Gentle Chiropractic

1 Disclaimer

Before you start reading this book I must express to you the importance of seeking medical attention when you have strong pain or after you have had an accident, a fall, or injured your back in any other circumstances. It is important to rule out any fractures, ruptures or other conditions that may be detrimental to proceeding with any of the exercises containing in this book. If you are not sure how to do certain exercises ask a health care practitioner, chiropractor or physiotherapist.

The information contained in this E Book is educational in nature. The author has made every reasonable effort to ensure that all information is complete, true, correct, appropriate and accurate. However, the information and advice contained in this E Book is not intended as a substitute for consulting your doctor or health care practitioner regarding any action that may affect your well-being. Gentile Chiropractic is –an E Book to refresh the knowledge of chiropractic practitioners and beginners in learning how to do great gentile chiropractic. It is intended as learning and repeating chiropractic only and not as medical or professional advice. Information contained herein is intended to give you the tools to make better gentile chiropractic. Individual readers must assume responsibility for their own actions, safety and health. The author shall not be liable or responsible for any loss, injury, financial consequences or damage what-so-ever allegedly arising from any information, exercise or other suggestion contained in this E Book.

I wish you success Christina Reuter

2 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Welcome to the gentile Chiropractic

Hello and welcome to the gentile chiropractic. I wrote this book to help more chiropractors to be successful and Use a soft gentile chiropractic technique.

For over 20 years I have worked as a naturopath and chiropractor in my own practice. When I lived in Canada, I developed this technique in order to treat my patients more effectively. I have refined and improved the technique more and more as time go by and am now able to teach it and hand it on to others. This is a book for chiropractors to learn different techniques and also for beginners who learn chiropractic.

It is important to me that many more naturopaths and chiropractors practice this safe and gentle method. It turns out that with proper use the results last longer than they do with “normal” chiropractic. For 96.9% of the time there are no side effects beyond occasional sore muscles, and even the daintiest of women can learn it. The “heave ho” techniques are out, and gentler techniques, that are effective, are what patients want today.

The treatment can be described as effective for 94% of all patients.

3 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Introduction:

We are talking here about a very gentle form of chiropractic, combined with other techniques:

»» Trigger points »» Stretching »» Back training »» Back exercises »» Physiotherapy »» Wedge technique »» Massages »» Lifting technique »» Cupping »» Deep tissue massage

4 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de History of Chiropractic:

Chiro = the hand As early as 3000BCE the musculoskeletal system was being treated by use of the hands, and through pressure and stretching it was possible to bring relief. Among prominent doctors of antiquity, Hippocrates and Galen treated the spine. We differentiate today between 2 techniques that come from the 19th century: »» 1) 1899: The Swiss doctor Otto Naegeli developed a method which cured headaches by manipulations with the hands and massage techniques. He wrote the book Ailments of the Nerves and Nerve Pain. Their Treatment and Cure through Use of the Hands.

»» 2) 1828-1917: Andrew Taylor Still founded osteopathy in America. According to an anecdote, Still suffered from very bad migraines from the age of 10, and had a crucial experience whereby he healed himself of his migraines. He lay down with his neck on a lasso strung between two trees – the assumption was that one of his vertebrae underwent an adjustment, and so he cured himself of his headaches. He went on to study medicine and observed many patients with ailments of the spine and the effect of these on human health. In 1892 he founded the American School of Osteopathy, in Kirksville, Mis- souri. His simple examination and treatment methods are the basis today for Manual Therapy. Universities were founded in America in order to teach Manual Therapy, so that today everyone in America who studies this technique gets a medical degree.

5 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de »» 3) David D. Palmer brought chiropractic into being in Davenport, Iowa – one could say that he was the naturopath of movement therapy in America. The first patient that he treated was a deaf janitor. He was able to put the man’s vertebrae into correct alignment, and the man regained his hearing. Palmer developed his own theoretical ideas about the function and treatment of the spine. He separated himself entirely from the osteopaths and physicians. In 1897, he opened the first chiropractic school, and later others as well.

The gentle Chiropractic is usually a very strenuous method, and in the wrong hands it can lead to side effects or pain. However, it is suitable as well for less robust people, as it does not require great strength, but rather the right technique. There are no two patients who are identical to one another, and therefore there are no two identical therapies that help all patients. But there is a therapy continuum that one can use to orient one’s self and which one can use to work out the best way to improve the patient’s health.

6 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Comparison of General Musculoskeletal Therapies

Gentle Chiropractic Chiropractic is a simple and gentle method to bring the vertebrae back into alignment. Gentle chiropractic developed out of chiropractic, but is much safer and gentler. Everything depends on using the correct technique – physical strength is secondary in using this technique. The most important thing is to position the patient in the best way, and to have a good stance one’s self. In addition, the patient receives exact instructions after the realignment how to move, he is given back exercises and movements to practice, and should not lift anything, bend over or carry anything for two hours after treatment. It is also important that the patient should not cross his legs after the treatment, or any other time, for that matter – as this can have a negative effect on the sacroiliac joint. Chiropractic has to do with moving the vertebrae with the hands, but there are different methods, which can be quite gentle or can use considerable force, to adjust the vertebrae. We should mention subluxation here – used improperly it can lead to paralysis or paresthesis. For that reason it is imperative to know what one is doing, and in the case of uncertainty to not practice chiropractic. We differentiate between the European chiropractic, which is a harder and more “heave ho” method and the gentle Canadian chiropractic, with its safer manipulations.

It is an old wives’ tale, that chiropractic wears the joints out!!!!!!!

7 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Dorn Method The Dorn Method is a branch of chiropractic and was developed by Dieter Dorn. He is a farmer and carpenter, who got to know the therapy through a farmer friend of his and then developed it further.Through pressure and movement, displacements of the spine and joints are brought into line again. As well, the patient is shown exercises that he can do himself to strengthen and stabilize the spine. In particular pelvic obliquity is treated.

Osteopathy Andrew Taylor Still (1828-1917)

Treatment through the skeleton (Osteen) »» Structural osteopathy »» Visceral osteopathy: inner organs, blood, vessels and nervous system »» Craniosacral Therapy: cerebrospinal fluid (CSF) is brought into movement through gentle pressure

Through osteopathy, the spine, inner organs and CSF are treated at the same time. Special manipulations are done that help to relieve symptoms.

8 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Craniosacral Integration Technique according to Dr. De Jarnette Here CNS (Central Nerval System), skeleton, muscles, inner organs and the endocrine system are brought into a harmonic rhythm with one another. This is only possible when there is CSF (Cranio Sacral Fluid) circulating in the sinuses of the brain. There is a connection between the cranium and the pelvis. Through breathing, the occiput moves in minimal, rhythmical movements, bringing the CSF into movement. Here we are speaking of the cranio-sacral pump.

9 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Chiropractic

Treatment from where, to where: In the gentle chiropractic, this is quite easy – you always treat from the bottom to the top. The better you treat from the bottom, to the top, the better the end result will be. As the saying goes: you don’t build a house on sand, but on a good foundation. It is that way, too, with the spine; if the pelvis is not right, then we won’t have good results higher up on the neck. In addition, you should always treat the entire spine, not just the individual areas or sections that your patient has reported to you. If you only treat the painful areas, your patient will be back to see you in a few days and will say “It hurts higher up, or lower down” – and this is not a good basis for a serious medical practice.

Techniques to improve sensitivity You must learn to transfer your eyes to the tips of your fingers, and with your fingertips to feel where warmth, swelling, knots, or improper positions are.

10 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Through specific exercises you will improve your ability to see with your fingers. As an exercise, run your fingers over everything that comes your way, food, walls, pictures, different kinds of wood, stones, fabric of various kinds. The more you practice, the easier it will be for you to develop the “eyes” in your fingers.

My students are given the task of going to a department store and to feel all kinds of material with their fingers. It can take up to 6 months before you get the feeling in your hands – but then, from one day to another, it will be there. Another exercise is to place a thick strand of wool under a smooth tablecloth and to run your fingers over the cloth, to feel the position of the strand. When you are able to do that, put thinner and thinner threads under the cloth, until it’s one of your own hairs that you have to try to feel, under the tablecloth.

11 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de How to learn to diagnose by using the fingers It’s important to use your fingers often, and as much as you can. You have to learn to have your eyes in your fingertips. You learn quickest by feeling with your eyes closed. It takes a relatively long time until one is able to feel if something is not quite right, but when you do learn it, you will never lose it. You will have to do many sensitizing exercises, but if you practice diligently, you will soon master the art of feeling with your fingers. »» Examples of exercises are: »» smooth and rough surfaces »» stones »» forms of various kinds »» walls »» presents that you get – check these out with your fingers first »» fruit that you buy – do as above »» tablecloths and silverware in a restaurant »» seats on a bus »» trees in a wood »» be creative, and feel everything that comes your way

Enjoy getting to know the world through your fingertips.

12 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Contraindications for Chiropractic If and when you are not sure of yourself – if you are afraid of doing something wrong – these are clear indications for keeping your hands off, and trying other therapies.

»» Herniated discs – here you need to decide whether the nerve itself is so impacted that an operation is necessary »» In the case of tumors, it is better not to treat, as it can come to dispersal, at least with tumors of the spine or other bones »» In the case of brittle bone disease you should not treat at all. »» In the case of osteoporosis, treat with great care only.

The most important thing with chiropractic is that one makes an exact diagnosis.

It is important to find out the position of a particular vertebra. Is it displaced to the right or to the left, is it twisted or inclined? All of this can be discovered with the help of one’s own fingers – of course it requires some practice, but with time one acquires a good feeling of how vertebrae are positioned.

If you don’t know the position of a vertebra, you can’t readjust it using any technique. So, very important: first an exact diagnosis and then the therapy. Learn to see with your fingers – that is your capital.

13 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de What is a spinal obstruction? An obstruction of the spine or of a joint is a displacement of the vertebrae. These displacements can have existed for a longer period of time, perhaps even since childhood.

