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1 biotensegrity aaom-workshop-2012-clark

  1. 1. Clinical BiotensegrityIllustration of Compression-Tension Forces That FacilitateOrthopedic Medical Diagnosis, Treatment, and Postural Rehabilitation .... Using a Data-based Model Gary B. Clark, MD, MPA Center for Orthopedic Medicine BOULDER PROLOTHERAPY Boulder, Colorado Disclaimers: None Graphic Illustrations: Faith Gowan Gary B. Clark, AAOM, Ft Lauderdale, 2012 1
  2. 2. “When we try to pick out anything by itself, we findthat it is bound fast by a thousand invisible cords . . . to everything in the universe.” John Muir Personal Journal July 27,1869 In Memory of Michael Wayne Seamans, DO Dedicated to James S. Miles, MD Professor Emeritus Chairman of Orthopedic Surgery University of Colorado School of Medicine Father of the “Five R’s of Orthopedics” Gary B. Clark, AAOM, Ft 2 Lauderdale, 2012
  3. 3. Educational Goals1. Introduce the Scientific Model Being Used to Illustrate Biotensegrity in this Talk1. Illustrate Natural Compression-Tension Forces in an Ideally Balanced State2. Illustrate Injurious Compression-Tension Forces in an Naturally Imbalanced State3. Illustrate Mapping of Compression-Tension Forces Gary B. Clark, AAOM, Ft Lauderdale, 2012 3
  4. 4. The Levels of Medical Evidence• Prospective Randomized Controlled Study (The Gold Standard)• Retro/Prospective Cohort Longitudinal Study• Retrospective Case-Control Study• Case Series Study- Retro/prospective and Consecutive/nonconsecutive• Multiple Case Series Casual Retrospective Observation/ Expert Opinion• Single Case “unique” Casual Retrospective Observation/ Expert Opinion Gary B. Clark, AAOM, Ft 4 Lauderdale, 2012
  5. 5. The Levels of Medical Evidence• Prospective Randomized Controlled Study (The Gold Standard)• Retro/Prospective Cohort Longitudinal Study• Retrospective Case-Control Study• Case Series Study--Prospective (rigorously pre-planned) and Consecutive (including all cases presenting over a specific period)• Multiple Case Series Casual Retrospective Observation/ Expert Opinion• Single Case “unique” Casual Retrospective Observation/ Expert Opinion Gary B. Clark, AAOM, Ft 5 Lauderdale, 2012
  6. 6. SIJD Physical Characteristics9,10 Initial Observations Leading to Study Most Reproducible Definitive Physical Signs Dropped Short-sided Vertebral Functionally Weakened Inferior Sacral Limp Scoliosis Short Leg Leg Angle aBductionLSIJD Left Left Step Dextro Left Left Down Lumbar DecreasedRSIJD Right Right Step Levo Right Right Down Lumbar Decreased Gary B. Clark, AAOM, Ft Lauderdale, 2012 6
  7. 7. SIJD Physical Characteristics9,10 Initial Observations Leading to Study Most Reproducible Definitive Physical Signs Dropped Short-sided Vertebral Functionally Weakened Inferior Sacral Limp Scoliosis Short Leg Leg Angle aBductionLSIJD Left Left Step Dextro Left Left Down Lumbar DecreasedRSIJD Right Right Step Levo Right Right Down Lumbar Decreased Frequently Supportive Physical Signs Dropped Restricted Supinated Pronated Shoulder Sacroiliac Foot Foot Joint with LSIJD Right Left Ileal Left Right Flexion RSIJD Left Right Ileal Right Left Flexion Gary B. Clark, AAOM, Ft Lauderdale, 2012 7
  8. 8. SIJD Physical Characteristics9,10 Initial Observations Leading to Study Most Reproducible Definitive Physical Signs Dropped Short-sided Vertebral Functionally Weakened Inferior Sacral Limp Scoliosis Short Leg Leg Angle aBductionLSIJD Left Left Step Dextro Left Left Down Lumbar DecreasedRSIJD Right Right Step Levo Right Right Down Lumbar Decreased Frequently Supportive Physical Signs Dropped Restricted Supinated Pronated Shoulder Sacroiliac Foot Foot Joint with LSIJD Right Left Ileal Left Right Flexion RSIJD Left Right Ileal Right Left Flexion Question: Why are all these physical parameters --from plantar arch to nuchal line— seemingly linked in SIJD?? Gary B. Clark, AAOM, Ft Lauderdale, 2012 8
