Our Approach | Your First Visit | What is Chiropractic
Treatment Techniques
Our core services include some of the following techniques. You can read further and of course, contact us with further questions or for an appointment.
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Chiropractic adjustments are manual treatments to the joints of both the spine and extremities and are used to restore range of motion, relieve pain, and normalize nerve function. They correct the “joint dysfunction” or the “subluxation complex.” Dr. Bochner uses a variety of techniques: Diversified, Gonstead, Blocking/SOT, Flexion Distraction and low-force adjustments. See What is Chiropractic for more information on chiropractic adjustment techniques.
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Active Release Techniques (ART) is a patented manual soft-tissue (muscle, fascia, ligament, tendon and nerve) technique that specifically treats scar tissue and adhesions. Scar tissue is formed as part of the healing response to acute injury and also with overuse injury and postural dysfunction. Adhesions form when the scar tissue then “sticks” to other nearby tissue, and can occur within a muscle or fascial area or between adjacent muscles. The adhesions restrict normal, free motion between the tissues, and can also compress nearby nerves and blood vessels. Often these adhesions contribute to chronic conditions such as back pain, neck pain, headaches, shoulder pain, tennis elbow, carpal tunnel syndrome, sciatica, knee problems, shin splints and plantar fasciitis. Many of these conditions involve a “cumulative trauma” to the tissues that over time results in scar tissue. Pain and dysfunction from the scar tissue can lead to more soft-tissue trauma and more scar tissue. This cycle must be addressed to heal and prevent chronic pain. ART treatments often can help, and are becoming standard treatment procedure for sports injuries in athletes of all levels as well as for the management of the chronic injuries mentioned above.ART treatments involve the doctor first palpating and assessing the motion and tension of the involved soft tissues to find the adhesion, which has a different texture and tone than healthy tissue. This exam is very specific. Typical range of motion, strength, and orthopedic testing are also done to rule out complete tears or other conditions. This “soft-tissue and nerve” exam takes over where those typical tests leave off, and directs the doctor to the exact area needing treatment.
Each individual muscle, ligament and nerve of the body has a protocol for treatment designed for the anatomical area- there are hundreds of ART protocols. To release the restricted tissue, the doctor puts the area in an anatomically “shortened” position, and holds a contact with a specific level of tension. Then, as the tissue is anatomically “lengthened”, the adhesion is also stretched and “broken up” and normal motion is restored to the restricted tissues. The number of treatments required to fix a restricted area will depend on the severity of the injury and other factors. Often ART, because of its’ specificity, is able to provide relief very quickly, in 3-5 visits. Additional treatments may be necessary as the patient resumes activity or addresses involved lifestyle factors, as well as for treatment of biomechanically related restricted areas, chiropractic treatment of related joint restrictions and rehab exercises.
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Before ART was developed, a commonly used method to relieve pain and soft-tissue dysfunction was to manually compress and deactivate myofascial trigger points and adhesions. This technique is still valuable in many cases. Trigger points, similar to adhesions, are local areas of muscle and fascia tightness and hypertonicity (increased muscle tone) that reduce range of motion, cause pain locally, and can refer pain and paresthesia (altered sensation) to other areas of the body. Dr. Bochner is an expert at locating and releasing trigger points and adhesions with over 20 years experience in this technique. Often, chronic pain syndromes and many sports injuries can be solved through trigger point therapy and a home stretching and strengthening program, in conjunction with posture and ergonomic advice.
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When acute or overuse injury occurs, the body heals strained and sprained ligaments and tendons with new connective tissue or scar tissue. Unfortunately, this new tissue is not as strong or flexible as the original tissue, and doesn’t allow proper joint and muscle function. This can cause additional pain and injury or re-injury. Cross-friction massage is manual treatment across‚ or perpendicular to, the scar tissue, which can cause the body to produce stronger and more flexible connective tissue. By introducing perpendicular pressure with friction to the injured area, the fibroblasts (which are cells that secrete new proteins for healing), produce a more flexible and stronger – a more elastic – scar. For example, sprained ankles often recur because the ligament’s scar tissue isn’t addressed once the initial swelling goes down. Cross-friction massage to the ligaments can heal more completely (along with ART or trigger point treatment to the calf and other involved lower extremity muscles, and balance and strength exercises). See the Ankle injury article for more.
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Acute or recurrent injuries often cause pain, swelling and muscle spasm. Manual therapy and stretching/range of motion and strength exercises may not initially be tolerated. Electrical muscle stimulation generates a specific current that can promote healing. Many different waveforms can be applied to the body depending on the condition (pain relief, spasm and swelling reduction, muscle strengthening, for example). EMS may also help chronic conditions, where muscles atrophy and weaken, and help restore normal muscle contractions so that rehab is easier. Dr. Bochner uses EMS when necessary, in addition to specific manual soft-tissue techniques and adjustments.
