IN-DEPTH: COMPLEMENTARY MEDICINE


used. This paper will briefly discuss the classifica- tion based on type of receptors and individual clas- sification10 of two specific receptors crucial for the understanding of spinal manipulation, which are GTOs and MSCs. MSCs are specialized receptors that measure changes in the length of the muscle and rate at which the muscle is contracting or elongating. The MSCs are found throughout the muscle but are found in higher concentration around the equatorial (muscle belly) region of the muscle. The MSC con- tains several “bags” that are found within the recep- tor; these are the nuclear bags and nuclear chain fibers. Nuclear bags are surrounded by another receptor called the annulospiral ring that connects to the I-a afferent fibers going to the dorsal horn. The MSC receives efferent information from the ventral horn cells (also known as lower motor neu- ron), allowing the muscle itself to have tone and sensitivity. The fibers that influence muscle tone and sensitivity are the and  motor neurons that provide what is described as “alpha and gamma gain”.11 Alpha-gamma gain describes the coactiva- tion of said motor neurons that helps to maintain the intrafusal fiber sensitivity and muscle tone dur- ing muscle contraction. Please note that although  motor neurons are part of the lower motor neu- rons, they will not be discussed in this paper. GTOs are neurotendinous receptors found at the


origin and insertion of the muscle. Each GTO is innervated by a single afferent Type Ib nerve fiber. The GTO is stimulated when the muscle contracts and exerts tension on both the origin and insertion region by compressing the sensory terminals. The Ib sensory afferent fiber influences/modulates mus- cle contraction by stimulating interneurons and ultimately projects directly to the ipsilateral cerebel- lum through the spinocerebellar tracts found within the spinal cord. If the temporal summation of the GTO is high enough, then the response would be considered as an autogenic inhibition reflex (i.e., muscle contraction would decrease or stop).11


3. Trajectory of Peripheral Nerve Fibers


It is crucial and imperative for the licensed health care provider to understand the trajectory of the nerves from the intervertebral foramen to the spe- cific receptor, as peripheral nerves contain afferent and efferent fibers (motoric and autonomic). It is not uncommon to develop what is called an “entrap- ment syndrome” in cases that have severe muscle spasms or extensive scar tissue formation. In es- sence, “entrapment syndrome” leads to a decrease in blood supply to the nerve secondary to the external pressure. Knowledge of the anatomic structures included in the cervical, brachial, and lumbosacral plexus are important to understand how chiroprac- tic manipulation can affect the patient or impact the anticipated outcome.12–14


316 2018  Vol. 64  AAEP PROCEEDINGS 4. Local Changes


Professionals providing receptor-based therapies (e.g., acupuncture and manual therapies) should un- derstand that the effect of these therapies begins at the cellular (local) level. The response to the stim- ulation provided at the local (cellular) level affects the individual central integrative state (CIS) of the receptors and its afferent fibers and affects the over- all CIS of the cortex. Changes at the cellular level are crucial to or respon-


sible for maintenance of the active and constantCIS of the “connections.” All the latter changes are and should be accepted, as long as counterproductive responses such as dysafferentation and transneural degeneration (also known as neuronal degeneration) are NOT created or caused as these changes could damage the health of that cell along with its post- synaptic connections and ultimately impact the way it influences the suprasegmental and other modu- latory effects, including its final efferent motoric expression.15–17 When discussing functional neurology, as it ap-


plies to spinal manipulation or other manual thera- py(ies), it is critical or important for all clinicians to keep in mind the CIS (or health) of the neuronal pathways and individual neuronal systems. It is well known that neurons need several things to remain healthy and viable. These “basic require- ments” include the following: oxygen, glucose (nutrition), neurotrophic factors, and correct and healthy stimulation by the presynaptic pool.15 The end result of cellular stimulation is the production of adenosine triphosphate (ATP) and protein. ATP is necessary for many cellular functions including the stimulation of the Na:K pump to help maintain ad- equate negative gradient and to produce proper amount of protein that is required to help with the negative cellular value and to replace and maintain “daily” cellular requirements. These cellular changes occur with proper stimulation of immediate early genes (also known as “cellular immediate early gene response”) cascade that occurs within the cytosol and the nucleus of the cell.15,18 Often, practitioners forget to assess parameters


which (quantitatively) determine if the patient is exceeding its own metabolic rate, providing a win- dow of when it would be prudent to stop or reorga- nize treatment protocol(s). When exceeding the metabolic rate of any neuronal connection(s), there will be decreased supplies of nutrients and oxygen, leading to downregulation of protein production. Persistent downregulation can lead to transneural degeneration/neuronal degeneration. Cells that start exceeding their metabolic rate will invariably become more sensitive to any external stimuli with the hope of trying to maintain adequate concentration of protein and or ATP, hence starting a degenerative cycle with less nutrition and oxygen and further cellular deteri- oration.3,4 This latter “deterioration” will invariably lead to apoptosis.


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