CBP® GOALS OF CARE
CBP® Technique emphasizes optimal posture and spinal alignment as the primary goals of chiropractic care while simultaneously documenting improvements in pain and functional based outcomes. The uniqueness of CBP® treatment is in structural rehabilitation of the spine and posture. In general the goals of CBP® Care are:
Normal Front & Side View Posture
Center of mass of head, rib cage & pelvis vertically aligned in Front and Side views.
Normal Spinal Alignment
Front view: vertical alignment
Side View: Harrison Ideal or Average Spinal Model
Normal function
Improved Range of Motion and quality of movement,
Improved muscle strength,
Improved Health & Symptom Improvements
Neck disability index
Oswestry low back index,
SF 36 or Health Status Questionnaire
IDEAL POSTURAL ALIGNMENT:
Ideal postural alignment is depicted in both the frontal and side views. In each view, the center of mass of the skull, thorax, and pelvis are in a vertical line with respect to gravity. In the frontal view, the spinal column is vertically aligned-a straight column- with respect to gravity. In the side view, the spine has three primary curvatures which will be described below:
Neck Curve – Cervical Lordosis
Ribcage Curve – Thoracic Kyphosis
Low back Curve – Lumbar Lordosis
IDEAL SPINAL ALIGNMENT: HARRISON FULL SPINE MODEL
As in all fields of study dealing with the human body, i.e. physiology, hematology, anatomy, etc., there exist normal values for alignment of the spine. The Harrison Spinal Model is an evidenced based model for side view spinal alignment. It is the geometric path of the posterior longitudinal ligament or the backs of the vertebra from the 1st neck vertebra to the bottom of the lower back or top of the sacrum.
CBP® researchers have extensively published ideal and average models for the human spinal curvatures as viewed from the side. This research has lead to the finding of the ‘Harrison Spinal Model’. This model details both Ideal and Average geometric shapes for the curves of the spine from the side. Additionally, ideal and average ranges for the spinal segmental angles for each of the spinal regions have been identified. The neck or cervical spine should have a geometric shape that approximates a ‘piece of a circle’. The ribcage or thoracic spine should have a geometric shape that approximates an oval-elliptical shape. And the low back or lumbar spine should have a geometric shape that approximates an oval-elliptical shape.
These are “evidence based” models. In fact, the CBP® neck-cervical circular model and the low back- lumbar elliptical model have both been found to have discriminative validity between pain and non pain subjects. In other words, the Harrison Spinal Model has been found to be able identify pain subjects versus non-pain subjects by what their spinal x-ray shapes are.
The Harrison Spinal Model in the Neck-Cervical region. The Harrison spinal model is depicted as the GREEN curved line in this figure. On the Right is a normal curved patient x-ray. On the Left is an abnormal curved patient x-ray; where the patient’s abnormal shape is shown by the Red dashed line. The Harrison Spinal Model in the neck has been shown to reasonably predict which person will have neck pain compared to normal subjects.
X-RAY ANALYSIS AND UTILIZATION
To establish optimal and average sagittal models, X-ray analysis and line drawing procedures are utilized. CBP® protocols require that the doctor must measure the displacements on spinal radiographs (segmental Subluxation). Both lateral-side view and anterior to posterior (AP) or frontal view CBP® X-ray line drawing procedures have been studied and found to be reliable. Furthermore, CBP® utilizes standardized x-ray positioning procedures that have been studied and found to be reliable.
As with measures of pain intensity, range of motion, and quality of life, periodic assessment of spinal structural alignment is important to evaluate progress and determine when maximum patient improvement has been reached. In CBP® Technique, the use of initial and follow-up spinal x-rays or radiographs is deemed necessary. Importantly, there is data to show that the use of medical/chiropractic x-rays constitutes a very minor health risk and in fact has been shown to be of benefit (decreased sickness and cancer mortality rates) in some studies.
CBP® POSTURAL ANALYSIS
Previously, engineering concepts were used to describe all spinal-vertebral segmental movements as rotations and translations in 3-dimensions. However, Dr. Don Harrison was the first to describe abnormal postures of the head, rib cage, and pelvis in this manner. There are twelve simple motions in six-degrees of freedom as rotations and translations of the human head, ribcage, and pelvis:
• Rotation is a turning, twisting, or tilting movement and is an angular movement.
