Q and A
While in school at Palmer College of Chiropractic West, though I didn't think about it at the time, I was confused. I was working very hard at being the best young chiropractor that I could be. This meant taking seminars constantly. I went to some helpful chiropractors for extra training at least twice a week for several years but still I was confused about how to treat a patient. What was I supposed to do with this patient? What would be the best approach to helping this individual? Am I just mobilizing the bone structure, and hoping for the best? Am I just popping the spine and joints and hoping to make my patients feel better? Why do patients have to come back so often to see the chiropractor?
Now, looking back after years as a chiropractor, I understand my confusion was due to so many unanswered questions. I proceeded, through the last 25 years, to answer my own questions. In my teachings and in my practice, I share my experiences so others may benefit. The Kiso Method takes a practitioner through the ins and outs of clinical operations.
While in school at Palmer College of Chiropractic West, though I didn't think about it at the time, I was confused. I was working very hard at being the best young chiropractor that I could be. This meant taking seminars constantly. I went to some helpful chiropractors for extra training at least twice a week for several years but still I was confused about how to treat a patient. What was I supposed to do with this patient? What would be the best approach to helping this individual? Am I just mobilizing the bone structure, and hoping for the best? Am I just popping the spine and joints and hoping to make my patients feel better? Why do patients have to come back so often to see the chiropractor?
Now, looking back after years as a chiropractor, I understand my confusion was due to so many unanswered questions. I proceeded, through the last 25 years, to answer my own questions. In my teachings and in my practice, I share my experiences so others may benefit. The Kiso Method takes a practitioner through the ins and outs of clinical operations.
- How does the spine go out of place? What causes nerve impingement? The spine goes out of place in a backwards direction. If you study Gonstead listings and most other listings from other systems, the "P" in the listing, for example PRIT, stands for posterior. PRIT all together would stand for: the vertebra moved in a posterior, spinous right, inferior on the side of spinous rotation, transverse process. While in school and in our trainings, our teachers did not talk much about why all vertebrae move in a backwards position when they move out of place. It's significant information.
- Why do vertebrae only move in this direction? Because the structure of the facets only allow this movement. If you look at the structure of the spine, the facets are a protective anatomical structure, there to give "armour" for the spinal cord. The spinal cord is in the posterior part of the spine. If you look at all the facets in the spine, located behind the spinal cord, they all have a flat plate on each side of the spinous. Each of these flat plates stack up, one above the other, from the sacrum to the C2 vertebra, guarding the spinal cord. That's why vertebrae cannot go too far forward. They are in their anatomically correct position when they are all the way forward. This anatomically correct position is termed "The Primary Soft Spot," where all the vertebrae are in a forward position. Our Kiso Ball helps the patient to "train" their vertebrae to stay in their home, to stay in this anatomically correct position called the primary soft spot.
- Why is it termed Primary Soft Spot? It's the place all vertebrae were meant to be in. It's the place the vertebrae was born to be in, the place where, as an embryo the structures of the spine were created. This concept helps explain many things concerning the clinical findings and clinical outcome of a patient's treatment program.
- Why do patients have to keep coming back to a chiropractor for further treatments? Remember, "life is adjusting you"! Your computer, your posture, your sitting too much in chairs, sleeping with too many pillows, looking down texting or reading... all these things cause flexion and flexion is the root cause of subluxation. Does it mean we should not ever flex forward? No, it means that too much flexion without your core muscles being toned causes subluxation. I'm not a pain doctor, I'm not just here to only relieve symptoms, that's only part of it. I'm here to help YOU heal yourself. Of course, when you first come to my clinic, especially if you have a specific issue, I will see you more often at first, but as you get better and hold your adjustments, I will space out the treatments. But even if you are symptom free, one should come in for an alignment once or twice per month. There is much evidence that shows just the chiropractic adjustment alone stimulates the connection from your spine to your brain, waking up this connection means that homeostasis will be "jump started" again. Making your body "aware" again of the joints in your spine. This allows communication between your spine and your brain. So lifetime care is the goal!
- What causes the vertebrae to go back out of place once it's been adjusted? Good question, one that was never answered for me during the seven years of schooling required at the time I became a chiropractor (now it is a minimum of 8 years of full time college in almost all states). Because a vertebra is happy in its primary soft spot, but its movement from the primary soft spot to its subluxated spot is done through the patient having undergone some type of spinal FLEXION. Looking at the spine and how it moves into a posterior position when subluxated (this is the only direction possible when looking at the anatomical structure of the facets) can only be accomplished by the patient flexing the spine. When spinal flexion occurs (great when doing yoga or stretching when not having back pain), this flexion "pushes" the vertebra backwards into this subluxated position call the "Secondary Soft Spot".
