|
January 2007, Vol. 17, No. 1
Table of Contents
• Are You Busy Selling Chiropractic or Correcting Subluxations
• BJ's House Needs Repairs • Another Look At Cell Phones
• Chiropractic R.I.P. • Colloca and CBP Nonprofit Study Wins Best Paper Award • Help Us Locate Allen Botnick • Letters to the Editor
• Michigan Chiropractic Society Sees Evidence of Growing Need For Chiropractic • Meeting With Success • A New Look At Mirror Image Exercise • Mourning The Loss Of Tony Keller • Past Present and Future In Chiropractic • Posture Study By UQTR Researchers and CBP® Published by JCO • PostureRay™, PosturePrint™ Helping Doctors Help Patients
• The Importance of A Clinically Relevant Presentation of Findings
• It's Pauls Opinion • Research Corner • Scoliosis: SpineCor Brace
• Triano and CCGPP's Will Give You Six Visits
• Clinical Indications for Videoflouroscopy
• Western States Chiropractic College Receives NIH Grant •
Back To Front Page
A New Look at Mirror Image® Exercise: Part I
by Brian Paris, DC
and Joshua Lander, DC
Dr. Brian Paris graduated form the University of Maryland with a Bachelor of Science in Kinesiology in 1996. He received his Doctorate of Chiropractic from Life University in 2000. While at Life University, Dr. Paris served as the Chiropractic Biophysics club President and received the CBP® Outstanding Achievement Award. Upon graduation Dr. Paris became a Distinguished Fellow of Chiropractic Biophysics. In 2006 Dr. Paris became a certified Performance Enhancement Specialist through the National Academy of Sports Medicine.
Dr. Paris opened Advanced Spine & Wellness Center in Rockville, MD in 2001. He incorporates a unique blended approach of structural correction techniques (CBP®), functional movement exercises and lifestyle changes to help his patients live healthier, active and more functional. Dr. Paris is involved in serving the community through his lectures, seminars and providing a resource for natural healthcare information.
Joshua Lander received a Bachelor of Science in Health Science from Lock Haven University(PA) in 1996. He received his Doctor of Chiropractic degree in 2001, graduating cum laude from Life University (GA). At Life University, he served as an instructor for the CBP® club. He is a certified Fellow of CBP®. Dr. Lander is also a certified Diplomate of the American Chiropractic Neurology Board. He operates a clinical practice in Westport, CT.
Introduction
The chiropractic profession is based strongly on the premise that proper structure of the human frame results in improved function and performance. This is the foundation of chiropractic practice at its most elemental level. Many studies have concluded that abnormal structure increases the probability of spinal pain, dysfunction, and/or disease.1-7 Some authors have even proposed specific parameters of spinal abnormality that will likely result in pathology.2,4,6,8 Despite the evidence, our profession has not, until recently, had a defined normal spinal structure of which to compare patient presentation. CBP® Non-Profit has produced unprecedented research that validates normal resting posture and spinal architecture as clinical treatment outcome measures.9
CBP® rehabilitation protocol involves traditional chiropractic manipulation techniques, Mirror Image® (MI) posture adjustments, MI exercises, and MI traction. For a complete review of CBP® methods, please refer to the various manuscripts available.9 The purposes of this article are to review the MI exercise component of CBP® care and introduce a novel approach that may prove to advance MI exercise applications.
Harrison’s Mirror Image®
Exercises — A Review
The primary purpose of the muscular system is to mobilize the skeleton. The muscular system accounts for 40-50 percent of total body mass and is a major factor in body metabolism.10 Poor muscle strength, endurance, and/or coordination result in dysfunctional movements, local fatigue, pain, and injury. Predictably, therapeutic exercise theories and methods are popular in the physical medicine literature.11-15 Our purpose is not to critique these protocols, but rather to impress upon the reader that exercise is, historically, an important aspect of spinal rehabilitation.16 Accepting the importance of muscular activity, CBP® includes exercise as part of its structural rehabilitation protocol.
Mirror Image® exercises are prescribed specifically to help normalize the patient’s neuromuscular dysfunction and postural deformation. Traditionally, the patient performs unilateral Mirror Image® exercises in the opposing plane(s) of subluxation. For example, if a patient presented with a left thoracic rotation(+Ry), the Mirror Image® exercise prescribed would be a right thoracic rotation(-Ry). This activity stresses the muscles, tendons, and connective tissues in exact opposition of the abnormal posture. Expected clinical results are tissue energy loss via hysteresis, normalized spinal loading, balanced muscular forces acting on the spinal column, reduce dysponesis, and improved neuromuscular efficiency during upright stance and body movements.17,18
Presently, CBP® Mirror Image® exercises are recommended as isometric and/or isotonic movements in one plane of motion, with or without resistance. For situations of multiple postural distortions, multiple MI exercises may be performed as a combined movement (i.e. Non-Commutative Property of Finite Angles). Recently, Meyer has broadened the MI exercise protocol by the addition of weighting and proprioceptive activity.19 We propose a new strategy for MI exercise that aims to support structural rehabilitation, while at the same time improving neuromuscular performance and body kinematics.
