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Biofeedback in Chiropractic

This article originally appeared in Chiropractic Journal

Wouldn't it be nice if you could double or triple the size of your practice by adding a treatment modality one third the cost of an X-ray machine with very strong insurance reimbursement? Adding biofeedback can do this. Imagine your current patient base thinking of you as the place to send their friends and relatives for the treatment hypertension, anxiety, irritable bowel, dysmenorrhea, hyperhidrosis, migraine headache, carpal tunnel syndrome, TMJ syndrome, insomnia and other nervous system dysregulation disorders that the public does not ordinarily associate with chiropractic. Biofeedback can make this happen. It is a therapeutic intervention that fits perfectly with chiropractic philosophy, licensure and training. It is simply the use of devices to help patients have more information about their body functions so they can control those functions-- particularly musculoskeletal, autonomic and cardiovascular.

There are a handful of chiropractors who have been helping their patients and practices with biofeedback for years. But there is another huge group of chiropractors who are already using biofeedback technology in their offices.

PARASPINAL EMG; a short conceptual step from Biofeedback

It's happening over and over again throughout the world. A chiropractor invests in a surface EMG system and discovers the power of biofeedback to heal patients and expand a practice.

If you are using (or considering using) paraspinal EMG scanning in your practice, you are using instrumentation that evolved from the field of biofeedback-- instrumentation that could be doing much more to help your patient if you used the biofeedback capacities inherent in the instrumentation. Unfortunately, most EMG manufacturers have emphasized the easy billing and profits of static EMG scans over the powerful clinical results of biofeedback.

Neuromuscular muscle re-education biofeedback can help patients to re-normalize learned dysfunctional postures, antalgic bracing and guarding patterns and over-reactive, irritable muscle activity patterns that cause, aggravate or re-activate subluxation and pain producing responses.

The Chiropractic-Biofeedback Connection

Chiropractic helps restore the patient's normal balance of the nervous and musculoskeletal systems. Biofeedback helps the patient restore and maintain normal homeostatic balance by teaching the patient self awareness and self regulation skills.

Biofeedback and Adjustment

Dr. Patricia Robertson, a chiropractor in Erdenheim, PA who is also certified in biofeedback says, "Biofeedback enhances adjustments because it teaches people to take responsibility for their own bodies and to become more aware of how they affect muscle stress and strain in their own bodies. Adding biofeedback has enhanced my practice because it offers something unique, more well-rounded and holistically oriented. It enhances referrals because it offers an alternative doorway for stress management rather than conventional chiropractic.

Doctor Steven Shuel, of Santa Paula California, started out with the intention of adding surface EMG to his practice, but quickly saw the potential of going the extra step to biofeedback. "Biofeedback is an incredibly powerful tool we've been ignoring. Now that I've begun integrating it into my practice, I've begun calling back difficult patients I couldn't help with manipulation-- the real chronic and treatment resistant ones. The results are very exciting. My practice has begun growing already. By going beyond static paraspinal EMG scans to actually measuring musculoskeletal function during movement, I can find out immensely more information.

Doctor Robertson uses biofeedback to treat headache, Temporomandibular joint syndrome, chronic pain, and a wide range of stress disorders. She says, "Biofeedback has been in the psychological arena but it belongs in chiropractic because the two approaches are so consistent with each other philosophically. Biofeedback adjusts the patient above atlas, chiropractic, below atlas. Most chiropractors are not taught how to counsel people on stress. It should be something they add to their education through post-graduate study. Since stress is indicated as the disease of the 90's and we are a drugless healing art we should be ready to offer a drugless technology for treating stress."

In her practice, EMG scanning is often the patient's introduction to biofeedback. "We show them that they can reduce their EMG by their self. Even without calling it biofeedback they've begun to learn how to reduce muscle tension and increase the effectiveness of the adjustments.

Dr. Robertson says that she will often start with EMG scanning, using the EMG findings to demonstrate to the patient there is soft tissue injury. "Then they can start taking responsibility. I adjust them for subluxations of the spine and then treat the muscles with EMG or thermal training depending on the headache disorder.

One patient Dr., Robertson treated had suffered with migraine headaches three times a week for 16 years. "She had received biofeedback before and it didn't help. People stuck her in a dark room and left. At our clinic she was adjusted and then trained with biofeedback to reduce muscle tension and increase temperature in her fingers. She's been headache free ever since her third week of combined chiropractic biofeedback treatment.

Dr. Robertson described a Trigeminal Neuralgia patient's treatment history, "Chiropractically, her subluxations would clear out. But that alone would not prevent the trigeminal neuralgia from flaring. Her stress levels would increase. The pain in her face would act up. Pain would cause her to clench her cervical and facial muscles-- frontalis, masseter, SCMs, Trapezii, cervical paraspinals. This tensing would cause the misalignment of her vertebra to recur. Biofeedback was the added treatment ingredient that resolved the problem. Surgery had been her only other alternative. but chiropractic biofeedback saved her from the surgery."

Logistics of adding biofeedback

The 20 to 50 minute session is on of the biggest arguments Chiropractors raise against adding biofeedback to their practice. But Dr. Robertson says, "You don't do the biofeedback yourself. You can use a technician certified in biofeedback or stress management. These individuals are trained in skills and techniques that are philosophically consistent with chiropractic."

Regular CA's are usually not adequately trained to perform the more sophisticated levels of therapeutic assessment and patient interaction required for biofeedback-- whether you are offering stress management or neuromuscular rehabilitation. If there are no certified people available in your area, try to find someone who has training and experience equivalent to the criteria for certification established by the Biofeedback Certification Institute of America.

Robert Kall is BCIA certified, has 28 years of experience in biofeedback and has been training chiropractors in biofeedback and surface EMG since 1983. Contact him at FUTUREHEALTH, 211 N. Sycamore, Newtown, PA 18940

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