Dear Friends and Patients.

What follows is an in-depth explanation of what and why we do what we do here in the office. My hope is that it will help you to understand why our office is different from other types of spinal rehabilitation centers, physical therapy centers, etc.., as well as from other traditional Chiropractic offices. This program is truly the most revolutionary development in Chiropractic care since chiropractic's inception in 1895. As with any breakthrough in the traditional thinking (i.e.: Columbus, Einstein, Sir Isaac Newton... you get the picture) It is a little hard for the mainstream to grasp that "out of the box" thinking. I'm sending this to you to help you to understand First, what it is that you are doing here in our office and why; and Second, how you may better explain the program to friends, family and co-workers who may be curious or in need of this unique chiropractic program.

Elevating 'The Gravity' of Gravity

For Pettibon practitioners, Dr. Henry Gray's fact is interpreted as:

Humans develop, act and react in time and need to their environment under the direction and control of the nervous system.

For Pettibon practitioners, humans' functional spinal environment is gravity. And gravity is an absolute environment to which the upright spine and posture must develop and relate to.

The role that gravity plays in how the spine gets displaced and subluxated is fundamental to Pettibon chiropractic principles. As Burl explains, "The nervous system always wants us to hold our heads upright. And the nervous system will do this at the expense of subluxlating the lower spine."

The Ten Key Principles of The Pettibon System
The skull is a vertebra. It's the only vertebra that is assured of its position in three- dimensional space. The nervous system's five righting reflexes continually send it positional information about the skull. The nervous system, acting on this reflex information, then works with the brain to produce an innate organizing energy that contracts and relaxes muscles of the lower spine as needed to hold the head upright. The inference of the nervous system's attention to the skull's position is that the nervous system considers the skull to be the spine's most important vertebra.

The normal global spine is divided by the opposing spinal curves of the human spine into six functional, crank-like lever arm units upon which spinal muscles act. The six spinal units-made up of vertebrae working together as a part of the lever arm system-rather than each vertebra, is considered a separate functional or motion unit. After the skull, the global spine's position is the most important. And the global spine's position relative to gravity must be corrected first, if it's displaced, before additional corrections can take place.

A spinal unit's position and function are second in importance—subservient to the global spine. A spinal unit is either in a normal position, a compensated subluxated position, a non-compensated subluxated position, or an uncompensated subluxated position. These unit positions are logical and explain expected spinal functions or non-function.
Individual spinal vertebra does not subluxate independent of its unit unless the ligaments that hold the vertebra together are torn. Individual spinal vertebra is last in importance. If ligaments aren't torn, the vertebra will be corrected by global or spinal unit corrections.
Muscles control the global spine, spinal units, and posture. Muscles' actions are directed by the nervous system and the innate organizing energy it creates. With the sensory input it receives from the five righting reflexes, the nervous system and the innate organizing energy organizes and re-organizes the lower spine and posture into displaced positions or aligned positions in order to keep the skull upright.

Gravity is an absolute environment to which the upright spine and posture of humans must develop and relate.

Since gravity is an absolute, there has to be an absolute optimum position for the upright spine and posture. The spine functions best when it's in its optimum position relative to gravity.

A less than optimum spine and posture position (form), relative to gravity, results in the loss of the spine's function and the individual's ability to function optimally.
The nervous system has five righting reflexes that continually send it skull and spine positional information. The five righting reflexes and their functions are:
Labyrinthine Reflex (inner ear). Its function is to maintain the head's orientation in space (medulla).

Optic Reflex (ocular). Its function is to keep the head in proper orientation to its gravitational environment (occipital cortex).

Neck Righting Reflex (joints of the neck). Its function is to orient the body in space (midbrain).

Body Righting Reflex # 1 (from the body's surface receptors). Its function is to orient the body in space (midbrain).

Body Righting Reflex #2. Its function is to keep the head oriented to the body (midbrain).

