Spondylotherapy and Related Vibropercussion Therapy

© 1999. R. C. Schafer, DC, PhD, FICC

INTRODUCTION

When patients enter a DC's office, they seek relief. Certainly, both patient and doctor want to know the cause of their problem (a diagnosis), but their priority is to find relief --and as rapid as possible. It is thus the attending doctor's goal to offer a rational means for the relief of pain and disability even before the diagnosis is firmed when possible. And more often than not, the patient's entering complaint will be almost resolved before the final diagnosis is determined. Of course, the relief of discomfort is just the initial stage of healing the cause of the complaint.

Gaining a reputation of offering such services is the basis of sound practice building and community relations. Media advertising cannot do it. It only announces to the public that the doctor is in need of patients. Degrading promotional gimmicks such as offering "free this" or "free that" cannot do it. It only broadcasts that the doctor's services have little value. Quickly satisfying patients' priority needs within the doctor's authorized scope of practice is the only basis for a satisfied patient recommending the practitioner responsible to a friend, relative, or colleague. It is the sole basis on which patient loyalty can be assured.

Although adjunctive procedures such as spondylotherapy are described in chiropractic case management protocols, it should always be remembered that the articular adjustment is the core of chiropractic therapy. Ancillary procedures can condition tissues to receive and respond to articular therapy and enhance physiologic mechanisms, but, with infrequent exceptions, they should not be considered substitutes.

"No instrument or machine has been invented that can replace the analytical and healing power ignited by a skilled practitioner's integrated hands, eyes, and ears." This was the belief of the great clinical diagnostician Cabot. Although it was the basis of his astute teachings to clinicians about 100 years ago, it is as true today as it was then.

It should be recognized that this author appreciates the value of numerous physiotherapeutic applications along with nutritional guidance, counseling, and standardized rehabilitative procedures. Yet they all stand in the shadow of the basis for and the proper administration of the skillful manual chiropractic adjustment.

D. D. Palmer founded chiropractic on the basis of maintaining neurologic homeostasis --a state he called "tone," as so announced to the world on the title page of his only book. Thus, any method that aids the achievement of this goal is in parallel with the basic premise of chiropractic whether it be a nonincisive surgical procedure such as an articular adjustment, spondylotherapy, heat or cold, electric stimulation, therapeutic nutrition, chemotherapy, major surgery or whatever. The manual adjustment is not the exclusive means of restoring health. It just happens to be the best means discovered so far to restore neural dysfunction at the articular level, which is so often the basis of pain and disability.

Despite what some might believe, no therapy is noninvasive and no therapy is devoid of chemical reactions. Any external stimulus applied to the body (even light touch) ignites multimillions of impulses from the periphery to the CNS where they are attenuated, dampened, correlated, synergized, integrated, and/or harmonized by neurochemical processes.

The error of allopathy is not in its use of chemotherapy, and DCs who use this argument to defend their position are in error. Our entire body is composed of chemicals. The water we drink, the food we eat, and the air we breath to survive are nothing but chemical compounds. No, the error of allopathy is not in its use of chemotherapy. It is in its use of compounds whose side effects may be more harmful than beneficial to the patient and its overemphasis of the power of common environmental microorganisms within a resistant host.

A chiropractic adjustment ignites a multitude of chemoneurologic mechanisms at the intervertebral foramen, on the spinal cord, along the neuraxes, and within the synapses and axoplasmic flow of the involved neurons. Spondylotherapy enhances this effect.


APPLYING SPONDYLOTHERAPY

Most clinical chiropractic students are introduced to the origin and basis of spondylotherapy in NCC's classic text Chiropractic Principles and Technic. The description presented therein refers to application within pioneer chiropractic. Nevertheless, it has served as a foundation for further research. We have progressed far from the block and hammer technique used in the 1920s.

The application of spondylotherapy is based on spinal cord function, especially the autonomic mechanisms, and takes the view that "the spinal cord is not a single contiguous structure but consists of 31 segments or neuromeres, each one of which serves as a little 'reflex brain' and from which point many of the vegetative (involuntary visceral) and even many somatic activities are initiated. These neuromeres serve both as the CNS part of a simple reflex arc and as a focal point for initiating remote synergistic physiologic processes often via the long tracts.


STIMULATION OF SPINAL CENTERS

To apply spondylotherapy, the clinician must be well acquainted with spinal cord function and visceral innervation. At one time, chiropractic students were required to memorize data similar to that shown in Table 1.

Deep, repetitive, short-duration percussion upon a neuromere, usually applied today by an electric vertical percussion vibrator at a rate of 1–3 impulses per second for about 20 seconds with a similar rest interval is used to stimulate a spinal center. Total session duration for excitation is usually 1–2 minutes. Pressure should be held firm to avoid slippage but not be excessive. Prolonged stimulation (over 3 minutes) tends to fatigue neuromere excitability and produces an inhibitory effect. See Tables 2 and 3.

Spondylotherapy can be applied manually by placing a clenched first over the appropriate spinal region and repeatedly striking it with the other closed fist. Decades ago, electrotherapists used a paraspinal sinusoidal current to apply spondylotherapy. In more recent years, pulsating ultrasound has been investigated.

A large number of types of visceral distress can be relieved in this manner; however, the effect is usually temporary. But not infrequently, the relief is relatively permanent. This has been attributed to breaking a self-perpetuating reflex arc.

