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Western/Chinese Herbal Therapy & Massage Therapy Michelle J. Rivera, MT, VDT Pedro Luis Rivera, DVM Healing Oasis Wellness Center Western and Chinese Herbs:
What Every Veterinary Medical Professional Should Know: Part I Chinese Herbology is an age-old science that combines a rigorous theoretical base with literally thousands of years of continuous research, innovation, and clinical use with human subjects. Herbal treatment, often in combination with acupuncture, therapeutic massage, nutritional therapy, moxibustion, and physical exercise, has been the primary health care modality in China and Southeast Asia for at least 3,000 years. Ancient Chinese medical texts list as many as 6,000 different herb combinations formulated for a myriad of uses. Through the centuries, Chinese physicians and herbalists have continually researched, tested, and modified the theory and practice of herbal treatment to create safe, effective remedies. Today there are at least 500 commonly used combinations, tailored to as wide variety of specific health complaints. WHAT IS AN HERB? An herb is virtually anything that is ingestible. It may be any part of a plant such as seed, stem, leaves, root, rootlets, or flowers. Animal parts such as nails, shells, semen, internal organs, even excrement may be considered an herb. In addition, many minerals are used as herbs especially in Chinese medicine to anchor and calm the spirit. ARE CHINESE HERBAL FORMULAS SAFE? When used with proper guidance and training, Chinese herb combinations (formulas) are extremely safe, and side effects are rare. Over the millennia, Chinese herbalists have developed procedures for processing herbs to remove any harmful properties. Chinese herb combinations are carefully formulated to balance the energetic effects of the herbs, eliminating undesirable reactions or side effects. It must be stated, however, that to receive the desired effect from any Chinese herb combination a proper Traditional Chinese Medicine diagnosis must be made. HOW DO CHINESE HERBS WORK? Chinese herbal formulas work by balancing the qi pattern of the entire body, rather than focusing on isolated symptoms, as do Western pharmaceuticals. The selection of a proper herb formula is not made according to Western medical principles, but rather through applications of the principles of yin and yang, wu xing (Five Elements), qi theory (the Eastern sciences concerned with the nature of energy in its many forms), tongue and pulse diagnosis, among others. HERBAL PREPARATIONS AVAILABLE Herbal combinations come in a variety of forms. The choice of the appropriate form should encompass the practioner's knowledge and expertise, client compliance, palatability for the patient, and availability. INTERNAL FORMULAS There is the raw (crude) form of the herb that needs to be decocted into a tea and added to the food or syringed directly into the mouth. There are tablets, capsules, pellets, powders, freeze dried, and alcohol extracts. EXTERNAL FORMULAS There are many types of ointments, liniments, balms, and plasters used to treat bruises and analgesia, some of these combinations are particularly popular for anti-rheumatic and temporary relief of minor muscle aches and pains. When choosing an herb combination the quality and purity are of utmost concern. Many internal patent formulas are substantiated with Certificates of Analysis from U.S. FDA approved laboratories. Those chosen should be manufactured in China, using the finest grade herbs, under strict quality controls by Australian GMP (Good Manufacturing Practice)-certified factories, whose standards are more demanding than those observed in the United States. DOSAGES In Traditional Chinese herbal medicine, standardized weights and measures were used to describe the amount of each herb in the formula. The Tang Dynasty established these measurements: 1 jin or caddy = 16 liang or taels 1 liang =10 qian 1 qian = 10 fen 1 fen = 10 li 1 liang = 31.25 grams. Since this is such an awkward number to work with, the Peoples Republic of China (1979) established a simpler metric equivalent for traditional weight measures. 1 liang =30 grams 1 qian = 3.0 grams 1 fen = 0.3 grams 1 li = 0.03 grams Traditional Chinese herbal medicine usually doses most of the ingredients in an herbal combination between 1-3 qian or 3-10 grams. The variation of dosages for a given species and weight class should be based on individual considerations such as client compliance, patient constitution, chronic vs. acute pathology, and the quality of herbal combinations chosen. Generally, I like to dose on the higher end of the scale in order to see rapid changes in the patient. Most clients do not allow us the luxury of "time" in our treatment choices and if I can make a slight change in a patient in a short time, I may have bought that patient more time for treatment or for life in general! TONIFYING HERBS Just as we in veterinary medicine attempt to focus on preventative medice, so does Traditional Chinese herbal medicine. Herbs that tonify are those that are used to strengthen or supplement an area or process of the body that is weakened or insufficient. They may also be used to strengthen the body's defense against disease. We tend to choose these herbs when there appears to be an absence of illness or the body shows signs of apparent "health". Generally, tonic herbs are used in treating patterns of deficiency of the qi, blood, yin, and yang. We can incorporate these herbs into our "wellness exams" very nicely for all patients, young or geriatric. These formulas are especially important in treating young patients to possibly avoid or lessen the onset or severity of disease. Some common herbs used include: Ren shen (radix ginseng) Dang shen (radix codonopsitis pilosulae) Huang qi (radix astragali membranoceus) Da zao (fructus zizyphi jujubae) Dang gui (radix angelicae sinensis) Gou qi zi (fructus lycii) Generally Chinese herbs are usually not used alone but in formulas (combinations) however many herbs in this category may be used alone as a tea, sprinkled raw in the food, or ground up into a powder. The Chinese believe we are in a constant flux of yin and yang never achieving a balance due to external pathogenic factors and tonic formulas are used throughout life to assist in achieving a balance in health. This balance is brought about not only with the herbs but in conjunction with proper nutrition, adequate exercise, and a happy and health spirit. Contraindications of a tonic formula is if taken too long or too frequently, we run the risk of tonifying the initial complaint i.e. in treating the common cold for too long may tonify this pattern into the flu. In addition, tonic herbs tend to be sweet in taste. Sweet helps tonify the Spleen (digestive system) therefore if taken too long it may congest the Spleen and we will then see loose stool, diarrhea with or without undigested food, vomiting, lethargy, etc. SOME COMMON TONIC FORMULAS
