The Pettibon Spinal Biomechanics System:

What Medical Doctors Dont Want You To Know!

The human body consists of a vast variety of organs and vital systems. The Central
Nervous System (CNS), or our brain and spinal cord, govern and coordinates work of
every organ, tissue, and cell in our body. The health of each organ depends on the
health and proper governing of the CNS. Thus, if CNS fails to work properly our
organs and therefore overall health will not be sufficient to support proper health,
youthfulness, and longevity.

Since the health of the CNS is very important, our body protects it by incasing it into
the bone armor of the skull and the spine. The health of the Spine directly influences
health of the CNS and therefore our overall health. Because the spine supports our
body in an up-right position, the health of the spine is directly reflected in our posture.

Every day our spine has to withstand tremendous forces. Forces such as, gravity and
the weight of atmospheric pressure act on us and destroy our spine every second of our
lives, even when we sleep. Add to these destruction forces injuries from prolonged
sitting, falls and blows, lifting, bending, car accidents, etc. and you will have recipe for
disaster. From this everyday abuse our spine, hence posture, deteriorates causing
insufficient performance of the CNS. As a consequence our neck, back, and/or
extremities become painful, tingly, or numb and our health begins to decline. It is only
then we start to seek treatment.

News Week magazine on April 18th of 2003 wrote that annually over $100 Billion is
spent on spinal ailments. Doctors prescribe patients ineffective but costly (about
$34,000 a pop) surgeries and pain killing narcotics. The article states that, chiropractic
is a safe and effective treatment for the spine. Though, the author does allege that: it
doesnt give long lasting results. However, there is a branch of chiropractic that
employs knowledge of Human Biomechanics as a unique method of spinal treatment,
which gives unprecedented and long lasting results.

Doctor Burl Pettibon, D. C. lives in Gig Harbor, WA where he leads The Pettibon
Institute. Today he is known around the globe as the Father of Spinal Biomechanics.
Dr. Pettibon started researching the human spine over 40 years ago. Through his
research he realized that the spine is an extremely complex neuro biomechanical
system. In the course of X-ray and video fluoroscopy studies he realized how our spine
works. Our body simply attempts to counteract harmful changes caused by everyday
activities. Further, through MRI studies, Dr. Pettibon and other researchers around the
world found that posture deterioration causes the spinal cord and nerves that exit the
spine to stretch and deform, impeding work and health of the CNS. By using
contemporary methods of research, Dr. Pettibon has developed a mathematical model
of the spine which explains how the spine works. He and his research team developed
a vast variety of instruments that have no equal in effectiveness. Most importantly they
have developed The Pettibon System which restores and rejuvenates the spine. If the
patient complies with all of the doctors prescriptions, the results are astonishing.
Moreover, the changes are long lasting. If you would like to learn more about this
revolutionary spine and posture restoration treatment please visit:
www.pettibonsystem.com and www.spinalfitness.com.

HOW DOES THE PETTIBON SYSTEM WORK?

The profound knowledge of neural and spinal functions allows the doctor, via a unique
manipulation system and specially developed core muscle exercises, along with the use
of patented equipment, to influence our bodys natural reflexes in the way that restores
spinal function, damaged spinal tissues, and therefore patients posture and health.

HOW IS IT DIFFERENT FROM CONVENTIONAL CHIROPRACTIC?

Most conventional chiropractic uses adjustments that may harm more than help and
the treatment is not permanent. The Pettibon System uses unique spinal minipulations
in connection with a series of exercises that are directed towards permanent spinal
correction and postural restoration.
The conventional system views the spine as 24 individula vertebra, thus limiting
results. Whereas the Pettibon System treats the spine as six separate units that function
as one and thus, all must be addressed.
Conventional x-ray techniques may not show hidden injuries. Pettibon chiropractors
use specialy developed x-ray procedures which reveale injuries which are not visible
otherwise.
Conventional chirorpactic does not use outcome measurments monitor patients
progress. The Pettibon System requires doctor to use x-ray, muscle, and neural testing
to monitor and regulate patients progress.

IF IT IS SO GREAT, WHY DONT MEDICAL DOCTORS WANT YOU TO

KNOW ABOUT IT?

The medical and pharmaceutical industry receives over $100 billion annually from
back pain patients. Thus, doctors continue to prescribe drugs and perform surgeries
which are more harmful than effective and obscure effective treatment from the public.
For, if more patients considered the Pettibone System for their needs, medical and
pharmaceutical industries would lose huge dividends.
 N. W. Spinal Rehabilitation Clinic, P. S. is one of the few clinics
in the State of Washington that is proud to offer The Pettibon
System at their office. Led by Doctor Slava Borisenko, D.C., the
clinic has been serving patients since 2001.

1993-1997: University of Utah: Major; Pre-Med and Psychology, Minor; Sociology

1997-2000: Palmer Chiropractic College West, training in Spinal Biomechanics.
Over 200 hours of post graduate studies, specializing in The Pettibon System at The
Pettibon Institute.
2001-Present: Owner of private practice in Kent, WA solely practicing The Pettibon
System.

Before Treatment After Treatment

 Injured, Pathological Curve Restored, Healthy Curve

N. W. Spinal Rehabilitation Clinic, P. S. Office: (253) 520-7531

Dr. Slava Borisenko, D. C. Fax: (253) 520-6589
10024 S. E. 240th St., Ste.119, 120 E-mail: nwsrc@qwest.net
Kent, WA 98031 (across from Fred Meyer)
(Map)

NEWSWEEK COVER: Treating Back Pain

Sunday April 18, 12:06 pm ET

The New Debate Over an Affliction Shared by 65

Million Americans

Sufferers Cost U.S. More Than $100 Billion

Annually in Medical Bills, Disability, Lost
Productivity at Work

Critics Charge There's Too Much Surgery, Docs

Look For New Ways To Think About and Treat
Pain

NEW YORK, April 18 /PRNewswire/ -- Back-pain sufferers in America cost this

country more than $100 billion annually in medical bills, disability and lost
productivity at work. And 80 percent of Americans will battle back pain at some
point in their lives, making it the number two reason for doctor visits, after
coughs and other respiratory infections, Newsweek reports in the current issue.
To relieve the pain, Americans wanted a quick fix and thus, between 1996 and
2001, there was a 77 percent increase in spinal-fusion surgery, the most costly
(about $34,000 a pop) and invasive form of therapy. But, as General Editor
Claudia Kalb reports in the April 26 cover story, "Treating Back Pain," (on
newsstands Monday, April 19), many of these procedures simply don't work and
doctors are now looking for simpler, more effective ways to treat one of the most
vexing problems in medicine. "We've come to the point where we have to think
out of the box," says Harvard researcher Dr. David Eisenberg, who is studying
nonsurgical alternatives like massage and acupuncture. "The time is now."

Kalb examines the controversy around spinal fusion and alternatives to treating
pain. Chiropractic treatment, the most popular nonsurgical back therapy, is
booming, with 60,000 chiropractors practicing today, a 50 percent increase since
1990. While experts generally agree that the treatment, which involves spinal
manipulation and stretching, is safe for the lower back, there's not a lot of data on
how effective it is in the long term. Dr. Dan Cherkin, of the Center for Health
Studies in Seattle, is now conducting the first large trial of the practice.

Massage has seen an increasing number of addicted patients, too, and research
shows it does help knead out persistent pain; one study even found that patients
took fewer medications during treatment, Kalb reports. Acupuncture is also
popular, though there's a dearth of evidence about its effectiveness. But even
conventional doctors say if it makes you feel better, go for it. Dr. Jeffrey Ngeow,
an anethesiologist by training, pushes the tiny needles into patients at New York's
Integrative Care Center. He says acupuncture, which seems to stimulate the
release of feel-good endorphins, won't provide instant relief, but it will have a
cumulative effect.

And then there's back pain's relationship to stress. Dr. John Sarno, of NYU
Medical Center's Rusk Institute of Rehabilitation Medicine, believes that almost
all back pain is rooted in bottled-up emotions. He says patients need to recognize
the connection between mind and body before they'll feel better.

In addition, there is currently an NIH-funded pilot program at Harvard where a

diverse group of 25 specialists -- surgeons as well as complementary medicine
experts -- are educating one another on how they diagnose and treat back pain.
The goal: to see if there is a more efficient, multidisciplinary way to attack the
problem -- and to make it cost-effective, too.
 Preface
Neurospinal Biomechanics and The Pettibon system:
A Neurophysiologic Approach to spine and Posture
Correction
Presented by:
Burl R. Pettibon, D.C.
Trevor V. Ireland, D.C.
Mark Morningstar, D.C. |
Carol L. Remz, Ph.D.

Pettibon system, Inc. April 2005w!

Introduction

Chiropractic considers the structure of the spine, and ultimately posture, to be

requisite to maintaining health and normal function. Abnormal posture can cause
alterations in some of our basic physiological processes, such as headaches, blood
pressure, emotions, lung capacity, and hormonal production.(4) Yet maintaining an
erect upright position is difficult because postural control is mainly reflexive and
involuntary. Therefore, although we can temporarily change our posture through
voluntary muscular action, inevitably our conscious control bows to our reflexive,
neurological control of posture. From this, we can logically presume that the best way
to make lasting change to spinal structure, or posture, is to correct posture from
reflexive, involuntary standpoint. This logic forms the foundation for treatment
protocol referred to as The Pettibon system developed by Pettibon''to correct the
spine and posture through gradual adaptation of the spinal and postural reflexes.

fundamental difference in the overall education of chiropractor is the amount of

importance placed upon restoring and maintaining the integrity of the nervous system.
Given that the nervous system controls and regulates ll other body functions, (12) it is
logical that it also controls spinal and postural position and movement. However,
chiropractic treatment has typically shown little success in making gross structural and
postural changes. (16,29) The procedures used in The Pettibon System, in contrast to
conventional chiropractic treatment, heavily emphasize the importance of postural and
paravertebral soft tissues in making structural changes. Although most chiropractors
also incorporate physical exercises into their treatment regimens, (22,23) these exercises
usually attempt to change posture through voluntary neuromotor pathways. They
include mirror-image type exercises, where postural isotonic exercises are performed
in mirror-image fashion to the patient's presenting posture. However, since we know
that posture is under reflexive control, it is much more difficult to change posture
through voluntary means.

From biomechanical perspective, chiropractors typically view the spine as series of

24 movable segments plus the sacrum and coccyx. As result, chiropractic
adjustment/manipulation is typically delivered on segmental basis, using variety of
exams performed to locate singular misaligned vertebra. In contrast, The Pettibon
system treats the skull as the 25th vertebra. Further, it is regarded as the single most
important vertebra, given that most of the reflexes that govern postural control are
housed within the skull, such as the visual system and vestibular apparatus. With these
neurophysiologic capabilities, the skull is the only vertebra that can orient itself to time
and space. Many of our postural reflexes, such as the vestibulocollic reflex, (47)
cervicocollic reflex, (35) pelvo-ocular reflex , (31) vestibulo-ocular reflex, (39) cervico-
ocular reflex, and cervical somatosensory input, ((41, 30, 49) all serve to maintain level
head position in relation to the visual field or to the neck and trunk. Therefore,
correcting the static structure of the skull and cervical spine becomes primary goal in
correcting overall spinal and postural position and movement, as the rest of the spine
orients itself in top-down fashion. (34) Once this is achieved, the rest of the spine is
corrected according to the normalized reference point.

Normal vs. Abnormal

Like any physiologic process, the spine and posture must also possess normal
measurement. Just as blood pressure, serum cholesterol, body temperature, and blood
pH have normal values, so too must static spinal structure. The spine serves two
distinct functions: 1) provide protection for the spinal cord, and 2) provide structural
support for the bony frame. In providing this structural support, one common
denominator exists for all upright bipedal mammals: gravity. Given that gravity is
constant on Earth, corollary to the second spine function is that it also serves to adapt
to gravity, while allowing for balance between support and flexibility. Various
authors have attempted to identify normal spinal model. ((9,10,1) Most recently,
Harrison et l., (5, 17, 20, 26) and Troyanovich et 1.44 outlined their definition of normal
sagittal spine by using elliptical shell modeling. They conclude that the normal cervical
curve should be 42.5 arc of circle from 2-7, the thoracic kyphosis should be
44.2 ellipse when measured from 1-12, and the lumbar spine should be 39.7
ellipse from L1-L5. According to Kapandji (27), each of these three areas should
measure 45 arcs of circle. The inherent problem with an ellipse is the fact that an
ellipse contains stress point. The arc of circle, on the other hand, is radially loaded,
meaning that an arc does not contain stress points. When modeling the lumbar spine as
an arc instead, as Kapandji (27) does, each of the lumbar segments bears the weight of
the trunk uniformly. Therefore, it seems logical to use the Kapandji spinal model as
clinical goal compared to sagittal ellipses. The spinal model proposed by Pettibon,38
adapted from the parameters identified by Kapandji, (27) is pictured in Figure 1.
Figure 1
The Pettibon Spinal Model shows six functional units of the spine.