  9. 9. A Data-Based Clinical Example ofSacroiliac Joint Dysfunction (SIJD) Clark G. Journal of Prolotherapy. 2011 9,10A Scientifically Planned Prospective Case-Series Study of SIJD Carried Out over Six Years Gary B. Clark, AAOM, Ft Lauderdale, 2012 9
  10. 10. Sacroiliac Joint Dysfunction (SIJD)Prevalence in Low Back Pain Patients9,10 Data-Based Study of SIJDn = 110 Total Female Male Sacral Sacral Stabilization Stabilization Requiring Requiring OMT ProloAll SIJD ------- 63% 37% LSIJD RSIJD Gary B. Clark, AAOM, Ft Lauderdale, 2012 10
  11. 11. Sacroiliac Joint Dysfunction (SIJD)Prevalence in Low Back Pain Patients9,10 Data-Based Study of SIJDn = 110 Total Female Male Sacral Sacral Stabilization Stabilization Requiring Requiring OMT ProloAll SIJD ------- 63% 37% LSIJD 81% 82% 80% RSIJD 19% 18% 20% Gary B. Clark, AAOM, Ft Lauderdale, 2012 11
  12. 12. Sacroiliac Joint Dysfunction (SIJD)Prevalence in Low Back Pain Patients9,10 Data-Based Study of SIJDn = 110 Total Female Male Sacral Sacral Stabilization Stabilization Requiring Requiring only OMT ProloAll SIJD ------- 63% 37% 30% 70% LSIJD 81% 82% 80% 29% 71% RSIJD 19% 18% 20% 31% 69% Gary B. Clark, AAOM, Ft Lauderdale, 2012 12
  13. 13. Sacroiliac Joint Dysfunction (SIJD)Prevalence in Low Back Pain Patients9,10 Data-Based Study of SIJDn = 110 Total Female Male Sacral Sacral Stabilization Stabilization Requiring Requiring only OMT ProloAll SIJD ------- 63% 37% 30% 70% LSIJD 81% 82% 80% 30% 70% RSIJD 19% 18% 20% 30% 70% ALL the above-mentioned patients were Right-Handed!! Only TWO Left-Handed patients have been encountered in 10 years of carefully documented Orthopedic Medical practice Gary B. Clark, AAOM, Ft Lauderdale, 2012 13
  14. 14. Left Sacroiliac Joint Dysfunction (LSIJD) Data-based Model Characterized by: Primary Left Sacroiliac Ligament Laxity and Sacroiliac Joint Displacement Compensatory Dextrolumbar Scoliosis Compensatory Left Short Leg Compensatory Right Long Leg Gary B. Clark, AAOM, Ft 14 Lauderdale, 2012
  15. 15. Left Sacroiliac Joint Dysfunction (“LSIJD”) Gary B. Clark, AAOM, Ft 15 Lauderdale, 2012
  16. 16. Left Sacroiliac Joint Dysfunction (“LSIJD”) “LSD” Gary B. Clark, AAOM, Ft 16 Lauderdale, 2012
  17. 17. Left Sacroiliac Joint Dysfunction (LSIJD) “LSD”AND Please Excuse the PA (Back Side) Views Gary B. Clark, AAOM, Ft 17 Lauderdale, 2012
  18. 18. Biotensegrity Historical Landmarks• Sir Isaac Newton (1642-1727): Third Law of Motion1• Sir Charles Scott Sherrington (1857-1952): Law of Reciprocal Innervation2• R. Buckminster Fuller (1895-1983): Principal of Tensional Integrity (“Tensegrity”)3• Kenneth Snelson (1927- ): Principal of Floating Compression4• Stevin M. Levin, MD: Coined “Biotensegrity”; Pioneer in clinical study of Biotensegrity since 1980’s5• Donald E. Ingbar, MD: Pioneer in academic study of Cellular and Tissue Biotensegrity since 1990’s6,7 Gary B. Clark, AAOM, Ft Lauderdale, 2012 18
  19. 19. BiotensegrityModels, Examples, Analogies Newton Apple Sherrington Agonist-Antagonist Wright Flyer Fuller Geodesic Dome Snelson Bead Chain X Column Levine Vertebrate Structures Ingbar Cytoskeletal Structures Gary B. Clark, AAOM, Ft Lauderdale, 2012 19
  20. 20. Biotensegrity Models, Examples, Analogies Newton Apple Sherrington Agonist-Antagonist Wright Flyer Fuller Geodesic Dome Snelson Bead Chain X Column Levine Vertebrate Structures Ingbar Cytoskeletal StructuresCantieri Degenerative Postural Low Back Cascade8 Gary B. Clark, AAOM, Ft Lauderdale, 2012 20