WHERE TO LEARN MORE Chi Institute 9791 NW 160th Street Reddick, FL 32686 Phone (352) 591-3165 Fax (352) 591-0988 Healing Oasis Wellness Center 2555 Wisconsin Street Sturtevant, WI 53177 Phone (262) 884-9549 Fax (262) 886-6460 Email howc@thehealingoasis.com www.thehealingoasis.com I.V.A.S. PO box 271395 Fort Collins, CO 80527 Phone (970) 266-0666 Fax (970) 266-0777 RECOMMENDED REFERENCES The Web that has No Weaver Ted J. Kaptchuk O.M.D. The Foundations Of Chinese Medicine Giovanni Maciocia Chinese Herbal Medicine material medica Bensky and Gamble Chinese Herbal Medicine: Formulas and Strategies Bensky and Barolet Chinese Herbal Patent Formulas Jake Fratkin Pulse Diagnosis Li Shi Zhen CHINESE HERBAL COMPANIES Golden Flower Chinese Herbs, Inc P.O. Box 781 Placitas, NM 87043 Phone (800) 729-8509 Fax (505) 837-2052 Health Concerns, Inc. 8001 Capwell Drive Oakland, CA 94621 Phone (510) 639-0280 Fax (510) 639-9140 I.T.M. 2017 S.E. Hawthorne Portland, OR 97214 Phone (800) 544-7504 Fax (503) 233-1017 Mayway Corp. 1338 Mandela Parkway Oakland, CA 94607 Phone (800) 2 Mayway Fax (800) 909-2828 Nuherbs Co. 3820 Penniman Avenue Oakland, CA 94619 Phone (800) 233-4307 Fax (800) 550-1928 Spring Wind Herb Company 2325 Fourth Street #6 Berkeley, CA 94710 Phone (800) 588-4883 Fax (510) 849-4886 *Please note, this is not a complete list. There are many excellent companies available. These are some of the ones that I have personally used and have helped provide educational materials for all herbalists. Western and Chinese Herbs What Every Veterinary Medical Professional Should Know: Part II For as long as we have had a place that we can call a "kitchen" we have had our own "herbal sanctuary". Western herbalism dates back to the first native Americans and settlers from the "old world". Most of the "western herbalism" knowledge was passed from one family member to another. This is why "herbalism" (among other health care systems) has been ridiculed by many people. Herbalism was considered "quackery" and "snake oil" for many years (centuries) until development of chemical assays sensitive enough to assess the primary chemical compound and its mode of action. The use of plants and their parts to treat illness in the human population is well-known to most of us through folklore tales and the current popularity of "natural" products. Early man discovered many medicinal plants by observing the behavior and grazing habits of animals, who instinctively know how to find and ingest plant materials for their own illnesses. For a person to become an herbalist, they must first master several things:
symptoms and using pharmaceuticals or surgery to remove the growth or suppress the symptoms. The use of what we call "anti-medicines" usually involves the direct killing of cells or organisms or suppression of the body's response to them. The "holistic" herbalist's approach is to search for the deeper causes of the symptoms and to work with the body's own systems to restore the balance that has been lost. As we all know, the body is designed to heal itself if given the proper help from nature. This is not to say that herbs cannot be used to relieve suffering in the short term, but ideally, this mode of treatment should never be viewed as a complete therapy. Although the isolation of "active" ingredients is the ultimate goal of most pharmaceutical companies, the herbalist views the whole plant as being superior to the sum of its constituent chemicals and is therefore generally less toxic and more in tune with the body's innate healing processes. For the body to heal correctly and to respond to the "herbal treatment", nutrition must be emphasized for without the proper basic "building blocks" of life the body will be unable to heal itself. HERBAL FORMS:
As licensed veterinary professionals, it is imperative to know and understand (to the best of our abilities) the above mentioned categories and their herbs. Example of herbs: ECHINACEA Echinacea is a plant native to the midwestern North America also known as Purple / pink or wite coneflower, snake root, scurvy root, hedgehog and red sunflower. It is a member of the Asteraceae family (sunflowers and daisies) being Echinacea purpurea the most common one Polysaccharides, flavonoids, chicoric acid (caffeic acid), essential oils, polyacetylenes and alkylamides are the main chemical components found in the Echinacea spp. Leaves, stems and roots are the parts of the plant that are more widely harvested and used for herbal mixtures. The root is supposed to contain the highest concentration of active chemical ingredients. Tinctures, extracts, ointments and raw herbs have been used by Native Americans for many centuries to treat different kind of illnesses. It has not been until recently (within the last decade) that the popularity of this herb has once again flourished. However, it has not been without a severe environmental impact on the population of wild Echinacea spp. In the Native American culture, echinacea has been used to treat an array of illnesses ranging from upper respiratory infections, and viral associated illness as an immune booster to topical applications for insect bites and bee stings, and snake bites (folklore use). The use of this herb is primarily for prevention and treatment of viral induced symptoms / illness. It has also been recommended as a general immune booster. Echinacea extracts have been proven to stimulate the immune system by increasing the function of some white blood cells and the production of specific chemical compounds necessary for the proper stimulation of the immune system. Specific readings and information regarding Echinacea spp: Echinacea spp herbal extracts are used primarily to stimulate the immune system against viral infections or to help immune modulation prior (if history of exposure exists) and during the recovery of the illness. Evidence shows that Echinacea extracts helps to stimulate the immune system by increasing macrophage function, tumor necrosis factor (TNF), immunoglobulin and interferon production. GARLIC Garlic (also know as allium)is a perennial bulb and a member of the lily family. It has a tall, straight flowering stem that can grow up to three feet tall. There is some evidence that man has been using garlic for over 10,000 years; in fact, the ancient world in general