Educational articles designed to help CA’s understand the underlying anatomy and physiology of conditions presenting to the chiropractic office.
Educational articles designed to help CA’s understand the underlying anatomy and physiology of conditions presenting to the chiropractic office.
Hypermyotonicity, aka hypertonia, is the medical term to refer to tight musculature. In the chiropractic office, we will often see this in conjunction with the subluxation of a spinal or extremity joint articulation. In many cases, it is a 'chicken/egg' question, which came first, the joint malalignment or the muscle spasm? It truly could be either. A misaligned joint could create a tight muscle, or a strained tight muscle could pull a joint out of alignment.
By the time a patient gets into the office, it doesn't really matter. The DC will detect and address both conditions so that the patient will stabilize in an optimum way. The associated muscle spasm that we see with things like 'facet syndrome' is why patients need to come in more than just once to get adjusted...the muscle pulls the alignment back out of place. Muscles, after all, have memory. So, we adjust to get the bones back in place and work on the muscles to retrain them to hold the joint back in the correct position.
Causes of Hypertonia
In the chiropractic office, we most often see muscle tightness as the result of things like: overuse, sprain/strain injury, or ill-positioning due to sleeping or due to a joint misalignment that is creating unnatural stress on the soft tissues. When the muscle is damaged, say from a whiplash injury, then the process of alignment is going to take as long as it takes for the muscle to heal. That does not happen in one visit.
Keep in mind that the causation of muscle spasms can also be drastic and include things like: cerebral palsy, brain trauma/head injury/stroke, or disease processes like multiple sclerosis. Those things, however, are not typical of what we encounter on a daily basis in chiropractic practice.
Common Areas of Muscle Spasm
Muscle tightness can happen anywhere, but a few very common places that we see in the office are as follows:
• Sub-occipital Muscles: At the base of the skull, these attachments are often tight with cervical misalignments, and headache patients.
• Trapezius Muscle Belly: The traps are huge diamond-shaped muscles on the back with a large belly that can be felt on top of the shoulder. This can be tight for a variety of cervical and thoracic subluxations, but we often see this belly very tight with patients that work all day at a computer or who engage in anterior weight-bearing posture.
• Paraspinal Muscles: It is very typical to find tightness in these muscle layers next to where subluxation is found.
• Gluteus Muscles and Piriformis: In the buttocks, we can see tightness in these with low back, pelvic, and sacral issues.
How DCs Address Muscle Spasm
During their examination, DC's will not only test for muscle strength and reflexes to note weaknesses and imbalances, but in their chart they will also note areas of static palpable hypermyotonicity and possible trigger points in the muscle that will allow them to compare patient progress from visit to visit.
In the chiropractic office (and with the patient at home) there are many ways to address muscle tightness including but not limited to the following:
Some offices will also encourage patients with supplements like a balance of Magnesium/Calcium to feed the muscles, or herbals like St. John's Wort to help the muscles relax.
Communicating with Patients
Understanding the cycle of joint misalignment and muscle tightness is very important. Especially when communicating with patients. Patients new to chiropractic may not fully understand the interconnections, or that muscles can play a key role in alignment. If a patient conveys concern to you about subsequent visits you may want to say something like:
"The doctor typically checks on patients at intervals because it is not uncommon for your muscles to go back into spasm and pull the joint out of position again. Doc wants to stop that cycle as soon as possible. Because muscles have memory, they often require retraining to hold the joint properly in place. It is very typical to require more than one visit to completely fix the problem."
Always offer to fetch the DC if the patient has concerns or more questions before they leave, but often the patient just needs a little more education and reassurance to feel engaged with the treatment plan. Also always encourage them to fully comply with their home care and ensure that they know that the office is accessible to them:
"Also the more you comply with what the doctor told you to do at home...the faster you will stabilize. If you get home and think of any questions or concerns before your next appointment please feel very welcome to give us a call here at the office."
Laurie Mueller, BA, DC, CFMP served in private practice in San Diego, California. She was the post-graduate director at Palmer College from 2000-2010; served as the ACC Post Graduate subcommittee chair for 6 years; peer reviewed for the Research Agenda Conference, and wrote the informal role determination study that aided in the development of FCLB's guidelines for chiropractic assistants (CCCAs). Dr. Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solutions LLC, and subsidiaries www.CCCAonline.com and www.fxmedonline.com. She is a clinician, an educator, and an expert in online educational pedagogy.
