“It Was Just a Fender-Bender”

Have you ever noticed that there are really only two types of auto accidents? There is the, “My car was smashed-I am lucky to be alive-wonder if they are going to total my car-I am hurting all over,” crash. And then, there is the, “It Was Just a Fender-Bender,” accident. You may be surprised, but the Fender-Bender where you just got a little neck pain and a slight headache may actually turn out to be the much more serious accident.

Let me explain. First, the physics of a motor vehicle accident. Force= Mass x Acceleration. Simply put, how hard something hits you is a combination of how big it is times how fast it is moving. If an object is small it can still hit you with a lot of force if it is moving rapidly. The classic example of that would be a bullet. If I throw it at you it wouldn’t do too much damage but when shot with high-velocity it is deadly. Likewise, a large object doesn’t have to be moving very quickly to hit you with a lot of force.
Now, let’s talk about car design. Most automobiles made in the last 15-20 years were designed with collisions in mind. They are engineered to preserve life in a high-speed crash and to preserve damage to the vehicle in a low-speed collision. In a high-speed collision, the car will crumple like an accordion to absorb the force. In low speeds, the car is designed to withstand such force.
In any auto accident, there is a transfer of force. The stiffer the object, the less it absorbs, so it transfers to the next softest thing. The softest structure in a car is a person. So, with high impact collisions, the car will absorb most of the force but in a low impact collision, it is the person in the vehicle that will. As a result, people who are in a minor collision can actually have worse soft tissue damage than someone in a really bad accident.
If you are ever in an auto accident, even if it seems like no big deal, I would highly encourage you to get an examination. Otherwise, what can happen is that joints that don’t heal properly can, over time, become dysfunctional which will lead to poor health and pain. I see people daily with necks that have been through a whiplash injury. At the time of the accident, there wasn’t too much pain. Months to years later, much like erosion, degenerative change takes over complicating the healing tenfold.

“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.

In all seriousness, a headache is never normal. I would venture to say that most people have experienced a headache but that doesn’t make it normal. So, if you suffer from headaches then you need to pay attention.
According to some studies, 70% of all headaches are actually cervicogenic, which is a fancy way of saying that the pain is caused by dysfunction in the neck. I would concur based on the number of people I have personally helped overcome headaches by working on the neck. All of the other headaches can either be triggered by neck problems or at least made worse.
Whatever the cause of the headache it should not just be written off. Pain is an indicator for dysfunction. If you have pain you can assume something is wrong. The true goal of health care is not to take away the pain but to get the pain to go away by correcting the dysfunction. Identifying the reason you are getting headaches and then working to correct it is the normal thing to do.

Bursitis? Isn’t That What My Grandma Has?

By request, I am going to blog about bursitis. Most people have no clue what I mean when I tell them they have bursitis, even though they may have heard of it. I like to explain it like this: Suppose you have a rope hanging over the edge of a cliff. If the rope swings or moves it will start to wear out at the point where it makes contact with the rock, right? So, to avoid the wear and tear, you place the bag that you used to carry the rope up to the top of the cliff (rock climbers and repellers will relate) under the rope. This will help reduce friction and keep the rope from fraying.

In this analogy, the rope is like a tendon which is the continuation of a muscle that inserts it into a bone. Tendons often stretch over a bony edge, the cliff. The bursa, then, is the bag y
ou put under the rope or tendon to reduce friction. It is, indeed, a sack that is flat and fluid filled. Because it is fluid filled, the outer edges glide back and forward on each other underneath the tendon thus limiting friction of the tendon.

Anytime you see or hear the suffix “itis” it just means inflammation. So, bursitis is inflammation of the bursa. How does it happen? There a few ways you can develop bursitis. The most common happens when you put too much tension on the tendon and therefore too much pressure on the bursa. Imagine the rope wearing out the bag. This can happen with poor muscle mechanics or just too much load. In a shoulder bursitis what comes to mind is someone with bad posture whose shoulders are slumping forward who starts to lift weights at the gym but doesn’t want to look like a sissy so they lift too much. This scenario neatly covers most of the common risk factors. (There can also be metabolic conditions that cause bursitis, like calcium deposits in the bursa and things like that but they are not as common and frankly would bore you, probably even more than this).