enjoyed garlic … from the Chinese to the Egyptians. In ancient Egypt, it was used as a source of money and was inscribed in pictures on the Cheops pyramid. Anecdotal curative uses for garlic were cited by Aristotle, Hippocrates and Pliny. It was not until 1858, that Pasteur noted garlic's antibiotic activity. Garlic was used during World War I as an antiseptic to prevent gangrene; and during World War II, garlic was known as "Russian penicillin." Due to the overwhelming amount of casualties, the antibiotic supply was scarce and Russian physicians relied on garlic for infected wounds. The main chemical ingredients in garlic oil is alliin which is converted in the body via the digestive enzyme allicinase to allicin, a sulfur-containing compound. MILK THISTLE Milk thistle is commonly called holy thistle, or silybum. It is indigenous to the middle east but it also grows from Canada to Mexico. It is a biennial plant that grows to between 6 to 10 feet. It has reddish purple flowers ridged with sharp spines where the leaves and stems exude a milky sap. Milk thistle was consumed as a vegetable in Europe with the despined leaves in salads and as a spinach substitute. It has been used medicinally for over 2000 years and was used (and still used) as a folk remedy for liver complaints. References/Suggested Reading For Echinacea spp: Readings: #1: Henneicke-von Zepelin H, Hentschel C, Schnitker J, Kohnen R, Kohler G, Wustenberg P. Efficacy and safety of a fixed combinatin phytomedicine in the treatment of the common cold (acute viral respiratory tract infection): results of a randomized, double blind, placebo controlled, multicentre study. Curr. Med. Res. Opin. 1999;15(3):214-27 Summary #1: This study included 263 patients from which 238 were considered valid cases. The primary efficacy parameters showed the superiority of the herbal remedy over placebo (p<0.05). Patients who suffered from at least moderate symptom intensity at baseline showed response rates of 55.3% in the herbal remedy group and 27.3% in the placebo group #2: Rehman J, Dillow JM, Carter SM, Chou J, Le B, Maisel AS Increased production of antigen-specific immunoglobulins G and following in vivo treatment with the medicinal plants Echinacea agustifolia and Hydrastis canadensis. Immunol Lett 1999 Jun 1; 68 (2-3):391-5 : Summary #2: In this study, the rats that were treated with Echinacea showed a significant augmentation of their primary and secondary IgG response to the antigen that they were injected with. The Hydrastis canadensis treated goup showed an increase in the primary IgM response. #3: Thompson KD. Antiviral activity of Viracea against acyclovir susceptible and acyclovir resistant strains of herpes simplex virus. Antiviral Res 1998 Jul;39(1):55-61 Summary #3: In this research, several concentrations of Viracea were used against ancyclovir resistant and susceptible herpes simplex strains. This research showed that although the active component of Viracea is not know, the extract has good antiviral activity against both ancyclovir resistant and susceptible herpes simplex virus (HSV-1 and HSV-2). #5: Sun LZ, Currier NL, Miller SC. The American coneflower: a prophylactic role involving nonspecific immunity. J Altern Complement Med 1999 Oct; 5(5):437-446 Summary #5: This research, which was done in mice, showed that natural-killer (NK) cells and monocytes, both mediator of nonspecific immunity were numerically and significantly increased in both the bone marrow and the spleen as early as 1 week after beginning treatment with the dietary herb. For Garlic spp. Readings: #1: Das SN, Pramanik AK, Mitra SK, Mukherjee BN. Effect of garlic pearls (Ranbaxy) on blood cholesterol level in normal dogs. Indian Veterinary Journal 1982; 59(12): 937-938. Summary #1: 18 dogs were given oral garlic supplementation. Mean values of blood cholesterol were significantly reduced. The reduction lasted only one week after supplementation was discontinued. #2: Jain AK, Vargas R, Gotzkowsky, S. Can garlic reduce levels of serum lipids? A controlled clinical study. The American Journal of Medicine. 1993; 94:632-635. Summary #2: To determine the effects of a standardized garlic tablet (KWAI), 42 adults (19 men and 23 women) with high cholesterol levels took a placebo or garlic (300 milligrams) three times/day for 12 weeks. The garlic group showed a significant reduction in both total cholesterol and low-density cholesterol levels. #3: Mader FH. Treatment of hyperlipidaemia with garlic-powder tablets. Arzneim.-Forsch/Drug Research. 1990; 40(II)(No.10):1111-1116. Summary #3: A study of 261 patients with high cholesterol found that those who took 800 milligrams of garlic powder for 16 weeks experienced a reduction in total cholesterol and also in triglyceride values. This would suggest standardized garlic dosage may be of value in the treatment of hyperlipidaemia. #4 Sharma MC, Dwivedi SK. Efficacy of a herbal drug preparation against dermatomycosis in cattle and dog. Indian Veterinary Journal 1990; 67(3): 269-271. Summary #4: Garlic, in combination with onion, lemon, tumeric, camphor and Karanji oil were used to treat ringworm (Microsporum canis) in 21 dogs. The result was a complete cure in 12-15 days with no signs of toxicity. #5 Barone FE, Tansey MR. Isolation, purification, identification, synthesis, and kinetics of activity of the anticandidal component of Allium sativum, and a hypothesis for its mode of action. Mycologia. 1977; 69:793. Summary #5: In this laboratory test, of the 41 fungi treated with a aqueous garlic extract, fungicidal activity was seen in 39. Furthermore, in this investigation the researchers identified allicin as the component in garlic responsible for this action. #6: Romano EL, Montano RF, Brito B, Apitz R, Alonso J, Romano M, Gebran S, Soyano A. Effects of Ajoene on lymphocyte and macrophage membrane dependent functions. Immunopharmacology & Immunotoxicology 1997;19(1):15-26. Summary #6: In vitro studies support the immune boosting effects of ajoene, a garlic derivative, on human cell in vitro. Abstract #6: Ajoene, (E, Z) -4,5, 9-trithiadeca-1, 6, 11-triene 9 oxide, is a compound originally isolated from ethanolic extracts of garlic that impairs platelet aggregation by inhibiting the functional exposure of platelet integrins GPIIb/IIIa. In vitro, Ajoene is toxic for several tumoral cell lines, and exert an antiproliferative effect on T. cruzi and murine malaria parasites. Here we show that Ajoene strongly inhibited the proliferation induced in human lymphocytes by the mitogens phytohemagglutinin (PHA), phorbol myristate acetate (PMA) and anti-CD3, and the capping formation induced in B lymphocytes by anti-IgM