remembering larry jones, do - american academy of...
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REMEMBERING LARRY JONES, DO
YAKIMA VALLEY APPLE ORCHARD
This is what I want to do for the rest of my life
PACIFIC SANITORIUM AND SCHOOL OF
OSTEOPATHY
Graduated from Osteopathic school
in 1936 at the age of 24
This was a 3 year program
Attended Gonzaga University
for Undergraduate work
Interesting that anatomy was one of his least favorite subjects.
DURING THE WAR YEARS
•Practiced as a GP,
•Delivered babies
•Following the return of MD
Physicians
after the war soon lost hospital
privileges and was asked not to
attend monthly CME programs
Medical records
were on 4x6 cards
FOCUSED ON OSTEOPATHIC MANIPULATIVE
MEDICINE “WORK”
During this era Dr. Jones worked with many of the giants of our profession, and many of the quiet practitioners that reinforced the discoveries he made.
This included Fred Mitchell Sr., Lon Hoover, TJ Ruddy, Hal Schwartz, Kim Korr, Rex Conyers, Bob Wendorff, Murray Black, Scott Heatherington, Sally Sutton, Berkely Brandt and Harmon Myers to name a few.
I one time asked him what it was like to meet with all those brilliant people? His response was that “they would sit in the hotel rooms
until the wee hours of the morning smoking cigarettes and drinking whiskey discussing how any OMT really worked!”
DISCOVERIES IN STRAIN/COUNTERSTRAIN
From this heritage of questioning physicians he had an accident, a discovery that left him “pacing” for an entire evening.
This was the initial discovery that brought him to the comfortable position experience.
This occurred sometime in 1955.
Second experience was again an accident which led him to the existence of anterior tender points.
DISCOVERIES IN STRAIN/COUNTERSTRAIN
1963: he published his first article titled Spontaneous Release by Positioning. This was followed by Atraumatic Treatment of the Feet.
Dr. Jones was prompted to begin tutorials that he held in his office in Ontario Oregon.
Small groups of physicians would gather together for 2 week periods and watch him treat his patients. This gave the physicians real-time access to injured patients and the resulting successful outcomes.
OFFICE BASED TUTORIALS
George Nahrang, John Stanfield, Robert Wendorff, LH Jones,
Adolph Zachow, Craig ?, Arlen Bass
TUTORIALS
LEARNING TO TEACH HIS DISCOVERY
Initially Larry was told he shouldn’t speak
Toastmasters First then the Kiwanis club
First visual aids
ACADEMIC ACHIEVEMENT
Concerned that his work Strain/CounterStrain
would not be recognized he completed his
fellows work with the first Strain/CounterStrain
book as his treatise for the fellowship.
CONFLICT IN TERMINOLOGY
Trigger Points versus tender points
Many discussions regarding this with many colleagues, not always collegial in nature
Larry was always very dogmatic on just how something needed to be done until later in his career
Maverick Points
AC1 rare, not so rare
One track Mind
MY INTRODUCTION
Blind Date
Parents on a year long trip around the world
Father was writing a book
Crazy guy lost his first copy on the trip and had to rewrite it
Proposed to Barb before they returned
I had no concept of Osteopathic Medicine
My father shared with me that Larry was a fancy Chiropractor
FIRST TREATMENT
Awoke one morning during calving season, bent over the sink coughed, literally crawled to my bed
Barb comes home that evening and tells me she is calling her Father
OMG!!!!
Posterior Rib Treatment
I crawled back into bed, and the next afternoon I was pushing cattle around
MULTIPLE CHALLENGES
Watching him work for several years
Treating in the back bedroom
Constantly telling him it couldn’t work the way he described
Discussion about the spindle and the inappropriate muscle tone, research on my part with quarter horses versus thoroughbreds
I didn’t believe it could work BUT if it did it was pretty simple
SO DO IT
My journey began;
Treating Richard
“Bloodless surgery”
Learning with my hands
had begun years before
Patient that needed to
“praise the Lord”
Published in 1979
BRINGING HIM MY NEW DISCOVERIES
New piriformis
Yep it works some of the time
Ed’s arm pit, Now known as the serratus
anterior superior - NOT IN THE BOOKS
Obturator internus
Barbs 1st Rib
MY FIRST TUTORIALS
Larry noted my anxiety about being around
physicians and allowed me to attend some
tutorials as an IT person.
I discovered these physicians were regular
people.
