Dr. Ratzow has worked with the Oregon Ballet Theatre dancers since 2002 to provide care to these magnificent athletes who rely on their bodies for their life's work and livelihoods. Sports injuries as well as those which occur in the course of daily life are all handled with the best possible methods here at this office. Don't put off feeling better, call us.
Modalities: A guiding principle at this facility is that each person is an individual with unique needs and pathways to their optimal health and well-being. Therefore, there is no one size fits all approach to treatment. The following is a list of modalities available to each person who comes to the clinic.
Manipulation or adjustment: Appropriately applied pressure to a joint for the purpose or restoring restricted motion, repositioning the articulating bones to optimal position or often both for the purpose of increased range of motion, reduction of pain, inflammation and muscle spasm. There are beneficial reflex neurological effects to the organs as well.
Soft tissue modalities: A variety of soft techniques are applied either singly but most often in combination to address each individuals unique circumstance. Methodologies that I use are derived from: Somatic and post-isometric release, Active release, shiatsu, Nimmo, Heller and Bowen techniques.
Electrical stimulation, microcurrent therapy and cold laser therapies are also available as called for.
Stretching and strengthening exercises are used appropriately to bring about balance and coordinated, integrated movement and postural patterns as well as for rehabilitation.
Diet, Nutrition, Exercise and Living Well: Diet, exercise and good health habits are the basis of a healthy life, therefore research based advice on nutrition, herbal remedies, supplements and exercise are available as well. Additionally strategies for stress reduction based on many years of experience with meditation and other techniques are offered.
THE NEUROLOGICAL EFFECTS OF MANIPULATION
In a normally functioning system, the stimulation of the mechanoreceptor system that occurs with normal joint function helps maintain a quiet state of the nociceptive, or pain system. When there is a fixation (subluxation) of a joint, there is a reduction in the amount of mechanoreceptor activity from that joint. This may result in not only pain, but an increase in sympathetic efferent activity causing vasoconstriction of the vessels supplying the affected area, as well as increase in muscle tone and spasm. If due to trauma, the cellular damage in the periphery leads to release of potassium ions and the synthesis of prostaglandins and bradykinin. Prostaglandins can increase the sensitivity of the terminal to bradykinin and other pain producing substances. These substances result in activation of the C fibers, which carry signals to the spinal cord through the dorsal root ganglia, and the efferent discharge can lead to the release of substance P. Substance P arrives at the periphery to cause neurogenic edema and results in the further accumulation of bradykinin. Substance P also has been shown to cause the release of histamine from mast cells and seratonin (5 hydroxytryptamine) from platelets. These substances further activate C fibers and the vicious cycle of pain results. The second order neuron of the anterolateral system, if it rises to threshold, carries information to the thalamus and relays to four brainstem nuclei, the Edinger- Westphal nucleus, superior and inferior salvatory nuclei, and the dorsal motor nucleus of the vagus nerve. The fibers ultimately end up in the parietal cortex, hypothalamus, temporal lobe and in the limbic system. It is in these areas that the localization of pain, autonomic concomitants, the memory of pain and the emotional experience of pain occurs.
By applying joint manipulation, there is an instantaneous discharge of types I and II joint mechanoreceptors that can cause action potentials in A alpha and A beta fibers. If the threshold of the golgi tendon organ is achieved, there is an action potential in its associated 1b fiber. A alpha and A beta fibers enter the dorsal horn and synapse directly and indirectly via interneurons with the delta type A and C fibers in lamina I, II and V. It is at this level that these fibers cause presynaptic inhibition of the primary neuron of the nociceptive pathway in a manner which can prevent the second order neuron from ever reaching threshold, thereby, reducing pain and the supraspinal effects of nociceptive stimulation (that is, reducing conscious localization and perception of pain, emotional experience of pain, and reduction in the autonomic effects of pain). At the same time, through interneuronal connections with the intermediolateral cell column (lamina VII) there can be a reduction in the sympathetic efferent discharge with the normalization of blood flow and pain. Also at the local spinal cord level, from the 1b fibers, again through interneuronal connections, there is synaptic activity with alpha and gamma motorneurons in the ventral horn which cause inhibitory actions resulting in reduction in muscle spasm and improvements in tone.
The supraspinal effect of manipulation is that mechanoreceptors will send information cephalad through the dorsal column pathway. Dorsal column afferent input will cause stimulation of the mesencephalic periaqueductal gray and this same area receives afferent connections from the hypothalamus. The periaqueductal gray stimulated the nucleus raphe magnus of the medulla projects back to the spinal cord via the dorsolateral funiculus (descending seratonergic pathway) to enkephalin containing neurons in the dorsal horn that will enhance the effects of the local effects of manipulation at the spinal cord level.
Additionally, these descending inhibitory pathways are actually stimulated by the activation of the anterolateral system through synaptic activity at the nucleus raphe magnus via the medullary reticular formation, as well as synaptic activity with the periaqueductal gray.
Seaman, David, DC, MS, DABCN. Chiropractic and Pain Control. DRS Systems. Asheville, North Carolina. 1993
Wyke, B. Articular Neurology and Manipulative Therapy in Aspects of Manipulative Therapy, Second Edition, Churchill Livingstone, New York, 1985.
J. Pansky, B, et al. Review of Neuroscience. McGraw Hill. Health Professionals Division. Second Edition. 1988
Kandel, Schwartz and Jessell. Principals of Neural Science. Appleton and Lange. Third Edition, Norwalk, CT 1991.