The Art of Diagnosis

Full confession, I really do not like the word diagnosis. It is a little too limited, definitive, and stodgy for my tastes. I believe that we would be better served just identifying dysfunctional body parts than knowing fancy words that typically just describe symptoms. That saying, understanding symptoms and how they relate to dysfunctional body parts is extremely beneficial when coming up with treatment options. Understanding anatomy, biomechanics,  and physiology can make diagnosing musculoskeletal injuries so easy it is a wonder why most doctors get it wrong most of the time.

It is important to understand the location and type of symptoms to make a proper diagnosis. Location of symptoms does not necessarily indicate the location of dysfunction. Many dysfunctional body parts refer symptoms to other parts of the body. Luckily, there are patterns which come is handy for those clever enough to recognize those patterns. The type of symptoms tell a good doctor what kind of structure is dysfunctional.

Embryologically speaking, there are three types of structures: bone, consisting of bones, joints, ligaments, discs, and cartilage; muscle, consisting of muscles, tendons, and organs; and nerve, which encompasses tissues of the brain, spinal cord, cranial nerves, autonomic nerves, nerve roots, and peripheral nerves. Bone symptoms are typically described as a deep dull ache and can refer to other bone-like structures. Muscle is also an ache but feels more like fatigue and soreness. Muscle is more superficial and usually stays within the same structure. Nerve symptoms are more electrical in nature; numbness and tingling, just numbness, burning, shooting, etc. Nerves stay in the network of nerves. Knowing this will get you pretty far.

Consultation is the first step. I ask for the location and have the patient describe the symptoms. I also look for the mechanism of injury knowing that some structures are more likely to fail, depending on the stress placed on them, than others. With a good consultation, I have a fairly solid idea of what the problem is.

The second step is to do an exam. Bone structures cannot move themselves. For these tests, I do the movement on the patient checking for instability, pain, and altered movement. When I isolate joint movements, I can narrow down the location of dysfunction. Instability tests will suggest ligament issues (assuming we are not dumb enough to do a stability test on a complete fracture). X-ray is helpful to see fractures and degenerative changes. MRI is helpful to see disc bulges, ligament tears, and pathology. Repetitive movement works great for determining how to reform a bulged disc.

Muscles and tendons move bones. To test a muscle or tendon, resisting the muscle’s movement is an easy way to determine which muscle is injured. Why most doctors do not do this is baffling. Pain with resistance at the end of the muscle is usually tendon related and anywhere else is usually the muscle itself. If the type of pain is described as muscular but cannot be recreated with resisted movement, it could be an organ referring pain. Here again, repetitively resisting movement can really help determine how to help treat the injured structure.

Nerve symptoms require some specialized tests in the form of reflexes and sensation testing. True neurological injuries are very difficult to diagnose and to treat. In addition, any of the above can cause secondary and tertiary issues in other parts of the body, like muscles spasms or nerve pain due to encroachment with a disc herniation, for example.

Finally, one of the best ways to diagnose an issue is to treat the issue and see if it helps. Obviously, you cannot do this with everything, but as a chiropractor, I can do this for most injuries. Even a surgeon will tell you that nothing is definitive until they open you up and see it in real life. The point being, do not get too caught up with figuring out what something is before trying to treat it. Ruling out conditions is still valuable.

There you have it. Instead of plugging symptoms into WebMD to discover that you have a rare, incurable, terminal illness, just step back and look at the anatomy, physiology, and biomechanics of the body and go from there. Or, see your local chiropractor and let them help you through your issues or point you in the right direction. We spend a tremendous amount of time learning about all aspects of the human body.

**Photo by rawpixel on Unsplash

 

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 fasciitis, 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.

 

Chiropractic and the 3 Main Causes of Vertigo

vertigoIt could be the late cold season or a rampant allergy season, but I have had several patients come  in with vertigo this month. If you do not know what vertigo is, lucky you! If you have experienced the nauseating feeling of being on solid ground while your brain is telling you that the tilt-a-whirl is in full force, then you know that vertigo can seriously affect your life. Vertigo is described as a feeling of being stable while objects around you are spinning. The three systems that can cause vertigo, in order of most common to least, are the inner ear, the neck, and the brain stem.