  21. 21. Biotensegrity Models, Examples, Analogies Newton Apple Sherrington Agonist-Antagonist Wright Flyer Fuller Dome Snelson Bead Chain X Column Levine Vertebrate Structures Ingbar Cytoskeletal StructuresCantieri Degenerative Postural Low Back Cascade8 Trister Umbrella Gary B. Clark, AAOM, Ft Lauderdale, 2012 21
  22. 22. Biotensegrity Man!! Gary B. Clark, AAOM, Ft Lauderdale, 2012 22
  23. 23. Biotensegrity Woman!! Gary B. Clark, AAOM, Ft Lauderdale, 2012 23
  24. 24. Goal 1: NaturalCompression-Tension Forces in an Ideally Balanced State Gary B. Clark, AAOM, Ft Lauderdale, 2012 24
  25. 25. The Usual Forces at PlayForces Causing Compression • Passive Compression: Directly Due to Gravitational Force (Weight) • Active Compression: Directly Due to Muscular ForceForces Causing Tension • Passive Tension: Directly Due to Gravitational or Indirect Muscular Force • Active Tension: Directly Due to Muscular Force Gary B. Clark, AAOM, Ft Lauderdale, 2012 25
  26. 26. The Usual Forces at Play Gary B. Clark, AAOM, Ft Lauderdale, 2012 26
  27. 27. Ideal Skeletal-Ligament-Muscle Balance and Alignment Gary B. Clark, AAOM, Ft Lauderdale, 2012 27
  28. 28. Goal 2: InjuriousCompression-Tension Forces in an Imbalanced State Gary B. Clark, AAOM, Ft Lauderdale, 2012 28
  29. 29. Ideally Aligned and Balanced Sacrum-Pelvis Gary B. Clark, AAOM, Ft Lauderdale, 2012 29
  30. 30. Primary Sacral Ligament Injury and Resultant Skeletal Displacement in LSIJD Gary B. Clark, AAOM, Ft Lauderdale, 2012 30
  31. 31. Goal 3: MapCompression-Tension Forces Gary B. Clark, AAOM, Ft Lauderdale, 2012 31
  32. 32. Clinical Biotensegrity Force Map Resultant Sacral-Pelvic PassiveCompression-Tension Forces in LSIJD Gary B. Clark, AAOM, Ft Lauderdale, 2012 32
  33. 33. A Spectrum of Potential Sacral-Pelvic Injuries in LSIJDChronic Active Tension—Produced During NormalStanding-Flexing-Extending-Side Bending-Rotating-and-Ambulating in a Right-handed World• Initially via Functionally Balanced Postural/Core Muscles• These Postural/Core Muscles eventually decompensate and become functionally imbalancedChronic Passive Tension—Produced by Muscular/Gravitational Forces• Bilateral Iliolumbar Ligament stress/strain/sprain/laxity• Bilateral Superior-Inferior Posterior Sacroiliac Ligament stress/strain/sprain/laxity• Bilateral Sacrotuberous Ligament stress/strain/sprain/laxityChronic Passive Bilateral Sacroiliac Joint Compression—Produced by Gravitational Forces• Left Sacroiliac Joint displacement Gary B. Clark, AAOM, Ft Lauderdale, 2012 33
  34. 34. A Spectrum of Potential Sacral-Pelvic Injuries in LSIJD Chronic Activation of Postural Muscles (Flexing/Side-bending/Torqueing/Transferring Weight) and Constant Force of Gravity Primary Secondary Secondary Chronic Passive Chronic Passive Chronic Passive Tension Tension Compression Injury Injury InjuryBilateral Iliolumbar Bilateral Sacrotuberous Left Sacroiliac JointLigament Stress>Strain> Ligament S>S>S>L NonphysiologicalSprain>Laxity (S>S>S>L) Displacement/ OsteoarthritisBilateral Sacroiliac Left Piriformis MuscleLigament S>S>S>Laxity Stress>Strain>Sprain> Tendinosis (S>S>S>T) Gary B. Clark, AAOM, Ft Lauderdale, 2012 34
  35. 35. Compensatory Scoliosis in LSIJD Theoretical Head Displacement Gary B. Clark, AAOM, Ft Lauderdale, 2012 35
  36. 36. Compensatory Scoliosis in LSIJDHead Maintained over Center of Gravity Gary B. Clark, AAOM, Ft Lauderdale, 2012 36
  37. 37. Compensatory Scoliosis in LSIJD Resultant Regional Side-Bending Gary B. Clark, AAOM, Ft Lauderdale, 2012 37
  38. 38. Compensatory Scoliosis in LSIJD Resultant Vertebral Misalignment via Normal Spinal Mechanics Gary B. Clark, AAOM, Ft Lauderdale, 2012 38
