer in the 1950s.  He performed miracles with his Toggle Recoil technique.  He taught many chiropractors to do as he did, but nobody it seemed could replicate his successes.  Several of his best students tried to make the analysis of the atlas malposition more exact, and the adjustment procedure more exacting.  Dr. John F. Grostic was one such chiropractor, and his adjustments to the upper cervical protocol did improve outcomes.  Later, there were 2 offshoots of the Grostic technique, NUCCA and Atlas Orthogonal.   The founder of Atlas Orthogonal Technique, Dr. Roy Sweat, appreciated the specificity of the Grostic x-ray analysis, but strived to improve on the specificity and reliability of the adjustment through the use of an instrument.  He worked together with Engineers to produce the Atlas Orthogonal Percussion Instrument in the 1970s, perfected it over the next decade, and continues to advance Atlas Orthogonal Technique through constant research.  
 See Atlas Orthogonal Technique in action:
Introduction to Atlas Orthogonal
"The Doctors" TV Show 2008
 "Montel Williams" TV Show 2007

Sacral Occipital Technique
 The primary focus of Sacral Occipital Technique (SOT) is to balance the entire body, from the foundation (pelvis) on up.  Much attention is given to soft tissue and using the patient's body weight to help with the adjustment, therefore minimal force is applied by the chiropractor.  The way SOT is practised by Dr. Chen-See is without any quick turns to the neck or back, making it even safer for people with vulnerable or hyperflexible spines.  For an adjustment, the soft tissue is often first stretched or released, and this allows the bones to move in the desired direction.  Many people find this process more comfortable and the body is better able to stabilize in the new position.  In addition to the spine and extremities (ie. shoulders, knees, etc), SOT can be applied to subluxations in the skull itself, or to organ reflexes.  As a result, SOT is beneficial for sinus congestion, TMJ, hormonal imbalance issues (PMS, endometriosis), hiatus hernia, constipation, etc.*  As SOT involves a huge body of postgraduate study, it is not widely practised among chiropractors.
 
Palmer Package
Palmer Package is the name for a collection of techniques taught as part of the core curriculum at Palmer College of Chiropractic, the original chiropractic college.  Palmer Package includes Toggle Recoil (BJ Palmer's upper cervical technique), Gonstead, Diversified, Thompson Drop, and Extremities.  Most other chiropractic colleges teach only Diversified.  In her practice, Dr. Chen-See uses some elements of Gonstead, Diversified, Thompson Drop and Extremities as she sees fit for a particular patient.  These techniques tend to focus on the joints and can be very effective for straightforward subluxations.*


Care for Children and Pregnant Women
 Dr. Chen-See is certified in Chiropractic Pediatrics, having taken courses and examinations through the International Chiropractic Pediatric Association (ICPA). She has comprehensive knowledge and experience in a wide range of gynecologic and pediatric disorders, including but not limited to: intrauterine constraint, breech babies, birth trauma, colic, developmental delays, autistic spectrum disorder, attention deficit hyperactivity disorder, scoliosis, etc.*  Dr. Chen-See has learned a variety of techniques to help children and pregnant women, including Webster's technique, Gonstead, Thompson, upper cervical, SOT, caniosacral, massage, nutrition and exercises.  As a mother to two boys herself, Dr. Chen-See understands intimately the challenges and thrills associated with conception, pregnancy, childbirth, babies and young children.  Dr. Chen-See views it as an honour to be invited to help a pregnant woman have a more comfortable pregnancy and a more positive birthing experience.  She is also very grateful to play a role in changing the lives of babies and children.  With chiropractic care, life and developmental milestones are less of a struggle, and these children have a greater opportunity to express how extraordinary they are!
 
ICPA Videos for more information:     
Why Chiropractic for Kids
Effects of Chiropractic Care on Kids
Chiropractic Care in Pregnancy for Safer Births
Holistic Pediatric Care

Webster's Technique
Occasionally, a fetus may have difficulty assuming the ideal position in the womb in the later stages of pregnancy.  In the last trimester, the fetus is most comfortable in the head-down and rear-facing position.  Misalignments of the pregnant woman's pelvis can prevent the baby from assuming this position and the baby may be lodged in an awkward position.  This is called intrauterine constraint.  Webster's technique helps relieve this tension and contortion so the mom's pelvis and uterus can relax the way it should. The baby will then have more room to move around and get comfortable.  Webster's technique is very effective in reducing the likelihood of breech births and "back labour" and thus helps make the birth process safer, quicker and less painful than otherwise.*  While Webster's technique can be done safely, even during labour, it is less stressful to the mom and baby if pelvic subluxations and intrauterine constraint are identified and dealt with earlier in pregnancy, or prevented before conception!


Care for Athletes
It takes an athlete to know an athlete's body, training, injuries, recovery and rehabilitation.  Dr. Chen-See has always been active in sports, including competitive running, badminton, tennis, dragon boating and now ballroom dancing.  She cycles regularly, and participates in a variety of other sports on a recreational basis.  She utilizes a variety of techniques to help athletes, including Atlas Orthogonal, SOT, Palmer Package, Myofascial Release and Physical Therapy stretches and exercises.  Over the years, Dr. Chen-See has volunteered her services, treating athletes at many sporting events, including the World Police and Fire Games, Ontario Summer Games, Toronto International Dragon Boat Festival, and Breast Cancer 2-Day Walk.
As a note to athletes involved in high-impact or contact sports:  If you have had hard or repeated impacts to the head, or concussions, it is highly recommended that you have your atlas bone checked for subluxations.  A subluxated atlas can significantly impact your ability to focus, body awareness (and coordination), and performance.*  While chiropractic is often beneficial throughout training and competition, the ideal time to begin chiropractic care (especially for the atlas) is during the off-season.  This is to allow the body to recover and stabilize before heavy training begins again.
 

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