Network Spinal Analysis™
The tenets of Network Spinal Analysis™ and an overview of the Epstein models
Reprinted From Today's Chiropractic May/June 2003
By Donald Epstein, D.C.
Network Spinal Analysis™ (NSA) is an evidenced-based approach to wellness and body awareness. 1 Gentle precise force applications to the spine cue the brain to promote new wellness strategies. Two unique healing waves develop with this work. They are associated with spontaneous reorganization, redistribution and release of spinal tension. 2 NSA is applied through a series of four levels of care. The application of NSA combines the practitioner's clinical assessment of refinements in self-regulation of spinal cord tension patterns, unique "self-organizing" spinal sensory motor strategies within the recipient of care, with the patients' self-assessments of personal wellness and changes in life style.
Greater awareness of "self" and conscious awakening of the relationships between the body, mind, emotion and expression of the human spirit are realized through NSA care. Doctors of chiropractic also use NSA as an application for the identification and self-regulation of vertebral subluxation patterns, spinal tension and autonomic defense posture and accompanying osseous structural changes.
NSA is currently taught exclusively to chiropractors and chiropractic students, and is presented in relationship to chiropractic practice and subluxation-based care. Practitioners are taught to implement NSA in their practices consistent with the guidelines established by the Council on Chiropractic Practice (and the cannon of ethics of the Association for Network Care). The Epstein models are soon to be offered through the curriculum of a certificate program of Wellness Education and Outcomes Assessment offered by Florida Atlantic University in Boca Raton.
The Epstein models upon which NSA is based are as follows:
The Epstein Model of Somatic Awareness:
Cognitive awareness of body structures, including the spine, is an essential component of healing and wellness. Cognitive somatic and spinal awareness, with the ability to verbalize the experience, suggests utilization of higher cortical centers. The inability to perceive, process and verbalize body sensations, emotions, and tension patterns limits the range of one's adaptive responses. This promotes the body-mind disconnection that can create and sustain spinal distortions and vertebral subluxation. Care is taken to establish and refine capacities, strategies and pathways that promote and nurture a wider range of auto-regulatory and self-empowering responses and choices. It is proposed that the body cannot self regulate adaptation to a situation if the neural pathways that promote observation of the area and choice in response are inhibited.
The Epstein Model of Spinal and Neural Integrity:
Panjabi3 and Epstein4 have proposed stability sub-systems that regulate the dynamic state of spinal and neural integrity. These proposed systems must be able to rapidly share energy and information with one another. Spinal and neural integrity as an expression of spinal and neural wellness is associated with instantaneous modifications of perception and adaptive responses to the changing environment. Clinical assessments are used to evaluate the body's ability to establish and nurture mechanisms to reorganize the relationship between the subsystems and the environment.
This system is composed of the vertebrae, ligaments and spinal discs. Palpation for compliance of these segments determines if tension is being stored within this system. If tension is present this suggests that the small inter-segmental muscles of the spine are acting in defense, as the individual is locked in protective physiology and lack of safety. The flexibility of the passive system can be enhanced, and tension released, through the NSA respiratory wave initiating rhythmic oscillations of the vertebral segments entrained with the mechanisms of breathing. This results in vertebral segments and neurologic afferent pathways offsetting defense physiology with pathways of safety and ease. In addition, active para-spinal muscle tension can build and then release tension through spontaneous stretching or motion of the musculature of the spine or extremities. When this occurs the vertebral segments move through a greater range of motion and tension is released. Moreover, a greater range of motion of vertebral segments and elimination of defense physiology is achieved.
This system is composed of the spinal muscles and tendons, especially the long muscles of the spine. Tension in the spinal long muscles is in relationship to adaptation to stress including emotional tension. The entrainment of spinal/respiratory movements that occur during NSA care can reset adaptive responses. Spontaneous movement through stretching, or through the somatopsychic wave5, may also redistribute tension and facilitation patterns within the musculature.
Neural Control Subsystem
This system is composed of the spinal cord, nerve roots and peripheral nerves. The attachment of the meninges to the vertebral segments is also included. The concept of Adverse Mechanical Cord Tension (AMCT), introduced by Alf Breig6, is associated with lengthening in flexion/extension or lateral bending of the cord. Relating to this concept, NSA considers five spinal cord tension patterns or "phases." NSA care is evaluated according to these five phases. For example, heel tension, resistance to flexion/extension of the Achilles tendon is suggestive of adverse mechanical cord tension that is also believed to be indicative of a facilitated subluxation of a flexion/extension nature. Eversion stress, resistance of the Achilles tendon to lateral bending motion, is suggestive of AMCT/facilitated subluxation related to aberrations in lateral bending of the spine.