The way to determine if you have bursitis is through a process of resistance and elimination. The first thing you have to rule out is a tendinitis, (which you have cleverly deduced based upon earlier information is inflammation of a tendon). The tricky part is that a tendinitis feels the same as a bursitis. Usually, bursae (the plural of bursae) have more that one tendon running over them so the only way to distinguish the two is to test all of the tendons by checking resistance of all of the muscles attached to the tendons. If stress on every tendon is painful it is more likely you have a bursitis instead of tendinitis of all of the tendons. In simplicity, if it hurts when you use your arm in every motion it is most likely the bursa.
Healing bursitis can be difficult. Motion causes the bursa to work, so any motion is potential for more inflammation and pain. The key is to reduce the inflammation. You can do that through icing (15-20 minutes at a time) and rest. For diet, it may sound crazy but a half a fresh pineapple a day for 6 six days reduces inflammation like a champ. Also, Omega 3 supplements really help.
The other thing you have to address is why you developed the bursitis. If a joint is subluxated or you have bad posture you need to be adjusted to reduce the amount of pressure on the bursa. Likewise, changing how your mechanics or the amount of resistance can make a big difference.

Once You Start Chiropractic You Can NEVER Stop! Muaw, aw, aw, aw!

In your profession is there a comment or question you get asked a lot that just sets you off? For me it is someone trying to tell me that once you start chiropractic care you can never stop. It is so ridiculous that I often respond, “I once had a patient who quit and she died the next day.”

Seriously, what do people think is going to happen? The truth is that when you go through a course of treatment your body gets used to functioning properly. Over time, as you put wear and tear on your body, things start to become dysfuncitonal. When things are dysfunctional long enough it produces symptoms. To add insult to injury, when you have been adjusted and know what it is like to feel well, it is more obvious when things are not functioning.
I usually encourage patients to do a maintenance program after their functional correction program. This program consists of getting adjsusted on a regular basis to maintain function. When you become dysfunctional enough to feel symptoms the damage is already done. The art of maintaining is keeping things functional so that you don’t feel symptoms.
With this in mind, the real question is once you start chiropractic care, why would you want to stop?

Your Chiropractor As Your Primary Care Doctor?

The concept of having a primary care physician is to control the cost of patients seeing a specialist directly. Under the primary care model, patients see their family doctor who treats or refers to a specialist. This frees up more expensive specialists from seeing patients directly who may or may not be a candidate for the specialist. All said, even though it does cut costs for insurance and patients, the concept can also help direct a patient to proper and appropriate care. In this way, managed care has it right in theory if maybe not exactly for the right reasons. 
Proper care is predicated upon a primary care doctor being a competent differential diagnostician who can manage the overall case especially if multiple specialists are involved. Unfortunately, the way it stands, most primary care physicians are either not very good at differential diagnosis or they just don’t have the time to do it right. Part of the problem, whether they like it or not, is that they are inundated with too many patients. Too many patients creates an environment of hasty visits and poor communication. In addition, there is pressure from the insurance companies to be more efficient and to save costs often at the expense of proper diagnostic protocols. 
Here is where chiropractors can come in. Chiropractors have learned the art of differential diagnosis, pathology, etc. just as much as our medical colleagues. In addition, chiropractors have more training in musculoskeletal diagnosis, radiology, and nutrition. In my practice, I spend a good amount of time during the initial visit discovering any and all health concerns and what is functioning well with a holistic outlook. In short, most chiropractors if they were interested would make excellent primary care doctors. 
There are some major advantages to using some chiropractors as primary care doctors (not all chiros are interested and some see diagnosing as a dirty word). First, we have a shortage of primary care doctors which really limits access to care (I wonder how much worse it will get if go to socialized medicine). Opening it up to chiropractors could significantly ease the burden. 
Second, chiropractors tend to build stronger relationships with their patients. Chiropractors tend to see patients much more than just when their patients are sick enough to go in. In addition, we put an emphasis on building relationships because we have to in order to grow our practices
Third, chiropractors are actually concerned about patients’ health and not just their sickness. Sure most people come in because of a problem but what is the underlying cause and what else can be prevented? You don’t know unless you ask and in my office, at least, we make it a point to comb through your entire history and do a full exam. 
Fourth, although we cannot prescribe medication, our ability to conservatively treat patients in a cost effective manner is second to no other health profession.  
Just like in anything cooperation is the key. There are still specialized MD’s who will not accept a referral from a chiropractor and, there are chiropractors who act like diagnosing is an evil art form invented by the medical community. Both are part of the reason that chiropractic still struggles with a legitimate identity (another post, altogether). 
I think my patients who know me well use me as their primary care doctor. Usually, the switch happens when they have something come up and they go to their MD. They then casually bring it up to me. I take the time to diagnose and educate and then point them in the right direction for proper care. Sounds like a win win to me. What do you think? 