Several “lay chiropractors” came to Europe from America and introduced the therapy that they called “Subluxation Therapy”. With time, all other chiro- therapeutic ideas developed out of this subluxation therapy. One discovered that displacements of the spine could cause other illnesses.

Through the “Schweizer Gutachten” these theories lost their validity, and unfortunately chiropractic was banned from academic circles. In the 1950s, after the German-Austrian and Swiss Medical Society for Manual Medicine was founded and the results of neuro-physiological research were recognized, a model could be developed which satisfied the demands of university-level training. In 1982, chiropractic was integrated into orthopedic medicine. Today, there are more and more orthopedists that get good results with chiropractic. Among naturopaths we can find excellent therapists in this field as well. The essential difference between orthopedists and naturopaths in chiropractic lies in the technique. Chiropractors are trained naturopaths; chirotherapy is done by orthopedists or other physicians.

14 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Most orthopedists work with a forceful, ungentle chirotherapy – the naturopath on the other hand works mostly with gentle chiropractic. But even here it depends on who the teacher was. With chiropractic itself, it is of great importance that the patient lies in a correct position and that the therapist has a correct stance and performs the manipulations correctly.

A good therapist treats a specific problem and knows exactly what he is doing! Nothing by chance!

15 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de What conditions can we treat? Most patients we see in the practice complain of: »» Headaches »» Tension »» Stomach complaints »» Digestive complaints »» Period pain »» Cardiac symptoms »» Depression »» Insomnia »» Joint pain »» Lack of energy

All of these can be side effects of a spine that is not in order. All of these symptoms can be treated effectively through chiropractic – you will learn a method that will achieve a lot with very little. You should treat your patient in any case holistically. That means, you should not only treat the back, but look as well for possible causes and further side effects, for instance in problems relating to work or family. This should all be a matter of course for any therapist. The naturopath can recognize the interaction between malfunction and shifts in the spine and therefore has a greater chance of successful treatment than other therapists.

Chiropractic is used prophylactically and therapeutically – it’s up to you to convince your patients that prevention is better than cure.

16 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de A good therapist will always round off therapy with: 1. A medical history 2. Examination 3. Palpation 4. Range of motion check 5. Neurological examination 6. X-rays, if indicated 7. Therapy 8. Additional measures: •• Massage •• Stretching •• Back exercises •• Back training •• Improvements to the workplace (PC, desk, etc.) •• Neuromuscular therapy according to St. John •• Nutrition •• Drinking behavior •• Detoxification •• Supplements

17 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Therapy for the Spine

1. Medical History »» What happened? »» When did the symptoms start? »» WHERE is the pain: just on one side, on both sides, always on one side? »» WHAT is the pain like, does it radiate? »» Any other symptoms? »» Has the patient had similar symptoms before? »» Accidents or operations? »» Cardiac or circulatory problems? »» Allergies? »» Psychological problems? »» Any particularities? »» Stress, work, home life, sport?

18 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 2. Examination of the spine: Anything that looks different to us we will note on a piece of paper. The patients stands with his back to us, undressed. Now we look at the following things: »» Is the head tilted to the right or the left, or is it straight? »» Are both ears on the same level? »» Are the shoulders on the same level? »» Do both arms hang straight, or are their differences between them? »» If you look at the shoulder blades: do they look the same to you, or do they protrude, like wings? »» What do the back muscles look like? Anything to note? Anything unusual? »» What about the hips, is there equal weight on both legs? »» Can you see the hip indentations? »» Are the two halves of the buttocks on the same level? »» Are the backs of the knees the same? »» Are the calves the same thickness? »» What about the Achilles tendon: inwards, outwards, or straight? »» How do the feet look? »» What is the position of each foot?

19 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Then from the front: »» Position of the head »» Clavicle »» Are both breasts the same size, or are their differences? (Women only) »» Ribs visible »» Position of the arms »» Position of the abdomen »» Position of the legs – bowlegged or knock kneed? »» Position of the ankles »» Position of the feet

During this examination we can pick up on quite a number of things that will make our later diagnosis easier. It is also important to have the patient walk a few steps, in order to pick up on any restrictions in movement while he is walking. It’s good to have a check list in your practice, to help everything go faster, and so you don’t forget any of the points listed here. Normally you shouldn’t need more than 2-3 minutes for this examination, as a rule. Lastly, look at the patient’s shoes. You’ll be able to get a lot of information from them.

20 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 3. Palpation Palpation can be done during the examination, or after. I usually recommend that one palpates the areas of the body that attracted one’s attention during the examination, or where the patient has reported pain. We begin by feeling along the lumbar area of the spine and the pelvis.

Valleix Pressure Points These points are pressed with the thumb for a short period of time to find out if there is any pain at the point, which could be an indication of sciatica or an irritation of the sciatic nerve.

»» L4 »» L5 »» Sacroiliac joint »» Middle of the buttocks (upper gluteal fold) »» Middle of the buttocks (lower gluteal fold) »» Hollow of the knee (inner side) »» Middle of the calf »» Beneath the outer ankle »» Achilles tendon

21 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 4. Testing Range of Motion: Have the patient bend the spine to the side, forward and backwards, taking care to observe any restrictions or if the patient is more flexible on one side or the other

The patient is standing. The therapist stands behind the patient, both hands on the iliac bones, and has the patient bend forward as far as possible. We keep our hands on the hips and our thumbs on the spina iliaca anterior inferior; these are the dimples that one can see in most people in the region of the sacrum. Often, as the patient is bending forward, one of the hands will shift. This indicates a difference in the length of the legs that we find particularly in such conditions as sciatica, lumbago and pelvic obliquity. We can check this standing or sitting.

Trendelenburg’s sign: We position ourselves in front of the patient and let him raise one of his legs, while giving him our hands to hold. »» Pain while doing this indicates a shift in the lumbar vertebrae. »» Rocking motion with the upper body indicates a weakness in the hip muscles (Duchene’s Sign) Both signs indicate diminished strength in the hips, as well as a possible pelvic obliquity.

22 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Pelvic turn Lift a leg and then turn it outward (at right angles) - flexibility of the hips

Lasègue Test: Lying on his back, the patient raises his extended leg until it becomes too painful. A truly positive Lasègue is only when the pain appears suddenly, accompanied by radiating pain from the sciatic nerve.

23 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 5. Neurological Examination Reflexes Patella tendon reflex = Quadriceps femoris reflex, hammer tap below the knee cap

L3 affected – from the extended side to the inner side of the thigh, to the knee=no patellar reflex

L4 affected – from the exterior of the thigh to the inner lower extremity and the interior edge of the foot= a weak patellar reflex

Achilles tendon reflex = N. tibialis reflex, hammer tap to the Achilles tendon while patient is sitting - Foot should drop

Babinski’s sign: pyramidal tract – extension upward of the toes, when sole of the foot is stroked

Foot dorsiflexion/Difficulty in lifting toes – L5 affected – from the outer lower extremity to the big toe=missing tibialis posterior reflex

S1 affected – posterior side of the thigh and lower leg to the small toe=missing Achilles tendon reflex

24 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 6. X-Ray or CT X-rays should only be ordered if a tumor or a fracture is suspected (CT)

7. Gentle Chiropractic Always treat from the bottom to the top and check through all the zones - that is the only way that the patient will remain symptom-free over a longer period of time. A follow-up is recommended after 3to 7 days. If problems still persist, one can do further therapy. Afterwards, my recom- mendation is to treat every 3 to 6 months, depending on the strength of the spine.

It is important that one is very careful for at least 2 hours after chiropractic, that means no lifting, no bending over (better to use the knees) and if possible, no carrying.

One should also advise the patient not to cross his legs, as this has a negative effect on the sacrum, and on the length of the legs. I explain to my patients, that they need to be particularly careful when they are getting in to the car. The easiest thing to do is to imagine that they are wearing a miniskirt, yes, men too – then they won’t just jump into the driver’s seat. It’s better to sit on the seat first, with one’s behind, and then bring the legs slowly into the car. The more careful the patient is in the two hours after treatment, the longer the results will persist. Through unsafe movements, it can happen that the spine will be displaced again.

The best thing a patient can do after treatment is to go for a walk, at a com- fortable pace. And no sports on the day of treatment.

25 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 8) Supportive Measures Massage: Massage loosens the muscles and releases tension. This helps the patient to regain normal patterns of movement

Stretching: by stretching, the muscles are extended and tension released. This has the effect of helping the patient to move his body in a more relaxed way, and to regulate the imbalance of a tense musculature.

Back exercises: the muscles of the back and abdomen stabilize the spine and maintain good posture, which in turn prevents any further displacement of the vertebrae

Back training: correct lifting, carrying, standing, walking, sitting and standing up are prac- ticed, so the patient avoids a new displacement of the spine

26 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Neuro-muscular therapy, according to St. John: Analysis of the patient’s movements and posture. It involves a three-dimen- sional interplay between muscle, posture and movement. An imbalance arises through wrong posture (sitting or sleeping) or a bad injury, whereby particular muscles or groups of muscles are shortened or extended. This leads to tissue rigidity, circulation problems and then to pain. Trigger points are created that then cause pain in other areas. In this way, pain and its cause are no longer identical. For example, heart pain through displacement in the thorax area, or lower back pain through problems in the lower leg. The provider brings the body back into balance=structural balance, which leads to relaxation of the tissue and relief of pain. The therapy involves stretching, toning the muscles and fitness exercises.

27 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Practical application and techniques for the lumbar area

1. To correct pelvic obliquity: What is pelvic obliquity? Pelvic obliquity is characterized by a position of the pelvis whereby it doesn’t sit straight, but rather one side is higher than the other.

How is a pelvic obliquity recognized? The patient stands before us and we feel for the spina iliaca posterior superior (rear upper iliac spine) with our thumbs. Then we have the patient lean forward, with straight knees, and observe if one of our thumbs is pulled forwards. This is called the flexion phenomenon. This is a possible cause of an unbalanced sacroiliac joint. If the spina iliaca anterior superior (front upper iliac spine) shows a difference in height, then one speaks of a true pelvic obliquity. In this case the edges of the hands are laid on the hips and one feels for the spine to determine differences in height.