In discussing the concept of a normal spine, it is also important to address the idea of
clinical symptoms in spine correction. Although clinical trials have not been
conducted, theoretical models have attempted to demonstrate the inevitable result of
chronic abnormal spinal loading. For example, a forward head posture can reverse the
stresses placed upon the cervical spine. This causes degenerative changes at the
anterior portion of the mid and lower cervical spine due to increased compressive force
at these areas. (19, 21) It also creates traction stress along the posterior longitudinal
ligament, thereby promoting traction spur development. This concept is supported in a
recent study by Wiegand et al., (45) where abnormal changes in cervical spine
configuration correctly predicted cervical pathology 79% of the time. A significant
relationship has also been shown between cervical spine pathology and symptoms.
Ironically, although cervical pathology may be present with abnormal cervical spine
structure, the relationship between an altered cervical spinal structure and clinical
symptoms is tenuous at best. (36) However, it could be postulated, as in the case of
scoliosis progression, (48) that because the cervical spine pathology may develop slowly
over time, the body continuously adapts to the abnormal position and advancing
pathology. Therefore, symptoms do not develop until a critical point has been reached,
such as neuroforaminal stenosis or spinal canal stenosis, e.g. cauda equina syndrome.
The ultimate purpose of identifying a normal spine and posture is simply to provide a
reference point from which a clinical goal can be developed. Spinal correction as a
clinical goal and outcome is becoming more important and necessary in a society
where musculoskeletal complaints total nearly $50 billion in health care
spending annually. (6) With the growing interest occurring in spinal correction,
consensus on a normal sagittal spine is desirable so that randomized trials and outcome
assessments in the clinical setting can be designed and tested.
Pettibon Chiropractic Adjustment/Manipulative Procedures

The Pettibon System uses a collection of manipulative techniques, performed both by

hand or adjustive mechanical instruments, and rehabilitative exercises not known to the
typical physiotherapeutic arsenal. (39) The adjustment/manipulative and rehabilitative
procedures are applied on an individual basis, so that every treatment plan can be
designed according to each patient's needs. A brief look into the biomedical literature
reveals that using a combination of adjustment/manipulation and rehabilitative
exercises seems to outperform either modality alone in achieving various clinical
outcomes. (2, 13, 24) In The Pettibon System, spinal adjustment/manipulation is performed
in order to provide a temporary increase in joint mobility so that the rehabilitative
exercises can take advantage of this increased range of motion. Central to The Pettibon
System is the idea that the adjustment/manipulation is not the corrective procedure;
rather, the rehabilitative exercise becomes the corrective procedure. The limited
corrective ability of spinal adjustment/manipulation stems from the neurophysiologic
adaptations to sudden applied mechanical forces. According to Guyton, (14) when the
spine is subjected to sudden mechanical forces, the paravertebral soft tissue is
stretched, eliciting intrinsic dynamic and static stretch reflexes in the paraspinal
muscles. These reflexes cause a reflex contraction of the stretched muscle until the
muscle has restored its initial resting length. Therefore, spinal adjustment/manipulation
performed alone does not address or counteract these reflex properties of the spine that
are designed to protect it from potentially injurious external mechanical forces.

Rather than addressing the spine as a series of individual segments, Pettibon (37, 38)
addresses the spine according to the muscular attachments of the postural muscles.
Through this the spine is conceptualized as a functional entity made of six specific
units, divided by these muscular attachments. Although the individual vertebrae have
independent motion, they do not move independently within a functional confine.
Therefore, the specific goal of manipulative treatment in The Pettibon System is to
mobilize a region of vertebral segments described by its common muscle attachments.
How muscle attachments relate to Pettibon's model of six functional units can be found
in Tables 1, 2 and 3.

Table 1

Muscles that Move a

Spinal Unit Relative to Origin and Insertion Stress Point
Another Unit

1) Iliocostalis Lower thoracic unit to upper thoracic unit T6-T7 disc

2) Iliocostalis Lumborum Sacrum & Ilium to lower thoracics L3

3) Longissimus Capitis Upper thoracic unit & C5-C7 mastoid C4/C5 disc
 Upper thoracic unit to upper cervicals C2- C4/C5 disc
4) Spinalis Cervices
C4

Upper thoracic unit (C4-C7, T1-T6 TPS) to C4/C5

5) Spinal Capitis
occiput bone

Lower thoracics (T7-T12 TPS) to upper

6) Semispinalis Thoracic T6-T7
thoracic unit (C6-T4 spinouses)

Upper T unit (C4-C7, T1-T6) to cervicals (C2- C4-05

7) Semispinalis Cervices
05)

8) Semispinalis Capitis Upper T unit (C4-C7, T1-T6) to occiput C4-05

Upper T unit (C5-C7, T1-T4) to mastoid &

9) Splenius Capitis C4-05
superior nuchal line

Upper T unit (spinouses of T3-T6) to cervicals C4-05

10) Splenius Cervices
(C2-C4)

Upper T unit (C5-C6, T1-T3) to cervicals (C2- C4-05

11) Longus Colli Cervices
C4)

Table 2

Muscles that Reinforce

Origin and Insertion Stress Point
Pivotal Areas

1) Scalenus Anterior 1st rib to TP's of C3-05 C4-05

2) Scalenus Medius 1st rib to TP's of C2-C7 C4-05

3) Scalenus Posterior 2nd rib to TP's of C4-05 C5

4) Iliocostalis Cervices 3rd-6th rib to TP's of C4-05 C5

5) Longissimus Cervices TP's of C5-T5 to TP's of C2-C6 C4

6) Spinalis Thoracis Spinous T11-L2 to T4-T8 T6

7) Longissimus Thoracis Tp's L1-L5 to ribs T2-T12 T7

8) Trapezius Spinous C7-T12 to scapula T6

 TP's & anterior body T12-L5 to lessor L3
9) Psoas Major
trochanter

10) Quadratus Lumborum Ilium to TP's of L1-L5 & 12th rib L3

Table 3

Muscles That
Origin and Insertion Spinal Units
Stabilize Spinal units

1) Latissimus Dorsi Ilium, lumbar fascia, T7-T12 to humerus Lower Thoracics

Upper Thoracic
2) Serratus Post-Superior 2nd-5th ribs to C5-C7, T1, T2
(C5-T6)

3) Serratus Post-Inferior T9-T12 ribs to T11, T12, L1, L2 Lower Thoracics

4) Psoas Minor Pectineal line of pubis to T12-L2 Lower Thoracics

5) Rhomboideus Major &

Spinous C7, T1-T5 to scapula Upper Thoracic
Minor

6) Levator Scapula Scapula to TP's of C1-C4 Upper Cervical Unit

The Pettibon chiropractic adjustment/manipulations performed by hand also differ

from conventional chiropractic methods. Typically, compressive-type manipulative
forces are administered in conventional chiropractic. These forces are vectored
perpendicular to the predominantly vertical orientation of the paravertebral soft tissue,
especially in the cervical spine. Therefore, these soft tissues cannot adapt to this
direction of force efficiently. In contrast, The Pettibon System uses distraction and
accumulative type manipulative procedures. The forces applied in the distraction
procedures are vectored more cranially, thereby allowing the vertically oriented soft
tissue to better adapt to the forces. The accumulative force procedures represent the
positional traction procedures.

Pettibon Rehabilitative Procedures

The heart and soul of Pettibon rehabilitative procedures is the patented (US Patent
#6,788,968) Pettibon Weighting SystemTM (Fig.2). Its goal is to realign the centers of
mass of the head, trunk, and pelvis. It incorporates the use of head, shoulder, and hip
weights placed at specific areas with varying amounts of weight, depending upon the
patient's needs. Since we know that the spine attempts to distribute body weight evenly
around the vertical axis of gravity, placing asymmetrical weights on the external body
surface causes the postural reflexes and spine to adapt to the change in weight
distribution, re-orienting this added weight around the vertical axis. In a study by
Saunders et al., (40) with 131 patients, initial neutral lateral cervical radiographs were
compared to lateral cervical radiographs with patients wearing 3 lb or 5 lb. frontal
headweights. On average, the cervical lordosis improved 34%, while the amount of
forward head posture was reduced by 14 mm in patients wearing 5 lbs. Those wearing
3 lbs. experienced a 31% improvement in cervical lordosis and 18mm reduction in
forward head posture. In a smaller study by Morningstar et al., (32) 15 patients
underwent a series of three manipulative procedures, and were then fitted for a 4-lb
frontal headweight. Radiographic measures of cervical lordosis improved 9.9 and
forward head posture reduced 1.25 inches. While these studies have shown that
external body weighting does make spinal changes, their position is a key to successful
treatment.

Figure 2
The Pettibon Weighting System consists of specially designed head, shoulder and hip weights that
patients wear.
Patent No. 6,481,795-B1

Cailliet (3) described adding weight to the top of the head to treat cervical
hyperlordosis. However, a previous study (17) has shown that in a non-patient
population, the average cervical lordosis is 34, less than the normal value of 42.5
identified by Harrison et al. (15) and 45 outlined by Kapandj (27) and Pettibon (38) .
Therefore, adding weight to the top of the head to reduce cervical lordosis seems
contraindicated for a majority of the population. However, the Pettibon headweight is
positioned on the patient's forehead just above the eyes, causing a posterior skull
translation versus a superior translation. The postural reflexes attempting to rebalance
the skull's new center of mass mediate this posterior translation. This results in a
reduction of the forward head posture and increase in the cervical lordosis.

The Pettibon Weighting System is also considered a type of "isometric demand

exercise" where the weighting system retrains and strengthens weaknesses in the
postural muscles. Because patients vary in height, weight, shape, muscular strength,
and medical history, the practitioner cannot assume that the same abnormal posture in
two different patients will associate with the exact same muscle weaknesses. The
Pettibon Weighting System can only be accurately utilized in conjunction with
radiographic measurements because the reliability of visualizing cervical and lumbar
sagittal alignment is extremely low (8). Therefore, all patients must undergo
radiographic analysis while wearing the weighting system designed specifically for
them. While concerns tend to arise regarding radiation exposure to the patient, the
dosage used is always minimal. In fact, Toppenberg et l. (43) concluded that it would
take 2500 cervical spine x-rays or 1250 lumbar spine x-rays to approach the radiation
safety limit of 5 Rad for fetus.

Another important aspect of the rehabilitative procedures used in The Pettibon system
is that they are intended to address the biomechanical properties of soft tissue.
Hysteresis, for example, is the stored energy in viscoelastic tissues, like muscles,
ligaments, and discs, that is decreased when these tissues are subjected to progressive
loading and unloading cycles over time . (47) Since muscles, ligaments, and discs are
the structural "glue" of the spinal column, it is logical then to address these tissues
when attempting to make changes in the static structure of the spine. In The Pettibon
system, exercises are performed to decrease hysteresis in these tissues using the
Wobble Chair, US Patent #6,481,795 1, (Fig.3) and the Pettibon Repetitive
Cervical Traction, US Patent#6,517,506 1, (Fig.4). From clinical standpoint, the
exercises are performed at the beginning of patient visit prior to manipulative
intervention. This reduces the overall resistance of the soft tissues to the manipulative
force, thus allowing that force to assume more corrective role. Once the manipulative
techniques are administered, the patient then wears the Pettibon Weighting system
while the soft tissue is less resistant. Therefore, in The Pettibon System, all of the
components of the spine are corrected and rehabilitated as unit, using rehabilitative
procedures designed to target each type of tissue specifically.
Figure 3
The Wobble Chair has specially designed seat that move 36040 side-to-side flexion and 35
frontto-back flexion-enabling the pelvis to make figure'8' and mimic full range rapid walking. The
Wobble Chair produces hysteresis in the entire spine, beginning in the pelvic girdle and low back's soft
tissues by putting them through loading and unloading cycles. Patent No.6,481,795 1
Figure 4
The Repetitive Cervical Traction produces hysteresis in the entire spine beginning in the neck's soft
tissues by putting them through loading and unloading cycles.
Patent No 6,517,506 B1
Figure 5
The Linked Exercise Trainer enables patients to perform isometric exercises for strengthening postural
muscles and increasing their endurance.

Finally, another type of isometric exercise is used to rehabilitate normal spine

alignment. Kendall et al. (28) demonstrated this exercise for the treatment of scoliosis,
and Pettibon has slightly modified the performance of these exercises by creating the
Linked Exercise TrainerTM (Fig.5) on which they are performed. The ways in which
these exercises are performed change the functional origin and insertion of the muscle.
For example, the action of a rhomboid muscle is to retract the scapula, when the
spinous processes of the mid thoracic vertebrae serve as the origin. However, when the
scapula is alternatively stabilized as the origin, the rhomboid now pulls on the thoracic
spinous processes, thus acting as a vertebral rotator muscle. Hence, this muscle can be
used to correct evidence of coronal curvatures in that region. Areas of muscle
imbalance can therefore be isolated and strengthened using the Linked Exercise
Trainer, thus reinforcing corrective spinal changes.

Pettibon Radiographic Analysis

For radiographic analysis to be reliable, the quantification of patient progress on pre-

and post-treatment x-rays must not be nullified by inconsistent patient placement.
Harrison et al. (18) showed that small deviations in patient placement can alter the
amount of cervical lordosis by 6.9. A pilot study by Stitzel et al. (42) found that
inconsistent bite line positioning on lateral cervical radiographs can result in up to a
20% measurement error. Therefore, The Pettibon System uses the bite line (hard
palate) as a reference point for lateral cervical radiographs.

The Pettibon System also uses seated x-ray analysis rather than the standard standing
or recumbent positions. From a theoretical standpoint, seated x-rays may reduce the
amount of potential variability in patient positioning because the lower extremity
cannot effect the overall positioning. Furthermore, a seated position increases the axial
stress on the lumbar spine by 35% over standing and 50% over laying down. (37)
Studies assessing the clinical validity for seated lumbar films in detecting and grading
spondylolistheses are currently being conducted. This method of patient positioning
produces a radiographic measurement error of only one-half to two-thirds of a degree
in the cervical spine.(25)

Dynamic radiographic study is also performed in The Pettibon System. Cervical and
lumbar flexion and extension studies help the practitioner locate areas of spinal
instability due to ligamentous disruption. This analysis is performed according to the
American Medical Association's Guide to the Evaluation of Permanent Impairment/
enabling the practitioner to document soft tissue injuries commonly overlooked in
recumbent and static x-rays.

