HAVE YOU NOTICED THAT PHYSICAL MEDICINE TREATS ONLY THE SYMPTOMS?
That’s what I noticed 28 years ago when I had my physical medicine clinical training at Bastyr University’s College of Naturopathic Medicine. “Why don’t people get better?” I asked Dr. Bastyr. He told me that these unfortunates were chronically injured and would never fully recover. Dr. Bastyr further explained that when these people suffered their injuries their ligaments were stretched and would never resume their original shapes. “Isn’t it good that we can offer them relief of their suffering?” he asked me. I wasn’t so sure….
I KNEW THERE WAS SOMETHING WRONG WITH THIS SCENARIO.
“There must be something we are all missing”, I cried. Then I heard about Bilateral Nasal Specific and Dr. J.R. Stober, DC, ND of the Portland, Oregon area. Dr. Stober said that moving the sphenoid bone (inside the skull) with a small endonasal balloon would correct the tension patterns in the meningeal tissues (inside the skull) and this would optimize brain function and the mechanical functions of the sinuses, eye orbit, the jaw, and the teeth. There was an impressive body of testimonials of clinical success and no published writings of any sort.
IT WAS LOVE AT FIRST EXPERIENCE!
I had chronic sinusitis, chronic neck pain, and chronic low back pain, and I felt good, really good, after getting my first BNS sessions—for the first time in a long time. I loved BNS treatments! When I opened my practice in Everett, Washington in 1982, BNS was one of the main features of my practice. By 1985, Dr. Stober told everybody that I was his best student, and referred many patients to me. I was convinced that moving the bones of the skull to allow the meninges to shift was the missing link that would correct my perceived defect in physical medicine—it would do this through controlled movements of the skull (as well as the spine and pelvis)—then people would totally recover from their assorted injuries.
BUT I WAS WRONG!
As the years passed, it became evident that, although some people fully recovered from their injuries, most of those I treated only partially recovered—some less than others. There were a few that I even made worse. These unfortunates were terrified of returning for treatment, so I was unable to help them further. Dr. Stober told me that they would get better if they weren’t such cry-babies; they simply needed to return for more treatment. I felt guilty classifying my patients as those who were at fault.
I asked all of the physical medicine doctors that I could to find out what was wrong, and a definitive answer was not offered. They always told me about the latest technique that they were using, but agreed that nothing seemed to offer the answers that I sought. I began investigating how physical medicine techniques evolved. There was no systematic approach possible—instead intuitive leaps were occasionally made. Essentially, everything in “modern” times seems to have started with the concepts visualized by Dr. Palmer (the first chiropractor) where he first noted the importance of bone position in effecting the nervous system. It was widely accepted that this caused compensatory (reflex) tightening of the musculature. Everybody kept working within these concepts, refining and improving the techniques they used if they could.
I reasoned that the problems I was having with the model that we were all using was that it was not accurate enough at portraying the conditions within the chronically injured body.
I thought about this a lot. In the science classes of my youth, I was told about the scientific method: first create a theory, test it with a experimental model, and keep revising the theory, making new models and more tests, further refining it. This is wasn’t exactly what we had all been doing—we had left out the revision. Experimentation without revising the original model was not the scientific theory, but it was the physical medicine model—since we ignored any contradictory evidence. But, in the scientific method, when facts present themselves to us that are contrary to the original theory, we are supposed to create an antithesis. The two ideas then can be synthesized to create a new theory.
I wondered “What was the antithesis of the physical medicine model?” I always seemed to have this question in the back of my mind. I kept tinkering with BNS, deep muscle therapies, and osseous manipulation—all without any real improvement. I felt lost. What should I do? My first degree was in mathematics, and my loves were symbolic logic and abstract algebra. I decided to use some of these mathematical analytic techniques to analyze the physical medicine problem.
I found physical medicine analysis techniques are rather simple in concept (and complex in practice). We focus on the local physical misalignments that result in the first-level, immediate-symptoms that our patients suffer from. If the neck (or low back, or the mid-back, or the TMJ) hurts, then we work on the bones, muscles, and tendons in the area. Essentially our model is that local misalignments of the bones, muscles, connective tissues, and nerves lead to malfunction that we should correct by re-aligning the bones, muscles, etc. in their original position as closely as we can. If it doesn’t go into place the first time, then repeat. And we do repeat, sometimes hundreds of times with minimal changes.