28 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Treating pelvic obliquity short leg With a short leg, the thumb is pulled forward, too. »» Shorter right leg: »» Patient lies on his left side, close to the edge of the table, top leg bent, bottom leg stretched »» Hands folded »» Take the patient’s knee between your legs, making sure you’re in a stable position »» Hand closest to the head, on the patient’s shoulder »» Hand closest to the feet, on the pelvis »» Correct posture »» Sternum over the patient »» Correct application on exhaling »» With a short pressure on the pelvis during the exhaling from the patient, will be the difference dissolved.

29 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Longer leg left: »» Patient lies on his right side, close to the edge of the table, top leg stretched and slightly over the edge of the table »» Bottom leg stretched »» Hands folded »» Take the patient’s top leg between your legs, making sure you’re in a stable position »» Hand closest to the head, on the patient’s shoulder »» Hand closest to the feet, on the pelvis »» Correct posture »» Sternum over the patient »» Correct application on exhaling

To determine whether either leg is truly anatomically shortened, the patient lies on his back and pulls his legs up at an angle. If both knees are at the same height, then there is no anatomical shortening.

30 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Use of blocks or wedges Blocks or wedges are always used if the lumbar area is in a spasm or if the usual techniques don’t work. It is important to use the wedges properly: »» With problems in the lumbar area – straight »» With differences in lengths of the legs – shorter leg, deeper than the hip placed, and longer leg, higher than the hip placed.

31 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 2. Displacement of the lumbar vertebrae Determining how the vertebra has been displaced, to the right, to the left, backwards or forwards

A displacement to the right: left transverse process higher. »» patient lies on his right side »» top leg bent »» bottom leg stretched »» arms crossed »» hands folded »» hand closest to head on the patient’s shoulder »» hand closest to the feet lies on the upper dislocated transverse process »» give a short push on exhalation

A displacement to the left: right transverse process higher. »» patient lies on his left side »» top leg bent »» bottom leg stretched »» arms crossed »» hands folded »» hand closest to head on the patient’s shoulder »» hand closest to the feet lies on the upper dislocated transverse process »» give a short push on exhalation

32 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de A displacement to the back: »» patient lies on his abdomen »» possible use of wedge technique »» put index and middle fingers on both of the transverse processes »» put the other hand across »» short push or thrust downwards

3. Lifting technique To use this technique, one lifts the skin next to the vertebra between thumb and forefinger as though one wanted to hold onto wet laundry. Starting at the bottom, one then rolls slowly towards the top. One can put this technique to good use after correcting the position of the vertebra. This loosens the fasciae that have been stuck together, leading to a relaxation of the muscles in the area of the vertebrae. It can be done on sitting or standing patients, until about the 8th or 10th thoracic vertebrae, but even as far up as the area between the shoulder blades. It depends on the amount of tension in the individual patient, how high up one can go. With some patients, one can’t lift any skin at all, and with others one can lift so much skin that another person could crawl inside the fold.

33 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Problems that can come from the lumbar vertebrae: »» Kidney problems »» Abdominal cramps »» Flatulence »» Gynecological problems in women »» Prostate problems »» Groin pain »» Hip pain »» Thigh pain »» Knee pain

Blockages are caused by: »» a) Unbalanced loads »» b) Poor posture »» c) Falls »» d) Accidents »» e) Internal illnesses »» f) After-effects of anesthesia

Important: after anesthesia patients always need a chiropractic treatment

34 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Various Treatments

a) Damaged discs (herniated discs) In this situation the jelly-like core of the disc slips forward out of its protective shell and presses on the nerve. This leads to severe pain and to restrictions in mobility. At times the pain radiates into the leg or into other areas. Damages to the disc are caused by a slow desiccation of this jelly-like mass, causing a loss of its “water-bed” function. The shell begins to break. It only needs one false movement, and it happens – a herniated disc, or prolapse.

Symptoms: »» Pain »» Feelings of paralysis »» Loss of sensation

Examination: »» Lasègue sign positive

Therapy: »» Chiropractic »» Massage »» Fango mud baths »» Neural therapy »» Vitamin therapy »» Deep tissue massage »» Back exercises/back training »» Strengthening the muscles »» Inversion Table Therapy (to make a relief of the pressure on the disc)

35 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de b) Lumbago Treated just like a herniated disc, as one can’t know if in fact a herniation lies behind it all. Examination techniques are the same as for a herniated disc.

Treatment plan for all therapies »» Medical history »» Examination »» Check range of motion »» Check gait »» Palpation »» Correction »» Chiropractic »» Massage or deep tissue massage »» Back exercises »» Back training »» Inversion Table Therapy »» Further therapies (homeopathy, phytotherapy, ear acupuncture)

36 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de c) Osteitis deformans=Paget’s Disease This is a chronic illness of the bones for which the cause has not yet been determined. It usually starts in middle age and affects several bones at one time, more frequently the pelvic bones, spine and skull. It can however affect a single bone.

Symptoms: The patient notices suddenly that his hat has become too tight, for example, as the circumference of his head is gradually increasing. Or the bones begin to bend, for instance the tibia, and the bones then fracture due to the increase in pressure. Usually the body temperature is elevated in the affected areas.

Lab values: alkaline phosphatase elevated

Prognosis: unfavorable, development of a sarcoma in 2% of the cases

Therapy: Calcitonin Splinting Activation of the immune system Autologous blood therapy Nutritional support Vitamins and Minerals Enzymes

37 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Techniques for the thoracic spine

Examination of the thoracic spine The patient stands, undressed to the waist, with his back to us. We look at the spine, the shoulder blades and any pertinent folds we notice on the back. Take a look at the posture of the arms and the head.

Palpation of the thoracic spine: The patient is prone, we probe the area along the spine. Either one uses the index finger and middle finger to the right and left of the spine, or one uses the thumb and index finger to one side of the spine. It is also possible to use both index fingers – these are all possible techniques and one has to discover for himself which is the best one to use. I myself prefer the index and middle finger as they are more sensitive than the thumbs. Not only do we palpate the transverse processes, but also the spinous process. In this way we can feel where there are differences in height, or tension in the muscles. During the diagnostic process it is important to determine how the vertebra has been displaced, because only when I know HOW the vertebra has been displaced is it possible to use the right technique to adjust it.

Checking on range of motion »» To the side »» Turning to the side »» Forwards »» Backwards

38 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Various Chiropractic Techniques for the Thoracic Spine:

1. Unspecific Double Balls of the Thumb Technique Here the balls of both thumbs are placed on the spine, to the right and left, on the transverse processes of the mid and upper thoracic spine. This serves as an unspecific chiropractic of the thoracic spine.

2. Shuttle technique or Double Pisi- form Technique Here both pisiform bones of the therapist are placed to the right and left of the thoracic spine, with hands crossed over each other, on the transverse processes, with pressure downwards. This brings a vertebra that has displaced forward, into the right position again.

39 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 3. Single-handed PisiformTechnique On the opposite side to where one is standing, turn the pisiform into the transverse process – hand closest to the feet does the turning, the other hand is laid on top, and sternum of the provider must be over the patient. This technique is used when one transverse process is higher than the other and we want to bring it back into line.

4a. Roller Technique with the Hand Feeling for the protruding vertebra, the vertebra beneath it will be adjusted used the Roller Technique. The patient sits on the table, legs drawn up, arms crossed and on the shoulders, first crossing the arm on the side I’m working on. This keeps the patient from letting go and unintentionally giving me a slap. One hand of the provider makes a strong fist and lies underneath the affected vertebra, the other hand holds the patient at elbow height. The patient is rolled slowly onto the fist –hold the fist tight - and is then swung back and forth over the fist, and then finally, there is a movement of pressure straight downwards.

40 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 4b. Roller Technique over the Knee »» The patient sits on the table, legs drawn up, one of the provider’s knees rests on the table, the patient folds his hands on the back of his neck. The patient then lies on the provider’s knee. »» The provider grasps the patient with his arms through the arms of the patient, behind his back and then the patient is pulled upwards, over the knee. »» It is also possible to adjust the vertebra using the double lamina technique. The patient lies prone. Index finger and middle finger, one hand under the vertebra, other hand supporting, downward thrust.

5. Mobilizing the first rib Patient lies on his back. Thumb lies on the first rib/clavicle, the rest of the fingers positioned downward, on the back. Lower arm parallel to the floor, apply pressure forwards, toward the feet.

41 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 6. Trigger points along the spine The thumb exerts downward pressure, at various points along the spine. There are also many pressure points around the shoulder. Pressure points are pressed for about 30, 60, or 90 seconds, causing the blood to pool in front of and behind the point. After letting go, there is a strong rush of blood, back into the area, which releases tension.

Triggerwood Technique This technique works the same way as the trigger point technique – through pressure on a specific group of muscles, it comes to a pool- ing of blood above and below the area. When the pressure is released, blood rushes into the area again. The increased blood supply allows deposits to be carried away and stimulates a good metabolism.It can sometimes take up to 10 minutes before tension in the muscles relaxes. It’s important to tell the patient that he should breathe particularly strongly into these areas that are so taut

42 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 7. Golf ball/Tennis ball Technique When the muscles between the shoulder blades are very taut, one can place a fist or a golf ball under the painful area. The patient, who is lying on his back for this, should take very deep breaths. This technique is at first quite painful and unpleasant for the patient, but the effect on the muscles is very positive. The tension will slowly be released.

