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03 Autumn | Autunno 2011<br />
CONTENTS | CONTENUTI<br />
Manual Biofeedback<br />
Manuale di Retroazione Biologica<br />
Dr. Philip Maffettone D.C., D.I.B.A.K.<br />
Sudeck’s Dystrophy<br />
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Dr. Ivan Ramšak D.I.B.A.K.<br />
Hands-on pain relief from<br />
“Stop Your Pain Now!”<br />
Eliminazione Manuale del Dolore da<br />
“Ferma Il Tuo Dolore Adesso!”<br />
Dr. Walter H. Schmitt D.C., D.I.B.A.K., D.A.B.C.N.<br />
Dr. Kerry M. McCord D.C., D.I.B.A.K.
Sistema di analisi posturale globale<br />
La postura può rappresentare un linguaggio comune per<br />
diverse discipline mediche se vi è interesse a considerare<br />
il soggetto nella sua globalità nell’ambito di un programma<br />
di prevenzione, cura e trattamento multidisciplinare.<br />
I nostri sistemi di analisi posturale sono consigliate<br />
a diverse categorie professionali.<br />
Dispositivo medico di classe 1 di Misura (1M),<br />
valutato conforme alla direttiva 93/42 e s.m.i. da<br />
organismo notificato (DNV). È progettato e fabbricato<br />
dalla Chinesport spa, azienda con sistema di qualità<br />
certificato secondo la UNI EN ISO 13485:2004<br />
C<br />
E<br />
I0434<br />
cod. 01762 GPS 400<br />
E’ un sistema di analisi della postura composto da diverse unità e da un software che consente<br />
l’acquisizione di immagini dei tratti corporei, nonché una serie di informazioni relative alla distribuzione<br />
del peso del soggetto in esame, al suo baricentro e stabilità.<br />
Su richiesta offriamo consulenze<br />
Chinesport spa �������������������������������������������������������������������������������������������
Dear readers,<br />
Introduction<br />
Lettera ai lettori<br />
Dr. Robert Morrison D.C., D.I.B.A.K.<br />
President of <strong>ICAK</strong> <strong>Italia</strong><br />
this autumn edition of <strong>ICAK</strong> Italy’s newsletter is a keeper.<br />
Inside there are step by step instructions on how<br />
to perform two very effective Applied Kinesiolgy techniques:<br />
that of Dr Phil Maffetone: Manual Biofeedback<br />
and that of Dr. Walter Schmitt: Stop Your Pain Now!<br />
technique. Also included is Dr. Ivan Ramsak’s own personal<br />
experience with Sudeck’s Dystrophy and how it<br />
helped him to understand the impact of emotions on<br />
physiology.<br />
We have exciting seminars lined up for you in 2012 and<br />
we invite you to become a member of <strong>ICAK</strong> to recieve<br />
discounts on these seminars. As a member you will<br />
receive this newsletter in magazine format to help you<br />
stay up to date on the latest news and breakthroughs<br />
in Applied Kinesiology around the world. Members<br />
also become part of our ever-growing international referral<br />
system for patients seeking A.K. doctors.<br />
<strong>ICAK</strong> Italy offers special thanks to Cristina Mirizzi, Enrico<br />
Pandiani, and Laura Finelli for their help in the creation<br />
of this newsletter.<br />
We invite you to email us with your questions and<br />
comments.<br />
Sincerely<br />
Dr. Robert Morrison D.C., D.I.B.A.K.<br />
Editor in Chief<br />
President of <strong>ICAK</strong> <strong>Italia</strong><br />
Cari lettori,<br />
l’edizione autunnale della newsletter dell’<strong>ICAK</strong> <strong>Italia</strong><br />
è di fondamentale importanza. Potrete trovare, passo<br />
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di <strong>Kinesiologia</strong> <strong>Applicata</strong>: quella del Dr. Phil Maffetone:<br />
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-<br />
sonale del Dr. Ivan Ramš���������������������<br />
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-<br />
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Abbiamo organizzato corsi e interessanti seminari per<br />
l’anno 2012. Vi invitiamo a diventare soci dell’<strong>ICAK</strong><br />
per ricevere agevolazioni sui corsi. Come soci riceverete<br />
questa newsletter in formato cartaceo per essere<br />
sempre aggiornati sulle ultime novità e le scoperte in<br />
<strong>Kinesiologia</strong> <strong>Applicata</strong> in tutto il mondo. I membri diverranno<br />
parte del nostro sempre crescente sistema<br />
di riferimento internazionale per i pazienti in cerca di<br />
medici A.K.<br />
<strong>ICAK</strong> <strong>Italia</strong> desidera ringraziare Cristina Mirizzi, Enrico<br />
Pandiani e Laura Finelli per il loro contributo a questa<br />
newsletter.<br />
Contattateci per qualsiasi commento o chiarimento.<br />
Cordialmente<br />
Dr. Robert Morrison D.C., D.I.B.A.K.<br />
Caporedattore<br />
Presidente dell’<strong>ICAK</strong> <strong>Italia</strong><br />
<strong>ICAK</strong> ITALIA Corso Venezia 13 - 20121 Milano - Italy Tel +39.02.36551000 info@icak.it www.icak.it<br />
1
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(Includes Injury Recall Technique & Stop Your Pain Now!)<br />
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Introduction<br />
Manual Biofeedback is a powerful technique that can<br />
dramatically improve body function by “strengthening”<br />
(neurologically facillitating) “weak” (neurologically inhibited)<br />
muscles. In doing so mechanical imbalances are<br />
corrected. In this article I will describe how to perform<br />
Manual Biofeedback.<br />
Body position<br />
Once a neurologically inhibited muscle has been determined<br />
via standard manual muscle testing, we then<br />
must establish the optimal body position for isolating<br />
the “weak” muscle and maximizing its ability to contract.<br />
The following are some important considerations<br />
regarding body position:<br />
1. The best body position is the same as that which occurs<br />
naturally when the muscle in question contracts.<br />
For example, when the deltoid muscle contracts, the<br />
shoulder abducts, bringing the arm up to a horizontal<br />
plane.<br />
3. In some cases it may not be possible for the patient<br />
to assume the correct position because of extreme<br />
muscle weakness, pain or other factors. When<br />
this occurs, try to obtain a position that will still allows<br />
the weak muscle to contract, even while other muscles<br />
are being recruited. In such cases it may be necessary<br />
to increase the number of repetitions to have achieve<br />
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4. Your body position during Manual Biofeedback is<br />
also important. Stand close to the patient with both<br />
Manual Biofeedback Part 2<br />
Manuale di Retroazione Biologica Parte 2<br />
Dr. Philip Maffettone D.C., D.I.B.A.K.<br />
Introduzione<br />
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di migliorare fortemente le funzioni del corpo “rinforzando”<br />
(facilitando neurologicamente) muscoli “deboli”<br />
(neurologicamente inibiti). Agendo in tal modo si<br />
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-<br />
nuale.<br />
Posizione del corpo<br />
Una volta determinato un muscolo neurologicamente<br />
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sario stabilire la posizione ottimale del corpo per isolare<br />
il muscolo “debole” e massimizzare la sua capacità<br />
di contrarsi. Ecco alcune importanti considerazioni<br />
riguardanti la posizione del corpo:<br />
1��������������������������������������<br />
-<br />
turalmente quando il muscolo in questione si contrae.<br />
Per esempio, quando il deltoide si contrae, la spalla<br />
abduce, portando il braccio in posizione orizzontale.<br />
2. It is essential that the patient maintain the initial 2. E’ essenziale che il paziente mantenga la posiziobody<br />
position during Manual Biofeedback. Very often ��������������������������������������<br />
when a muscle is weak, the patient’s will try to com- Molto spesso, quando un muscolo è debole, il papensate<br />
by assuming positions that allow recruitment ziente cercherà di compensare assumendo posizioni<br />
of other muscles. Consequently the weak muscle will che permettono il coinvolgimento di altri muscoli. Di<br />
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conseguenza, il muscolo debole si contrarrà meno (per<br />
into the muscle’s contraction) and the effectiveness of �������������������������������������� -<br />
the therapy is reduced.<br />
no della contrazione muscolare) e la terapia sarà meno<br />
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3. Talvolta il paziente è impossibilitato ad assumere la<br />
posizione corretta a causa di debolezza muscolare, dolori<br />
o altri fattori. Quando ciò accade bisogna cercare<br />
di assumere una posizione che permetterà ancora al<br />
muscolo debole di contrarsi anche mentre vengono<br />
coinvolti altri muscoli. In questi casi potrebbe essere<br />
necessario incrementare il numero di ripetizioni per<br />
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4. Anche la posizione del vostro corpo durante il Bio-<br />
3
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one to steady yourself and the patient, and the other paziente con i piedi ben ancorati al pavimento, e usate<br />
to work on the muscle. When working on the deltoid entrambe le mani: una per mantenere stabili voi stessi<br />
for example, one of your hands stabilizes the shoulder e il paziente e l’altra per lavorare sul muscolo. Quando<br />
while the other is placed on top of the elbow ready to lavorate per esempio sul deltoide, una mano stabilizza<br />
provide adequate force against the patient’s contrac- la spalla, mentre l’altra va messa sul gomito, pronta a<br />
ting deltoid.<br />
fornire la forza opportuna contro il deltoide del paziente<br />
che si sta contraendo.<br />
Direction of Movement<br />
Once the proper body position has been attained, we<br />
need to determine the direction of movement. This is<br />
the direction in which the patient’s arm, leg, or other<br />
body part will move when the muscle contracts. For<br />
example, the direction of movement for the deltoid<br />
is further into abduction, the elbow moving cephalad<br />
(upward direction). Your force will oppose the patient’s<br />
direction of movement.<br />
Once you and the patient are in the best position and<br />
direction of movement has been determined, you’re<br />
ready to begin Manual Biofeedback.<br />
4<br />
Direzione del Movimento<br />
Una volta ottenuta la corretta posizione del corpo,<br />
avremo bisogno di determinare la direzione del movimento.<br />
E’ la direzione in cui il braccio, la gamba o altre<br />
parti del corpo del paziente si muoveranno quando<br />
il muscolo si contrarrà. Per esempio, la direzione del<br />
movimento del deltoide è ancora di più in abduzione, il<br />
gomito si muove verso l’alto. La vostra forza si opporrà<br />
alla direzione del movimento del paziente.<br />
Una volta che voi e il vostro paziente sarete nella posizione<br />
ottimale e la direzione del movimento determi-<br />
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Assessment and treatment<br />
Before applying Manual Biofeedback we must eva- Valutazione e trattamento<br />
luate the muscle’s ability to contract. In the case of ����������������������������������������<br />
the deltoid muscle, for example, place your hand on ����������� ��� ��������� ���� �������� �<br />
top of the patient’s elbow and ask him or her to push caso del deltoide per esempio, posizionate la mano sul<br />
upward against your hand. As the patient pushes, ap- gomito del paziente e chiedetegli di spingere verso l’al-<br />
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mano. Quando il paziente spinge,<br />
to counter the patient’s force. Your pressure must be ���������� ���� ���������� ����������� �����<br />
enough to keep the arm from going any higher up into (verso il basso) per contrastare la forza del paziente.<br />
abduction, but no so much that you push the patient’s La vostra pressione deve essere abbastanza intensa da<br />
arm down. The patient will be using only one muscle, evitare che il braccio vada in abduzione ma non ecces-<br />
while you are using several in order to resist their consiva da spingere il braccio del paziente verso il basso. Il<br />
traction.<br />
This initial assessment will result in one of three pos-<br />
paziente utilizzerà solo un muscolo, mentre voi ne starete<br />
usando diversi per resistere alla loro contrazione.<br />
sible outcomes:<br />
Questa valutazione iniziale porterà a uno di tre possibili<br />
1. Normal<br />
risultati:<br />
2. Weak with minimal contraction<br />
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3. Weak with no contraction<br />
2. Debole con contrazione minima<br />
The following describes these outcomes and provides 3. Debole con contrazione assente<br />
the respective intervention required:<br />
1. A normal contraction occurs when the patient is able<br />
Ciò che segue descrive questi risultati e fornisce i rispettivi<br />