First course
LARRY’S RELUCTANCE
Recommendation for school
“Well, I don’t know much about Veterinary medicine
but from what I see, it looks OK to me”
I returned to school after 15 years from my
graduation from undergraduate and 10 years from
my Veterinary degree.
Studied for the MCAT after a couple months and
entered the struggle
RETURN TO SCHOOL
Warned to keep a low profile at COMP,
Dr. J and Dr. F did not have the best relationship
Discovered by Dr. Jones
Teaching in the curriculum with Dr Jones and Dr Jones, “Thought he would come if Katey could come and visit the grandkids”
Our wives soon became bored with us
He thrived on the student input and questions
Encouraged me to write the section on physiology in the new text
BEING PREPARED
During tutorials you got one chance to lecture
If not prepared you would not be asked again
for months
When Larry deemed you were ready he would
present you with your own set of Kodachrome
slides
Only then could you leave the nest on your own
WORKING WITH THE CONCEPTS
“Kinks” have a part in everything
Family created a cheer “kinks cause everything, KINKS, KINKS, KINKS”,
because he would say about many problems “you know there is a kink for that”
Larry was very much a pragmatist but still very rigid in his treatment teaching initially, loosened up over the years
His family was not allowed to use aspirin
OBSERVATIONS
Sent me to study with Dr Hal Schwartz
“He does it all wrong but the patients all
improve”
Hal helped me understand that the segment
was the key to the treatment
New treatment techniques and clarification of
anatomic structural locations and relationships
This led to a different focus from Larry
ALWAYS A TEACHER
Whether it was SCS or compound interest he
was constantly teaching.
Remember that point requires more pressure,
that point requires more rotation
Up to 1-2 pounds of pressure
Accepting the limitations of others was hard for
him in the beginning
PATIENT TO A FAULT
Always politely answered even the stupid questions
Frustration with his own profession led him to work with Dick Darby DO and Randall Kusonosa PT in the arena of Physical Therapy
These people marveled at the techniques and the results they would see using this method
They still have the Jones Institute dedicated to teaching the Strain CounterStrain to the world
CONSTANT RESOURCE
Calling Larry in all reasonable hours and for all
things Osteopathic
Patient with ulcerative colitis
6th out, Anterior 6th thoracic= crabby kink
7th is a hungry kink
LED BY EXAMPLE
Tutorial and the PFH
Teaching anterior versus posterior points/pain
Trip home from Southern California with Frieda
Return to school and treating colleagues
JAPAN
Traveling to another part of the world and
discovering a whole new Osteopathic World
Helping with the translation for the book
Japanese Osteopathic Academy
Koichi Hirasuka, now his son Yoshi
COST RICA
Treatment for conversation
American doctor will provide osteopathic treatment
in trade for English conversation
Met many life long friends
Belgian ambassador
Alex Murray, wife Chi-Chi
WRITING THE LAST BOOK
Planning and writing and rewriting
Pictures at Eastmoreland
Reviewing the text and frustrations with some
incorrect pictures and unclear dialogue
Acknowledging that if we didn’t publish he
would be gone before we could
Laying a firm foundation
BLUE TEXT
New Printing with modest
changes
Available:
Jones Strain/CounterStrain
155 Wendell St
Lebanon, Oregon 97355
Attn: Barbara Jones Goering
AT THE END
Larry welcomed treatments at the end
Fell on his last day and fractured his pelvis
Told me his biggest concern was that SCS
should outlive us all!
I promised him I would do my best
Teaching
Travelling
Writing
CONCLUSIONS
CONCLUSIONS
The Andrew Taylor Still Award (too late?)
March 1996 died in April 1996
Dr Mark Cantieri and Dr John Glover treasured
friends and students
Science has proven his clinical experience and
postulates to be true
The location of the dysfunction, the location of
the tender points and the location of the pain
FUTURE OF SCS
Frame work of SCS basis for all new variations
of this technique
Visceral
Lymphatic
Arterial
Venous
Nervous system
KEEP WORKING
Don’t let the bad
guys (bastards)
grind you down!
90 percent of all benign headaches fall under a few categories
migraine,
tension-type,
cluster
chronic daily headache.
While episodic tension-type headache is the most frequent headache type in population-based studies, migraine is the most common diagnosis in patients presenting to primary care physicians with headache.
