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Clinical Biotensegrity
Illustration of Compression-Tension Forces That Facilitate
Orthopedic Medical Diagnosis, Treatment, and Postural Rehabilitation
. . . . Using a Data-based Model
Gary B. Clark, MD, MPA
Center for Orthopedic Medicine BOULDER PROLOTHERAPY
Boulder, Colorado
Disclaimers: None
Graphic Illustrations: Faith Gowan
Gary B. Clark, AAOM, Ft Lauderdale, 2012 1
Gary B. Clark, AAOM, Ft Lauderdale, 2012
2
“When we try to pick out anything by itself, we find that it is bound fast by a thousand invisible cords . . .
to everything in the universe.” John Muir
Personal Journal July 27,1869
In Memory of Michael Wayne Seamans, DO
Dedicated to James S. Miles, MD Professor Emeritus
Chairman of Orthopedic Surgery University of Colorado School of Medicine
Father of the “Five R’s of Orthopedics”
Educational Goals
1. Introduce the Scientific Model Being Used to Illustrate Biotensegrity in this Talk
1. Illustrate Natural Compression-Tension Forces in an Ideally Balanced State
2. Illustrate Injurious Compression-Tension Forces in an Naturally Imbalanced State
3. Illustrate Mapping of Compression-Tension Forces
Gary B. Clark, AAOM, Ft Lauderdale, 2012 3
The Levels of Medical Evidence
• Prospective Randomized Controlled Study
(The Gold Standard)
• Retro/Prospective Cohort Longitudinal Study
• Retrospective Case-Control Study
• Case Series Study- Retro/prospective and Consecutive/nonconsecutive
• Multiple Case Series Casual Retrospective Observation/ Expert Opinion
• Single Case “unique” Casual Retrospective Observation/ Expert Opinion
Gary B. Clark, AAOM, Ft Lauderdale, 2012
4
The Levels of Medical Evidence
• Prospective Randomized Controlled Study
(The Gold Standard)
• Retro/Prospective Cohort Longitudinal Study
• Retrospective Case-Control Study
• Case Series Study--Prospective (rigorously pre-planned) and Consecutive (including all cases presenting over a specific period)
• Multiple Case Series Casual Retrospective Observation/ Expert Opinion
• Single Case “unique” Casual Retrospective Observation/ Expert Opinion
Gary B. Clark, AAOM, Ft Lauderdale, 2012
5
SIJD Physical Characteristics9,10 Initial Observations Leading to Study
Most Reproducible Definitive Physical Signs Dropped
Inferior Sacral Angle
Short-sided Limp
Vertebral Scoliosis
Functionally Short Leg
Weakened Leg
aBduction
LSIJD Left Left Step Down
Dextro Lumbar
Left Left Decreased
RSIJD Right Right Step Down
Levo Lumbar
Right Right Decreased
Gary B. Clark, AAOM, Ft Lauderdale, 2012 6
SIJD Physical Characteristics9,10 Initial Observations Leading to Study
Most Reproducible Definitive Physical Signs Dropped
Inferior Sacral Angle
Short-sided Limp
Vertebral Scoliosis
Functionally Short Leg
Weakened Leg
aBduction
LSIJD Left Left Step Down
Dextro Lumbar
Left Left Decreased
RSIJD Right Right Step Down
Levo Lumbar
Right Right Decreased
Gary B. Clark, AAOM, Ft Lauderdale, 2012 7
Frequently Supportive Physical Signs Dropped Shoulder
Restricted Sacroiliac Joint with
Supinated Foot
Pronated Foot
LSIJD Right Left Ileal Flexion
Left Right
RSIJD Left Right Ileal Flexion
Right Left
SIJD Physical Characteristics9,10 Initial Observations Leading to Study
Most Reproducible Definitive Physical Signs Dropped
Inferior Sacral Angle
Short-sided Limp
Vertebral Scoliosis
Functionally Short Leg
Weakened Leg
aBduction
LSIJD Left Left Step Down
Dextro Lumbar
Left Left Decreased
RSIJD Right Right Step Down
Levo Lumbar
Right Right Decreased
Gary B. Clark, AAOM, Ft Lauderdale, 2012 8
Frequently Supportive Physical Signs Dropped Shoulder
Restricted Sacroiliac Joint with
Supinated Foot
Pronated Foot
LSIJD Right Left Ileal Flexion
Left Right
RSIJD Left Right Ileal Flexion
Right Left
Question: Why are all these physical parameters
--from plantar arch to nuchal line— seemingly linked in SIJD??