interventi necessari:<br />
to resist your force for 2 or 3 seconds without either 1. Una contrazione normale avviene quando il paziente<br />
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è in grado di contrastare la vostra forza per 2 o 3 se-<br />
cases, there is usually no need to treat that muscle. condi senza debolezza, dolore o affaticamento muscolare.<br />
In questi casi di solito non c’è bisogno di trattare<br />
2. A muscle that is weak with minimal contraction will<br />
quickly fatigue or the patient will be not be able to<br />
quel muscolo.<br />
maintain the initial body position when force is applied. 2. Un muscolo debole con contrazione minima si affati-<br />
When this occurs, the weak muscle can be treated as cherà velocemente oppure il paziente non sarà in gra-<br />
follows:<br />
do di mantenere la posizione iniziale del corpo quando<br />
a. Begin treatment in the same position that was si applica forza. Quando accade ciò, il muscolo debole<br />
established during the original assessment, then have si può trattare come segue:<br />
the patient contract against your force for up to about a. Iniziate il trattamento nella stessa posizione stabi-<br />
5 seconds. Have them steadily increasing their force as lita durante la valutazione originale, successivamente<br />
you use your hand to provide the least amount of re- il paziente contrasta la vostra forza per 5 secondi al<br />
sistance possible but enough to encourage increased massimo. Fategli aumentare stabilmente la forza dato<br />
contraction force. The goal is to get the muscle contrac- che usate la vostra mano per fornire la minima quantità<br />
ting at its potential without over-powering the muscle.<br />
di resistenza possibile, ma abbastanza intensa da inco-
. Repeat this 3 or 4 times in slightly different posi- raggiare l’aumentata forza di contrazione. L’obiettivo è<br />
tions along the direction of movement, with a rest pe- far contrarre il muscolo al suo potenziale senza sovracriod<br />
of about 5-10 seconds in between. For example, in caricarlo.<br />
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b. Ripetete l’operazione 3 o 4 volte in posizioni leg-<br />
action with the arm horizontal, then bring the arm down germente differenti lungo la direzione del movimento,<br />
slightly toward adduction for the second application, con un periodo di riposo di circa 5-10 secondi tra una<br />
then further still for the third application and so on. sessione e l’altra. Per esempio, nel trattamento del<br />
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certain position. When this happens, focus on that po- braccio orizzontale, successivamente portatelo lievesition<br />
during treatment more so than the other posimente verso il basso verso l’adduzione per la seconda<br />
tions.<br />
applicazione e poi ancora per la terza applicazione e<br />
c. Following treatment in 3 or 4 different positions, così via. Potreste rilevare che il muscolo è più debole<br />
re-assess the muscle with the same test that was ini- in una certa posizione. Quando accade, focalizzatevi<br />
tially used. The muscle should be stronger after treat- in particolar modo su quella posizione invece che sulle<br />
ment. If there is no change, the procedure may need altre.<br />
to be repeated. (Usually it is quite obvious when the c����������������������������������<br />
muscle is stronger and it may not be necessary to re- valutate nuovamente il muscolo con lo stesso test che<br />
test unless you’re unsure.)<br />
avete utilizzato all’inizio. Il muscolo dovrebbe risultare<br />
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3���� ������ ��������� �������� ��� ������� cambiamenti, ��si �������������<br />
deve ripetere la procedura. (Di solito<br />
weak muscle with no contraction. This is the case with è abbastanza ovvio quando il muscolo è più forte e<br />
seriously injured muscles (i.e. brain or spinal cord in- potrebbe non essere necessario testarlo nuovamente<br />
juries). A patient who suffered a stroke often has muscles<br />
that are weak to the extent that there is no con-<br />
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traction at all (very tight antagonist muscles). In these 3. Un terzo possibile risultato è trovare un musco-<br />
cases, before treating the muscle it helps to increase lo sensibilmente debole con contrazione assente. In<br />
the brain’s awareness of that muscle by stimulating va- questo caso siamo in presenza di muscoli gravemente<br />
rious sensory and motor pathways. This can be done danneggiati (per esempio lesioni al cervello o al midol-<br />
three ways:<br />
lo spinale). Un paziente che ha subito un ictus spesso<br />
a. First, use your muscle and arm movement to presenta muscoli deboli senza contrazione (muscoli<br />
show the patient how the body should move when the antagonisti molto rigidi). In questi casi prima di trattare<br />
muscle contracts. This imagery informs the brain of il muscolo è di grande aiuto aumentare la consapevo-<br />
the desired action.<br />
lezza cerebrale di quel muscolo stimolando i vari sina-<br />
b. Next, with the patient’s arm very relaxed, move spsi sensoriali e motorie. Questo si può eseguire in 3<br />
it through passive range of motion (as if the muscle fasi:<br />
����� �������������� ����� ��� ���������� a. Per ��������� prima cosa usate ����il movimento ��� del vostro<br />
accompanying muscle tightness, but any amount of muscolo e del vostro braccio per mostrare al paziente<br />
movement will help to stimulate proprioception in the come si dovrebbe muovere il corpo quando il muscolo<br />
joint(s).<br />
si contrae. Questa visualizzazione trasmette al cervello<br />
c. Third, stimulate the skin and muscle with both l’informazione dell’azione desiderata.<br />
light and moderate massage for about 30 seconds. b�� ����������������� �������� ��� ���<br />
This increases local circulation, proprioception and the del paziente attraverso una serie passiva di movimenti<br />
brain’s awareness of the muscle.<br />
(come se il muscolo si stesse contraendo). A volte que-<br />
Movement<br />
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-<br />
mento aiuterà a stimolare la propriocezione dell’artico-<br />
Once you have assessed and treated a muscle, or selazione.veral muscles, it is very important that the patient use c. Terzo passaggio: stimolate pelle e muscolo con<br />
the muscle(s) during daily activity. In the case of a se- un massaggio lieve e moderato per circa 30 secondi.<br />
verely weak deltoid, for example, moving objects from Questo aumenta la circolazione locale, la propriocezio-<br />
a table to a shelf, combing their hair, or putting on and ne e la consapevolezza cerebrale del muscolo.<br />
taking off a hat will utilize this muscle.<br />
Movimento<br />
With severe weakness, simple contraction of the mu- Una volta che avrete valutato e trattato uno o più muscle<br />
may be the starting point. Most patients, once scoli, è molto importante il loro utilizzo da parte del<br />
they’ve experienced contraction during the manual paziente durante l’attività quotidiana. Nel caso di un<br />
biofeedback session can recall how to reproduce it at deltoide gravemente debole, per esempio, si utilizzerà<br />
home. Initially, the ability to contract a muscle may be nello spostamento di oggetti da un tavolo ad un ripia-<br />
very minimal. In these cases be careful to not overwork no, nell’acconciare i capelli o nel mettere e togliere un<br />
the muscle, as this may result in discomfort or pain. It cappello. Quando si è in presenza di una grave de-<br />
is also essential that any new movement that hs been bolezza, una semplice contrazione del muscolo può<br />
obtained during treatment (even just contracting the diventare il punto di inizio. La maggior parte dei pa-<br />
muscle) should be incorporated into some activity no zienti, una volta provata la contrazione durante il Bio-<br />
5
matter how minor the movement may appear. Repetive<br />
movement will increase the brain’s awareness of that<br />
muscle, thereby augmenting its power and mobility.<br />
Follow up Manual Biofeedback for a muscle that was<br />
weak with no contraction is usually indicated. In most<br />
cases, correcting a muscle that was weak with minimal<br />
contraction requires only one effective treatment.<br />
If weakness recurs, it’s usually due to some other muscle<br />
being primary.<br />
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a casa. Inizialmente la capacità di contrarre il muscolo<br />
può essere minima e in questi casi è opportuno non<br />
sovraccaricare il muscolo, per evitare disagio o dolore.<br />
E’ essenziale che ogni nuovo movimento che abbiamo<br />
ottenuto durante il trattamento (anche solo contrarre<br />
il muscolo) venga incorporato in qualche attività, non<br />
importa quanto irrilevante possa apparire. Il movimento<br />
ripetitivo aumenterà la consapevolezza cerebrale di<br />
�������������������������������������� -<br />
tere e la sua mobilità.<br />
Summary<br />
Manual biofeedback is a very effective technique for ���������������������������������������<br />
strengthening weak muscles, relaxing tight muscles, in presenza di un muscolo debole in assenza di contraimproving<br />
physical movement, reducing and elimi- �������������������������������������� -<br />
nating pain, and enhancing quality of life. To perform mento quando si correggono muscoli con contrazione<br />
��������������������������������������������������<br />
- ������������������������������������ -<br />
scle anatomy and kinesiology combined with a good tivo è che un’altro muscolo debole ha precedenza.<br />
understanding of body positioning is necessary. I’ve<br />
put together a DVD which outlines these procedures in<br />
detail, and provides thorough explanations on assessment<br />
and treatment of individual muscles.<br />
Conclusione<br />
��� ������������ �������� �� ���� ��������<br />
per: rinforzare muscoli deboli; rilassare muscoli rigidi,<br />
����������� ��� ���������� ������� �������<br />
dolore e migliorare la qualità della vita. Per poter uti-<br />
��������������������������������������<br />
��������������������������������������<br />
-<br />
nesiologia, combinate con una buona comprensione<br />
delle posizioni del corpo.<br />
Ho realizzato un DVD che evidenzia dettagliatamente<br />
queste procedure, e fornisce spiegazioni su valutazioni<br />
e trattamenti di muscoli individuali.<br />
Dr. Philip Maffetone is an internationally recognized Il Dr. Philip Maffetone è un ricercatore, clinicoeau �����������������������������������������������������<br />
- tore nel campo dell’allenamento, medicina dello sport,<br />
cise, sports medicine, food and nutrition, and biofe- alimentazione e nutrizione e retroazione biologica riedback.<br />
He is a former chairman of the <strong>ICAK</strong>-USA conosciuto a livello internazionale. È un ex Presidente<br />
and Vice President of <strong>ICAK</strong>’s International Council. ������������� �� ����� ����������� ���� - �����<br />
Dr Maffetone is the author of Complementary Sport nazionale dell’<strong>ICAK</strong>. Il Dr. Maffetone è autore dei libri<br />
Medicine (with English and <strong>Italia</strong>n version available); ���������������������������������������<br />
The Big Book of Endurance Training and Racing; In la versione in inglese sia in italiano); “Il Grande Libro<br />
Fitness and In Health; and many others. In 2003, dell’Allenamento della Resistenza e Corsa”; “In Forma<br />
he was presented with the prestigious Statuette ������������������������������������<br />
award by the International Academy for Child Brain l’Accademia Internazionale per lo sviluppo del cervello<br />
Development, named Coach of the year in 1995 by ��������������������������������������� -<br />
Triathlete Magazine, and in 2000 was honored by In- to Allenatore dell’anno 1995 dalla rivista Triathlete, e nel<br />
side Triathlon magazine as one of the top 20 most 2000 la rivista Inside Triathlon lo celebra come una del-<br />
�����������������������������������������������������<br />
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Maffetone continues to lecture on diet, nutrition and mondo. Il Dr. Maffetone continua a tenere conferenze<br />
stress management, and biofeedback. He became che riguardano alimentazione, nutrizione, gestione dello<br />
a songwriter in 2003 working with some of music’s stress e retroazione biologica. Diventa un cantautore nel<br />
legends including Johnny Cash, Rick Rubin and The 2003 e lavora con leggende della musica come Johnny<br />
Red Hot Chili Peppers.<br />
��������������������������������������<br />
His website combines his educational material along<br />
with his unique music: www.philmaffetone.com.<br />
6<br />
��������������������������������������<br />
sia la sua eccezionale musica: www.philmaffetone.com.