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Ultrasound can also help tissue healing. An electric current is converted into a sound-wave which, when applied to the body, creates heat in muscles, ligaments, or tendon tissue. This heating effect creates “increased molecular activity” at a cellular level, which can stimulate the body’s healing process, as well as relax and decrease muscle spasm and tension. A metal “transducer” carries the sound-wave to the body through direct skin contact, which is comfortable for the patient. Treatment lasts 5-10 minutes depending on the case. Dr. Bochner uses ultrasound for acute muscle spasm and/or tendon swelling, and sometimes for chronic scar tissue as an adjunct to the manual soft-tissue techniques such as ART, trigger point therapy, and cross-friction massage.
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Another treatment for acute and chronic sports and soft-tissue injuries is assisted stretching where the patient and doctor work together to increase range of motion in tight muscles and joints. As noted in the overview section, the entire “kinetic chain” (meaning the joints and muscles above and below an area of pain as well as the “opposing muscles” and “synergistic muscles”) must be addressed for effective treatment.
Often that means releasing a tight muscle that is either over- or under-active with assisted stretching. The doctor may actively move the patient’s leg, gradually increasing the range of motion, or may have the patient first “use” the muscle by contracting it against the doctor and then relaxing the muscle as the doctor gently stretches it further. This contraction-relaxation protocol makes it easier to stretch a muscle because there is a brief “reflex” inhibition that allows for greater range of motion for a few moments. Gentle joint traction and breathing techniques are also part of therapeutic stretching. These techniques help reduce acute muscle spasm and chronic muscle and joint tightness along with ART and trigger point therapy. As part of the rehabilitative process (see rehab section), patients are taught to stretch themselves to continue care at home or in the gym, sometimes using the “stretch rope, ” such as with “Active-Isolated Stretching.”
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Once acute pain and muscle or joint dysfunction is treated, it’s necessary to stabilize and strengthen both the painful area and the true cause of the injury, as they are often different. Systematically, we look at whole body movements to achieve this. Our office has an open exercise area with stability balls, rocker boards, foam balance pads, wobble boards, theraband resistance tubing/bands, medicine balls, dumbbells, weight benches, step/plyometric boxes, foam rollers and stretching cords and mats. This equipment stretches, releases fascial restrictions, activates muscles, strengthens, facilitates normal movement, and improves balance, plyometric strength and agility as described below:
1) Muscle Lengthening, Inhibition, and Re-Activation Techniques: Exercises are prescribed to restore normal length, tone and contraction patterns of key muscles – otherwise, pain and injury may recur. For example, in knee injuries, the inner quadriceps muscle, or vastus medialis, is often inhibited by the pain of the injury or immobilization after surgery, and the body “shuts down” the muscle, resulting in eventual atrophy and lengthening of the muscle fibers. The same process occurs in the deep lower back muscles called the multifidi (one of the “core” muscles) and the gluteus maximus in both acute and chronic lower back pain. Meanwhile, often the opposite muscles, the hamstrings for the knee and the hip flexors for the lower back/pelvis, are overactive and shortened. Exercises such as small, isometric contractions help to “re-activate” and tighten the inhibited muscles, and foam rolling and corrective stretches help to “deactivate” and lengthen the overactive muscles. Additionally, related muscles around a joint as well as above and below must be assessed as well for the same inhibition/lengthening and overactivity/tightness. Fixing these imbalances with these techniques is part of Core strengthening, which is necessary for many conditions, and the core
is assessed in all patients. Even though our bodies naturally resist using an acutely injured area, the earlier we return to regular motion, the better (which is why bed rest and resting injured areas should be limited as much as possible).2) Balance and proprioception exercises: These are used to restore or improve stability when upright and on one leg. When we move, our body’s peripheral nervous system tells our brain where a limb is and in what direction it’s moving, so that instantaneous adjustments may be made, subconsciously enabling us to react to direction or speed changes and keep moving efficiently and safely. The body’s ability to gather information from the joints is called proprioception, and the receptors are called proprioceptors. Ankle sprains, knee injuries and chronic lower back pain can be caused by, or result in, altered propriocetion and poor balance. Exercises on devices such as the rocker or wobble board, bosu apparatus and stability ball are used to regain proper proprioception and prevent re-injury. They are also used to enhance performance in the Prepare to CompeteTM program.