A Data-Based Clinical Example of Sacroiliac Joint Dysfunction (SIJD)
Clark G. Journal of Prolotherapy. 2011 9,10
A Scientifically Planned Prospective Case-Series Study of SIJD
Carried Out over Six Years
Gary B. Clark, AAOM, Ft Lauderdale, 2012 9
Sacroiliac Joint Dysfunction (SIJD) Prevalence in Low Back Pain Patients9,10
Data-Based Study of SIJD n = 110
Total Female Male Sacral
Stabilization Requiring
OMT
Sacral Stabilization
Requiring Prolo
All SIJD ------- 63% 37%
LSIJD
RSIJD
Gary B. Clark, AAOM, Ft Lauderdale, 2012 10
Sacroiliac Joint Dysfunction (SIJD) Prevalence in Low Back Pain Patients9,10
Data-Based Study of SIJD n = 110
Total Female Male Sacral
Stabilization Requiring
OMT
Sacral Stabilization
Requiring Prolo
All SIJD ------- 63% 37%
LSIJD 81% 82% 80%
RSIJD 19% 18% 20%
Gary B. Clark, AAOM, Ft Lauderdale, 2012 11
Sacroiliac Joint Dysfunction (SIJD) Prevalence in Low Back Pain Patients9,10
Data-Based Study of SIJD n = 110
Total Female Male Sacral
Stabilization Requiring only OMT
Sacral Stabilization
Requiring Prolo
All SIJD ------- 63% 37% 30% 70%
LSIJD 81% 82% 80% 29% 71%
RSIJD 19% 18% 20% 31% 69%
Gary B. Clark, AAOM, Ft Lauderdale, 2012 12
Sacroiliac Joint Dysfunction (SIJD) Prevalence in Low Back Pain Patients9,10
Data-Based Study of SIJD n = 110
Total Female Male Sacral
Stabilization Requiring only OMT
Sacral Stabilization
Requiring Prolo
All SIJD ------- 63% 37% 30% 70%
LSIJD 81% 82% 80% 30% 70%
RSIJD 19% 18% 20% 30% 70%
Gary B. Clark, AAOM, Ft Lauderdale, 2012 13
ALL the above-mentioned patients were Right-Handed!!
Only TWO Left-Handed patients have been encountered in 10 years of
carefully documented Orthopedic Medical practice
Left Sacroiliac Joint Dysfunction (LSIJD)
Data-based Model Characterized by:
Primary Left Sacroiliac Ligament Laxity and
Sacroiliac Joint Displacement
Compensatory Dextrolumbar Scoliosis
Compensatory Left Short Leg
Compensatory Right Long Leg
Gary B. Clark, AAOM, Ft
Lauderdale, 2012 14
Left Sacroiliac Joint Dysfunction (“LSIJD”)
Gary B. Clark, AAOM, Ft Lauderdale, 2012
15
Left Sacroiliac Joint Dysfunction (“LSIJD”)
“LSD”
Gary B. Clark, AAOM, Ft Lauderdale, 2012
16
Left Sacroiliac Joint Dysfunction (LSIJD)
“LSD”
AND Please Excuse the PA (Back Side) Views
Gary B. Clark, AAOM, Ft Lauderdale, 2012
17
Biotensegrity Historical Landmarks
• Sir Isaac Newton (1642-1727): Third Law of Motion1
• Sir Charles Scott Sherrington (1857-1952): Law of Reciprocal Innervation2
• R. Buckminster Fuller (1895-1983): Principal of Tensional Integrity (“Tensegrity”)3
• Kenneth Snelson (1927- ): Principal of Floating Compression4
• Stevin M. Levin, MD: Coined “Biotensegrity”; Pioneer in clinical study of Biotensegrity since 1980’s5
• Donald E. Ingbar, MD: Pioneer in academic study of Cellular and Tissue Biotensegrity since 1990’s6,7
Gary B. Clark, AAOM, Ft Lauderdale, 2012 18
Biotensegrity Models, Examples, Analogies
Newton Apple
Sherrington Agonist-Antagonist
Wright Flyer
Fuller Geodesic Dome
Snelson Bead Chain X Column
Levine Vertebrate Structures
Ingbar Cytoskeletal Structures
Gary B. Clark, AAOM, Ft Lauderdale, 2012 19
Biotensegrity Models, Examples, Analogies
Newton Apple
Sherrington Agonist-Antagonist
Wright Flyer
Fuller Geodesic Dome
Snelson Bead Chain X Column
Levine Vertebrate Structures
Ingbar Cytoskeletal Structures
Cantieri Degenerative Postural Low Back Cascade8
Gary B. Clark, AAOM, Ft Lauderdale, 2012 20
Biotensegrity Models, Examples, Analogies
Newton Apple
Sherrington Agonist-Antagonist
Wright Flyer
Fuller Dome
Snelson Bead Chain X Column
Levine Vertebrate Structures
Ingbar Cytoskeletal Structures
Cantieri Degenerative Postural Low Back Cascade8
Trister Umbrella
Gary B. Clark, AAOM, Ft Lauderdale, 2012 21
Biotensegrity Man!!