- What's so important about the secondary soft spot? The Secondary Soft Spot is an anatomically bad position in the spinal column. The vertebrae was allowed to enter this new, bad position for several reasons. First, the musculature holding the spine together (ie fascia, muscle etc.) was week. The second reason, the posture of the patient or inappropriate continued flexion of the spine, for example, slouching and lifting wrong for low back pain and excessive flexion and curling forward of the thoracic spine or the constant flexion of the neck (while texting or sleeping with too many pillows, for example), causes various areas to go into this secondary soft spot. The third reason is the communication of the brain to the spinal cord has dulled, allowing the spinal cord not to be protected by the homeostasis that naturally occurs when brain communication to the spine is normal. This is why getting adjusted at least once or twice a month for life is important.
- How can we train the spine not to go into the secondary soft spot after a manipulation to correct the subluxation? When the patient is out of severe pain, they can start to do light exercise to begin to strengthen the spine. This strength will help "hold" the vertebrae in the primary soft spot. After strengthening the spine for one to two weeks, the patient may start to stretch lightly at first, then using the Kiso Ball and the Para-Stim to help train the spine to hold this new position...the vertebra in the primary soft spot.
- Why does the patient first have to exercise then stretch? Because the secondary soft spot called the vertebra out. The patient did not have sufficient strength to "hold" the vertebra in its anatomically correct position, its primary soft spot. Why did this occur? Perhaps the patient has allowed him or her self to become weak in the area of subluxation. How did this occur? By not exercising or using their spine in any way to build strength. The other reason is that, if you stretch first, right after a manipulation, it's likely that the vertebra will move into the subluxated position again. Stretching causes the spine to often times go into a flexed position. For example, when you stretch the back of your legs, you bend forward and try and touch your toes. This puts the spine in flexion, if I had just adjusted your vertebra into the primary soft spot, which is forward in the spinal column, this forward flexion could have re-positioned the vertebra right back into the secondary soft spot setting up more pain and discomfort. It may feel good at first to stretch forward, stretching the tight muscles in the back of the legs, but this movement could have drawn the vertebra back into the secondary soft spot again. This is precisely what happens in most other chiropractic offices, over and over again, making the patient have to come back in over and over again forever to reposition the vertebra. The other reason the vertebra has come out into the secondary soft spot again is due to the brain communication has been dulled which is re-awakened by the adjustment process and allows homeostasis to re-establish itself again.
- Is there another exercise that patients can do to help hold their vertebra in the primary soft spot? Yes, using the Kiso Ball properly helps gently push the vertebrae forward into their primary soft spots throughout the spine. The Kiso Ball is used from the T1 area, near what I call the hump just below the neck, down about half way down the spine to about the T10 vertebrae. The ball is also used in the sacrum and L5 area. It can be used in the lower back from the sacrum to about the L3 vertebra. Any higher than this is not recommended. So the areas in the spine the Ball should not be used is between the T10 vertebra to the L3 vertebra. The Para-Stim, a wooden device, is used like the Kiso Ball but for the neck. It's so named because it stimulates the Para-Sympathetic nervous system. Many patients with neck pain have something called "sympathetic over-ride". This condition lets the sympathetic nervous system go wild. It can cause panic attacks, shortness of breath, sensitivity to light and rapid heart rate. It's caused from the relationship of the cranium to the atlas vertebra. The atlas is the very top vertebra in the spine. It's the only vertebra that moves sideways when it subluxates. All the rest of the spinal vertebrae move in a posterior direction. So the primary soft spot for the atlas vertebra is in a neutral, "normal" position under the skull and the C2 vertebra. In the Kiso Method, when the atlas vertebra subluxates, it moves either right or left with possible posterior or anterior direction of the transverse processes. This makes the cranium compensate. The atlas moving right, for example, would usually cause the cranium to lift on the opposite side of the atlas. This compromises the brain stem, putting pressure on the spinal cord covering setting off a response in the body called the fight or flight system. The Para-Stim is used in three areas of the spine. One is at the top of the cervical spine right under the skull. This position helps stimulate the para-sympathetic nervous system. It's used in the mid neck to help accentuate the lordodic cervical curve. Just adjusting the patient to help alleviate their reduced cervical curve could take numerous adjustments. Using the Para-Stim quickly helps train the neck to allow a beautiful cervical curve. Finally, the Para-Stim is used in the lower neck from C5 to C7 for patients suffering from a brachial nerve problem. For example, if you have a brachial nerve problem with radiating nerve pain down the arm at the C5-6 nerve root or radial nerve, you will obviously try and manipulate this vertebra to reposition it in a better position, close to the primary soft spot. Using the Para-Stim will greatly improve the patient between visits, doing something that can't be accomplished in your office, daily training of the vertebra to HOLD it's proper position.