  39. 39. Compensatory Scoliosis in LSIJD Causal Active Muscle Tension Gary B. Clark, AAOM, Ft Lauderdale, 2012 39
  40. 40. Additional Compensatory Right Posterior Sling Action in LSIJD Gary B. Clark, AAOM, Ft Lauderdale, 2012 40
  41. 41. Clinical Biotensegrity Force MapResultant Compression-Tension Forces in Compensatory Scoliosis of LSIJD Gary B. Clark, AAOM, Ft Lauderdale, 2012 41
  42. 42. Clinical Biotensegrity Force Map Resultant Arcs of Force in Compensatory Scoliosis of LSIJD Gary B. Clark, AAOM, Ft 42 Lauderdale, 2012
  43. 43. A “Perfect Storm” Gary B. Clark, AAOM, Ft Lauderdale, 2012 43
  44. 44. A Spectrum of Potential Scoliotic Injuries in LSIJDChronic Active Tension—Compensatory Chronic Passive Tension—Alongalong Concave Arcs Convex Arcs• Right Cervical Suboccipital/ Paraver- • Left Cervical Intervertebral Ligament tebral Muscle activation/shortening/ and Muscle stress/strain/spasm/sprain/ strain/spasm/sprain/tendinosis laxity-tendinosis• Left Thoracic Paravertebral Muscle • Right Thoracic Intervertebral Ligament activation/shortening/strain/spasm/ and Muscle stress/strain/spasm/sprain/ sprain/tendinosis laxity-tendinosis• Right Lumbar Paravertebral Muscle • Bilateral T11-L 2 (crossover zone) activation/shortening/strain/spasm/ Intervertebral Ligament and Paraspinal sprain/tendinosis Muscle stress/strain/spasm/sprain/• Right Posterior Sling (Right Latissimus laxity-tendinosis dorsi and Left Gluteus maximus) • Left Lumbar Intervertebral Ligament activation/shortening/strain/spasm/ and Muscle stress/strain/spasm/sprain/ sprain/tendinosis laxity-tendinosis• Right Quadratus Lumborum Muscle activation/shortening/strain/spasm/ sprain/tendinosis• Right Thoracic Costovertebral Joint dysfunction/Interscapular Muscle activation/shortening/strain/spasm/ sprain/laxity-tendinosisChronic Active Compression—Along Chronic Passive Tension—OtherConcave Arcs Compensatory along Convex Arcs• Right C1-7 Vertebral Body wedging/ • Right Upper Trapezius Muscle stress/ Facet Joint arthritis/Disc disease/Nerve strain/spasm/sprain/tendinosis impingement • Right Levator Scapulae Muscle stress/• Left T1-12 Vertebral Body wedging/ strain/spasm/sprain/tendinosis Facet Joint arthritis/Disc disease/Nerve • Right Rotator Cuff impingement/stress/ impingement strain/spasm/sprain/tendinosis• Right L1-5 Vertebral Body wedging/ • Left Quadratus Lumborum Muscle Facet Joint arthritis/Disc disease/Nerve stress/strain/spasm/sprain/tendinosis impingement Gary B. Clark, AAOM, Ft Lauderdale, 2012 44
  45. 45. A Spectrum of Potential Scoliotic Injuries in LSIJD Chronic Active Chronic Passive Chronic Active (Concave Arc) (Convex Arc) (Concave Arc) Tension Tension Compression Injury Injury InjuryMUSCLERight Cervical Suboccipital- Left Cervical/RightParavertebral/ Left Thoracic Thoracic/Left LumbarParavertebral Right Lumbar Intervertebral MuscleParavertebral/Right S>S>S>TPosterior Sling/Right Right Upper Trapezius/ RightQuadratus Lumborum/Right Levator Scapulae/ RightInterscapular Muscle: Rotator Cuff/Left QuadratusChronic Compensatory Lumborum Muscle S>S>S>TActivation resulting inS>S>S>TLIGAMENT Left Cervical/Right Thoracic/Bilateral T11-L 2 (crossover zone)/Left Lumbar Intervertebral Ligament S>S>S>LSKELETON Vertebral Body Wedging; Facet Joint Arthritis; Degenerative Disk Disease Nerve Impingement Right Thoracic Costovertebral Lordotic Deformity Gary B. Clark, AAOM, Ft Lauderdale, 2012 45
  46. 46. Compensatory Short Left Leg in LSIJDResultant Skeletal Displacement Gary B. Clark, AAOM, Ft Lauderdale, 2012 46
  47. 47. Compensatory Short Left Leg in LSIJD Resultant Joint Deformities Gary B. Clark, AAOM, Ft Lauderdale, 2012 47
  48. 48. Compensatory Short Left Leg in LSIJD Causal Active Muscle Tension Gary B. Clark, AAOM, Ft Lauderdale, 2012 48
