Doctorate of Chiropractic degree (D.C.) in 1977 from the Canadian Memorial Chiropractic College in Toronto.
Definition of chiropractic
First Visit
Chiropractic Treatment
Chiropractic Treatment & Management of Headaches
Conditions Treated At Dr. Fuller's Clinic
Motor Vehicle Accidents (MVAs)
Weight Training Injuries & Management
Nutrition Corner
Research & Other Updates
When To Consult A Chiropractor
Laser Therapy & Phototherapy
The bones in the back (spine) are termed ‘vertebrae’ and are connected by cartilage, ligaments, discs, and work together in a very specific way to provide strength and flexibility.
However, the stresses of daily living, as well as car accidents, daily falls, athletic injuries to name a few can cause the bones in the joints of the spine or of the extremities (hands, wrist, elbows, shoulders, feet, ankles, knees, hips) to shift out of alignment and become stiff with resulting pains, protective muscle spasm (tightening), weakness, and impaired function.
Dr. Fuller and other chiropractors take particular interest in the “holding elements” of the spine such as the facet joints (also called “zygapophyseal” or “apophyseal” joints) as these have been shown to be responsible for up to 66% of neck and back pain (Ketroser in the Journal of Whiplash & Associated Disorders 2004 Vol.3,No1) wrote that 60% of people suffering from chronic headaches, neck and/or back pain have “facet” joint injury as the cause of some or all of their pain, and that this figure increases to 90% for those people having pain mostly or completely on one side.
These joints are a focus of manipulative therapy as they are the “gliding” portion of the vertebrae which frequently become “fixated” or stiffened up and often respond favourably to the chiropractor’s hands-on skill of manipulation {“adjustments”}. Many other researchers have made similar conclusions for the past 20 years or more (eg. Bogduk in Archives Neurology 2000;57(4):590 reported that 50% of persisting neck pain was due to cervical facet joints; also McDonald in the Journal of Neurosurgery 1999(1):61 and Lord et al in Spine 1996;21(15):1737 and Barnsley et al in Pain 1994;58(3):283.
The “facets” or “zygapophyseal joints” of the spine are part of each vertebra and essentially represent the main ‘gliding’ portion of vertebrae as we move. The facet joints frequently become jammed, jarred, or “fixated” from injuries as well as many less obvious everyday events, such as prolonged sitting or standing. The chiropractor’s method of determining facet joint involvement is to rule out other more serious causes, then by hand to perform provocative manoeuvres which add stress to these joints and to measure findings. Also employed are methods of manual (hands-on) passive accessory joint play testing to feel for levels between vertebrae (also between other joints of the body such as the extremities) of tenderness and relative stiffness (“fixations”). Also essential to perform are indicated test procedures such as performing testes for deep tendon reflexes, sensory changes, and resisted muscle strength testing. Frequently these indicate the need for safe and conservative joint adjustments by a chiropractor, the results of which must be re-assessed in a timely manner. Currently the gold standard for definitively determining facet syndrome is the medical specialty procedure of facet joint “blocks” (needle injections under fluoroscopy and observing patient pain responses). This medical procedure is painful, not readily available, and must be reserved for the most difficult cases, if the patient consents to it.  Elsehere in this website there are references to researchers who have for years studied facet joints and their importance.
Facet joint spondylosis refers to arthritic changes in the actual facet joint.
Very recent research…..Tachihara et al in Spine 2007;32(4):406 conducted surgically-induced facet inflammation in rats and proved that this leads to nerve root infiltration, degenerative arthritic changes of the facets, and signs of radiculopathy (symptoms radiating into the lower extremities. The importance of this confirmation to humans is that symptoms (pain, numbness) radiating into the extremities may be caused not only by disc herniations, but also by facet inflammation, as these can both cause chemical mediators such as cytokines to create an inflammatory cascade around nerve roots and which can also cause radiculopathy.
Chiropractors in Canada undergo an equivalent or greater number of hours of professional training in anatomy and human dissection than medical doctors, and much of this is taught by expert medical specialists in this field who are cross-appointed with the University of Toronto School of Medicine and Sunnybrook Hospital and Health Centre. One of Dr. Fuller’s teaching professors was Dr. John Duckworth who was then cross-appointed with the U of T Medical School and was an honorary consulting medical physician to Her Majesty Queen Elizabeth II.