ETIOLOGIES OF HEADACHES
MOST COMMON FINDINGS IN A MUSCLE
TENSION HEADACHE
Upper Ribs and thoracic WHY
Cervical Intervertebral dysfunction WHY
Cranial Dysfunction WHY
Sacral Dysfunction WHY
WIRING OF THE HEAD AND NECK AND
THORACIC AND RIBS AND UPPER EXTREMITY
AND SACRUM
1. Sympathetic innervation of the ribs, cervical spine, upper extremity and head is from the upper thoracic segments!!!
2. Pain= Increased sympathetic tone =increased tension in the muscles
(increased firing Gamma motor neurons)
3. Chronic environmental changes in the spinal cord fluid mix= increased glutamate, bradykinens, substance p, with reduced functionality of the inhibitory mechanisms in the spinal cord
Musculoskeletal
PR1 (watch out for the omohyoid)
PC3 (ipsilateral lateral column requires forward
bending with side bending and rotation away)
AC1 (may need the addition of the mastoid
lymphatic drainage to treat)
OCCIPITAL HEADACHE PROTOCOL
INITIAL MUSCULOSKELETAL APPROACH
1. PR1
2. PC3
3. AC1
INITIAL MUSCULOSKELETAL APPROACH
• 1. PR1
• 2. PC3
• 3. AC1
Anterior
Lateral
columns
POSTERIOR RIB
POSTERIOR 1ST RIB POINT
Region of the tender point
PR1
1ST RIB ATTACHMENTS
PC3
PC3
PR1
PC3
PR1
PC3 Semispinalis
Scalene
DEEP CERVICAL MUSCLES
Intertransversarii
Levatores costarum breves
POSTERIOR SCALENE
MIDDLE/ANTERIOR SCALENE
AC1
AC1
Stylomandibular ligament
Sphenomandibular
Ligament
Sphenomandibular Ligament AC1
Sphenomandibular
Ligament
Stylohmandibular Ligament
Sphenomandibular ligament
CONCEPTS IN CARE
Difficult Headaches
Difficult Shoulder Pain
Difficult Rib Pain
Difficult Anatomy
1st Personal Finding
Referral for tumor in the shoulder
ANATOMY HICCUPS
Posterior 1st Ribs (Barbs Rib)
Omohyoid
Serratus anterior Superior
•Omohyoid Tender Point Location
•Superior Belly
•Inferior Belly
Treat Posterior 1st Rib with the Omohyoid
Muscle
OMOHYOID MUSCLE
Omohyoid
Superior belly
Inferior belly
C1 upper belly
C3C4 lower belly
OMOHYOID CLINICAL FINDINGS
Recurrent headaches
Shoulder pain
Impingement with referral down the arm
Overlying trapezius spasm
Aggravated Levator Scapa pain
Thoracic Outlet Syndrome
TREATMENT TECHNIQUE
Supine Treatment
Without PR1
With PR1
Seated Treatment
SUPINE
POSTERIOR FIRST RIB WITH OMOHYOID
TREATMENT
Treat Posterior 1st Rib with the Omohyoid
Muscle
OMOHYOID MUSCLE
SEATED
Although sinus headache is commonly diagnosed by physicians and self-diagnosed by patients, acute or chronic sinusitis appears to be an uncommon cause of recurrent headaches, and many patients presenting with sinus headache turn out to have migraine
Patients frequently attribute headaches to eye strain. However, an observational study suggested that headaches are only rarely due to refractive error alone. Nevertheless, correcting vision may improve headache symptoms in some of these patients.
There is a common belief, particularly among patients, that hypertension can cause headaches. While this is true in the case of hypertensive emergencies, it is probably not true for typical migraine or tension headaches.
As an example, a report from the Physicians' Health Study of 22,701 American male physicians ages 40 to 84 years analyzed various risk factors for cerebrovascular disease and found no difference in the percentage of men with a history of hypertension in the migraine and nonmigraine groups. Furthermore, a prospective study of 22,685 adults in Norway found that high systolic and diastolic pressures were actually associated with a reduced risk of nonmigrainous headache.
HEADACHE MYTHS
NOVEL ETIOLOGY OF TENSION HEADACHES
NOVEL ETIOLOGY OF TENSION HEADACHES
Still was an advocate of appropriate lymphatic treatment
This belief developed independently of European influence
Although not a follower of Dr Still, Danish massage practitioner Emil Vodder, PhD, was motivated—like Dr Castlio, Dr Ferris-Swift, and other osteopathic medical researchers—to explore the lymphatic system.
