When I think about advancing chiropractic into the future, I believe that we can do more to connect to the brain. We have many effective ways of addressing vertebral subluxation; through chiropractic care of the spine alone, we can influence many functions of the body. However, some issues can undermine even the best chiropractic adjustments. The one we face daily is how to identify and prioritize factors contributing the most to vertebral subluxation that the chiropractor needs to address. Issues such as overpronation, poor posture, and even a poor breathing technique can cause repetitive stress and subluxation patterns, making them high priorities. The basis for focusing on these issues lies within our most advanced neurological models and emerging observations from neuroscience. A review of these models supports our care of the spine and helps prioritize how we can best support spinal adjustments toward better brain health.
The role of proprioception
Let’s start with proprioception. The brain maintains a constant internal awareness of the body through proprioception, including our positioning. Particular importance is given to the biomechanical status of the spine and the feet because we balance against the constant force of gravity. While this points us toward addressing any neuromusculoskeletal deficits that we can detect in the spine and lower extremities, there are broader implications because of the neurological compromise. For the brain to control and coordinate all functions of the body, it relies on a complete communication network that continually feeds the brain accurate information from the rest of the body through the spine. One complication of the vertebral subluxation complex is reduced proprioceptive input to the brain. The key factor is that spine function is involved in higher functions of the brain and monitored continuously, even at rest. By adjusting the spine alone, we can help the brain maintain awareness of the whole body, and today we will consider how to build on that.
Another opportunity to leverage the power of spine function and identify the best practices to support adjustments can be derived from examining electrical activity of the brain (EEG). When we observe both brain electrical activity and the essential functions that remain active while the brain is at rest, respiration (another constant need) and balancing (through proprioception) become even more prominent. Breathing (to support respiration) and posture (to maintain balance) are deeply integrated functions with the spine, whether we are at rest or in motion. From a review of a wide body of neuroscience, and from my own clinical experience and research (including EEG/NCV/EMG studies), I’ve learned that patients can benefit from strong relationships between spinal function, breathing, and posture in their efforts to achieve homeostasis in addition to pain relief.
"A key feature of breathing and posture is that they both can be controlled intentionally."
Breathing and Posture Control for Improved Patient Outcomes
Achieving homeostatic balance through chiropractic strengthens the essential functions related to the spine and integrates them into our primary goals of care while teaching patients how to live with greater spine and brain awareness. Chiropractors are known for getting great results, and we want people to achieve their full potential. While it’s imperative that we remain focused on the spine, we want to keep these metafunctions in mind. There’s more to chiropractic homeostasis, but the first step is to incorporate breathing and balance into our care models.
We can successfully design care around the importance given to these essential functions and their relationship to the spine, which is powered by neuroscience and applies to all patients. In my practice, that involves adjusting the cranium and extremities in addition to the spine. We can further embrace the opportunity to provide complete care by advising patients on breathing, posture-based rehabilitation, and using custom orthotics to address overpronation.
A key feature of breathing and posture is that they both can be controlled intentionally. That means that the brain gives great importance to these functions, and an individual can influence them through behavior modification (for better or worse). Chiropractors who provide spinal care and guide their patients to make strengths of functions that may have been weaknesses can add great value to care. It also means that regardless of the presence or absence of musculoskeletal complaints, chiropractic care can be applied toward building strength and resilience to a wide variety of stressors.
After receiving chiropractic care, patients will only need to know how to best maintain adjustments and make the most of their opportunities to build on each visit. Chiropractic perspective is needed to discern what those steps should be while teaching our core principles in the process. Home care starts with establishing breath control as a new barometer for exercise tolerance while patients build resistance to graduating levels of stress.
Overpronation contributes to pelvic tilting and forward head carriage (compromised sagittal curves), which affects quality of breathing and the ability to do so efficiently. It is vital that patients use custom orthotics that restore proper biomechanical foot function while they acclimate to new breath and posture work and before beginning endurance, strength-conditioning, or interval exercises to avoid developing compensation patterns to overpronation. If a factor such as unhealthy alignment consistently affects whole-body positioning in a way that compromises breathing, it should be detected and corrected so it doesn’t continue to impact a patient’s life negatively.
Breathing can’t be fully automated. Patients must be trained on how to breathe until they can support respiration in all situations and guide the nervous system away from stress. The first thing we do in clinic is teach people how to establish breath control. Once they have breath control, they can learn how to maintain it during posture-building calisthenics and on to more rigorous exercise. Respiration is a constant biological need that drives us to breathe, and we can learn to satisfy this need even under stressful conditions with breath control.
Quick start: While focusing on breathing into the abdomen, inhale and exhale through the nose whenever possible, following an exhale-to-inhale ratio of 2:1 and maintaining space between breaths.
Automating function through foot stabilization
Posture, on the other hand, can be automated with in-office tools like a digital foot scanner for a complete posture assessment and home care through the use of custom orthotics. When combined with weight-bearing x-rays, digital foot scans provide you with powerful data to educate patients and identify the gaps in their posture that need to be addressed to avoid premature aging and future injury. The feet are the primary contact and reference points for all standing activity when centering against gravity. Overpronation is a widespread but overlooked condition involving structural and functional deficiencies of the lower extremities which are valuable indicators of predictable, repeated, chronic spinal imbalance that a chiropractic is best suited to address.
So much of the damage we address in chiropractic is caused by prolonged sitting. By correcting and supporting the lower extremities and spine we afford patients the opportunity to properly recondition in a flat world without recurring debilitating postural stress. Stabilizing orthotics is an advanced solution for a common modern problem that can ensure the hands-on work that we do.
In my practice, one goal is to automate as many decisions as possible so that patients can focus on other behaviors that require their attention. Whether the goal is to improve alignment and balance in the standing position or support the spine during more dynamic activities, care of the extremities (foot/ankle/knee) is one of our most successful strategies. Whether you are willing to adjust the feet or simply support them, custom orthotics offer solutions to a number of problems:
1. Chronic misalignment throughout the biomechanical chain due to overpronation (usually bilateral and asymmetrical),
2. The need for dynamic flexible support of the arches, and
3. The need for stability in holding adjustments.
In conclusion
The common thread that ties all these strategies together is the importance given biologically to the spine, respiration and balance. So, when we think about our original goal of brain health, if we skip any of these areas of spine care we may miss a critical step that limits our potential.
Anish Bajaj, DC, is a 2000 graduate of Life University in Atlanta, Georgia. He is the owner of Bajaj Chiropractic in New York City. Dr. Bajaj serves on the executive board of the New York Chiropractic Council and is the chair of their Neuroscience and Research Committee. Dr. Bajaj is a member of the Foot Levelers Speakers Bureau. To see upcoming continuing education seminars with Dr. Bajaj, visit FootLevelers.com/seminars
