"Health is not simply
the absence of sickness"
- Hannah Green

Working out the kinks with naprapathy

Chicago Daily Herald - March 30, 2005

By Steve Zalusky

Treatment aids patients who are under stress

  • Tight muscles and joints stand little chance against naprapath Patrick Nuzzo’s fingers.
  • This army of 10 digits promises to pummel even the tensest of bodies into pleasant submission.
  • During each session, Nuzzo’s hands wander along his client’s back and neck, relentlessly probing the deepest recesses of muscles and joints.

By the end of the session, you’re left with a tingling sensation, relaxed and ready once again to battle the world. Nuzzo’s medium is, indeed, the massage. But this naprapath says his treatment is more than just an expert rubdown. He bills it as an alternative health care system with a culture developed over more than a century.

Nuzzo operates Safe Waters Naprapathic Health Care, 228 W. Main St. in Lake Zurich. He also travels to an office in New Mexico. He has been in the business since the late 70’s, with a clientele that has included such sporting luminaries as the late Walter Payton. The Chicago National College of Naprapathy and Clinic, which was established in 1907 and is based in Chicago, specifically defines naprapathy as a licensed health-care system using hands-on techniques supplemented by nutritional counseling. “Connective tissue disorders is our specialty,” said naprapath Paul Maguire Jr., the college’s CEO. “That’s our scope of practice. Connective tissue disorders are basically ligaments and tendons and muscles that have a tendency to strain or tear slightly.”

During a naprapathic exam, the naprapath taps and feels different areas of the body to ferret out any pain or swelling. The naprapath’s enemies include muscle spasms and tears, inflammation, scar tissue formations, bruises and atrophied muscles. Treatment involves manipulating connective tissue, restoring proper posture and nutritional counseling. It does not involve radiology, surgery or the use of drugs. Naprapathy was developed in the late 1800’s by Dr. Oakley Smith, a trained chiropractor who abandoned his original calling to work on a technique that would cure his chronic back pain. He found the answer to his problem by attacking the soft tissue around the spine through manipulation of the muscles, ligaments and tendons. Nuzzo also discovered the naprapathic path via chiropractic. His uncle was a chiropractor. “I did not go to a doctor. I went to my uncle”, he said. “I don’t remember ever taking medication in my life. The body can and will heal itself. It’s a natural health care system.”

Nuzzo became a licensed naprapath in 1983. But it was in 1979 that he met his most famous client, Walter Payton. At the time, Nuzzo was studying at the Chicago National College of Naprapathy and earning a few bucks giving massages at the Charlie Club in downtown Chicago. “He was as flexible a man as I’ve ever met,” said Nuzzo. “He worked more on stretching than pumping iron.” Nuzzo’s goal in working with the running back was to work out the tension in his body. He continued to work with Payton through his illness and right up until the night before he died. At that point, Nuzzo said the Bears legend was in a lot of pain, and he was working to soothe him. For Nuzzo to see such a splendid physical specimen in decline at the end of his life acted as a wake up call that “we live by the grace of God. We’re not in control,” Nuzzo said. One shouldn’t get the idea that Nuzzo just works on athletes. “I work on a lot of highly motivated your stressful executives,” he said. No less an authority than Chicago White Sox trainer Herman Schneider can attest to the effectiveness of Nuzzo’s treatments. Schneider said a number of professional athletes have submitted themselves to Nuzzo’s ministrations. As for Schnieder, he visits Nuzzo regularly to take of a chronic back condition. “He may not cure the problem, but he makes it more tolerable,” Schnieder said. “This is not just deep massage. There is a real art to it. This guy is a quality person and a quality naprapath. Treatment does not necessarily mean a cure, warns Maguire of the Chicago naprapathy school. “We’re all getting over the magic bullet theory. I don’t deal in that world.”

 

Clinical Journal of Pain

September 2010

By Stina Lilje DN

Abstract

 

Objectives: Traditionally, orthopedic outpatient waiting lists are long, and many referrals are for conditions that do not respond to interventions at an orthopedic outpatient department. The overall objective of this trial was to investigate whether it is possible to reduce orthopedic waiting lists through integrative medicine. Specific aims were to compare the effects of Naprapathic manual therapy to conventional orthopedic care for outpatients with nonurgent musculoskeletal disorders unlikely to benefit from surgery regarding pain, physical function, and perceived recovery.