Testing Prospective Patients for Treatment

Patients presenting to a conventional chiropractic facility will typically provide a full
case history, be subjected to some type of examination including palpatory,
neurological, and orthopedic testing, and undergo special studies such as plain film
radiography, magnetic resonance imaging (MRI), ultrasound, or computerized
tomography (CT). As long as there are no contraindications to manipulative treatment,
such as fracture, malignancy, marked instability, dislocation, or prior surgical
intervention, all patients are accepted for treatment, regardless of prognosis. The
Pettibon System, in contrast, allows for individualized patient testing to help
determine, before treatment begins, whether or not benefits are likely.

This patient testing is performed by weighting the patient's head and shoulders, and
sometimes hips, according to his/her preliminary x-ray findings. While wearing
weights, the patient performs a series of exercises on the Wobble Chair, followed by
specific stretching exercises. Afterwards, the initial x-rays are retaken, but this time
while wearing the head and shoulder weights. For example, if the patient's cervical
curve improves measurably, and the forward head posture is reduced, then the patient
can be expected to achieve a significant outcome. However, if the cervical spine
measurements worsen, then the patient does not possess adequate muscle strength
and/or endurance necessary to respond to the spinal corrective care. At this time, if the
patient "fails" this test, he/she is not accepted as a candidate for treatment. However,
the patient may elect to participate in a strengthening program for a specified time
period. Once this program is completed, the patient is re-subjected to the testing
protocol, and if improvement is obtained, the patient is then accepted for treatment.

Phases of Care

The Pettibon System is divided up into three distinct phases: Phase I - Acute Care,
Phase II - Rehabilitation and Correction, and Phase III - Maintenance and Supportive
Care.37 The goals of the acute phase, which lasts from 14 to 21 days, include reducing
or eliminating the patient's symptoms as quickly as possible, improving joint range of
motion, and beginning the restoration of normal sagittal spine alignment. Patients
receive training on home care equipment and procedures that they must do twice daily
for strengthening postural muscles and building endurance. At the end of acute care,
patients are re-examined and re-x-rayed to assess their progress and qualification for
rehabilitation and correction. This phase of care requires three treatments per week,
based upon the common knowledge and physiological fact that muscle strength gains
are achieved when a muscle is fully exercised three times per week. Rehabilitation and
correction continues until normal sagittal and coronal spine alignments are achieved.
This typically takes from 90 days for the non-injured patient and up to 24 months for
the injured patient, depending upon the extent of injuries, age of the patient, chronicity
of the presenting complaint, and patient compliance.' Finally, maintenance and
supportive care focuses upon making the structural changes long lasting, through
weekly workouts using the Linked Exercise Trainer and training in lifestyle habits to
support the patient's health goals.
Preliminary Data

Although many of the individual parts of The Pettibon System have been peer-
reviewed, any treatment method should also seek to provide outcome data on the
overall method to determine effectiveness, risks, side effects, and target populations.
To date, two studies outlining two specific subsets of patient populations have been
conducted. In a progressive study by West et al. (46) , 200 of a possible 1936 patients
met the inclusion criteria for this study. Of these, 177 participated in the trial
intervention. Each patient was evaluated using a visual analog scale (VAS), range of
motion quantification, plain-film radiography, and CT or MRI to rule out treatment
contraindications. These patients were treated by adjustment/manipulation under
anesthesia (MUA) using The Pettibon System manipulative methods. Following the
full MUA protocol, patients with cervical complaints reported an average 62.2%
improvement in VAS scores, while patients with lumbar complaints reported a similar
60.1% improvement. A 68.6% decrease in patients out of work and 64.1% return to
unrestricted activity 6 months post-MUA was achieved. Finally, there was a 58.4%
reduction in prescription pain medication usage, and 24% required no medication six
months after the MUA.

A retrospective case series by Morningstar et al.(33) followed the results of 22 idiopathic

scoliosis patients selected consecutively at three different U.S. chiropractic clinics.
After a maximum of six weeks of treatment using The Pettibon System, an average 17
reduction in Cobb angle measurements resulted. Although long-term follow up was not
recorded for this study, it does provide hope for an alternative to surgical intervention.

Conclusion

The Pettibon System is a conservative treatment approach based upon basic anatomical
and physiological processes to correct the structure of the spine. There is little doubt,
according to the literature, that postural and spinal problems play a major role in the
United States, with a large portion of health care spending devoted to musculoskeletal
treatment annually. (6) Therefore, it is appropriate to evaluate both the clinical
effectiveness and cost effectiveness of any treatment option. Future studies should also
compare the cost of treatment for The Pettibon System to other treatments using the
same outcome measures.

The advantages of The Pettibon System over other postural treatment methods center
on the utilization of neurophysiology to correct and maintain postural control. Since
posture is under a well-developed network of reflexes, any system recruiting these
postural reflexes to aid in spine and posture correction inevitably addresses more than
just the mechanical components. The effects of The Pettibon System on other
physiological systems are currently being explored. Randomized clinical outcome
trials are also being designed and conducted.
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Exercise to Eliminate Spinal Pain

Up to 95 percent of all chronic pain is located in the musculo-skeletal system, and it
predominately affects the aging population. However studies show that age alone is not
the problem. The problem is caused by lack of exercise, excess weight gain and poor
nutrition. Common responses from the general population regarding exercise include,
I dont know how to exercise without hurting my back. or I was told to consult my
doctor before exercising. Unfortunately, their doctors don't usually know which
exercises they should perform either.

To better understand that people are whole human beings rather than just parts, it is
necessary to understand a concept first expressed by the Ayrvidic science which
originated in northern India over 7,000 years ago. They stated that all living organisms
develop, act and react in both time and need to their environment. About 100 years
ago, the chiropractic profession adapted this verbiage as part of its philosophy. Grays
Anatomy, 29th American Edition, Page 4, makes a similar statement. It states, "Of the
nine systems of the body, the nervous systems is supreme. It runs, regulates and
controls all other systems, organs and parts and relates the individual to their
environment." We thank Grays and the Aurvidic science for their insight and have
expanded upon it in "The Pettibon System of Clinical Procedures."

Interestingly, the statements of Greys and Ayrvidic science describe the evolutionary
process; biological species evolve in time and need to their environment. So, the
demand placed on our bodies by the environment that we live in dictates and causes
changes in our body. We usually think of evolution as requiring millions of years.
However, in Pettibon clinics, we find that our patients can and do evolve in both time
and need to the spinal weighting and exercise demands we place on them, often
immediately. With our exercises, a patients spine changes shape from pathological or
unhealthy to a normal healthy spine over short periods of time.

To understand how this change happens, we need to first understand the

following definitions and functions of our body:

Our spine and our body are made of soft and hard tissues.

Spinal hard tissues are made up of the vertebrae, skull and pelvis (bones).

Spinal soft tissues are made up of cartilage, ligaments, discs and muscles,
collectively called "connective tissue," for they connect and hold bones together.

Muscles also move bones and are absolutely necessary for our locomotion and
maintenance, our posture and upright position.

Spinal soft tissues are divided into white and red tissues. White tissues are cartilages
that line up joints, ligaments which hold bones together, and discs that absorb vertical
forces like gravity, lifting, walking, etc. Red tissues are the muscles, which move the
body.
 The discs are also responsible for an incredible spinal mobility and for vast freedom
of motion, which we enjoy every day of our life. In other words, white tissues form
joints and hold the spine together while transferring weight from one structure to the
structure below (see additional information below). Dr.: This is not clearly defined
anywhere below. What other structure? It should be reworded to make more sense.

Red tissues work to move the body while at the same time orientating and re-
orientating the person's spine relative to gravity. We can call it a constant balancing act
that our body performs billions of times per day. We take it for granted until the ability
to balance our body is lost and we loose our health.

Muscles (red tissues) are further divided into various shades of red. To better
understand, observe the meat of a chicken. The dark meat gets its nutrition from blood
and oxygen. It is made up of predominantly postural muscle fibers that hold the spine
together and perform static work.

The light meat gets its nutrition from glycolysis. Glycolysis is a chemical process in
our body that converts sugar into energy. In other words, white muscles break down
sugars and convert it into energy which they can use for motion.

The white meat is made up of predominantly phasic muscle fibers. These muscles are
employed for rapid motions called phasic or fast twitch muscles. Phasic muscle fibers
do not spasm. When they are injured or fatigued, they go flaccid or relaxed. Fast, full
range exercises are used to strengthen them. When you go to a gymnasium, you
exercise these muscles.

If our postural muscles acted just like phasic muscles, people would collapse every
day on the streets, in the stores, at work, etc. The fatigued muscles would relax and not
be able to support our spine in upright position. This does not happen because our
postural muscles work on different principles than phasic muscles.

The red muscles are called postural or slow twitch muscles and are used for functions
that require slower motions, such as maintaining ones posture. When they are injured
or fatigued, they spasm and splint causing a great deal of pain. These muscles require
isometric or non-motion exercises to increase their strength and endurance.

The trainers at gyms, as well as the majority of medical doctors and physical
therapists, do not know this information. Therefore, they give their patrons or patients
bad advice on exercising wrong muscles. Trusting people who have spinal problems
follow this advice, therefore worsening their condition.

After a persons back or extremity pain becomes excruciating, doctors recommend

costly surgery, which in many cases does not work. News Week Magazine published
an article on April 18, 2003 in which it asserted that surgery does not work for spinal
problems.
 To strengthen and correct the spine, one must increase the strength of the isometric or
postural muscles. In a gymnasium or at physical therapy, patients exercise phasic
muscles; therefore, they are not getting better but in fact are getting worse. Surprised!

Furthermore, each muscle bundle is made up of both phasic and postural muscle
fibers, but the predominant type of fibers determines whether a muscle is a postural or
a phasic muscle.

Activity requiring holding for long periods can cause phasic muscles to change into
postural muscles. When and if ones activities are changed, the once postural muscle
can and does change back to phasic. Therefore, static exercises must be performed on a
regular basis for prophylactic care.

Note that postural muscles do not change to phasic unless they were first phasic
muscle fibers that changed because of need.

Further, muscles are subdivided into agonists and antagonists. To understand what that
is, lets look at our arm. The bicep muscle bends the arm and is agonist. On the
opposite side of the arm, the tricep muscle straightens the arm or opposes the action of
the bicep. Therefore, the tricep is antagonist. All muscles in our body work according
to this principle.|

Now, lets look at the spine. Patients who have weak postural muscles usually have
strong antagonist muscles opposing the weak muscles. Weak muscles lengthen as they
lose their tone, while their antagonist muscles shorten.

Shortened muscles often are in spasm while their antagonists are weak. This muscular
unbalance forces the spine into an abnormal or pathological position, which in time
causes degenerative arthritis.

Thus, the lack of motion in discs causes them to loose their height, dry out, and crack,
creating disc bulges that compress nerves. These compressed or irritated nerves cause
excruciating and debilitating pain.

A pathological spinal position such as discussed above causes calcium deposits on the
spinal bones, or spur growth. These spurs, when large enough, will also constrict and
irritate the nerves coming out of the spine, causing pain in extremities and various
organ dysfunction.

This spinal pathology could be seen as a postural aberrance. A patients shoulders will
become uneven (one shoulder higher than the other. Their head may tilt to one side,
and their hips are not level. This person will slouch and carry his/her head far in front
of the body. This aberration is referred to as forward head posture (FHP).

This position has various biomechanical disadvantages that increase muscular fatigue,
muscle pain, postural distortions, and headache.

Motion Is The Key to A Healthy Spine!

Blood is supplied to all tissues in the body between birth and approximately age 12.
However, between the ages of 12 and 15, blood supplies to spinal cartilage, ligaments
and discs atrophy (dry up). These tissues still need the same or more nutrients than
they did before atrophy occurred. As a result, for the rest of our lives, we are dependant
on daily full range spinal motion to pump nutrition rich fluids into the discs and
ligaments while tissue cell, waste-filled fluids are pumped out.

When a person is injured, the first action is spasm and splinting by postural muscles to
protect from them further injury. Muscles in spasm are shortened due to an injury or a
chemical imbalance such as "algogenic inflammatory exudates" or "leaking" of body
fluids that have become toxic and in need of elimination.

Motions such as repetitive stretching or active PTLMS (see below for more
information) during stretching are needed to rid the affected muscles of the toxic
chemicals. Pain takes this guarding one step further and prevents movements in the
injured areas.

This lack of motion stops the normal metabolic nutrition-waste interchange functions
of the white tissues, resulting in toxic buildup and increasing pain in the spine and
back. In the past well-intended clinicians treated the patient with the RICE formula, or
Rest, Ice, Compression and Elevation.

For example, you strained/sprained your ankle, and the doctor told you to get plenty of
rest, put ice on the ankle, place a tight bandage on it, and elevate your foot above the
heart. This kind of treatment has proven to worsen the condition, increase pain,
prolong recovery time, and encourage scar formation, which in time will lead to
pathology.

Healing begins within hours of an injury. Therefore, the best treatment for a
musculoskeletal injury is motion and it must be started immediately.

Doctors used to think that muscles hurt because of accumulation of lactic acid within a
muscle. However, diseases that do not produce lactic acid still cause a great deal of
muscular pain. Years of research show that when muscle is injured, byproducts of
chemical reactions called catabolites accumulate within the muscle. Those catabolites
cause muscular pain, toxicity, and dysfunction and even decrease nerve conductivity.

To treat injured muscles and reduce pain, one must pump out toxic chemicals that
cause muscle dysfunction. The best way to do this is to move, and the best motion is
stretching and contraction of the red and white tissues in line with the ultimate loads
they are responsible for.
Note that the Wobble ChairTM procedures have proven to be the best and easiest
exercises for an injured patient with a low back injury, while the Pettibon Cervical
TractionTM has proven to be the best remedy for cervical injuries. Both of these
revolutionary devices and procedures were developed by the Pettibon Institute and are
employed by Pettibon practitioners.