  49. 49. Clinical Biotensegrity Force Map Resultant Compression-Tension Forcesin Compensatory Left Short Leg of LSIJD Gary B. Clark, AAOM, Ft Lauderdale, 2012 49
  50. 50. Clinical Biotensegrity Force Map Resultant Arcs of Forcein Compensatory Left Short Leg of LSIJD Gary B. Clark, AAOM, Ft Lauderdale, 2012 50
  51. 51. A Spectrum of Potential Short Left Leg Injuries in LSIJDLeft Hip and Upper Leg Left Ankle--Step-down/varus gait hip joint com- --Varus joint deformity prone to lateralpressive injury sprain--Hamstring chronic active shortening/ --Medial articular cartilage compressivestress/ strain/sprain/tendinosis at left erosionischial tuberosity -- Achilles Tendon active shortening/--Internal Rotator and aDductor active stress/strain/sprain/tendinosisshortening/stress/strain/sprain/tendin- --Lateral Collateral Ligaments passiveosis at ileum and/or Greater Trochanter stress/strain/sprain/laxity--Posterior Capsular Ligament passivestress/strain/sprain--External Rotator passive stress/strain/sprain/tendinosis at sacrum and/orGreater TrochanterLeft Knee and Lower Leg Left Foot--Varus joint deformity --Supination foot deformity--Medial Tibial-Femoral articular cartilage --Medial Tibialis posterior tendon activecompressive erosion shortening/stress/strain/sprain/tendin---Lateral Retropatellar articular cartilage osiscompressive erosion --Medial Plantar muscles active shorten---Medial Gastrocnemius active shorten- ing/stress/ strain/sprain/fasciitis/tendin-ing/stress/sprain/tendinosis osis--Pes anserinus Tendon active shorten- --Dorsilateral Ligaments passive stress/ing/stress/strain/ sprain/tendinosis strain/sprain/laxity--Lateral Collateral/Coronary Knee and --Lateral Peroneus brevis/longus tendonFibular Ligaments passive stress/strain/ passive stress /strain/sprain/tendinosissprain/laxity--Posterior Cruciate Ligament passivestress/ strain/sprain/laxity Gary B. Clark, AAOM, Ft Lauderdale, 2012 51
  52. 52. A Spectrum of Potential Short Left Leg Injuries in LSIJD Chronic Active Chronic Passive Chronic Active (Concave Arc) (Convex Arc) (Concave Arc) Tension Tension Compression Injury Injury InjuryKEFT HIP AND UPPER LEGInternal Rotator (anterior Posterior Capsular Ligament Step-down impact/varusGluteus medius) and S>S>S>L joint deformityaDductor S>S>S>S>TMedial Hamstring External Rotator (Piriformis)S>S>S>S>T Muscle Shortening > S>S>S>TLEFT KNEE AND LOWER LEGPes anserinus S>S>S>S>T Lateral Collateral/Coronary Varus joint deformity Knee Ligaments S>S>S>LMedial Gastrocnemius Posterior Cruciate Ligament Medial Tibial-femoralS>S>S>S>T S>S>S>L articular cartilage erosion Lateral Retropatellar articular cartilage erosionLEFT ANKLEAchilles Tendon S>S>S>T Lateral Collateral Ligaments Varus joint deformity S>S>S>L Medial articular cartilage erosionLEFT FOOTTibialis posterior Peroneus brevis/longus internal rotation/Supina-S>S>S>S>T S>S>S>S>T tion deformityMedial Plantar Muscles Dorsolateral Mid-to-forefootS>S>S>S>T Ligaments S>S>S>L Gary B. Clark, AAOM, Ft Lauderdale, 2012 52
  53. 53. Compensatory Long Right Leg in LSIJDResultant Skeletal Displacement Gary B. Clark, AAOM, Ft Lauderdale, 2012 53
  54. 54. Compensatory Long Right Leg in LSIJD Resultant Joint Deformities Gary B. Clark, AAOM, Ft Lauderdale, 2012 54
  55. 55. Compensatory Long Right Leg in LSIJD Causal Active Muscle Tension Gary B. Clark, AAOM, Ft Lauderdale, 2012 55
  56. 56. Clinical Biotensegrity Force Map Resultant Compression-Tension Forcesin Compensatory Short Left Leg of LSIJD Gary B. Clark, AAOM, Ft Lauderdale, 2012 56
  57. 57. Clinical Biotensegrity Force Map Resultant Arcs of Forcein Compensatory Short Left Leg of LSIJD Gary B. Clark, AAOM, Ft Lauderdale, 2012 57