A few therapists working with techniques like NUCA, SOT, Network, vector cranial, Rolfing, SOMA, and NET talked about changing the entire structure through their treatments, but this didn’t seem to influence the majority’s thinking. (Besides, none of these people had a high percentage of success either, so the prevailing sentiment was not to change at all.) What I noticed was that the model’s focus was on which bones (or which body parts) were “out of place.” People would even say, “My neck is out.” Or “My back is out.” So, as our model concluded, if the bone would just stay in place, then the problem would be corrected. So we moved that bone back “in” every treatment, again and again, hoping for success.
With such typically poor results that all of the physical medicine techniques displayed, I decided that I would not just learn more mediocre therapy. I looked elsewhere and found nothing better. Since nobody was offering a method that I could embrace, I decided to look within and do it myself. Somebody had to, I reasoned, so why not me? My mathematical training suggested that I choose the opposite track from the thinking of the model. How could I create the antithesis? If our focus was on the bones that were “out of place” because the body would work better with the bone (or joint, etc.) in place, then maybe I should conjecture the opposite. Surely that would show me the errors in my thinking! So I made the assumption that the body was best off with the bones, etc. in the position I found them in. Even though I had called these bones “out of place,” I began treating people that way—ignoring bone alignment and ignoring muscle tension patterns—the methods that I had been taught. I still worked on the sore muscles and joints; I still opened the nasal breathing passages with a balloon. I just treated the painful areas without really thinking about it at all. Nothing had really changed from ignoring the model. The results were just about the same. People still liked treatment, too. I had been convinced that I would make people worse if I didn’t correct the needed bone back “in,” and I was wrong.
People didn’t get worse from not correcting the presumed bone mal-position. I began to suspect what I had not guessed. The bones weren’t really “out of place.” I thought, “What if the body needed the bones to be there, in the position we had considered out?” Then, I reasoned, our treatments would be trading short-term improvements for permanent impairment. We would rarely, if ever, truly get better. Our treatments would be ineffective through defective treatment design. Horrors! And I was convinced, deep in my heart, that this was true. So I reasoned further—if it were so, what would be the reason for the body to behave that way? What was the missing synthesis to create a new theory and a new model of treatment?
One day I realized that the missing factor was GRAVITY. We ignored gravity in physical medicine. Yet, the very concept of posture and skeletal alignment was based on living our lives in a gravity environment. I began looking at an anatomical chart on the wall, visualizing the gravitational patterns running through it. I looked at old bridges and noted the differences between them and new bridges. The old bridges had heavy beams and posts and held all of the weight in straight, vertical lines. The new bridges had gracefully curving struts, poles, and beams, and used much less concrete and steel. The new bridges were gravitationally more efficient! The symmetry of the skull, the graceful curves of the spine and legs, the very curves of the long bones—all of these must be the body’s response to life in a gravitational environment!
I watched a documentary and saw a man fall off a building. He covered his head as he fell. I had seen the reaction many times before. When people fall, they protect their heads. I realized that the nervous systems were protecting themselves! Further, I thought about the primitive functions of the brainstem and midbrain. Could our postural patterns be a result of our brain’s desire to not fall down and injure itself? Self-preservation was part of our brainstem’s control of our posture? Could it be that the reason that the bones kept going “out” was that the overall body was more stable with the bone “out” than it was with the bone “in?” I could see how this could be so. This would mean that reverting to the pre-manipulation position was not “muscle memory” or “bone memory” but was, instead, a movement towards a more gravitationally-stable position caused by poor therapy.
The treatment that I regularly gave my patients decreased their pain and increased their mobility, but I now knew that it usually worsened the pattern of gravitational-stability. I thought about most treatments.
I liken the “traditional” physical medicine treatment success to have similarities to rolling a dice. After the therapist finishes treating the muscles, bones, etc. that he/she finds “out of place,” then the body determines its stability pattern with some complex determinations made by the brain. Occasionally, just like with the dice, the right “number” will come up and the body will retain the benefits of the treatment. More often the pattern is unsatisfactory (unstable) and the nervous system subtly alters the musculoskeletal system to improve the pattern. Most of the time with physical medicine treatments, the improvement of the stabilization pattern will be to simply return to the best (most stable) pattern near the current pattern—that is, the body returns to where it was prior to treatment. Sometimes the pattern actually changes, and this is the gradual improvement that we can often show in physical medicine; the patient does not get a total recovery, but they are better than when they began.