These tools and procedures were developed through research started in 1959 by Dr.
Pettibon. He and his research group at the Pettibon Institute realized that the spine is an
extremely complex neuro-biomechanical system. In the course of X-ray and video
fluoroscopy studies, it became clear that it is wrong to regard the spinal column as a
chain of independent vertebrae. Rather it must be seen as a closed kinetic chain that
functions in units rather than segments and cannot be simply pushed around or
adjusted for spinal correction. In this system ligaments and muscles play a major role.
Ignoring these ligaments and muscles means ignoring the main component of the
treatment.

By using contemporary methods of research, Dr. Pettibon developed a mathematical

model of the spine which explains how the spine works. He and his research team
developed a vast variety of instruments that are unequaled in effectiveness. Most
importantly they developed The Pettibon System of treatment, which restores and
rejuvenates the spine. This system of treatment allows patients to restore lost disc
height, heal discs bulges, and correct scoliosis, which previously was considered
impossible.

What to Expect at A Pettibon Practitioners Office

Lets take a brief tour through one day of treatment at the office. The patient first
performs the cervical, upper back warm-up exercises during each office visit (and
twice daily for home care exercise sessions or as instructed).

Then the patient performs the wobble chair exercises to warm up the spine, which
includes 5 to 10 minutes of full range of motion pattern procedures, incorporating
slow, full diaphragm inhalation and exhalation. The physician will add exercises as the
patient progresses through treatment, depending on individual needs.

Head and shoulder weights may be used during the Wobble Chair warm-up phase each
visit.
With or without the weights on, as determined by the physician, the patient is
instructed to warm up their neck and upper spine just like they warm up their low back.
This is accomplished by stretching the head and neck in forward, backward, side to
side and around and around movements both ways until the neck feels loose and
supple.

The ppatient performs cervical traction incorporating up to 60 repetitions, as

instructed, with deep diaphragmatic breathing. The cervical traction exercises may
precede or follow wobble chair exercises, as instructed by the physician.
After wobble chair and cervical traction procedures are completed, the patient usually
proceeds to the adjusting table for further evaluation or static PTLMS treatment to rid
the joints and muscles of algogenic inflammatory exudates.associated with joint
immobility and muscle spasms.

Pettibon Tendon Ligament Muscle StimulatorTM (PTLMS)

All injured and misaligned joints produce algogenic inflammatory exudates (AIE) or
toxins around the injury and malfunctioning joints. Injured muscles produce
catabolites, which cause muscular pain. These fluids lake and remain painful until
eliminated. The PTLMS increases metabolic activity and begins the process of toxin
(AIE) removal, which is extremely beneficial to the patients recovery time.
Furthermore, the PTLMS removes muscle splinting by forcing toxins out of the
muscle and increases blood flow to the muscles for better nutrient exchange and toxin
elimination. It is very efficient for pain control and enhanced metabolic function as
well as regeneration of the injured para-vertebral soft tissues. The PTLMS is also
used to prepare temporo-mundibular joint (TMJ) or jaw joint for the adjustment.

Diaphragm pump exercise is performed to increase diaphragmatic action for increased

lung activity and increased stability of this region of the spine. These procedures are
usually performed during acute care only or if exacerbation occurs.

After the PTLMS and diaphragm pump exercises are completed, the patient is
examined by a physician who performs the neurological leg check. This is followed by
standing or seating functions, posture exams, and adjustment/manipulation as needed.
The functional/postural examination is performed each office visit by the physician to
determine required patient adjustments for the day. If the physician determines that no
adjustments are necessary, the patient proceeds to neuro-muscular re-education using
head, shoulder, and hip weights, as prescribed by the physician.

Post Spinal Adjustment/Manipulation

Sensory input/isometric procedures are required for further spinal correction. If an

adjustment is performed by the physician, the patient sits on the table, and the
physician performs the cervical reflex stimulation of the cerebellum with the Pettibon
MDT instrument (Multiple Digital Toggle instrument). This stimulation is necessary,
so spinal repositioning is not counteracted by the nervous system. It also assures that
the weighting system applied next can function un-impeded.

After this procedure, the patient is fitted with head and shoulder weights. The patient is
instructed to walk until comfortable with the weights. This exercise could take up to 15
minutes, during which time they are instructed to perform neuromuscular exercises on
a posture-med, tread-mill, vibrating platform or other proprioceptive device. These
exercises are prescribed by the physician in order to improve reflexes, balance and
motion.
The patient leaves the office with their weights and other home rehabilitation supplies.
Home care is the most critical component of successful rehabilitation and is performed
twice daily during acute and corrective care.

Each morning the patient must orientate himself or herself to gravity. The best results
are achieved by wearing the weights immediately after rising. Further exercises depend
on the patients individual needs as prescribed by the Pettibon practitioner.

What to Expect at A Pettibon Practitioners Office

Lets take a brief tour through one day of treatment at the office. The patient first
performs the cervical, upper back warm-up exercises during each office visit (and
twice daily for home care exercise sessions or as instructed).

Then the patient performs the wobble chair exercises to warm up the spine, which
includes 5 to 10 minutes of full range of motion pattern procedures, incorporating
slow, full diaphragm inhalation and exhalation. The physician will add exercises as the
patient progresses through treatment, depending on individual needs.

Head and shoulder weights may be used during the Wobble Chair warm-up phase each
visit.
With or without the weights on, as determined by the physician, the patient is
instructed to warm up their neck and upper spine just like they warm up their low back.
This is accomplished by stretching the head and neck in forward, backward, side to
side and around and around movements both ways until the neck feels loose and
supple.

The patient performs cervical traction incorporating up to 60 repetitions, as instructed,

with deep diaphragmatic breathing. The cervical traction exercises may precede or
follow wobble chair exercises, as instructed by the physician.

After wobble chair and cervical traction procedures are completed, the patient usually
proceeds to the adjusting table for further evaluation or static PTLMS treatment to rid
the joints and muscles of algogenic inflammatory exudates.associated with joint
immobility and muscle spasms.

Pettibon Tendon Ligament Muscle StimulatorTM (PTLMS)

All injured and misaligned joints produce algogenic inflammatory exudates (AIE) or
toxins around the injury and malfunctioning joints. Injured muscles produce
catabolites, which cause muscular pain. These fluids lake and remain painful until
eliminated. The PTLMS increases metabolic activity and begins the process of toxin
(AIE) removal, which is extremely beneficial to the patients recovery time.
Furthermore, the PTLMS removes muscle splinting by forcing toxins out of the
muscle and increases blood flow to the muscles for better nutrient exchange and toxin
elimination. It is very efficient for pain control and enhanced metabolic function as
well as regeneration of the injured para-vertebral soft tissues. The PTLMS is also
used to prepare temporo-mundibular joint (TMJ) or jaw joint for the adjustment.

So, at the Pettibon practitioners office after exercises, Wobble Chair, and Cervical
Traction Procedures are completed, the patient usually proceeds to the adjusting table
for static PTLMS treatment to rid the joints and muscles of Algo-genic inflammatory
exudates associated with joint immobility and muscle spasms.

Diaphragm pPump exercise is performed to increase diaphragmatic action for

increased lung activity and increased stability of this region of the spine. These
procedures are usually performed during acute care only, or if exacerbation occurs.

After the PTLMS and diaphragm pump exercises are completed, the patient is
examined by a physician who performs the neurological leg check. This is followed by
standing or seating functions, posture exams, and adjustment/manipulation as needed.
The functional/postural examination is performed each office visit by the physician to
determine required patient adjustments for the day. If the physician determines that no
adjustments are necessary, the patient proceeds to neuro-muscular re-education using
head, shoulder, and hip weights, as prescribed by the physician.

Post Spinal Adjustment/Manipulation

Sensory input/isometric procedures are required for further spinal correction. If an

adjustment is performed by the physician, the patient sits on the table, and the
physician performs the cervical reflex stimulation of the cerebellum with the Pettibon
MDT instrument (Multiple Digital Toggle instrument). This stimulation is necessary,
so spinal repositioning is not counteracted by the nervous system. It also assures that
the weighting system applied next can function un-impeded.
After this procedure, the patient is fitted with head and shoulder weights. The patient is
instructed to walk until comfortable with the weights. This exercise could take up to 15
minutes, during which time they are instructed to perform neuromuscular exercises on
a posture-med, tread-mill, vibrating platform or other proprioceptive device. These
exercises are prescribed by the physician in order to improve reflexes, balance and
motion.

The patient leaves the office with their weights and other home rehabilitation supplies.
Home care is the most critical component of successful rehabilitation and is performed
twice daily during acute and corrective care.

Each morning the patient must orientate himself or herself to gravity. The best results
are achieved by wearing the weights immediately after rising. Further exercises depend
on the patients individual needs as prescribed by the Pettibon practitioner.

A RATIONALE FOR CORRECTING FORWARD HEAD POSTURE

AND
CERVICAL SPINES LORDOTIC CURVE USING PROVEN
PETTIBON
CHIROPRACTIC CLINICAL PROCEDURES
COPYRIGHT 1998 BY BURL PETTIBON, D.C.

REVIEW OF LITERATURE

Ninety percent of chronic pain is located in the musculoskeletal system. Prevalence of

pain with individuals up to 59 years of age show the most common sites of
involvement to include the shoulders, head, neck, low back and the pelvis. (1, 2, 3)
Eighty percent of individuals in the western world will be affected by some form of
acute and/or chronic spinal pain. Out of every ten people under forty-five who have
chronic conditions that are limiting their activity of daily living (ADL), four are back
and spine pain victims. (4) Musculo-skeletal conditions have been recognized as a
major health and economic problem, imposing a $126 billion dollar burden in 1998.
(5) Spinal related disorders are second only to the common cold as a reason for
missing work. (6)

Most causes of back pain are the result of mechanical derangement of the hard and soft
tissues of the spine that cause inflammation leading to varying degrees of resting and
motion pain, decreased functional capacity and decreased ability to perform activities
of daily living. Often, paravertebral tissue nonciceptors and ascending afferent nerves
become depolarized via direct pressure or other derangement. This derangement alters
neurosynaptic transmission along the nerve either at the axon, dorsal, and/or ventral
root, or along intemeural branches that penetrate soft tissues and to end organ
receptors. (6)

RENE CAILLIET, M.D., DIRECTOR OF THE DEPARTMENT OF PHYSICAL

MEDICINE AND REHABILITATION, UNIVERSITY OF SOUTHERN
CALIFORNIA, FOUND THE FOLLOWING REGARDING MECHANICAL
DERANGEMENTS OF THE HARD AND SOFT TISSUES OF THE SPINE. (13)
THEY ARE:

Incorrect head position leads to improper spinal function. Both the neck and low back
have normal and necessary lordotic curvatures. Proper cervical and lumbar lordosis are
necessary for normal function. With a forward-extended head, normal lordosis is lost
both in the cervical and lumbar spine. The shoulders are rotated inward and come
forward with the headposition. Cailliet explains the effects of the head forward of the
expected position over the cervical spine (13). They are:

1) Head in forward posture can add up to thirty pounds of abnormal leverage on the
cervical spine. This can pull the entire spine out of alignment.

2) Forward head posture results in loss of vital capacity. Lung capacity is depleted by
as much as 30%. This shortness of breath can then lead to heart and blood vascular
disease.

3) Loss of gastrointestinal function, The entire gastrointestinal system is affected;

particularly in the large intestine. Loss of good bowel parastolic function and
evacuationis a common sequelae to forward head posture.

4) Forward head posture causes an increase in discomfort and pain, The first 4 cervical
vertebrae action are a major source of stimuli that produce endorphins in the spinal
cord. With inadequate endorphin production, many otherwise non-painful sensations
are experienced as pain. Forward head posture dramatically reduces endorphin
production by limiting range of motion of the cervical spine.

5) Forward head posture causes loss of normal spinal and body motion. One becomes
hunched. The entire body becomes rigid and range of motions become less. The better
the posture, the better and younger one looks and feels.

Cailliet also states: "Most attempts to correct posture are directed toward the spine,
shoulders, and pelvis. All are important, but, the position of the head is the most
important. The body follows the head. The entire body can be aligned by first aligning
the head." (13)

SPINAL HARD AND SOFT TISSUE MECHANICAL DERANGEMENTS

BEGIN WITH "THE INITIATING EVENT SUBLUXATIONS." THAT IS, LOSS
OF SKULL FLEXION ON ATLAS, WEAK AND UNEQUAL CERVICAL
FLEXOR MUSCLES, FORWARD HEAD POSTURE AND LOSS OF THE
CERVICAL LORDOTIC CURVE.

All health care professionals that deal with the spine need to understand the
neurological features of cervical vertebrae, lateral inner body joints, and the mechano-
receptor system's effect on musculo-skeletal conditions, posture, and gait. In man,
cervical mechano-receptors dominate the vestibular system in the relation to the reflex
regulation of static posture and gait. (7, 8) The density of the mechano-receptors in the
human cervical spine are greater than any other spinal levels. (9, 10) All health care
providers that deal with the spine need to understand the far reaching effects of proper
and improper functioning lateral inner body joints, as well as the neurological features
and effects of the mechano-receptors system that are part of them.

The typical cervical vertebrae and the bottom of C2 are the only spinal segments that
have lateral inner-body joints (Joints of Luschka). There are two joints of Luschka, one
on each side of each typical cervical vertebrae.

The mechano-receptors contained in the fibrous capsule of each of the joints of

Luschka are of two types:

1. Type I mechano-receptors fire at the normal rate as long as the vertebrae has normal
function. Altered global spine and vertebrae position produces abnormal joint motion
and dysfunction that immediately alter the frequency of reflex arc discharge. These
fibers have a low threshold and are slow to adapt to strains and changes.

