and decreased blood flow, leading to increased pain stimula-tion and decreasing joint mobility. The second step, which is the key to the entire system, is assessing motor inhibition of the tissues around the scapular and pelvic girdles. Le Pera (2001) describes muscle motor inhibition as the inability of the peripheral nerve to contract the muscle due to chemical or physical trauma. This motor muscle inhibition can be cause by three different factors: nociception, pain and arthrogenous changes. plitudes and they are slower which most likely represents a functional adaptation to experimental jaw muscle pain. Finally, studies have shown the presence of arthrogenous muscle inhibition. Sedory (2007) found arthrogenic inhibi -tion of the hamstrings muscles bilaterally and facilitation of the quadriceps muscle ipsilateral to the involved limb were noted in subjects with unilateral chronic ankle instability. WHY INHIBITION MATTERS Portenoy (1994) described nociception as the neural pro-cesses of encoding and processing noxious stimuli. It is the afferent activity produced in the peripheral and central ner-vous system by stimuli that have the potential to damage tis-sue. Nijs (2012) concluded that chronic nociceptive stimuli result in cortical relay of the motor output in humans, and a reduced activity of the painful muscle. Nociception-induced motor inhibition might prevent effective motor retraining. In addition, the sympathetic nervous system responds to chronic nociception with enhanced sympathetic activation. Not only motor and sympathetic output pathways are affected by nociceptive input – afferent pathways (proprioception and somatosensory processing) are influenced by tonic muscle nociception as well. Svensson (1996) studied people suffering from jaw pain and concluded that sensory-motor interactions can be ex-plained by a facilitatory effect of activity in nociceptive mus-cle afferents on inhibitory brain-stem interneurons during agonist action.Thus, generated movements have smaller am-Practitioners in manual medicine spend too much time focusing on the area of pain, which may not be specifically localized to the area of pathology. The Exstore assessment system allows the practitioner to determine the inhibition of the patient’s dysfunction in a sys-tematic and efficient manner. The system is simple to apply in practice and is ideal for chiropractors and manual thera-pists who use acupuncture and myofascial release as part of their treatments. INJURY PREVENTION Unlike most assessment systems, Exstore is also very effec-tive in helping patients and athletes prevent injury. This sys-tem has been used on many professional athletes as a means of pre-screening and treating before any serious injuries can occur. Exstore is useful not only in helping elite athletes but also can help practitioners be more specific and time effi-cient while helping patients from all age groups and levels of activity. NOT JUST FOR CHIROPRACTORS Since this system was created, it has been taught to chiro-practors, physiotherapists, occupational therapists, massage therapists, athletic therapists and medical doctors for use on all of their patients. The Hamilton Family Health Team in Hamilton, Ontario, which houses primary care physicians and nurses and serves approximately 280,000 patients, has asked Dr. Lombardi to teach Exstore to its MDs, nurse-practitioners and nurses. Dr. Ravinder Ohson, an MD from Hamilton, utilizes the assessment system in his own practice. “I have used the Exstore system and found it to be an ef-ficient way to localize the cause of the dysfunction,” says Dr. Ohson. “This has saved me time as well as reduced my reli-ance on radiology to give me the diagnosis. I would suggest this system to any primary care provider in the assessment of a musculoskeletal disorder.” Exstore has changed the way I approach patients daily. It has given me the confidence to accurately diagnose and treat any musculoskeletal complaint and I feel it would be a welcome system in any clinical practice. • For the article with references, please see Current Issue page at www.canadianchiropractor.ca. Editor’s note; Dr. Hurley does not work for, or have any interests in, Exstore or Dr. Lombardi. 28 • CANADiAN CHiROPRACTOR | FEBRUARY 2013 www.canadianchiropractor.ca
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