3) Movement Pattern Correction exercises: These are used to restore and improve movement coordination. These exercises are for groups of joints and muscles and progress from simple to complex movements, such as rotating your neck and torso, moving from a supine to sitting to standing position, to adding lunging with rotation. As these altered patterns often have been present for years in many cases, and as our modern lives encourage poor motion or lack of it, correcting them can take time. Full body activity instruction, such as walking and running correctly is often also needed. Any dysfunctional movement pattern discovered in the initial exam, painful or not, must be addressed before training or fitness activity resumes. Doing so can help relieve stress and pain on muscles, fascia, nerves and joints far or near from the area of altered movement.
4) Plyometric exercises have the patient perform quick jumping, skipping and bounding movements, sometimes with boxes and hurdles. Often with injury, or before injury, tendons lack strength throughout their entire range of motion and don’t react quickly to sudden stretching. Plyometrics strengthen the tendon in its lengthening phase, which is often where injury occurs during motion. This improves the reaction time of the nerve/tendon/muscle function for explosive movements.
5) Agility exercises: Agility is the ability to move laterally and in “combined” directions and is necessary for athletes to perform at high levels, and for ease of motion in everyday activities. Drills and sport- and activity-specific exercises, such as lateral hopping, side-to-side, cross-over, leg movement patterns during strength exercises, and rotational or “spiral” movements, can improve agility and also complex movement patterns.
6) Sport/Activity Specific Exercises/Drills: To finish a rehab program, athletes and patients alike must be able to handle the demands of their particular sports, and activities. They need to tolerate movement at full speed by the injured areas, and altered movement patterns must be corrected. Often this “functional” ability to move is not present in de-conditioned individuals who suddenly take up an exercise routine or sport and acute or overuse injury results.
Many of the above rehab techniques are also used in the Prepare to CompeteTM Injury Prevention System (below).
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After years of seeing similar patterns of injury in his patients, Dr. Bochner developed an injury Prevention System called Prepare to CompeteTM. This is a screening program for the neuromusculoskeletal system. You can learn this system either as a patient or at a PTC clinic, which are given several times a year. Check the Events section for clinic dates. Below is a summary of the system.
Our healthcare system provides screening for eyes, teeth, and cardiovascular systems, but little attention has been paid to the neuromuscuskeletal system. This, combined with the decreased daily physical activity in our country, has led to an epidemic of “overuse” or what Dr. Bochner also calls “overuse/underuse” injuries.
In other words, many of us only do the same repetitive motions each day, which leads to overuse of some muscles and movement patterns and underuse of others. This in itself leads to pain and injury, but Dr. Bochner and others in the neuromusculoskeletal healthcare fields have found that these patterns are often stressed in some popular exercise routines, such as marathon running and triathlon training (think of sitting with your knees flexed all day and then how running continuously for hours stresses the same already-tight area). This flexion “overuse” often leads to injury. For example, the hip extensor muscles are often underused and become weak, then don’t offer proper posture support and hip extension during physical activity. This “underuse” also leads to injury. Thus, athletes training an imbalanced body are, effectively, taking a car out for a ride with uneven tire pressure and rust in the engine. Eventually, both will break down.
Prepare to CompeteTM is an organized system to screen for common patterns of dysfunction in posture (P), in muscle length and strength and joint range of motion, or “tension”(T) and in movement pattern quality or “control”(C).
The PTC program evaluates your Posture, Tension and range of motion in key muscles and joints, and your ability to Control your movement and perform proper movement. Doing this before you start an exercise or training program can reveal “weak links” that may lead to injury. Then, if necessary, treatments are presecribed, and you are taught self-care or “prehab” exercises and restorative measures to correct the weak links before training starts to prevent pain and injury. Your weak links are then re-checked to make sure you are in the “ready-range” for exercise and training. Then, these corrective, muscle activation, and balance and movement exercises and self-myofascial release (foam/ball rolling) techniques are done daily and seasonally for self-checking of the status of your neuromusculoskeletal system and proper maintenance of your “PTC.”
To summarize, the PTC program can help prevent “overuse/underuse” injury in four steps:
1. Evaluate your level of health and fitness BEFORE TRAINING STARTS.
2. This evaluation will reveal “weak functional links” that may lead to injury and reveal your neuromusculoskeletal system’s "health status" or "readiness" for exercise, training or competition.
3. Add treatments and exercises to your daily and weekly workouts to fix these problem areas (“prehab”). This is done before, or as part of, “base” training. Re-evaluate your "readiness" level as you progress with these treatments and exercises. If it is in range for training, start or increase training beyond low base level!
4. Keep your body healthy by using restorative measures to keep these areas fixed so you are maintaning normal "PTC" and are “exercise ready”! -
For both recreational and competitive athletes, Dr. Bochner works with and recommends experienced coaches to provide advice and training plans. See the Links section of the website for more information.
