Tennis Elbow? I Do Not Even Play Tennis!

tennis-elbow-pictureIn a world where we have so much access to information, I find that when it comes to diagnoses, there are some overly-simplified patterns. If there is pain in the foot, it is plantar fascitis, pain down the leg is labeled sciatica, and elbow pain is tennis elbow. Not that these conditions are not common; just not that common. Tennis elbow is particularly over-diagnosed. Pain in the elbow is common. Tennis elbow, however, is specifically pain resulting from injury to the extensor tendons which insert at the lateral epicondyle causing inflammation and dysfunction. Simply put, to be tennis elbow, the pain must be right around the little knob on the outside of the elbow and get worse when trying to extend the wrist with resistance. It is called tennis elbow presumably because repetitive backhand swings in tennis will cause such a condition. Incidentally, pain on the inner knob is known as golfers elbow.

I have found that neither tennis elbow or golfers elbow are more common than just a regular subluxated elbow. As a hinge that rotates and pivots and is made up of three bones and two joints, dysfunction is easy to come by. Often, the radial head will get stuck farther back than it should be. This will cause a strain on the muscles that insert in that area and mimic or create tennis elbow. The good news is that with an adjustment or a few, the condition typically responds quickly. If it is, indeed, tennis elbow, the best thing to do is to make sure the elbow is adjusted and functioning properly, then focus on the tendons with ice, stretching, and myofascial massage or active release. So, the next time somebody complains of tennis elbow, tell them to see their local friendly chiropractor.

 

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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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.

Preventative Health Care?

For you football fans out there, you will get this analogy. Your team is up by 2 with just over a minute remaining in the game. Your offense has done just enough to be up but your defense has played lights out. Now they start playing “prevent defense” and everyone drops back. What are the odds the other team drives down the field and kicks a field goal despite your screaming at them through the television to keep playing aggressively? Prevent defense stinks!

Likewise, preventative health care in most forms either does not work or does not exist, no matter how popular the term is. What exactly are you trying to prevent anyway? In chiropractic we mostly treat injuries either from a one time big traumatic event or cumulative trauma. How does one prevent that? In medicine they talk about preventing disease. Besides the fact that most of their tools are designed to fight existing disease, the premise is wrong. What is disease other than the body not functioning the way it is supposed to? Shouldn’t we then focus on health rather than disease? If we focus on health, then what we are really saying is that we want to maintain good health. In my opinion, “maintenance health care” is a far superior term.

When we maintain good health we focus on the positive. Instead of trying to create scenarios where the possibility of injury or becoming sick is prevented, shouldn’t we put our energies into helping our bodies work the best they can? In this way, when pathogens or traumas come around, our bodies will be better equipped to either fight or heal in an efficient manner. We cannot live in a protective bubble!

Let us focus on attaining and maintaining proper health. If we improve function and keep making the healthy choices that helped us achieve better health, we will avoid all of the issues that so called preventative health care seeks to treat. Let’s make maintenance care our priority and get rid of the term prevention care.

Strengtheining the Core Through Coordination

When we talk about “the core” of the body, we are typically referencing the musculature around the abdomen and low back. These muscles consist of the abdominal muscles (rectus abdomini,  internal obliques, external obliques, and transversi) and the muscles of the back (lattisimus dorsi, serratus posterior inferior muscles, erector spinae, multifidi, interspinalis muscles, lateral intertransversi muscles, quadratus lumborum, and to some degree the iliopsoas).

Strengthening the core has become a fairly popular mantra these days. Many of us are walking around with poor posture and a fair amount of dysfunction as a result of poor core stability. A weak core leaves one susceptible to a host of joint and disc injuries as well as overly tight butt and leg and muscles. In contrast, a strong core can prevent a host of back injuries.

The word strength, however, needs some clarification in the context of strengthening the core. When most people think of strengthening muscles, they picture muscles moving against  significant resistance like lifting weights or power movement against gravity or some other force. These type of exercises can actually be detrimental to the core muscle and increase the risk of injury to the spine. Coordinating the movement of all of these muscle is what is most beneficial.

I mentioned in my last article that postural muscles are slow twitch, white fiber muscles designed for endurance. They need to be strong enough to hold you up all day. Strength in this case does not come from bigger muscle fibers but from having all of the muscle firing in a controlled and proper order. For example, if you lift a box, ideally your abdominal muscle and your spinal muscle would contract at the same time to stabilize the body so the shoulder and arms and hips and leg muscles can utilize their power to lift it. What often happens is that core muscle lay dormant until a significant strain forces is to respond. So, when you lift a box, you first engage your back muscles until you are upright then, if you go past vertical, the abdominal muscles will engage. Then, they will fire back and forth while they try to find a semblance of stability.