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Sudeck’s Dystrophy<br />
������������������<br />
Dr. Ivan Ramšak D.I.B.A.K.<br />
After a very painful personal experience with Sudeck’s<br />
Dystrophy, I devised a therapeutic program for dealing<br />
with this condition.<br />
Dopo un’esperienza personale molto dolorosa con la<br />
�������������������������������������� -<br />
peutico per trattare questa condizione.<br />
��������� �������� ����� ��������� - ������������������������������������������ ��� ������ �����<br />
thetic Dystrophy Syndrome (RSDS) is reported to ������������ ���������� ��������� ����<br />
occur after 5% of all traumatic injuries. It may occur ������������������������������������� -<br />
following fractures to the extremities, joint sprains or ��� ��� �������� ������������� ��� ���� ��<br />
following surgery. It has also been reported following a fratture alle estremità, distorsioni delle articolazioni<br />
immobilization and frostbite. It is thought to be caused o dopo operazioni chirurgiche. E’ stata riscontrata anby<br />
a dysfunction of the sympathetic nervous system, ������������������������������������<br />
which is involved in the regulation of blood supply to ritiene che sia causata da una disfunzione del sistema<br />
the affected part.<br />
The 3 phrases of symptomatology of Sudeck’s<br />
nervoso simpatico, che è coinvolto nella regolazione<br />
della fornitura del sangue alla parte interessata.<br />
Dystrophy occur as follows:<br />
����������������������������������������<br />
Phase 1<br />
����������������������<br />
Severe pain when resting or when moving; the skin Fase 1<br />
becomes swollen, shiny, bluish-colored, and there is Acuto dolore durante il risposo o movimento; la pelle si<br />
perspiration over the area.<br />
�������������������������������������� -<br />
Phase 2<br />
ne nell’area interessata.<br />
The color of the skin becomes pale and swelling di- Fase 2<br />
sappears but pain persists.<br />
��������������������������������������<br />
-<br />
Phase 3<br />
pare ma persiste dolore.<br />
Extremities feel stiff, pain free, atrophic and useless. Fase 3<br />
Therapeutic measures are only possible in phase 1 and<br />
2: In phase 1 by immobilizing and treating with ice, in<br />
phase 2 through intensive physiotherapeutic excercises.<br />
�������������������������������������� -<br />
I suffered a traumatic Patella subluxation of my left<br />
knee at age 36, tearing the Medial Retinaculum and<br />
parts of the Vastus Medialis. I was operated on the<br />
very next day in Villach, Austria by a surgeon who is<br />
also a friend of mine. The injured structures were sewn<br />
back together in layers and I had to remain in the hospital<br />
for 5 days.<br />
In the days that followed my release from the hospital,<br />
I lay at home and was haunted with thoughts “Will<br />
I ever be able to walk or play soccer again?” “Will I<br />
now have to live the rest of my life with pain?” and<br />
so on. Then I began to notice that the more I stayed<br />
���������������<br />
����� ���������� ������� ������������� ���<br />
due fasi:<br />
��������������������������������������<br />
ghiaccio;<br />
����������������������������������������<br />
All’età di 36 anni subii una sublussazione traumatica<br />
alla rotula del ginocchio sinistro, strappando il Retinaculum<br />
Mediale e parte del Vasto Mediale. Venni operato<br />
il giorno successivo a Villach, Austria, da un chirurgo<br />
che è anche un mio amico. Le strutture lesionate furono<br />
suturate insieme a strati e dovetti restare 5 giorni in<br />
ospedale.<br />
��������������������������������������<br />
-<br />
9
with these thoughts, the more my knee would ache. I<br />
even noticed a change in color as the area would become<br />
more black-and-blue. I would wake in the middle<br />
of the night in pain, particularly when these negative<br />
thoughts persisted. Such are the classic symptoms of<br />
the beginning phases of Sudeck’s Dystrophy.<br />
When I progressed to walking on crutches I was anxious<br />
to get back to work and my wife assisted me<br />
in doing so. Then a curious thing happened, I noticed<br />
that, as I listened intently to my patients’ problems, I<br />
forgot to listen to my own knee pain. It was as though<br />
my knee forgot to ache! I returned home enlightened<br />
and above all elated that my pain was gone.<br />
10<br />
le rimasi a letto sentendomi perseguitato da pensieri<br />
“Tornerò mai a camminare o a giocare a calcio?” “Dovrò<br />
vivere il resto della mia vita coi dolori?” e così via.<br />
��������������������������������������<br />
���������������������������������������<br />
cromatico dato che l’area stava diventando bluastra.<br />
Mi svegliavo nel cuore della notte in preda a dolori, in<br />
particolare quando persistevano questi pensieri negativi.<br />
Questi sono i classici sintomi delle fasi iniziali della<br />
�������������������<br />
Quando migliorai nel camminare con le stampelle ho<br />
voluto tornare al lavoro e mia moglie mi aiutò molto.<br />
Poi successe una cosa curiosa: mi accorsi che quando<br />
ascoltavo attentamente i problemi dei miei pazienti mi<br />
dimenticavo di ascoltare il dolore al ginocchio. E come<br />
previsto il mio ginocchio si scordò di dolere! Tornai a<br />
casa illuminato e soprattutto contento perchè il dolore<br />
era passato.<br />
This experience convinced me that Sudeck’s Dystrophy<br />
is caused by primarily by anxiety. In the literature,<br />
���� ����� ������ ������������ ���������� ������ ��� �����<br />
used interchangably for this condition which helped to<br />
����������������������������������������������������<br />
- Questa esperienza mi ha permesso di affermare che la<br />
thetic nervous system is completely overcharged and �������������������������������������� -<br />
there is spasm within the vascular system, leading to ��������������������������������������� -<br />
decreased circulation and pain. Emotionally we can sa” è anche intercambiabile per questa condizione e<br />
become gripped by fear. In fact a Sudeck’s Dystrophy ha aiutato a confermare la mia convinzione. Durante<br />
is often referred to colloquially as “painful ankylosis.” un attacco d’ansia il sistema nervoso simpatico è com-<br />
The following describes my observations as well as pletamente sovraccaricato ed è presente spasmo nel<br />
the practical procedures (by hands and by words) by sistema vascolare, che peggiora la circolazione e pro-<br />
which I was able to arrive at a successful outcome to voca dolore. Emozionalmente possiamo farci prendere<br />
this condition.<br />
��������������������������������������<br />
chiamata colloquialmente “anchilosi dolorosa“.<br />
������������������������������������������������������<br />
- Ciò che segue descrive le mie osservazioni e i metodi<br />
jury in one’s life or one which occured under very tragic pratici (con le mani e le parole) con cui sono stato in<br />
circumstances. The sense of invincibility that young grado di raggiungere risultati stimati per uscire da que-<br />
people typically enjoy is shattered by the experience sta condizione.<br />
of intense pain and/or confrontation with death. This<br />
becomes even more pronounced when a second party<br />
was responsible for the injury.<br />
At sporting events, ankle sprains of the external ligaments<br />
is a very common occurence, and such injuries<br />
usually heal quickly and without much ado. A typical<br />
scenario of patient presentation with an acute ankle<br />
sprain involves a young person on crutches, accompanied<br />
by worried parents many of whome have already<br />
had a cast over the area. As such most are avoiding<br />
any type of pressure on the injured limb. On the<br />
contrary, they thend to hold it away from the body like<br />
an alien object. Any attempt to shift weight onto the<br />
injured limb or stretch the muscles over the area in any<br />
way, gives way to facial expressions of agony, sometimes<br />
real sometimes exaggerated. In any case this is<br />
an indication of a psychological component. Now it’s<br />
up to the doctor to earn the patient’s trust by playing<br />
down the injury with good bedside manner. This can<br />
achieved by showing them how the maximum tension<br />
in the A.K. muscle or weight-bearing tests demonstrate<br />
normal results. Then once I’ve ascertained that there<br />
was no injury to the bone, I will remove their crutches<br />
and cast and have them shift their weight onto the injured<br />
limb, assuring them that only a small ligament of<br />
the exterior ankle has been strained. To demonstrate<br />
this, I will actually sit on the patient’s thigh to prove<br />
�������������������������������������� -<br />
sione nella vita di una persona o una che è accaduta in<br />
circostanze molto tragiche. Il senso di invincibilità che<br />
hanno tipicamente i giovani viene distrutto dall’esperienza<br />
di un dolore intenso e/o confronto con la morte.<br />
Questo è ancora più evidente quando c’è una seconda<br />
persona come responsabile dell’incidente.<br />
Agli eventi sportivi le distorsioni alla caviglia del legamento<br />
esterno sono molto comuni e generalmente<br />
guariscono in poco tempo e con poche complicazioni.<br />
Un tipico scenario di distorsione acuta della caviglia<br />
coinvolge un ragazzo che si presenta nel nostro studio<br />
con le stampelle, accompagnato da genitori preoccu-<br />
��������������������������������������<br />
considerebbero nemmeno l’idea di ricevere pressione<br />
sull’arto ferito. Lo tengono invece lontano dal corpo<br />
������������������������������������<br />
-<br />
stare il peso sull’arto ferito o di stirare in qualche modo<br />
il muscolo del piede, la loro espressione facciale esprime<br />
un dolore esagerato, in che indica una componente<br />
psicologica. Adesso tocca al dottore guadagnare la<br />
���������������������������������������<br />
�������������������������������������<br />
frattura all’osso, rimuoverò il gesso e le stampelle e<br />
farò in modo che il peso si sposti sull’arto ferito, assicurando<br />
loro che si è stirato solo un piccolo lega
that they can even support the weight of my body without<br />
pain. By this point most patients are convinced,<br />
but nevertheless I will often walk several steps with the<br />
patient, supporting him long enough for them to be<br />
reassured that that they will be OK. and on their way<br />
toward full recovery.<br />
However no matter which supplemental therapies I<br />
apply, I have yet to see any homeopathic remedy or<br />
otherwise work as fast and effectively as that which<br />
an be achieved by combining the right words with the<br />
aforementioned procedures!<br />
I wish you a lot of success in your treatment of Sudeck’s<br />
Atrophy patients in the future and look forward<br />
to your feedback.<br />
As a general medical doctor working in private practice<br />
in Klagenfurt, Austria since 1996 Dr. Ramšak uses<br />
Applied Kinesiology both diagnostically and therapeutically<br />
into his standard medical protocol. He has<br />