Gary B. Clark, AAOM, Ft Lauderdale, 2012 22
Biotensegrity Woman!!
Gary B. Clark, AAOM, Ft Lauderdale, 2012 23
Goal 1:
Natural
Compression-Tension Forces
in an
Ideally Balanced
State
Gary B. Clark, AAOM, Ft Lauderdale, 2012 24
The Usual Forces at Play
Forces Causing Compression • Passive Compression: Directly Due to
Gravitational Force (Weight)
• Active Compression: Directly Due to Muscular Force
Forces Causing Tension • Passive Tension: Directly Due to
Gravitational or Indirect Muscular Force
• Active Tension: Directly Due to Muscular
Force
Gary B. Clark, AAOM, Ft Lauderdale, 2012 25
The Usual Forces at Play
Gary B. Clark, AAOM, Ft Lauderdale, 2012 26
Ideal Skeletal-Ligament-Muscle Balance and Alignment
Gary B. Clark, AAOM, Ft Lauderdale, 2012 27
Goal 2:
Injurious
Compression-Tension Forces
in an
Imbalanced
State
Gary B. Clark, AAOM, Ft Lauderdale, 2012 28
Ideally Aligned and Balanced Sacrum-Pelvis
Gary B. Clark, AAOM, Ft Lauderdale, 2012 29
Primary Sacral Ligament Injury and Resultant Skeletal Displacement
in LSIJD
Gary B. Clark, AAOM, Ft Lauderdale, 2012 30
Goal 3:
Map
Compression-Tension Forces
Gary B. Clark, AAOM, Ft Lauderdale, 2012 31
Clinical Biotensegrity Force Map Resultant Sacral-Pelvic Passive
Compression-Tension Forces in LSIJD
Gary B. Clark, AAOM, Ft Lauderdale, 2012 32
A Spectrum of Potential Sacral-Pelvic Injuries in LSIJD
Chronic Active Tension—Produced During Normal Standing-Flexing-Extending-Side Bending-Rotating-and-Ambulating in a Right-handed World • Initially via Functionally Balanced Postural/Core Muscles
• These Postural/Core Muscles eventually decompensate and become functionally imbalanced
Chronic Passive Tension—Produced by Muscular/ Gravitational Forces • Bilateral Iliolumbar Ligament stress/strain/sprain/laxity
• Bilateral Superior-Inferior Posterior Sacroiliac Ligament stress/strain/sprain/laxity
• Bilateral Sacrotuberous Ligament stress/strain/sprain/laxity
Chronic Passive Bilateral Sacroiliac Joint Compression —Produced by Gravitational Forces • Left Sacroiliac Joint displacement
Gary B. Clark, AAOM, Ft Lauderdale, 2012 33
A Spectrum of Potential Sacral-Pelvic Injuries in LSIJD
Primary Chronic Passive
Tension Injury
Secondary Chronic Passive
Tension Injury
Secondary Chronic Passive
Compression Injury
Bilateral Iliolumbar Ligament Stress>Strain> Sprain>Laxity (S>S>S>L)
Bilateral Sacrotuberous Ligament S>S>S>L
Left Sacroiliac Joint Nonphysiological Displacement/ Osteoarthritis
Bilateral Sacroiliac Ligament S>S>S>Laxity
Left Piriformis Muscle Stress>Strain>Sprain> Tendinosis (S>S>S>T)
Gary B. Clark, AAOM, Ft Lauderdale, 2012 34
Chronic Activation of Postural Muscles (Flexing/Side-bending/Torqueing/Transferring Weight)
and Constant Force of Gravity
Compensatory Scoliosis in LSIJD Theoretical Head Displacement
Gary B. Clark, AAOM, Ft Lauderdale, 2012 35
Compensatory Scoliosis in LSIJD Head Maintained over Center of Gravity
Gary B. Clark, AAOM, Ft Lauderdale, 2012 36
Compensatory Scoliosis in LSIJD Resultant Regional Side-Bending
Gary B. Clark, AAOM, Ft Lauderdale, 2012 37
Compensatory Scoliosis in LSIJD Resultant Vertebral Misalignment
via Normal Spinal Mechanics
Gary B. Clark, AAOM, Ft Lauderdale, 2012 38
Compensatory Scoliosis in LSIJD Causal Active Muscle Tension
Gary B. Clark, AAOM, Ft Lauderdale, 2012 39
Additional Compensatory Right Posterior Sling Action in LSIJD
Gary B. Clark, AAOM, Ft Lauderdale, 2012 40