  58. 58. A Spectrum of Potential Long Right Leg Injuries in LSIJDRight Hip and Upper Leg Right Lower Leg and Ankle-- Long leg vaulting/valgus gait compres- -- Valgus joint deformity prone to medialsion joint injury sprain/laxity-- External rotator active stress/strain/ -- Lateral articular cartilage compressivesprain/tendinosis at sacrum and/or erosionGreater Trochanter -- Anteromedial Tibialis posterior passive-- Lateral Quadriceps and Patellar tendon stress/strain/sprain/tendinosis (“shinactive stress/strain/sprain/tendinosis splints”)-- Anterior capsular passive stress/strain/ -- Medial collateral ligaments passivesprain/laxity stress/strain/sprain/laxity-- Internal rotator passive shortening/stress/strain/sprain/tendinosis Right FootRight Knee and Lower Leg -- Accentuated Pronation foot deformity-- Valgus joint deformity -- Lateral Peroneus brevis/longus tendon-- Lateral tibial-femoral articular cartilage active stress/strain/sprain/tendinosiscompressive erosion -- Dorsilateral foot myofascial active-- Medial retropatellar articular cartilage stress/strain/sprain/”fasciitis”--tendino-compressive erosion sis-- Medial knee ligaments passive stress/ -- Medial-plantar ligaments passive stressstrain/sprain/laxity /strain/sprain/laxity-- Anterior cruciate ligament passivestress/ strain/sprain/laxity Gary B. Clark, AAOM, Ft Lauderdale, 2012 58
  59. 59. A Spectrum of Potential Long Right Leg Injuries in LSIJD Chronic Active Chronic Passive Chronic Active (Concave Arc) (Convex Arc) (Concave Arc) Tension Injury Tension Injury Compression Injury Right Hip and Upper Leg External Rotator Anterior Capsular Ligament Hip Joint Vaulting-gait Injury Muscle (Piriformis) S>S>S>L S>S>S>S>T Lateral Quadriceps Internal Rotator Muscle Muscle and Patellar Shortening>S>S>S>T Tendon S>S>S>S>T Right Knee and Lower Leg Medial Knee Ligaments Knee Joint Valgus Deformity S>S>S>L Anterior Cruciate Ligament Lateral Tibial-Femoral S>S>S>L Articular Cartilage Erosion Right Lower Leg and Ankle Lateral Gastrocnemius Anteromedial Tibialis Valgus Joint Deformity Muscle S>S>S>S>T posterior muscle S>S>S>S>T (“shin splints”) Medial Collateral Ligaments Lateral Articular Cartilage S>S>S>L Erosion Right Foot Lateral Fibularis Medial plantar (e.g., Spring) External Rotation/Pronation (Peroneus) brevis/ Ligaments S>S>S>L Joint Deformity longus Muscles S>S>S>S>T Gary B. Clark, AAOM, Ft Lauderdale, 2012 59
  60. 60. Whole-Body Compression-Tension Arcs and Spectrum of Potential Injuries in LSIJD From the Plantar Arch to the Nuchal Line Gary B. Clark, AAOM, Ft Lauderdale, 2012 60
  61. 61. Whole-Body Compression-Tension Arcs and Spectrum of Potential Injuries in RSIJD From the Plantar Arch to the Nuchal Line Gary B. Clark, AAOM, Ft Lauderdale, 2012 61
  62. 62. Sequence of Therapies for SIJD• FIRST, stabilize sacral displacement!! o OMT: 30% o Prolotherapy: 70% Gary B. Clark, AAOM, Ft 62 Lauderdale, 2012
  63. 63. Sequence of Therapies for SIJD• FIRST, stabilize sacral displacement!! o OMT: 30% o Prolotherapy: 70%• THEN, resolve and rehabilitate compensa- tory injuries sequentially or in tandem. Gary B. Clark, AAOM, Ft 63 Lauderdale, 2012
  64. 64. Sequence of Therapies for SIJD• FIRST, stabilize sacral displacement!! o OMT: 30% o Prolotherapy: 70%• THEN, resolve and rehabilitate compensa- tory injuries sequentially or in tandem.• WARNING: Avoid potential iatrogenic worsening of pre-existing scoliosis. Gary B. Clark, AAOM, Ft 64 Lauderdale, 2012