43 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de When to Use 1. Bechterew’s Disease (Ankylosing Spondilitis) Symptoms: »» Respiratory failure (as a conse- »» Lower back pain (particularly in the quence, the patient can die of a second half of the night) light case of pneumonia) »» Stiffness in the morning »» Night sweats Lab values: Positive for HLA-B27 »» Illness progresses in episodes »» Positive antigen/antibody reaction »» Beginning sclerosis »» Immunodeficiency »» Stiffness in the sacroiliac joint »» ES elevated »» Heel pain »» Pain in the Achilles tendon Radiology: »» Iridocyclitis=inflammation of the »» Bamboo spine iris »» Evidence of sclerotic process

Secondary Symptoms: Cause: »» Gradual stiffening of the spine »» Hereditary (from caudal to cranial) »» Inflammations of the muscular- »» Shortening of the longitudinal liga- skeletal system ments »» Collagenosis »» Kyphosis of the thoracic spine »» Stress »» Rotation of the spine possible »» Obesity »» Sclerosis of the shoulders, knees »» Too few muscles and elbows »» Deformations (knock knees, bow »» Sclerosis of the ribs legs)

44 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Begin: »» Foot reflexology »» Between 20 and 30 years old »» Respiratory therapy »» Diffuse symptoms »» Vitamin and mineral therapy »» Phytotherapy Therapy: »» Acupuncture/ Ear Acupuncture »» Chiropractic »» Deep tissue massage »» Osteopathy »» Sauna »» Cranio-sacral therapy »» Jogging and other kinds of athletic »» Physiotherapy activities »» Inversion Therapy »» Detoxification The patient should do exercises to »» Nutritional support, plenty of raw improve mobility on his own, at least foods twice daily. »» Baunscheidt Method »» Cupping »» Massage »» Homeopathy »» Liver therapy »» Swimming »» Neural therapy

45 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 2. Scheuermann’s Disease=juvenile osteochondrosis With this disorder there is a curvature of the spine in early youth that can be halted only with a great deal of therapy.

Symptoms: Therapy: »» Weakness in the back »» Intensive work to strengthen the »» Fatigue muscles »» Pain »» Isometry »» Stretching Cause: »» Back exercises »» Probable endocrine imbalance »» Chiropractic »» Massage Radiology: »» Kneipp treatments »» Wave form in the vertebral end »» Fango mud baths plates »» Swimming »» Schmorl’s nodes »» Sport »» Usually several vertebrae affected at one time, creating kyphosis and vertebral wedge formation

46 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 3. Osteoporosis This is a breakdown of the entire substance of the bones due to a reduction in calcium metabolism. In X-rays the bone appears low in contrast and transpar- ent.

Causes: »» Long-term cortisone treatment (Cushing syndrome) »» Hyperparathyroidism »» Tumors (plasmocytoma, usually in the bone marrow) »» Menopause »» Vitamin D deficit It can cause cod-fish vertebrae through impression of the end plates, and there is a greater chance of fractures in the long tubular bones (femur, humerus, radius and ulna)

Therapy: »» Vitamin D, plus Calcium and Magnesium in the right mixture »» Movement (trampoline 3x5 minutes) »» Good nutrition »» Diet low in sugar

During a bone density test, the bones of women of all ages are compared with the bones of a young man of 30. The comparison leaves something to be desired, as women have lower bone density than men in general, and it also depends whether the particular woman did a lot of sports in her life.

It’s important to know that only the body of the vertebrae are affected, not the spinous or transverse processes – for this reason it is possible to do very gentle chiropractic treatment.

47 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Cervical Spine Techniques

Examination: »» Position of the ears »» Position of the shoulders »» Tilt of the head

Palpation of the cervical spine: »» It’s important to find out if the vertebrae are displaced towards one side, or twisted!

Range of motion check: »» Tilt head to the side »» Rotation the head »» Bend head forward »» Bend head backward »» Open the jaw to see if it moves to one side

Gait: In order to observe the patient’s gait, have him walk up and down a few times. We can observe if the arms and legs swing in opposition to one another, if the head and the arm move together, if the hip is unsteady, how the feet move and many other things that one can only observe when the patient moves.

48 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de ‘Kleijnsch’ Hanging Test The patient lies on his back, the head is turned to the right side and stretched downwards – very carefully. (Then change the side to the left) If the patient gets dizzy, there is the possibility that there is atherosclerosis of the carotid artery. And we do not manipulate in the cervical area Chiropractic for the cervical vertebrae

Displacement or twist? To determine whether we are dealing with displacement or with rotation, one needs to make an exact diagnosis using palpation. Rotations move the transverse process higher, displacements move it more to the side.

49 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Various Chiropractic Techniques for the Cervical Spine

1. Displacement of T1/C7/C6 Patient is prone, starting with the index finder metocarpophalangeal joint turn the head in the same direction, so the vertebra comes back to a normal position. Simple and easy to do – above all, without much energy. As an example: Provider on the left, right hand starts on the right cervical vertebra, left hand on the left temple, gentle turn of the head to the right.

50 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 2. Contortion of C5 to C1 Patient lies on his back, start with the displaced transverse process. Turn the head in the same direction as the hand. Provider stands on the same side on the front end .

Example: Provider on the right side, upper hand on the right side of the neck, upper hand on the left temple, turn head to the right

Displacement of C5 to C2 Patient on his back. Start with the displaced transverse process. Push the head in the direction of the way the hand is positioned. Provider stands on the same side to the working hand. Atlas displacements are brought back into the right position by starting with the atlas itself and moving it sideways.

51 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 4. Neck traction Patient lies on his back, provider stands at the head, holds the neck and gently pulls the head towards him. It is important that one pulls the head gently and smoothly, and that one just as gently brings the head back into start position. If one twists the head at all this can cause strain, which is very uncomfortable for the patient.

5. Trigger points This is a technique to bring vertebrae that one has not been able to treat with normal chiropractic back into the right position. One presses with the thumbs on the transverse process that protrudes, and holds the position for 30 to 90 seconds. Through the pressure, the vertebra will be brought into the right position and tension will be released. These trigger points are all located to the right and the left of the spine on the transverse processes. The vertebra slips slowly back into position by means of this pressure.

52 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Uses

a. Torticollis technique=acute torticollis Careful stretching, chiropractic only if possible, otherwise torticollis technique: Patient on his back, have him turn his neck as far as possible. Lay one hand under the head, under the lower cheek. Other hand on the upper cheek. Pressure and rotation on exhaling, but not suddenly, rather with feeling, causing a gentle stretching of the sternocleidomastoideus muscle. On inhaling, use counter pressure. On exhalation, let go and turn further in the direction. Repeat 3-6 times, and then change sides. Depending on the severity of the torticollis, it can take 3 days to 4 weeks for a full recovery. In addition one should apply warmth, such as a hot water bottle. Arnica salve and homeopathic arnica are also a great help. A torticollis is comparable to acute lumbago in the lumbar vertebrae. There are no warning symptoms, such as there is with sciatic pain in the case of lower back pain (diffuse problems with the lumbar area). It usually happens after a simple movement, and the patient is immobilized from one second to the other. It causes severe pain, so much so that the patient is totally immobilized. There are severe muscles spasms – thus the main objective is to release these spasms.

These are all protective measures that the body takes to protect against greater damage.

53 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de b. Migraines and Headache Treatment Most headaches are caused by tension in the neck area. Tension in this area causes the muscles to cramp, and the flow of CSF out of the brain is disturbed – it comes to a congestion of CSF and to an increase in pressure, which causes headaches. There are 4 ventricles in the brain that produce around 100 ml of fluid per day. The more this congests and cannot flow properly the longer the migraine or the headache will last. Migraines only affect one side, headaches both sides. Migraine patients have a tendency to do everything not just 100%, but 200%, which doesn’t make their lives easier. For this reason migraine patients need a lot of relaxation and recreation to balance their everyday lives.

Therapy Chiropractic, and letting the neck lie in a stretched position for several minutes. This works best with a pillow or a roll made from a towel.

Acupressure points for pain: »» Eye brows: the beginning, middle and end points »» Outer edges of the eyes »» Mid-point under the eyes /cheek bone »» Inner side of the eyes/cheek bone »» Upper side of the nose »» Below the nostrils

Hold these points on both sides for at least 60 seconds

54 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Supportive Therapy for Migraines Ear acupuncture for migraines and headaches Ear acupuncture has proven to be very appropriate in the treatment of headaches and migraines in connection with chiropractic. The needles are best applied when the patient is lying down and left for about 15 minutes.

»» Cushion 29 »» Sun35 »» Forehead 33 »» Roof 36 »» Grey matter 34 (inside) »» Cervical vertebrae »» Segment »» Shen men 55

55 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de c.Tinnitus (noises in the ears): With tinnitus there is a huge disturbance in circulation. One hears higher or lower tones as background noise, which is extremely disturbing. The usual treatment for tinnitus is infusions with medications that increase circulation. This doesn’t really solve the problem, as nothing has been done to treat the cause. Tinnitus patients generally suffer from a lot of stress, and the body tries to send a signal through these noises in the ear – “hey, listen – take it a little slower, relax”. But people, as usual, don’t want to hear this. The real cause is stress, which causes tension in the neck musculature, accompanied by a displacement of the first and/or second cervical vertebra. This causes circulatory problems, which then lead to noises in the ears.

Therapy: »» Chiropractic, especially the first and second cervical vertebrae. Sometimes also the fourth vertebra »» Massages to relax these areas »» Possibly deep tissue massage to stabilize the muscles »» Stretching »» Inversion Table Therapy »» Ear acupuncture (very important): •• Cushion 29 •• cervical vertebrae •• Segment •• Inner Ear 9 •• Heart 100 •• Shen men 55 •• Possible frustration and aggression point

56 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Oxygen therapy »» Support to improve circulation »» Application of rosemary oil (to the mastoid) »» Gingko biloba

You have only 12 months to get to grips with tinnitus. Treatment after that is very difficult and often unsuccessful. The earlier one begins treatment, the greater the chances of successful treatment.

57 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Course of a therapy: »» Medical history »» Examination »» Palpation »» Range of motion check »» Reflexes (patellar, Achilles tendon) »» Standing on tiptoe »» Lasègue Test »» Valleix points »» Patient prone »» Check for differences in lengths of legs and equalize »» Check lumbar spine and correct positions »» Lifting technique »» Loosening of lumbar spine through roll technique and walk technique »» Massage »» Back exercises »» Back training

58 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Practical Uses (Techniques for the Upper Extremities)

Shoulder Chiropractic Examination of the shoulders: »» What is the position of the shoulder blades? »» What is the position of the shoulders? »» How do the arms hang?