Only two of the cephalad parasympathetics can be directly influenced by spondylotherapy: The vagus nerve at the C1-2 level and the phrenic nerve at C3-4. Vagal stimulation is usually applied to increase gastric activity, intestinal peristalsis, and nasal secretions. Phrenic inhibition is helpful in chronic cough and hiccups.


Table 1. Effects of Induced Sympathetic and Parasympathetic Stimulation (eg, Spondylotherapy

Sympathetic Division

Parasympathetic Division

Structure	Supply	Effect of Stimulation	Supply	Effect of Stimulation
Thyroid gland	T1	Increases secretion	X	Decreases secretion
Parathyroids	T1	Increases secretion	X	Decreases secretion
Mucous mem- branes of the head	T1–2	Vasoconstriction	VII	Vasodilation
Salivary glands	T1–2	Increases organic substances	IX	Increases watery substances
Pupils	T1–2	Dilation	III	Constriction
Lacrimal glands	T1–3	Vasoconstriction	VII	Secretion
Heart	T1–5	Increases rate and force of contraction, dilates coronary arteries	X	Decreases rate and force of contraction, contracts coronary arteries
Upper limbs	T1–6	Vasoconstriction, sweating, piloerection		? (unknown)
Bronchi and lungs	T1– 7	Dilation, vasoconstriction	X	Constriction, vasodilation
Sphincter of Oddi	T4–8	Constricts	X	Relaxes
Gallbladder	T4–8	Relaxes muscle, constricts sphincter	X	Constricts muscle, relaxes sphincter
Stomach	T5–9	Decreases secretion and motility	X	Increases secretion and motility
Spleen	T6–8	Contracts smooth muscle	X	Relaxes smooth muscle
Pancreas	T6–9	Decreases secretion	X	Increases secretion
Liver	T8–10	Increases glycogen to glucose, protein metabolism; vasoconstriction	X	Opposite
Pyloric sphincter	T9	Increased tone, contraction	X	Relaxation
Adrenals	T9–10	Increases secretion	X	? (unknown)
Small intestine	T9–L1	Slightly decreases peristalsis and secretions; vasoconstriction	X	Increases peristalsis and secretions, relaxes sphincters
Kidneys	T10–L1	Vasoconstriction, inhibits	X	? (unknown)
Prostate	T10–L1	Contracts muscle and spermatic vein	S2–4	Increases secretion
Fallopian tubes	T10–L1	Contracts muscle		? (unknown)
Urinary bladder	T12–L2	Constricts sphincter, relaxes wall	S2–4	Relaxes sphincter, constricts wall
Lower limbs	T12–L2	Vasoconstriction, sweating, piloerection		? (unknown)
Uterus	L1	Contracts body	S2–4	Relaxes body, contracts cervix
Ileocecal valve	L1	Contracts	S2–4	Relaxes
Penis, clitoris	L1–2	Duct contraction, ejaculation	S2–4	Erection
Colon and rectum	L1–3	Decreased peristalsis	S3–5	Increased peristalsis
Anal sphincter	L3	Contracts	S3–5	Relaxes

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NOTE: Supply segments may vary slightly depending on the authority used. The above is typical of most studies researched. Individuals' anatomy often refuse to follow textbook models. Ask any surgeon. It is also well to keep in mind that a midthoracic spinous process, say T7, is about one level below the T7 neuromere. All five sacral neuromeres are located at the T12–L1 levels. See Figure 1.

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Table 2.   Duration Guidelines for Vibropercussion Therapy

Concern	Time (min)	Comments
Spinal center stimulation	1-2	Use low velocity with firm pressure. Monitor patient at 1-min intervals.
Spinal center inhibition	4-5	Use sustained high velocity. Monitor patient at 2-min intervals.

 

Miscellaneous Applications

Concern	Time (min)	Comments
Localized treatments	10 or less	Use more time for chronic conditions, less time for acute and subacute disorders.
Reducing trigger points	6–8	Too long or too strong treatment can retraumatize the site and possibly bruise the surrounding area.
Relaxing muscles	2–10	Use high-velocity low-force setting.
Postural drainage	3–15	Duration varies considerably depending on the particular condition being treated.
General body relaxation	3–5	Use mild high-velocity force over the whole spine.
Moderate toning massage	10–12	Duration varies considerably, depending on the particular condition being treated.

Table 3.   Variable Effects of Vibropercussion Speed in Miscellaneous Applications

Velocity	Effects
High	Analgesia and anesthesia by production of dynorphins and enkephalins. Decrease trigger points Muscle and periarticular tissue goading Spasticity relaxation Pre-exercise or stretching conditioning Superficial circulatory stimulation
Medium	Similar effects as high but used when a milder effect is desired.
Low	Decongestion Edema reduction Anesthesia (mild) Myotonia Venous and lymph drainage enhancement

Relationship of Vertebra Level and Neuromere Level

In the embryo, the spinal cord extends the entire length of the vertebral canal. Nerve roots then extend laterally from the cord throughout. However, because the vertebral column grows faster than the spinal cord, the relationship of neuromere level and vertebra level does not exist during progressive growth. In the newborn, the spinal cord ends near the L2–L3 level. In the adult, it usually terminates with the coccygeal neuromere near the lower border of L1.

The length and obliquity of nerve roots increase progressively as the caudad end of the vertebral is approached because of the increasing distance between the spinal cord segments (neuromeres) and the corresponding vertebrae number. See Figure 1.

Figure 1. Schematic relationship of neuromere and vertebra level.

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