A Frank Discussion with Your Medical Doctor

The purpose of this blog post is in no way to belittle or degrade the medical profession. My best friend is a medical doctor and I have several friends whom I admire and respect who are medical doctors. Furthermore, I have many medical doctors who refer patients to me on a consistent basis. No, this article is for those medical doctors who refuse to educate themselves on the benefits of alternative health care. Lately I have had a few medical doctors tell our mutual patients that they should not get adjusted anymore. Every single one of them cited arthritis as the reason why they should discontinue care with me. I hope this article will educate you as a patient of such physicians and maybe even influence some of them to do some research.

First of all, arthritis is a very generic term. Medical doctors routinely use it for any ache or pain in a joint. Most of the time calling it arthritis is technically true but over simplistic. It seems to me like they use it liberally because they do not want to explain what is really going on. Arthritis means is inflammation in a joint. It can be caused by auto-immune conditions like Rheumatoid or Lupus but more often it is caused by wear and tear. This is rarely explained to a patient so I am going to.

When doctors tell you that you have arthritis, most of the time what they are saying is that they can see signs of degeneration on your x-rays. Examples of degeneration are decreased joint space, bone spurs and misalignment. Essentially, instead of seeing nicely aligned joints with smooth edges, they see jagged edges with varying degrees of misalignment. This happens over time. How quickly is determined by how dysfunctional the joint is. The more dysfunctional the quicker it degenerates. Dysfunction of a joint means it is either not moving properly or not moving at all.

In the spine, the vertebrae have discs that can degenerate. Usually, this is associated with a disc herniation or bulge. Degeneration in the spine can lead to stenosis or narrowing of the openings where the nerve roots travel. Spinal degeneration or arthritis can come in varying degrees and complications. I am very aware of the risks involved with adjusting a highly degenerative spine.

Let me repeat that. I am very aware of the risks of adjusting a spine that has arthritis or degeneration! I also know the benefits. For this reason, I am very frustrated with these MD’s who are telling my patients to stop. Do they think I am unaware of my patient’s condition? Do they believe that I have no regard for my patient’s health? To be honest, I don’t believe they consider this, at all. I see fear derived from ignorance.

The truth is that an adjustment of a degenerating joint can be very beneficial. Retraining the joints to move properly can decrease inflammation and increase the nerve flow to that area which will at the very least slow down the degenerating process. Increased function will lead to improvement to the health of the joint. Are there risks? Of course. There are risks to everything. I believe the greatest risk is doing nothing. It is certainly the most predictable risk.

Trusting in your chiropractor to know when to adjust or not is important. Communication is the key! If you have a condition and you are unsure of your chiropractors awareness of it, express your concern. On that same note, avoid taking advice from people who don’t know. They shouldn’t be making recommendations about things of which they are ignorant. That doesn’t seem to be stopping some of them. If you stopped chiropractic care because your MD told you to, but have’t discussed it with your chiropractor, its time to have a frank and open discussion with all the parties involved, OK?

Chiropractic and Physical Therapy

I was asked to write this article by one of my patients. She actually asked me write about chiropractic vs. physical therapy but I feel like there isn’t really a competition. They are different even if the end goal of improving one’s health is the same. There is some overlap but at the very least they are complementary. Nevertheless, here is the comparison.

Chiropractors focus on proper joint motion and nerve flow. Philosophically, we want to make sure that the innate intelligence that flows in each of us through the nervous system is not impeded. Subluxations or altered joint function can be a major cause of altered innate flow. When a chiropractor adjusts, the correct movement of a joint is restored and the nervous system flows as intended.

I don’t believe physical therapists have any such allusions to such a philosophy. Their focus is on mechanics, rehabilitation and improving activities of daily living. Physical therapists are rehabilitation specialists. After major injuries or surgeries, bodies need to be reeducated and strengthened. Exercises, joint mobilization, soft tissue work, and physiotherapy are their tools. They spend a lot more time teaching and pushing the patient.

Although most chiropractors are taught the same rehab techniques techniques as PT’s, the vast majority, including yours truly, have no interest in them. Our tool is the adjustment which can be compared to mobilization that PT’s do but the adjustment is much quicker and thorough. It is technically considered a Grade 5 Mobilization. I think most chiropractors would argue that it is much more than just a mobilization.

