The Dural Connection, October 2001, Volume 3, Number 2

 

The Dural Connection: October 1999 – July 2002 was the first publication of the Sacro Occipital Technique Organization – USA and produced and edited by Robert Monk, DC. The following information will help illustrate the history of SOTO-USA and its grand aspirations many of which have been accomplished and others still in process.

Please see the various editions of this newsletter in chronological order from most recent to the oldest.

Klingensmith RD. Who Are We?

Proper diligence requires an organization to periodically review itself and evaluate its performance against its mission statement. As we conclude our second year of operation, a close review of our mission statement and our accomplish-ments offers us a greater insight of just

WHO we are and WHAT Sacro Occipital Technique Organization (SOTO-USA) is.

The mission of SOTO-USA is to acknowledge, preserve, disseminate, and expand the work of Dr. M. B. DeJarnette. Furthermore, SOTO-USA seeks to provide an open forum for the interdisciplinary exchange of information as it relates to S.O.T. and its advancements.

The first sentence quite succinctly states the “what,” while the latter allows for a most broad and respectful platform to conduct the “how.”

First and foremost, we are a chiropractic organization.

It’s just that we are a chiropractic organization with a multi-disciplinary membership. Why? Because in addition to offering Sacro Occipital Technique training to members of the chiropractic profession, we also conduct an annual multi-disciplinary Clinical Symposium as the forum for the open exchange and sharing of information for members of our sister professions. Just as a clergy finds comfort in preaching to members of its own choir, it has been our profession’s practice to keep SOT safely “within the fold” of our fellow chiropractors. Difficult as it may be for some to accept, the time has come to get the message out far and wide. The Clinical Symposium is just that opportunity: to share and share alike.

This does NOT mean we plan to teach non-chiropractors SOT. Just like the choir, it’s possible for others to hear and enjoy the music (and maybe even critique it) without necessarily learning how to play it.

The annual multi-disciplinary Clinical Symposium is a chance for us to show the world what SOT is and what it can do. For perhaps the first time we are voluntarily allowing our sister professions to witness and (possibly) judge us in a spirit of cooperation. It is an essential part of our mission to expand the work of Dr.Dejarnette. It is our intention to respectfully further it, nurture it, and allow it to grow without diluting or distorting it. How can we do that if we keep the information hidden amongst ourselves?

Is this risky? Perhaps. Is it scary? Possibly! But without such an honest, open, forum of mutual ideas, our profession can never grow.

At the Second Annual Clinical Symposium we were overwhelmed with comments regarding the genuine, warm and respectful attitude we had created. This was quite a unique experience for some: to be around so many different and diverse ways of seeing and treating patients. Respect for each other is the cornerstone to building a willingness to learn and then work together.

To date, there have been nine regional Hands-On-Training (HOT) seminars conducted across the U.S. which have given doctors, new and experienced alike, the opportunity to learn the basics of SOT and SOT Cranial as well as share more advanced information.

Also consistent with the first part of our mission statement is that we have already completed the first of many works that will serve to preserve the SOT heritage. The recent publishing of “The SOT Compendium” by Eastland Press and “The SOT Collection” is representative of the wealth of literature published in peer and non-peer reviewed journals relating to the subjects of SOT and SOT Cranial.

The professional certification process has already begun. The initial round of reciprocity examinations will serve as the basis of the full certification examinations beginning at the second annual HOT Conference in Jacksonville, Florida in March 8-10th, 2002.

Given that our organization is barely two years old, there have already been many exciting developments. But we have a long way to go. There are a great many plans in development and plenty of room for those who wish to contribute….. so please join with SOTO-USA and be a part of the future of SOT, chiropractic and health care.

Monk R. SOTO-USA Holds 2nd Annual Clinical Symposium.

SOTO-USA’s second annual Clinical Symposium in Chicago was a great success. Held on August 16-19, 2001, the conference featured a tremendous group of instructors who lectured on a variety of fascinating topics. Imagine the excitement of sitting in a lecture hall with Marc Pick teaching “the Neurology of Category One” and seeing Drs. Cleo Bludworth, Robert Coté, David Denton, Vern Hagan, David Walther and Ray Zindler all in the same room!