I bring this all to your attention to encourage you to strengthen your core appropriately. Exercises that promote coordinated movement like yoga, pilates, and modified exercises from yoga can make a huge difference. It can take time to build coordination  and it takes a consistent effort. In the following videos I demonstrate four very useful exercises for coordinating core muscles and therefore, strengthening it.

Cat/Cow

Bird Dog

A Safe Crunch

Side Bridge

ObamaCare and Chiropractic

How does ObamaCare affect chiropractic care in my office? That is a great question! I will tell you honestly, it doesn’t, at least not on my part. Say what you want about the Affordable Care Act, I do not need the Federal Government or anyone else to tell me that people are struggling with paying for healthcare insurance let alone healthcare.

However, for me the crisis in America is less about affordability and more about health. Don’t get me wrong, I know how expensive health insurance premiums, deductible, co-pays, and non-covered services can be. When all is said and done this year, between surgery on my knee, my son’s broken arm, my wife’s pregnancy and my daughter’s eye surgery, I am going to be out a large chunk of money before the insurance company that I faithfully pay $600 a month to contributes a dime.

Setting aside the debate about how insurance should be regulated, the truth is that Americans are among some of the least healthy people in the world. Contrarily, we spend more than every other country on health care. Timeout while I clarify something. We are not really talking about healthcare. Healthcare is cheap! No, we are talking about sick care. That is where the money is. Compare the cost of a healthy person over a lifetime with one who is in and out of doctors’ offices and hospitals and there is no comparison. OK, now that that is out of the way, my question is how can a highly developed country who spends a ridiculous amount of money on doctors, hospitals, medications, and technology, have a higher infant mortality rate than… anyone? The answer is simple. Money doesn’t make you healthy; doing things to improve or maintain your health does!

At the end of the day, the healthier you are, the less you will have to spend on medical bills. In theory, if everyone made a concerted effort to be healthy, insurance premiums would drop as they would not have to shell out so much for expensive procedures and tests. This is where chiropractic comes in. If you believe as I believe (and I am assuming that as my patient you agree with me on some level), then chiropractic is a powerful health promoting tool.

Because I know and you know that chiropractic is effective at helping improve and maintain your health, it makes sense that getting regular adjustments helps to reduce your overall healthcare costs. Furthermore, I am committed to making sure that everyone who walks in my office can afford the care they need. This is why ObamaCare will not change anything here. If you are desirous to continually work on your health and I am here to help with your chiropractic needs, you have the start of a pretty good team to not only reduce your healthcare expenses but, more importantly, keep you healthy.

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!

Pregnancy and Chiropractic

First of all, yes, it is completely safe to receive chiropractic adjustments when you are pregnant even at 9 months. In fact, it can be very beneficial. Shoot, my wife’s OBGYN is my top referring MD. Why? Because when his patients are suffering from the ravages of pregnancy, all he can do is be a sympathetic ear or recommend Tylenol. He knows that chiropractic care is safe and can help manage his patients symptom where options are limited.

For those who are unaware, pregnancy can be really hard on a body. For the record, when we men argue that we are the tougher of the two genders, women can always trump the argument by simply mentioning pregnancy and child birth. Trust me, no man is tough enough to withstand. Add to that list the duties of motherhood and it is game, set, match. During pregnancy the fetus becomes top priority. This means that the body will compensate and adjust to keep the baby viable. Nutrients needed will be taken from whatever source available. In addition, the shape, weight, posture, and the mechanics of the body, especially the core, change and adapt for the growing baby. Combine that with the production of the hormone relaxin which softens up all of the joints to allow the baby to be birthed, and the potential for dysfunction is inevitable.

Getting chiropractic adjustments during pregnancy helps the body cope with all of those changes. When joints and ligaments become lax, the muscles tighten to compensate. This alters the mechanics. The adjustment helps restore the body’s mechanics and therefore reduces the secondary and tertiary responses like muscle spasms. Proper function will make it easier to carry and deliver the baby and will also help joints maintain coordination which positively affects the nervous system. Properly functioning nerves will promote better health, in general. A classic example of this is managing heartburn. When my wife was pregnant with our 2nd child, she had terrible heartburn. We found that adjustments were much more effective than antacids in controlling it because of the connection between the nerve roots in the midback that go to the esophagus.

Chiropractic care during pregnancy is not just effective for low back pain relief and heartburn, it is also helpful in treating tension headaches, foot pain, hip pain, mid back pain and tightness, shoulder soreness, constipation, and much more.

Keep in mind that predicting a schedule for treatment during pregnancy is impossible. The body changes too fast. Some women need chiropractic adjustments every so often and others may need an adjustment several times a week. The key is to keep things functioning as best we can and not let it get bad.

Finally, during pregnancy the body does not heal as well. If you are pregnant and experience trauma or just have a traumatic pregnancy, be patient. It will take time after the delivery to heal up properly. If you are adjusted during pregnancy and again after delivery, your healing time will improve dramatically.

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.