Palpation: »» Clavicle »» Sterno-clavicular joint »» Processus coracoideus »» Acromio-clavicular joint »» Supraspinatus tendon »» Deltoid muscle »» Biceps tendon insertions (long and short)

Range of Motion: »» Lift the shoulders »» Lift an arm to the side, bent and stretched »» Lift an arm to the front and to the side and turn the hands up and down »» Lift and arm and rotation to the front and back »» Comb grip (as though one were combing one’s hair) »» Apron tying grip (as though one were tying an apron behind one’s back)

59 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Therapy 1. Chiropractic for the shoulder: The patient sits in front of the provider, and the patient’s right hand holds the patient’s left shoulder. The provider grasps the elbow of the patient. Thrust from below upwards, horizontally, horizontally to the left, horizontally to the right. Afterward the shoulder joint needs to be “oiled” – locomotive movement.

Right hand holds the right hand, straight movement forward and back, about 10 times.

2. Traction for the shoulder: Grasp the wrist of the patient with both hands and shake a little, then pull the arm gently forward. This can be done sitting or lying down and helps to loosen the shoulder joint.

60 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de For Use in the Shoulder Area Shoulder Problems and Possible Therapies

1. Shoulder-Arm Pain It is also called the sciatica of the arm. A pinched nerve that radiates into the arm can cause tingling, feelings as though ants were running up and down the arm, loss of feeling and feelings of paralysis.

Therapy: »» Chiropractic »» Massage »» Stretching »» Back exercises »» Back training

61 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 2. Periarthritis humeroscapularis = painful stiff shoulder Inflammatory change in the shoulder joint caused by neuro-vegetative irritation. The primary cause is to be found in the spine.

Symptoms: »» Shoulder pain »» Stiffness in the shoulder »» Pain at the coracoid process and at the acromion process »» Pain particularly with abduction

It comes to calcium deposits in the supraspinal tendon and around the capsule

Therapy: »» Neural therapy »» Chiropractic »» Massage »» Fango mud baths »» Movement therapy »» Stretching »» Baunscheid Therapy

62 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 3. Frozen Shoulder = Reduction/Irritation of the supraspinatus tendon Pain in the deltoid muscles of the tendon, swelling of the tendon and therefore restricted mobility

Therapy: »» Baunscheidt therapy »» Neural therapy »» Chiropractic

63 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Chiropractic for the Elbow

Examination of the elbow The position of the elbow determines how the arms hang

Palpation of the elbow Medial and lateral epicondyles – press lightly above and below the joint with the index finger

Range of motion »» Supination »» Pronation »» Bending »» Stretching

1. Elbow chiropractic Provider stands behind the patient, put the thumb on the medial epicondyle, the other fingers rest on the muscle itself. The elbow is slightly bent, and with a snap movement the joint is brought into the correct position again. During this therapy it is important that the thumb is turned outward, away from the body.

2. Elbow rubbing Rub at right angles to the muscle, to loosen deposits and tension.

3. Elbow stretching Using the wrist, one can stretch the elbow joint, and the provider can stretch the joint as well.

64 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Elbow Treatments

Tennis Elbow = Epicondylitis humeri Epicondyles painful to the touch, primarily radial, seldom ulnar. Pain radiates into the fingers.

Therapy: »» Applications of cold »» Neural therapy »» Massage »» Deep tissue massage

65 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Chiropractic for the Wrist

C. Wrist (Examination, Palpation, Palpation) Examination Are the hands crippled, swollen or deformed? The same for the fingers.

Palpation Can you feel any thickening or nodes, do the carpal bones protrude? Haberden’s nodes?

Range of motion »» Inflexion and extension of the hand »» Sideways movement »» Pronation and supination »» Inflexion and extension of the fingers »» Rotation of the thumb »» Strength of grip

66 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Chiropractic for Hand and Fingers The wrist is pulled gently apart and turned to the right and the left. »» One grasps one finger of the patient with one’s hand and pulls it gently out of the phalangeal joint to bring the joint into a correct position »» The thumb and index finger grasp the joint of the middle finger and mobilize it »» Phalangeal joints – same process as above »» Thumb is enclosed in the hand and the pronator rotate his body to stretch the thumb – while he is softly pulling on the thumb

Stretching for hands and fingers Stretching the hand – flexion and extension Place the fingers against one another, spread them and stretch

Smoothing out the fingers Like deep tissue massage. Works very well with all fingers that have been crippled and deformed by arthrosis. Massage in the direction of the finger tips with your thumb or index finger, on the upper and under sides of the finger and along the sides, three times each side, so that you massage the entire finger. Massage each finger in turn.

67 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Concentric circulation around the wrist Very suitable for wrists. A similar positive effect can be gained with sand that has been warmed in the oven and then applied to the hands and fingers in a circular motion.

Strengthening exercises A sponge works well for this, or a massage ball, as well as Chinese Chi Gong balls that one rolls on the surface of the hands, in both directions, without letting them touch each other. To strengthen the fingers one can do kneading exercises with a soft sponge.

68 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Uses for the Hands and Fingers

1. CTS In this condition we are dealing with a narrowing of the sleeve of the hand that causes the nervus medianus to be pinched. Symptoms such as tingling and loss of sensation in the hand are usually experienced at night, and it is mostly the three middle fingers that are affected.

Examination: Pain upon percussion of the inner wrist=Tinel’s sign

Therapy: »» Stretching »» Neural Therapy »» Deep tissue massage

69 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 2. Dupuytren’s Disease Here we are dealing with a flexion contracture of the hand affecting the pal- mar fascia, usually fingers 4 and 5. One can palpate small nodules along the tendon.

Cause: Unknown, but a disturbance of the liver is suspected

Therapy: »» Neural therapy »» Movement therapy »» Stretching »» Liver Therapie »» Detoxification »» Deep tissue massage »» Massage

70 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 3. Inflammatory Processes in the Joints a) Arthritis = inflammatory process in the joints It is caused by a bacterial infection – the pathogen gains entry through a wound or as a result of sepsis. The course can be acute or chronic. It causes functional disturbances through adhesions in the joint capsule and fusions in the joint itself, which lead to deformation

Symptoms: swelling, pain, warmth at the joint, edema, fever, reactive depression

Lab values: leukocytosis, ESR elevated

Sequelae: stiffness and immobility

Therapy: »» Strengthening the immune system »» Homeopathy »» Autologous blood therapy »» Vitamin and mineral supplements »» Deep tissue massage »» Detoxification »» Chiropractic »» Colonic irrigation »» Massage »» Kneipp therapies

71 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de b) Rheumatism of the joints Rheum (gr.) – from one place to another Rheumatic conditions are characterized by being in one place today and in another tomorrow. We differentiate between two forms:

Rheumatic Fever Polyarthritis=rheumatoid arthritis

72 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Rheumatic Fever: This is an autoimmune disease caused by beta-hemolytic streptococcus, a bac- terium. Usually following strep throat, bronchitis or scarlet fever, the joints are affected three weeks after the initial infection. Symptoms include swelling, pain and a high fever. Sometimes the illness affects the heart, primarily the mitral valve or the myocardium, which can lead to valve defects or myocarditis. It is usually seen in school children, but can also affect older patients.

Lab values: »» AST positive – over 400 »» ESR elevated »» C-reactive protein »» Leukocytosis

Therapy: »» Bed rest until fever-free »» Homeopathy »» Detoxification »» Nutritional therapy »» Penicillin often necessary to prevent later complications, afterward intestinal cleansing »» Autologous blood therapy »» Chiropractic and massage »» Strengthening of the muscles »» Heart therapy

73 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Chronic Polyarthritis Affects primarily adults and more women than men (3 to 1) The process begins in the smaller joints, usually the fingers, but also the toes, and moves onto the larger joints later. Early morning stiffness is typical, as an early sign. It comes later to swelling and stiffness, with typical deformations of the fingers. In the initial stages one can palpate Haberdens nodes. Can take the form of attacks that come and go. In 60% of the cases it is mild, and in 15% of cases it can come to remission.

X-Ray: »» demineralization and osteolysis

Consequences: Therapy: »» subluxation and deformation »» Nutrition and intestinal cleansing »» Movement therapy Lab value: »» Chiropractic »» AST normal »» Massage/Deep tissue massage »» ESR elevated (not always) »» Kneipp therapies/sauna/Fango »» Rheumatism factor positive in only mud baths 50% of cases »» Application of cold »» Activation of the immune system »» Homeopathy

74 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de c) Gout = Arthritis urica Symptoms: »» acute, highly painful swelling, reddening and inflammation of the joints, usually the big toe joint. »» Often the patient cannot even stand to have bed clothes resting on the joint.

Cause: elevated uric acid and deposits of uric acid crystals in the joint capsule. Im- moderate meat intake, particularly pork!!! But also legumes and alcohol.

Therapy: »» Cold applications »» Therapy for the pain »» Baunscheidt therapy

Nutrition: »» No pork »» No legumes (lentils, corn ,beans, peas) »» No beer »» For a short period of time, treatment with Allopurinol or similar medication, but only as a temporary measure!!!

75 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de d) Arthrosis deformans: This is destruction of the joints themselves due to wear and tear and after an early stage of inflammation in the joint. It plays a large role in the muscular- skeletal system.

In the beginning the cartilage undergoes changes, becomes coarse, and then, within a certain time, the bones themselves are exposed. It can come to cysts. The parts of the bones rub against one another and cause pain – slowly it comes to a deformation of the joint. It can come to the creation of a “joint mouse”, caused by pieces of cartilage that have come loose in the joint. This joint mouse can move to areas between the parts of the joint and can cause a sudden paralysis of the joint, which only becomes supple again with time. The joint mouse can only be removed surgically.