Adverse mechanical cord tension is proposed to be associated with stress physiology and is believed to be expressed by the individual as a defense posture. It is suggested that the spinal cord tension patterns and attending vertebral subluxation(s) are the mechanisms through which the defense processes are retained in the body and disconnected from the brain's reassessment of the adverse mechanical cord tension.
It is proposed that the presence of AMCT and vertebral subluxation is associated with a loss of critical self-perception and self-regulatory processes due to dissociation of higher brain centers.
The Emotional Subsystem:
This subsystem is proposed to be associated with a range of motion (rhythmic oscillation) and tension within any tissue of the body, including the elements of the passive and active neural control subsystems. A relationship is suggested between range of motion of vertebral segments and emotions. That is, within the range of motion of spinal segments there is a corresponding range of expression of emotions through these segments. The emotional motor system (Holstedge)7 is reported to influence the sensory and motor gain (threshold of excitability) at every spinal level. The ability or inability to perceive, process and verbalize a body sense or emotion is believed to be linked to the emotional motor system. Although the chiropractor utilizing NSA does not assess the emotional subsystem directly, he/she considers its implication in spinal and neural integrity.
The concepts of wellness and illness exist on a continuum.
One's position along the wellness-illness continuum represents the realm through which one experiences his body, circumstances, symptoms, sense of self, relationships and the world in general.
Neither wellness nor illness exist in a direct relationship with pathology or lack thereof. Wellness-illness is a function of one's internal experience, and not one's circumstance. Therefore, an individual may exhibit various stages of pathology, remission or health regardless of where he/she is on the wellness-illness scale.
Wellness and illness include domains such as: physical, mental and emotional state, and social well-being. They are based upon one's subjective experience of self and one's health beliefs. It is possible to objectify these domains through specific survey instruments that ask the individual to report their perceptions.
Two classes of vertebral subluxations exist (described below), each having different etiology and responding to a different force application.8 The structural (Class A) subluxation is a segmental distortion associated with a compromise of the inter-vertebral structures within the foramen. This is most commonly produced by a localized physical trauma or is adaptive to spinal cord tension patterns.
The facilitated (Class B) subluxation is associated with lack of recovery from emotional, mental or chemical stress and is believed to be associated with a state of adverse mechanical spinal cord tension. This clinical finding is believed to be a product of stress physiology and attendant stress posture, and is best addressed through a gentle touch at or in the vicinity of the vertebral/dural attachments in the cervical and sacral-coccygeal spine.
Rather than viewing the vertebral subluxation as the single cause of ill health, it is instead viewed as an integral link in the process of body-mind disconnection and a physical consequence of defense physiology and postural changes.
It is suggested that the brain can learn to recognize such distortions and develop mechanisms to self-regulate restoration to normal function. The spinal contacts applied in NSA are used to the brain to self-regulate to normal the mechanisms that produced and perpetuated the subluxation(s) while promoting new spinal and neural pathways and strategies of self organization to offset future episodes of vertebral subluxation.
The Spinal Gateway:
When vertebrae distort as a consequence of defense posture, at least one of the vertebral articulations is in relationship to the stress experienced at the time. Within the concept of NSA, a force is not applied to a segment that is a product of defense posture. That is, within the NSA phasing system, a segment that invites contact and is believed to be associated with a peaceful state is selected for contact. The "spinal gateway" is such an area. No force in NSA is applied to the region of tension, facilitation or fixation. Although an adjustment applied there may correct the vertebral distortion, it will not allow for rapid progression thought the NSA Levels of Care (see page 26 for details) and the emerging properties available with NSA.
Within the method of Network Spinal Analysis™, I have introduced the concept of the "spinal gateway."8 This is viewed as an interface between the dimensions of energy, consciousness and physical tissue. The spinal gateway serves as a nexus or hub for interaction between the sub systems that establish and maintain spinal and neural stability and integrity. Spinal gateways are located on, or adjacent to the spinal segments having physical vertebral-dural attachments. Application of a light force or touch to a spinal gateway assists the body-mind to shift from a dominant state of stress physiology (which is expressed as defense posture) to a state of greater adaptive self-assessment and organization. Precise and gentle touch contacts at these Spinal Gateways assist the brain to connect more effectively with the spine and body. As a consequence, the individual develops new strategies for living and healing.
