In a recent podcast hosted by Shireesh Bhalerao of Tulip Seminars, Jerome Fryer reveals the backstory behind the origins of Dynamic Disc Designs among many other topics.

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Topics include:

  1. Practice (down time between patient visits)
  2. Pain is dynamic should be modeled for patient education
  3. Connecting patients and their anatomy with self awareness
  4. The connection between Dynamic Disc Designs and Degenerative Disc Disease
  5. Explaining and revealing the progressive changes of the disc
  6. The patient encounter and optimizing outcomes
  7. Jerome’s research in joint cavitation
  8. Jerome’s inspiring background
  9. How do you find a receptive audience to partner with?
  10. Cavitation research from the observations of research and development of a Dynamic Disc Model
  11. Collapsing Bubble vs. Bubble Formation does that make any sense?
  12. Early discoveries of sound origin of joint cracking, it may not be either — formation nor collapse
  13. Vacuum phenomenon – vacuum sign. (unpacking of joint cracking research)
  14. Tulip seminars and teaching moments from dynamic disc models. Students are blown away.
  15. How one should connect with patients.
  16. Pathoanatomic diagnosis vs. movement based diagnosis – Jerome does not think they should be separated.
  17. Empowering patients with their understanding
  18. Chiropractic and Physiotherapists tension – why? There is no need.
  19. Surgical world – NASS meetings
  20. Making Jerome work with advancing modeling of different pathoanatomical models
  21. Bridging medical and chiropractic
  22. Optimize patients with Dynamic Disc Designs
  23. The Pain Meter – new venture.

A very recent systematic review 1, in the Journal of Pain, went over the neurotransmitter systems associated with the placebo and nocebo effects in healthy humans as well as those with chronic pain. It did offer a fascinating insight.

What Was the Context?

Researchers have been interested in pain for a long time. That’s why numerous studies have been conducted involving neurotransmitters. The placebo and nocebo effects associated with pain are a big part of better understanding underlying mechanisms.

However, most of the said studies feature healthy participants who are exposed to experimental pain or are experiencing acute postoperative pain.

With a continued focus on finding a way to optimize placebo effects while minimizing nocebo effects during clinical practice, it has been deemed crucial for the neurotransmitter systems (that are involved in nocebo and placebo effects) to be directly investigated in subjects with chronic pain.

According to studies, the endogenous opioid system has been observed to be involved in the placebo effects demonstrated by healthy participants. Also, placebo effects in such subjects have been reported to involve the endocannabinoid, oxytocinergic, dopaminergic, and vasopressinergic systems, too. The CCKergic or cholecystokininergic system has shown involvement in the nocebo effects in healthy subjects.

But, it’s important to note that short-duration experimental pain or acute pain (in healthy subjects) is different from subjects with chronic pain. An intact nociceptive system for modulating pain is typically present in healthy participants.

However, chronic pain is linked to various mechanisms and complex pathophysiology that might be causing the pain. Psychological components for processing pain are usually more apparent in people with chronic pain.

That’s why it makes sense to think that the mechanisms associated with placebo effects present in healthy subjects might not necessarily be the same for subjects dealing with chronic pain.

Why Conduct Such a Review?

The current systematic review is the first to go over existing evidence pertaining to the involvement of the neurotransmitter systems in healthy subjects experiencing acute postoperative or experimental pain as well as subjects with chronic pain.

The goal was to offer an answer to how placebo effects might differ in said healthy patients and those with chronic pain.

LxH Model

What Was the Methodology?

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed for the methodology and reporting of the current paper. The team identified placebo studies by searching several electronic databases, namely Embase, PubMed, Scopus, as well as the Cochrane Library. The nocebo studies were identified post hoc by using the same electronic databases.

The articles were all in English. Also, the range included the earliest dates available in the databases through May 23, 2019. Take note; to be added, some of the factors involved the articles featuring studies aiming to understand the placebo and nocebo mechanisms as well as displaying statistically significant effects.

