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r The skin is one of the most important components of the human body. Its primary function is to serve as a
l protective envelope for all the underlying tissues. A secondary function is to serve as an organ of excretion,
regulating the body temperature through evaporation and radiation.'
o he three classifications of burns are as follows:
a
d Thermal burns, due to heat
D
e Chemical burns, due to acids and alkalis
c Electrical burns, due to electrical current passing through the body.2
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Despite the many technological advances made in the diagnosis of burn depth; most commonly, however, burn
R depth is determined based on the clinical judgement of the burn surgeon.3
e Thermal burns cause approximately 9,000 deaths annually in the United States. Clinical presentation of direct
n thermal injury is dependent on the degree of damage, a direct function of the intensity and duration of exposure
a to skin. First-degree burns are painful, red, swollen, and they blanch with pressure. The most common causes
l are ultra-violet radiation, scalding, low-intensity exposure to steam, or contact with a hot object. Second-degree
b burns create painful red blisters or broken epidermis, exposing a weeping edematous surface. They are most
often caused by sca ds or brief exposure to a flame. Third-degree burns usually result from prolonged contact
l with steam, hot objects, or flames. They create ulceration, tissue necrosis, and are often painless because nerve
o tissue in the area has been destroyed.4
o
d Many complications occur during the healing phase of burns. Infection remains the major cause of morbidity and
mortality. Measures to reduce the risk of wound infection and subsequent sepsis include early excision, where
possible, and the use of topical antimicrobial creams, such as Silver Sulphadiazine.s Mechanisms of re-
f epithelialization, reattachment (skin grafting) and remodeling may result in skin prone to blistering, dryness,
l itching, contact dermatitis, photosensitivity, and hypertrophic changes in the relatively early course of healing.6
o
w Noxious pain and thermal stimuli are carried by small myelinated fibers (delta) and unmyelinated fibers (G
fibers). The diameter of these fibers differs greatly. Therefore, the speed with which stimuli travel varies, creating
R a consequence known as "double pain." The stimulus carried by the delta fibers is faster and causes a sharp
i pain that rises to a crescendo. This is the fast pain or first pain. The second pain, or slow pain, is poorly localized
s and particularly unpleasant.7
k
Burn-related pain is often severe and intermittently excruciating for months after the initial injury as a result of the
multiple interventions necessary. While procedure-induced pain is untreated, general pain management is
o usually integrated into the overall patient care plan. In the case presented here, thermoreceptors had responded
f to noxious thermal stimuli, lowering their thresholds. Therefore, the thermoreceptors were responsive to
i relatively mild stimuli.8
l
When this patient presented for chiropractic management of her back and leg pain, the choice of an effective, yet
e non-invasive technique was necessary. Activator Methods (AM)* adjusting technique was selected because it is
u a standardized system of chiropractic analysis and low-force spinal adjusting technique. The Activator instrument
s was developed, and is currently used, to increase control of speed, force and direction of adjustive thrusts and
D reduce physical stress on clinicians. The modern Activator adjusting instrument is the product of many
e modifications and makes use of a hammeranvil effect to produce safe, reliable, and controlled force to osseous
misaligned or subluxated structures.10
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Case Report

Ms. K, a 61-year-old white female, sustained second- and third-degree burns over eight percent of
her body. The burns came about when a hot steamer fell on her while she was attempting to remove
wall paper in January, 1996. The patient sustained burns on the lower back, buttocks, and posterior
lower extremities. (See Photo 1) She was treated by her private medical physician for four days, then
referred to Trinity Medical Center Burn
Treatment Unit in Moline, Illinois. Four days after the initial injury, she began outpatient treatments of
hydrotherapy debridement, followed by the application of Silver Sulfadiazine dressing." This course was followed
daily, on an outpatient basis, for one week. Ten days into treatment, she underwent debridement under general
anesthesia. Daily hydrotherapy debridement continued until Ms. K experienced a progressive disabling pain and
itching. She was subsequently admitted to Trinity Medical Center Burn Unit and given parenteral medication for
pain and itching. At that time, the topical treatment was changed to Silvadene, another antimicrobial. Within 72
hours, the patient improved considerably and was discharged with instructions to return to the outpatient burn
facility.

On her first visit back to the outpatient burn clinic, the ointment was once again changed to "Scarlet
Red Dressing" (See Photo 3, post application), which is a combination of 5 percent Scarlet Red,
Lanolin, Olive Oil, and Petroleum. This dressing is used to promote epithelial cell growth.

In due course, she was released from the outpatient burn clinic, with instructions to continue skin-
softening KeriAide soaks. She resumed care with her personal physician. During the entire period
following her injury, she experienced pain in the lower thoracic and lumbar regions that interrupted
her sleep and daily activities.

Four months after the initial injury, Ms. K requested care at the Palmer College of Chiropractic
Community Outreach Clinic, located at the Center for Aging Services Inc., in Davenport, Iowa. Her
chief complaints were moderate constant pain in the low back and buttocks region, headaches, and
the inability to sleep without medication.
Physical examination revealed a well-nourished 61-yearold female in a mild antalgic position. Vital signs were
well within normal limits. Examination of the head and neck revealed no abnormalities, with the exception of
tenderness and palpatory pain in the posterior inferior occipital region on the left. Nose and throat were
unremarkable. There was a slight congenital convergence of the right eye, but no other opthamalogic
abnormalities were noted. There was no tenderness, rigidity, or palpable masses noted in the abdomen. There
was an eight percent whole body burn noted on the lumbar spine, buttocks, legs bilaterally, and right foot that
was in various stages of healing. New skin growth appeared normal, and there were no open wounds or
vesicles. Orthopedic and neurological testing were deferred.

The patient was placed in the prone position on a Thule portable adjusting table. Activator checks
revealed a right Pelvic Deficiency (PD). The following spinal segments were found to be subluxated
and were corrected, using AM protocol as outlined in the Activator Methods Chiropractic Technique
Basic ManualS: right Ilium (posterior / superior / lateral); Ifi/L-5 (body right with right rotation, specific
isolation tests revealed no laterality); T-7 (body left with rotation and right laterality); T-3 (body left
with rotation and right laterality); and C-6 (body right with rotation and no laterality). Post-
adjustment checks, according to AM protocol, were negative and the Pelvic Deficiency appeared to
be corrected.9
http://www.scribd.com/doc/17604738/Pathophys-BURN#