NSA continues to expand the application of wellness care and outcomes assessments for the chiropractic profession. This involves clinical application for the correction and self-regulation of vertebral subluxation(s). It also provides for the development of new sensory motor strategies to assist in spinal and neural integrity. As chiropractic, the care is in relationship to both the practitioner's clinical health and spinal assessments and the patient or practice member's self-assessment of their experience of advancements in spinal and neural integrity and wellness.
An active research program investigating various parameters of NSA was initiated nearly a decade ago and will continue into the future. Early on, a commitment was made to foster the research program through major universities using the expertise of senior researchers. Subsequently, the program has developed through study at the University of California in Irvine and the University of Southern California, and is commencing at Florida Atlantic University.
Following standard protocol for the establishment of an evidence base for emerging methodologies, the program first involved publication of a descriptive paper representing the clinical approach. This was followed by a retrospective study to ascertain if anecdotal reports could be substantiated. Results of the retrospective study indicated statistically significant health and quality of life benefits reported by over 2,800 recipients of care. The outcomes of the study led to further refinement of Network Chiropractic to the levels of care now practiced in NSA. A longitudinal study investigating the benefits of care related to the refined approach has been completed and is awaiting final analysis prior to publication. However, preliminary results indicate similar benefits as reported through the retrospective study.
An important spin-off of the retrospective study has been the establishment of a health and quality of life questionnaire that is oriented towards "well" populations as opposed to other questionnaires that focus primarily on sick populations. This questionnaire has application to all health-related disciplines, not just NSA.
While a major thrust of NSA research is to investigate its clinical impact, research into other aspects of NSA is also necessary. The unique somatopsychic wave accompanying NSA care is intriguing. Study has been undertaken to ascertain the nature of this wave phenomenon by analyzing the surface electromyographic (sEMG) signals during the different levels of care. Study has thus far revealed a high level of predictability between signals received and the different levels of care. Results indicate that as recipients progress through the NSA levels of care, the associated somatopsychic wave increases in organization. Investigation into all aspects of NSA will continue as results, both anecdotal and evidence based, suggest a wide range of implications into areas as diverse as neurophysiology, psychothearpy, systems analysis of non-linear systems, behavioral modification and bioculturalism.
As NSA continues to be investigated in these different arenas, the models underpinning NSA will certainly be enhanced. This is expected to provide a yet deeper understanding of the expression of the innate wisdom found within all living systems.
1. Epstein, D. The Theoretical Basis and Clinical Application of Network Spinal Analysis™ (2001, Longmont, Colorado, Innate Intelligence, Inc.)
2. Bohacek, S and Jonckheere, E: Chaotic Modeling in Network Spinal Analysis™: Nonlinear Canonical Correlation with Alternating Conditional Expectation (ACE): A Preliminary Report. Journal for Vertebral Subluxation Research 1998; 2 (4) 188-195
3. Panjabi M. The stabilizing system of the spine, Part I. function, dysfunction, adaptation, and enhancement. Journal of Spinal Disorders 1992; 5(4): 383-389.
4. Epstein, D. The Theoretical Basis and Clinical Application of Network Spinal Analysis™ (2001, Longmont, Colorado, Innate Intelligence, Inc.)
5. The somatopsychic wave is a spinal wave that develops unique to Network Care, and which is associated with a reduction of spinal tension, various spinal re-organizational states and patient reports of enhanced wellness. As care progresses, this wave undergoes visible refinement which can be mathematically mapped and has been the topic of academic studies and articles.
6. Breig A. Adverse Mechanical Tension in the Central Nervous System. (1978; Stockholm, Sweden: Almqvist & Wiksell Int.; New York: John Wiley & Sons) 39-41, 45, 96, 116, 121-123, 129-130, 155
7. Holstege G. The Emotional Motor System. European Journal of Morphology 1992; 30 (1): 67-69.
8. Epstein, D, Network Spinal Analysis™: A System of Health Care Delivery Within the Subluxation-Based Chiropractic Model Journal for Vertebral Subluxation Research 1996; 1 (1) 51-59
[Editor's note: "Spinal Gateway" is a termed trademarked to Donald Epstein]