In its function, then, the body has a hierarchy. It ignores pain, lack of joint movement (mobility), and poor physical function in general—if the body is in a stable gravitational alignment. The pattern that is most convenient and most stable is the structure that is maintained by the nervous system through its control of the muscles, bones, and connective tissues. When we would make our “corrections” (treatments) of the bones, muscles, etc. that we considered “out of place,” we only had long-term success by luck. Relative to the pattern of gravitational stability, our treatments were random.
One black day, as I realized all of this, I despaired, “How could I remedy the situation?” I decided to begin testing my patients’ gravitational stability and to learn from this. I discovered that the kind of adjustments, manipulations, and massage techniques one uses makes a difference in the patterns of stability. Some movements made it better, others made it worse. I found that the force used in the treatment would affect my patients’ patterns of gravitational stability—with different results in the short-term and the long-term. And, of course, the location where I treated (pushed on) my patients’ bodies was extremely important. What I clinically discovered is that the nervous system is always trying to improve the stability of its position, so the vestibular system triggers the postural muscles and fascia to contract specifically to improve the gravitational pattern of stability. When the therapist has done a poor job of treating the patient (which is most of the time) the body simply returns to the position the patient found him/herself in prior to treatment. We tell our patients that it is muscle memory or bone memory because we are too embarrassed to admit to the truth—we don’t know how to do it correctly.
As the information began piling up, I discovered, when my treatment was at its best, that the body continued to get better after treatment. I realized that the same reaction, which I had considered self-correction, was in action all of the time. The body was always attempting to improve its gravitational stability patterns. When I treated somebody correctly, they would change for days, weeks, or even months! Always this same mechanism seemed to be in action—the nervous system moves the musculoskeletal system in the directions that make the body its most gravitationally stable.
I realized that I was no longer treating my patients as my classmates and acquaintances did. I no longer treated my patients like my teachers Dr. Bastyr, Dr. Breznen, Dr. Stober, Dr. Miller, Dr. Black, and others had shown me. As my methodology morphed into something new, my patients began asking me what this new treatment was called. A friend and I made up a new term, NeuroCranial Restructuring®, or NCR®.
I have been following this routine of manipulation in my practice for more than fifteen years now, and I know a great deal more about all this then I did in those early days just discussed here.
I am would love to teach you what I have learned. I would love to teach you—NCR!
Dean Howell, ND
Enrollment Questionnaire
Please provide the following during enrollment:
- Proof of professional licensure adequate for manipulation therapy.
- List any special considerations regarding your candidacy for training.
- Please Remember! A non-refundable deposit of $2000 is due when you are notified of acceptance into the program.
Individual Doctor Training Dates
If you are interested in taking the training course please send us a copy of your license, along with a short explanation of your clinical and manipulation experience and your curriculum vitae. Be sure to include any special considerations for your candidacy and why you are interested in our course!
Additional courses may become available upon demand.
COURSE & TREATMENT DATES FOR 2008 | ||
Schedule by Location | Schedule by Month | |
BELLEVUE, WA August 23-26 October 28-31 December 19-22 | JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER
| |
 | ||
BOULDER, CO August 19-22 November 21-24 | ||
| ||
CARACAS, VENEZUELA | ||
| ||
LOS ANGELES, CA July 25-28 August 2-10 for doctors August 7-10 for training patients September 6-9 (10-11 available for those who don’t want weekend or wish for six) October 14-17 October 18-26 for doctors October 23-26 for training patients November 28-December 1 December 8-11 | ||
| ||
NEW YORK, NY August 14-17 September 24-27, 28-October 1 December 13-16 | ||
| ||
SAN DIEGO, CA July 29-August 1 September 2-5 November 17-20 | ||
| ||
LONDON, ENGLAND July 10-13 for patients July 14-22 for doctors | ||
| ||
ZURICH, SWITZERLAND July 4-7 | ||
| ||
NCR DOCTORS TRAINING Sydney, Australia | February 25 - March 2 Los Angeles | April 7-16 August 2-10 for doctors, August 7-10 for training patients San Diego | August 2-10 for Doctors August 7-10 for Training Patients Tonasket, WA | October 18-26 for Doctors October 23-26 for Training Patients | ||
For more information, call (888) 252-0411 or email us at info@DrDeanHowell.com