extensive training in manual medicine and sports<br />
medicine and has been He is a Diplomate (D.I.B.A.K)<br />
in Applied Kinesiology and President of the Austrian<br />
chapter of Applied Kinesiology (<strong>ICAK</strong>) since March<br />
2000 and lectures internationally.<br />
mento della caviglia esterna. Per fornirgli una prova,<br />
mi siederò sul loro femore dimostrando che riescono<br />
a sostenere il peso del mio corpo senza provare dolore.<br />
Di solito questo basta per convincerli, tuttavia li<br />
���������������������������������������<br />
-<br />
do non si sentono sicuri di stare bene. A questo punto,<br />
���������������������������������������<br />
This strategy can be applied to any joint using the associated<br />
muscle tests and all other reasonable impact Un’ulteriore prova della probabile causa della Distrochallenges.<br />
There are no limits to the therapist’s imagi- �������������������������������������<br />
nation and creativity.<br />
sempre in modo positivo al Rescue Remedy e altri ri-<br />
Further proof of the probable cause of Sudeck’s Dymedi dai Fiori di Bach con standard di test muscolari<br />
strophy is the fact that patients nearly always respond K.A. Ma devo ancora vedere gli effetti positivi di rime-<br />
���������������������������������������������������<br />
di omeopatici o altrimenti lavorare tanto velocemente<br />
with standard A.K. muscle testing. I also typically use ed operativamente quanto ciò che si può raggiungere<br />
acupunture points from the yin cycle in order to calm utilizzando le parole giuste e le procedure descritte!<br />
anxiety as well as other therapeutic measures such Arrotondando la terapia, per calmare l’ansia uso solita-<br />
as magnetic induction (calcium, vitamin D3 - rather in mente punti di agopuntura dal ciclo yin così come altre<br />
phase 3), potentiated arnica, comfrey, horse chestnut metodologie terapeutiche come l’induzione magnetica<br />
preparation and so forth.<br />
(calcio, vitamina D3 - preferibilmente nella fase 3), preparazioni<br />
di arnica potenziata, symphytum, ippocastano<br />
e così via.<br />
Queste metodologie supplementari non potranno mai<br />
rimpiazzare il potere delle strategie descritte sopra!<br />
Vi auguro molto successo nei trattamenti sui pazienti<br />
��������������������������������������<br />
����������������<br />
Il Dr. Ramšak, in qualità di medico generico che dal<br />
1996 lavora anche privatamente a Klagenfurt (Austria),<br />
utilizza la <strong>Kinesiologia</strong> <strong>Applicata</strong> sia per terapia sia per<br />
diagnostica, all’interno del suo protocollo medico standard.<br />
Possiede ampie conoscenze di medicina manuale<br />
e medicina dello sport ed è stato He is a Diplomate<br />
(D.I.B.A.K.) in <strong>Kinesiologia</strong> <strong>Applicata</strong> e presidente del<br />
capitolo austriaco di <strong>Kinesiologia</strong> <strong>Applicata</strong> (<strong>ICAK</strong>) a<br />
partire da marzo del 2000. Tiene conferenze a livello<br />
internazionale.<br />
11
Note: This paper was originally published in the Florida<br />
Chiropractic Association Journal. Reference: Nociceptor<br />
Stimulation-Blocking (NSB) Technique for<br />
Acute Pain Relief, Florida Chiropractic Association,<br />
Inc. Journal.<br />
NSB Technique is taught in Session 1 of the “What<br />
to Do First, Next, & Last - Quintessential Applications<br />
Clinical Protocol” Course that is now being offered in a<br />
distance learning format.<br />
Go to www.quintessentialapplications.com<br />
Part 1<br />
NOCICEPTOR STIMULATION-BLO-<br />
CKING (NSB) TECHNIQUE FOR<br />
ACUTE PAIN RELIEF<br />
Abstract<br />
A pain control technique is presented based on functional<br />
neurological assessment using applied kinesiology<br />
(AK) manual muscle testing (MMT) procedures. Severe<br />
acute pain results in general muscle inhibition (MMT<br />
weakness) due to nociceptive barrage. Likewise, pressure<br />
to an acute painful area or moving a joint through<br />
a painful range of motion can cause general muscle<br />
inhibition (MMT weakness). The induced weakness is<br />
negated when the doctor taps or the patient touches<br />
(therapy localizes - TLs) to ipsilateral acupuncture head<br />
points. Tapping or touching one head point will negate<br />
the general weakness. Tapping this head point coincident<br />
with pressure to painful area or moving the joint<br />
through the painful range of motion results in dramatic<br />
pain relief and increased range of motion.<br />
Introduction<br />
Our understanding of the functional neurology of pain<br />
and pain control has led to the development of an<br />
Hands-on pain relief from<br />
“Stop Your Pain Now!” Part 1<br />
Eliminazione Manuale del Dolore da<br />
“Ferma Il Tuo Dolore Adesso!” Parte 1<br />
Dr. Walter H. Schmitt D.C., D.I.B.A.K., D.A.B.C.N.<br />
Dr. Kerry M. McCord D.C., D.I.B.A.K.<br />
����������������������������������������<br />
-<br />
cato sul Florida Chiropractic Association Journal.<br />
������������������������������������������<br />
-<br />
���������������������������������������<br />
-<br />
tic Association, Inc. Journal.<br />
a ��������������������������������������<br />
����������������<br />
����������������������������������������<br />
-<br />
zioni Fondamentali” del corso offerto anche in versione<br />
video per insegnamento a distanza. Per maggiori informazioni<br />
visitare www.quintessentialapplications.com<br />
Parte 1<br />
LA TECNICA DI BLOCCO DELLA<br />
������������� ��������<br />
��������������������<br />
Riassunto<br />
����������������������������������������<br />
su un’analisi neurologico-funzionale attraverso procedure<br />
di test muscolari della <strong>Kinesiologia</strong> <strong>Applicata</strong>. La<br />
presenza di dolore acuto consiste in una generale inibizione<br />
neurologica che coinvolge tutto il sistema muscolare.<br />
Allo stesso modo la stimolazione di un area<br />
di dolore o il movimento di un’articolazione dolorante<br />
provoca la stessa risposta inibitoria a livello sistemico.<br />
Tale inibizione può essere eliminata stimolando i punti<br />
di agopuntura della testa sullo stesso lato del corpo<br />
ove si trova il dolore con un picchiettio o terapia locale<br />
(TL) da parte del paziente. Picchiettare o toccare<br />
il punto corretto nega l’inibizione sistemica nocicettivo-indotta<br />
che si traduce nella normalizzazione della<br />
risposta muscolare. Picchiettare tale punto mentre si<br />
aggrava leggermente il dolore attraverso la pressione<br />
nell’area o muovendo l’articolazione nella direzione dolente<br />
risulta in una importante eliminazione del dolore<br />
��������������������������������������<br />
13
NSB technique involved tapping of an acupuncture<br />
head point coincident with activation of a nociceptive<br />
barrage. This results in a presumed stimulation of descending<br />
pain blocking pathways and also normalizes<br />
sources of muscle inhibition resulting in dramatic decreases<br />
in pain and increases in range of motion.<br />
14<br />
Introduzione<br />
extremely useful clinical approach to acute pain. No-<br />
������������������������������������������������������<br />
-<br />
troduced in 19891 , is based on the application of the<br />
neurophysiology of pain. In 1999, the use of NSB technique<br />
without MMT was introduced in the book entitled<br />
Stop Your Pain Now! that was produced for patients<br />
and non-AK practitioners. 2 NSB technique can be used<br />
immediately following an injury and is most useful up to<br />
one or two weeks following the onset of pain.<br />
NSB technique employs applied kinesiology (AK) manual<br />
muscle testing (MMT) to identify patterns of general<br />
inhibition (MMT weakness) that are often present<br />
following injury. MMT used in this fashion becomes an<br />
extension of the standard neurological exam. That is,<br />
MMT is employed as functional neurological assessment<br />
that extends potential of the neurological exam<br />
to identify the array of neurological phenomena between<br />
“normal” and overt pathology. 3<br />
La nostra comprensione dei meccanismi alla base del<br />
dolore e del suo controllo dal punto di vista neurologico-funzionale<br />
ha permesso lo sviluppo di tecniche<br />
molto utili nell’affrontare situazioni di dolore acuto. La<br />
����������� ��������������������� ��������<br />
��� �������������������� ������ ���������� -<br />
trodotta nel 19891 si basa sull’applicazione diretta di<br />
��������������������������������������� -<br />
��������������������������������������<br />
����������������������������������������<br />
il dolore adesso!) scritto nel 1999 per l’utilizzo da parte<br />
di persone non specializzate in campo sanitario. 2<br />
��������������������������������������<br />
subito un trauma e risulta molto utile nelle due settimane<br />
successive l’incidente e quindi l’inizio del dolore.<br />
��� �������� ���� ��������� ��� ����� - �����<br />
��� ����� ���� ������������ ������� ��� ������<br />
spesso presenti dopo il trauma. In questo contesto il<br />
test muscolare risulta un’aggiunta ai classici test neuro-<br />
�������������������������������������<br />
di analisi neurologica-funzionale per discernere fra uno<br />
stato neurologico normale o patologico. 3<br />
��������������������������������������������������������<br />
-<br />
���������������������������������������������������������<br />
����������� ������ ��������� ���� ������� ��� ����� �������<br />
���������������������������������������������������������<br />
-<br />
multaneously inhibiting ipsilateral extensors promoting<br />
�������������������������������������������������������<br />
-<br />
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��������������������������������������������������������<br />
contralateral extensors to support the body against gravity<br />
and allows for the extensor inhibition on the side of<br />
4<br />
��������������������������������������������<br />
In reality, the entire process in humans is better termed<br />
��������������������������������������������������������<br />
����������������������������������������������������<br />
even reversed depending on the starting position of the<br />
patient when the tissue encounters the threatening stimulus.<br />
The strength of the withdrawal is dependent on<br />
the intensity of the peripheral stimulus. The greater the<br />
����������������������������������������������������������<br />
��������������������������������������������������������<br />
a point. In fact in excessive nociceptive barrage such as<br />
in minor fracture or major sprain, there is a facilitation of<br />
�����������������������������������������������������<br />
-<br />
tive splinting or guarding reaction of surrounding muscles<br />
so commonly observed following these injuries. 4<br />
����������������������������������������<br />
agopuntura, situato sul viso, con il risultato di attivare<br />
una barriera in grado di bloccare lo stimolo nocicettivo.<br />
Questo risulta, probabilmente, nella stimolazione di vie<br />