Mirror Image® in Motion —
Concept
In recent years, there has been a burgeoning popularity of “functional” training within the rehabilitative and fitness arenas. Functional training can be considered any exercise that intends to improve strength, endurance, and stability during specific dynamic movement patterns, principally of the spine and trunk. Most modern protocols involve the use of unstable surfaces such as balance boards, low density padding, Swiss balls, and more recently, vibration platforms. Functional exercise protocols have shown improvements in neuromuscular activity, spinal stability, balance, and performance in both athletic and patient populations.13,15,20-22
The goals and effects of functional training are well accepted and are not challenged. However, we suggest that functional protocols are incomplete because they do not appreciate underlying spinal architecture. As CBP® practitioners, we propose that functional exercise protocols would be better prescribed after a complete CBP® spinal analysis and structural assessment.
After such analysis, MI exercises could be prescribed as part of a traditional CBP® structural rehabilitative plan, added to an athlete’s training regimen, and/or combined with functional type exercise movements. We have termed this idea Mirror Image® in Motion (MIM). MIM exercises can be prescribed using integrated movements in various planes of motion. An example would be a lunge in the vertical and horizontal plane with a MI exercise of thoracic rotation in the transverse plane.
MI exercises utilizing resistance bands and unstable surfaces such as balance pads increase the neuromuscular demand of the spine and trunk. Theoretically, we believe this type of movement may prove to be superior in spinal structural and functional rehabilitation.
Understanding Mirror Image® in Motion
A complete understanding of the MIM concept requires some basic comprehension of the mechanisms of spinal stability. There are three basic control mechanisms that maintain the spine at rest and in motion. The neurological, muscular, and ligamentous systems provide a network of synergy that sustains the normal position of the spine.
It is not by coincidence that CBP® encompasses all three components in its treatment protocol. MIM exercises capitalize on the synergy of the system by exploiting all sensory and motor faculties simultaneously. A brief review of the normal physiological responses of such synergy is reviewed below. These concepts must be understood to appreciate the difference between MIM and traditional MI exercises.
In response to any spinal movement, many neurological responses occur. Muscle spindles detect the stretch and velocity of intrafusal fibers. The golgi tendon organs detect muscle-tendon tension and end-range stretch. The articular and ligamentous mechanoreceptors provide feedback of local connective tissue position and motion.
There are a variety of reflexes that take place as a result of spinal receptor activation including segmental, propriospinal, visceral, and suprasegmental.23-25 In short, spinal receptor potentials provide necessary activation of the central nervous system and are the cornerstone of human function.
Motor control of the spinal musculature is the effector of all neurological feedback. The sensory parietal cortex synapses directly with the frontal lobe to induce motor output. The majority of skeletal muscle activation is mediated by the pyramidal pathway. The pyramidal pathway activates prime movers- termed spurt muscles. Examples include the quadriceps that extend the leg, biceps that flex the arm, and the rectus abdominus and erector spinae that flex and extend the spine, respectively.
Extra-pyramidal pathways consist of accessory tracts which help coordinate mechanoreception and pyramidal motor output.
Extra-pyramidal centers include the cerebellum, mesencephelon, basal ganglia, thalamus, and vestibulum. Extra-pyramidal centers have an indirect, yet commanding, influence on the small, deep muscles of the body — termed shunt muscles. Shunt muscles act as synergists and joint stabilizers during active movement. Examples include the soleus, brachialis, gluteus medius, internal oblique, transverse abdominus, multifidus and other spinal intrinsics. Pathological extra-pyramidal function may present hypertonic as dystonia, clonus and cogwheel rigidity or hypotonic as pendular reflexes and joint subluxations/dislocations.
As chiropractors, we must understand that spinal motor control is predominantly reflexive in nature and dependent on the health of extra-pyramidal pathways and coordination of shunt musculature.26,27
Spinal rehabilitative exercise should include coordination of spurt-shunt activation in order to achieve improved stability and function. Weight bearing — closed chain exercises, the use of unstable surfaces, and altered sensory input create extra-pyramidal reflex activity while also increasing mental cognition and attention to the exercise. Neurologically, this is a great advantage as learning takes place throughout the neuraxis. Mentality and imagery greatly enhance the motor output of the exercise and also support spinal learning.
Since posture is highly controlled by reflex activity and many spinal injuries occur while performing simple activities of daily living, we suggest it is of paramount importance to rehabilitate the spine in a reflexive environment. We propose that Mirror Image® in Motion exercise fulfills this requirement.
To remedy the fact that functional rehabilitation models do not account for structural deformations and that traditional MI exercises utilize predominantly pyramidal function, we advocate Mirror Image® in Motion exercises be utilized as part of existing CBP® methods.
Mirror Image® in Motion —
Conclusion
In our practices, we have found MIM exercises successful in both athletic and sedentary individuals. In fact, although both populations require stability training, studies conclude that sedentary individuals require spinal stability training more than the trained athlete.15 Our opinion is that MIM active exercise provides the patient with more exciting ways to include spinal correction at work, in the gym or on the field. MIM exercises have been prescribed effectively for all body types and age groups and can be performed in most, if not all, CBP® offices. Providing these services not only enhances patient retention and referrals, but also aids in understanding the benefits of spinal hygiene and lifelong chiropractic care.
The addition of the MIM concept to CBP® protocol satisfies structural, functional, and performance goals of spinal rehabilitative care. We feel that MIM exercises correct the inadequacies of functional rehabilitative programs and add a valuable component to CBP® structural rehabilitative methods.
An algorithm for application of MIM exercises into a spinal corrective program will be discussed in Part 2 of A New Look at Mirror Image® Exercise.
For the list of our 27 references, contact josh@drlander.com or drparis@parischiro.com
| 