76 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Special Forms of Therapy for Inflammatory Processes in the Joints Baunscheidt Therapy: This is a good form of therapy that helps to get a handle on rheumatic problems. In my practice, it has proven to be an excellent supportive therapy for all problems with the muscles, the bones and the joints.

The “Lebenswecker” (“life awakener” or “artificial leech”) used in this therapy has a set of small needles, that open the top-most layer of the skin allowing the Baunscheidt oils, that are rubbed onto the skin, to penetrate into it. This creates small pustules where lymph collects.

Areas affected with rheumatic pain that respond well to this therapy are those to the right and left along the spine, or those directly over the affected joint.

The lymph will later be absorbed into the lymphatic system again, but for 4-8 hours, the body has fewer toxins in its lymphatic system and is able to get rid of other toxins more easily and efficiently.

I recommend a treatment 2-3 times a week, depending on the illness, and also, depending on how quickly the pustules heal, about 10 times in all – occasion- ally 8 times is enough, but one needs to decide from case to case.

Treating 2-3 times a year has a positive effect, depending on how affected the patient is.

77 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Practical Uses/Techniques for the Lower Extremities

A. Hips

Examination »» Position of the legs »» Level of the iliac crests »» Unusual features of the skin

Palpation »» Palpate the level of the hips

Range of motion Check movement forward, backward and to the side; rotation with bent leg

Four sign: Patient lies on his back, left leg extended, right heel on the left thigh, and let the knee fall outward, creating a “4”.

Patient on his back, both legs drawn up, soles of the feet touching, let the knees fall outward

78 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Trendelenburg’s sign: We stand before the patient and let him lift his legs one after another while we give him our hands. If this is painful for the patient it is an indication that there are displacements in the lumbar vertebrae. If the patient leans forward with his upper body this indicates a weakness in the hip muscles. (Duchene’s Sign) Both signs together indicate a diminished load-bearing capacity in the hips as well as a possible pelvic obliquity.

Check how well the pelvis can turn: »» Lift the legs and turn those outwards (right angle) »» Mobility of the hips

Techniques

1. Chiropractic Patient prone, lift stretched leg, press down on spina iliaca posterior superior

2. Traction Patient on his back, bent knee lies on the provider, direct upward pull in the groin

3. Shake the entire leg Patient on his back, provider holds patient’s ankle, pull towards the foot and then shake the leg. This loosens the muscles.

79 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Uses for the Hips 1. Coxarthrosis=Degeneration of the Hip Joint This is a degenerative condition of the hip joint that includes a breakdown of the boney tissue caused by chronic inflammation, leading usually to bow-legs, that later has an effect on the knees. Very often the legs just give way, or the patients report that they have trouble climbing the stairs.

Therapy: »» Treating the inflammation »» Neural therapy »» Enzyme therapy »» Chiropractic »» Physical therapy for the legs

80 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 2. Dysplasia of the hip Here we are dealing with a hip socket that is too flatly formed. Affects girls more than boys. Today, the condition is found through screenings early in infancy and can be treated in a timely manner. If the condition is found later, the therapy is much more difficult. It is usually an inherited condition.

Consequences: Symptoms: Therapy: »» Luxation of the joint »» Limping »» Spreading trousers »» Subluxation »» Waddling »» Very thick diapers »» Complete luxation

81 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 3. Perthes’ Disease=aseptic necrosis of the femoral head in childhood Here the core of the bone dies due to an ischemic infarction. This condition occurs most often between the ages of 3 and 12. Affects boys more than girls. The condition begins with a limp to protect the affected side, in the beginning there is usually little pain. The femoral head necrosis heals spontaneously by building new boney tissue. It is important to make sure there are no deformations that lead to lasting damage. Relieve strain on the bone!!!

82 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de b. The Knee

Examination of the knee: »» Swelling »» Deformation

Palpation: Palpate any misalignments and compare both knees Dancing patella (one hand placed around the patella, the other presses gently on the patella to see if it “dances” or swings)

Range of motion: »» Flexion, extension »» Rotating flexion, extension »» Rotation

Mobility of the knee: Meniscus Sign: thigh and lower leg are not in alignment with one another. Pain indicates a meniscus defect. Test mobility further by pushing gently on the outside of the thigh and the inside of the lower leg In addition, palpation of the joint space.

Drawer phenomenon: With injuries to the cruciate ligament. Patient lying down, legs drawn up. Place thumbs to the right and left of the knee cap. If the knee cap allows itself to be moved forward or backward when you push or pull it, then the front or back cruciate ligament has been damaged.

83 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Uses for the Knee 1. Gonarthrosis = Arthrosis of the knee joint This is a very common degeneration of the knee joint. Cause: various mechanical and biological factors contribute to the degeneration of the knee, including infections, rheumatism and improper use.

Results: it can lead to knock knees or bowlegs which during the period of growth in childhood can be corrected with splints or through operations. Later this will be difficult as signs of wear and tear are already there.

2. Effusion It can be serous (white-yellow), bloody (reddish) or purulent (yellow), which is determined by doing an aspiration. The collection of fluid in the capsule leads to enormous swelling of the knee, accompanied by the dancing patella symptom.

84 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 3. Chondropathia Patellae Here there is a change in the cartilage of the knee cap and to a shredding and a desquamation of the cartilage tissue. Affects primarily younger patients between 15 and 25, more girls than boys.

Symptoms: »» Feeling as though there is fine sand under the patella »» Pain upon movement particularly when climbing stairs or hiking

Therapy: »» Stretching »» Chiropractic »» Back and knee exercises »» Strengthening the muscles, particularly of the thigh »» Insoles

85 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 4. Meniscus: Causes of Damage to the Meniscus: Function: (Tear or Wear?) »» The meniscus is a cushion within Typical here is the turn- and- fall the knee joint that helps to cushion injury, where the foot and the lower the pressure between the thigh extremity remain fixed,t he knee is and the lower extremity. It helps to slightly bent and the thigh makes a protect the cartilage. turning movement under pressure. »» Shock absorber (Often during sports and skiing) »» Control A healthy meniscus can only be torn »» Stabilization of the knee when the force acting on it is too great for it. Problems with the meniscus are indicated by the following signs: Symptoms: »» Drawer phenomenon Pain in the joint space »» Patient lies on his back, one leg Difficulty in stretching, bending and bent at an angle, extension of the rotating leg outward and inward, under light pressure Therapy: »» Patient lies on his back, one leg An operation is usually necessary, bent at an angle, rotate the foot afterwards lots of physical therapy »» Patient sits with both legs bent and crossed, press affected knee gently downward

86 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 5. Schlatter-Osgoode Disease Schlatter-Osgoode disease is an aseptic necrosis of the tibial tuberosity which appears at the time of puberty in boys and girls. Pain occurs when climbing down a mountain and when kneeling. It can sometimes take 2-3 years to heal.

Therapy: »» Support bandages »» Casting (if necessary) »» Traction for the knee by wearing light weights on the ankles »» Stretching »» Placing the leg on a chair to stretch it »» Stretching the back of the knee

87 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Good Sports for the Knees: »» Cycling »» Swimming »» Walking, to begin with, then easy hikes, but always using hiking poles »» Special exercises in the gym to strengthen the thighs, buttocks and calves »» Dancing »» Cross-country skiing »» Light jogging

88 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de C) Ankle

Examination Palpation Traction Therapy »» Patient prone, the closest leg to the provider is brought to a right angle, the provider fixes the leg with his knee. Both hands grasp the ankle while pulling the foot lightly upward, with a slight supination or pronation, to finish. »» Then let go carefully – it’s important not to put too much weight on the thigh. »» Standing on tip toe is an excellent way to stabilize the ankle. »» Another great exercise is rolling a ball with the sole of the foot.

89 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Uses for the Ankle 1. Dislocation=Luxation 4. Torn Ligaments When the condyle is pushed out of These occur often at the knee or its socket by a strong force from the ankle, and are mostly painless, in outside. comparison with sprains, but leading later to arthrosis of the joint. Results: overstretched or torn joint capsule Therapy for sprains and strains: and ligaments »» As a first aid measure cold applications and elevate leg. 2. Habitual Luxation »» X-rays and strapping until the When the condyle continues to worst of the pain is gone. spring out of its socket even without »» Apply arnica salve a strong outside force, usually after »» Arnica D200 globules a traumatic luxation, which causes »» Phlogenzym Tablets for the swell- an extreme overstretching of the ing and inflammation ( Bromelain ligaments. Often affects shoulders or and Papain Enzymes) knees. »» Afterwards support bandage during sport Therapy: »» Strengthening exercises and Wrapping or operation stretch, stretch, stretch!!!

3. Sprains Here the muscles and capsule have been torn or crushed, causing severe pain, bruising, and effusion.

90 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de D. Feet – Chiropractic for the Feet

Examination: Buckling: »» How do the feet, the Achilles »» Drop between Achilles tendon and tendon and the ankle look, can one heel observe any abnormalities just in a standing position? Splayfoot: »» Bunions »» Front part of the foot is splayed, »» Abnormal positions of the toes often with hammer toes »» Look at the shoes – where do they show signs of wear? Bunion (hallux valgus): »» Large toe bent in the direction of Palpation: the second toe »» Inner and outer side of the ankle »» Achilles tendon, toes Foot drop: »» through paralysis of the foot and One can also have a foot print made the stretching muscles of the toes Range of motion: »» Flexion, extension, pronation, supi- Hollow foot: nation »» very high arch »» Gait mobility »» Therapy for all faulty positions of the feet is properly fitted insoles Flat foot: and foot exercises. »» Deformation of the arch

91 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Supportive Therapies:

Massage General Guidelines for Performing Massage »» All strokes should be done in a direction towards the heart »» All strokes should be repeated 3-6 times »» Massage should be done with smooth, flowing, rhythmical movements »» Use your whole body »» Always massage the opposite side of the side of the body to where you are standing

Always begin and end with light strokes.