We can both teach exercises, do soft tissue work, and physiotherapy (e-stim, ultrasound, heat, ice, etc.). I personally will teach some basic exercises in a course of treatment and will do soft tissue work, if need be. However, physical therapy requires more time each visit. As a chiropractor I don’t spend very much time with each patient. An adjustment only takes a few minutes. Physical therapy appointments are typically at least a half hour.

Both treatments are effective for what they are. Getting joints adjusted is very important and may be all the body needs to heal. Sometimes the patient needs more. I refer to PT when it is more than I can feasibly handle. On the same token, some soft tissue injuries, especially muscle strains, need physical therapy and adjustments don’t really have an affect either way.

Like I said, Physical Therapy and Chiropractic are very complementary. With complicated cases, doing both can be extremely effective.  If a PT or a chiropractor tells you differently it is probably because they are insecure about their own skills.

How to Treat Sprained Ankles.

Whenever I get several patients who come in with the same ailment, I always feel like the universe is telling me to write about it. When that same ailment happens to me, the hint is as subtle as a two by four to the head. Such is the case with this article.

I have had a lot of patients come in with sprained ankles lately. For me, I didn’t think it was possible to sprain my ankles anymore. The ligaments in my ankles are pretty much gone from spraining them several times playing soccer in high school and college. So much for that. I rolled it jumping on the trampoline with my kids yesterday. It usually smarts initially and that is about it. This time it continued to hurt and started swelling a little, too. So, “Doctor, heal thyself!”

Here is the protocol: First you have to remember the mnemonic PRICE. P=protect, R=rest, I=ice,  C=compress, E=elevate. I stopped jumping and walked it off. I rested with it elevated. Then, I put it in an ice bucket (protocol details below). I planned on wrapping it up but it felt stable and the swelling was down when I woke up this morning so I thought I would be alright. In fact, I walked to work today and it felt just fine.

The most important thing to do if you sprain an ankle is ice it. Ice packs on an ankle are almost useless. You just don’t get enough surface contact to penetrate to the joint. If you are going to do it, be sure to leave it on for 20 minutes. However, the best way to ice the ankle is to put it in an ice bath. Here are the steps:

1.As soon as possible after a sprained ankle get a bucket big enough to fit your foot

2. Fill it with ice about 4 inches deep

3. Fill the bucket with water deep enough to reach just below the calf muscle (higher for high ankle sprains)

4. Cover the toes with a sock if needed

5. Immerse foot for 6-10 minutes until numb.

This is not exactly fun (unless you are a masochist) so, be tough. The stages of icing are intense cold followed by aching then burning then numbness. You have to get to numbness to benefit. Some people cheat a little and put on a sock covered by a baggie. This is ok as long as the sock is not too thick and there is not an air barrier in baggie. It still has to get to numb!

If you chronically sprain your ankles like I used to, you will have to rehab them. The more you sprain a joint, the worse the proprioception or the communication between the brain and the joint. In short, it becomes dull and you are much more likely to sprain it again. I recommend standing on a wobble board for several minutes each day. That will improve the proprioception and dramatically decrease the likelihood of future sprains.

Chiropractic and the Healing Process

In this world of instant gratification, realistic expectations are often scarce. We have instant coffee, fast food, automatic deposit, etc. We demand results quickly and for most things we get them. Unfortunately, healing is not an instantaneous event. It takes time. Don’t get me wrong. I am as impatient as anyone. I like to see or experience improvement quickly. However, when it comes to healing, there is still a process.

This article was written to help you understand the healing process and what to expect on your road to recovery.

The healing process has several stages. They can be broken down into three major steps:

1. Inflammation: Whenever an injury occurs there is damage to tissue. Tissue damage causes a reaction in the body that brings chemicals to take care of the damage. It causes swelling which keeps the affected area from moving too much. The reaction also generates heat, hence the term. I like to compare inflammation to firefighters putting out a fire. They arrive quickly and start shooting water onto the fire. Though necessary, often times the damage from the water is just as bad as the damage from the fire itself. This is even more true of inflammation. If not taken care of quickly, inflammation will begin to destroy the good tissue and cause a host of other problems. For this reason, ice is a powerful tool. Controlling the swelling with compression and an anti-inflammatory diet can also be very valuable.

