Pettibon Rehabilitative Procedures
Pettibon Treatment in Lakewood
The heart and soul of Pettibon rehabilitative procedures is the patented (US Patent #740087.403C1) Pettibon Weighting System™ (Fig.2). Its goal is to realign the centers of mass of the head, trunk, and pelvis. It incorporates the use of head, shoulder, and hip weights placed at specific areas with varying amounts of weight, depending upon the patient’s needs. Since we know that the spine attempts to distribute body weight evenly around the vertical axis of gravity, placing asymmetrical weights on the external body surface causes the postural reflexes and spine to adapt to the change in weight distribution, re-orienting this added weight around the vertical axis. In a study by Saunders et al.,40 with 131 patients, initial neutral lateral cervical radiographs were compared to lateral cervical radiographs with patients wearing 3 lb or 5 lb. frontal headweights. On average, the cervical lordosis improved 34%, while the amount of forward head posture was reduced by 14 mm in patients wearing 5 lbs. Those wearing 3 lbs. experienced a 31% improvement in cervical lordosis and 18mm reduction in forward head posture. In a smaller study by Morningstar et al.,32 15 patients underwent a series of three manipulative procedures, and were then fitted for a 4-lb frontal headweight. Radiographic measures of cervical lordosis improved 9.9° and forward head posture reduced 1.25 inches. While these studies have shown that external body weighting does make spinal changes, their position is key to successful treatment.
Cailliet3 described adding weight to the top of the head to treat cervical hyperlordosis. However, a previous study17 has shown that in a non-patient population, the average cervical lordosis is 34º, less than the normal value of 42.5º identified by Harrison et al.15 and 45º outlined by Kapandji27 and Pettibon38. Therefore, adding weight to the top of the head to reduce cervical lordosis seems contraindicated for a majority of the population. However, the Pettibon headweight is positioned on the patient’s forehead just above the eyes, causing a posterior skull translation versus a superior translation. The postural reflexes attempting to rebalance the skull’s new center of mass mediate this posterior translation. This results in a reduction of the forward head posture and increase in the cervical lordosis.
The Pettibon Weighting System is also considered a type of “isometric demand exercise” where the weighting system retrains and strengthens weaknesses in the postural muscles. Because patients vary in height, weight, shape, muscular strength, and medical history, the practitioner cannot assume that the same abnormal posture in two different patients will associate with the exact same muscle weaknesses. The Pettibon Weighting System can only be accurately utilized in conjunction with radiographic measurements because the reliability of visualizing cervical and lumbar sagittal alignment is extremely low8. Therefore, all patients must undergo radiographic analysis while wearing the weighting system designed specifically for them. While concerns tend to arise regarding radiation exposure to the patient, the dosage used is always minimal. In fact, Toppenberg et al.43 concluded that it would take 2500 cervical spine x-rays or 1250 lumbar spine xrays to approach the radiation safety limit of 5 Rad for a fetus.
Another important aspect of the rehabilitative procedures used in The Pettibon System is that they are intended to address the biomechanical properties of soft tissue. Hysteresis, for example, is the stored energy in viscoelastic tissues, like muscles, ligaments, and discs, that is decreased when these tissues are subjected to progressive loading and unloading cycles over time.47 Since muscles, ligaments, and discs are the structural “glue” of the spinal column, it is logical then to address these tissues when attempting to make changes in the static structure of the spine. In The Pettibon System, exercises are performed to decrease hysteresis in these tissues using the Wobble Chair™ (Fig.3) and the Pettibon Repetitive Cervical Traction™ (Fig.4). From a clinical standpoint, the exercises are performed at the beginning of a patient visit prior to manipulative intervention. This reduces the overall resistance of the soft tissues to the manipulative force, thus allowing that force to assume a more corrective role. Once the manipulative techniques are administered, the patient then wears the Pettibon Weighting System while the soft tissue is less resistant. Therefore, in The Pettibon System, all of the components of the spine are corrected and rehabilitated as a unit, using rehabilitative procedures designed to target each type of tissue specifically.
Finally, another type of isometric exercise is used to rehabilitate normal spine alignment. Kendall et al.28 demonstrated this exercise for the treatment of scoliosis, and Pettibon has slightly modified the performance of these exercises by creating the Linked Exercise Trainer™ (Fig.5) on which they are performed. The ways in which these exercises are performed change the functional origin and insertion of the muscle. For example, the action of a rhomboid muscle is to retract the scapula, when the spinous processes of the mid thoracic vertebrae serve as the origin. However, when the scapula is alternatively stabilized as the origin, the rhomboid now pulls on the thoracic spinous processes, thus acting as a vertebral rotator muscle. Hence, this muscle can be used to correct evidence of coronal curvatures in that region. Areas of muscle imbalance can therefore be isolated and strengthened using the Linked Exercise Trainer, thus reinforcing corrective spinal changes.