antibodies. On macrophages, Ajoene was also found to partially inhibit the lypopolysaccharide-induced production of Tumor Necrosis Factor (TNF), and to decrease the phagocytic activity of thioglycolate-elicited mouse peritoneal macrophages for IgG-opsonized, human erythrocytes. Ajoene also partially prevented the lytic effect of human and rabbit TNF on Actinomycin D-treated WEHI 164 cells. These results strongly suggest that Ajoene is a potent modulator of membrane-dependent functions of immune cells. #7: Ide N, Lau BH. Aged garlic extract attentuates intracellular oxidative stress. Phytomedicine 1999;6:125-131. Summary #7: This study examined the antioxidant effects of aged garlic extract in vitro on endothelial cells and macrophages. The extract inhibited oxidized low density lipoprotein-induced peroxides and nitric oxide production. Moreover, in a cell free system, the aged garlic extract scavenged H2O2. By eliminating peroxides, garlic can protect endothelial cells from oxidation injury. #8: Apitz-Castro R, Ledezma E, Escalante J, Jorquera A, Pinate FM, Moreno-Rea J, Carrillo G, Leal O, Jain MK. Reversible prevention of platelet activation by (E,Z)-4,5,9-trithiadodeca-1,6,11-triene 9-oxide (ajoene) in dogs under extracorporeal circulation. Arzneim.-Forsch./Drug Res 1988; 38(7): 901-904. Summary #8: Ajoene, an organosulfur compound from garlic inhibits platelet aggregation in dogs and recuperation of platelet function was achieved 3-4 hours later. #10: Pantoja CV, Chiang LC, Norris BC, Concha JB. Diuretic, natriuretic and hypotensive effects produced by Allium sativum (garlic) in anaesthetized dogs. Journal of Ethnopharmacology 1991; 31(3): 325-331. Summary #10: Gastric administration of garlic powder to anaesthetized dogs decreased arterial blood pressure in a dose-dependent manner for more than 250 minutes. #11: Sundaram SG, Milner JA. Impact of organosulfur compounds in garlic on canine mammary tumor cells in culture. Cancer Letters 1993; 74(1-2): 85-90. Summary #11: Some organosulfur compounds found in garlic are effective inhibitors of the growth of the neoplastic CMT-13 cell (a canine mammary tumor cell). The inhibitory effects of these compounds are modified by intracellular glutathione. Milk thistle spp. Readings: #1: Dehmlow C, Erhard J, de Groot H. Inhibition of Kupffer cell functions as an explanation for the hepatoprotective properties of silibinin. Hepatology 1996;23:749 754. Summary #1: The flavonoid silibinin, the main compound extracted from the milk thistle Silybum marianum, displays hepatoprotective properties in acute and chronic liver injury. To further elucidate the mechanisms by which it acts, the investigators studied the effects of silibinin on different functions of isolated rat Kupffer cells. The strong inhibition of leukotrine B(4) formation by silibinin was confirmed in experiments with phagocytic cells isolated from human liver. Hence, while rather high concentrations of silibinin are necessary to diminish free radical formation by activated Kupffer cells, significant inhibition of the 5 lipoxygenase pathway already occurs at silibinin concentrations which are achieved in vivo. Selective inhibition of leukotriene formation by Kupffer cells can at least partly account for the hepatoprotective properties of silibinin. #2: Basaga H, Poli G, Tekkaya C, et al. Free radical scavenging and antioxidative properties of 'silibin' complexes on microsomal lipid peroxidation. Cell Biochemistry & Function 1997;15:27 33. Summary #2: The antioxidant properties of silibin complexes were evaluated by studying their abilities to react with the superoxide radical anion (O2 .), and the hydroxyl radical. The results support the free radical scavenger and antioxidative properties of silibin when it is complexed with a suitable molecule to increase its bioavailability. #3: Murray MT. Milk Thistle. In: The Healing Power of Herbs: the Enlightened Person's Guide to the Wonders of Medicinal Plants (2nd Ed.) Prima Publishing, Rocklin, CA 1995:243-252. Summary #3: In a study of 19 patients with a history of gallstone problems, 420 milligrams of either silymarin or a placebo was given daily for 30 days. It was found that in those receiving silymarin, the solubility of the bile was increased as measured on the bile saturation index. #4: Alarcon de la Lastra AC, Martin MJ, Motilva V, et al. Gastroprotection induced by silymarin, the hepatoprotective principle of Silybum marianum in ischemia reperfusion mucosal injury: Role of neutrophils. Planta Medica 1995;61:116 119. Summary #4: Silymarin may have gastroprotective and antiulcer effects. This study examined the antiulcer effects of silymarin in gastric injury induced by ischemia reperfusion and its effects on mucosal myeloperoxidase activity, an index of polymorphonuclear leukocyte infiltration, after injury in rats. Pretreatment with silymarin prevented post ischemic mucosal injury. The mean ulcer indexes (U.I.) of rats treated with 25, 50 mg, and 100 mg silymarin/kg body weight (4.79 +/ 0.75, 4.50 +/ 0.81, and 3.63 +/ 0.74, respectively) were significantly lower (p < 0.05, 0.05, and p < 0.005) than that of control rats. These data indicate that silymarin has inhibitory effects on neutrophil function, contributing to its gastroprotective actions and that neutrophils play an important role in the gastric mucosal dysfunction associated with ischemia reperfusion. #5: Murray MT. Milk Thistle. In: The Healing Power of Herbs: the Enlightened Person's Guide to the Wonders of Medicinal Plants (2nd Ed.) Prima Publishing, Rocklin, CA 1995:243-252. Summary #5: Silymarin can help fight psoriasis in several ways: 1) by inhibiting the synthesis of leukotrienes, one cause for excessive cell replication; 2) by improving the liver's ability to filter the blood, eliminating the endotoxins and chemical toxins which can aggravate psoriasis; 3) by controlling the ratio of two agents which control cell replication (cAMP to cGMP). #6: Murray MT. Milk Thistle. In: The Healing Power of Herbs: the Enlightened Person's Guide to the Wonders of Medicinal Plants (2nd Ed.) Prima Publishing, Rocklin, CA 1995:243-252. Summary #6: There is a long history of milk thistle's folkloric use as an aid to nursing mothers in the production of milk. General reading: Tilford-Wolf Mary; Tilford, Greg: Herbs for Pets - All you ever wanted to know about. Press Wynn, Susan; Emerging Therapies - Using Herbs and Nutraceutical Supplements for Small Animals. AAHA Press, 1999 Western & Chinese Herbs: What Every Veterinary Medical Professional Should Know: Part III The herbs that we will be discussing today are relatively safe and can be used on a day to day basis.