2. Scar Tissue Repair: After a 2-6 days of inflammation, the body starts to lay down scar tissue. Scar tissue is weak and it complicated by the fact that it is laid down quickly and haphazardly. To further the analogy of a home damaged by fire, imagine a crew going in after the water has mostly dried and quickly supporting the overall structure with whatever wood they can find. They make it more stable than it was but it is not as functional and it is certainly not as stable. Scar tissue is supposed to be a temporary process that takes 6 weeks to 6 months depending on the damage. Unfortunately, many people do not do what it takes to get beyond this stage. As a result, they easily tear the scar tissue and the process starts again. This is the cause of chronic injury.

3. Remodeling of Tissue: When scar tissue starts to act like the original tissue, the remodeling process has begun. It is critical to get to this stage if true healing is to occur. This stage can last for a long time. For some tissues, like the nervous system, the process can be so slow it is almost imperceptible. For such tissues, support therapies like hyperbaric can help. In joint,  muscle, bone, ligament, tendon, etc., proper motion and function dictate this process. You have to train the scar tissue to line up all in the same direction and act like and be in sync with the surrounding tissue. Only at this point will true healing occur.

Unrelated topic: when you make a comment on this blog, you will automatically be entered into a drawing to win free chiropractic care for April.

Why Isn’t Everyone a Regular Chiropractic Patient?

Please help me out if you will. I am trying to wrap my brain around what patients think? Maybe I have failed as a doctor in educating people about their health. Maybe it is just a time thing. Maybe it is a financial thing. Maybe it a combination of all of the above or something different all together. Whatever it is, please share your opinion!

Over the 6 years I have been in practice in Roseville, I have had thousands of new patients. Some come once or twice just to check it out or get some relief, some go through a full course of treatment designed to restore function, and some continue to receive regular adjustments long after function is restored. I also  have plenty of patients who come in every so often when they are hurting, get a few adjustments and then I won’t see them again until that or another problem comes back. My burning question is why? If a patient knows that regular chiropractic care will help them maintain proper function which will in turn help maintain better health, why doesn’t everyone come in regularly for an adjustment?

For the record, I know I have had some patients who came in and just felt like chiropractic was not, for whatever reason, their thing. I am also sure, though it is hard to believe (insert tongue in cheek) that a very small number of patients may have not enjoyed their experience in my office or just didn’t feel like it was a good fit. I get those. There have even been some patients that I wasn’t able to help. It happens. The patients that really puzzle me are the ones who are getting good results and then disappear. No return phone calls or emails. They were doing great and then gone. Finally, the next most baffling patient is the one who goes through the time and expense of restoring their function and then decides not to maintain.

If you are in one of these categories, especially, let me know. Is there an incentive I can offer? What can I do to help you be as healthy as you want to be. For those of you who have never been adjusted, all I can say is you should really discover what you are missing.

Custom Orthotics from a Chiropractor? For $150? Sign Me Up!

At the behest of many of my patients who didn’t know but now do, I offer custom orthotics in my office. I feel compelled, however, to educate you on what a good orthotic is  and how you could benefit from it.

There are 3 different types of orthotics, generally speaking: non-custom, custom casted for the perfect stance, and custom evaluated for the perfect gait.

The first is the non-custom orthotic. These are the Dr. Scholl’s, SuperFeet or the kind from the Good Feet Store. Some can be a very good and beneficial product. Dr. Scholl’s are mostly just a padding to decrease shock absorption. SuperFeet and orthotics from the Good Feet Store are a lot more substantial and can

actually improve the way you walk or stand. The only issue I have with the Good Feet Store is the cost. You are paying custom prices (very expensive in my opinion) for non-custom or semi-custom orthotics. The semi is just because they have a wide selection for the salesperson to fit you as best as possible.

Custom orthotics created to mold the foot into the perfect stance is by far what most podiatrists use. They manipulate the foot and hold it in what is called taler neutral, basically, the ideal position of the foot. Then they make a cast which will be the mold to create the orthotic. Another method is to have you stand on a plaster or foam mold from which they create an orthotic. Typically, the orthotic is made of a hard plastic with no flexibility to keep the foot in the same position.

