Local sympathetic dominance

[Nick]

Is "sympathetic dominance" a general physiological state or can it be a localized phenomenon? For instance, can a dysfunctional vertebral segment have heightened sympathetic activity?

Nick

[Barrett Dorko]

Hi Nick,

I don't have the reference witth me but I recall Irvin Korr saying in his classic paper on the facilitated segment in the early 50s something to this effect:

(I believe I can paraphrase it accurately) The facilitated segment has come to be conceived as something palpable -something upon which we can place our hands. This is a mistake. It as wrong as it would be to mistake the tip of the iceberg for the iceberg itself.

To me, this cautions us against ever assuming that what we can feel in the way of sympathetic increase locally (cooling, sweating, increased muscular activity and responsiveness to pressure), we should not try to change that spot with direct care. The patient will need more than that.

[christophb]

Nick,
The facilitated segment seems to be the craze now (at least in the organization I work for) and justifies "stabilization" protocol for so many of my colleagues.

The causes are thought to be input of nociceptive or mechanical signals and spinal hypermobility. The signs apparently are hypersensitivity, hypertonicity in related paravertebral muscles and muscles supplied by the involved segments motor nerve, increased sympathetic tone, exaggerated reflexes, muscle weakness in key muscles of the segment, and trigger/tender points.

The "treatment" of choice recommended and marketed by those in the know at my clinic is activation of the multifidi/transversus abdominus and all those good things... however, being the rebel I am, have been keeping an eye on people classified as having a facilitated segment and seeing how they do with simple contact. Almost always I see a significant increase in strength, decreased tone, and decreased pain. No stabilization needed and as long as they do some ideomotion everything remains good. The characteristics of correction are key, none of these and I don't see any of the other changes.

Chris