nervose discendenti in grado di inibire la nocicezione.<br />
Questo fenomeno e’ osservabile dall’eliminazione dei<br />
pattern di inibizione muscolare e dal importante aumento<br />
di movimento e rispettiva diminuzione del dolore.<br />
L’attivazione dei nocicettori sfocia nello stimolo<br />
���� ����� �������� ���������� ��������� ���<br />
������������������������<br />
����������������������������������������<br />
-<br />
so lato dello stimolo nocicettivo inibendo simultaneamente<br />
i muscoli estensori e provocando un rapido<br />
���������������������������������������� -<br />
������������������������������������� -<br />
��� ��������������� ������ ��������� - ������<br />
��������������������������������������<br />
����������������������������������������<br />
al corpo di rimanere stabile contro la gravità e quindi<br />
evitare di cadere a terra.<br />
But if the nociceptive stimulus is extremely excessive,<br />
such as in a major fracture or major body impact (e.g.,<br />
contact sports or severe fall), then this elevated level of<br />
nociceptive barrage results in a total inhibition of �������<br />
and extensors, not just locally, but extending throughout<br />
the body. Witness the football player who takes a severe<br />
“hit”, goes down on the turf, and just lies there without<br />
������������������������������������������������������<br />
4<br />
L’intero processo nell’essere umano prende il nome<br />
����������������������������������������<br />
���������������������������������������<br />
-<br />
����������������������������������������<br />
alterato o addirittura opposto rispetto alla posizione<br />
in cui il paziente si trovava un istante prima di venire<br />
a contatto con lo stimolo nocicettivo. L’intensità e la<br />
�������� ������ ��������� ��� ���������� �<br />
dall’intensità della stimolazione nocicettiva periferica:<br />
maggiore è la risposta nocicettiva e maggiore sarà la<br />
�������������������������������������<br />
E’ infatti noto che in presenza di una stimolazione nocicettiva<br />
elevata come nel caso di una frattura mino-<br />
��������������������������������������<br />
estensori vengano facilitati provocando quella reazione
Interneuron Inhibits<br />
(incoming) Nociception<br />
TO<br />
Anterolateral<br />
Spinal Tracts<br />
- Spinothalamic<br />
- Spinoreticular<br />
- Spinotectal<br />
MECHANORECEPTOR ACTIVITY<br />
Mechanoreceptor<br />
Nociceptor<br />
TO: Autonomic Ganglion<br />
Flexor Alpha-Motorneuron (for)<br />
Flexor Withdrawal Response<br />
1. Inhibits Incoming Nociception (as shown);<br />
2. Restores Alpha-Motorneuron Activity Negating Muscle Imbalance<br />
Associated with the ���������������������<br />
(Withdrawal) Response;<br />
3. Blocks Autonomic (Sympathetic) Effects (Intermediolateral Cell Column)<br />
Autonomic<br />
Motorneuron (in)<br />
Intermediolateral<br />
Column<br />
Fig.1 Nociceptor Transmission & Mechanoreceptor Blocking in Spinal Cord 6 © 2009 Kerry M. McCord and Walter H. Schmitt. Used with permission<br />
protettiva da parte dei muscoli circostanti spesso incontrata<br />
sotto forma di spasmo. 4<br />
the player conscious, but not moving. The nociceptive<br />
barrage has resulted in a massive inhibition of all skeletal<br />
muscles. As the barrage lessens, the player “comes out<br />
of it”, and those observing from the stands see him jump ������ ����������� ��� ���� ��� �������� ��<br />
�����������������������������������������������������������<br />
esagerato, come nel caso di grosse fratture o impat-<br />
play. As this inhibitory barrage wears off, the player can ti molto violenti, la cascata di stimolazione nocicettiva<br />
usually return to full action within a few minutes if there ����������������������������������������<br />
are no signs of local or neurological injury.<br />
estensori a livello globale e non solamente locale. E’ il<br />
15
It is this principle of generalized inhibition of muscles resulting<br />
from excessive nociceptive barrage upon which<br />
NSB technique for acute pain control is based. Using<br />
muscle testing as functional neurological evaluation, we<br />
can employ these neurological principles to evaluate<br />
16<br />
caso del giocatore di football americano che dopo un<br />
impatto violento rimane a terra esanime. L’allenatore<br />
corre sul posto per scoprire che il giocatore e’ cosciente<br />
ma immobile: la cascata nocicettiva ha provocato<br />
la temporanea inibizione di tutto il sistema muscolare.<br />
Più la stimolazione diminuisce più il giocatore inizia ad<br />
������� ��� ������ ��� ��������� ������� ���<br />
alzarsi e con un paio di scatti uscire dal campo. L’abbassamento<br />
dello stimolo, in assenza di effettivi traumi<br />
locali e/o neurologici, spesso permette al giocatore di<br />
����������������������������������������������������������<br />
������������������������������������������������������������<br />
���������������������������������������������������������<br />
������������������������������������������<br />
��������� ������������ ������� ��� ���� tornare ����� sul campo ������������<br />
in pochi minuti.<br />
������� ��� ��� ��������� ��� ���� ��� �����<br />
L’utilizzo del test muscolare come mezzo di valutazione<br />
neurologico-funzionale permette di affrontare e trattare<br />
condizioni di dolore acuto, sia sul campo che in studio.<br />
Andiamo ora nel dettaglio sui due fronti, ossia nell’applicazione<br />
della tecnica sia in studio che sul campo.<br />
Il primo scopo terapeutico dovrebbe essere mirato<br />
all’eliminazione o abbassamento del dolore. Gli effetti<br />
della stimolazione nocicettiva sul sistema autonomo,<br />
���������������������������������������<br />
muscolo-scheletrico non permettono una chiara analisi<br />
���������� ��������������� ��� �������� ���<br />
procedure primarie da considerare nel trattamento del<br />
paziente attraverso un approccio neurologico comprensivo.<br />
5-6<br />
endeavor addressed when treating patients. The effects<br />
of nociception on autonomic, endocrine, immune, and<br />
emotional patterns as well as the neuromuscoskeletal<br />
adaptations to nociception will obscure clear evaluation<br />
of these areas of concern. NSB technique is near the top<br />
of the list of procedures to be considered in a comprehensive<br />
neurologically based approach to patient care. 5-6<br />
������������������������<br />
When a patient has an injury, it is accompanied by<br />
varying levels of pain and decreased range of motion<br />
depending on many factors. Part of our assessment<br />
of an area of injury should include a functional neurological<br />
evaluation of the amount of nociception arising<br />
from the injured site which is the basis for the NSB<br />
����������� ���� ����� ����� ��� ����� - ����������� ��� ��� ���<br />
form MMT on several muscles distant to the site of<br />
injury using standard MMT procedures. 7 Identify muscles<br />
that show a “strong” response to MMT since<br />
these muscles will be used as indicators of the level of<br />
nociceptive barrage in the next step of NSB which is<br />
nociceptive stimulation.<br />
Increase the amount of nociceptive barrage by either<br />
pressing over the area of injury or asking the patient to<br />
move the area enough to elicit pain. In many cases, we<br />
ask the patient to press on the painful area so that we<br />
do not exceed the patient’s pain tolerance. In structural<br />
(muscle, ligamentous, and bone) injuries, where the stability<br />
of the area may be compromised and movement<br />
may result in further injury, we opt for the pressure to the<br />
injured area rather than the movement of the area.<br />
Of course, we do not wish to injure the patient further,<br />
but evaluation of the nociceptive system does require us<br />
Trattamento di situazioni acute in studio<br />
In seguito ad un trauma, il paziente avrà diversi livelli di<br />
dolore e di diminuzione del movimento. Una parte del<br />
nostro modo di esaminare l’area traumatizzata dovrebbe<br />
includere una valutazione neurologico-funzionale<br />
che permetta di determinare il grado di stimolazione<br />
nocicettiva derivante dal tessuto leso: questa e’ la base<br />
������������������<br />
Il primo passo consiste nel testare diversi muscoli lontani<br />
dal sito traumatizzato utilizzando le procedure classi-<br />
����������������������������������������<br />
tonici, ossia forti, in quanto essi permetteranno l’analisi<br />
dei livelli nocicettivi nel passo successivo della tecnica<br />
��������������������������������������<br />
�������������������������������������� -<br />
sione sul punto traumatizzato o chiedendo al paziente<br />
di muovere l’arto nella direzione dolente. E’ buona norma<br />
chiedere al paziente anche di stimolare la parte lesa<br />
���������������������������������������<br />
���������������������������������������������������������<br />
the area of injury. We inform the patient that the procedure<br />
is to analyze the amount of pain experienced, and<br />
���������������������������������������������������������<br />
muscolo-scheletrici (muscoli, legamenti ed ossa) dove<br />
pain with the goal of decreasing it if possible. Patients la stabilità dell’area potrebbe essere messa a repenta-<br />
cooperate well with the procedure if they are informed glio da ulteriori movimenti che potrebbero peggiorare il<br />
of what is being done and why it is being done.<br />
Palpation of the injured area should proceed ca-<br />
danno, basta premere sul punto evitando di muoverlo.<br />
refully until the most painful area is identified. It is In alcun modo intendiamo peggiorare la situazione<br />
this area which we then stimulate. Nociceptive sti- ma la valutazione del sistema nocicettivo richiemulation<br />
is enough to cause the patient a painful ��� ��� �������� ������������� ��� ���� �<br />
experience but within tolerable limits for the pa- dolore derivante dal punto di trauma. E’ necessario<br />
tient. We ask the patient if the level of pressure is spiegare al paziente che la procedura necessita di<br />
tolerable and try to stimulate pain within this tole- analizzare la quantità di dolore provata e che stiamo<br />
rance boundary.<br />
cercando il punto centrale del dolore per eliminarlo.<br />
Immediately upon initiating the painful pressure we<br />
������������������������������������
etest the previously strong indicator muscle(s) using<br />
MMT. General weakening (inhibition) of strong muscles<br />
implies a nociceptive barrage that is not being appropriately<br />
blocked by the body’s normal pain control mechanisms.<br />
This is the indication to proceed with NSB<br />
technique.<br />
Normal nociception results in stimulation of spinal<br />
cord transmission cells. See Figure 1.<br />
These cells give rise to the contralateral ascending anterolateral<br />
spinal tracts which include the spinoreticular,<br />
spinotectal, and spinothalamic tracts. The spinoreticular<br />
tract gives off collaterals to the large celled nuclei in<br />
the caudal reticular formation (e.g., nucleus raphe magnus,<br />
nucleus gigantocellularis) which in turn give off<br />
