Humpty Dumpty and Chiropractic

Humpty dumpty falling of the wall with the sky and clouds behind
Humpty dumpty falling of the wall with the sky and clouds behind

Recently, I had a patient ask me if I ever got stressed out about trying to put all of the Humpty Dumptys back together again. I joked that I am not all the king’s horses and all the king’s men so it is not my job to put Humpty Dumpty together again. This exchange brings up an interesting point, though. Several times a day people ask me to fix them. I understand what they want and I always do my best to help them, but somewhere in the back of my mind I am thinking that their expectations are mis-focused.

My job is to adjust the joints of the body. In doing so, the nervous system is stimulated which allows the body to communicate better. Better communication leads to better function. Better function leads to proper healing. Contrast helping the body function better with fixing something and you can appreciate why I am reluctant to claim that I fix or heal anything.

Bear with me while my BA in Linguistics drives the bus for a little while. If you take a very literal definition of the word fix, it means to “fasten (something) securely in a particular place or position.” That is the opposite of what I want to do. My aim is to help joints move. Likewise, it would be the height of hubris to think that I heal people. The body heals itself. Again, my job is to help the body function better so that it can heal properly and, hopefully, quicker.

Finally, giving me the burden of “fixing” someone is an impossible task no matter how willing the participants. That is like asking your exercise equipment to get you in shape. Sure the end goal is for you to get in shape but the responsibility is on you not on the equipment. Focus on improving function and not on getting fixed and you will find that not only are your expectations in line with your goals, but that your care will also be much more effective and productive.

 

The Cost of Waiting

Abraham Lincoln once said, “You cannot escape the responsibility of tomorrow by evading it today.” The same is true for addressing your health concerns. Several times each day I have patients come in who tell me they have been hurting for days, weeks, months, or even years. The story is usually that they just thought it would get better on its own but it never did. Inevitably, they express their remorse at waiting to come in.

The truth is that with any injury, the body starts the healing process immediately. The concern is whether you will heal correctly. The body will compensate in whichever way it can to stabilize. If muscles are tight or ligaments are overstretched, it will alter the proper movement of joints. Such improper movement causes the nervous system to become confused and ultimately desensitized. Consequently, the body will lay down scar tissue that will promote the new and improper movement patterns which leaves the body susceptible to reinjury or to injury of surrounding tissue.

As a chiropractor, if I can help move the joints in a proper manner before inflammation and scar tissue sets in, then the healing process is a much easier ordeal. If you wait until scar tissue repair has set in when you come in to see me, the first step will be for me to tear down most of that process so the healing can start over. As with remodeling kitchens, the demolition can be ugly. The old adage of getting worse before it gets better is often in play and can lead to a few days of discomfort.

Another caveat to waiting is establishing movement patterns that can be difficult to retrain. Old habits are harder to change than simply making new ones in a fresh environment. Chronic conditions can take years to correct for this very reason. Muscles and joints have memory locked in to the nervous system. In my experience, it typically takes around three months of consistent treatment to change that memory.

Finally, with altered movement, the the body will degenerate quicker. At a joint level that means that tissues will dry up and bone spurs will form. Once a bone spur has formed, everything changes. No amount of adjusting, taking supplements, acupuncture, or whatever is going to remove that. Tissues can be rehydrated but they are never as good as they used to be. This is mortality. However, we can help slow down the degenerative process. At the end of the day, if we just improve the function it is worth it.

All conditions will change over time. The body will strive to compensate but that compensation can lead to issues down the road. If you have an injury or if dysfunction has been brewing for too long, get in! Better yet, come consistently and do your best to maintain good health and function.

 

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Even If I Want to, I Cannot Help Everyone. Neither Can Chiropractic.

The great Aristotle once wrote that “The more you know, the more you know you do not know.” For me, the more experience I gain, the more I realize my limitations. People who know me well, know that I do not lack confidence. I try not to be arrogant but I do my best to assure myself that I can be a force for good in this world. That saying, I must confess that no matter how much I may want to make everyone better, there are just some people that I cannot help.

Recently, I had a patient come in that I hadn’t seen in a couple of years. She did not come in for an adjustment. She came in to explain why I couldn’t help her. You see, back then I gave her several adjustments which provided little to no relief and then she started heading south so she discontinued care. As a doctor, that is the most helpless feeling. It is made significantly worse when there is no explanation why. In her case, she was born with a birth defect called a Chiari Malformation where the lower part of the brain drops below the skull. This can lead to a syringomelia, a pocket of fluid in the spinal cord which can be very painful and dangerous. Anyway, this was never mentioned in her MRI report from years earlier. The neuro/spine specialist that she saw some time after seeing me saw it on the MRI. This little bit of information explained everything. I am grateful she came in and shared that with me.

There will always be conditions that are too far advanced for me to help. I don’t like it, but that is the way it is. We do not always know when a condition is beyond help until after we have tried. I have had many patients with serious back pain come in and ask if I can help. As a chiropractor, I know I can adjust them. In most cases, this will help in the healing process. At the very least, it is a conservative start. Most patients get better and we can manage. Others do not. I have recommended MRI’s and surgery when it is beyond my help. For the most part, those patients have seen good results and have come back to me for care after their surgeries.

Finally, there are people who either do not really want to be helped or have unrealistic expectations of how long and what it will take to heal. Healing takes time and effort. One adjustment can make a big difference in how a patient feels but it does not mean that their injury has healed. Consistent care is tentamount to healing properly. Likewise, just because there is still pain, it does not mean that injury is not healing. Pain can be tricky and is not a very good indicator of the level of damage.