**HAWTHORN CAN BE SAFELY MIXED WITH GINKGO, DANDELION, or any other adatogen {herbs that improve immune system functions and generally improve the body's responsiveness and ability to stress} and alteratives {herbs that improve and strengthen various systems}
***Can be used as an ANALGESIC, ANTI-INFLAMMATORY, ANTI-MICROBIAL AND ANTI-OXIDANT
** ANALGESIC, ANTI-COAGULANT, ANTIPYRETIC AND ABORTOGENIC
References/Suggested Reading See reference list of sections I and II of the presentations Section: Complementary / Alternative Medicine *Title*: Introduction to Chiropractic in Modern Veterinary Practice I & II *Author*: Pedro Luis Rivera, DVM *Affiliation*: The Healing Oasis Wellness Center *Email*: howc@thehealingoasis.com *Phone*: 262-878-9549 Notes Text Spinal Manipulation or "chiropractic" has been around for centuries. It dates back to ancient Egyptians and Greeks, making this one of the oldest non-invasive and drugless forms of medicine. It was not until the late 1890's that D.D. Palmer postulated a theory on it's proposed etiology and mode of action. Although based on a simplistic view of "pinched nerve", or "bone out of place" on today's standards; it has evolved into a crucial health care modality (for both humans and pets) based on solid functional neurology correlating to anatomical and biomechanical changes as it applies to the body. Recent and current research (within the last 30 years) has demonstrated and shown the neurological consequences of an aberrant motion of an articular facet and the secondary compensatory changes that occur not only cranial and caudal to that particular joint but to the nerves that arise from that specific segment. The definition of the word "chiropractic" is derived from the Greek words cheir meaning hand and praktike meaning "business or to practice". Thus, chiropractic literally means, "to use the hands to diagnose, treat and prevent disease"(1,2). If you think about it, it doesn't' defer from what we do (and what we use) in our every day practice to diagnose and treat our patients. Although many doctors and practitioners feel that "chiropractic" medicine doesn't utilize other diagnostic tools to assess the patients, this could not be further from the truth. Ethical practitioners that have been properly trained (including veterinarians) understand that diagnostics play a crucial part of veterinary spinal manipulative therapy (VSMT) to ensure proper diagnosis and treatment. Radiographs, EKG's, MRI's, CAT's scans, blood work, etc are some of the diagnostics that would bring invaluable information to achieve the final diagnoses and main goal of improving the patients quality of life. It is very important to understand and realize that any complementary health care modality should be use side by side with conventional and concurrent health care! Depending on the needs of the patient, other manual therapies such as massage, stretching, and rehabilitation might be indicated as an adjunct therapy as long as it would benefit the patient. Veterinary chiropractic is growing by leaps and bounds. Veterinary chiropractic was officially formalized or "born" in the late 1980's by Sharon Willoughby, DVM, DC. Dr. Willoughby is one of the few professionals holding a dual degree, one in veterinary medicine and one in chiropractic medicine. Dr. Willoughby started a program, now known as Options for Animals, designed to teach both licensed veterinarians and licensed chiropractors the benefits of this health care modality for animals. Dr. Willoughby and several of the instructors also started the American Veterinary Chiropractic Association (AVCA), an association composed of licensed veterinarians and chiropractors with the sole purpose and goal of educating other peers and advancing the research of this modality in animals. As defined by the AVCA, "Animal chiropractic includes the adjustment of vertebral joints, the adjustment of extremity joints and the adjustment of cranial sutures. Animal chiropractic care includes management advice as to what is needed to insure proper response to chiropractic care, including rehabilitation and therapeutic exercise". Furthermore, a chiropractic adjustment is defined as a "short lever, high velocity controlled thrust by hand or instrument that is directed at specific articulations to correct vertebral subluxations" and "Animal chiropractic does not dispense medications, perform surgery, inject medications or replace necessary traditional veterinary care". The above definitions can be viewed in its entirety on the AVCA's website at www.animalchiropractic.org The American Veterinary Chiropractic Association (AVCA) has currently approved three programs that have met their standards for certification (www.avcadoctors.com or www.animalchiropractic.org ) which are currently set at 200hrs. Chiropractic medicine is based on the unique concept of "vertebral subluxations" and the accompanying compensatory changes (also known subluxation complex, chiropractic subluxation complex or segmental vertebral hypomobility) (3,4,8). Subluxation can differ in its definition depending on what dictionary is used (medical vs. chiropractic medical). Some definitions are: American Chiropractic Colleges; in The Chiropractic Theories: A textbook of Scientific Research; 4th Ed, Leach, Robert (Ed); Lippincottt Williams & Wilkins, Baltimore 2004 Subluxtion is a complex of functional and / or structural and / or pathological articular changes that compromise neural integrity and may influence organ system function and general health Bantam Medical Dictionary, Revised Ed. 1990, Bantam Books, NY A partial dislocation of a joint so that the articular surfaces of the joints are misaligned but still in contact with one another Foundations of Chiropractic Subluxation; Gatterman M (Ed), 1995 Mosby Publishing Co, St. Louis A motion segment, in which alignment, movement, integrity, and / or physiologic function are altered although contact between joint surfaces remains intact International Chiropractic Association Any alteration of the biomechanical & physiological dynaimcs of the contiguous spinal structures which can cause neuronal disturbances American Chiropractic Association An aberrant relationship between two adjacent structures that may have functional or pathological sequelae, causing an alteration in the biomechanical &/or neurophysiological reflections of these articular sturctures, their proximal structures, &/or body systems that may be directly affected by them Seaman DR, JMPT 1997;20(9):634-644 A misalignment of one or more articulations of the spinal column or its immediate weight bearing surfaces, which by inference causes change on nerve function. If you have a subluxation on a specific joint (segmental dysfunction), the normal range of motion (how the two adjacent vertebrae moves) would be hindered, hence making or forcing the segments above or below to pick up the "slack" for the affected area, creating then a "regional dysfunction". Although this is a normal compensatory change of the body, this would place an undo strain on the region, the articular facets, the components of the intervertebral space and all of the inter- and peri-articular components of the specific joint(s). Some of the components mentioned above are (but not limited):