This mechanism represents the body’s builtin<br />
self-limiting reflex pain blocking system.<br />
This inhibition takes place both presynaptically<br />
and postsynaptically as well as through<br />
interneurons. It is suggested that this reflex<br />
mechanism is not functioning optimally when<br />
NSB is indicated.<br />
meglio la procedura una volta informati di cosa sta<br />
per succedere.<br />
���������������������������������������<br />
il punto più doloroso. Questo sarà il punto su cui lavoreremo.<br />
Chiedere al paziente se la pressione eccede i<br />
livelli di sopportazione e regolarsi di conseguenza.<br />
Inhibition of pain by descending<br />
Dopo aver stimolato il punto, bisogna immediatamen-<br />
suprasegmental pathways<br />
te testare il muscolo normo-tonico precedentemente<br />
Nociceptive stimulation normally results in a simple brain- ��������� ���� ����� ��� ���� ����� �������<br />
���������������������������������������������������������<br />
��������������������������������������� -<br />
cord level via descending pathways. See Figure 2.<br />
cicettiva non può essere bloccata in modo appropria-<br />
You can easily observe this self-limiting pain control to dai meccanismi naturali del corpo. Ecco allora che<br />
pathway by trying a simple exercise to demonstrate ���������������������������������������<br />
the principle. See box.<br />
OBSERVE THE SELF-LIMITING<br />
PAIN CONTROL PATHWAY<br />
ON YOURSELF<br />
Inibizione del dolore attraverso le vie<br />
discendenti sopra-segmentali<br />
A livello neurologico uno stimolo nocicettivo risulta<br />
nell’attivazione di un semplice riflesso sotto-cerebrale<br />
che spegne il nocicettore stesso a<br />
livello spinale attraverso delle vie discendenti.<br />
Ecco un modo per capire il funzionamento di que-<br />
� Pinch the back of your hand or your<br />
sta via nervosa.<br />
�������������������������������������������<br />
�<br />
hand.<br />
� Use moderate pressure - enough to<br />
create a very mild pain response - and<br />
����� ��������� ������� �������<br />
maintain this constant pressure for one<br />
LA CAPACITÀ INIBITORIA DELLE VIE<br />
full minute.<br />
���������������<br />
� Observe the level of discomfort on<br />
initiating the pinching and then how it<br />
� Datevi un pizzicotto sul dorso della mano<br />
diminishes over time.<br />
o del braccio.<br />
� About ninety percent people who do this<br />
� Fatelo con una pressione moderata<br />
�������������������������������������������<br />
�<br />
senza esagerare e mantenete tale<br />
of their pain perception during the minute<br />
pressione per 1 minuto intero.<br />
of the exercise.<br />
� Osservare come lo stesso stimolo<br />
doloroso col tempo si attenui rispetto<br />
all’inizio.<br />
���������������������������������<br />
effettuano tale procedura sentiranno<br />
una diminuzione del dolore dopo<br />
un solo minuto.<br />
Quando uno stimolo nocicettivo provoca una<br />
reazione di ipotonicità generalizzata questi<br />
�������������������������������������������������������<br />
meccanismi di controllo non funzionano in<br />
���������������������������������������������������<br />
- modo appropriato. Questo permette allo sti-<br />
ming nociceptive input as shown in Figure 2.<br />
molo di raggiungere il sistema nervoso centrale<br />
provocando la reazione di ipotonia sopra<br />
spiegata.<br />
Uno stimolo nocicettivo normalmente risulta<br />
A number of neurotransmitter substances are implicanell’eccitazione<br />
di una cellula di trasmissione a livello<br />
spinale. Queste cellule iniziano il tratto spinale<br />
contro-laterale antero-laterale ascendente che<br />
comprende il tratto spino-reticolare, spino-tettale<br />
e spino-talamico. Il tratto spino-reticolare, nello<br />
specifico, produce collegamenti collaterali con i<br />
���������������������������������������������������<br />
nuclei delle grosse cellule della formazione retico-<br />
on which pathway is involved. These include serotonin, lare caudale (come il nucleo del raphe magnus, il<br />
17
18<br />
Anterolateral<br />
Spinal Tract<br />
CAUDAL<br />
RETICULAR<br />
NUCLEI<br />
Inhibition at<br />
Spinal Cord<br />
Fig.2 SUPRASEGMENTAL INHIBITION OF INCOMING NOCICEPTION BY DESCENDING PATHWAYS (6)<br />
© 2009 Kerry M. McCord and Walter H. Schmitt. Used with permission<br />
GABA, norepinephrine, and endorphins including Metenkephalin.<br />
NSB treatment procedure<br />
The indicator for the need of NSB technique is when<br />
general muscle weakness to MMT is created by aggravating<br />
an area of injury - either by pressure to the area<br />
or by moving the area into a painful range of motion.<br />
Aggravation of the pain should be mild, that is, to the<br />
patient’s tolerance. The patient is often asked to create<br />
the pressure or movement so that pain tolerance is not<br />
exceeded. The goal is to induce nociception, but not<br />
to create further tissue damage.<br />
nucleo giganto-cellulare) che a loro volta formano<br />
le fibre discendenti del fascicolo dorso-laterale.<br />
Queste fibre discendono a livello spinale e bloccano<br />
lo stimolo nocicettivo in entrata come mostrato<br />
in figura.<br />
Tale meccanismo rappresenta uno dei sistemi automatici<br />
del corpo di limitare e bloccare il dolore.<br />
NOCICEPTOR<br />
Transmission Cell in Lamina V<br />
Tale inibizione avviene per-sinapticamente, postsinapticamente<br />
ed attraverso interneuroni. Abbiamo<br />
ipotizzato che nella situazione in cui fosse<br />
������������ ����������� ������ ��������<br />
meccanismo non funzionerebbe adeguatamente.<br />
Diversi sono i neurotrasmettitori implicati nel meccanismo<br />
di interruzione del dolore a seconda del-<br />
��� ���� ������������ ���� ��� ����� ����<br />
��� ������ ��� �������������� �� ��� ��������<br />
Met-encefaline).<br />
Procedura del trattamento NSB<br />
Quando si aggrava il dolore e si provoca una generale<br />
ipotonia, attraverso una pressione sul punto di trauma<br />
o un movimento doloroso, e’ indicato l’utilizzo della<br />
����������������������������������������<br />
-<br />
re la tolleranza del paziente al dolore stesso. Lo scopo<br />
e’ quello di indurre nocicezione senza però provocare<br />
ulteriori danni.<br />
��� ������������ ��������� ���������������<br />
agopuntura situati sul viso. Tali punti sono stati chia-<br />
�������������������������������������<br />
(Ending) dei rispettivi meridiani di agopuntura. 8 NSB treatment procedure for acute pain employs<br />
�������������������������������������������������<br />
called the “B and E” points because they are either<br />
the beginning or ending points of their respective<br />
acupuncture meridians.<br />
� ����<br />
corpo troviamo 6 meridiani bilaterali e 2 centrali che o<br />
iniziano o terminano sul viso.<br />
8 There are six bilateralmeri dians and two midline meridians that either begin or<br />
end on the head. See Figure 3.<br />
Stimulation of the appropriate acupuncture head<br />
������ ��� ������ ��� ���������� ����� ������������ ��� �����<br />
point negates the nociception induced muscle weakening<br />
effects. The point should be found ipsilateral<br />
to the area of injury. In midline injuries, the midline<br />
points (GV-27 or CV-24) will usually be found.<br />
��������������������������������������������������<br />
�����������������������������������������<br />
-<br />
1. Patient therapy localization (TL) - which means ha- vando quale di essi annulli la generale ipotonia nociving<br />
the patient touch each point<br />
cettore-indotta, cioè che rafforzi il muscolo indebolito<br />
2. The doctor taps each point two or three times.<br />
dopo aver aumentato il dolore. Il punto si trova sullo<br />
stesso lato del corpo in cui e’ avvenuto il trauma.<br />
As nociception is induced,each acupuncture head ���������������������������������������<br />
point (ipsilateral to the injury) is stimulated one-by-one<br />
until the induced weakness is negated by one of them.<br />
GV-27 e CV-24 saranno solitamente positivi.<br />
Only the appropriate treatment point will block the mu-<br />
Esistono due modi per trovare tale punto:
scle weakening reaction induced by pressure or movement<br />
to the injured area.<br />
Upon identifying the acupuncture head point which<br />
blocks the general nociception induced weakness, the<br />
treatment procedure is quite simple. Tap the indicated<br />
acupuncture head point (at a rate of 4 5 times per second)<br />
while intermittently stimulating the painful area<br />
within the limits of the patient’s tolerance.<br />
Fig.3 ACUPUNCTURE HEAD POINTS (6) © 2009 Kerry M. McCord and Walter H. Schmitt. Used with permission<br />
It is best to stimulate the painful area with intermittent<br />
pressure rather than continual pressure while tapping<br />
on the head point. Continuous pressure tends to over<br />
stimulate the nociceptive system. Even though we are<br />
attempting to block the incoming nociceptive barrage,<br />
intermittent pressure to the painful area simultaneous<br />
with tapping the head point has proven more effective<br />
and less rigorous for the patient. Intermittent nociceptor<br />
stimulation for about one second with about three<br />
seconds in between stimuli is effective yet tolerable.<br />
Tapping will tend to decrease the sensitivity of the<br />
painful area and allow increased pressure or range<br />
of motion to be applied as the tapping is continued.<br />
The tapping is continued until a maximal response<br />
of relieving pain is achieved. This usually requires<br />
from thirty seconds up to two or three minutes. A<br />
typical response causes a dramatic decrease in pain<br />
and increase, if not a return to normal, of range of<br />
Case history<br />
A 35 year old male was seen the day following a lateral-to-medial<br />
trauma to the left knee. The injury had taken<br />
place while playing beach volleyball when a teammate<br />
fell cross body against the lateral aspect of the<br />
1. Il paziente tocca con un dito (TL) il punto<br />
2. il medico picchietta 2-3 volte il punto, fino a<br />
che non si osserva un cambiamento del test muscolare.<br />
Quindi, mentre si aumenta il dolore (il che provoca ipo-<br />
������������������������������������<br />
���������������������������������������<br />
il punto corretto sarà in grado di bloccare la debolezza<br />
Acupuncture Meridian Head<br />
Point Translation Key<br />
1. LI - Large Intestine 20<br />
2. S - Stomach 1<br />
3. B - Bladder 1<br />
4. GB - Gall Bladder 1<br />
5. TW - Triple Warmer 23<br />
6. SI - Small Intestine 19<br />
7. GV - Governing Vessel 27<br />
8. CV - Conception Vessel 24<br />
muscolare indotta dalla pressione sul punto lesionato o<br />
il movimento doloroso.<br />
�������������������������������������� -<br />
sto semplice: picchiettare il punto con un ritmo di 4-5<br />
volte al secondo mentre ad intermittenza si stimola il<br />
punto di dolore nei limiti di tolleranza del paziente.<br />
����������������������������������������<br />
-<br />
mittenza l’area lesionata, senza mantenere una stimolazione<br />