In short, I sleep at night knowing that I do my best to help others live healthier lives. There are always challenges and there will be people that despite my knowledge, skills, and determination, I cannot help. For those people, I am sorry. I feel bad for you and hope there is some one out there with the answers and approach to help you in your journey.

Momentum of Healing

It is always interesting when a new patient who has never seen a chiropractor before,  and knows very little about it, asks what it will take to get better. When I explain that we are going to start off adjusting them three times a week, their eyes usually get very big and the eventual question is, “Why so often?” My answer is always the same, because you need consistency and momentum to heal.

Healing can be like climbing up a sand hill. When you first start out, the sand is the thickest and you are very prone to getting stuck or sliding back down. Likewise, if you are not concentrating on healing correctly, you can start going sideways and waste a lot of energy but not get anywhere. Heading in the right direction with enough momentum to gain traction is the only way.

Getting adjusted three times a week in the beginning of care provides the momentum necessary to progress up the sandy hill of healing. A little higher up on that hill it does not take as much energy so twice a week is sufficient to keep healing. However, stopping or slowing too much can make it difficult to get started again and complete the healing process.

Concussions

While listening to sports talk radio the other day, the topic of Sidney Crosby came up. For those who don’t know, Sid the Kid has been one of the best, if not the best, player in professional hockey since he was drafted by the Pittsburgh Penguins into the NHL in 2005. He won a gold metal for Canada at the last Winter Olympics in Vancouver and the Stanley Cup in 2009. However, no one is talking about Sid’s accomplishments right now. His career is in jeopardy due to a concussion he sustained back in the 2010-2011 season that has kept him sidelined for all but a few games where he tried to come back only to have his symptoms return.

Anyone who has played hockey or any other physical sport has at least seen someone get a concussion. It doesn’t take much. Football has tried to make safer helmets and create rules that severely penalize hits to the head. Prevention is noble but if you ask anyone who has played sports, it is going to happen no matter how cautious. The more important question to me is how to treat it when it does happen. Time and avoiding another blow to the head are the recommendations these days. I think there is more we can do.

The brain, by all accounts, is a slow healer. As a pattern, tissue that has a limited or controlled blood supply is difficult to heal. Blood and brain tissue has to be controlled because blood is very toxic to nervous tissue hence the poor healing capacity. The reason blood is important in healing is because oxygen is a necessary component to healing. Oxygen is needed to burn the fuel in the form of glucose to give the cells energy to repair itself.

If more oxygen to the brain is the solution, then we have an effective remedy: hyperbaric therapy. In a hyperbaric chamber pressure is used to help oxygen saturate into the liquids of the body and can therefore easily cross the cell membrane and be used by the cell. In the brain this is especially effective because it also allows oxygen to cross the blood/brain barrier that is an extra protection for the brain and other nerves. More oxygen will allow the brain to actually heal.

Now, I realize that most people have not have ever heard of a hyperbaric chamber let alone know where to find one. Doesn’t it make sense, though, with all of the concern about concussions that we push for a treatment with a track record of success?

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?

Pillow Talk. (About Actual Pillows, Not the Other Kind)

Ah, the frustration of finding the perfect pillow! Have you found yours, yet? Once you do, your spouse or kid will probably steal it or your dog will chew it up. Or, do you have that pillow that has been perfect for longer than you are willing to admit and it is just moments away from disintegrating in the middle of the night as you blissfully rest? I know how it is. I wish I was writing this article with the perfect solution for everyone. Alas, there is no perfect solution but there are some general guidelines that can help.

First off, finding the right pillow can take time and you may need to invest a little in several different pillows. How much is up to your commitment to a perfect night’s sleep and how important it is for your neck to feel good in the morning.

The most important factor to consider is that you need to keep your head and neck is a neutral position relative to the shoulders. If your head is closer to one should over the other or flexed forward or extended back, you are no longer in a neutral position. This can put a strain on the joints of the neck and cause shortening of one side of the neck muscles and conversely lengthening of the other side. Because we spend so much of our lives sleeping, it is vital that you keep your neck and head in a position that puts little stress on all of the structures.

For side sleepers the biggest issue typically is finding  a pillow thick enough to take up the space between the shoulders and the head. This is especially hard if you have broad shoulders. A firmer pillow is usually your best bet because it will hold its shape all night. Down pillows tend to be fine for the first few hours then compress during the night. I, personally, sleep on a water based pillow that holds it shape really well but is soft enough to be comfortable. It has over a gallon of water in it so it weighs a ton which makes it hard to change the pillow case, but what do you do?

Back sleepers typically need a fairly thin pillow or no pillow at all depending on the curvature of the upper back. The shape of your neck will largely determine the style of pillow. If you have a good curvature (which is ideal), a pillow that helps maintain the arch can be great. If your neck is unfortunately straight or reversed, then that style of pillow might be very uncomfortable. Some say that using a pillow as a neck orthotic to restore the ideal curvature is a good idea. I could definitely make that argument but sacrificing sleep might not be worth it.

OK, I know the what you are thinking, “I switch from side to back all night.” Let me say it right now, unless you are just the right structure, there is not really a pillow that is dual purpose. Sorry! If you have a pillow thick enough to take up the space between the head and shoulders, it is going to be too thick to sleep on your back and vice versa.  Furthermore, if you are a stomach sleeper, there is no way to keep your head in neutral and still breath unless you have a slot for your mouth and nose.

There you have the basic guidelines. Happy hunting. FYI, just because pillows are expensive doesn’t mean they are going to be a good fit for you. Still, cheap is cheap. The pillows I sell in my office are around $50, if that is useful. Good luck and sweet dreams!

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.

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.”