Kinesiopathological changes: Faulty biomechanical problems hence altering normal joint mobility Neuropathology: Due to the direct or indirect pressure on the nerves (dorsal / ventral roots and spinal nerves), the ability to affect the cerebrospinal fluid circulation, the ability of propagating the action potential, and last but not least the ability of hindering the normal axoplasmic flow Myopathological and connective tissue changes: Muscle weakness, myofacitis or lactic acid buildup, ligament / tendon problems Inflammatory process: Micro- or macro-strains / sprains Biomechanical changes or somato-autonomic relationships As with any cascade, there is always a common denominator; being "kinesiopathology" what is considered the main denominator with this "vertebral subluxation cascade". This is why, it is important to regain or return to function those joints that are not working correctly. As doctors, it is important to understand the reasons for helping the body regain some or full function of a specific joint. Improving afferent input, which diverges as it enter the spinal cord; allowing the stimulation of large diameter fibers which will inhibit nociceptive pathways; how the muscle spindle cell, golgi tendon organ and other mechanoreceptors function after a manipulation and adjustment is administered; maintaining pre-synaptic stimulation of motor units; trying to maintain normal stimulation of cellular functions (such as immediate early gene response) hence maintaining normal production of ATP and normal function of the Na:K pump; trying to stimulate normal cellular health; trying to maintain stimulation of the cerebral cortex and its "regional representations" or "homunculus" and how it affects the body from allowing a "sympathetic" override are among some of the main basic reasons to understand veterinary spinal manipulation. There are hundreds of double blind scientific studies done within the last 30 years to prove its validity. However, even at this time, there is some misunderstanding regarding the what, how, when and where of this modality.(3,4,5,6,7) A veterinary chiropractic assessment is performed by conducting a complete physical exam first and taking a thorough medical history; then utilizing our God -given sense of "touch" to assess for motion, pain / discomfort and inflammatory changes of each segmental unit. A segmental unit (also known as a motion unit) is composed of two vertebral bodies of adjacent vertebrae and all the associated structures (ligaments, blood vessels, joints, nerves, muscles and contents of the intervertebral foramen). Once the affected segment is identified, the joint will be brought to tension (manipulation) and a quick controlled thrust will be applied into the plane of motion of that particular joint. Remember that ADJUSTMENTS are done to specific and individual joints ONE at a time. As previously discussed, an adjustment is a quick controlled thrust, high velocity and low amplitude, into the specific joint plane of the joint that is being worked on. The latter is the main reason for those seeking to offer this health care modality must understand and truly know anatomy, neurology & basic musculoskeletal biomechanics to avoid causing harm to a patient. It is very important that a veterinary chiropractic adjustment is performed by a trained professional and not self-proclaimed "expert". This will assure the well-being and safety of the patient. There is a big difference between a "weekend" "learn it and know it all" seminar, vs. an in depth post graduate training (no less that 200hrs) dealing with this health care system. As with any medical modality, veterinary chiropractic should be used as a preventative tool. By the time we have severe degenerative (pathological) changes, the benefit of ANY medical modality would be minimal (which we understand that something is better than nothing when there is advanced pathology). PREVENTION is the name of the game!! Considering the aspects of chiropractic theory and the goals of treatment, these are the patients who may benefit from chiropractic:
References/Suggested Reading
Sympathetic nervous system response to mechanical stress of the spinal column in rats Akio Sato, MD, PhD and Rand S. Swenson DC, PhD JMPT 1984;7:141-147 Keywords: spinal column, spinal cord, sympathetic nervous system, autonomic reflexes, renal nerve, adrenal nerve, blood pressure, rats Heterogeneous sympathetic innervation in German Shepherd dogs with inherited ventricular arrhythmia and sudden cardiac death Michael W. Dae,MD; Randall J. Lee, MD, PhD; Philip C. Ursell, MD; Michael C. Chin, BA; Carol A. Stillson, BA; N. Sydney Moise,DVM Circulation. 1997;96:1337-1342 Keywords: arrhythmia, catecholamines, imaging, nervous system, scintigraphy Acute effects of spinal manipulation on gastrointestinal myoelectric activity in conscious rabbits Kenneth F. DeBoer, Michael Schutz, and Michael E. McKnight Manual Medicine 1988;3:85-94 Keywords: EMG, rabbits, spine, gastrointestinal tract, manipulation Joint complex dysfunction, A novel term to replace subluxation / subluxation complex: Etiological and Treatment considerations (#3) David R Seaman, DC JMPT 1997; 20 (9): 634-644 Keywords: Subluxation, joint complex dysfunction; subluxation complex, mechanoreceptors, muscle spindle cells, golgi tendon organ, allodynia, hyperalgesia A motion analysis of the cervical facet joint (#6) O. Atilla Onan, Md, ; Michael H. Heggeness, MD, PhD and John A. Hipp, PhD Spine 1998:23(4);430-439 Keywords: biomechanics, cervical facet, spine Inflammatory cells in full-thickness annulus injury in pigs (#7) Aklilu Habtemariam, MD, Johanna Virri, MS, Mats Grondblad, MD, PhD, Sten Holm, Phd, Allison Kaigle, PhD, Erkki Karaharju, MD, PhD Spine 1998: 23(5);524-529 Keywords: annulus injury, inflammation, pig, disc, Treatment of cervical disc protrusion via instrumental chiropractic adjustment Bradley S. Polkinghorn, DC JMPT 1998: 21(2);114-121 Keywords: chiropractic manipulation, cervical vertebrae, intervertebral disc, trauma, activator Links between pelvic biomechanics and lower urinary tract dysfunction (#10) Caroline Stone, DO, MRO Physiotherapy 1996:82(11);616-620 Keywords: Pelvic biomechanics, altered afferent information, neural facilitation, chronic inflammation, altered collagen content, osteopathic The sacroiliac joint: a review of anatomy and biomechanics with clinical implications (#11) Deed E. Harrison, DC; Donald D. Harrison DC and Stephan J. Troyanovich DC JMPT 1997;20(9):607-617 Keywords: sacroiliac joint, posture, chiropractic manipulation, rehabilitation, low back pain Conservative Treatment of Acute and Chronic Nonspecific Low Back Pain: A systematic review of randomized controlled trials of the most common intervations (#12) Maurits W. van Tulder, PhD,; Bart W. Koes, PhD and Lex M. Bouter, PhD Spine 1997: 22(18); pp 2128-2156 Keywords: conservative treatment, low back pain, randomized controlled trials, systematic review Sympathetic Nervous System Response to Mechanical