The featured speaker and honored guest was Dr.David Denton, who rejoins the SOT community after an absence of nearly 20 years. He has integrated DeJarnette SOT technique with his Vector Point Cranial technique, creating a lecture he titled “Holographic Physiology”.

Those who have a history in SOT they will remember Drs. Bludworth (Dr. “B”), Cot, Hagen, and Zindler, all of whom gave innovative and interesting presentations, not to mention those by Drs. Marc Pick, David Walther, Vincent and Carmine Esposito, Robert Walker, Glen Frieder, Carol Phillips, Stephen Berman, Martin Rosen, Esther Remata, Hal Fuhr, Barry Goldberg, Anthony Rosner, Ron Ruppert, Dennis P. Steigerwald, James Winterstein, as well as Karen Boulanger, M.A, and George Francisco, Esq.

Please join SOTO-USA’s 2nd Annual HOT Conference in Jacksonville, Florida on March 8-10th, 2002. One track will be offering Level One – SOT: Chiropractic Manipulative Reflex Technique and Craniodental Section (focusing on TMJ disorders and Dental and Chiropractic Co-Treatment). Our other track will feature Dr. Robert Walker along with an elite cadre of premiere dentists in the field of Craniomandibular Dysfunction CMD/TMD, each with specific expertise in their areas of TMJ restoration. Emphasis will be on teaching how chiropractors and dentists can work together. This will be a great opportunity to bring a dentist from your area so that you both can learn how to integrate your efforts to help your patients.

Further information on the August 15-18 th , 2002 Symposium in Phoenix, Arizona, the March 8-10 th , 2002 HOT conference and upcoming regional technique seminars can be accessed at event section of SOTO-USA’s website [www.soto-usa.org], or by calling SOTO-USA at (336) 760-1618. We look forward to your participation!

Benner C. SOTO-USA Certifies SOT Practitioners

SOTO-USA is proud to announce that our first group of doctors was certified in SOT at the Chicago Clinical Symposium this August.

The following doctors can now add SOTO-USA Certified SOT Practitioner to their laurels:

Christine Benner, Charles Blum, Michael Cindrich, Carmine Esposito, Vincent Esposito, Richard Gerardo, Barry Goldberg, Robert Klingensmith, Jeffrey Mersky, Robert Monk, Marc Pick, Esther Remeta, Marty Rosen, Dwight Shaneyfelt, David Simmons, Elaine Stout, Noel Taylor, Hans Van Heule, and Ray Zindler.

Reciprocity exams will continue to be offered to ALL SOT doctors who are certified by organizations other than SOTO-USA through December of 2002. Those with previous Cranial Certifications will be eligible to sit for the SOTO-USA Certified Cranial Practitioner reciprocity exam beginning in March of 2002 at the “HOT” Conference. Doctors and students with no prior certification are encouraged to move ahead with the process, as SOTO-USA seeks as many highly qualified doctors as possible to add to our world-wide referral network. Inquiries on certification requirements may be directed to Dr. Christine Benner at DoctorBenner@gmail.com or call (212) 929-2424.

Steigerwald D. Headaches & Neck Pain … Symptoms of Whiplash Induced TMJ Injuries.

Cervical whiplash injuries and temporomandibular disorders are each capable of producing a constellation of symptoms. These symptoms are known to include, but are not limited to, headache, neck pain, shoulder pain, dizziness and tinnitus. Doctors should be aware that the same event may cause cervical whiplash injury and injury to the temporomandibular joints with potential symptom overlap. This can and does lead to misdiagnosis and misdirected treatment. It should also be considered that the onset of or report of local signs and symptoms commonly associated with TMD, e.g. clicking, locking and jaw pain, may be delayed for weeks to months following the traumatic event. This lag in recognition and/or report of local TMD symptoms occurs because patients will report the dominant symptoms, e.g. headache and neck pain, first and because the articular surfaces of the temporomandibular joints are not pain sensitive. Scar formation and synovial proliferation which lead to local temporomandibular joint pain and destabilization take time to evolve. A patient with a whiplash induced TMJ injury may then present to you with headache and neck pain while not reporting jaw pain and/or dysfunction.

