аЯрЁБс>ўџ ўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџмЅhWр e‰ #‰lllllllЖЖЖЖЖЖ РЖн"1жжжжжжжжbddd/“–)!–П"#Xf#:н"lж жжжжн"жllжжжжжжlжlжbР=ў0,М€”"llllжbжŒжKNEE INJURIES Exercises should be performed with consideration for the presence or absence of pain. If it is persistent, then the exercises may be being performed incorrectly or may not be appropriate for the injury or the patient. INITIAL PHASE OF REHABILITATION WARM-UP Whirlpool, hot bath or hot packs. 5 min. Isometric knee exercises - contract muscles in all four quadrants for three sets of 5 seconds each. Forward, backward, inside, outside. Range of motion - move knee in flexion (backward) and extension (forward) when seated. Hip Exercises Hip flexion - seated at edge of table or bed with knee flexed (hanging). The hip is actively flexed without resistance for three sets of 10 reps. Hip abduction - lying on the non-injured side with the non-injured knee and hip flexed. The injured knee and hip are fully extended and the injured leg is abducted (side away) until it is well above the mat. It should be held at the top for two seconds and then relaxed for 5 seconds. 3 sets of 10 reps. Hip extension - lying face down, with the injured leg over the edge of a table or bed. The leg is raised keeping the knee extended (straight), until even with the edge of the table. Hold for two seconds, relax for five seconds. 3 sets of 10 reps Hip adduction - isometric contractions of the adductors against a rolled towel between knees or practitioners resistance. KNEE EXERCISES - INITIAL Isometric (do not move joint, just contract muscle) leg extensions (forward) - Performed in the seated position and performed with 2 seconds contraction with 4 seconds of relaxation. Do not fully extend the knee in these exercises. 3 sets of 10 reps Isometric leg curls (backward) - Performed face down, curling the leg up. Do not fully extend the knee (straight) in these exercises but do perform several different joint angles. Resistive Exercises Using resistive theraband, tubing, weights, etc.. Leg extensions - performed in the seated position much like the Isometric but with resistance. Emphasis is put on contracting the Vastus Medialis at the top of the arc. 3 sets of 10 reps. Leg curls - These are performed prone on most machines. Care should be taken to avoid full knee extension under weight as this could compromise the injured knee joint. Lunges - These are performed with dumbell weights held in both hands. Care is taken with performance of this exercise. Knee is straight over the ankle. Agility exercises - These are designed to recover normal function of movement to the injured area and allow the nervous system / proprioceptive system to readjust to complex movements. These can be any complex exercise involving the lower extremities. Stretching - Knee rehabilitation usually involves the Gastroc-soleus group, the hamstring group, the adductors and gluteals. Stretching the quadriceps is generally contraindicated at least in the early stages because extreme flexion may cause pain in the injured knee. The stretching is usually performed initially by the practitioner and then taught to the patient for performing it on their own. Stretching is not to be taken to the extreme but must be performed with the intention of inhibiting the stretch reflex pathway and lengthening the connective tissues involved. STARTING PHASE PROGRAM WARM-UP - Whirlpool, hot pack. RESISTIVE EXERCISE Exercises Repetitions Sets Weights / Resistance Hip abduction 10 2-3 Hip extension 10 2-3 Hip Adduction 10 2-3 Quadriceps isometric contract 10 2 45 degree quad extension 10 2 Hamstring isometric contract 10 2-3 Toe Raises 20 2-3 Stretching Calf 10 3 Body Weight Hamstring 10 3 5 lbs. Adductors (gently) 10 3 5 lbs. Isometric muscle contraction in all ranges of motion, Pool walking, Gentle Range of Motion. INTERMEDIATE PHASE PROGRAM WARM-UP Bike Stretching Calf w/ tilt board Hamstring, passive stretch Other area if indicated (adductors, abductors, glutes, quads) Exercise Repetitions Sets Weight / Resistance Hip Adduction 10 3 Hip Abduction 10 3 Hip Flexion 10 3 Hamstring Curls 10 3 45 degree quad extension 10 3 Step ups or Stairmaster, Treadmill to patient tolerance, not to exceed 15 min. Swimming Bicycling to patient tolerance ADVANCED PHASE Bike, to tolerance Jog-walk Stairmaster Exercises Repetitions Sets Weight / Resistance Same as intermediate but add: Lunges 20 3 Agility drills - complex movements, basketball, racquetball Єа/Ѕр=ІЇЈ Љ’Њic intervention prevent degeneration of visceral organs and reverse the degenerative process to restore vitality to degenerating tissues?

If so, for what conditions and how effectively? This is perhaps the more controversial issue in chiropractic theory. The evidence, however, tends to support such a concept.