EARLY LYMPHATIC TREATMENT
To drain cervical lymphatics stand on the right side of the patient, in dorsal position, place the left hand on the forehead, and with the right hand reach over the sternocleidomastoid muscle, draw the muscles up closely around the chin, with pressure on parotid and sub-mental gland, turn the head away gently with the left hand, and continue this movement downward, one vertebra at a time, to the seventh cervical.
LYMPHATICS
THE UNDERAPPRECIATED CULPRIT
In an article published in 1920 titled
“New method of diagnosing various diseases by palpating lymphatic glands”
Dr Millard described major points of lymph node palpation for specific clinical diagnostics based on lymphatic, osseous, fascial, and nerve lesional findings. His recommended treatments typically took 5 to 10 minutes to complete.
In 1929, William Otis Galbreath, DO, developed a simple lymphatic technique using mandibular manipulation in a pumping fashion to help open and close the eustachian tube, thereby allowing “the ear to drain accumulated fluid more effectively.
OTHER LYMPHATIC TECHNIQUES
Frank D. Chapman, DO, and his wife, Ada Hinckley Chapman, DO—both graduates of ASO—made important contributions to research on the lymphatics during the 1930s.
In 1937, Dr Ada Hinckley Chapman and Charles Owens, DO, wrote the book An Endocrine Interpretation of Chapman’s Reflex, which described a system of reflex points first used by Dr Frank Chapman.
OTHER LYMPHATIC TECHNIQUES
Lymphatic Structure
Lymph Angions
Filtration
Pumping
Stimulated by force vector/rate of flow over the bulb of the valve which induces Nitrous oxide synthetase, which in turn induces dilation with following contraction.
Rate and strength of contraction have been shown to directly relate to the stimulation of the valve
HOW DOES IT WORK
Minimal documentation of parasympathetic innervation
Sympathetic causes modification of the immune response by contraction of the lymph nodes, activates lymphocytes but does not increase flow, indeed it may decrease flow
Trauma will reduce the function of the lymphatic components to remove fluid “Nature’s Cast”
INNERVATION
Dr. Frank Chapman explained that the surface changes of Chapman’s reflex can be found in the deep fascia as “gangliform contractions” located at specific points of the body and related to fixed organs
Similar reflex points were documented by Dr. Henri Jarricot, 1903-1989, and are treated in a similar methods to Chapman's reflex points
These are both believed to be areas of lymphatic congestion secondary to increase sympathetic influence
VISCERO-SOMATIC FINDINGS
The abnormal sympathetic tone has effects in sites not always directly understood, be it local or distant.
Utilizing these functional referral points as indicators for diagnosis and treatment is again becoming a hot topic.
The Jone’s fascial tenderpoint, the Chapman's reflex point, the Jarricot “dermalgias reflex” all seem to have some similarity
Treatment techniques have a consistent thread
BELIEF
Gentle tractioning
Gentle firm circular massage
Visceral manipulation effecting the sympathetic
stimulated structure
Local effect versus Distant effect
Distant effect versus Local effect
TREATMENT METHODOLOGY
Classic Jones Tenderpoint is a consistent musculoskeletal finding
Treatment addresses the central neuromuscular innervation of the specific muscles and nerves involved.
Requires 90 seconds to get a consistent results
Treatment effects a muscular group or joint articulation, a distant treatment with a local effect.
A DISCUSSION REGARDING
THE TENDER POINT
Musculoskeletal Points consistent with
consistent response and resolution
The tender point that wouldn’t go away
Fascial
Visceral/Arterial/venous/lymphatic/Nerve
PRETTY COOL,
HUH!
The endothelial lining of the tubular viscera and
the vessels: lymphatic, arterial, and venous are
the primary means of modulating the tension
involved in the resting and active tone of the
structures wall
The nerve modulation functions in a manner not
well understood but the gentle compression of the
nerve towards its source will relieve the
tenderness found in the more distal components
ANATOMIC AND PHYSIOLOGIC CORRELATIONS
AND CONSIDERATIONS
So the modifier is activity of the endothelial wall; the activation of the nitrous oxide synthetase enzyme which in turn is involved in the release of nitrous oxide into the local tissue
This results in vasodilatation.
Veins and lymphatic require a gentle stretch to activate the process
Arteries require a gentle compression which results in vasodilatation proximally from the compression, stretching the endothelial wall and the process is engaged
ANATOMIC AND PHYSIOLOGIC CORRELATIONS
AND CONSIDERATIONS
BREAK!!!!!