Developing an index of suspicion that specific symptoms emanate from a particular region or tissue is important in both acute and chronic patient presentations. Nowhere is this more evident then in the instance of an injury which produces damage to multiple body parts simultaneously such as whiplash. The neck, brain and temporomandibular joints are all known to be vulnerable to injury during whiplash and all may well be injured during the same event. The potential for symptom overlap is high in these cases and central neural pathways common to these regions may lead to a symptom complex produced by their combined central influence. This is not an uncommon scenario in whiplash injury cases.

One of the most problematic aspects of the whiplash induced TMJ injury is that the injured temporo-mandibular joints do NOT refer pain to the neck, rather, the injured temporomandibular joint will produce reactive muscular co-contraction of the cervical musculature. This confounds the issue as the patient not only complains of neck pain that may not be cervicogenic in origin but has signs, i.e. muscle hypertonicity and tenderness, that point falsely to a cervical origin as well. This reactive muscular co-contraction may also lead to trigger point formation in the involved muscles and produce tertiary symptom sites. The injured temporomandibular joint may cause contraction in the upper trapezius for example and this may lead to trigger points which produce temporal headache and referred neck pain. The same reaction may occur in the SCM musculature and cause dizziness and ear pain.

It is impossible to say how many whiplash patients have symptoms which emanate from injured temporo-mandibular joints although it appears to be far more prevalent than previously thought. It is important for the doctor of chiropractic to realize that they face these confounding presentations on a regular basis in their personal injury practice and that they can take simple steps to improve their diagnostic accuracy, treatment efficiency and documentation.

TM-joint trauma-induced pathology can lead to severe joint derangement if it goes undiagnosed and untreated and may eventually demand surgical intervention. Early diagnosis, appropriate home care and timely treatment may well intercept this process.

Specific examination, diagnosis, documentation, treatment and referral form the cornerstone of a successful personal injury practice. Expanding your whiplash workup and case management to include the potential for temporomandibular joint injury will only serve to improve treatment and help establish appropriate compensation. Expanding your diagnostic and treatment skills in this arena can result in interdisciplinary referrals as well and open the door to a world of patients you might otherwise never see. Patients who would be much the better for being exposed to your care.

In this vein I would refer you to a new website:

http://www.whiplashandtmj.com/ which contains scientific literature, medico-legal guidelines, references and other resources you can use to help your patients and expand your practice.

THANK YOU, DR. STEIGERWALD
Dr. Steigerwald has generously offered to donate $40 from the sale of each of his TMJ courses (text, workbook and video tape) to SOTO-USA. These monies will be used as part of the research fund from which honorarium payments are made to authors who publish SOT articles.

Blum CL. 6th Annual Research Agenda Conference.

Developing a firm foundation in the world of research is essential for a strong future for SOT and healthcare in general. Each year a prestigious “Research Agenda Conference” (RAC) is organized where the “tops” in research and the colleges come together to discuss the future of chiropractic and chiropractic research.

A keynote speaker at the conference, John A Austin, PhD from the Complementary Medicine Program at the University of Maryland School of Medicine, discussed “Chiropractic: Manipulation, Mind body, or Energy Therapy: Implications for Research.” Dr. Austin’s presentation focused on encouraging chiropractic research to include and embrace the vitalistic and subtle energies. He suggested two possible research questions:

(1) Can we use random event generators (REGs) and cardiac coherence indices to detect ‘subtle energies’ following spinal manipulation and are such changes correlated with clinical outcomes?

(2) Can we study individuals who claim to ‘see’ subtle energies and test (under blinded conditions) their ability to observe these changes in energy patterns following spinal manipulation?

Another interesting panel discussion, involving experts ranging from chiropractic college presidents to researchers in the field, focused on encouraging future chiropractic research. It quickly became apparent that doctors in practice are otherwise occupied, not trained in publishing, and do not see the value of research publication. Students, who are also expected to publish, are more concerned with passing classes and financial burdens. James Dillard, MD, DC, Lac, suggested that the schools need to refocus their priorities and direction regarding research. He also pointed out the existence of NIH government grants for research for which colleges can apply.