2. Type II mechano-receptors are deeper in the joint capsular connective tissues. They
also have a low threshold. However, they rapidly adapt to changes caused by different
postures. (11, 12, 17)

Cervical mechano-receptors connect through ascending and descending inter-spinal

collateral nerves to the motor neuron pool of the neck and nerve muscles and through
the entire length of the spinal cord. Stimulation of the mechano-receptors especially of
the C3 and C4 have a powerful effect on the muscles of the patient's limbs. (11, 12)

The activity and function of the mechano-receptors of the cervical vertebrae, Cl

through C4, are directly related to the patients head position relative to the spine. (11,
12)
Ascending collateral nerves of the fibers from CI and C2 mechano-receptors ascend to
the brain stem and synapse with neurons in the motor nerve pool of the tongue, the
external oscular muscles of the eye, and the motor pool of the mandible. (11, 12)

Further, the first four cervical vertebral joint mechano-receptors normal motion
stimulates endorphin production by the C.N.S. (10, 13) With inadequate endorphin
production, many otherwise non-painful sensations are experienced as pain.
Endorphins modulate our responses to all noxious stimuli. Forward head posture
causes a loss of cervical lordotic curve that in turn block neck motion. Loss of neck
motion dramatically reduce endorphin production by limiting range of motion of the
cervical spine. (2, 10)

CERVICAL INJURIES ALTER AND DISRUPT THE POSITION AND

FUNCTION OF Cl THROUGH C4 AND THE RESPONSE OF THE
MECHANORECEPTORS WITH DETRIMENTAL EFFECTS ON THE
FOLLOWING (9, 10, 14):

1) Muscles that control eye movement

2) The patient's posture
3) The patient's balance
4) The patient's gait
5) The patient's ability to taste and smell and the execution of speech
6) The ability to swallow and swallowing patterns
7) TMJ muscle tension and coordinated movement
8) Mandibular-cranial position and posture
9) Dexterity
10) Causes rotatory vertigo and bilateral tinnitus

SPLINTING OF THE CERVICAL MUSCLES IS THE FIRST RESPONSE TO

WHIPLASH INJURIES

Splinting restricts movement of the head and the cervical spine. Persistent forward
head posture with postural instability and abnormalities of gait will result if these
injuries are improperly and/or untimely treated.

Varying degrees of dysarthria and dysproxia also occur (particularly under poorly
lighted conditions). These conditions persist until cervical form, function, and posture
subluxations causes osseous pathologies which in turn destroy the population of joint
mechano-receptors and the patient again suffers from dysequilibrium along with
additional side effects. (14)

Forward head posture and the loss of cervical lordosis results in compression of the
cervical upper facet joints. As the occiput approaches the Cl, impingement into the
suboccipital triangle is inevitable. A number of painful mechanical and muscular nerve
entrapments are produced by this posture if it is allowed to persist, (15, 16, 17)

Loss of all or part of the cervical lordosis cause a loss of all or part of the normal
cervical and thoracic coupling motion. (16) After age 12, the patients' coupled motions,
flexion and extension, are responsible for normal metabolic function and the nutrition
delivery system of the avascular spinal discs, ligaments and cartilages. (18) Loss of
these motions result in loss of disc height with facet pain and other spinal hard and soft
tissue pathologies. (19)

Loss of the cervical lordosis also blocks the action of the hyoid muscles, especially the
inferior hyoid that is responsible for lifting the first rib during inhalation. This rib
lifting action is necessary for complete aeration of the lungs. Loss of the cervical
lordosis reduces the patient's lung and vital capacity up to 30%. (2, 13, 20)

LOSS OF HEAD POSTURE AND CERVICAL LORDOSIS ARE OFTEN

VIOLENTLY PRODUCED AS THE FIRST REACTION OF A FLEXION
EXTENSION INJURY.

Sometimes whiplash injuries are so violent that the posterior ring of Cl is crushed
between the skull and C2. (21, 22) The lingering effects of sudden applied loads and/or
accumulative trauma cause nerve root compression, neuro-vascular compression,
posterior vertebral facet irritation, and restrictions resulting in peripheral entrapment
neuropathies. (15, 16, 17) A common occurrence is the entrapment of the greater and
lesser suboccipital nerves as they pass between the occiput and Cl. Suboccipital

4) In addition to the pain and health problems documented above caused by loss of
form and function of the skull and cervical spine, nerves exiting the involved spinal
areas are also adversely affected with disruption of their afferent and efferent
information delivery system. This causes dis-harmony, dis-function, and dis-ease in
those distant organs and parts innervated by the affected nerves.

5) The major conclusion one should get from this paper is that form and function of the
A to P (Front to Back) and lateral (From the Side) lower spine can not be completed
and/or that partial corrections will not remain corrected and functional until the
"INITIATING EVENT SUBLUXATIONS" INCLUDING FORWARD HEAD
POSTURE AND CERVICAL LORDOSIS HAVE FIRST BEEN CORRECTED.

HEALTHY,
PATHOLOGY,
AFTER 4 WEAKS OF PETTIBON CARE X-
BEFORE CARE X-RAY
RAY
REFERENCES:

1) Davis CG: Chronic Cervical Spine Pain Treated With Manipulation under
Anesthesia. JNMS 1996:1.
2) Anderson Statistics of Differences in Age, Gender, Social Class, and Pain
Localization. Clin. J Pain 1993:9:174-182.
3) Bland JH (ed): Disorders of the Cervical Spine: Diagnosis and Medical
Management. 2fla ed Philadelphia: WB Saunders 1994: 72-73.
4) White, AR: Your Aching Back: Who Suffers. 1983: 1990: 17-27.
5) Preamer A., Furner S., and Rice DP: Musculoskeletal Conditions in the United
States, Park Ridge. American Academy of Orthopedic Surgeons. 1990: 3-20.
6) ZeBranek JD., Kahan B., and Marinira: Managing Low Back Pain Using Injection
Therapy and Spinal Manipulation. Surg. Phys Asst. Vol 13: No 7. Pg 43
7) Igarashi M., Alford BR., Watanabe T., and Max CM: Role of the Neck
Proprioceptors for the Maintenance of Dynamic Body Equilibrium in the Squirrel
Monkey. The laryngoscope, 69. (8): 1713-1727, 1969
8) Raymond G., Disturbance of Nervous Function. Vol 1 Chapter 11 PJ Vinker and
GW Brayn (eds). New York: John Wiley and Sen 1969
9) Molina F., Ramcharan JE., Wyke BD., Structure and Function of Articular Receptor
System in the Cervical Spine. Journal of Bone and Joint Surgery, 58B (2): 255-256.
1965
10) Wyke B., Workshop, Neurology of Joints. Dallas, TX. 1980
11) Molina F., Wyke BD., Structure and Function of Articular System in the Cervical
Spine. JBJS 58 (2) 1965
12) Korr IM., Proprioceptors and Somatic Dysfunction. .1 Am. Orth. Assoc. 74: 638-
650. 1975
13) Cailliet R., Gross L., Rejuvenation Strategy. New York, Doubleday and Co. 1987
14) Wyke BD., Neuromuscular Mechanism Influencing Mandibular Posture: A
Neurolgist's Review of Current Concepts. Journal of Dentistry, 2
15) Hoppenfield S., Physical Examination of the Spine and Extremities. New York,
AppletonCentury-Crofts. 1976
16) Kopell HP. And Thompson WAL., Peripheral Entrapment Neuropathies. New York:
Robert Kreiger Publishing Co., 1-11, 147-170, 1976
17) Rocabado MS., Cebeza y Cuello Tratamiento Articular, Buenos Aires: Inter-
Medica, 1979
18) Virgin W., Experimental Investigation into Physical Properties of Intervertebral
Disc. J Bone, Joint Surg. 33B: 607, 1951
19) Bernini P., Wiesel SW., and Rothman RH., The Aging Spine, W.B. Saundes Co,
1982
20) Kapandji IA., Physiology of Joints. Vol. 3. New York: Churchill Livingstone, 1974
21) Darnell MW., Proposed Chronolgy of Events for Forward Head Posture. J.
Craniomandibular Practice, 1. (4): 49-54, 1983
22) Rocabado J., Johnson BE., and Blankney MG., Physical Therapy and Dentistry: An
Overview. J Craniomandibular Practice. 1(1): 47-49. 1983
23) Brennen, et al. JMPT, 14-7, 1991
24) CJA, Chiropractic Journal of Australia, 23 (132-135), 1993
Pettibon System.

CHIROPRACTIC, PUT TO THE TEST

2004 By Burl Pettibon, D.C.

The growth of any profession dictates that it is in a constant state of examination and
reexamination. The health care profession is no exception. This paper is a
dispassionate examination of conventional Chiropractic as it is currently being taught
in our colleges. It is also the sharing of information and testing procedures that will
allow our profession to step up and compete in an ever-expanding marketplace of
holistic healthcare.

Instruction of conventional Chiropractic manipulation/adjusting methods and

procedures can be described quite simply as follows: if the spine or vertebrae is
displaced to the right, chiropractors apply a dynamic thrust aimed to push it left. If one
or more vertebrae are displaced posterior, a dynamic thrust aimed to force them
anterior is applied. Every patient is treated the same with no attempt to determine if a
person's body type or physiological make up will accommodate dynamic thrusts or be
injured by them.

Keeping these facts in mind, prudence dictates that the effects of dynamic
adjusting/manipulating forces be critically examined. A literary review of dynamic
force adjustment/manipulation applied to the spine reveals the following:

1. Guyton's Physiology states that "the dynamic stretch reflex causes body parts,
such as vertebrae, to be re-positioned back into their original (subluxated)
position by the muscles that were stretched by a dynamic force, such as a
manipulation or adjusting forces that changed their spinal position." (5th
Edition, page 611)
2. Guytons also states that a static stretch reflex always follows the dynamic stretch
reflex. (Page 611)

3. The static stretch reflex functions to cause muscles to continue contracting. This
contraction is in the direction the dynamic force originated from and continues
for hours, but not for days.

It is vital to recognize that unless the dynamic and static stretch reflexes are controlled,
they will negate any spinal correction. The reflexes will continue to displace the spine
or vertebrae that had been moved in the direction the manipulating/adjusting forces
originated from without controls. This explains why current chiropractic methods of
instruction do not correct spinal displacements and often make the spine more
displaced than before they were applied. While we may say we treat each case as to
their individual needs, the present instruction does not take into account that every
person is unique and responds differently to external mechanical forces.

Dynamic and static stretch reflexes can be controlled. Through clinical trial and years
of testing, the patented head, shoulder and hip weighting system have proven
invaluable. When weighting is applied immediately post adjustment/manipulation
and/or rehabilitation it produces an isometric (force over time) response. This
predictable response sends sensory input to the nervous system causing it to generate
an innate organizing energy, which is created out of the need to re-balance the
imbalance caused by the weights. The energy activates postural spinal muscles,
causing them to relax and contract as needed. This contraction re-positions the lower
spine to re-align with the new center of mass of the weighted head in line with gravity.
After the head and shoulder weighting procedures have corrected the cervical and
thoracic spine (down to L-3), hip weights can be added to correct the lumbo-pelvic
spine.

It is critically important to recognize that hip, knee, ankle and foot position, stance and
gait function are a by-product of spinal correction. After 48 years of practice and
thousands of cases it is my estimation that 80% of extremity problems are resolved by
spinal correction. Adjusting of the un-corrected 20% is now easier and more permanent
when the displacing actions of the stretch reflexes are controlled through the weighting
procedures.

One can now understand that the "Chiropractic premise", that is, the original concept
that the "initiating event" is the vertebral subluxation and it is the cause of all of the
patient's problems is inaccurate. The real "initiating event" has its geneses when the
nervous system receives sensory impute that causes it to change the spine. Therefore,
the spinal displacement caused by the nervous system may or may not impede
transmission of neural impulses. However, the displacements are the effects and not the
cause of the problem. In either instance, the Pettibon weighting system, when
performed correctly changes the sensory impute to the nervous system so it causes the
spinal displacing reactions to be changed into correction reactions, as well as control
the adverse reflex actions and cause isometric stimulations necessary for ultimate
spinal holism and function.

TWO TYPES OF REHABILITATION PROCEDURES THAT AFFECTS

THE SPINE AND POSTURE

The examination of conventional chiropractic procedures also includes what is

accepted as the correct approach to rehabilitation. The first type can be referred to as
kinetic muscle exercises. These are the same or similar exercises used in gymnasiums
such as pumping iron and/or pulling against rubber cords. Their purpose is to
strengthen and hypertrophy phasic muscles.

The problem with these exercises is that they yield the reverse effect: they strengthen
the spine so that it is held in its' displacement configurations, making it harder to
correct. The rubber cord exercises cause the spine to become measurably more
displaced than pumping iron. Kinetic exercise strengthening activity should be
discontinued until spine displacements are corrected. More research is necessary to
reach an agreement as to why this occurs. Aerobic exercise activities did not seem to
interfere with spinal correction.

1. After repeated use of the rehabilitation equipment purported to restore strength

and function to soft tissues, I invented a new isometric exercise machine called
"The Linked TrainerTm". The function of this 3'x6' piece of equipment is to
perform mostly isometric exercises on the postural muscle groups that are
responsible for a strong spine, posture, stance and gait.
2. The Linked Exercise TrainerTM exercises correct spinal displacement
subluxations and posture patterns identified by x-ray measurements. The results
of outcome measurements in a recently completed research project prove that
isometric stretching and exercises with controlled sensory input to the brain
produce predictable spine and posture correction. The research included the
examination of 29 patients 8 months after treatment was completed. All of the
29 spinal measurements indicate that their spinal correction was maintained or
had improved since treatment was discontinued. This research has been
reviewed and now awaits publication. To my knowledge no other research with
such positive results have been published showing the efficacy of chiropractic
as it has and is currently taught in our colleges.