costante mentre si picchietta il punto di agopuntura.<br />
Una pressione costante tende a provocare troppa<br />
����������������������������������������<br />
bloccare il dolore, clinicamente la stimolazione ad intermittenza<br />
con un ritmo di 1 secondo di stimolazione e 3<br />
�����������������������������������������<br />
Più si procede in questo modo più si potrà aumentare la<br />
stimolazione nocicettiva per ottenere lo stesso risultato<br />
����������������������������������������������������<br />
�������������������������������������� -<br />
the sharpness of the pain, although the area is often ����������������������������������������<br />
-<br />
still described as sore following application of NSB do non si raggiunge un plateau dove non si ottiene più<br />
technique. However, we have had a number of pa- ulteriore miglioramento. Il tempo di stimolazione necestients<br />
report a complete reduction of pain with no ��������������������������������������<br />
recurrence.<br />
la risposta consiste in un forte aumento del movimento<br />
e/o diminuzione del dolore, nonostante la conseguente<br />
irritazione del punto. Abbiamo avuto casi di completa remissione<br />
del dolore che e’durata nel tempo.<br />
Caso clinico<br />
Un uomo di 35 anni viene visitato 24 ore dopo un<br />
19
patient’s knee. The patient presented with a severe<br />
protective limp and reported great pain with each<br />
step. He had been treated with applied kinesiology<br />
procedures and chiropractic manipulation shortly<br />
following the injury with only slight improvement.<br />
The left pectoralis major, clavicular division (PMC) was<br />
tested with MMT and found to show normal testing<br />
��������������������������������������������������������<br />
the center of the painful area. Increased pressure to<br />
this area elicited a weakening reaction of the PMC<br />
(and any other muscle tested.)The patient TLed each<br />
of the eight acupuncture head points, one at a time,<br />
while the doctor activated the nociceptors at the site<br />
of injury. TL to the stomach-1 point blocked the weakening<br />
response elicited by the painful pressure.<br />
20<br />
impatto latero-mediale sul ginocchio sinistro. Il<br />
trauma era avvenuto giocando a volleyball a causa<br />
di un compagno di squadra che in tuffo lo aveva<br />
colpito. Il paziente si presenta con atteggiamento<br />
protettivo nei confronti del ginocchio e dolore ad<br />
ogni passo. Era già stato trattato con procedure di<br />
���������������������������������������<br />
trauma con scarsi risultati.<br />
�������������������������������������<br />
sinistro viene trovata normotonica. Una pressione<br />
leggera sulla parte laterale del ginocchio sinistro<br />
permette di trovare il punto centrale della lesione e<br />
�������������������������������������<br />
sinistro (e qualsiasi altro muscolo testato). Il paziente<br />
fa terapia locale (TL) sui punti B ed E uno alla volta<br />
mentre il dottore aumenta il dolore proveniente<br />
dal ginocchio sinistro.<br />
The stomach-1 point was tapped at a rate of about<br />
����������������������������������������������������<br />
-<br />
sure was applied to the pain area on the lateral knee. ��� ��� �� �������� ���� ������ ����� - ����<br />
NSB technique was continued for about 90 seconds ������������������� ����� ������ ���������<br />
until pressure no longer elicited a painful response. di 4-5 picchettii per secondo mentre una pressione<br />
At this moment, pressure to the area of pain no lon- intermittente viene applicata al punto di lesione sul<br />
ger weakened the muscle. The patient got up and ���������� ���������� ��� �������� ���� ���<br />
walked without the slightest amount of pain or any ������������������������������������� -<br />
perceptible alteration of gait. He went on to a com- ����������������������������������������<br />
plete recovery within the next two days.<br />
si alza e inizia a camminare senza alcun problema o<br />
alcuna alterazione nella deambulazione. In un paio di<br />
�������������� ������giorni ����� il trauma viene�������� recuperato senza problemi.<br />
with NSB<br />
Occasionally we encounter a patient who has just suf- Controllo del dolore “sul campo”<br />
fered a painful injury and is still in the throes of the Può capitare di avere pazienti che in seguito ad un<br />
acute experience. NSB technique may be employed trauma doloroso continuano ad avere l’esperienza di<br />
on these patients as soon as we are able to elicit their �������������������������������������� -<br />
������������� ��� ���� ������������ ����������� zata anche in questo ���� ��������<br />
caso.<br />
patient will be in the state of general muscular inhibi-<br />
������������������������������������������������������<br />
�������������������������������������<br />
preferably one far distant to the injured site, asking the si troverà in uno stato di ipotonia generalizzata non<br />
patient to resist your pressure.<br />
appena soccorso. Cercate di testare un muscolo<br />
lontano dal punto di trauma chiedendo coopera-<br />
The patient’s familiarity with muscle testing procezione al paziente. L’esperienza clinica accumulata<br />
dures is of great value in getting cooperation under suggerisce di utilizzare muscoli semplici da testare<br />
these circumstances. We have found the opponens come il muscolo oppositore del pollice e del migno-<br />
pollicis/opponens digiti minimi test to be useful lo. Tale test viene effettuato facendo tenere al pa-<br />
in some of these patients who were incapable of ziente mignolo e pollice insieme mentre il dottore<br />
mounting a response adequate to test a larger muscle.<br />
This test is performed by the patient holding<br />
the thumb and little finger together while the tester<br />
attempts to pull the thumb and little finger apart.<br />
cerca di separarli.<br />
There will be weakness of any muscle, including<br />
the opponens test, in these acute, on-the-field cases.<br />
Tap each of the acupuncture head points ipsilateral<br />
to the injured area one-by-one and immediately<br />
test the indicator muscle until tapping one<br />
point negates the weakness. The point which negates<br />
the muscle weakness is the point to be treated.<br />
���������������������������������������<br />
-<br />
no deboli. Picchiettate i punti di agopuntura del viso<br />
uno ad uno sullo stesso lato del corpo ove si trovi<br />
��� ������� ���� �� ���� ���� ��� ������ ��<br />
riportare normotonicità muscolare. Il punto che rafforza<br />
il muscolo debole sarà quello che necessita<br />
trattamento.<br />
Picchiettare il punto fino a massima riduzione del<br />
dolore. Questo può richiedere dai 10 secondi a diversi<br />
minuti a seconda del grado di gravità del trau-<br />
���� ������������ ��� ��������� ��� �����<br />
The indicated point is then tapped continuously at the<br />
�������������������������������������������������������<br />
quella “in studio” ed il paziente e’ l’unico in grado di<br />
describes a maximum reduction in pain. The time re- dirvi come sta andando. Una volta usciti dal campo<br />
quirement of this is quite variable and may take as little<br />
ed effettuati gli opportuni accertamenti, la tecnica
as ten seconds or as long as several minutes depen- �������������������������������������<br />
ding on the severity of the injury. However, the effect ���������������������������������������<br />
-<br />
on the patient’s discomfort is unmistakable. There is a �������������������������������������� -<br />
�����������������������������������������������������<br />
do i tempi di recupero a breve e lungo termine.<br />
time frame than is usually expected.<br />
La tecnica non e’ stata ancora utilizzata in situazioni<br />
di fratture ossee ma spesso con stiramenti<br />
����� ���� �������� ��� ���� ���� ����� - ���� dei legamenti �� ����� e contusioni ������severe.<br />
In questi casi la<br />
gh diagnostic evaluation has been performed, NSB tecnica si e’ rivelata estremamente utile e gratifi-<br />
���������� ���� ����� ��� �������� ������ cante sia ���� per��������� il dottore sia per il paziente.<br />
approach previously described. Application of NSB<br />
technique immediately following injury seems to gre- Caso Clinico<br />
����� ��������� ���� �������� ������������ Un bambino ��������� di 8 anni ���� già al corrente di cosa fosseenhance<br />
the patient’s recovery, both in the short term �������������������������������������<br />
of the next few minutes, and in the long run of the next precedentemente trattato in questo modo, si ritro-<br />
few days or weeks.<br />
va con un piede sotto la gamba di una sedia dove<br />
��� ���� �������� ��� ����� ��� ���� ���<br />
In our experience with this technique, we have not en- dell’adulto si ritrova sulla parte laterale del piede<br />
���������� ����������� ���������� ������������ del bambino ������ a livello del ������ cuneiforme laterale e del<br />
onset. We have used NSB immediately following major ��������������������������������������<br />
ligament injuries and severe contusions, however. The di piangere ma con ancora le lacrime agli occhi<br />
technique has been gratifying to both doctor and patient. ������������������������������������<br />
Case history<br />
ipotonico.<br />
An eight year old boy familiar with applied kinesiolo- Il dottore picchiettando i punti di agopuntura del<br />
gy managed to put his bare foot under the leg of the viso trova che il punto GB-1 riesce a riportare il<br />
chair upon which a 250 pound man was in the pro- muscolo allo stato normotonico (da notare che il<br />
cess of being seated. The full weight of the man came meridiano della cistifellea corre esattamente nel<br />
down on the chair which contacted the lateral foot of punto traumatizzato; ecco come una relazione<br />
the child over the lateral cuneiform and cuboid area. anatomica fra area implicata e punto di agopuntu-<br />
As soon as the child stopped screaming, but still with ��������������������������������������<br />
tears pouring from the eyes, a muscle (PMC) was te- picchiettato ad un ritmo di 4-5 volte al secondo<br />
sted and found weak. The doctor tapped the ipsilateral fino a quando il bambino smette di piangere e altri<br />
acupuncture head points one-by-one until it was found 2 minuti in cui il bambino e’ capace di appoggiare<br />
that the gall bladder point (GB 1) negated the muscle<br />
weakness. (The gall bladder meridian ran through the<br />
il peso sul punto stando in piedi.<br />
injured area. An anatomical relationship between the Al termine il bambino non sente più dolore. Viene<br />
location of the meridian closest to the injury and the quindi applicato del ghiaccio per 10 minuti ed il<br />
acupuncture head point for treatment occurs about bambino si ritira per la notte.<br />
eighty percent of the time.)<br />
Il mattino seguente l’area traumatizzata e’ legger-<br />
������������������������������������������������������<br />
- mente sensibile alla pressione ed e’ notabile una<br />
gun and the child’s tears rapidly stopped. The tapping leggera decolorazione ma non è presente alcun<br />