What do You Think of Socialized Health Care?


The debate is in full swing over socialized health care. It seems to me that it is only a matter of time before the politicians decide to take control of the rising costs. I can understand both sides. I am not going to even argue between both sides because it seems like the two sides are comparing apples and oranges. I think most agree that whatever we have right now is not a great solution for the masses. My point in witing this article is will it work in the US? 

Now, I know what you are thinking, “It works in Canada and Europe and people are not as antagonistic or supportive as the two camps portray.” I agree. All of the debate is focused on whether it will be right for the people. But, just as in everything there are other parties involved. I have yet to see much discussion about whether the providers are going to go for this. 
You see, the doctors in Canada and Europe have never really known anything different. They went to school with a certain expectation and are working under those circumstances. This will not be true for doctors in the US if we switch to socialized health care. Think about it this way. Most US docs went into healthcare because it is career where one can help and serve others while also enjoying a certain status and income level. Keep in mind there are two sides to this: the ability to practice as one chooses and the money. 
Lets talk money for a bit because that seems to be the major focus (though I will argue that for the majority of docs it is the lesser issue). Going to professional school is expensive. A lot of time and money is invested in the education of a doctor. As of now, the compensation in most cases is satisfactory but not as good as it used to be. I wonder what compensation will be under government regulation?  
The real issue, however, is not money; it is control. Doctors have taken a beating since the onset of HMO’s. Take a poll of any profession and job satisfaction has more to do with the ability to affect outcomes. If HMO’s are bad wait until the government decides to take over. Medicare is the classic example. Medicare dictates very specifically what a doctor can and cannot do. In additon, if you feel a procedure is warranted but the government does not, guess who wins? Accountability is good, but when a doctor spends more time justifying his course of treatment than actually treating people satisfaction starts to wane. 
The question then becomes how many doctors are going to stick around with changes that will limit their ability to treat patients the way they want to and with a cap on how much money they can make? The other question is whether the government will allow doctors to opt out of universal health care and take private pay only? If they don’t, will enrollment at professional schools decrease and will you see more doctors leaving the field for less stressful and more profitable professions? If they can do private pay how many docs will opt out? Either way, what will our access to health care look like? I don’t know the answers for sure but I can tell you as a health care professional I would opt out so as to avoid the pitfalls and the headaches of governmnt controlled “sick care” and if the government doesn’t give us choice… well I guess I will have to cross that bridge when we get there. 

“But Doc, It Feels So Good to Crack My Own Neck!”

Everybody knows that guy that pops his own neck. You know, the guy who is sitting by you who grabs his chin and yanks it from side to side waking up your co-worker or the sleeper in church who suddenly dreams they are being shot with a machine gun. Maybe you are that guy. If you are let me pass on some good advice. STOP!

First of all, you are annoying every one around you. Second, you are doing damage to the ligaments and joint capsules of your neck. 

Here is how it happens. When you get a hankering to pop your neck it is usually because one of the 33 joints in the neck is not moving as much as it wants to, which can cause inflammation, stiffness, and a decrease in proprioception (the sensation that tells us what the joint is doing).

When you try to get that joint moving using your chin as a long lever you apply a very non-specific shearing force to the entire neck which works as a unit. Under force the the most pliable joint will move and pop. Perpetual force over a period of time will cause the joint to be hypermobile.