  1. The Inner Ear has a complex system of tiny hairlike sensors, called cilia, that send information to the brain based on the movement of fluid through a maze of canals. When there is in an increase of fluid in the inner ear or the fluid gets too thick and mucousy, it affects the movement of the cilia, and can cause vertigo. This is common with inner ear infections, colds, flus, hay fever, and sinus infections. Drainage is critical to success in treating vertigo caused by inner ear congestion. Chiropractic adjustments help loosen the muscles in the neck which allows for freer lymph flow and better drainage. In addition, cranial adjustments can help pump the congested sinus and promote drainage. Drinking plenty of water will also help to thin the mucous which will help is drain.
  2. The Neck, especially the top two vertebrae called the atlas and the axis, respectively, have sensors in the joints called proprioceptors. Proprioceptors relay position to the brain.  They are found in all joints but the nerves in the neck are particularly sensitive to head movement. When these vertebrae do not move as they should, they send a mixed signal which can make the brain feel like the body is moving when it is not. Again, chiropractic adjustments will help reset proprioceptors which will restore the proper flow of position sense, thereby halting the vertigo.
  3. Brain Stem Dysfunction is by far the least treatable of the three. In general, brain injuries are extremely slow to heal. Depending on the nature of the injury, there is little hope of treatment save time and prayer. I have no empirical evidence, but I would imagine that hyperbaric therapy could be helpful. Chiropractic adjustments will not directly help but keeping the body and nervous system functioning well is always beneficial.

If you are suffering with vertigo, there are some easy, non-invasive tests to figure out which system is causing the symptoms. Treatment is effective and we usually see results pretty quickly in most cases.

Read More

5 Things To Do When Your Back Goes Out

Have you ever bent over to pick up something only to experience a pain like someone shoved a hot poker into your low back and then started pulling your muscles apart? Yeah, most of us have felt that at some point. Hopefully, it never happens to you, too, but if it does, here is what you do.

  1. Stop and Breathe. You are probably feeling like your life is about to end. Most of what you are experiencing is a muscle spasm. Your back muscles are trying to protect you but they have dramatically overreacted. If you can, stay where you are and do your best to let the muscles settle down. Deep breaths and relaxation will dramatically speed up the process. Have some water and wait it out.
  2. Stretch backward. Typically, when a back goes “out” the disc in between the vertebrae is stuck in a bulging position. Bending backward will help squish that disc back to the center and will also shorten the spasming muscles. Go easy with this. Gently push into a cobra position if you are on the floor. Otherwise, brace yourself with your hands on your backside and carefully arch backward. Do it several times in a row and often thereafter. Here is an old video as a demonstration.
  3. Walk, Lie Down, Do NOT Sit. When the spasm has settled down, walk a bit. Movement will help get the blood moving which helps to settle the muscles and get the disc moving. You do not want to overdo this. Move a bit and then lie down on your back with the knees bent. The firmer the surface, the better. Sitting will be counterproductive. When you sit, you increase the pressure on the disc and stretch the muscles of the lower back.
  4. Ice. Icing helps reduce inflammation. Typically, when a back goes out, there is inflammation. The quicker you can get rid of the inflammation, the better. It is not completely out of the question to use heat. Heat will soften the spasming muscles and allow you to move. However, heat also brings more inflammation. If you decide you cannot move without heat, use it, but then move around for a while and then follow up with ice. Both heat and ice should only be used for a maximum of 20 minutes. For ice, the skin needs to get cold enough to go numb to be successful. Here are the stages of ice, so you know you are doing it right. 
  5. Go See Your Chiropractor. Once the spasms have settled down a bit, the inflammation is under control, and you are able to move, it is time to get the joints working properly and the disc back to a good shape. This is what chiropractors do best. An adjustment will get all of the joints in the area to move correctly which will allow the disc to heal properly. Get in as soon as possible before scar tissue makes that first adjustment a painful one.
Read More

I Was Told I Have One Leg Longer Than the Other

Short LegI see it every day. For some patients, it is a major concern. They tell me their previous chiropractor diagnosed them with it. I tighten my lips and lower my eyebrows with an empathetic look. On the inside, my eyes are rolling. I can tell the patient needs me to understand that this is a serious chronic issue. This is obviously learned behavior from their previous doctors. I wonder if I am the only one that thinks this is no big deal. I try not to be condescending and to acknowledge their concern. The truth is that it is another temporary sign. I am talking, of course, about having a “short leg.”

Symmetry in nature is rare. I am sure everyone has one leg a little shorter than the other if you start measuring in millimeters. This begs the question as to why one leg can look so much longer than the other? The answer is found in the mechanics of the body.

Most movements in the body have a coupled movement to help maintain balance and flexibility. Side to side bending and rotation go together. In the low back, when a disc bulges and causes the vertebrae to bend to one side, it is accompanied by rotation. Rotation, in turn, contracts the muscles on the same side pulling the leg toward the trunk of the body. When lying face down, this leg will appear short because it contracts up.