• Translation is a straight line movement (up, down, left, right, forward, backward).
MIRROR IMAGE® POSTURAL ADJUSTMENTS
In March 1980, Dr. Don Harrison originated postural Chiropractic adjusting procedures that he coined Mirror Image®. Clinically, these adjusting set-ups were found to result in postural and spinal alignment improvements verified with follow up x-ray.
Dr. Don Harrison and his brother Glenn Harrison originated drop table adjustments, instrument adjustments (both table and hand-held). For these new Mirror Image® patient positions, Dr. Don Harrison placed the patient in their opposite posture. These Harrison Mirror Image® positions can be described as reflecting the patient’s head, rib cage, and/or pelvis across the median-sagittal plane in the AP view, and positioning the head, rib cage, and/or pelvis across the mid-frontal plane in the lateral view.
Mirror Image Adjustments, assists the Chiropractor in the rehabilitation of the patient’s posture. In theory, these adjustments re-balance the bodies sense of proper balance or alignment by way of triggering improved muscle and nerve reflexes. Thus, postural adjustments as performed with drop table, hand-held instrument, or even mirror image manipulation procedures, are performed for resetting the nervous system regulation of postural muscle balance.
MIRROR IMAGE® POSTURAL EXERCISES
Further, in 1980-1986, Dr. Don and Dr. Glenn Harrison began developing and testing Mirror Image® posture exercises. Mirror image® exercises are performed to stretch shortened muscles and to strengthen those muscles that have weakened in areas where postural muscles have adapted to asymmetric abnormal postures. Although strength and conditioning exercise has not proven to correct posture, postural exercises performed in the mirror image have shown initial promise in the reduction of posture and spinal displacements.
MIRROR IMAGE® POSTURAL AND SPINAL TRACTION
Additionally from 1980-1986, for use in difficult cases, Dr. Don Harrison and Dr. Glenn Harrison originated several Mirror Image® postural traction (rotations and translations of the head, rib cage, and pelvis) and cervical extension (backwards bending) traction methods to restore the sagittal cervical curve. These CBP® Technique cervical extension traction methods were improved upon over the years by several other CBP® practitioners.
From 1996-2000, several postural and spinal traction methods to restore thoracic and lumbar sagittal curvatures were developed by Dr. Deed Harrison; Dr. Don Harrison’s son. Dr. Deed began to further refine the CBP® Technique cervical traction methods with an analysis of head posture, curve configuration, thoracic curvature, gender, and body size. From 1992-2004, six non-randomized clinical control trials, one randomized clinical control trial, and five case studies have been performed on these CBP® Technique Mirror Image® procedures.
Postural mirror image and extension traction for the side view spinal curves provides sustained loading periods of 10-20 minutes and is necessary to cause visco-elastic deformation to the resting length of the spinal ligaments, muscles, and discs. In clinical controlled trials, extension traction, as done in CBP® Technique, is the only proven method (without surgery) shown to consistently correct abnormal spinal curvatures back towards their normal alignment.
There are MANY types of spinal extension traction methods used in CBP® Technique; some are more aggressive and technical than others. Each patient’s spine is unique and thus, a variety of traction devices are used depending upon the exact condition of the patient.
TREATMENT INTERVENTIONS
CBP® structural rehabilitation procedures include Mirror Image® exercises, adjustments, and traction (referred to as the E.A.T protocol). The mirror image® posture positions are the rotation and translation pairs in or about each coordinate axis. Thus, CBP® care is multi-modal and is consistent with Bolton’s ideas of clinical applications in evidence based practice.
The reason for postural mirror image exercises, adjustments, and traction procedures is to address all the tissues involved in spine and posture alignment.
Unlike the pain management care, the E.A.T corrective care protocol is unique to CBP®.
REFERENCES
1 Harrison DD. CBP Technique: The Physics of Spinal Correction. National Library of Medicine #WE 725 4318C, 1982-97. Harrison DD. CBP Technique: The Physiscs of Spinal Correction.
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