Clinical Biotensegrity Force Map Resultant Compression-Tension Forces
in Compensatory Scoliosis of LSIJD
Gary B. Clark, AAOM, Ft Lauderdale, 2012 41
Clinical Biotensegrity Force Map Resultant Arcs of Force
in Compensatory Scoliosis of LSIJD
Gary B. Clark, AAOM, Ft Lauderdale, 2012
42
A “Perfect Storm”
Gary B. Clark, AAOM, Ft Lauderdale, 2012 43
A Spectrum of Potential Scoliotic Injuries in LSIJD
Chronic Active Tension—Compensatory along Concave Arcs • Right Cervical Suboccipital/ Paraver-
tebral Muscle activation/shortening/ strain/spasm/sprain/tendinosis
• Left Thoracic Paravertebral Muscle activation/shortening/strain/spasm/ sprain/tendinosis
• Right Lumbar Paravertebral Muscle activation/shortening/strain/spasm/ sprain/tendinosis
• Right Posterior Sling (Right Latissimus dorsi and Left Gluteus maximus) activation/shortening/strain/spasm/ sprain/tendinosis
• Right Quadratus Lumborum Muscle activation/shortening/strain/spasm/ sprain/tendinosis
• Right Thoracic Costovertebral Joint dysfunction/Interscapular Muscle activation/shortening/strain/spasm/ sprain/laxity-tendinosis
Chronic Active Compression—Along Concave Arcs • Right C1-7 Vertebral Body wedging/
Facet Joint arthritis/Disc disease/Nerve impingement
• Left T1-12 Vertebral Body wedging/ Facet Joint arthritis/Disc disease/Nerve impingement
• Right L1-5 Vertebral Body wedging/ Facet Joint arthritis/Disc disease/Nerve impingement
Chronic Passive Tension—Along Convex Arcs • Left Cervical Intervertebral Ligament
and Muscle stress/strain/spasm/sprain/ laxity-tendinosis
• Right Thoracic Intervertebral Ligament and Muscle stress/strain/spasm/sprain/ laxity-tendinosis
• Bilateral T11-L 2 (crossover zone) Intervertebral Ligament and Paraspinal Muscle stress/strain/spasm/sprain/ laxity-tendinosis
• Left Lumbar Intervertebral Ligament and Muscle stress/strain/spasm/sprain/ laxity-tendinosis
Chronic Passive Tension—Other Compensatory along Convex Arcs • Right Upper Trapezius Muscle stress/
strain/spasm/sprain/tendinosis • Right Levator Scapulae Muscle stress/
strain/spasm/sprain/tendinosis • Right Rotator Cuff impingement/stress/
strain/spasm/sprain/tendinosis • Left Quadratus Lumborum Muscle
stress/strain/spasm/sprain/tendinosis
Gary B. Clark, AAOM, Ft Lauderdale, 2012 44
A Spectrum of Potential Scoliotic Injuries in LSIJD
Chronic Active (Concave Arc)
Tension Injury
Chronic Passive (Convex Arc)
Tension Injury
Chronic Active (Concave Arc) Compression
Injury
MUSCLE
Right Cervical Suboccipital- Paravertebral/ Left Thoracic Paravertebral Right Lumbar Paravertebral/Right Posterior Sling/Right Quadratus Lumborum/Right Interscapular Muscle: Chronic Compensatory Activation resulting in S>S>S>T
Left Cervical/Right Thoracic/Left Lumbar Intervertebral Muscle S>S>S>T
Right Upper Trapezius/ Right Levator Scapulae/ Right Rotator Cuff/Left Quadratus Lumborum Muscle S>S>S>T
LIGAMENT
Left Cervical/Right Thoracic/Bilateral T11-L 2 (crossover zone)/Left Lumbar Intervertebral Ligament S>S>S>L
SKELETON
Vertebral Body Wedging; Facet Joint Arthritis; Degenerative Disk Disease Nerve Impingement
Right Thoracic Costovertebral Lordotic Deformity
Gary B. Clark, AAOM, Ft Lauderdale, 2012 45
Compensatory Short Left Leg in LSIJD
Resultant Skeletal Displacement
Gary B. Clark, AAOM, Ft Lauderdale, 2012 46
Compensatory Short Left Leg in LSIJD
Resultant Joint Deformities
Gary B. Clark, AAOM, Ft Lauderdale, 2012 47
Compensatory Short Left Leg in LSIJD