EXPERIMENTS, RESEARCH AND OTHER LITERARY REVIEWS

As an investigator of the truth I decided to experimentally reverse conventional

Chiropractic adjusting methods; that is, if the vertebrae were displaced to the right, an
adjusting force was applied to push it further to the right. This reversed procedure
caused a popping sound, an increase in spinal mobility and the patient said they felt
better which yielded the same results of present day conventional chiropractic clinical
methods. Post x-rays were taken with measured improvement in spinal position noted
soon after the adjusting forces had been completed. X-ray measurements made on
follow up post x-rays taken 7 days after the adjustment found that the spine was in the
same position as before the adjustment or manipulation had been administered.

Posterior displacement that occurs in the cervical and lumbar spine could not be
adjusted/manipulated from A to P using the reversed adjusting methods; therefore, the
experimental reverse method was of limited value.

To further our research we collected and measured pre and post x-rays of students and
others that were nearly normal before conventional chiropractic methods had been
applied. The results confirmed Guyton's Physiology: the un-controlled dynamic and
static stretch reflexes had caused all of the spines to be more displaced than before
conventional chiropractic procedures had been applied. (See pages I and II in the
preface of Chiropractic and Rehabilitation Procedures Re-invented). (1) From
experimentation, old errors were exposed and new methods were invented.

1. In further literary reviews, we found that Lovett, in 1903 published research

where he explained that normal spinal motion is coupled. That is, two motions
occurring as one and that opposing spinal curves, (lordosis and kyphosis) are
necessary for normal spinal "coupled motion". (2)
2. In 1971, Pandjabi and White reviewed Lovett's findings and concluded that
Lovett was accurate, "all normal spinal motion is coupled." Further, they found
that all lateral and A to P normal spinal position and function are dependent on
opposing lordotic and kyphotic curves. (3)

3. These researchers effectively explained our experimental clinical findings

regarding conventional chiropractic procedures and the effects of reversing
those procedures.

LOSS OF THE CERVICAL LORDOTIC CURVE IS PART OF A

DISPLACEMENT SUBLUXATION COMPLEX CHAIN OF EVENTS

By analyzing a large number of spinal x-rays it was determined that loss of cervical
lordosis is a reaction to preceding events. The eyes and the front of the skull first rotate
upward, like the whip of a "whiplash" and the condyles become locked in extension on
the atlas in 98.7% of the chronic lateral cervical spines.

When this chain of events occurs, the righting reflexes then cause the eyes-head, spine
and body posture to become displaced, with the head forced forward of the body, as the
eyes are leveled by the righting reflexes, while the skull remains locked in extension
on the atlas. The eyes being leveled while the skull remains locked in extension on the
atlas forces the cervical spines lordosis to be straightened and/or into kyphosis, often
tearing the posterior ligaments, especially between C-4 and C-5.

The cervical lordosis cannot be permanently corrected until the skull-atlas position and
then the headbody positions are addressed first. The cervical lordotic correction is a
reaction that follows eye-skull-atlas and then skull-body posture corrections, rather
than a P to A force.

While in practice, I found that 30-40% of the patients presented with the skull locked
in flexion rather than extension on the atlas. This skull locked in flexion position was
found to be present in 95% of scoliosis, A.D.D. and A.D.H.D. patients. They also had
forward head posture. However, their lateral cervical spine was in an "S" curve, usually
with the top of the cervical spine in lordosis and the bottom in kyphosis. In either
instance, at least partial correction of the skull on atlas is the necessary first step
followed by head-body position correction, to begin correction of the cervical lordosis.

It is important to note that the "S" curve of the lateral spines produce shorter lever arms
thus requiring more force (head weight) and more time to correct than non-"S"-curved
lateral spines.

From these findings and other research, one must conclude that restoration of cervical
and lumbar lordotic curves and their position relative to gravity are the essential first
step in permanent A to P spine and posture correction. Spine and posture rehabilitation
is a step-by-step process, which begins with correction of the cervical lordosis.
Rehabilitation and correction procedures must be administered in the sequence that the
body will accept.

The Future of Our Profession

Burl R. Pettibon, DC

Chiropractic and the public's perception of our product and why they should utilize our
services is as varied as the definitions of subluxation or what an adjustment is between
peers, schools and politics.

Washington's RCW 18.25.006 defines "chiropractic adjustment" as "chiropractic care

of a subluxation complex, articular dysfunction, or musculoskeletal disorder. Such care
includes manual or mechanical adjusting of any vertebral articulation and contiguous
articulations beyond the normal passive physiological range of motion." Strangely,
"beyond the normal passive physiological range of motion" is one of many definitions
of what a subluxation is. Therefore, it would appear that in addition to not knowing
what a chiropractic adjustment is supposed to achieve, the state advocates forcing the
spine out of its normal physiological range of motion.

Prudent action should dictate that the first order of chiropractic business would be to
reach a consensus about our terminology. Example: A chief license investigator under
oath in a recent deposition stated that he "did not know what an adjustment is." If we
and our policing agencies don't know what we are and what our purpose is, how can
we expect our patients NOT to be confused by our advertising and explanations of
their present and future care needs?

The unbelievable success of McDonalds has not been because they sell a exemplary
hamburger, it is because the public knows what they will get in each and every instance
when they order a Big Mac, whether it is in Berlin or New York or Gig Harbor. The
McDonalds approach makes marketing and advertising simple and they get value for
their advertising dollars spent.

It is obvious that our chiropractic political organizations don't know what their product
is. This makes professional marketing and advertising impossible as a joint effort
resulting in wasted advertising dollars and further public confusion. We never miss an
opportunity to miss an opportunity.

If one can trust the surveys, we are told that only about 6% of the public knows that a
chiropractor should be used for musculoskeletal problems, while the research proves
that 9o% of all chronic pain is musculoskeletal in nature. (Anderson HI, et al: Chronic
Pain in general population. Clin J Pain 1992:9:174-182)

To market and advertise effectively requires a provable scientific basis of the product
marketed and/or advertised. Wouldn't it be prudent to discard the words and phrases
that confuse the public, the legislature and us? Logic dictates that we should agree on
our product and concentrate on identifying and describing it to build our presence
through marketing and advertising. In the Pettibon System Inc., "our product is, the
detection and correction of abnormal spinal form and function". With this definition,
we understand that our product can be objectively and scientifically measured and
expressed in vector values allowing pre and post treatment measurements to determine
the effectiveness of what we do, as well as, perform research and experimentations to
improve our product.

Now we have a science that addresses the geneses of 9o% of chronic pain. The public
understands simple values that they can compare. In addition, we would be able to
market to other health care professionals so they can refer patients they cannot help to
us and we can refer those we cannot help to them. In that way patients are better
served.

Chiropractic has been discovered and lost many times by many different names.
Presently, surveys show that less and less people are using chiropractic care and that
the yearly income of chiropractors is steadily declining. (ACA Statistical Survey on
Chiropractic Practice from 1997 to 2004 and Chiropractic Economics Surveys from
1996 to 2004.) Surveys further show that more and more consulting and coaching
services are being used as chiropractors panic about their loss of income.

The industrial business procedures book entitled Sixth Sigma by Harry and Schroeder,
Doubleday) points out that "no industry can prove, disprove or improve that which
they cannot or do not accurately measure." Accurate measurement is essential for the
M.A.I.C. Formula: Measurement, Analyze, Improve and Control that this book
explains. It is essential for any scientific, repeatable and explainable product, if it is to
gain mainstream acceptance and success.

The Pettibon Institute provides a system that includes research-tested adjustment procedures and
equipment, patient training in home care for faster recovery and x-ray techniques that ensure exact
diagnosis. For more information call (888)774-6258

Aging and the Patterns of Postural Change

Developing therapeutic exercise programs to relieve the areas of restriction
and strengthen the areas of weakness is important for long-lasting
symptomatic relief

By Sara Meeks, PT

This is the third article on Aging and The Patterns of Postural Change. Figure 1. In
the first article, the concept of The Patterns of Postural Change and the possible
causes of these changes that occur as, but not necessarily because, people age, was
presented. The second article outlined the way that these changes most probably occur
during a person's lifetime. In this third article, I will present the areas of soft tissue
restriction and weakness that I have most commonly observed in these patterns.

Brief Review of Key Points

The human body may exhibit signs of The Patterns of Postural Change early in life.
These signs may continue throughout the lifespan until some intervention is made.
Children go to school, sit in seats that haven't changed in decades and, at home, sit and
watch television and play video games for hours at a time. As people grow, many
become more sedentary and eventually enter a work force with more and more time
spent at desk jobs requiring hours at computers. Not only do people sit too much, they
do not sit in good body alignment; rather, they tend to sit with more of a "C-shaped"
spine Figure 2 Habitual poor body mechanics, combined with illnesses, accidents and
periods of immobilization result in patterns of change in which certain muscles become
restricted and others become elongated and functionally weakened.

Figure 2 depicts not only the change in spinal alignment that occurs with improper
sitting but also depicts the most important muscle groups and relationships around the
hip area that are involved in the pattern.

Iliopsoas/Rectus Femoris/Gluteus Maximus

When a person sits, the muscles on the front of the hip, particularly the iliopsoas and
the rectus femoris, tend to become shortened and, eventually, restricted. The muscle on
the posterior aspect of the hip, the gluteus maximus, lends to become elongated and
functionally weakened.

The psoas is a multi-joint muscle that originates from the bodies and transverse
processes of all the lumbar vertebrae and the discs in between and inserts on the lesser
trochanter of the femur. Tightness of this muscle 'may contribute to restriction of hip
joint extension and, because of its attachments of origin, to changes in the alignment of
the lumbar spine.

The rectus femoris is a two joint muscle that originates with two heads from the
anterior inferior iliac spine and a groove above the acetabulum and inserts into the base
of the patella as part of the quadriceps tendon. Restriction at the origin of the rectus
femoris may contribute to restriction of extension of the hip joint.
Figure 2.
Changes in the Curves of the Back in Seated, Perched and Standing Postures
Drawing from the book The Chair by Galen Cranz 1998 WW Norton Publishers
a. Typical Seated Posturenote "C" shaped spine
b. Perch Posturecurves more like standing posture
c. Standing Posturenote normal "S" shaped spine

In addition, the rectus femoris may become chronically elongated across the knee joint
thus possibly contributing to knee instability and pain.

The restrictions in length of the iliopsoas and rectus femoris muscles may also
contribute to an anterior tilt of the pelvis when the person comes into the standing
position. This particular postural relationship is debatable but I have noted it in my
patient population.

The opposing muscle, the gluteus maximus, one of the largest and strongest muscles in
the body, becomes elongated and functionally weakened as a result of long hours of
sitting and the restriction of the iliopsoas and rectus femoris.

Hamstrings/Gastrocnemius

In the sitting position, the hamstring muscles become shortened at their tendons of
insertion posterior to the knee joint. This restriction, combined with restriction of the
origin of the gastrocnemius muscle, can result in knee symptoms as the chronically
elongated and weakened quadriceps attempt to extend the knee against the restriction
of the hamstrings and gastrocnemius. I have noted, in my patient population, that this
altered relationship explains much knee pain of unknown origin and that a treatment
regimen targeted at relieving this imbalance frequently relieves the symptoms.
The hamstring muscles will become elongated and weakened at their origin on the
pelvis. The weakening of the hamstrings at their origin, along with the weakness of the
gluteus maximus, helps to explain why people, as, but not because, they age, have
increasing difficulty getting out of chairs and walking up steps and ramps.

Triceps Surae/Ankle Dorsiflexors

The gastrocnemius/soleus muscle group (calf muscles) is composed of large, powerful

muscles that are much stronger than their opposing muscles, the ankle dorsi-flexors.
This anatomical relationship, along with the wearing of high heels (primarily in
women), accounts for the restriction of the gastrocnemius and weakness of the ankle
dorsiflexors that occur as people age.

Erector Spinae

As people sit with a "C-shaped" spine, the primary support muscles of the back, the
erector spinae, become elongated and functionally weakened. This weakness will most
likely occur in all parts of this muscle group resulting in poor or no back support in the
standing position.

In order to maintain an upright posture when standing, the spine will assume an
increased lordotic posture in compensation for the tight, flexed hips. Many therapists
mistakenly assume the erector spinae are restricted in the lumbar spine when there is
an increase in the lumbar lordosis in standing. However, if the lumbar lordosis is
secondary to the tightness of the hip flexors, there will be no tightness of the erector
spinae but rather there would be weakness due to their chronic elongation in poor
seated alignment. Exercises designed to stretch the lumbar extensors would only
exacerbate the problem.

As a person compensates for tightness in the hip flexors with an increase in the lumbar
lordosis when standing, the next compensatory change will be an increase in the
thoracic kyphosis. Along with this increase will come more elongation and weakness
of the thoracic back extensors (and the posterior longitudinal ligament) and restriction
of the upper abdominals pulling the upward trunk forward and downward. This
tendency is probably aggravated by the inherent weakness in the back at the thoraco-
lumbar juncture. (2) (Zack)

Sub-occipitals/Scalenes/Sternomastoids

As the thoracic spine changes, there will be changes occurring in the cervical spine and
possibly a forward glide of the head as the person tries to look up to see where he/she
is going. Restriction/weakness patterns of the cervical spine can be quite complicated
as the person adapts the alignment of the head and neck to accomplish normal daily
activities. Generally speaking, I have seen weakness of the cervical extensors (from the
chronic "C-shaped" spine and restriction of the scalenes and sternomastoids.)
However, certain specific cervical extensors and muscles with other functions may also
be restricted in specific movement patterns.

Pectorals/Intra-scapular Muscles

As the body is generally being pulled forward, by gravity and muscle imbalances, the
shoulders become more rounded. This tendency will result in restriction of the pectoral
muscles with a corresponding weakness of the opposing intra-scapular muscles.
Although both the pectoralis major and minor muscles will be restricted and all of the
intra-scapular muscles are usually weakened, I have found the most important area of
restriction / weakness to be the pectoralis minor / lower trapezius relationship. This
particular relationship has been one of the most difficult to change with an exercise
program.