- What are some other concepts in the Kiso Method that explain phenomena associated with patient care? When a patient has low back pain, often they experience leg cramping in various areas down the leg. Determining what area of the lower back a patient is being afflicted by is actually fairly simple. Symptomatology helps lead us to the right area of the spine. If a patient comes in with strong low back pain, localized to the L5/S1 area of the spine, I ask the patient if they have any leg pain, as in sciatica. They patient may say "no, I have no leg pain." I proceed to push on the musculature starting at the buttock and moving down the legs to the lower calf. I often feel what I call "abnormal tightness." This abnormal tightness of the leg muscles is sometimes not felt, or was unnoticed, by the patient. The patient may say "I often get leg cramps when I run," or say " I get leg cramping when I sleep." This phenomena is termed "Latent Sciatica" in the Kiso Method. It's not overtly noticed by the patient when undergoing a bout of back pain, or with chronic back pain. Often times when I draw the patient's attention to the situation, they will say "oh wow, now I know I have been feeling tight muscles in my legs." In the Kiso Method, feeling tight muscles either in the arms or legs, clues us into what vertebrae are affecting the patient's condition. Pain down the buttock, down the back of the leg and into the outside calf, for example, is caused from a subluxation of the L5/S1 vertebra. It's amazing in Kiso Seminars, we find someone with "latent sciatica," with a tight posterior thigh for example, and adjust the vertebra on the Kiso Bench, non force, and we all can feel the leg muscle relax immediately after the adjustment. Also the softening of the muscle lasts.
- Are there many other concepts in the Kiso Method that define it as a unique healing art? Yes, many more. Too many to address here. Concepts like "spill over." A phenomenon where the patient experiencing tenderness at the top of the head in various places caused from the upper cervical spine being subluxated. This is due to energy raising up from the back of the spine over the top of the skull as it makes its way down the front of the body. This "stagnation" manifests as pain, often accompanied by swollen pockets and headaches. Yes, there is a simple fix for this problem.
- What other factors influence a persons ability to hold an adjustment? Food is very important. Over the years, I've seen many patients have trouble holding adjustments if their food intake is poor quality. I have written an easy to read, fun book called The Kiso Diet and its successor the Eat for Sex Diet. The Kiso Diet is succinct and the Eat for Sex Diet is more expanded into hormones and foods that specifically help vitality. Both books are for patients and practitioners alike. If patients learn to eat well, they will feel better, have more energy and have a greater ability to hold their adjustments.
- Is the Kiso Method a non force technique? It has non force throughout the entire technique. It also has force techniques. What sets the force techniques apart from other techniques is the posterior to anterior direction of force that is stressed when making an adjustment. The Kiso Bench is the number one aspect of this art that is entirely different compared with any other technique in the world. It is extremely powerful, completely non force and takes only seconds to perform. All the other areas of the spine can be adjusted with either force or using an oscillation non force method. This oscillation non for method is what is taught to non chiropractors.
- How often should a patient come in? With the Kiso Method and frequency of coming in for treatments, there is a specific protocol. If you don't fallow it, usually the patient and you, the practitioner won't be happy. Remember, the primary soft spot is where you want the vertebra to be. the secondary is where it subluxated back to. It's like hammering a nail. In order to get it in, you will need to put the subluxated vertebra into the primary soft spot requiring sometimes subsequent treatments. When a patient comes in with severe low back pain, you are only using the Kiso Bench...a non force method of alignment. What stops the vertebra from going into place at one adjustment? The swelling now present. Also muscle memory will pull this vertebra out of place into the secondary soft spot. The other major reason the vertebra does not hold into the primary soft spot is posture. Slouching when you sit is the major reason for lumbar subluxation in the first place. Counseling the patient on sitting and bending correctly is a must. Having the patient come in to your office two times in one day at the beginning is very helpful. Once in the morning and once in the afternoon. Having them come everyday is also helpful until the vertebra in question starts to hold into the primary soft spot. How do you know? Because the symptoms are getting better quickly.
- Is there a time when the Kiso Method does not work? Yes, when you don't have the patient come in in time for the follow up visit. If you have a new patient with severe pain and you set your follow up visit in one week....the patient and you will not be happy. It's too long between visits. The body will pull this vertebra back out to the secondary within two days so you better have your patient come in in two days from the initial visit. Remember, your pushing this subluxation from the secondary to the primary....hammering a nail....you need to keep pushing...adjusting it over and over until it is in place. Don't let your patient control when he or she comes in next....they are the worst judge of when to come in next. At the beginning of treatment with a new patient, every other day is good for most people. With severe low back injuries, twice in one day is good. I personally don't charge the second treatment...this is up to you the practitioner though. The other time is usually in the cervical spine or the thoracic spine. A non force adjustment just does not make the change from putting the vertebra into the primary soft spot. Why? Because it's sometimes just resistant to non force adjusting and needs an initial force adjustment. So if you've tried the Kiso Method and found it did not work, it was probably because of one of the above reasons. The last reason the Kiso Method may not seem to work comes from not telling your patient not to stretch and how to sit and bend correctly....this is crucial.