Causal Active Muscle Tension
Gary B. Clark, AAOM, Ft Lauderdale, 2012 48
Clinical Biotensegrity Force Map Resultant Compression-Tension Forces
in Compensatory Left Short Leg of LSIJD
Gary B. Clark, AAOM, Ft Lauderdale, 2012 49
Clinical Biotensegrity Force Map Resultant Arcs of Force
in Compensatory Left Short Leg of LSIJD
Gary B. Clark, AAOM, Ft Lauderdale, 2012 50
A Spectrum of Potential Short Left Leg Injuries in LSIJD
Left Hip and Upper Leg --Step-down/varus gait hip joint com- pressive injury --Hamstring chronic active shortening/ stress/ strain/sprain/tendinosis at left ischial tuberosity --Internal Rotator and aDductor active shortening/stress/strain/sprain/tendin- osis at ileum and/or Greater Trochanter --Posterior Capsular Ligament passive stress/strain/sprain --External Rotator passive stress/strain/ sprain/tendinosis at sacrum and/or Greater Trochanter
Left Knee and Lower Leg --Varus joint deformity --Medial Tibial-Femoral articular cartilage compressive erosion --Lateral Retropatellar articular cartilage compressive erosion --Medial Gastrocnemius active shorten- ing/stress/sprain/tendinosis --Pes anserinus Tendon active shorten- ing/stress/strain/ sprain/tendinosis --Lateral Collateral/Coronary Knee and Fibular Ligaments passive stress/strain/ sprain/laxity --Posterior Cruciate Ligament passive stress/ strain/sprain/laxity
Left Ankle --Varus joint deformity prone to lateral sprain --Medial articular cartilage compressive erosion -- Achilles Tendon active shortening/ stress/strain/sprain/tendinosis --Lateral Collateral Ligaments passive stress/strain/sprain/laxity
Left Foot --Supination foot deformity --Medial Tibialis posterior tendon active shortening/stress/strain/sprain/tendin- osis --Medial Plantar muscles active shorten-ing/stress/ strain/sprain/fasciitis/tendin-osis --Dorsilateral Ligaments passive stress/ strain/sprain/laxity --Lateral Peroneus brevis/longus tendon passive stress /strain/sprain/tendinosis
Gary B. Clark, AAOM, Ft Lauderdale, 2012 51
A Spectrum of Potential Short Left Leg Injuries in LSIJD
Chronic Active (Concave Arc)
Tension Injury
Chronic Passive (Convex Arc)
Tension Injury
Chronic Active (Concave Arc) Compression
Injury
KEFT HIP AND UPPER LEG
Internal Rotator (anterior Gluteus medius) and aDductor S>S>S>S>T
Posterior Capsular Ligament S>S>S>L
Step-down impact/varus joint deformity
Medial Hamstring S>S>S>S>T
External Rotator (Piriformis) Muscle Shortening > S>S>S>T
LEFT KNEE AND LOWER LEG
Pes anserinus S>S>S>S>T
Lateral Collateral/Coronary Knee Ligaments S>S>S>L
Varus joint deformity
Medial Gastrocnemius S>S>S>S>T
Posterior Cruciate Ligament S>S>S>L
Medial Tibial-femoral articular cartilage erosion
Lateral Retropatellar articular cartilage erosion
LEFT ANKLE
Achilles Tendon S>S>S>T Lateral Collateral Ligaments S>S>S>L
Varus joint deformity
Medial articular cartilage erosion
LEFT FOOT
Tibialis posterior S>S>S>S>T Medial Plantar Muscles S>S>S>S>T
Peroneus brevis/longus S>S>S>S>T Dorsolateral Mid-to-forefoot Ligaments S>S>S>L
internal rotation/Supina- tion deformity
Gary B. Clark, AAOM, Ft Lauderdale, 2012 52
Compensatory Long Right Leg in LSIJD
Resultant Skeletal Displacement
Gary B. Clark, AAOM, Ft Lauderdale, 2012 53
Compensatory Long Right Leg in LSIJD
Resultant Joint Deformities
Gary B. Clark, AAOM, Ft Lauderdale, 2012 54
Compensatory Long Right Leg in LSIJD
Causal Active Muscle Tension