Massage – how often and how long? Generally, it’s beneficial to do a massage 2x a week. Depending on whether we are doing a partial or a whole-body massage, we should do it as follows:

»» Partial massage 20-30 minutes »» Whole-body massage 45-60 minutes »» When working with older people, a somewhat shorter time is better, so as not to strain the heart. For most people, one can do a 30 minute back massage once a week, to release tension and to promote relaxation. After a chiropractic treatment, I recommend a short cupping session and then a 10-15 minute massage, to help the muscles relax and get used to the new situation.

92 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Deep-Tissue Massage:

History: Deep-tissue massage is a massage of the deeper tissue and connective tissue, and was discovered by Elisabeth Dicke in 1926. Elisabeth Dicke suffered from severe circulation problems in her right leg, and it appeared that an amputation was inevitable. Ms. Dicke, who was herself a physiotherapist, attempted to relieve the back pain, which accompanied her condition, by means of a kind of massage which used deeper strokes than those used in conventional massage. This caused tingling and shooting pain in the affected leg. In this way, the circulation in the leg was increased, the back pains disap- peared, and within a year she was completely healed. Based on this experience Elisabeth Dicke developed and refined this effective treatment method, and taught it to others until her death in 1952. Dr. Hede Teirich-Leube learned this method from Elisabeth Dicke and refined it With Mr. Kohlrausch. She developed massage for the reflex zones in connective tissue that could be used with rheumatic conditions and internal illnesses.

Effects: The effects of deep-tissue massage include not only a stimulation of the metabolism and a detoxifying action but also the release of certain nerve-sense reactions.

93 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Diagnosis: To make a diagnosis of the deeper tissues, it is important to take a look at the connective tissues in the back.

The patient sits upright in front of us-it is important to have a good source of light and that the patient is not sitting in shadow. We can recognize affected areas by looking at changes in the connective tissues. We are talking here about contractions, or swelling around the contractions. At times one can observe reddened or hairy areas, or rashes, that give us a clue. Disturbances in the function of inner organs often lead to painful swelling and tension in the connective tissues. Every organ or organ system has a corresponding segment in the connective tissues. It helps enormously to get to know the zones of the connective tissues, even if you don’t intend to do deep-tissue massage. This gives you helpful indications when making a diagnosis. Make use of every opportunity to confirm your diagnosis.

Therapy: By palpating and working through the connective tissue zones you can release the tension in these areas and support the healing processes of damages organs, or heal them completely. This is a technique that has enriched physical therapy and the therapy done by naturopaths considerably. Deep-tissue massage is a stimulating treatment – for this reason it can cause mild, spasm-like pain during treatment which is usually experienced by the patient as pleasant .

94 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Goal: The goal is a firm, well-perfused connective tissue, an indicator of general good health, and the release of tension in the subcutaneous connective tissue.

Possible Indications: »» Migraines »» Period pain »» Rheumatism »» Circulation problems, particularly in the legs »» Venous conditions »» Ulcers in the lower extremities »» Varicose veins »» Thrombophlebitis »» Digestive problems »» Liver problems »» Cardiac problems following myocarditis »» Heart failure »» Dilation of the myocardium »» High blood pressure »» Dysmenorrhea »» Problems with breast feeding »» Pelvic inflammations »» Neuralgia »» Inflammations of the nerves »» Paresthesia and paralysis

95 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Spiral of Stress:

We speak of a “spiral of stress” when more than one joint in the body is affected and causes pain. Often the pain takes a “zigzag” course over the entire body. This can happen from the top downward or from the bottom upward.

Example: »» Right ankle is painful »» Left knee is painful »» Right hip is painful »» Left lumbar vertebra is painful »» Right thoracic vertebra is painful »» Left cervical vertebra is painful »» Right jaw is painful

96 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Explanation: In a healthy foot the ankle absorbs the bumps it gets during walking. If one sprains an ankle, the knee instead of the ankle has to take these bumps and although the ankle is protected the knee has to take the stress, causing weight in the knee to be distributed differently. This in turn affects the hip, causing a difference in length between the two legs and an increase of tension in the muscles.

This then causes a severe strain on the sacro-iliac joint, which in turn has an effect on the spine. Tension builds in the back, which affects the muscles in the neck and shoulder – and that can cause headaches or other problems in the head area.

So, to put it simply: a foot out of alignment can lead to headaches. But just as easily, a jaw that is not in alignment can affect the knee or the feet. The more stress the muscles have to deal with, the tenser they become. And the more stress a person has to deal with, the tenser he is. Therefore, make sure that all your therapies contain a pinch of relaxation. Whether this is a stretching session, yoga or meditation, it doesn’t matter – main thing is you do something about it, So that the body and muscles get in balance.

97 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Effects of Displacements in the Spine on Other Areas

C 1 (cervical): C4: • Hay fever • Headaches • sinusitis • nervousness • loss of hearing • sleep disturbances • increased blood pressure C5: • Laryngitis • migraines • hoarseness • exhaustion and dizziness • sore throat

C2: • Sinusitis C6: • Stiff neck • allergies • upper arm problems • deafness • tonsillitis • ear pain • bronchitis • fainting spells • vision problems C7: • Colds • thyroid problems C3: • Neuralgia • bursitis of the elbow • acne • eczema

98 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de T1 (thoracic): T7: • Gastric ulcer • Asthma, bronchitis • gastritis • breathing difficulties • pain in the lower arm T8: • Increased tendency • problems with the hands to get infections

T2: • Heart disease T9: • Allergies • angina • rashes

T3: • Bronchitis T10: • Kidney problems • pneumonia • atherosclerosis • angina • exhaustion • nephritis T4: • Gall bladder dysfunction • jaundice T11: • Skin problems • herpes zoster? • acne • eczema T5: • Liver problems • fever T12: • Rheumatism • low blood pressure • flatulence • anemia • sterility • circulation problems • arthritis

T6: • Stomach problems • digestive disturbances

99 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de L 1 (lumbar): L4: • Sciatica • constipation • lumbago • colitis • problems with urination • diarrhea • hernias L5: • Circulation problems in the legs L2: • Cramps • swollen legs, cold feet, • breathing problems cramps in the legs • hyperacidity • varicose veins

L3: • Bladder problems • menstruation problems • birth defects • impotence • knee problems

Sacrum/coccyx • Hip problems • hemorrhoids

100 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Connections Between Various Joints

Jaw-Pelvis Shoulder-Hip Elbow-Knee Hand-Foot C1-L5 C2-L4 C3-L3

We can often discover problems that affect the right shoulder and the left hip, at the same time – these problems are related to one another, and the one caused the other. Therefore, it is always important to keep in mind that there can be a variety of causes for an illness. We are dealing with the whole person, not just one body part.

Look at the person as a whole, as a sum of all the parts.

101 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Pain

Cultural Aspects of Pain In general one can say that our culture is getting increasingly soft. When one compares children who live in the country with those in the city, one can see how “tough” the country youth still are. A similar phenomenon can be observed in other countries and cultures. In Canada the children are pretty tough, they rarely complain much when they fall, for instance. Native Ameri- can children, even today, are dipped in a cold river or lake by their fathers after birth – to be sure this only happens with boys, girls have an easier time of it. Boys in Africa are circumcised at the age of 10 or11, which is seen as a sign of manliness. Girls’ vaginas are sewn closed, with no form of anesthesia, until marriage. These are a number of things that make no sense to us, in our culture, but are very important in others. Suffering an agonizing death is another very important cultural value. Think of the films where Native Americans who are taken prisoner are tortured – the less they show their pain, the more honorable their death. In Australia pain is “magically away” by medicine men and by the whole tribe dancing and singing hypnotically around the ill person. Attitudes toward pain have changed a great deal in the course of the cen- turies. In the Middle Ages bearing pain was seen as a chance to be close to Christ and as such was highly regarded by the community. It was regarded as an honorable task, as something sent from God. Pain today is regarded as a malfunction in the body.

102 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de We differentiate between acute and chronic pain: Acute pain: Pain is caused by tissue damage and lessens as the tissue heals. Pain is one of the body’s warning signals (it can keep us from bleeding to death, for example) and can be treated effectively by the use of pain medication. In cases of extreme pain, the opiates (morphine-like medications) can be very effective.

Chronic pain: In this case there is often a separation between the pain and the actual tissue damage, so that no primary cause can be ascertained. Chronic pain needs to be treated differently from acute pain. There are socio-medical, ergonomic, psychological, bodily and social factors that need to be considered.

103 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Consequences of chronic pain: Physical: loss of mobility brought about by pain leads to poor posture to protect the affected area, which in turn leads to loss of mobility (vicious circle)

Psychological/emotional: depression, exhaustion and lack of energy, fear. All of these symptoms lead to psychosomatic problems: anxiety, tachycardia, sleep difficulties and digestive problems. (vicious circle)

Social Contact: reduction of performance of daily tasks causes conflicts in the family, with the employer (fear of losing a job), circle of friends (lack of understanding) and in the long term, financial problems.

104 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Experiencing Pain The primary symptom in branches of medicine that deal with the muscular- skeletal system is pain, considered by patients to be extremely disabling. It is not only an indication of a damaged system, but areas further away are affected as well. Everyone experiences pain in a different way – it is highly individual, and just because we might be able to deal with it, when it comes our way, does not mean that we should mock the experiences of others. Pain is not only caused by localized processes, but also by centrally located instances.

How pain makes itself known

On the body’s surface it is: »» sharp »» clear »» sharply defined »» piercing or biting

In deeper areas of the body it is: »» dull »» diffuse »» frightening »» spasmodic

The most common pain in the muscular-skeletal system is that which is re- ferred by pain receptors.

105 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Pain receptors:

Point of departure are the free-standing ends of the nerves=the nociceptors that transmit the first pain by means of the A-Delta fibers under the skin (clear, sharp or piercing); the pain is then slowly carried further by the C fibers (these lie deeper) until it finally causes dull, deep, pain that is difficult to localize.

Pain is a signal that reports damage to the brain by means of the nociceptors.

Pain is brought to the dorsal horn, and nociceptors and other instances there decide if the pain will be sent any further. As the pain threshold is distinctly higher than the nociceptor threshold, it takes a certain accumulation of im- pulses before the pain arrives in the CNS.