Methods: Seventy-eight patients referred to an orthopedic outpatient department in Sweden were included in this pragmatic randomized controlled trial. The 2 interventions compared were Naprapathic manual therapy (index group) and conventional orthopedic care (control group). Pain, physical function, and perceived recovery were measured by questionnaires at baseline and after 12, 24, and 52 weeks. The number of patients being discharged between the naprapath and the orthopedist were also estimated.

Results: After 52 weeks, statistically significant differences between the groups were found regarding impairment in pain, increased physical function, and regarding perceived recovery, favoring the index group. Sixty-two percent of the patients in the index group agreed to be discharged from the waiting list. The level of agreement concerning the management decisions was 80%.

Discussion: The trial suggest that Naprapathic manual therapy may be an alternative to consider for orthopedic outpatients with disorders unlikely to benefit from surgery.

 

 
Dynamic Chiropractic – July 1, 2011

It's the Fascia, Stupid

By Warren Hammer, MS, DC, DABCO

Bill Clinton used the campaign slogan, "It's the economy, stupid," to help defeat George H.W. Bush in the 1992 presidential election. The sooner the chiropractic profession recognizes the importance of fascia and its treatment in the world of soft tissue, the sooner will we receive the recognition we rightly deserve.

No need to hash over the value of the chiropractic adjustment, but when will we open our eyes and recognize the world of soft tissue and especially the most ubiquitous of all soft tissue, the fascial system? Maybe I should say the fascial organ, which one day it will be designated as. The fascial system is a neurosensory organ that must be considered along with chiropractic neurology. Why depend on one modality with our hands when we can have an even greater effect by including soft tissue?

Most chiropractic colleges still do not pay enough attention to the soft-tissue world. I feel sorry for their graduates, our profession and most of all, our patients. I have seen too many patients over the years treated with spinal manipulation for extremity and spinal lesions, to no avail. I have written about studies that repeatedly show spinal manipulation plus soft-tissue treatment is more effective than spinal manipulation alone.

I recently viewed a DVD on fascia "research pioneers" that includes lectures by Carla Stecco, Helene Langevin, Serge Gracovetsky, Tom Myers, Andree Vleeming and Robert Schleip. I recommend this DVD for anyone interested in an introduction to the fascial system or anyone who has benefited their patients by using soft-tissue methods that have a fascial effect. Much of what this article is about is derived from this DVD, especially the lecture by Robert Schleip, PhD.

It seems that the rebirth of fascial inquiry occurred at the First International Fascia Research Congress at Harvard Medical School in Boston in 2007. Over the past few years, there has been a tremendous increase in the number of MEDLINE-indexed publications with the term fascia in their title or abstract.

Scientists have traditionally ignored fascia, possibly because of its extensive expansion throughout the body. Anatomists usually just cut away the "white stuff." Recently, ultrasound has been used to determine in vivo its thickness, sliding and motion; and histological studies have proven that fascia is a sensory organ.

Fascia was defined at the First Fascia Research Congress as "the soft-tissue component of the connective tissue system that permeates the human body, forming a whole-body continuous three-dimensional matrix of structural support. It interpenetrates and surrounds all organs, muscles, bones and nerve fibers, creating a unique environment for body systems functioning."

"Fascia serves both global, generalized functions and local, specialized functions"1 As far back as 1964, Dittrich2 referred to "rupture of the lumbodorsal fascia, with subsequent fibrosis of the subfascial tissues and adhesions between these structures." And as recently as 2009,3-4 connective tissue fibrosis has shown to be causative. Just go to www.pubmed.com, the Web site of the National Library of Medicine, and put in Stecco, fascia; and at least 43 studies on fascia will appear.

Fascia has the ability to move; it can contract and relax on its own. The myofibroblasts originate from normal fibroblasts stimulated by mechanical tension and specific cytokines such as TGFß-1. Myofibroblasts are composed of alpha smooth-muscle actin, allowing these cells to maintain a contractile force over long periods with little energy expenditure. They are increased normally in dense connective tissues like joint ligaments, menisci, and tendons; and abnormally increased in Dupuytren's contracture, plantar fibromatosis, excessive scar formation, frozen shoulder, and lumbar fascia.