Gary B. Clark, AAOM, Ft Lauderdale, 2012 55
Clinical Biotensegrity Force Map Resultant Compression-Tension Forces
in Compensatory Short Left Leg of LSIJD
Gary B. Clark, AAOM, Ft Lauderdale, 2012 56
Clinical Biotensegrity Force Map Resultant Arcs of Force
in Compensatory Short Left Leg of LSIJD
Gary B. Clark, AAOM, Ft Lauderdale, 2012 57
A Spectrum of Potential Long Right Leg Injuries in LSIJD
Right Hip and Upper Leg -- Long leg vaulting/valgus gait compres-sion joint injury
-- External rotator active stress/strain/
sprain/tendinosis at sacrum and/or Greater Trochanter
-- Lateral Quadriceps and Patellar tendon active stress/strain/sprain/tendinosis
-- Anterior capsular passive stress/strain/ sprain/laxity
-- Internal rotator passive shortening/ stress/strain/sprain/tendinosis
Right Knee and Lower Leg -- Valgus joint deformity
-- Lateral tibial-femoral articular cartilage compressive erosion
-- Medial retropatellar articular cartilage compressive erosion
-- Medial knee ligaments passive stress/ strain/sprain/laxity
-- Anterior cruciate ligament passive stress/ strain/sprain/laxity
Right Lower Leg and Ankle -- Valgus joint deformity prone to medial sprain/laxity
-- Lateral articular cartilage compressive erosion
-- Anteromedial Tibialis posterior passive stress/strain/sprain/tendinosis (“shin splints”)
-- Medial collateral ligaments passive stress/strain/sprain/laxity
Right Foot -- Accentuated Pronation foot deformity
-- Lateral Peroneus brevis/longus tendon active stress/strain/sprain/tendinosis
-- Dorsilateral foot myofascial active stress/strain/sprain/”fasciitis”--tendino- sis
-- Medial-plantar ligaments passive stress /strain/sprain/laxity
Gary B. Clark, AAOM, Ft Lauderdale, 2012 58
A Spectrum of Potential Long Right Leg Injuries in LSIJD
Chronic Active (Concave Arc) Tension Injury
Chronic Passive (Convex Arc)
Tension Injury
Chronic Active (Concave Arc) Compression
Injury
Right Hip and Upper Leg
External Rotator Muscle (Piriformis) S>S>S>S>T
Anterior Capsular Ligament S>S>S>L
Hip Joint Vaulting-gait Injury
Lateral Quadriceps Muscle and Patellar Tendon S>S>S>S>T
Internal Rotator Muscle Shortening>S>S>S>T
Right Knee and Lower Leg
Medial Knee Ligaments S>S>S>L
Knee Joint Valgus Deformity
Anterior Cruciate Ligament S>S>S>L
Lateral Tibial-Femoral Articular Cartilage Erosion
Right Lower Leg and Ankle
Lateral Gastrocnemius Muscle S>S>S>S>T
Anteromedial Tibialis posterior muscle S>S>S>S>T (“shin splints”)
Valgus Joint Deformity
Medial Collateral Ligaments S>S>S>L
Lateral Articular Cartilage Erosion
Right Foot
Lateral Fibularis (Peroneus) brevis/ longus Muscles S>S>S>S>T
Medial plantar (e.g., Spring) Ligaments S>S>S>L
External Rotation/Pronation Joint Deformity
Gary B. Clark, AAOM, Ft Lauderdale, 2012 59
Whole-Body Compression-Tension Arcs and Spectrum of Potential Injuries
in LSIJD From the Plantar Arch to the Nuchal Line
Gary B. Clark, AAOM, Ft Lauderdale, 2012 60
Whole-Body Compression-Tension Arcs and Spectrum of Potential Injuries
in RSIJD From the Plantar Arch to the Nuchal Line
Gary B. Clark, AAOM, Ft Lauderdale, 2012 61
Sequence of Therapies for SIJD
• FIRST, stabilize sacral displacement!! o OMT: 30%
o Prolotherapy: 70%
Gary B. Clark, AAOM, Ft Lauderdale, 2012
62
Sequence of Therapies for SIJD
• FIRST, stabilize sacral displacement!! o OMT: 30%
o Prolotherapy: 70%
• THEN, resolve and rehabilitate compensa- tory injuries sequentially or in tandem.