Arthur C. Guyton, M.D., Textbook of Medical Physiology,
Philadelphia: WB Saunders Company, 2000

Collectively, the righting reflexes and the nervous system's innate organizing energy control all aspects of the muscular-skeletal system so that the lower spine is organized and/or reorganized in time and in need in order to hold the head upright with respect to gravity (front-to-back and side-to-side).

How then do Pettibon practitioners take these principles and put them into practice by re-aligning the spine so that it can function optimally in its upright position relative to gravity? They apply the science at the core of The Pettibon System. The patented Pettibon Weighting SystemTM.

The Pettibon Weighting SystemTM consists of specially designed head, shoulder and hip weights that patients wear. The amount of weights and their placement depend upon the spinal displacement that needs to be corrected.

How the weights work: Wearing the weights alters the head's, thoracic cage's and pelvis's centers of mass, causing the righting reflexes to send spine correcting sensory input to the nervous system. To balance the body to the weights, the nervous system's innate organizing energy causes some involved spinal muscles to relax and others to contract, thereby repositioning and correcting the spine and posture relative to gravity. Additionally, the weights make the involved muscles do isometric exercises, needed to restore their strength, endurance and balance.

There is, of course, much more to The Pettibon System. But before taking a closer look at a few key individual components and how they're organized into a comprehensive system, let's go over some physiological properties and function of soft tissues. Why?

For Pettibon practitioners, the spine is viewed as a closed kinetic system made up of hard and soft tissues. The soft tissues—muscles, discs, and ligaments—hold the spine upright in its optimum position for function relative to gravity, while moving it through its expected ranges of motions. So spinal correction has to involve the entire spine rather than just one segment or vertebrae. An example: If ligaments are torn in the lumbar spine, the part that's torn allows aberrant motions which often cause pain and dysfunction in other areas of the spine such as the neck. The neck pain and dysfunction won't be resolved until the torn ligament and aberrant motion are treated first.

Three different types of forces can injure the spinal system: sudden applied, repetitive, and cumulative. A whiplash is the most common example of a sudden applied force. Repetitive and cumulative forces come from time dependent functions of our positions over long periods. In other words, the spine's positions in work, play, or daily living activities like sleeping, reading, watching TV, etc. Understanding how soft tissues react to these forces provides the reasons why conventional chiropractic doesn't produce permanent spine and posture correction. And more importantly, it explains why The Pettibon System does!

Soft Tissue Physiology & Function
Dynamic Stretch Reflex & Static Stretch Reflex
When a muscle—especially a muscle that hasn't been warmed up—is suddenly stretched, an instant dynamic stretch reflex causes muscle contraction. Our body is protecting the position of its parts from changing. The dynamic stretch reflex happens whether the sudden stretch was intentional—from an adjusting thrust—or accidental.

The static stretch reflex always immediately follows the dynamic stretch reflex. This reflex continues muscle contractions that oppose the stretched muscle. These contractions last for hours but not days.

Now consider conventional chiropractic adjustments and some techniques like CBP. They're high velocity, low amplitude thrusts delivered into the spine to induce joint movement. So after a conventional chiropractic adjustment, the dynamic stretch reflex causes the muscles to reposition the changed spine back to its original displaced position. Then the static stretch reflex continues muscles contractions that oppose the stretch. This is why it's possible for the spine's position to become more displaced than before it received a 'so-called' adjustment.

Let's go over how stretched muscles react. Their physiological properties and function are: deformation, visco-elastic stretch, plasticity, creep, and hysteresis.

Deformation
Deformation: The change in the form of a structure. We consider all changes in the spine's form to be a deformation. And we categorize deformations as 'bad' or 'good'. A 'displacement deformation' is bad because it deforms the spine away from its normal, optimal functional position. 'Correction deformation' is good because it moves the spine back or toward its optimal functioning position.

Visco-elastic stretch
Visco-elastic stretch: Spring-like deformation. The fibers in spinal ligaments and discs have this property. Ligaments' visco-elastic stretch along with muscle reflexes are what cause vertebrae to deform back to their subluxated position after the force of an adjusting thrust is removed.