Diaphragm
The diaphragm muscle is a very large muscle that separates the abdominal and thoracic
cavities. It has tendons of origin on the lumbar spine, the xiphoid process and the lower
6 ribs. Insertion of these tendons of origin is into a central tendon. In aging people, this
muscle may become both restricted and weak. Many people do not use their diaphragm
muscle correctly for breathing resulting in weakness secondary to disuse. As a person
progresses through the Patterns of Postural Change and the trunk is being pulled
downward, the diaphragm may also become restricted.

Additionally, there is some evidence to suggest that the diaphragm has a postural
component. This component may be weakened in persons with COPD and other
breathing problems.

Tensor Fascia Lata-itb /Gluteus Medius

The ilio-tibial band tends to become very restricted and frequently painful in many
individuals. Along with the psoas and rectus femoris, one of the actions of the tensor
fascia lata is to assist in hip flexion. Restriction of the tensor fascia lata, psoas and
rectus femoris along with chronic poor hip positioning may result in weakening of the
gluteus medius, the most important hip stabilizer.

Abdominals

Secondary to advancing postural changes, the abdominal muscles may become

weakened and also restricted. I have found that restriction of the abdominal muscles
usually occurs later in the pattern in individuals with longstanding postural change and
is one of the easiest to reverse.

However, weakness of the abdominals is also quite common and may occur for many
reasons. Exercises to strengthen the abdominals require careful consideration in an
aging population at risk for osteoporosis. This issue of SAFE abdominal strengthening
will be dealt with at some length in a separate article.
Other Muscular Restrictions

Other areas of muscular restriction include the Latissimus Dorsi, Quadratus

Lumborum, Long Toe Flexors, Scapular Origin of the Triceps, Insertion of the Biceps,
and the Long Finger Flexors.

Table 1
SPECIFIC SOFT TISSUE PATTERNS OF RESTRICTION AND
WEAKNESS

RESTRICTION ELONGATION/WEAKNESS

Iliopsoas Gluteus Maximus

Rectus Femoris Origin Upper Hamstrings

Pectoralis Major Intra-Scapular Muscles Lower

Pectoralis Minor Trapezius

Scalenes/Sternomastoids* Cervical Extensors*

Sub-Occipitals* Sub-Occipitals*

Erector Spinae
(Thoracic, Lumbar, Cervical)

Triceps Surae Ankle Dorsiflexors

(esp. gastrocnemius origin)

Insertion Hamstrings Lower Quadriceps

Diaphragm Diaphragm

ITB-TFL Gluteus Medius

Abdominals Abdominals

Latissimus Dorsi (origin and

insertion)
Quadratus Lumborum

Long Toe Flexors

Scapular Origin Triceps

Insertion Biceps

Long Finger Flexors

*The muscles of the entire cervical region may actually have specific
areas of weakness and/or restriction as a person adapts alignment of
the neck for daily activities.

The Latissimus Dorsi, as well as other muscles, may be restricted both at origin and
insertion. Exercise programs need to address both origin and insertion for more
complete relief of restriction.

Contra-lateral Hip Flexor/Hip Extensor

Not obvious when looking strictly at The Patterns of Postural Change is the
relationship between the hip flexors and quadriceps on one lower extremity and the hip
extensors and hamstrings on the contra-lateral limb. My empirical observation has
been that, when the hip flexors and quadriceps are restricted on one limb, the hip
extensors and hamstrings will be more restricted on the other side. Thus the
relationship of the soft tissue of these opposing muscle groups may actually cause
pelvic asymmetries (i.e. an anterior tilt on one side and a posterior tilt on the other
side.) I have found it important to address this area of restriction/weakness for a more
complete exercise program for low back, hip and knee pain.

Summary And Implications For Practice

In the three articles I have written thus far, I have presented The Patterns of Postural
Change, the possible causes of the most common pattern I have observed, and the
areas of muscular weakness and restriction that occur as a result.

There may be other patterns to be identified. For example, not all people will
compensate for an anterior pelvic tilt with an increase in the lumbar lordosis. There are
some individuals who may develop an anterior trunk lean and bend forward more and
more as the pattern continues. These individuals may need a walker or other assistive
device for walking to prevent them from falling completely forward.
Recognizing The Patterns of Postural Change as contributing to pain and other body
symptoms is important when assessing pain of "unknown origin" or chronic pain.
When a patient has a symptom in one area of the body, that symptom is not necessarily
due to a problem in that particular area. The symptom may actually be due to a
compensatory movement or pain avoidance pattern that has developed over a patient's
lifetime.

As clinicians work with the geriatric population, they need to carefully assess the entire
patient to determine areas of restriction and weakness that may explain symptoms of
unknown origin (i.e., not due to direct trauma or surgery.) Developing therapeutic
exercise programs to relieve the areas of restriction and strengthen the areas of
weakness is important for long-lasting symptomatic relief. An exercise program,
developed in this way, will help restore more normal body alignment, relieve pain, and
improve weightbearing forces through the skeleton.

In the next article, I will present the beginning of an exercise program designed to
reverse The Patterns of Postural Change.

REFERENCES

1. Meeks SM. Aging and The Patterns of Postural Change. Posture Magazine.
2. Zacharkow D. Women's Driving Posture An Overlooked Health Issue. World Wide
Spine and Industrial Rehabilitation. 2001 Vol 1:2(5-10).

Sara Meeks, P.T., M.S., G.C.S. received her B.S. in Physical Therapy from Ithaca
College in 1962, became a Geriatric Clinical Specialist in 1994 and received her M.S.
in Physical Therapy from Rocky Mountain University of Health Professions in 2000.
She has spent past 18 years specializing in the unique treatment needs of the geriatric
population especially those diagnosed with osteoporosis and postural dysfunction.

The recipient of the 2001 Section on Geriatrics Clinical Excellence in Geriatrics

Award, Sara teaches seminars nationwide on the management of osteoporosis and
reversing The Patterns of Postural Change.
She can be reached via her website www.sarameekspt.com.
 ARTHRITIS

Osteoarthritis typically attacks two types of joints: those that bear weight (such as the
lower back, hips, neck, knees, etc.),and those involved in repetitive motions (such as
the hands, wrists, and shoulders).

Osteoarthritis can also develop in injured joints, for example in the vertebrae of the
neck or lower back after a whiplash injury or in prolonged abuse in front of computer,
at the desk, repetitive work, from playing sports, etc.

Although osteo means bone, and itis means inflammation, osteoarthritis is actually
a disease originating in the cartilage, not the bone. This is why the more recent and
accurate name for osteoarthritis is Degenerative Joint Disease or DJD.

A joint is made of two or more bones connected by a capsule or envelope made of

ligaments. At the end of each bone is a thin, smooth layer of cartilage. This cartilage
layer acts as a protective cushion between bones to absorb the stress on joints during
movement.
Although cartilage is very strong, it can be damaged when a joint is injured. Cartilage
is made of protein strands called collagen that form a tough, mesh-like framework. The
mesh is filled with substances that hold water, called proteoglycans, that act much like
a sponge. When weight is placed on cartilage, water is squeezed out of the mesh. When
weight is removed, the water returns. Cartilage does not contain blood vessels, which
makes healing them when they are injured more difficult. It also does not contain
nerves, which means that problems may go undetected until significant degeneration
has occurred.

Similar to our skin, there is a normal balance between the wearing down (known as a
catabolic activity) and building up (known as an anabolic activity) of cartilage cells
(called chondrocytes). This is a delicate and extremely important balance and anything
that alters this balance will ultimately affect the health of our joints.
The cartilage balance in our joints is the key to understanding a costly mistake in the
typical medical treatment of osteoarthritis. Here is why. In osteoarthritis the cartilage
brakes down faster than it is rebuilt and therefore it gradually wears away.

So it is reasonable to say that anything that promotes the building up of the cartilage
cells would be a benefit to the joint, whereas anything that promotes the breakdown of
the cartilage cells would be destructive to the joint. You now possess the knowledge
necessary to understand a key part of the Osteoarthritis Epidemic in our country. Do
not let it happen to you!

For more information and for appointment call our office at: (253) 520-7531.
For more information on new revolutionary spinal restoration treatment visit:
www.pettibonsystem.com .

The Neck Pain!

Your neck was created in the shape of an Arch, with build in shock
absorber

Imagine trying to balance a bowling ball on a stick. To make it more difficult, tilt the
stick forward while trying to maintain balance of the bowling ball. Thats what it is like
trying to support your head on your neck if it loses its natural arch or a curve!

Your neck was created with a built-in shock absorber called a curve or lordosis. This
was formed by design because the curve acts like a spring and absorbs the shock of
your head resting and/or moving on your neck. To make this concept easier to
understand, think of the same bowling ball resting on a large spring. Or picture the care
traveling on the road and shocks absorbing force from the bumps on the road.

When your neck loses its curve, or ability to absorb shocks, the ligaments supporting
your neck become stretched and lose their ability to maintain the curve. This loss can
occur from a motor vehicle accident, chronic poor posture, from sitting all day in front
of the computer, or carrying heavy back pack every day to school. In other words it
may be caused by any activities that may cause Vertebral Subluxation. If this Vertebral
Subluxation left uncorrected, it will cause the neck to loose its so needed curve.

Once your neck has lost its normal curve, your neck and shoulder muscles attempt to
hold your head in the proper position. Unfortunately they were not created for this and
they tire easily. Unless you decide to let your head drop into your lap, your neck
muscles will have to continue holding up your head long after becoming fatigued.
Thats precisely when muscle spasms occur, and tightness begins in your neck and
shoulders.

In our Clinic we specialize in restoration of normal or natural curves of the spine. We

will assist you in restoring your necks and lower backs normal curvature. These
restored curves will put your muscles at ease and they will stop hurting you. You will
get rid of headaches, pains, and ashes that you have been heaving for a long time. Your
nervous system will finally begin to function at full capacity and your overall health
will improve.

For more information call our office at: (253) 520-7531 and visit Pettibon Institute web
site at: www.pettibonsystem.com

HEADACHES and BACK PAIN?!

Headache is the #1 reason people use over the counter drugs! Almost all people
experience a headache at some time in their lives. One study estimates that over 50
million people in the US suffer from headaches! Although most headaches do not
indicate serious ellness, they are a major cause of suffering and missed work, and rank
as one of the most common reasons people consult a doctor. The most common
headaches come from the muscles (muscle tension), and joints of the neck and the jaw
(cervico-genic and temporo-mandibular (TMJ)). Interestinly enough headache usually
means that person has postural or spinal problems.

The News Week magazine on April 18, 2003 published an article about back pain.
The author asserts that, back pain in the US is only to respiratory or flu illnesses and
annually we spend $120 billion on the disease of the century. So, why do we have a
back pain?

Carrying the kids on your shoulders, cleaning the floors, lifting groceries out of the car,
or a little extra up front (thats the pendulous abdominal syndrome). Lifting, bending,
or worse yet sitting all day at work and even worse if you sit in front of computer. Add
to this a slip and fall or a previous car accident and its not difficult to understand why
studies show that approximately 80% of Americans will suffer from a back pain some
time in their life. Many times back pain begins after just bending over to pick up a
pencil. Now, it is not the pencil causing your back pain, but rather your back structural
instability which developed due to a poor posture.

The effects of posture on health is becoming more evident. Spinal pain, headache,
mood, blood pressure, pulse, and lung capacity are among the functions most easily
influenced by posture. The corollary of these observations is that many symptoms,
including pain, may be moderated or eliminated by improved posture. John Lennon,
BM, MM, C. Norman Shealy, MD, Roger K. Cady, MD, William Matta, PhD, Richard
Cox, PhD, and William F. Simpson, PhD. Postural and Respiratory Modulation of
Authonomic Function, Pain and Health. AJPM Vol 4. No. 1 January 1994.

One of the most common postural problems is the forward head posture (FHP). Since
we live in a forward facing world, the repetitive use of computers, TV, video games,
trauma, car accidents, and even backpacks have forced the body to adapt to a forward
head posture. Restak, R.M. 1979 The Brain: The Last Frontier NY Warner Books. And
The Laws of Fasciculation Porlands Medical Dictionary. Dorkonos.

Ideally, the head should sit directly on the neck and shoulders, lide a golf ball on a tee.
The weight of the head is more like a bowling ball than a golf ball, so holding it
forward, out of alignment, puts a strain on your neck and upper back muscles. The
result can be muscle fatigue and, all too often, an aching neck. Mayo Clinic Health
Letter. March 2000, Vol 18, #3.

Because the neck and shoulders have to carry this weight all day in an isometric
contraction, this causes neck muscles to lose blood, get damaged, fatigue, strain, cause
pain, burning and fibromyalgia. Whin spinal tissues are subject to a significant load for
a sustained period of time, they deform and undergo remodeling changes that could
become permanent. This is why it takes time to correct FHP. In addition, FHP has been
shown to flatten the normal neck curve, resulting in disc compression, damage, and
early arthritis. Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the
cervical spine in a symptomatic people. Spine 1986; 6:591-694. This abnormal posture
is also responsible for many tension headaches, often named tension or cervicogenic
headaches.

Doctors and especially dentists notices that people with bad bite and TMJ headache
have FHP. This is because abnormal cervical or neck curve causes front muscles of the
neck, which are responsible for TMJ balance, to weaken and go out of balance. This
abnormal neck and head position causes tension in the TMJ joint leading to pain,
headaches and bite problems.