was continued for about two minutes at which time the segno di infiammazione tanto che il bambino rie-<br />
1. Schmitt, Walter H., Jr. Nociceptor Stimulation Blocking<br />
Technique. I.C.A.K. collected papers, Winter,<br />
1989. p. 88.<br />
2. Schmitt, Walter H., Stop Your Pain Now! Chapel Hill,<br />
NC: privately published, 2002.<br />
3. Schmitt, W.H., & Yanuck, S.F. Expanding the Neurological<br />
Examination Using Functional Neurological<br />
Assessment - Part II: Neurologic Basis of Applied Kinesiology.<br />
Intern J Neuroscience, 1999, 97, 77-108.<br />
4. Wyke, B.D., Neurological Aspects of Pain Therapy.<br />
in Swerdlow, Mark, editor. The Therapy of Pain. J. B.<br />
Lippincott:1980.<br />
5. Schmitt, Walter H., The Neurological Rationale for a<br />
��������� � ���������<br />
Comprehensive Clinical Protocol Using Applied Kinesiology<br />
Techniques. Proceedings of the I.C.A.K. - U.S.A.<br />
Annual Meeting, Volume 1, 2005-2006. p. 157-191.<br />
6. McCord, KM, and Schmitt, WH, Quintessential Applications:<br />
A(K) Clinical Protocol 2nd Edition. St. Petersburg,<br />
Florida: Privately Published, 2009.<br />
7. Schmitt WH, Cuthbert SC: Common Errors and Clinical<br />
Guidelines for Manual Muscle Testing: “The Arm<br />
Test” and Other Inaccurate Procedures. Chiropr Osteopat.<br />
2008 Dec 19;16(1):16.<br />
http://www.chiroandosteo.com/content/16/1/16<br />
8. Goodheart, George J. Applied Kinesiology 1982 Research<br />
Manual. Detroit: privately published, 1982.<br />
21
child was able to bear weight with no pain and direct<br />
pressure to the injured area elicited only soreness. Ice<br />
was applied for about ten minutes and the child went<br />
to bed for the evening.<br />
The following morning, the injured area was only mildly<br />
tender to touch, there was only mild discoloration and<br />
Discussion<br />
It appears from our present understanding of the functional<br />
neurology of pain and pain control that the<br />
tapping of the acupuncture head points probably activates,<br />
through some poorly understood interneurons,<br />
the caudal reticular neurons that descend on the spinal<br />
cord and inhibit incoming nociception. See Figure 2.<br />
The spinal cord blocking of incoming nociception also<br />
22<br />
sce ad indossare le scarpe senza problemi.<br />
Discussione<br />
La nostra comprensione del meccanismo neurologicofunzionale<br />
del dolore e dei meccanismi di controllo del<br />
dolore sembra sostenere che attraverso la stimolazione<br />
���������������������������������������������������<br />
���������������������������������������<br />
-<br />
awareness of the injury.<br />
verso oscure interconnessioni neurologiche, i neuroni<br />
della sostanza reticolare caudale che discendono a livello<br />
spinale nell’inibire lo stimolo nocicettivo. Fig2<br />
Tale inibizione ha come effetto anche quello di limita-<br />
��������������������������������������<br />
che normalmente provocherebbero la perdita di movimento<br />
nel paziente. L’esperienza clinica con la tecnica<br />
��������������������������������������� -<br />
siti più dei meccanismi di immobilizzazione locale una<br />
�����������������������������������������������������������<br />
��������������������������������������<br />
result in limited range of motion in the injured patient. ���������������������������������������<br />
�����������������������������������������<br />
It appears that this guarding or splinting reaction<br />
is much less necessary to the body following NSB ���������������������������������������<br />
-<br />
treatment. It also appears that this technique has torie può essere molto utile dopo aver utilizzato la tec-<br />
���� ������� ��� ��������� ���� ������������ - �������������� ����� ������� ��� �������� ������ �������<br />
ce decreasing perceived need for the commonly over limita molto gli effetti collaterali di distruzione tissutale<br />
����� ���� ������ ���������� �������������� - ���������������������������������������<br />
����� �����<br />
-<br />
matory drugs (NSAIDs). However, nutrients that have cità di provocare danni permanenti a strutture neurolo-<br />
��������������������������������������������<br />
giche locali come i propiocettori. 4<br />
�������������������������������������������������<br />
-<br />
�������������������������������������������������������<br />
��������������������������������������������<br />
These destructive effects have the ability to cause<br />
permanent damage to local neural structures including<br />
proprioceptors4 Inoltre, il blocco sistemico della risposta ipotonica muscolare<br />
permette non solo un istantaneo miglioramento<br />
della situazione ma anche una maggior protezione<br />
dell’area grazie all’azione coordinata della muscolatura<br />
locale tradotta nel miglioramento del movimento.<br />
if they are not controlled rapidly.<br />
��� �������� ��� ���������� ���� ������� ���<br />
Additionally, the blocking of the nociceptive induced mu- permesso di avere nel nostro armamentario uno struscular<br />
reactions allows for not only an immediate impromento in grado di aiutare istantaneamente i pazienti<br />
vement, but also allows increased muscular protection con situazioni di dolore acuto che precedentemente<br />
by normalizing muscular function through greater ranges<br />
of motion. This appears to promote more rapid healing<br />
ADVERSE EFFECTS OF NSAIDs<br />
that every doctor should know!<br />
� GI Hemorrage<br />
� Create “Leaky Gut”<br />
� Increased Vitamin C need<br />
� Antagonize Folic Acid<br />
� Enhance Leukotrienes<br />
� Block Gags Synthesis ( SO4)<br />
� Slow Fracture Healing<br />
� Create Muscle Imbalances<br />
� Cardiovascular Risks<br />
�������������������������������<br />
�� �<br />
Secondary Effects on the Endocrine<br />
System<br />
� Immune System Dysrlegulation<br />
EFFETTI COLLATERALI DEGLI<br />
����� ���������������<br />
������ ���<br />
che tutti i medici dovrebbero<br />
conoscere!<br />
� Emorragia gastrica ed intestinale<br />
�������������������������������������<br />
� Aumento della richiesta di vitamina C<br />
������������������������������������<br />
�����������������������������������<br />
� Bloccano la sintesi dei Glicosaminoglicani<br />
� Diminuendo la disponibilità di solfuro<br />
rallentano la cura delle fratture<br />
� Creano sbilanciamenti muscolari<br />
� Aumentano i problemi cardiovascolari<br />
� Aumentano il lavoro epatico creando<br />
effetti secondari nel sistema endocrino<br />
������������������������������������
and a timely beginning on rehabilitation when necessary.<br />
NSB acute pain control technique has afforded us a<br />
tool which has enabled us to readily help patients for<br />
whom we have previously had to rely on only the RICE<br />
(or ICE-R) regimen, that is: rest, ice, compression, and<br />
elevation. In our experience, the application of NSB<br />
technique is recommended as the primary technique<br />
to be applied in dealing with painful injuries of any<br />
type, to be followed by the more traditional RICE therapies<br />
and related procedures.<br />
NSB technique is a powerful hands-on tool for relief of<br />
pain immediately following the onset up to one or two<br />
weeks following injury. It is a low-tech, cost-effective,<br />
non-invasive procedure that has helped and continues<br />
to help many people.<br />
SUMMARY OF PROCEDURES FOR<br />
NSB TECHNIQUE FOR ACUTE<br />
PAIN RELIEF 6<br />
� Identify Strong Indicator Muscle<br />
� Aggravate Pain With Pressure<br />
or Range of Motion<br />
� If Strong Muscle Weakens: Doctor Taps<br />
(3 to 4 Times) or Patient TLs to Ipsilateral<br />
Acupuncture Head Points Until One Point<br />
Found that Negates Aggravation<br />
Induced Weakness<br />
��������������������������������������������<br />
�<br />
While Intermittently Aggravating Pain<br />
si sarebbero dovute attenere al protocollo R-I-C-E<br />
(Rest-Ice-Compression and Elevation) ossia riposo,<br />
ghiaccio, compressione ed elevazione.<br />
�����������������������������������������<br />
-<br />
be essere impiegata come primo strumento in qualsiasi<br />
tipo di trauma, prima del RICE o di qualsiasi altra<br />
terapia.<br />
���������������������������������������<br />
���������������������������������������<br />
������������������������������������<br />
e’ una tecnica non invasiva che non richiede alcun tipo<br />
di tecnologia o strumento.<br />
���������� ������ ����������<br />
��������������<br />
������� �����������<br />
6<br />
���������������<br />
����������������������������������������<br />
� Aggravare il dolore con pressione<br />
e/o movimento.<br />
��������������������������������������<br />
volte o far fare terapia locale al paziente<br />
�����������������������������������<br />
a che non si trova quello che nega<br />
la debolezza.<br />
������������������������������������<br />
4-5 volte al secondo mentre ad<br />
intermittenza si aggrava il dolore<br />
Dr. Walter Schmitt is a graduate of Duke University Il �����������������<br />
�������������������������<br />
-<br />
and the National College of Chiropractic. In 1991, he ���������������������������������������<br />
������� ���� ����� ���������� ��� ����� ��������������������������������������<br />
���������� �������<br />
in both Applied Kinesiology and Chiropractic Neurolo- ���������� ���� ��� ����������� �������������<br />
-<br />
gy. As a practicing chiropractic physician since 1974, �������������������������������������� -<br />
Dr. Schmitt has served on the Board of Directors of duto il Consiglio dei Direttori dell’International College<br />
the International College of Applied Kinesiology (<strong>ICAK</strong>) ��� ������������� ���������� ������� ��� ��<br />
and as a trustee for the Foundation for Allied Conser- FACTR (Foundation for Allied Conservative Therapies<br />
vative Therapies Research (FACTR). He is an adjunct Research). E’ un membro subalterno della facoltà post<br />
member of the postgraduate faculty of Logan Colle- laurea del Logan College di Chiropratica e fa parte del<br />
ge of Chiropractic and serves on the Editorial Review Consiglio di Revisioni Editoriali di Chiropractic Techni-<br />
Boards of Chiropractic Technique and Alternative Meque e Alternative Medicine Review.<br />
dicine Review. The author of over 70 papers for the �����������������������������������������<br />
<strong>ICAK</strong>, two books for physicians, Common Glandular Common Glandular Dysfunctions in the General Prac-<br />
Dysfunctions in the General Practice and Compiled �����������������������������������������<br />
Notes on Clinical Nutritional Products, and one book ��������������������������������������<br />
for laypersons, Stop Your Pain Now. Dr. Schmitt lectu- ���������������������������������������<br />
-<br />
res nationally and internationally and is renowned for ternazionale ed è rinomato per il suo innovativo uso dei<br />
his innovative use of muscle testing for functional neu- test muscolari per valutazioni funzionali neurologiche e<br />
rological and neurochemical assessment.<br />
neurochimiche.<br />
23
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