Plasticity
Plasticity: The property of a material to permanently deform when it's loaded beyond its elastic range. Consider an intact spring. If you load it—stretch it—beyond its elastic range, it becomes permanently elongated. Subject a ligament to greater than 40% of its ultimate load, and it also can be permanently elongated. That's how ligaments are torn. Accidents involving whiplash typically result in ligament tearing.

Creep
Creep: How a visco-elastic material deforms (changes) into the shape it's held in when it's subjected to a constant, applied load over time. You just learned that the spine's ligaments and discs are visco-elastic material. Because of their spring-like ability, a force applied for a short period of time won't change their positions. They'll 'spring back'. But subjecting the spine's ligaments and discs to a constant, applied load deforms (changes) them into the shape they're held in over time.

An example of creep is how an individual's height, after standing or sitting all day, can be less at night than in the morning. The individual is shorter at night because the compression forces the nutrition-filled fluids out of the inter-vertebral discs and ligaments. Similarly, people's position over long periods of work, play, or their daily living activities such as the position they sleep in, watch television, read, etc. can cause discs and ligaments to creep.

Creep deformation of the discs and ligaments must be arrested and reversed daily. If it isn't, the fallout is dysfunction, spinal joint pathologies, nerve compression, and chronic pain. These same conditions are also considered the natural consequences of the aging process. The prevailing belief is that nothing can be done to correct these problems. Not true! Soft tissue creep can be arrested and reversed daily if hysteresis is produced in the ligaments, discs, and tendons.

Hysteresis
Hysteresis: A phenomenon associated with energy loss exhibited by viso-elastic materials when they're subjected to progressive loading and unloading cycles over time.

Ligaments, discs, and tendons, have holding energy. Loading and unloading cycles through compression and traction cause the temporary loss of this energy or hysteresis. Hysteresis changes the nucleus pulposis of the discs from hydro-gel, a Jell-O like resistance to motion, into hydro-sol, water-like solutions with limited resistance to positional changes. When the soft tissue's resistance is significantly reduced, then the joints can easily be repositioned before the holding energy is regained. Within 15 to 20 minutes of inactivity, the holding energy is regained.

Specific Pettibon equipment produces hysteresis. You'll be introduced to those in the next section, where we go over The Pettibon System's key components. Threaded through the explanations will be how soft tissue physiology and function are applied.

Seated x-rays for diagnosis, testing, assessing progress, and proof of treatment effectiveness
The Pettibon System starts with an x-ray examination. Seven views of the spine are routinely taken, more if necessary. X-rays are also used in impairment ratings and 'tests' to determine if and how patients will respond to care.

The initial set of examination x-rays are compared to x-rays taken during treatment to assess progress and ultimately to prove the treatment's success. Whether the x-rays are for diagnosis, testing, assessing progress, post-treatment evaluation and/or proof, patients are seated and the x-rays are always taken, marked, and measured the same way, every time.

Why?

Spinal displacement subluxations can't be detected on x-rays until the soft tissues fail. When the soft tissues are no longer are able to hold the hard tissues (vertebrae) together, erect and aligned with gravity, the spine buckles into its injured position.

When we go from a standing to a sitting position, we increase interdiscal pressure by 30%. When we go from lying down to sitting, the pressure is increased by 50%. So Pettibon x-rays are taken seated to increase stress in the spinal para-vertebral soft tissue. Having patients seated for x-rays also eliminates the influence of unequal contraction from the legs' muscles that attach to the spine.

Conventional chiropractic and medical x-ray procedures don't consider spinal soft tissue injuries. The Pettibon System's x-ray procedures do. Using aligned x-ray machines and repeatable patient positioning, Pettibon practitioners can:

Make valid scientific measurements of the direction and amount of spinal displacement
Classify the configuration (balanced or un-balanced) and its severity
Calculate the amount of soft tissue injury and impairment
Show patients how their spines compare to the optimum upright spine
Determine if new patients' spines will respond and correct under care
Prescribe appropriate treatment plans and assess progress
Prove their clinical care corrected patients' spine and posture
Debunking the myth about x-rays with facts:

The accepted cumulative dose of ionizing radiation during pregnancy is 5 rads; the most sensitive time is between 10 and 17 weeks.