What Were the Results?

The initial search presented 1133 placebo along with 147 nocebo articles. With the duplicates removed, 505 placebo and 74 nocebo articles remained. After further exclusion, the final review included 28 placebo and 2 nocebo articles.

A total of 16 studies showed the involvement of the endogenous opioid system in a healthy subject’s placebo effects. Also, 8 studies shared how naloxone can be used to fully or partially block the placebo effects. However, 2 studies revealed that such effects, in a healthy subject, can’t be blocked with naloxone.

Furthermore, 2 studies talked about the contribution of the endocannabinoid system with regards to healthy subjects and placebo effects. A total of 2 studies had mixed results when it came to the involvement of the dopaminergic system. The same held true for the oxytocinergic system. The vasopressinergic system was said to be involved by one study. Take note; no study shared the involvement of the CCKergic system.

As for the placebo effects in those with chronic pain, two studies shared how the endogenous opioid system wasn’t involved. No studies about the endocannabinoid system and patients with chronic pain were found. The same happened for the oxytocinergic, vasopressinergic, and CCKergic systems. Two studies about the dopaminergic system showed mixed results.

Furthermore, 2 studies observed how the CCKergic system might be involved in a healthy subject’s nocebo effects. However, no studies were found talking about the involvement of the other systems.

Coming to subjects with chronic pain and nocebo effects, no studies were found.

What Does It Mean?

More research is needed to collect data about the types of neurotransmitter systems involved in placebo and nocebo effects in healthy subjects and those with chronic pain. A majority of the studies have focused on healthy patients.

And according to certain findings (as an example), the endogenous opioid system might not be involved in the placebo effects in chronic pain as it is involved in the pain experienced by healthy participants.

Furthermore, the psychological mechanisms linked to placebo effects are suggested to differ in subjects with chronic pain and in those who are healthy. This might play a role in why verbal suggestions display minor results when dealing with chronic pain when compared to the pain that’s experimental or acute postoperative. Understanding such differences in varying populations and conditions could aid in creating better ways to treat and manage pain.

Stuart McGill, ddd spinal models

In an online interview with Bill Morgan, President of Parker University, world-renowned spine researcher and scientist, Stuart McGill, uses dynamic disc models from Dynamic Disc Designs to explain lumbar disc herniations, extrusions, and the mechanisms for lumbar disc injuries and treatments.

When treating spinal injuries, McGill stresses the importance of recognizing that the cause of most disc extrusions and herniations is a combination of factors, occurring over time. The cumulative array of factors may present as an acute condition causing pain, but in most cases, the disruption has not been created by a single loading event.

McGill uses the analogy of cloth to explain how repetitive loading and movement fray the collagen fibers that cover the socket joints, eventually working a hole into the fibers by repetitive stress strains occurring in a back and forth motion.

“The disc is layer upon layer of collagen fibers held together with [a tightly woven lamination matrix]. If you keep moving the disc under load, the hydraulic pressure of the pressurized nucleus slowly starts to work its way through the delamination that forms because of the movement,” he says.

He explains that when the collagen is intact and supple, a person has full range-of-motion without danger of creating tears, but when the spine is stiff and has become adapted to bearing heavy loads, it is in danger of injury.

“The problem comes when you combine the two worlds and confuse the adaptation process,” he says.

“In a modern lifestyle, you might have a person who sits at a computer for eight or more hours in a flexion stressed position which—on its own—may not be that bad. But then they go to the gym for an hour every night and start lifting loads. They’re taking their spine through the range of motion, so cumulatively, the collagen is asked to move, but it’s also pressurized. The nucleus behind gets pressurized and slowly works its way through the delaminated collagen.”

Stuart McGill, Models

Stuart McGill and the many ddd models he uses.

McGill, Dynamic Disc Designs

Professor Stuart McGill and Dynamic Disc Designs endorsement.

