Translation:
Angela Berg, MSc
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Treatment Methods
Manual therapy of
the cervical spine
Manual therapy in infants is not comparable to the
thrust-type manipulation conventionally used in adults. Treatment of infants involves
gentle impulse manipulation, without rotation or sudden application of force.
Two commonly used methods are Atlas Therapy according to Arlen,
and Therapy according to Drs. Gutmann and Biedermann.
Techniques vary,
and the results achieved by an individual doctor are more closely related to their
individual style of treatment than to the certificates that they hold.
1.
Atlas Therapy according to Arlen involves the atlas alone, and is effective
in a single direction only. Treatment often needs to be repeated.
2. Therapy
according to Dr. Gutmann, as modified by Dr. Biedermann, involves the
entire head joint between the base of the skull and C3, and the impulse is applied
in three directions (ie. left/right, forwards/backwards and in the direction of
possible rotational malpositioning of the vertebra).
This second technique
as applied to adults is called "HIO", as in Hole In One,
therapy, since one impulse addresses the complete 3-dimensional picture.
Adults
and children are not physically manipulated in the same way, but although the
therapy technique differs, analysis of the problem is similar (patient history,
physical examination, x-ray analysis).
The technique: A moderate
lateral pressure is applied to the upper neck, just below the back of the head.
Improvement in the range of movement of the head and neck is demonstrable
directly after treatment. Various other functions can also be affected via the
reflex centre in this area, which influences muscle control and, for example,
sleep patterns.
An immediate improvement of balance and a relatively rapid
relaxation of the muscles involved in maintaining posture are often a consequence
of treatment. It is thought that manipulation alters the stimulation of the numerous
sensory receptors in the neck which are important for posture.
The treatment
is fundamentally pain-free, but babies don't particularly like it, even during
the diagnosis stage. However, it is obvious that no great pain is involved as
babies rapidly calm down afterwards (mostly the moment they are given back to
their mother/father).
In contrast to older techniques, these modern therapeutic
methods do not result in significant movements of the vertebrae involved.
This type of treatment is consequently low-risk, assuming that it is performed
properly, and can be used even for young infants. Because perception and control
are significantly affected, however, treatment should not be performed too often.
In
most cases, babies only need a single treatment. According to Dr. Biedermann,
a maximum of 15% of infants require a second treatment within the first year.
In order to allow the body time to adjust after therapy, other "stimulating"
treatments should be avoided for a period of 2-3 weeks, such as vaccinations,
other intensive medical investigations, osteopathy or physiotherapy. This adjustment
period varies from patient to patient, and is partly dependant on the extent of
the problem and the age of the patient.
After this pause, physiotherapy needs
can be evaluated, and where necessary adjusted to suit the current developmental
stage of the patient.
A routine check-up is advisable when the child reaches
three years of age, and again before starting school. This allows for early identification
of poor motor skills or perception problems, avoiding the risk of oversight during
normal medical checkups.
Brief relapses, for example during an infection
or a growth spurt, do not require a new visit to the specialist. It may be that
a child falls back into old habits for a short period.
Once freedom of movement
has been established, the child's body is usually able to cope with minor challenges.
After major falls or anasthaesia it may be sensible to have a checkup, if symptoms
recur and persist for longer than 1-2 weeks.
Babies from families with a
history of spinal problems such as scoliosis should be regularly monitored. This
can usually be achieved via a physiotherapist and general practitioner, so that
visits to the specialist can be restricted to 1-2 times per year.
Manual
therapy does not replace other forms of therapy, but provides a starting point
from which occupational therapy (Ergotherapie), physiotherapy, INPP therapy or
psychomotor therapy can be provided more efficiently. Manual therapy optimizes
biomechanics (joint and muscle function) and central control.
Manual
therapy of the head and neck for adults
Treatment of older children
and adults takes longer, because the vertebrae are usually fixed into their positions
and not so open to re-setting. Again, it is again important to avoid using manual
therapy too frequently, since the body's response to an improved head joint position
needs time and patience. Daily treatments have now been abandoned by most atlas
therapists. Depending on the diagnosis, the time between treatments may be several
weeks to months.
In addition to corrections to the head joint, the pelvic
joint and the rest of the spinal column are assessed and treated as necessary.
Various techniques may be used, for example osteopathy, particularly "soft
tissue techniques" such as myofascial release or muscle energy technique.
Manual
therapy of the cervical spine can help with:
- Neck pain
- Whiplash
- Dizziness
- Balance
problems
- Movement difficulties (spasticity, Parkinsons)
- Chronic
backache
- Slipped discs
- Ringing in the ears (tinitus)
A
routine examination of the head joint in babies (as is carried out for
the hip joint) could potentially help very many people in reducing headaches,
back pain and even certain behavioural problems in later life.
The time-consuming
nature of investigation and treatment means that many doctors working in this
area only treat private patients. Whether public health insurers cover treatment,
and to what extent, is often a question of negotiation.