Stress of the Spinal Column in Rats (#24) Akio Sato, MD, PhD; and Rand Swenson, DC, PhD JMPT 1984; 7(3):pp 141-147 Keywords: Spinal column, sympathetic nervous system, autonomic reflexes, renal nerve, adrenal nerve, blood pressure, rats Mechanoreceptor endings in human thoracic and lumbar facets joints (#25) Robert F. McLain, MD and Joel G. Pickar, DC, PhD Spine 1998; 23(2):168-173 Keywords: Anatomy, facets, mechanoreceptors, nerves, spine Skin accelerometer displacement and relative bone movement of adjacent vertebrae in response to chiropractic percussion thrusts (#31) Dennis B. Smith, PhD; Arlan W. Fuhr, DC; Barry P Davis, PhD JMPT 1989;12(1):26-37 Keywords: Manipulation, chiropractic, dog, skin accelerometer Nerve irritation: A possible model of sciatic neuritis (#32) Spine 1982;7(2):129-136 John J. Triano, MA and Marvin W. Luttges, PhD Keywords: nerve irritation, compression, inflammation, conduction velocity, stimulus sensitivity, mice Joint disease in the athletic horse: A review of pathologic findings and pathogenesis (#27) Roy R. Pool, DVM, PhD AAEP Proceedings 1995; Vol 41: pp 20-34 Keywords: Joint, joint disease, horse, pathology Nerve irritation: A possible model of sciatic neuritis (#32) John J. Triano, MA and Marvin W. Luttges, PhD Spine, 1982;7(2):129-136 Keywords: Nerve irritation, compression, inflammation, conduction velocity, stimulus sensitivity, mice, animal, compressive neuropathy Cervical vertebral mobilization under anesthetic (CVMUA) (#33) T. J. Ahern BVSc Journal of Equine Veterinary Science 1994;14(10):540-545 Keywords: Equine, horse, animal, vertebral mobilization, anesthesia Allografting Intervertebral Discs in Dogs - A possible clinical application (#34) Hiromi Matsuzaki, MD, Ken Wakabayanashi, MD, Kazuhiro Ishihara, MD, Hiroto Ishikawa, MD and Akihiro Ohkawa, MD Spine 1996; 21(2):pp 178-183 Keywords: Anulus fibrosus, intervertebral disc, nucleus pulposus, spine, vertebral column, dogs Functional stability of the canine cervical spine after injury - A three month in vivo study (#35) J. Ulrich Buff, MD; Manohar M. Panjabi, PhD; Charles M. Sonu MD; Joseph J. Crisco, PHD; Thomas R. Oxland, MASC and Richard R. Pelker, MD, PhD Spine 1990; 15(10): pp 1040-1046 Keywords: Canine, dog, cervical stability, stability, injury, spine Experimental chemonucleolysis with chondroitinase ABC in monkeys (#36) Tsuneto Sugimura, MD; Fumihiko Kato, MD; Kentaro Mimatsu, MD; Osamu Takenaka, ScD; Hisashi Iwata, MD Spine 1996; 21(2):pp 161-65 Keywords: lumbar disc herniation, rhesus monkeys, chondroitinase ABC, chemonucleolysis Gross morphology of the composite occipito-atlas-axis joint cavity in the dog (#38) AG Watson, HE Evans and A. De Lahunta Anat. Histol. Embryol. 1986; 15:pp 139-146 Keywords: morphology, occipito - atlas - axis joint; composite occipito-atlas-axis A rabbit model for nonunion of lumbar intertransverse process spine arthrodesis (#39) Michael A. Feiertag, MD; Scott D. Boden, MD; Jeffrey H. Schimandle, MD; and John T. Norman, MD Spine 1996; 21(1):pp 27-31 Keywords: Rabbit, nonunion, lumbar, intertransverse, arthrodesis Experimental acute dorsal compression of cat spinal cord (#40) Toshiaki Takahashi, MD; Yuji Suto, MD; shinsuke Kato, MD; Eisaku Ohama, MD Spine 1996; 21(2):pp 166-173 Keywords: Cat, spinal cord, dorsal decompression The reflex effects of spinal somatic nerve stimulation on visceral function (#41) Akio Sato, MD, PhD JMPT 1992; 15(1):pp57-61 Keywords: animals, autonomic nervous system, reflex, efferent pathways, somatic afferent pathways The direct connections of the C2 Dorsal Root Ganglia in the Macaca Irus Monkey: Relevance to the Chiropractic Profession (#42) Don Fitz-Ritson, DC JMPT 1985; 8(3):pp 147-156 Keywords: C1-2, Atlas, Occiput, Nuclei, Nystagmus, Neurological contact C1-2 Nerve compression syndromes as models for research on osteopathic manipulative treatment Louise Luckenbill-Edds, PhD & Greg B. Bechill, BS JAOA 1995; 95(5):319-326 Keywords: Nerve sheaths, nerve compression syndrome, pathophysiology of nerve compression, osteopathic manipulative treatment Experimental Osteoarthritis in the Rabbit (#45) T. Videman ACTA Orthop. Scand; 1982;53:339-347 Keywords: Animal, rabbit, immobilization, knee, osteoarthritis, degenerative joint disease Evaluation of Joint Mobilization Treatment - A method (#46) Varick L. Olson Physical Therapy; 67(3):351-356 Keywords: Immobilization, Joints Physical Therapy, Dog, Animal Parietal bone mobility in the anesthetized cat (#48) Thomas Adams, Phd; Richard S. Heisey, ScD; Mahlon C. Smith, PhD; Barbara J. Briner, DO JAOA 1992;92(5):599-622 Keywords: Cranial motion, cranial sutures, cat, animal, intra-cranial pressure, cerebrospinal fluid, cranial bone mobility Spine stiffness measures in a dog model of restricted joint motion (#49) Michael J. Papakyriakou, M.Sc.E; John J. Triano, MA, DC; and Patricia C. Brennan, PhD Proceedings of the 1991 International Conference on Spinal Manipulation; April 12-13, 1991; Crystal Gateway Marriott Hotel, Arlington, VA Keywords: animals, dog, spine, stiffness Connective tissue response to immobility - Correlative study of biomechanical and biochemical measurements of normal and immobilized rabbit knees (#51) Savio L-Y Woo, John V. Matthews, Wayne H. akeson, David Amiel and F. Richard Convery Arthritis and Rheumatism, May-June 1975;18(3):257-264 Keywords: Rabbit, immobility, biomechanical Subtle, Intermittent Mechanical Irritation of Sciatic Nerves in Mice (#51-A) John J. Triano, DC; Marvin W. Luttges, Ph.D. JMPT, 1980;3(2):pp75-80 Keywords: Mice, mechanical irritation, sciatic nerve, chiropractic subluxation syndrome, facilitation, decreased nerve conduction velocity Immunologic Correlates of Reduced Spinal Mobility: Preliminary Obsrevations in a Dog Model Patricia C. Brennan, Ph.D; Katrina Kokjohn, DC; John J. Triano, MA, DC; Thomas E. Fritz, DVM; Craig L. Wardrip, DVM and Maria A Hondras, DC Proceedings of the 1991 International Conference on Spinal Manipulation; FCER Keywords: Dogs, beagles, immune system, non-specific immune system, specific immune system, SP (substance P) The present use of guinea pigs for chiropractic research (#54) Marion McGregor, DC; Michael Wiles, DC; Adrian Grice, DC J of the CCA, 1980; 24(3):101-107 Keywords: Guinea pigs, chiropractic research Changes in Nerve Physiology in the Rat After Induced subluxation (#55) Valerie Israel, MS Articulations, 1983:9-10 Keywords: Rats, Changes, nerve physiology, subluxation Figures and Tables For more information regarding post -graduate training in veterinary chiropractic contact: The Healing Oasis Wellness Center 2555 Wisconsin St. Sturtevant, WI 53177 262-878-9549 or fax: 262-886-6460 HOWC@THEHEALINGOASIS.COM WWW.THEHEALINGOASIS.COM American Holistic Veterinary Medical Association 2218 Old Emmorton Road Bel Air, Maryland 21015 410-569-0795 or fax: 410-569-2346 www.ahvma.org office@ahvma.org American Veterinary Chiropractic Association www.animalchiropractic.org or amvetchiro@aol.com Healing Oasis Wellness Centre of Canada, Web Site: http://www.veterinarychiropractic.ca/ or contact the main office at above address and phone numbers. Options for Animals Mailing