Two routine chest x-rays = .00007 rad.
Radiation to the fetus shouldn't exceed 10,000 millirads.
Annual environmental radiation is 300 millirads/year which equals 12 chest x-rays.
The Pettibon X-ray Series (7 views) = 20 millirads.
To exceed 10,000 millirads would take 3,124 x-rays.
Hysteresis-type rehabilitation preparation for spinal corrections
Patients coming to a Pettibon practitioner's clinic won't be passively waiting to be seen by the doctor. They'll be using the Pettibon Repetitive Cervical TractionTM and the Wobble ChairTM.

Why?

The Cervical Traction and Wobble Chair produce hysteresis in the soft tissues by putting them through loading and unloading cycles. The Cervical Traction does this for the neck and the Wobble Chair does this for the low back. The Wobble Chair has a specially designed seat that can move 360? so making a figure '8' with the pelvis mimics full range rapid walking. Together, they're warming up and preparing the soft tissues for the doctor's examination, other rehabilitative procedures, and adjustment.

Remember the earlier explanation of creep and how it must be arrested and reversed daily? Now it should also make sense to you why Pettibon practitioners advocate using the Cervical Traction and Wobble Chair for 5 to 7 minutes, twice a day, for arresting and reversing the common musculoskeletal complaints we associate with getting older!

Spinal correcting adjustments based on x-rays and functional, neurological, and postural exams
Within fifteen minutes after patients have completed their warm up using the Cervical Traction and Wobble Chair, they're examined and adjusted. Hysteresis has reduced the soft tissues' resistance so they won't impede the adjusting forces. Without resistance, there's also no pain. And pain free adjustments are another distinction of The Pettibon System. After 20 minutes of inactivity, the soft tissues' resistance is regained.

Each visit, Pettibon practitioners decide what adjustments patients need based on their x-rays, and functional, neurological and postural exams. Those adjustments won't apply painful compressive forces like conventional chiropractic that can be associated with the development of pathologies over time. Instead, they use distraction and accumulative type forces that are more aligned with biological functions and are more effective for relieving nerve compression, pain, and dysfunction.

Correction-causing sensory input controlled by the placement of weighted devices
After patients have been examined, adjusted, and re-assessed, they have to wear their weights. The patients' initial tests will have determined the weight amount, placement, and how long the weights are to be worn. Patients can wear the weights in the clinic or wear them while they're driving or walking to their next destination. Patients typically wear the weights for up to 20 minutes.

Why?

Patients wear their weights for postural muscle strengthening—the weights cause the muscles most involved with supporting posture to do isometric exercises—and to hold their correction. As you learned earlier, wearing the weights alters the head's, thoracic cage's and pelvis's centers of mass, causing the righting reflexes to send spine correcting sensory input to the nervous system. To balance the body to the weights, the nervous system's innate organizing energy causes some involved spinal muscles to relax and others to contract, thereby repositioning and correcting the spine and posture relative to gravity.

Testing Before Being Accepted As A Patient
Pettibon practitioners can always diagnose prospective patients' problems and measure the direction and amount of spinal displacement. But that doesn't mean all prospective patients are automatically accepted for care. The doctors need to determine 'if' and 'how' prospective patients will respond to care. And this requires testing.

The testing includes spinal stretching using the Cervical Traction and then wearing head and shoulder weights while warming up and working out on the Wobble Chair. More spinal stretching and reflex procedures follow and then the lateral cervical x-ray is re-taken with the weights still on the prospective patient's head and shoulders. Additionally, spinal muscle strength and endurance are evaluated.

For care to be effective, patients must have spinal muscles that are strong enough to participate in the corrective procedures. For as many as 30% to 40% of those tested, their muscles are too weak. So they will have to go through a rehabilitation program designed to strengthen their spinal muscles before being accepted for spinal correction. And that rehabilitation won't be like working out in a gym.

