POSTURAL REHAB
Getting to the Roots of Pain, Posture, and Chronic Health Issues
by Monika Buerger, BA, DC
The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” (Raja et al., 2020). It is important for practicing chiropractors to understand the different types of pain that patients may present in their office.
The three types of pain at presentation are nociceptive pain that occurs acutely following damage to body tissues; neuropathic pain that warns of harm to the person’s nervous system; and bioplastic pain that involves the production of pain sensations disproportionate to, or even completely independent of, physical harm as a stimulus. The bioplastic model of pain is essentially pain that has been mapped onto the brain and leads to chronic pain. Chronic pain is defined as pain lasting longer than three months without any ongoing or known tissue injury or pathology. Continued suffering from chronic pain is critically dependent on the state of motivational and emotional mesolimbic-prefrontal circuitry of the brain. The plastic changes that occur within this circuitry in relation to nociceptive inputs dictate the transition to chronic pain (Mansour, Farmer, Baliki, Apkarian, 2014).
"Chronic pain is a sensory, emotional, and cognitive “experience” that becomes mapped on the brain."
Chronic Pain and Related Disorders
Dysfunction within the mesolimbic-prefrontal circuit can contribute to neuropsychiatric diseases, including major depression disorder (MDD) and addiction. Clinical research has demonstrated substantial comorbidity between pain and depression, with one study estimating a prevalence of 30% comorbidity (Serafini, Pryce, Zachariou, 2020).
Chronic pain is also associated with hyperactivity in the amygdala. This will lead to an exaggerated fear response to noxious stimuli and “fear avoidance” behavior. This behavior will lead to alterations within cellular and metabolic pathways, ultimately leading to increased allostatic load and decreased homeostasis.
A study published in the Journal of Manipulative and Physiological Therapeutics found that chiropractic adjustments resulted in increased brain activity in areas associated with pain
processing and stress response. Changes in the way the human brain processes pain, as well as the capacity to modulate the pain experience, underlies the pathogenesis of most chronic pain conditions. In this study, they found habituation to pain following the sham intervention, with no habituation occurring following chiropractic intervention. This suggests that chiropractic spinal adjustments may alter central processing of pain and unpleasantness (Navid et al., 2019).
Postural Rehabilitation and Integrative Health
Integrative health and postural rehabilitation have joined forces over the past several years and have gained recognition. This approach looks at the whole person, recognizing that pain and dysfunction can have physical, emotional, and psychological causes. They work together to promote optimal health and well-being by addressing the root cause of pain and dysfunction.
Postural rehabilitation involves a comprehensive assessment of the musculoskeletal system, including the spine, pelvis, and extremities, to identify imbalances and determine the most effective treatment plan. The expertise of the chiropractor is to locate and correct vertebral subluxations and extremity joint dysfunction. Therefore, they should be considered a “critical factor” in postural rehabilitation.
Integrative health practitioners take a holistic view of health, recognizing that physical, mental, emotional, and spiritual factors all play a role in a person’s well-being. This philosophy is congruent with the chiropractic philosophy. In fact, according to the Cleveland Clinic, chiropractors are recognized as “integrative health professionals.”
The Root of Postural Stabilization
Postural rehabilitation can be used to treat a wide range of conditions, including back pain, neck pain, shoulder pain, and knee pain. By addressing the root cause of pain and dysfunction, postural rehabilitation can help patients achieve longterm pain relief, improved function, and overall improved physical, emotional, and cognitive health.
The central nervous system is constantly recalibrating information coming from the proprioceptive, visual, vestibular, and cognitive systems to ensure postural control in both static and dynamic conditions (Feller, Peterka, Horak, 2019). If information from any of these senses is limited, maladaptive in nature, or nonexistent, then brain functional connectivity will be limited, maladaptive, or nonexistent. Therefore, ensuring that the brain receives proper sensory information is not only the root of postural stability and postural control but also neuroplasticity and brain health and function.
Taking a “Whole-Person” Approach
By understanding the posture-brain-pain connection and taking a whole-person approach, chiropractors have the unique ability to lead the way in postural rehabilitation and integrative health. With specific chiropractic adjustments to address vertebral subluxations and mechanical dysfunction of the extremities, along with postural rehabilitative exercises, patients can achieve longterm pain relief, improved function, and an overall greater degree of health and well-being.
When employing rehabilitative exercises for postural control, care plans should focus on the visual, vestibular, and proprioceptive systems. This can be done either by comanaging with a physical therapist well versed in this field or seeking additional training to implement specific exercises into practice. Basic exercises to consider are balancing strategies based on a person’s functional capacity, such as balancing on one leg at a time or on vestibular cushions, wobble boards, or BOSU balls. Yoga, Pilates, and weightlifting are also great options for body positional awareness and enhancing proprioception.
Since the feet are the foundation of postural control, custom-made three-arch support orthotics should also be considered an integral part of a whole-person approach to addressing the roots of the posture-brain-pain triad. This is especially important for patients who have sustained foot, ankle, or knee injuries or have chronic vertebral subluxation patterns.
Dr. Monika Buerger, a 1991 graduate of Life Chiropractic College West, is the owner of Eagle Canyon Wellness & Sensory Development Center in Ammon, Idaho. She is a teacher, international lecturer, author, and the founder of lntersect4Life Educational Seminars and developingMINDS certification program in childhood and adolescent neurodevelopment. For additional information, visit www.intersect4life.com and www.devmindsu.com.
References
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2. Mansour, A. R., Farmer, M. A., Baliki, M. N., & Apkarian, A. V. (2014). Chronic Pain: The Role of Learning and Brain Plasticity. Restorative Neurology and Neuroscience, 32(1), 129-139. https://doi.org/10.3233/RNN-13...
3. Serafini, R. A., Pryce, K. D., & Zachariou, V. (2020). The Mesolimbic Dopamine System in Chronic Pain and Associated Affective Comorbidities. Biological Psychiatry, 87(1), 64-73. https://doi.org/10.1016/j.biop...
4. Navid, M. S., Lelic, D., Niazi, I. K., Holt, K., Mark, E. B., Drewes, A. M., & Haavik, H. (2019). The Effects of Chiropractic Spinal Manipulation on Central Processing of Tonic Pain: A Pilot Study Using Standardized Low-Resolution Brain Electromagnetic Tomography (sLORETA). Scientific reports, 9(1), 6925. https://doi.org/10.1038/ s41598-019-42984-3
5. Cleveland Clinic, (n.d.). Integrative Medicine. https://mv.clevelandclinic. org/health/treatments/21683-integrative-medicine#:~:text=A%20varietv%20of%20healthcare%20Droviders.Chiropractic%20doctors
6. Feller, K. J., Peterka, R. J., & Horak, F. B. (2019). Sensory Re-Weighting for Postural Control in Parkin -son’s Disease. Frontiers in Human Neuroscience, 13, 126. https://doi. org/10.3389/ftihum.2019.00126