Gary B. Clark, AAOM, Ft Lauderdale, 2012
63
Sequence of Therapies for SIJD
• FIRST, stabilize sacral displacement!! o OMT: 30%
o Prolotherapy: 70%
• THEN, resolve and rehabilitate compensa- tory injuries sequentially or in tandem.
• WARNING: Avoid potential iatrogenic worsening of pre-existing scoliosis.
Gary B. Clark, AAOM, Ft Lauderdale, 2012
64
Biotensegrity To Do List
Generate Other Data-Based Biotensegrity Models: Improve the SIJD Model with its major clinical variants
Head-TMJ-Neck- Shoulder Injuries (e.g., whiplash) Upper Extremity Injuries (e.g., epicondylosis)
Lower Extremity Injuries (e.g., Pes planus, Pes cavus) Left/Right Sacroiliac–Right/Left Posterior Sling–Right/Left Shoulder Dysfunction
Determine mechanism of leg aBductor (Gluteus medius) inhibition in SIJD
(perhaps due to Sherrington-oid “reciprocal innervation”
between anterior and posterior fibers) Determine on a Biotensegrity Basis when NOT to stabilize the sacrum
to preclude iatrogenic worsening of pre-existing scoliosis
Determine physiological and therapeutic differences between Passive Musculo-Tendinous Injuries
versus Active Musculo-Tendinous Injuries
Explore the most appropriate
OMT, Injection Therapy, Orthotic Therapy, and Rolfing, Pilates, Physical Therapy, and
Other therapeutic and postural rehabilitative sequential approaches for various Biotensegritous injuries
. . . . . . and more
Gary B. Clark, AAOM, Ft Lauderdale, 2012 65
Biotensegrity To Do List
Generate Other Data-Based Biotensegrity Models: Improve the SIJD Model with its major clinical variants
Head-TMJ-Neck-Shoulder
Upper Extremity
Lower Extremity
Gary B. Clark, AAOM, Ft Lauderdale, 2012 66
Biotensegrity To Do List
Generate Other Data-Based Biotensegrity Models: Improve the SIJD Model with its major clinical variants
Head-TMJ-Neck-Shoulder
Upper Extremity
Lower Extremity
Explore Mechanism
of Leg aBductor (Gluteus medius) Inhibition in SIJD
perhaps due to Sherrington-oid “reciprocal innervation”
between anterior and posterior fibers
Gary B. Clark, AAOM, Ft Lauderdale, 2012 67
Biotensegrity To Do List
Generate Other Data-Based Biotensegrity Models: Improve the SIJD Model with its major clinical variants
Head-TMJ-Neck-Shoulder
Upper Extremity
Lower Extremity
Explore Mechanism
of Leg aBductor (Gluteus medius) Inhibition in SIJD
perhaps due to Sherrington-oid “reciprocal innervation”
between anterior and posterior fibers
Explore on a Biotensegrity Basis When NOT to Stabilize the Sacrum
to preclude iatrogenic worsening of pre-existing scoliosis
Gary B. Clark, AAOM, Ft Lauderdale, 2012 68
Biotensegrity To Do List
Generate Other Data-Based Biotensegrity Models: Improve the SIJD Model with its major clinical variants
Head-TMJ-Neck- Shoulder Injuries (e.g., whiplash) Upper Extremity Injuries (e.g., epicondylosis)
Lower Extremity Injuries (e.g., Pes planus, Pes cavus) Left/Right Sacroiliac–Right/Left Posterior Sling–Right/Left Shoulder Dysfunction
Explore mechanism of leg aBductor (Gluteus medius) inhibition in SIJD
(perhaps due to Sherrington-oid “reciprocal innervation”
between anterior and posterior fibers)
Explore on a Biotensegrity Basis when NOT to stabilize the sacrum to preclude iatrogenic worsening of pre-existing scoliosis
Explore Physiological and Therapeutic Differences between
Passive Musculo-Tendinous Injuries versus
Active Musculo-Tendinous Injuries
Gary B. Clark, AAOM, Ft Lauderdale, 2012 69
Biotensegrity To Do List
Generate Other Data-Based Biotensegrity Models: Improve the SIJD Model with its major clinical variants
Head-TMJ-Neck- Shoulder Injuries (e.g., whiplash) Upper Extremity Injuries (e.g., epicondylosis)
Lower Extremity Injuries (e.g., Pes planus, Pes cavus) Left/Right Sacroiliac–Right/Left Posterior Sling–Right/Left Shoulder Dysfunction
Explore Mechanism of leg aBductor (Gluteus medius) inhibition in SIJD
(perhaps due to Sherrington-oid “reciprocal innervation”
between anterior and posterior fibers)