Address: PO Box 125, Hillsdale, IL 61257, Telephone: 309-658-2920, Fax: 309-658-2622, Physical location: Wellsville, Kansas. For current information check their web Site: www.animalchiro.com Parker College of Chiropractic, 2500 Walnut Hill Lane, Dallas, TX 75229, Post Graduate Department, Michelle Yungblut, 800-266-4723 or 214-902-2479 Web Site: http://www.parkercc.edu/continuing/index.asp Veterinary Massage and Rehabilitation Therapy For Veterinary Medical Professionals Veterinary massage therapy has become one of the most popular and abused rehabilitation therapy aids within the last five (5) years. Although it is used every day in many hospital settings, its primary success and information comes from clinical responses and minimal (double blind) scientific research studies on animals. Since there are no medical or veterinary medical schools teaching this therapeutic modality to professionals, there has been a resurgence of "overnight schools" which gives the attendees a fictitious degree of either Animal Neuromuscular Therapist, Animal Massage Therapist, or Pet Massage Therapist. It should make sense to say that massage therapy occupies the biggest portion of rehabilitation therapy. Rehabilitation therapy is not just the use of "instruments" or "machines"; but whatever means are necessary to "recondition" muscles. It is our intention not only to discuss what massage techniques and rehabilitation techniques are available, but to discuss the safety of them. In 1996, the American Veterinary Medical Association (AVMA) through the Alternative / Complementary Therapy Modality Committee, defined the above mentioned modalities as follows (see AVMA Directory, 1997, 1998; Section of Alternative / Complementary Therapy): Veterinary massage therapy is a technique in which the person uses only their hands and body to massage soft tissues. Massage therapy on non-human animals should be performed by a licensed veterinarian with education in massage therapy or, where in accordance with the state veterinary practice acts, by a graduate of an accredited massage school who has been educated in non-human animal massage therapy. When performed by a nonveterinarian, massage therapy should be performed under the supervision of, or by referral from, a licensed veterinarian who is providing concurrent care. Veterinary physical therapy is the use of noninvasive techniques, excluding veterinary chiropractic, for the rehabilitation of injuries in nonhuman animals. Veterinary physical therapy performed by non-veterinarians should be limited to the use of stretching; massage therapy; stimulation by use of a) low-level laser, b) electrical sources, c) magnetic fields, and d) ultrasound; rehabilitative exercises; hydro therapy and applications of heat and cold. Veterinary physical therapy should be performed by a licensed veterinarian or, where in accordance with the state practice acts, by 1) a licensed, certified or registered veterinary or animal health technician educated in veterinary physical therapy or 2) a licensed physical therapist educated in non-human animal anatomy and physiology. Veterinary physical therapy performed by a non-veterinarian should be performed under supervision of, or referral by, a licensed veterinarian who is providing concurrent care. The normal definition of massage and rehabilitation therapy that we would like for you to go home with is as follows: The use of fingers, hands and machines to manipulate the soft tissues, or stimulate at the cellular or neurological level of the body in such a way that will improve healing and recovery!! The conditions that most frequently will benefit from veterinary massage and rehabilitation therapy includes:
Before practitioners decide to practice this health care modality, they themselves should seek advance training. Although there are "week end" seminars available, the only thing that they are good for is to "open up the eyes" of the licensed health care professionals not to make them experts in one week end. Advanced training must be sought! Before working on any animal, it is essential for the practitioner or veterinary technician to practice on willing friends (husbands or partners) that could vocalize and verbally explain on what are they feeling. I would suspect that it would be safer to practice on someone that can describe what they are feeling than find yourself staring down the oral cavity of a 60 kg Rottweiler! Several things are needed for the practitioner and technician to be proficient on any of these health care modalities.
Before you start working on any animal, you should:
ADJUNCT THERAPIES CRYOTHERAPY One of the most widely used therapies involves the application of various forms of cold, particularly ice. It includes the common ice pack, cold sprays, cold whirlpools and ice massage. It is agreed that the application of cold is indicated to treat most acute musculoskeletal injuries such as strains, sprain and contusions. The acronym used for the treatment of acute injuries is RICE: R = rest I = ice C = compression 
E = elevation The initial reaction to cold is local vasoconstriction with a consequent reduction in blood flow, decreasing edema and it should be used during the acute stage of the process (first 48-72hrs). Some of the physiologic effects of cold that we as practitioners must learn to KNOW include:
HEAT THERAPY The local application of superficial heat is recommended in many sub-acute or chronic conditions to reduce pain and inflammation and to increase blood flow and venous return. Heat causes vasodilatation and a subsequent increase in local blood flow; it also increases the elasticity of connective tissue and helps in stretching of shortened tissues. Physiologic effect of heating includes:
ULTRASOUND THERAPY (Deep Heat) Basically, therapeutic ultrasound involves the conversion of electrical energy into a mechanical energy in the form of acoustic (sound) waves. The above is accomplished by passing electrical current through a crystal (lead-zirconium-titanate) resulting on the vibration of this crystals and the formation of "sound waves". These sound waves will cause the tissue cells to create what is called a "molecular vibration" which causes the formation of heat. Ultrasound waves have an affinity for tissues that are highly organized, such as tendons and ligaments. Physiologic reactions to therapeutic ultrasound includes:
ELECTRICAL STIMULATION THERAPIES Electrical current typically is used for its physical effects. These are:
The above effects can be altered from one to another by changing some parameters like shape of pulse, intensity of pulse, frequency of the pulse, duration or width of the pulse, polarity and pulse charge. The most popular electrical stimulation therapies include interferential, microcurrent and TENS units (transcutaneous electrical nerve stimulation 
This picture illustrates how the microcurrent that is being used at the sensory level stimuli (SLS) affects the cell membrane, its action potential and cellular permeability 
HOW TO IMPLEMENT these health care modalities in your practice:
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