  65. 65. Biotensegrity To Do List Generate Other Data-Based Biotensegrity Models: Improve the SIJD Model with its major clinical variants Head-TMJ-Neck- Shoulder Injuries (e.g., whiplash) Upper Extremity Injuries (e.g., epicondylosis) Lower Extremity Injuries (e.g., Pes planus, Pes cavus) Left/Right Sacroiliac–Right/Left Posterior Sling–Right/Left Shoulder Dysfunction Determine mechanism of leg aBductor (Gluteus medius) inhibition in SIJD (perhaps due to Sherrington-oid “reciprocal innervation” between anterior and posterior fibers)Determine on a Biotensegrity Basis when NOT to stabilize the sacrum to preclude iatrogenic worsening of pre-existing scoliosis Determine physiological and therapeutic differences between Passive Musculo-Tendinous Injuries versus Active Musculo-Tendinous Injuries Explore the most appropriate OMT, Injection Therapy, Orthotic Therapy, and Rolfing, Pilates, Physical Therapy, and Other therapeutic and postural rehabilitative sequential approaches for various Biotensegritous injuries . . . . . . and more Gary B. Clark, AAOM, Ft Lauderdale, 2012 65
  66. 66. Biotensegrity To Do ListGenerate Other Data-Based Biotensegrity Models: Improve the SIJD Model with its major clinical variants Head-TMJ-Neck-Shoulder Upper Extremity Lower Extremity Gary B. Clark, AAOM, Ft Lauderdale, 2012 66
  67. 67. Biotensegrity To Do List Generate Other Data-Based Biotensegrity Models: Improve the SIJD Model with its major clinical variants Head-TMJ-Neck-Shoulder Upper Extremity Lower Extremity Explore Mechanism of Leg aBductor (Gluteus medius) Inhibition in SIJDperhaps due to Sherrington-oid “reciprocal innervation” between anterior and posterior fibers Gary B. Clark, AAOM, Ft Lauderdale, 2012 67
  68. 68. Biotensegrity To Do List Generate Other Data-Based Biotensegrity Models: Improve the SIJD Model with its major clinical variants Head-TMJ-Neck-Shoulder Upper Extremity Lower Extremity Explore Mechanism of Leg aBductor (Gluteus medius) Inhibition in SIJD perhaps due to Sherrington-oid “reciprocal innervation” between anterior and posterior fibersExplore on a Biotensegrity Basis When NOT to Stabilize the Sacrum to preclude iatrogenic worsening of pre-existing scoliosis Gary B. Clark, AAOM, Ft Lauderdale, 2012 68
  69. 69. Biotensegrity To Do List Generate Other Data-Based Biotensegrity Models: Improve the SIJD Model with its major clinical variants Head-TMJ-Neck- Shoulder Injuries (e.g., whiplash) Upper Extremity Injuries (e.g., epicondylosis) Lower Extremity Injuries (e.g., Pes planus, Pes cavus) Left/Right Sacroiliac–Right/Left Posterior Sling–Right/Left Shoulder Dysfunction Explore mechanism of leg aBductor (Gluteus medius) inhibition in SIJD (perhaps due to Sherrington-oid “reciprocal innervation” between anterior and posterior fibers)Explore on a Biotensegrity Basis when NOT to stabilize the sacrum to preclude iatrogenic worsening of pre-existing scoliosis Explore Physiological and Therapeutic Differences between Passive Musculo-Tendinous Injuries versus Active Musculo-Tendinous Injuries Gary B. Clark, AAOM, Ft Lauderdale, 2012 69
  70. 70. Biotensegrity To Do List Generate Other Data-Based Biotensegrity Models: Improve the SIJD Model with its major clinical variants Head-TMJ-Neck- Shoulder Injuries (e.g., whiplash) Upper Extremity Injuries (e.g., epicondylosis) Lower Extremity Injuries (e.g., Pes planus, Pes cavus) Left/Right Sacroiliac–Right/Left Posterior Sling–Right/Left Shoulder Dysfunction Explore Mechanism of leg aBductor (Gluteus medius) inhibition in SIJD (perhaps due to Sherrington-oid “reciprocal innervation” between anterior and posterior fibers)Explore on a Biotensegrity Basis When NOT to stabilize the sacrum to preclude iatrogenic worsening of pre-existing scoliosis Explore Physiological and Therapeutic Differences between Passive Musculo-Tendinous Injuries versus Active Musculo-Tendinous Injuries Explore the Most Appropriate OMT, Injection Therapy, Orthotic Therapy, and Rolfing, Pilates, Physical Therapy, and Other Therapeutic and Postural Rehabilitative sequential approaches for various Biotensegritous injuries Gary B. Clark, AAOM, Ft Lauderdale, 2012 70