THORACIC AND LYMPHATIC DUCT
CRANIO-CERVICAL LYMPHATICS AND
LYMPHATIC TENDER POINTS
Internal jugular
LTP Thoracic/Duct LTP
Anterior Axillary
LTP
Submandibular LTP
Parotid LTP
Jugular Digastric LTP
Anterior Jugular LTP
Mastoid LTP
Anterior/posterior auricular
Nodes
Posterior
Axillary LTP
LYMPHATICS WITH A
COUNTERSTRAIN TWIST
Thoracic/Lymphatic Duct(DUC- LTP) LTP: Located over the superior medial aspect of
the first rib(AR1) at costochondral margin.
Left=Thoracic duct
Right =Lymphatic Duct
Treatment; Fascial glide of lymphatic vessels
posterior to the clavicle and lateral to the SCM
mm. in a lateral and slightly posterior direction
LYMPHATICS WITH
A COUNTERSTRAIN TWIST
Internal Jugular Lymphatic
LYMPHATICS WITH A
COUNTERSTRAIN TWIST
Muscle mass of PC5 lateral
Anterior Jugular Nodes (AJ- LTP)
LTP: Located over the
posterior C5/6 muscle
mass
Bilateral
Treatment; Patient supine
Fascial glide-grasp the
SCM and distract the
tissue medially at the level
of C5
LYMPHATICS WITH A
COUNTERSTRAIN TWIST
PC2 muscle mass
Jugulodigastric Node (JD- LTP)
LTP: Over the posterior aspect
of the C2 articular pillar in the
muscle mass, boggy,
Bilateral
Treatment; Pt. supine
Cervical; rotation of the head
away from the tenderpoint side
moderately.
Fascial glide; along the line of
the Jugulodigastric muscle in
an anterior superior direction.
LYMPHATICS WITH A
COUNTERSTRAIN TWIST
Within the major muscle mass between the PC2 and Inion
tenderpoint Occipital Nerve
Parotid Nodes (PAR/OCC- LTP: )
LTP: Located below the
superior nuchal on the
inferior aspect of the occiput
Bilateral
Treatment; pt. supine
Cervical; Moderate rotation
away from tenderpoint
Fascial glide; skin and
lymphatics anterior to the
lobe of the ear in an anterior
/superior direction along the
inferior aspect of the
zygomatic process
OCCIPITAL
NODES
LYMPHATICS WITH A
COUNTERSTRAIN TWIST
Close to the lambdoidal point
Submandibular Nodes (SUB- LTP )
LTP: Located Lateral to the
external occipital
protuberance, about 1 cm
above the PARR/OCC LTP.
Bilateral
Treatment; Pt. supine
Cervical; Moderate rotation
away with mild extension.
Fascial Glide; Submandibular
lymph nodes, anterior to the
angle of the jaw, in a superior
and anterior direction
LYMPHATICS VERSUS AC1 VERSUS LC1
Mastoid lymphatic LTP
Remember with the Lymphatics start at the beginning
LYMPHATICS WITH
A
STRAIN/COUNTER
STRAIN TWIST
Direction of Pressure important
Close to the AC1 beneath external auditory meatus
Mastoid Nodes (MAS- LTP)
LTP: Located on the inferior
aspect of the external
auditory meatus, anterior
and superior to the mastoid
process
Bilateral
Treatment: Pt. supine
Cervical; mild rotation away
unless treatment involves
AC1, then marked rotation
away
Fascial glide; Fascia and
lymphatics located along the
posterior/ upper aspect of
the SCM mm and occiput in
a superior and anterior
direction (towards the
mastoid)
LYMPHATICS WITH A
STRAIN/COUNTERSTRAIN TWIST
Anterior Auricular nodes (AA- LTP)
Tenderpoint; found above
the posterior aspect of the
zygomatic process of the
temporal bone in a small
depression
Bilateral
Treatment; Supine with
marked rotation away
Fascial Glide; scalp tissue
above the tenderpoint in a
superior motion
ANTERIOR
AURICULAR
NODES
LYMPHATICS WITH A
STRAIN/COUNTERSTRAIN
TWIST
Posterior Auricular Nodes (PA- LTP)
Tenderpoint; located
behind the ear in a small
depression that is
anterior and superior to
the upper mastoid
process
Treatment; Pt. supine with
the head rotated away.
Fascial glide; Scalp tissue
above the tenderpooint in
a superior direction
ANTERIOR
AURICULAR
NODES