Recreating Compression Loading, Disc Bulge, and Proper Thrust Line with our Dynamic Model

Using the disc model, McGill demonstrates how the gel inside the disc remains pressurized under compression, but in cases where the collagen has become delaminated, bending the spine under a load creates a disc bulge.

“This is exactly what we see on dynamic MRI,” he says, manipulating the disc model to demonstrate. “In the laboratory we would inject the nucleus with various radio-opaque markers. We would watch the migration as the bulge would come through. Touch a nerve root and now you would match where the disc bulges with the precise anatomic pathway. If you sit for 20 minutes slouched and your right toe goes on fire, we know it’s the right ring and that’s exactly where the disk bulge is.”

McGill stacks the disc model into a thrust line and squeezes the spine segment to show how proper alignment adapts the movement experience.

“The whole disc is experiencing movement, but there’s no pressure, and nothing comes out to touch the nerve root,” he says.

Empowering the Patient with Simple Posture and Stress Exercise

McGill says his insight is based upon years of experiments studying the exact mechanisms of spinal injury and pain. He recommends using improved posture and stress—lying on the stomach for five minutes with two fists under their chin—to help,” mitigate the dynamics of that very dynamic disc bulge.”

He says the immediate relief provided by this simple exercise can empower a patient with discogenic pain and help alleviate the potential psychological trauma of feeling hopeless at not understanding the source of, or how to mitigate, pain.

spine pain, models

Ed Cambridge: “Our colleague Jerome Fryer created some models for us, and this is some of the work that has come out of our lab with you and Christian Balkovec about the dynamic changes we see after herniation. Where we have disc height loss at one level, creating hypermobility at the adjacent level. So here you can see, when you move the spine around there is a stiffening effect down in the lower joint and in the upper joint hypermobility. That’s what we see when an injury propagates from one joint to the next. The patient says, “Well, the pain used to be lower but now its starting to creep up my back a little bit.” “

Stuart McGill: “Fabulous. Another little take on that … By the way, these are all cast from real human specimens. So this is the real deal. Once again, Dynamic Disc Designs has been so clever in representing the biofidelity. We start to see how this disc has been damaged, and it’s quite lax as we move it around. So those micro-movements now are triggering pain just at that level. And this joint has normal stiffness, but then look what happens. Over time, the join changes because of the change in mechanics. The lax disc now cases a bit more arthritis in those facet joints, because they are now responsible for much more motion. So then, look what happens to the cascade. As the person now extends, look what happens. The joint that was hypermobile has now bound up, has no mobility because the facets have bound up and all the motion is now left at the previously stiffened joint. The polar opposite. And then you need some kind of mobility to pop those facet joints open again after they’ve been jammed.”

inflammatory mediators

The changing spine and the anatomy. Professional LxH Dynamic Disc Model

Stuart McGill:  “So, when you understand the cascade of change that happens at a joint, it might be kicked off with a little bit of a flattened disc, which puts more load in the facet joints, which causes a little bit of arthritic growth. In two years, the joint has changed and so have the pain patterns and the mechanics. So, it really does lend insight to allow us to understand the cascade of how the patient reports those changes and their pain changes over the years. And it better allows us to show them what to do to wind down the pain sensitivity. “


cervical model, anatomy

Cervical Disc Anatomy Model Helps One Learn About Neck Injuries

If you’ve ever been a student of anatomy, there’s a huge chance that you spent many a night staring blankly at the pages of your text book and the photographs and drawings inside. The human body is a complicated system as millions of mechanisms are occurring at once and to understand it – even if you’re really into the science surrounding it – can be quite difficult. There are so many bones, tissues, tendons, organs, nerves, etc. and each one has its place and its purpose.
Anatomy students – as well as students of particular medical disciplines – spend a lot of time studying artists’ rendering of the parts underneath our skin. We try to picture how they’d really look if we could see them or how they’d feel if we could touch them. If you have been a student of the spine – be it a chiropractor, a spine surgeon, or perhaps a physiotherapist – you’ve certainly spent a good amount of time with those drawings, trying to understand how the parts of the spine move and what happens when things go wrong.
But perhaps those who teach spinal anatomy, chiropractic, or any number of other anatomy-related courses, could use something that would enhance the teachings of it. Rather than offering high-quality drawings of the spine to students for study, they should be prepared to offer their students something much better – 3D dynamic models like the cervical disc anatomy model and others offered by Dynamic Disc Designs.