Explore on a Biotensegrity Basis When NOT to stabilize the sacrum to preclude iatrogenic worsening of pre-existing scoliosis
Explore Physiological and Therapeutic Differences between
Passive Musculo-Tendinous Injuries versus
Active Musculo-Tendinous Injuries
Explore the Most Appropriate OMT, Injection Therapy, Orthotic Therapy, and
Rolfing, Pilates, Physical Therapy, and Other Therapeutic and Postural Rehabilitative
sequential approaches for various Biotensegritous injuries
Gary B. Clark, AAOM, Ft Lauderdale, 2012 70
Biotensegrity To Do List
Generate Other Data-Based Biotensegrity Models: Improve the SIJD Model with its major clinical variants
Head-TMJ-Neck- Shoulder Injuries (e.g., whiplash) Upper Extremity Injuries (e.g., epicondylosis)
Lower Extremity Injuries (e.g., Pes planus, Pes cavus) Left/Right Sacroiliac–Right/Left Posterior Sling–Right/Left Shoulder Dysfunction
Determine mechanism of leg aBductor (Gluteus medius) inhibition in SIJD
(perhaps due to Sherrington-oid “reciprocal innervation”
between anterior and posterior fibers) Determine on a Biotensegrity Basis when NOT to stabilize the sacrum
to preclude iatrogenic worsening of pre-existing scoliosis
Determine physiological and therapeutic differences between Passive Musculo-Tendinous Injuries
versus Active Musculo-Tendinous Injuries
Explore the most appropriate
OMT, Injection Therapy, Orthotic Therapy, and Rolfing, Pilates, Physical Therapy, and
Other therapeutic and postural rehabilitative sequential approaches for various Biotensegritous injuries
. . . . . . and more
Gary B. Clark, AAOM, Ft Lauderdale, 2012 71
www.clinicalbiotensegrity.com
Gary B. Clark, AAOM, Ft Lauderdale, 2012 72
www.clinicalbiotensegrity.com
• Home for the e-Journal for Clinical Biotensegrity
Gary B. Clark, AAOM, Ft Lauderdale, 2012 73
www.clinicalbiotensegrity.com
• Home for the e-Journal for Clinical Biotensegrity
• Data-Based Report Articles on Clinical Biotensegrity
Gary B. Clark, AAOM, Ft Lauderdale, 2012 74
www.clinicalbiotensegrity.com
• Home for the e-Journal for Clinical Biotensegrity
• Data-based Report Articles on Clinical Biotensegrity
• Outcome Database Formats for Various Body Regions and Specific Joints
Gary B. Clark, AAOM, Ft Lauderdale, 2012 75
www.clinicalbiotensegrity.com
• Home for the e-Journal for Clinical Biotensegrity
• Data-based Report Articles
• Outcome Database Formats for Various Body Regions and Specific Joints
• Clinical Biotensegrity Presentation Videos
Gary B. Clark, AAOM, Ft Lauderdale, 2012 76
Bibliography
1. Newton I. http://www.britannica.com/EBchecked/topic/413189/ Sir-Isaac-Newton/12253/The-Principia.
2. Sherrington CS. http://.www.britannica.com/EBchecked/topic/ 540150/Sir-Charles-Scott-Sherrington.
3. Fuller RB. Tensegrity. Portfolio and Art News Annual, No 4, 1961.
4. Snelson K. Letter to R. Motro. International Journal of Space Structures, November 1990.
5. Levin S. "Tensegrity, the New Biomechanics"; Hutson, M & Ellis, R (Eds.), Textbook of Musculoskeletal Medicine. Oxford: Oxford University Press. 2006.
6. Ingbar DE. “The Architecture of Life”, Scientific American, Jan 1998; 278:48-57.
7. Ingbar DE. Tensegrity I. J Cell Sci, 116(April):1157-1173.
8. Ravin, Cantieri, Pasquarello. 2008. Principles of Prolotherapy. Denver: Amer Acad Muscuskel Med: 40-44.
9. Clark GB. Building a rationale for evidence-based prolotherapy in an orthopedic medicine practice. Part III: A case series report of chronic back pain associated with sacroiliac dysfunction treated by prolotherapy. A six-year prospective analysis. Journal of Prolotherapy, 3(May):632-639;2011.
10. Clark GB. Building a rationale for evidence-based prolotherapy in an orthopedic medicine practice. Part IV: Diagnosing linked prolotherapy targets by applying a data-based biotensegrity model. Journal of Prolotherapy, 3(August):722-735;2011.
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