Here's why: There are two kinds of striated muscle fibers that make up the musculoskeletal system. One is fast twitch muscle fiber. The other is slow twitch muscle fiber. Muscles have both types of fibers but usually one fiber type dominates a muscle group. The muscles that support posture have mostly slow twitch fiber. To make it easier to understand this distinction, we categorize those muscles that have more fast twitch fiber as phasic muscles. And we'll categorize the muscles with more 'slow twitch fiber' that support posture as 'postural muscles'.

In the gym, when we're 'pumping iron' and doing aerobic exercises, we're affecting fast twitch fibers or phasic muscles. Phasic muscles can quickly increase their mass and strength. What's happening to our postural muscles? Not much. Also, when phasic muscles fatigue and/or when they're injured they go flaccid and collapse. So exercises to strengthen phasic muscles don't improve posture.

Postural muscles react very differently from phasic muscles when they're injured or fatigued: they splint and spasm. And the way postural muscles splint and spasm is rarely even, either side-to-side or front-to-back. That's why postural muscles are responsible for spinal displacement subluxation and postural deformities. So what type of exercise eliminates postural muscle splints and spasms as well as rehabilitates their balance, strength, and endurance? Isometric exercises. Isometric exercises involve pushing against a force that doesn't move.

Even after new prospective patients' postural muscles have been sufficiently rehabilitated, there's one more condition that has to be met before their acceptance as patients. They have to agree to follow through on their home care. Why?

Actively Participating In Care
With The Pettibon System, patients must take an active role in their rehabilitation. This requires using equipment at home, twice daily, to do procedures that strengthen their postural muscles and build endurance. Patients understand that home care accelerates their correction.

Phase I: Acute Care
This phase of care lasts from fourteen to twenty-one days. Its emphasis is on pain relief, restoration of cervical lordosis, and A to P spine balancing. During acute care, patients receive training on their home care equipment and procedures.

Each visit to the clinic includes a visual functional, neurological, and postural examination. Patients are adjusted based on the visual examinations and their x-rays. And those adjustments won't apply painful compressive forces typically associated with conventional chiropractic. Instead, they'll be distraction and accumulative type forces. These types of forces are more aligned with biological functions, more effective for relieving nerve compression, pain, and dysfunction, and most importantly, are necessary for spinal correction.

At the end of acute care, patients are re-x-rayed to assess their progress and qualification for the next phase of care. Re-x-raying serves another purpose. If patients have been in an accident, it's only after their muscles are no longer in spasm, guarding the spine, that the exact damage can be seen.

Phase II: Rehabilitation and Correction
The goal of rehabilitation is to achieve permanent correction. This requires a minimum of three rehabilitation sessions per week in the clinic for a period of at least 90 days. Using the Linked Exercse TrainerTM gets added to patients' preparation for their examinations and adjustment. And, of course, patients are expected to be doing their home care procedures twice a day.

Each of the three times a week visits includes a visual functional, neurological, and postural examination. Patients are adjusted based on the visual examinations and their x-rays. The clinic staff makes sure that patients are doing their home care procedures. Their compliance is formally checked after 30 to 45 days of rehabilitation. Based on the patients' height and cervical muscle strength measured at the beginning of treatment, there should be a height increase of ? to 1 ? inches and an increase of 30% to 50% in cervical flexor muscle strength.

Rehabilitation continues until the correction goals are achieved. While many patients achieve permanent correction in the minimum time period, others may take 24 months or more, especially for those with torn ligaments.

Phase III: Maintenance and Supportive Care
The purpose of this last phase of care is to maintain and enhance patients' spinal correction and muscle strength and endurance. Once a week, for a year, patients come to the clinic to do a full workout using the Linked Exercise Trainer and receive a brief functional, neurological and postural exam by the doctor or staff. The doctor will only adjust patients if the exam indicates the need.

As you can tell by now, for doctor, staff, and patients, The Pettibon System represents very different chiropractic care. Yet it's care that consistently gets results and kudos!

Yours In Health,

Dr. Jeff