Pettibon Treatment in Lakewood
Pettibon 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 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 manipulation and rehabilitative exercises seems to outperform either modality alone in achieving various clinical outcomes.2,13,24 Classically, the goal of chiropractic manipulation is to correct misalignments within the spinal column. However, the literature available to support this idea is limited at best. In The Pettibon System, by contrast, spinal 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 this system is the idea that the manipulation is not the corrective procedure; rather, the rehabilitative exercise becomes the corrective procedure. The limited corrective ability of spinal 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 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, Pettibon37,38 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
The 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, and may sustain injury from this type of manipulation. 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 with less chance of injury. The accumulative force procedures represent the positional traction procedures.