Sato and Swenson(4) have sh ы j‚D Y  › K T є ћ    Œ — ЮфL$ој†ЗЋЙф‰ ќњњњњњњњњњјјњјњјіu^UUc!ъы  >?ШЩ !/Тѕюijƒ„† ; < = > ? @ A B C D E F Z Œ  K є §Р!K§Р!ћР!ћР!ћР!ћР!ћР!ћР!ћР!ћР!ћР!ћР!ћР!ћР!кР!кР!кР!кР!ћР!ћР!ћР!кР!кР!ћР!ћР!ћР!ћР!ћР!ћР!ћР!ћР!ћР!ћР!ћР!ћР!ћР!ћР!кџР!VкџР!V h˜ў 4џџh.'є  Œ ЭЮхцMNh‚šОо%@[~лмнољњпџР!;пџР!rпџР!УОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР!ОР! h˜ў 4џџh. h˜ў 4џџh."(E…†ИЙЯхљ12‚‹ЊЋКЛЮзуф6FGƒ„…‰пР!пР!пР!пР!пР!лР!лР!лР!лР!лР!лР!лР!лР!лР!лР!лР!лР!лР!лР!лР!лР!лР!лР!лР!лР!лР!лР!лР!лР!йР!йР!йР!h h˜ў 4џџh. K@ёџNormala c"A@ђџЁ"Default Paragraph Font‰‰џџџџ!џџ џџ џџC‰\  є ‰ ŒMark H. StreetC:\WINWORD6\1MARK\KNEE1.DOC John P. Duffy$C:\WIN95\DESKTOP\MARK\TEMP\KNEE1.DOC Joe GarolisD:\FOLKWEB\html\forms\KNEE1.docџ@HP DeskJet 660CLPT1:HPFDJC04HP DeskJet 660CHP DeskJet 660C6”џ€d,,HP DeskJet 660CLPT1ф і ,,HP DeskJet 660C6”џ€d,,HP DeskJet 660CLPT1ф і ,,€1Times New Roman Symbol &Arial"ˆаhQEЦQEЦѓ9цE‰uƒ$: KNEE INJURIESMark H. Street Joe Garoliscompromised immunological response. However, this work does not address the idea that subluxati ўџџџ§џџџўџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџRoot EntryР!Р!Р!Р!Р!Р!Р!џџџџџџџџ РF€\вн.,МР=ў0,М€Р!WordDocumentР!џР!VџР!VџР!;џР!rџР!УР!џџџџР!Р!Р!Р!Р!Р! #CompObjР!Р!Р!Р!Р!Р!Р!Р!џџџџџџџџџџџџР!Р!Р!jР!SummaryInformationР!Р!Р!Р!(џџџџџџџџР!Р!Р!аР!ўџџџ ўџџџ ўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџ џџџџ РFMicrosoft Word Document MSWordDocWord.Document.6є9ВqаЯрЁБсўџр…ŸђљOhЋ‘+'Гй0 ˜ ИФмшє ( P \ h t€ˆ˜фKNEE INJURIESџџџMark H. Street_E Normal.dotT Joe Garolis2Microsoft Word for Windows 95DocumentSummaryInformation8џџџџџџџџџџџџ мџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџеЭеœ.“—+,љЎ0ЌHP\dl t| „ф A0 KNEE INJURIESes in reducing such pain, one must explore the role which spinal biomechanical factors play in normal neurological function.

ARTICULAR NEUROLOGY

The field of articular neurology is germane to the theory and practice of chiropractic. Wyke (98) has classified the spinal joint receptors into four groups, Types I-IV; three types of mechanoreceptors and the nociceptor (pain) receptor system. The role that each plays in degenerative processes, and particularly in pain (91), is the subject of intensive reserve. Gillet(10) has proposed that co-activation of the articular receptor system and other somatic receptors constitute a major component of t)e chiropractic adjustment. It is further known that the SZA are involved in the mechanism of referred pain (somato-somatic reflex), but the neurological mechanisms are not well understood(21,22). Given the significance of the spinal articulations in chiropractic theory, we cannot minimized the importance of articular neurology in understanding the effectiveness of chiropractic procedures.

The afferent discharges derived from articular mechanoreceptors have a three-fold impact when they center the neuroaxis: 1)Reflexogenic effects: mobilization or manipulation at one level may have an impact on areas remote from the side of motion; 2)Perceptual effects: influence on postural and kinesthetic senses;(3) Pain Suppression: modulation of the pain gate trough changes in mechanoreceptors located in the joint capsules can result in abnormalities of posture and movement (including gait), impairment of postural and kinesthetic sensation(100) and an increase in pain perception(91).

There is a significant correlation between proprioceptive input from the cervical spine and coordination of the extremities (100). Experimental studies on the knee joint have demonstrated the discharge of afferent fibers following passive movements of the leg (101). The impulses were particularly prominent when the knee was subjected to noxious movements, such as twisting. It was proposed that this constituted a warning signal which stimulate motor reflex patterns designed to prevent joint damage. Studies performed on cats with inflamed knee joints(102) showed that joint inflammation sensitizes articular nociceptors to fire at rest during normally non-noxious joint movements. The proportion of neurons displaying resting discharges was higher, the frequency of discharges was higher and the receptive field were larger in the inflamed joints than in normal controls.

Studies in humans(103) showed that distension of the joint capsule of the knee by gradual infusion of plasma into the joint led to reflex weakening of the quadriceps muscles. Injection of saline into the lumbar facets resulted in pain and significant increases in the myoelectric activity of the quadriceps(21). These responses were abolished by injection of local anesthetic. Traction or passive movement of the posterior elements of the vertebrae or of the limbs with the concomitant stimulation of the mechanoreceptors of the joint capsule, can inhibit nociceptor activity or central integration and can thereby significantly reduce the perception of pain by means of the gating mechanism of presynaptic inhibition(91). These procedures are known to reduce the patient's need for analgesic drugs, thereby avoiding the@FУ#@’QоЙ@ЖFј/,М@ЖFј/,М‰uаЯрЁБс>ўџ ўџеЭеœ.“—+,љЎ0ЌHP\dl t| „ф A0 KNEE INJURIESаЯрЁБс>ўџ џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