Why Does AO Work?by Joe Ierano DC BCAO MACC
Roy W. Sweat, D.C., B.C.A.O., is a 1950 graduate of Palmer College of Chiropractic and has been in practice ever since and currently manages a clinic in Atlanta, Georgia, USA.
An associate professor at Life College, he is a noted author of many books on atlas orthogonality and was a presenter of specialized seminars on programs developed by John F. Grostic, beginning in 1960, and on his own atlas orthogonality program, created in 1981. He has designed an atlas orthogonal computerized X-ray analysis program, a chiropractic adjusting instrument and X-ray equipment.
My experience with this man is that he is innovative, humble and dedicated to public health. I spent time in his office gaining a feel for practice as a student and I made several pleasant trips to Atlanta, Georgia that remain unforgettable experiences.
Dr Roy's son, Matt and his wife Tecla, made me feel like a family member, though I was so far from home.
AO's application of anatomical knowledge, including dissection, arthrokinematics and patient management is second to no other discipline or basic academic curriculae.
I would encourage all people interested in disorders of the spine to at least gain an appreciation of this man's work.
Atlas (the first vertebra in the neck) Orthogonal (at 90 degrees) recognises the whole influence that the upper cervical (upper neck) area has on body function. It is now thought that input into the brain from the spinal structures is the main influence on health which chiropractic affects.
This input is what chiropracic care seems to normalise through high velocity, specific manual force input. This influence is perhaps greatest at the occipito-atlanto-axial joint complex. That is, the occiput, or base of the skull, on the atlas, which contacts the axis, or second neck vertebra. If the atlas is subluxated (misaligned, not moving correctly, or adversely affecting nerves), then myriad health problems may arise.
diagram Joe Ierano (after a seminar by Dr Dan Murphy DC)
How the Instrument WorksUniqueness of instrument adjusting
• Dr Sweat adjusted by hand for over 20 years, so he would be the last to claim that it does not get results. He then switched to instrument for the correction of atlas problems. I have offered up some points to consider about instrument adjusting
• an instrument may remove some human variables that exist in hand contacts and thrust variation
• speeds unattainable by voluntary muscular contraction are produced efficiently
• the correction occurs within the normal range of motion of the vertebra, and thus differs from manipulation which, by definition, takes the joint (or several joints) beyond the end range of motion.
• After several prototypes, the instrument today is made from a specific metallic density and activated by a solenoid. That is; a magnetically activated impact on one end of the stylus that transfers to the end in contact with the skin surface. The force generated on the skin is as little as 3 pounds. The movement of the atlas bone has been verified on cineradiographic studies.
How is the Atlas determined to need and Adjustment?
• a thorough history and examination is conducted
• this includes scanning palpation, and a leg length check, described below
• a specific set of AO x rays are taken
• the information is presented, along with choices, risks, etc, to the patient who may elect to have it corrected
Is Leg Length Inequality related to health outcomes?
• Recent studies demonstrate that this phenomenon of leg length inequality (LLI) may be involved in spinal pain syndromes.
• The patient lies on their back, and doctor contact with the legs and feet is kept to a minimum, the difference in leg length measured. This is measured again when the patient rests after each adjustment, and the chiropractor assess what the change means.
What is Scanning Palpation?
• The AO practitioner contacts the soft tissue overlying the points of exit of the left and right C1 and C2 spinal nerves and assesses tissue compliance, inflammation and tenderness. The four points are then rated from 0 - 3, with 3 being the most severe and usually eliciting a painful "jump sign" from the patient. There should be some immediate improvement in the scanning palpation after adjustment.
• If more objectivity is desired, the more accepted method of algometry (use of a skin pressure instrument) over the neck can elicit the same documentation, in my experience. Instruments are being developed in the USA to provide objective measurement based on tissue compliance.