COLUMNIST bUsINEss TALk c 10 things I didn’t learn in school, part 1 of 2 How creativity and resourcefulness revolutionized my practice by anthony loMbarDi of it until after I left school. The motor point is the junction where the motor nerve innervates the skeletal muscle. It’s the end point of all motor neural processes, which culminates in the desired contraction of skeletal muscle. The most popular factors that influence this clinical phenomenon are nociception and joint changes. Nociception is the processing of noxious stimuli by the peripheral sensory system, which can adversely affect the motor neuron, causing a weaker muscle contrac-tion. Changes in spinal and peripheral joints cause nociception which projects sensory information via interneurons onto alpha motoneurons in the spinal cord, triggering peripheral muscle inhibition (Lund 1999, Svennson 1996, Nijs 2012, Hurley 1997, Horre 2006). onventional curriculums teach concepts and prin-ciples that are within the traditional realm of the profession. Consequently, academia is unable to keep up with the continually changing clinical and economic climates that today’s chiropractors prac-tice in. School, for the most part, teaches us the basics – but I’ve learned that it’s those individuals who go beyond what is taught in school who make the biggest impact as their careers move forward. Fortunately, I have had some very good clinical mentors and have followed sound business advice. These two, when merged together, have produced some very fruitful results for my practice. In this two-part article, I will share 10 things I didn’t learn in school that have forever revolutionized my practice and allowed me to provide innovative ways to make every visit a patient experience. Restoring motor inhibition 1. Assess for success Over time, studies have demonstrated there is a lack of research to support conventional orthopedic testing. Research has been telling us that conventional assessment approaches often lead to incorrect interpretations of diagnostic imaging and conven-tional orthopedic testing (Jensen, 1994, Cadogan, 2011, Cont-ant, 2003). As clinicians, we are presented with injuries and different clinical presentations that challenge the way we assess our patients. Functional assessment The work of several researchers has built the foundation for the growing use of Functional Motor Point Acupuncture and Acupressure to restore motor inhibition. Take the example of a patient with low-back pain who has a weak gluteus maximus muscle brought on by an old ankle sprain. In this case, locating and stimulating the neuromuscular junction or “motor point” of the inhibited tissue will help restore dysfunction. This dys-function can be restored by using an acupuncture needle or manual compression directly on the motor point, with or without the use of electricity (Jensen, 1994, Cadogan, 2011, Contant, 2003). When done correctly, the clinical results as-tound most patients, leading them to come back and talk to other people about your clinic. Functional assessment is changing the way chiropractors assess their patients. It is a contemporary term that focuses on locat-ing biomechanical dysfunction so that our assessment can specifically direct where treatment will occur. I use a functional assessment system (EXSTORE) with favourable results be-cause it provides patients with tangible perspective in the progression of their treatment. If the initial assessment reveals a weak gluteus minimus, and if on the following visits that muscle tests strong, then patients may observe and appreciate the differences even if they still experience pain. Functional assessment constitutes the majority of referrals to my practice. 3. Doctors really don’t fix anything 2. Getting to the (motor) point The concept of the motor point has dramatically improved my treatment results and I did not learn the clinical significance AnthOny LOmbArdi, dc, is consultant to athletes in the NFL, CFL and NHL, and founder of the Hamilton Back Clinic in Hamilton, Ont. He teaches his fundamental EXSTORE Assessment System and conducts practice-building workshops to health professionals. Visit www.exstore.ca for information. 12 Canadian Chiropractor October 2013 Many clinicians feel their treatments help their patients by “fixing” the problem, much like an auto mechanic corrects the function of a car. The reality is that clinicians who treat human conditions never actually “fix” anything; they merely help the ever changing human organism to adapt from one day to the next. Three years ago, I interviewed Dr. Alejandro Elorriaga, who has trained thousands of successful practitioners as the director of the McMaster Contemporary Medical Acupunc-ture Program. Elorriaga said the biological reality of any clinical dysfunction of the musculoskeletal system is that the underlying problem most likely has been present for the better part of the person’s life, before it reaches the point of becoming part of a pain ex-perience. The biological reality is that no therapeutic interven-tion will ever be able to fully correct the very complex under-lying elemental dysfunctions associated to the presenting biomechanical clinical problem. However, therapeutic inter-ventions such as electro-acupuncture, manual techniques and www.canadianchiropractor.ca
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