cervical, disc, anatomy, model
Good spinal health for patients starts with good educational tools for future doctors and other caretakers of the spine. A classroom equipped with a cervical disc anatomy model, or any of the more than two dozen models offered by Dr. Jerome Fryer of Dynamic Disc Designs (ddd), is a classroom where true hands-on and  takes place.
Designed and originally rafted by a highly-experienced chiropractor, these lumbar and cervical models take learning out of the text books and put it in the hands of students, where their fingers can manipulate the discs in a dynamic way. With these models, future spine surgeons, for example, understand what they need to do to make their patients better in a patient education platform they can trust. Up-and-coming chiropractors better understand the specifics of manipulation therapy and the value of an adjustment to the spine. And physiotherapists can picture how their stretches and exercises will help their clients achieve better spine health.
“Dynamic Disc Designs spinal segmental models are unique in many ways and represent a new standard in quality and anatomical detail far superior to any of their predecessors. Their value far exceeds their cost,” explains Ara Deukmedjian MD CEO of the Deuk Spine Institute.
“The ddd models have helped me as an instructor in a DPT program show a more realistic anatomical representation of the human spine,” adds physical therapy instructor Stephen Elam. “This helps the students have a more accurate image of the spine in their head and allows them to have a stronger anatomy foundation.”

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Dynamic Disc Design cervical disc anatomy models and other carefully-crafted spine models are available individually or as a package. Choose one or several to improve how you educate the spine care professionals of tomorrow.

Human spine models, modeling, anatomical models, patient education

A Selection of Human Spine Models Make Patient Education Easier

Most individuals don’t really enjoy going to their doctor, no matter what the reason, be it a routine checkup or for a problem that they’re worried might be serious. Some people get nervous at the mention of a doctor visit and others see their blood pressure spike when they enter any medical office. Experts call this “White Coat Syndrome”.

Why does this occur? One reason is very obvious. The patient is afraid that they’ve developed a serious disease. Unfortunately, sometimes that’s the case. But in many instances, the anxiety comes from the fear of the unknown. In other words, patients don’t know what will transpire when they’re in that office. For that reason, patient education that involves talking about what’s wrong and how it will be fixed is essential.

For chiropractors, who often deal with patients who are in severe pain, this education is super important and should be done on the first visit after an overall assessment is performed. The fact that this instruction is done at all is obviously essential, but how it’s done is even more important. In short, chiropractors who use human spine models to educate their patients produce patients who are more satisfied with their care and who are pleased that they can walk out of the office knowing the facts about their pain and what can be done to fix it.

Human spine models from Dynamic Disc Designs (ddd) are continuously touted as the best available in this category. That’s because they’ve been designed and crafted by an experienced chiropractor who starting making these models because he was frustrated by the tools available for patient education.

Spine modeling, human, spine, models

Posters, while perfect for decorating office walls, just didn’t do the trick. After all, it’s tough to portray a disc bulge via a flat picture of the spine. Dr. Fryer, the owner of ddd, also found that the static models available for patient education didn’t fit what he needed to help his patients. Though 3-dimensional, they didn’t move like the spine moves, making it difficult to portray any number of spine-related problems. That’s why his human spine models move, making it possible for a patient to truly grasp the workings of the spine and why theirs isn’t functioning properly.