Because the neck functions as a unit, to compensate for the hypermobility of one joint, other joints will become fixated or hypomobile. Joints that move too much or too little are dysfunctional joints and will degenerate quicker than properly functioning joints. 

Popping your own neck also creates a viscious cycle. You pop your neck because a joint isn’t moving. The joint you pop makes it feel better because of a natural endorphine release but those joints are not the ones that need to move. In fact, the joints that need to move become less mobile because they now have to compensate for the joints that move too much because you keep moving them. Also, the good feeling you get when you pop hypermobile joints only last a short while. 

In addition, the combination of overly hypermobile and hypomobile joints in the neck make it very difficult for your chiropractor to give a specific, effective adjustment because with overstretched ligaments it is very difficult to get the right tension to adjust the proper vertebra. 

So please, do yourself, everyone around you, and your chiropractor a favor and stop turning your neck into silly putty for a 30 second high and a cool sound. 

Have We Lost Our Minds Over a Virus?

Are you buying the hype of the Swine Virus? The media is completely outdoing themselves on this one and people are panicking like Chicken Little. I just heard that in Egypt, where there are no reported case, they just slaughtered thousand of, you guessed it, swine.

Please be rational about this. First of all, thousands of people die every year from ordinary viruses. So, it makes no sense to get worked up over a new one; they are all new. Second, we have an immune system for a reason. Keep yours in good working order and you will be fine even if you are exposed. Even if the virus gets a hold of you it will probably just feel like a bad flu. Take care of yourself and your body will fight it off better than any anti-virus medication.

And, if your immune system is compromised then wash your hands frequently and avoid crowded places. But please, stop stressing over this, it will only weaken your immune system.

“Stand Up Straight!” Part II – The Neck and Shoulders


Some could argue that good posture of the neck and shoulders is vital to your health. I agree! Most of the processes of life are controlled by the brain. Information then travels down through the spinal cord or through the cranial nerves. Either way, to get to the body it has to go through the neck somewhere. If there is not an efficient path then communication suffers.

As discussed in Part I, the outer part of the ear should line up with the middle of the shoulder. This has become so rare these days that you almost never see it. If you do, often times the only reason it is lined up is because the shoulders sit forward as well. If you go deeper (like on an x-ray) you should see a nice arc with the vertebrae neatly stacked on top of each other. The arc allows for maximum tensile strength and appropriate loading of the discs, ligament and muscles.

The head weighs about as much as a bowling ball so, in order to support the head all day long the neck should be underneath it. Generally, for every degree the head goes forward of the neck, you add an additional 10% more force. This is based on the pull of gravity and angles etc. With the head carrying forward the mechanical advantage of having an arc and the lever the muscles use start to lose ground. Pretty soon ligaments get overstretched and muscles are working much harder. There is also added pressure to the front of the vertebrae and decreased pressure on the back which creates imbalance. Imbalance leads to altered function which leads to altered nervous system flow which leads not only to poor coordination but also improper communication and disease.

Additionally, as the neck goes so go the shoulders. Shoulder injuries are one of the most common injury complaints. With shoulders you already sacrifice stability for mobility so if they are resting at an even less stable location (ie. rounded forward) then wear and tear is bound to happen. Furthermore, slumped shoulders can affect lung capacity and function. The last time I checked, most of us were already bad at breathing properly and I am pretty sure that oxygen is important to the body.

So what to do? First things first, in order to effectively improve posture, you have make sure that all of the joints are moving properly and coordinated together. Adjustments are very effective for this

Second, you have to stabilize the shoulder blades. The best way to do this is to pull the blades down and back while gently lifting the chest. This will stimulate the usually dormant postural muscles of the neck and upper back and relax the muscle that are carrying most of the work but shouldn’t.

Third, getting back the curve in the neck is tricky but important. I use what is referred to as a traction wedge my office. It is not very comfortable but allowing the head to hang over and edge with a tension band is effective in reshaping the neck.

Obviously, this is a process. It is usually not that effective to just try and stand up straighter. Nevertheless, with effort, results can be visible in less than a few weeks and long lasting results in less than 3 months.

Stay tuned for Part III where we discuss posture of the low back!