Chiropractic and the Barrier Concept
Joints and their associated soft tissues (i.e. muscles, tendons, ligaments, fascia/connective tissue and even skin) must have free unrestricted movement for the body to function properly. Any restriction or “barrier” to normal joint and soft tissue movement will often be the main cause of musculoskeletal pain and is a potential area of treatment –with changes in joint mobility, tissue texture, tenderness and muscle tone being frequent clinical findings. Some examples include a restricted joint in the neck causing a headache or a painful surgical scar.
Historically, Chiropractors referred to these restrictions or barriers to movement as subluxations, Osteopaths coined the term “Osteopathic lesion”, the European Physiotherapy and Manual Medicine community calling them “joint blockages”. Common to all these manual therapy schools is the diagnosis of the barrier to movement by manual methods, with subsequent release or reduction in joint and soft tissue restriction using mobilisation, manipulation or adjustment techniques.
Expanding on the barrier concept, other road blocks to recovery include neuromuscular barriers (such as muscle imbalances and incoordination) or psychosocial barriers (such as avoiding certain movements or physical activity out of fear of aggravating an injury). The former will lead to joint overload and core/spinal instability and the later will lead to deconditioning perpetuating pain.
Neuromuscular barriers are best assessed via a functional examination which focuses on the "quality" of muscle activation. It determines whether a muscle is inhibited or excessively used in commonly performed movements such as a squat or arm raising for example.
Psychosocial barriers are best measured using questionnairres called "outcome measures" (e.g. OMPQ score for musculoskeletal pain or DASH score for upper extremity) which are used to determine progress and treatment efficacy by insurance companies and return to work organisations like Workcover
Current trends in neuromusculoskeletal care show us that passive care alone (manual therapy) often only brings temporary relief from musculoskeletal pain, especially when it is chronic (lasting more than 3 months). Addressing all aforementioned barriers will ensure treatment is tailored to the patient, with Chiropractic reactivating the patient and accelerating the healing process so more active methods of Rehabilitation (e.g. DNS, sensorimotor training) can be integrated, thus chronic pain and disability avoided.