Dynamic Disc Designs offers a large selection of human spine models. In the “lumbar” category, the most popular is the Professional LxH model, which includes a flexible and totally dynamic herniating nucleus pulposus as well as a host of other features, including an audible release feature.

“This is the best model I’ve see,” opines Dr. Robert Gregory Lusk. “As a strong visual learner myself I’ve always appreciated that aspect of the educational process with patients. The moving parts accurately demonstrate how the lumbar spine functions. The disc is particularly impressive as it demonstrates the biomechanics involved with compression, flexion/extension, and rotary forces.”

In the “cervical spine” category, Dr. Fryer offers the Professional CxH model, which is a matching specimen to the Professional Lumbar LxH model (same human spine) portraying  identical cervical size with natural morphology including a two-part intervertebral disc with six degrees of natural motion with a red post-lateral nuclear migration upon manual compression, posterior longitudinal ligament (PLL), anterior longitudinal ligament (ALL) and periosteal fascia (POL) (adjacent to uncovertebral joint).

Many chiropractors choose more than one human spine model for their practice. As a matter of fact, Dynamic Disc Designs offers a Patient Educator Bundle, which combines 7 of the companies most popular models at a drastically-reduced price over what would be paid if they were purchased separately.

Check out the vast selection of human spine models available from ddd. Remember, with the proper education, your patients’ fear will lessen and they’ll develop confidence in you and your profession.

Dynamic Disc Models

Where Can I Buy Anatomy Models?

If you’re fresh out of school and setting up your practice for the first time, you’re no doubt feeling both excited and overwhelmed by all the things you need to do to get ready before that first patient walks in.

Quite obviously, the first priority is finding exactly the right location for your practice. City or suburbs? On a busy street or in a quiet neighborhood? Will you share it with someone else or strike out on your own? Next, you’ll need to start outfitting your office and exam room(s) so that they are warm and welcoming and make your patients feel comfortable and at home when they enter. Sometimes that takes a little creativity and perhaps some help from a clever friend or two.

Next, you need to purchase all the equipment necessary to treat your patients. Some of that equipment is obvious but other items may not be. For example, you’ll want to be sure to invest in items that cater to good patient education so that once your new patients have walked in the door of your sparkling new facility they’ll feel confident enough in you to return again and again.

So, as a professional who specializes in the field of spine health, what do you need? If you’re a doctor of the 21st century, perhaps you’ve already recognized that those old posters of the spine are no longer the best options for educating your patients about their spine problems. You’ll need something more realistic. Something that allows your patients to truly understand how the spine works. You need dynamic anatomy models.

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“So, where can I buy anatomy models?” you might wonder, and where do I find models that really do work the way the spine works? Dynamic Disc Designs, a Canada-based company owned and operated by a chiropractor with vast experience in treating spine disorders, offers what doctors from a variety of fields have called the “best spine models available.”

Dr. Jerome Fryer founded Dynamic Disc Designs in 2006, intent on providing models that truly provide the entire picture when it comes to how the spine works. A student of the spine and its workings, Dr. Fryer aimed to helping the medical community and their patients understand the mechanisms related to degeneration. This in turn, Fryer notes, will stimulate innovative solutions in prevention and regeneration treatment strategies.

Anatomy Models

“All models begin with identical copies of original natural specimens with a reconstruction of soft tissues,” Fryer explains.  “With a trademarked two-part intervertebral disc, dynamic spine motion can be demonstrated by hand to allow a realistic look into nuclear motion and the progressive nature of disc height loss in the degenerative disc disease paradigm. The emphasis on accurate anatomical detail helps in the education of definitive pain generators of back pain in a dynamic and interactive way.”

Today’s patients are all about education and gathering the facts. When you buy a quality anatomy model, you can provide them with the information they need to make informed decisions about their body’s well-being…right from the start. Get your practice off on the right foot by perusing the vast collection of Dynamic Disc Design models available to you and your patients.