Either way, this method, in this doctor’s opinion, is outdated and shortsighted. The foot is designed to be flexible. When we walk, the perfect gait is for the heel to strike. Then, the arch flattens out while the foot pronates (flattens inward). Ideally, the flattening of the foot stretches the plantar fascia which creates a taut spring. When the pressure is released, the spring

pushes off  the big toe to the next step. When you put in a piece of hard plastic, you negate the action of the foot. Essentially, you make your foot into a post. You take away the foot’s ability to absorb shock or act as a dynamic player while walking or running. The shock has to be absorbed by something. If the foot cannot absorb shock then it will certainly transfer to the knee, hip, or low back. Plus, it forces those other structures to compensate for the altered mechanics. Who cares if the foot is in a perfect position when you stand still? We are mobile creatures who need to move and function.

The best type of orhtotic and hence, the type I offer in my office, is the kind that corrects the gait. Often times, for various reasons, the foot doesn’t perform the way it should. It makes sense to me to help it work the way it was intended and designed. When we create an orthotic we take into consideration the stance and the gait. We have a digital plate that captures the pressure and the pattern of your stance and your gait. The goal is now to create a flexible and dynamic orthotic that will assist your foot in behaving the way it should.

Not everyone needs orthotics. Every time you add external devices there will be secondary and tertiary reactions. It is difficult to account for all of them. I have had plenty of patients who were wearing orthotics and complaining of all sorts of issues. I told them to take out the inserts and things resolved.  My first course of action when someone asks for an orthotic is to discuss why. Sometimes just adjusting the foot will take care of the foot issue. I also like to look at value. If a patient can resolve their issues with non-custom orthotic for $35, then paying $150 for a  custom pair might not seem worth it. That saying, if you need a custom pair of orthotics, they can be of tremendous benefit and can really preserve not only your foot but your knees, hips, and back, as well.

Post Script: Don’t let the price fool you. I could easily charge $300-600 for these orthotics (everyone else does). These are made by the same types of labs that do work for every doctor who works with orthotics. I keep my prices low because if people need them I want them to be able to afford them. Do I make much money from them? No. For now I am going to keep them at $150. I actually dropped them down from $200 because I switched to a direct lab and they only charge me around $100 per pair. If you want some, act quickly because the time it takes to gather the information is substantial and I will probably go back up to $200 again, soon (which is still a bargain).

It’s Not All About Pain, People!

Pardon my rant for moment and please consider what I am about to say. Pain is a symptom or an indicator. Pain is annoying. Pain can be frustrating. Pain can even be debilitating. Treating for pain, however, is a terrible way help someone get out of pain.

The origins of pain are not well understood and can be a very deep topic. That saying, from my study, most of our pain is distributed through the limbic center of the brain. The limbic system is really the emotional center of the brain. So, to me, pain is an emotional response. Ever notice that some people have a high pain threshold and others have little to none? Likewise, some cultures are very stoic about pain while others are extremely passionate. The very same stimulus can be applied but the reaction is completely different.

Don’t get me wrong. Pain is very real. I am not suggesting we write off anyone in pain with the idea that it is all in their head. What I am suggesting is that we keep pain in perspective. Bad pain does not always mean horrible damage. Likewise, some of the most serious damage to the human body can display very little pain. Furthermore, pain can be a good thing when it gives a warning that something can be harmful. Have you ever stepped on hot sand and immediately pulled away so you didn’t burn your feet? What if you were a diabetic with poor blood circulation and therefor poor feeling in your feet. Would you say that it was a good thing to burn your feet because you couldn’t feel it? Of course not!

Rather than focus on the pain of an injury, I like to focus on the rehabilitation or function. If we only treated for pain, very few people would ever recover. Rehabilitating an injury whether chronic or acute can be painful. Let me say that again, TREATMENT CAN BE PAINFUL!  Sometimes we have to break down a lot of scar tissue. This will be painful. When you are dealing with functional and physical medicine, like chiropractic, the end result is to get you functional which will eventually lead to less pain. By the way, this takes time.

Please don’t kid yourself that you can rehabilitate an injury without pain or discomfort. It is just not how the body works. Would you expect to work with a personal trainer to get in shape and never feel soreness or fatigue? Instead, focus on improving function and accept pain for what it is. In the words of the Dred Pirate Roberts aka Westley from The Princess Bride, -”Life is pain, your highness. Anyone who tells you differently is selling something.”

"I Just Get Normal Headaches."

What is a normal headache? I hear it all the time from new patients. There are migraine headaches, tension headaches, cluster headaches, sinus headaches, hormone headaches and cervicogenic headaches but I have yet to understand what a normal headache is. I don’t think they exist.