More over, studies show that abnormal posture is due to pathological spinal position.
This spinal position can effect the nerve tissue by altering blood flow to the spine,
forcing serebro-spinal fluid (CSF) away from the nerves, and by directly constricting
nerve roots by pulling on perineurium of the nerve roots. People with uncorrected FHP
usually suffer from variety of disorders such as; pinched nerve, pain in arms or legs,
numbness in extremities, back pain, frequent headaches, thoracic outlet syndrom,
syndromes like fibromyalgia, chronic strains, early degeneration, etc. Donatelli R,
Wooden M. Orthopedic Physical Therapy. N. Y: Churchill Livingtone Inc., 1989.
Cailliet R. Low Back Pain Syndrome. Philadelphia: FA Davis Co., 1981. Cailliet R.
Neck and Arm Pain. Philadelphia: FA Davis Co., 1981. Cailliet R. Soft Tissue Pain and
Disability. Philadelphia: FA Davis Co., 1977.

Hence, if you do not correct your posture you are placing yourself into precarious
position were your spine and health will deteriorate fast. The Pettibon System is
designed for Postural correction and FHP elimination. To learn more about this
revolutionary system visit: www.pettibonsystem.com

Do you have frequent TMJ headaches or is your jaw

constantly clicking?

Then read this!

A person's spine and posture displacement configurations often cause upper and lower
extremity muscle inequality. The TMJ (Jaw) is an extremity of the skull and neck.
Inequalities often start with muscles that originate in the displaced spine and have
insertions in the extremities, just like anterior neck muscles, which are responsible for
TMJ dysfunction and severe TMJ headaches.

Spinal displacements often cause partial joint dislocations in the extremities. Between
70 and 80 percent of the time, spinal corrections will also cause extremity
displacements to be corrected. Many people have severe headaches because of the TMJ
dysfunction. Others do not experience headaches, but their jaw is constantly
clicking, causing constant discomfort or pain.

As discussed above, this is due to cervical or neck muscle dysfunction. In addition,

spinal dysfunction precedes and accompanies muscular impedance. So, if you wish to
fix your jaw, you must first restore your spine, specifically your neck.

Furthermore, the inability to open or only partially open your mouth (your mouth
should open at least three of your fingers wide) often occurs after an accident that
affected the cervical spine (neck). Usually this is caused by either a car accident or a
severe fall on your back or side, i.e., a fall while skiing, snowboarding, biking, etc.

TMJ problems are one of the by-products of neck injury. Dentists and orthodontists
have found that all patients with TMJ problems also suffer from forward head posture
(patient is slouching and carries head anterior to shoulders). With most temporo-
mandibular dysfunctions (TMJ), a patient experiences pain and dysfunction, and the
face distorts so that one side is different than the other.

Interestingly enough patients that have partial hip, knee, ankle and foot dislocations
and restricted motions do not usually include extremity problems in their complaints.
This is typically because they don't think their problems are associated with the spine
and that spinal or extremity correction can't help them.
This could not be further from the truth. When correction of the spine takes place, it
usually corrects up to 80 percent of extremity problems. The remaining 20 percent can
usually be easily corrected by extremity manipulations.
Do not suffer from headaches or a clicking jaw -- get them fixed!

Spinal Decompression Therapy Decompression Table

Spinal Decompression Therapy is a non-surgical spinal treatment that replenishes

water and nutrients within intervertebral discs. Combined with the state of the art
Pettibon System, this gentle treatment targets the cause of the problem. These
treatments help in the management of spinogenic pain or pain induced by spinal
disorders. The treatment has been proven to restore damaged discs, bring back proper
spinal alignment, spinal function, and restore posture.

Our discs are compressed by our weight 16 hours every day. Intervertebral discs under
constant compression will dry out, loose height, and bulge. As a result, discs become
inflamed and this leads to pain.

Spinal Decompression Therapy really is just that, decompression of the intervertebral

discs and facet joints. This treatment allows discs to absorb and replenish lost nutrients.

The Pettibon System uses exercises that lessen and relieve pressure caused by daily
compression and pathological spinal alignment or poor posture.

When combined, these two therapies restore discal health, muscles, and spinal
alignments, consequentially restoring posture. The Pettibon System offers unique
exercises that if practiced on a regular basis, will help patients maintain proper spinal
health throughout their lifetime. This new revolutionary spinal treatment gently relaxes
the painfully spasming muscles, stretches scar tissue and restores the spine.

Are you a good candidate for this treatment?

You are if you have/been involved in any of the following:

Poor Posture
Forward Head Posture (These people usually have frequent headaches)

Headaches

Spinal Pain (Acute and Chronic)

Degenerative Disc Disease

Bulging and Herniated Discs

Upper extremities pain, tingling, or numbness

Sciatica (leg pain, Tingling, or Numbness)

Fibromyalgia

Whiplash

Facet Syndrome or Facet imbrication (usually a result of an Auto Accident)

Auto Accident
 Work injury

Repetitive work (Repetitive Stress over time causes severe spinal and other
disorders, i.e. Carpal Tunnel Syndrome)

Sports Injury

Scoliosis

10 Reasons Why You Need To Try This Treatment:

1. It is a new and revolutionary spinal rehabilitation and postural restoration

treatment that does not have an equal anywhere in the world!
2. No Surgery Required

3. No Anesthesia or Drug use Required

4. Non-Invasive

5. The Decompression Treatment combined with the Pettibon System gives

unprecedented results. (At the European Scoliosis Convention the Pettibon
System showed to produce at least 50% better results than any other
Scoliosis treatment known today)

6. Safe treatment that allows you to return to your favorite activities in no time.

7. Most patients can continue working throughout treatment (no re-coup time.)

8. You will save tremendously when compared to surgery and prescription

medication combined!

9. Most insurance companies will pay for the treatment!

10. Your first consultation is FREE, no strings attached

N. W. Spinal Rehabilitation Clinic, P. S. Office: (253) 520-7531
Dr. Slava Borisenko, D. C. Fax: (253) 520-6589
10024 S. E. 240th St., Ste.119, 120 E-mail: nwsrc@qwest.net
Kent, WA 98031 (across from Fred Meyer) Website: http://www.worldspinalfitness.com/
(Map)

Our Children!
Our children from the very birth undergo tremendous stress to their spine to which they
must constantly adapt. Thus to begin with, the birthing process in itself is extremely
traumatic experience for the spine. Later the first tries at walking place grate demand
on childs spinal column. Later in life children experience constant spinal stress which
they must overcome.

Did you know that some deliveries are so traumatic that the child actually fractures
their collar bone (clavicle) during the birthing process?

As our children grow they start school which places tremendous stress onto their spine.
More over, as they become active in sports such as gymnastics, soccer, football, tennis,
or when they begin to play a musical instrument, their trowing spines are subjected to
enormous amounts of stress.

Lets take a look at some stressors:

Backpacks - Children are now using backpacks

to carry school books weighing up to an
alarming 30-40 lbs! This forces the head
forward to counter balance the weight resulting
in abnormal stress to the spine, discs, joints, and
nerves of the neck, shoulders, and lower back.

Homework and Computer Ergonomics -

sitting hunched for ours at a time doing home
work. Positioning computer screen to low,
together with repetitive motion of moving the
head forward to read the book or the screen is a
primary factor of postural distortions that cause
spinal abnormalities.
 Video Games or watching TV - Most kids use
poor posture when playing video games and
watching TV. Repetitively sitting in one position
for long periods of time (just like during
studying at home or at school) causes the body
to adapt to this bad or pathological posture.

Trauma - Not only car accidents but falls and

various traumas, which children undergo every
day when their parents cannot see them) can
cause whiplash resulting in muscle imbalance.
These injured muscles pull the spine our of
alignment forcing the head forward and may
cause development of Scoliosis.

Spinal alignment is so important, especially when we grow. For if Scoliosis develops

in the early ears, when the vertebrae are soft and pliable and can change their shape
under abnormal forces, these changes become permanent and are impossible to correct
later in life. Many of the spinal problems that we see in adults can be tracked back to a
childhood fall, injury, poor posture resulting from carrying back packs or spending
endless ours at the desk studying, playing video or computer games. It is very
important at this developmental stage of their lives for you to seriously consider
regular chiropractic car for your children. The Pettibon System is specifically
developed for correcting postural abnormalities by strengthening postural muscles. So
that child may overcome any postural challenges that life places upon them.
I was involved in a high-speed car accident, resulting in severe impact to his head.
Several of his friends lost their lives in this collision. I actually suffered from a post-
accident stroke and spent several months in a coma at a local hospital. The injury to the
nervous system paralyzed one side of my body, leaving me in a wheel chair. On the
advice of my parents I came to Dr. Borisenko, D.C. for help with my condition. I was
receiving many other various therapies without significant relief when treatment
began. After several years of treatment, I am out of his wheel chair and walking on my
own. I even gave up my cane and started driving again. I am currently attending
college, preparing to graduate and lounge in my carrier. Thank you very much Dr.
Borisenko!

Anton Zingman (Renton, WA)

I came to see Dr. Borisenko after being diagnosed with Fibro Myalgia. I have had this
condition all my life, and went to all types of doctors, including chiropractors. All of
my previous treatments gave me little or no relief. After 6 months of the treatment, my
inability to sleep and anxiety have disappeared. Today, I feel that I am cured of this life
long ailment and I owe it to my wonderful doctor and the Pettibon system! Thank you!

Wendy R. (Renton, WA)

This is a letter of appreciation and confirmation of the good work that Dr. Borisenko
and his staff have done for me. I was recommended to Dr. Borsenko by a friend when I
was having back problems and began seeing him in the spring of 2005. My x-rays
showed problem areas including neck, upper spine, and middle back. I had a
pronounced dowagers hump area which has bothered me for many years. Dr.
Borisenko began treating me using Pettibon Spinal Bio-mechanic methods.

Dr. Borisenkos methods and hard work have made a marked difference concerning my
spinal problems and in my ability to stand tall. I saw my sister recently and I now
carry myself so much straighter she was very impressed. I am now able to turn my
head without pain and as much more flexible than when I began treatment. Many
thanks to NW Spinal Rehabilitation and I highly recommend the clinic and the good
they do.

Wendy Basham (Kent, WA)

I have always had pain in my back and joints, but I did not realize how bad it was until
I could no longer do simple household tasks and had to quit my job. My family doctor
said I had Degenerative Joint Disease and x-rays showed that I had two disc bulges and
lost 100% disc height. He insisted that I have spinal surgery. I said no. After 18 months
of treatment using the Pettibon Biomechanics System I am now feeling better than I
ever did and the pain is gone! When I showed my family doctor the x-rays from NW
Spinal Rehabilitation he said that the results were impossible and that they were not
real. I dont care, all I know is that the pain was real, and now it is completely gone!!

Tamara S. (Kent, WA)

My friend Tamara S. recommended Dr. Borisenko, D.C. to me. I had severe

Osteoarthritis (DJD) and had lost my job due to my inability to function in every day
life. I had also been seen by multiple specialists (orthopedists, neurologists, physical
therapists, etc.) without any significant improvement. After treatment by Dr. Borisenko
with Pettibon System, my symptoms began to dissipate and were soon gone. Now I am
on a routine maintenance schedule at Dr. Borisenkos to maintain my achievements. I
want to be healthy the rest of my life. So, I am taking charge of my life.

Nadya M. (Federal Way, WA)

I could not even tie my own shoes or put on my own socks. I had lost my job due to
severe pain in my neck, mid back, lower back, hips, and knees and debilitating
headaches. I had tried multiple doctors, both medical and chiropractic, in an attempt to
heal myself and become normal again. At the initial consultation with Dr. Borisenko, I
told him that, I just want my life back. After 15 months of spinal rehabilitation using
the Pettibon ISystem, I completely forgot about my problems. Now I have what I
wanted got my life back!

M.O. (Auburn, WA)

While at work, I fell off a ladder and broke two Vertebrae. I went straight to my family
doctor who told me that if I do not get an operation soon, I would be crippled for life. I
couldnt believe that surgery was my only option so I decided to seek out other
opinions. I happened to read an advertisement in a pamphlet about the Pettibon system.
I never heard of anything like it before and thought I would give it a try. After 12
months of treatment I felt like a new man. My x-rays showed near complete restoration
of my spine! I truly feel that this system is a miracle!!

Nikolay K. (Federal Way, WA)

I was told by all my medical doctors and chiropractors that my problem was in my
head and that to treat my depression, I should take high dosages of antidepressant
drugs to alleviate my body aches and pain in my back and jaw. I refused to admit that I
was crazy. After being involved in a car accident, I sought the help of Dr. Boriseko,
D.C. I have now been treated with the Pettibon System for over three years. All my
problems vanished after my first year of treatment. With maintenance care, I have been
able to maintain my health and eliminate the need for antidepressant drugs.

Lidia Makarova (Federal Way, WA)

I work in a warehouse at a very physically challenging job. All day I must lift and
stock heavy items. My job requires frequent bending, lifting, and overhead activities.
In addition, I must stand all day on my feet. My back pain was forcing me to quit my
well-paid job. Using my sick leave and L&I (Workmans Compensation), I sought
treatment from Dr. Borisenko, D.C. At the first consultation, my posture and spinal
condition were despicable. I was all bent forward, resembling an old lady (despite my
young age), and my head was tilted to one side while my torso tilted to the other. In
addition, my entire body was twisted like a cork screw. My shoulders were rotated one
direction, and my hips were rotated the opposite way. I never new about my poor
posture until doctor sowed it to me by taking my picture. I had severe pain in my lower
back, mid section and neck. Every day I had severe headaches, and experienced
numbness in my hands and feet. I have been continuously treated with the Pettibon
System for six consecutive months. All my friends, relatives and co-workers are telling
me that, my posture has dramatically improved. All my physical problems have
disappeared, and I do not have any aches or pains. I am standing straight, and able to
bend sideways or twist my hips and shoulders. I am well on the way to complete
recovery. Thank you very much Dr. Borisenko.

I.K. (Kent, WA)