So, the frozen shoulder may be similar to a "frozen back," in that the causative restriction is due to increased myofibroblasts in the fascia rather than the muscle. The density of myofibroblasts correlates with tissue stiffness. A high density of myofibroblasts is often found in the perimyceum that separates muscle bundles from each other, which may be a reason why the upper trapezius is often tight, since this muscle tends to have a thicker perimyceum. Fascial adhesions occur due to inflammation, immobility and micro-injuries caused by overloading.

Fascia is also a sensory organ that responds to mechanical stimulation. Schleip discussed the fascial mechanoreceptors and their role in deep-tissue manipulation,5 and the influence of fascial manipulation on mechanoreceptors such as Pacini, Paciniform and Ruffini (Type II), interstitial Type III and IV, and proprioceptives such as Golgi (Type Ib), and spindle cells. Increasing receptor stimulation input strongly inhibits spinal cord processing of myofascial nociception. Receptor stimulation has shown its effectiveness in pain reduction with elastic taping and apparel that mimic the skin.

High velocity stimulates Pacini, located in spinal ligaments and facet joints of spine. The tangential angle of direction, rather than a perpendicular or longitudinal directed force, is more effective than the amount or duration of force in creating a global inhibition of sympathetic tone. Sympathetic activation (stress) can cause increased TGFß-1, resulting in increased myofibroblastic activity and fascial stiffness due to the manufacture of stiffer collagen matrix over time.

Treatment involving slow, gradual fascial release (Barnes) or lighter "melting" techniques stimulates Ruffini receptors that inhibit sympathetic activity, reducing a global sympathetic state to a global parasympathetic (relaxing) tone. Other methods such as friction massage or fascial manipulation also affect receptors, of course, but work on the premise of amount and duration of force and particular locations based on functional testing. Depending on how you use Graston Technique, both light and more forceful technique can be used.

A recent study points to fascia as the painful mechanism in delayed-onset muscle soreness.6 Another recent (unpublished) study by Franklyn-Miller studied strain transmission during straight leg raising. One would think that the hamstrings would present with the most tension during this maneuver, but with the hamstring tension rated at 100 percent stretch, the iliotibial tract (ITB) percentage reached 240 percent the ipsilateral lumbar fascia was 145 percent, lateral crural compartment was 103 percent, the Achilles tendon was 100 percent, and the plantar fascia was 26 percent. The collagen covering epimyceum on the lateral ITB was parallel and dense, while the posterior fascia on the hamstring was more criss-cross, allowing more freedom.

Based on the study of the connective tissue, it may be more important to stretch and treat with soft-tissue methods the lateral extremity structures and ipsilateral lumbar fascia, rather than the posterior connective-tissue fascia of the hamstrings.

References

  1. Findley TW, Schleip R (editors). Fascia Research: Basic Science and Implications for Conventional and Complementary Health Care. Elsevier / Urban & Fischer, 2007:2-9.
  2. Dittrich RJ. Soft tissue lesions as cause of low back pain; anatomic study. Am J Surg, 1956 Jan;91(1):80-5.
  3. Langevin HM, Stevens-Tuttle D, Fox JR, Badger GT, et al. Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain. BMC Musculoskeletal Disorders, 2009;10:151.
  4. Langevin HM, Sherman KJ. Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms. Medical Hypotheses, 2007;68:74-80.
  5. Schleip R. Fascial plasticity- a new neurobiological explanation. J Body Mov Ther, 2003;7(1):11-19. Also in 7(2):104-116.
  6. Gibson W, Arendt-Nielsen L, Taguchi T, Mizumura K, et al. Increased pain from muscle fascia following eccentric exercise: animal and human findings. Exp Brain Res,2009;194(2):299-308.

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Warren Hammer, a graduate of Lincoln Chiropractic College, has been in practice in Norwalk, Conn. since 1959. For the past 25 years, Dr. Hammer blends a keen interest in soft-tissue methods of healing with his expertise in spinal adjusting. He has studied numerous soft-tissue methods and applies them to the practice of chiropractic.

Dr. Hammer's third edition of Functional Soft-Tissue Examination and Treatment by Manual Methods is available from Jones & Bartlett publishers. He writes a regular column for Dynamic Chiropractic and has written articles for prominent journals such as Chiropractic Sports Medicine, the Journal of Manipulative and Physiological Therapeutics, Chiropractic Technique and the Journal of Bodywork and Movement Therapies.

Dr. Hammer has lectured for the Motion Palpation Institute since 1987, and has lectured nationally and internationally on the examination and treatment of soft-tissue lesions.

 

 

 

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