This website makes references to many conditions afflicting the human body and primary and complementary methods of treatment.
Radiculopathy is caused by irritation or mechanical impingement (“pinching”) of spinal nerve(s) within the spinal canal or the IVF (intervertebral foramen which is the opening on each side of every vertebra through which nerves travel from the spinal cord to other body parts, including the arms and legs).
Causes include : degeneration of osteocartilage resulting in deformation of discs or of facet joints, as well as by congenital deformity, or more serious but rare diseases such as tumors.The most common symptom is pain radiating into the arm or leg, while 33% of people with radiculopathy have numbness, 64-75% have weakness on examination of resisted muscle testing, and 84% have reflex abnormalities.
A C6 radiculopathy (meaning pinching of one of the lowest neck nerves) can present as pain in the neck, shoulder, outside of the arm & forearm, and even into the thumb and index finger. This person may have reflex changes of the biceps, brachioradialis or pronator teres reflexes. In 36% of cases, there will be weakness of wrist extension.  EMG testing reveals a high rate of weakness of the pronator teres muscle on the inside of the forearm (this is not true for C5 radiculopathies but is true for 50% of C7 radiculopathies).
C6 radiculopathy has been found to be accompanied by a high rate of weakness of wrist extension, elbow flexion, and overall pronation. C7 radiculopathies present with weakness of pronation accompanied by weak elbow extension.Relevance of radiculopathy to chiropractic care…….. firstly, chiropractors are frequently consulted about such conditions and must be able to differentially diagnose or refer to others for tentative diagnosis.
Then, if there are indications and no contraindications, chiropractors apply various techniques which may include electrical muscle relaxation, manual myofascial massage type therapy of the neck and inner forearm, and mobilization or manipulation of the lower neck. These methods of treatment are designed to restore normal muscle tone and relieve pressure on pinched nerves where possible. Finally, appropriate, timely supervised and home stretching and strengthening exercises should be advised by the treating chiropractor, as well advice on any factors that may cause recurrence where identifiable.
Usually this is referred to as “cervical myelopathy” or “cervical spondylotic myelopathy” which is the most common  acquired type of spinal cord dysfunction in people over age 55.  Causes? Generally this is due to narrowing of the spinal canal space where the spinal cord travels secondary to anatomical degeneration of discs, facet joints, ligaments, and connective tissue generally. As the spinal canal narrows, the risk of symptoms increases. Such static anatomical factors (either congenital and/or acquired) combine with dynamic factors such as repetitive overuse and/or movement abnormalities (ie. joint dysfunction). These all combine to cause a cascade of inflammation, degeneration, and altered movement which leads to neuronal and glial injury, ischemia, exitoxicity, and apoptosis (cell death).
Who gets it? More often men over 50 years old.
Most common areas of the neck affected? ….. C5-6 and C6-7 (lower neck). Symptoms?  Pain, neck stiffness, upper limb numbness, generalized weakness, clumsiness, gait disturbances, dizziness or imbalance, bladder dysfunction. Note that numerous other conditions could be the reason for such symptoms.
Clinical signs when tested by a medical physician or chiropractor could include reduced neck movements, abnormal responses to testing skin sensation, vibration, sense of position, weakness on manual resisted muscle testing, increased overactive deep tendon reflexes below the level of compromise, muscle spasticity, gait abnormality, co-ordination deficits, “long tract” neurological signs, atrophy of shoulder or intrinsic hand muscles, inability to perform heel/toe test. Special tests? If warranted after such examinations, xrays (which must have measurements made of the size of the spinal canal), MRI, SSEPs and other tests may be ordered by medical specialists.
Other different diseases that may appear similar? …. Multiple sclerosis, syringomyelia, rheumatoid arthritis, post-polio syndrome, spinal cord tumor, psychogenic disorders, pernicious anemia.
Latest research? Salvi in the medical journal, Spine December 2006;6:S182.
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