  71. 71. Biotensegrity To Do List Generate Other Data-Based Biotensegrity Models: Improve the SIJD Model with its major clinical variants Head-TMJ-Neck- Shoulder Injuries (e.g., whiplash) Upper Extremity Injuries (e.g., epicondylosis) Lower Extremity Injuries (e.g., Pes planus, Pes cavus) Left/Right Sacroiliac–Right/Left Posterior Sling–Right/Left Shoulder Dysfunction Determine mechanism of leg aBductor (Gluteus medius) inhibition in SIJD (perhaps due to Sherrington-oid “reciprocal innervation” between anterior and posterior fibers)Determine on a Biotensegrity Basis when NOT to stabilize the sacrum to preclude iatrogenic worsening of pre-existing scoliosis Determine physiological and therapeutic differences between Passive Musculo-Tendinous Injuries versus Active Musculo-Tendinous Injuries Explore the most appropriate OMT, Injection Therapy, Orthotic Therapy, and Rolfing, Pilates, Physical Therapy, and Other therapeutic and postural rehabilitative sequential approaches for various Biotensegritous injuries . . . . . . and more Gary B. Clark, AAOM, Ft Lauderdale, 2012 71
  72. 72. www.clinicalbiotensegrity.com Gary B. Clark, AAOM, Ft Lauderdale, 2012 72
  73. 73. www.clinicalbiotensegrity.com• Home for the e-Journal for Clinical Biotensegrity Gary B. Clark, AAOM, Ft Lauderdale, 2012 73
  74. 74. www.clinicalbiotensegrity.com• Home for the e-Journal for Clinical Biotensegrity• Data-Based Report Articles on Clinical Biotensegrity Gary B. Clark, AAOM, Ft Lauderdale, 2012 74
  75. 75. www.clinicalbiotensegrity.com• Home for the e-Journal for Clinical Biotensegrity• Data-based Report Articles on Clinical Biotensegrity• Outcome Database Formats for Various Body Regions and Specific Joints Gary B. Clark, AAOM, Ft Lauderdale, 2012 75
  76. 76. www.clinicalbiotensegrity.com• Home for the e-Journal for Clinical Biotensegrity• Data-based Report Articles• Outcome Database Formats for Various Body Regions and Specific Joints• Clinical Biotensegrity Presentation Videos Gary B. Clark, AAOM, Ft Lauderdale, 2012 76
  77. 77. Bibliography1. Newton I. http://www.britannica.com/EBchecked/topic/413189/ Sir-Isaac-Newton/12253/The-Principia.2. Sherrington CS. http://.www.britannica.com/EBchecked/topic/ 540150/Sir-Charles-Scott-Sherrington.3. Fuller RB. Tensegrity. Portfolio and Art News Annual, No 4, 1961.4. Snelson K. Letter to R. Motro. International Journal of Space Structures, November 1990.5. Levin S. "Tensegrity, the New Biomechanics"; Hutson, M & Ellis, R (Eds.), Textbook of Musculoskeletal Medicine. Oxford: Oxford University Press. 2006.6. Ingbar DE. “The Architecture of Life”, Scientific American, Jan 1998; 278:48-57.7. Ingbar DE. Tensegrity I. J Cell Sci, 116(April):1157-1173.8. Ravin, Cantieri, Pasquarello. 2008. Principles of Prolotherapy. Denver: Amer Acad Muscuskel Med: 40-44.9. Clark GB. Building a rationale for evidence-based prolotherapy in an orthopedic medicine practice. Part III: A case series report of chronic back pain associated with sacroiliac dysfunction treated by prolotherapy. A six-year prospective analysis. Journal of Prolotherapy, 3(May):632-639;2011.10. Clark GB. Building a rationale for evidence-based prolotherapy in an orthopedic medicine practice. Part IV: Diagnosing linked prolotherapy targets by applying a data-based biotensegrity model. Journal of Prolotherapy, 3(August):722-735;2011. Gary B. Clark, AAOM, Ft Lauderdale, 2012 77

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