Pain always depends on how much meaning it is given. A child that falls and is ignored when it starts to cry, is told that it’s “not that bad”, will not start to make a “big deal” out of it, unlike a child that is fussed over - “oh, you poor thing, that looks really bad.”

106 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Forms and Sources of Pain: 1. Nociceptor pain: pain receptors are stimulated and pain carried to the brain

2. Neuropathic pain: damage to the peripheral or central nervous systems (amputations, quadriplegia, herpes zoster, polyneuropathy)

3. Functional pain: for instance with migraines caused by a disturbance in the vascular system (lack of adequate perfusion), or back pain caused by poor posture

4. Psychosomatic pain: fear activates the sympathetic nervous system. Consequence: muscle tension. Emotional stress, for example marriage problems, can cause psychosomatic pain as well. Increased attention and concern on the part of others for one’s problems can be a secondary ben- efit of being ill

107 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Pain and its Localization Headaches migraines, cluster headaches (more often men, periodic occurrences, short attacks), tension headaches

Facial pain trigeminal neuralgia

Back pain cervical/ thoracic syndrome, lumbago, sciatica

Joint pain arthrosis, rheumatic pain

Muscular pain fibromyalgia, torticollis

Neuropathic pain phantom pain, stroke, polyneuropathy

Tumor pain

Ischemia

Psychogenetic pain

108 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Forms Pain Can Take 1. Inflammation pain: arthritis, myositis, appendicitis, pancreatitis, tooth ache, wound pain 2. Spasmodic pain: heightened contractions in the smooth muscles of inner 3. organs: gall bladder colic, period pain, chronic gastritis, colitis 4. Nerve pain: neuralgia, amputation, carpal tunnel syndrome, herniated disc, peripheral neuropathy

Pain in the Muscles and in the Connective Tissues: Most of the pain in the connective tissues and the muscles is caused by acido- sis in the tissues brought on by diminished perfusion to these areas. A hyperacidity of the tissues causes tension. Drinking too much coffee, a sugary diet, and a diet rich in meat contribute to the creation of deposits in these regions.

Important for all those with pain in the muscular-skeletal system: No pork!!!! The cell nucleus of pigs is nearly identical to that of humans, and our body cannot differentiate between animal and human tissue. For this reason animal cells are deposited in connective tissue, in joints, or in muscles.

This is of great importance for patients with rheumatism or gout as well!

109 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Course of Pain through the Pathways of the Brain: Neocortex: cognitive process (cognitive recognition)

Limbic System: emotional process (emotional recognition)

Hypothalamus/Hypophysis: secretion of hormones and endorphins (endogenous morphine=analgesic effect)

Brain Stem: regulation of circulation and respiration, reticular activation system

Spinal Cord: motor and sympathetic reflexes Chronic pain can lead to feelings of depression!!!

Substances that the body itself makes to create pain: Serotonin: constricts the arterioles, stimulates smooth muscles, probable cause of migraines (built from tryptophan)

Bradykinin: causes pain (kinins)

Prostaglandin: fever, inflammation and pain

110 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Therapies for Pain: 1. Neural therapy 2. Quaddeling 3. Trigger points 4. Massage 5. Deep tissue massage 6. Chiropractic 7. Acupuncture 8. Ear Acupuncture 9. Homeopathy 10. Phytotherapy 11. Foot zone reflexology 12. Psychotherapy 13. Neuro-linguistic Programming (NLP) 14. Convention pain medication

1. Neural Therapy: With neural therapy, disturbed areas are calmed by the use of a local anes- thetic (for instance procaine or lidocaine). The nerves of the affected organ or painful area are freed and anesthetized. Injecting the area surrounding scars with procaine is particularly beneficial, as the scar becomes softer and “relaxes”. One need to do these injections 3-6 times, sometimes more often. Afterwards, affected areas far from the scar itself get better by themselves, for example migraines that disappear after a scar on the knee have been treated.

111 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 2. Quaddeling: With quaddeling procaine or lidocaine is injected intracutaneously under the skin to create wheals (quaddels). This method is especially effective for back pain – one injects to the right and left of the spine. One needs to consider, however, that the injections are very unpleasant for the patient – the wheals create small depots of medication that are then slowly absorbed into the body.

3. Trigger points: Trigger points are points that, when touched, cause pain at first. It was discovered that if one holds the trigger points for at least 90 seconds, the pain in this area decreases. This method is especially effective in the neck and shoulder area. The patient needs to be instructed to breathe deeply during the session, which aids relaxation. We have trigger points all over the body, but particularly on the back.

4. Massage: Every form of massage brings relaxation and loosens muscles. One can bring relief through stoking and kneading. A massage should never be done in such a way that it causes pain, but rather in such a way that it helps the patient to relax, neither too lightly nor too hard – if one only lightly brushes the skin, this has no effect, and if one massages too deeply, the muscles cramp even more. A middle way is the best one here.

5. Deep tissue massage: This is a special technique that uses sharper, pulling strokes on the skin. It is appropriate for circulation problems and deposits in the joints and other areas of the body, as well as for back pain and pain in the extremities. Excellent therapy for rheumatic illnesses and pain in the muscular-skeletal system.

112 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 6. Gentle Chiropractic: A gentler form of chiropractic, that I developed in Canada to help patients with back problems. Here, technique is important and not actual physical force. The advantage of this technique is that one cannot cause lasting damage. The method was developed from traditional chiropractic, but is much gentler and has far fewer side effects, which actually only occur when the technique is used improperly. For this reason the stance of the provider and the correct position of the patient as well are of great importance. This is a technique to bring the spine back into proper alignment through manipulations that correct displacement. If vertebrae aren’t in alignment, they press on nerves, which cause nerve pain that can be extremely unpleasant.

7. Acupuncture: Chinese acupuncture treats painful muscular conditions and spasms effectively. Acupuncture needles are applied at particular points along meridians to relieve pain. The therapist uses pulse diagnosis and other Chinese methods to determine where the needles should be applied and what combination of needles should be used.

8. Ear acupuncture: Ear acupuncture was developed by the French, and takes place, as the name indicates, only on the ear. It is especially appropriate for problems in the spine. Using small, short needles, applied to particular points, pain can be relieved. Also migraines and colic can be helped with this method. The ear represents an upside down embryo, which gives us an indication where the organ and spine points are. There is also a device which can help us to find the correct points. If one masters the art of pulse diagnosis, one can find the points that way, too – but this requires a lot of practice.

113 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 9. Homeopathy: Various homeopathic remedies, especially chosen for painful conditions can relieve pain or eliminate it completely. We distinguish between Classic Homeopathy and Clinical Homeopathy. Clas- sical Homeopathy takes an exact medical history and afterward the remedy is chosen. With Clinical Homeopathy the remedy is chosen according to the symptoms, and the remedies can be injected, given as a single remedy, or as a combination of remedies.

»» Aconite for acute pain »» Arnica for sprains and bruising »» Gelsemium for headaches »» Symphytum for fractures

10. Phytotherapy: Here various teas and tinctures are given to relieve pain and other symptoms. Teas can be used as a mixture, or singly. Phytotherapy is regarded as a supportive therapy.

»» Willow bark for headaches »» Licorice for gastric ulcers

11. Foot reflexology: With foot reflexology, certain points on the feet are massaged in a particular way, and points that prove to be painful are given extra attention. A session always includes a massage of the entire foot, not merely particular points. For successful treatment it should be done regularly, 3-6 times.

114 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de 12. Psychotherapy: In psychotherapy it is above all important to discover the psychological reason for the pain. When one has worked this out – that the patient is using the pain to try to get more attention, for example – then one can work with the patient to learn new patterns of behavior, so that, for example, the patient finds other ways to gain recognition than through pain.

13. NLP (Neuro-linguistic Programming): NLP is a therapy that helps the patient to recognize his core beliefs and to change those beliefs in order to focus on something else besides pain, for example - “I’m healthy and have a ton of energy” Our language has an influence on our psychological condition. If one says to one’s self “I can’t do that, I don’t know that, it’s too hard”, this has an effect on us, but in principle one can reprogram everything. All it needs is recognition and the readiness to change one’s beliefs.

14. Conventional pain medication – analgesia: Non-opiate pain medications: Tylenol (lowers fever)

Aspirin and NSAIDS: Ibuprofen,etc.

Opioïdes: Codeine, tramadol

Opiates: Morphine, fentanyl (as patch), etc.

Use of opiates can lead to dependency!!!

115 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de Other publication from Christina Reuter

DVD and E book: Reuter Massage a complete new home study course. In this course you will learn how to perform a very good, rhythmical and soft massage. You will learn all the techniques used in massaging other people, so that they will be totally relaxed and stress free. www.learning-massage.com

Holistic Back training for a healthy back: In this E Book you learn how you perform an excellent posture and how to strengthen your muscles - so that you will not suffer from back pain.

Link: noch nicht verfügbar

If you have questions I will be happy to answer them: [email protected]

Sent me your comments to my email address: [email protected] or to www.twitter.com/Chiropraktik1

I wish you all the best with your clients and a lot of success

Christina Reuter

116 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de A last word from the author

I hope you enjoyed this E Book about Chiropractic and that you learned a lot for your clients.

Treat your clients always in the best way you can.

You will in fact earn more money and respect, if you treat your patients as though your life depended on it and give your very best, out of true conviction.

You will move vertebrae, if not mountains!

Your reputation will soar, because nothing spreads through the world faster than stories of successful treatment, or failure, too, for that matter. Propagan- da by word of mouth is the best that can happen to you.

I wish you a life full of success and happy clients

Christina

Impressum: Reuter Verlag: ISBN 978-3-944823-03-4 Author: Christina Reuter Proofreading: Madeleine Reuter Layout: nau-arts.de

117 © Copyright Christina Reuter • Chiropractor and Naturopath Otto Fischer Weg 2-1 • D-72766 Reutlingen, Germany • Phone +49 (0) 7 121 - 208 343 • [email protected] • www.christina-reuter.de