Lastly Daniel Redwood, DC and Anthony Rosner, PhD, reviewed a paper they had written concerning the importance of context:

Morely J, Rosner AL, Redwood D, A Case Study of Misrepresentation of the Scientific Literature: Recent Reviews of Chiropractic, Journal of Alternative and Complimentary Medicine, 2001; 7(1): 65-78.

This paper is based on the following publications:

(1) “Chiropractors’ Use of X-Rays,” a commentary published in the British Journal of Radiology (Ernst, 1998),

(2) “Chiropractic for Low Back Pain: We Don’t Know Whether It Does More Good Than Harm,” an editorial in the British Medical Journal (Ernst and Assendelft, 1998), and

(3) “Adverse Effects of Spinal Manipulation,” a chapter in the textbook Essentials of Complementary and Alternative Medicine (Ernst, 1999).

Healthcare professionals expect the peer review publications to make sure that what they print is

(a) accurate,

(b) not purposefully misleading, and

(c) demonstrative of integrity in scientific reporting.

Ernst, a well respected researcher, was found to include “repeated misuse of references, misleading statements, highly selective use of certain published work, and errors in citation and that these misrepresentations were clearly intentional. While to some, this may not seem like anything new, this article, appearing as it does in a multidisciplinary journal, will hopefully encourage greater diligence by those involved in the peer review process and discourage publishing by those who write without supportive facts.

The next RAC Conference on March 14–16th, 2002, in New Orleans, will be held in conjunction with the Association of Chiropractic Colleges (ACC) Educational Conference. SOTO-USA will be presenting a poster presentation relating to SOT.

NCRT Committee. Nasal Cranial Release Technique (NCRT).

The Nasal Cranial Release Technique (NCRT) study group (formerly known as BACA) met at the SOTO-USA Clinical Symposium in Chicago and reported growing interest in this novel method of craniofacial bone correction. While various methodologies have been practiced over the past decades, the NCRT study group seeks to consolidate all these techniques within the chiropractic field. We welcome all chiropractic practitioners who have practiced NCRT, as well as techniques related to it such as “nasal specific,” “neurocranial reorganization,” and “balloon assisted craniofacial adjusting.”

Our present focus is to consolidate our resources and develop a series of 2 twelve hour teaching programs designed to give the doctor a basic working knowledge of NCRT. Following completion of the 24 hours of class hours, the doctor will be qualified to sit for a certification examination. The goal is to create a nationwide and worldwide referral base of qualified professionals.

As of now, the committee consists of Drs. Stephen Berman, Richard Gerardo, Jeffrey Mersky, Glenn Frieder, and Michael Pascoe. We welcome help, suggestions, and assistance in our programs of instruction, certification, and research publication. An NCRT manual is presently being written which will combine all the research that has been published. Please contact SOTO-USA if you have information or interest in being part of our study group. All are welcome!!!

Monk R. SOTO-USA Represented at AAPM Clinical Meeting.

The SOTO-USA booth at the12th Annual Clinical Meeting of the Academy of Pain Management took another step forward in bridging the gap between us and our sister professions.

This year’s annual meeting, held in Washington DC Sept. 6-9, 2001, was attended by over 1000 doctors of all disciplines, including several hundred chiropractors. Our organization generated tremendous interest among chiropractors, osteopaths, dentists, and pain management specialists alike.

Drs. Remeta and Klingensmith, who represented SOTO-USA, received numerous comments (including some by doctors of osteopathy), appreciating us for our vigilance and persistence in our efforts to preserve the works of Dr. DeJarnette. They were especially appreciative to see our book store/library with its vast array of SOT texts along side of the associated works from the osteopathic community and were encouraged to see the professional manner in which cranial work is being preserved and promoted.

Blum CL. DeJarnette’s Methods and Wisdom Regarding “The Emotional Distortion.”

While there are a multitude of presenting symptoms for a patient presenting with an “emotional distortion,” DeJarnette, in his 1946 book “Sacro-Occipital Technic” explored this subject with sensitivity and insight.

“Emotion in its true sense, is a driving power which often leads to great accomplishments, and again that same driving power may lead to destruction. In using the term emotion, we do not mean to imply that these patients are show-offs, rather, they are sick and actually suffer. Their great tragedy is the locking-up process which has taken place in their own bodies.”

“True emotional distortion patients seldom manifest their trouble by loud outbursts of wailing. These people are retainers of grief. They have locked within themselves something that needs to be withdrawn.”

The Physical Component of the Emotional Distortion:

In SOTO-USA’s recent book “Chiropractic Manipulative Reflex Technique,” Dr. DeJarnette recorded his emotional distortion observations in the occipital line two, area five/ lumbar 3 relationship. But in his 1946 book, he dealt with this condition in greater detail, including additional indicators and suggestions on methods of support for this type of patient:

Indication:

With the patient supine, the doctor will gently squeeze the patient’s pubes. A positive finding will be if the abdomen distends upon pressure to the pubes. Maintaining this contact the doctor’s other hand contacts the “left transverse sixth cervical from the posterior.” If the sixth cervical is painful then “it is an emotional distortion.” “If the pubes squeeze causes the abdomen to distend but the sixth cervical left transverse is not painful, there is a perineal lesion.”

Treatment:

With the doctor contacting the pubes and left transverse process of the sixth cervical vertebra, both contacts are held until the abdomen relaxes. While this treatment will help relax the patient with an emotional distortion, this distortion “like all distortions, has causes, and if the abdominal distention takes place on the subsequent tests, and if the left sixth cervical transverse remains painful, there are other causes and these require much tact to discover and remove.”

DeJarnette noted that, “Psychoanalysis attempts to right your life through a confession of wrong doings. [His] Emotion Technique attempts to right your life through guidance, counsel and actual therapy.”

“Many practitioners are unqualified to understand or analyze a patient’s emotional difficulties. Many practitioners look only to the sordid phase of a person’s life. Not all emotional distortions are caused by capital sins. Many of them are caused by wrong companionship, improper mating, wrong environment, poor working conditions, physical breakdowns through wrong living habits and over-drinking.”

DeJarnette discussed specific manners of talking to patients with an emotional distortion. “It is entirely wrong to say to any patient, ‘There is something on your mind. Tell me what is worrying you.’ It is much better to say, “Is there something you would like to talk to me about? Is there anything that I can do for you that has not been done?’ Reticence and indecision are the cardinal attributes of the emotional distortion.” The patient may have reluctance to remove clothing for an examination or adjustment, or might have scars or disfigurements. “The good Doctor never mentions these marks unless asked to express an opinion. If there is an incision scar upon the patient’s body, you may inquire as to the type operation performed. If a patient wishes your further opinion, that opinion will be asked for.”

“Always let the patient make the first move, if a confession is to be made. Do not pry into other people’s affairs.

“Never make suggestions to a patient which will be impossible to carry out, and never betray a patient’s confidence.

“Gentleness must take the place of sympathy. Force must take the place of pity. Calmness must take the place of fear. Love must usurp hate. Trust must overcome mistrust.”

Monk R. The Universal Picture of SOT.

On July 6-8, 2001, SOTOA (Australasia) held their Winter Research Conference at The Gold Coast near Brisbane, Australia. Dr. Esther Remeta, representing SOTO-USA, was invited to speak regarding the rehabilitation of brain and spinal cord injuries using SOT and SOT Craniopathy. Dr. Robert Klingensmith, executive director of SOTO-USA, was also in attendance.

Dr. Remeta has created a new organization for the benefit of brain and spinal cord injured patients to advance their knowledge, enabling them to reach the highest state of wellness. Drs. Remeta and Klingensmith enjoyed the tremendous warmth and hospitality from the seminar attendees and SOTOA colleagues.

SOTO-USA is pleased to have two of their members spreading SOT worldwide.

© SOTO-USA 1999-2015

All rights are reserved by SOTO-USA to the electronically printed material herein.

The Dural Connection: October 2001 and all its contents herein are published by SOTO-USA solely for the purpose of education and should not be used by patients or unlicensed persons to diagnose or treat any condition.

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