I will not get into the mechanics and how it looks when standing up but think of standing with one shoe on. In addition, if the pelvis is rotated it can cause a different scenario. Suffice it to say that no matter what, a “short leg” is usually temporary and correctable, if not very manageable. No reason to get alarmed and go out to find the perfect sized lift or to change all of your shoes. After one chiropractic adjustment, balance can be restored. Now, how long that balance will last is anyone’s guess. It may take a series of adjustments before the legs become or stay relatively the same length. However long it takes, just remember, a “short leg” is not the end of the world.

Read More

Chiropractic and the Law of the Club

In Jack London’s Call of the Wild, the main character, a dog named Buck, finds himself face to face with a man who has a club in his hand. Buck attacks that man in an attempt to escape his abduction, only to be hit painfully on the head nearly unconscious. He attacks again with the same result. Buck is a large and powerful dog and honestly feels he can beat this man. However, after several more attempts, he finally submits believing that if he continues, he will end up dead. He reasons that the man with the club in his hand is too persistent and strong and therefore must be obeyed.

Switching perspectives to the man with the club, there has to be some trepidation when confronted by a large animal with sharp teeth. Safety only comes from using the club effectively. Not using the club at the right time or the right way can be disastrous. It is likely there is a fear that the dog may be to big or too fast. Finally, not being prepared or ready to use the club again, at all times around the dog could also be fatal. Each animal has a different temperament. Some are more predictable than others but none are truly controlled.

This scenario is like an injury. Sometimes, after one or two adjustments the injury heals and is never a problem again. Other times it is good for a while but comes back again. Some injuries take several adjustments before healing and some never heal completely and need continuous work. There are injuries that will never get better. The best we can hope for, sometimes, is that we slow down the progression of an injury. The worst are injuries for which we cannot help.

Often times, in the healing process, we believe we have healed and disontinue care too early. When this happens, healing momentum is lost and can prolong the overall healing time. The question I get more often than not is how many adjustments it will take. As much as I would love to give an answer, I do not know. I can give general outlines and recommendations. Average injuries generally take about three months to heal with consistent treatment. There are so many factors that can decrease or increase the healing time. Factors such as age, degenerative change, weight, etc. can significantly change a prognosis.

The healing plan for chiropractic is the same as the law of the club. We keep hitting or adjusting the incoopertive joint until it decides to submit to the proper movement and heal appropriately. Some joints and injuries are going to respond quicker and easier than others and some are not going to respond at all. We do not always know how the healing process is going to respond without consistent care over a significant period of time.

Read More

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.

 

Read More

Meet Eric Wagnon, DC!

Eric Wagnon Photo

If you have been in the office over the last three weeks, you may have seen a tall gentleman in passing or treating patients. We are happy to welcome Dr. Eric Wagnon!

Dr. Wagnon has relocated his practice from Rocklin to be with us. He brings with him nearly seven years of experience in helping others improve their health through chiropractic care. Dr. Wagnon and his wife, Jackie, are residents of Rocklin along with their children Tucker, Taylor, Tessa, Tyce, and twins, Trey and Talia. Dr. Wagnon was raised in the Sacramento area. His father has been practicing as a successful chiropractor for 30 years. Dr. Wagnon’s undergraduate studies in Biology were completed at Brigham Young University, and his Doctor of Chiropractic degree was attained from Life Chiropractic College West. He is also fluent in Spanish.

Dr. Wagnon plays an active role in the community involved with the Rocklin Chamber of Commerce and speaks regularly to different clubs, groups, schools, and organizations on different Wellness topics to help change the health of our community.

Growing up with chiropractic in the home, Dr. Wagnon possesses a deep passion and personal understanding for what chiropractic can truly do for individual and family health. Nothing gives him more satisfaction than to be able to give that health to the core unit of society, the family.

Read More

Now Offering Custom Orthotics, Again

Not all insoles or orthotics are created equally. Most of the orthotics out there are really posts. What that means is that they make your foot inflexible, but in a perfect position, making it part of the post that is your leg. In this case, shock absoprtion is transferred to the knees, hips, and back. I much prefer an orthotic that helps improve the biomechanics of the foot. One that allows the force of walking to be cushioned properly by the flattening of the arch and then uses the kinetic energy generated by the stretching of the arches to propel you forward off your big toe.

Unfortunately, creating a custom orthotic that improves the function of the foot is not very common and surprisingly hard to find. The last company I used did a great job until the software crashed and the company disappeared. It took me years to find a new one but I have found a good one. Check out this video from the new company that is making the custom orthotics I am now selling.

If you want or need a pair, I am selling them for an introductory price of only $150. These type of custom orthotics retail for around $350. The special price is good until June 30th. After that they will be $225.

Read More

Consistency and Persistency in Chiropractic

First off, I know that persistency is not a real word. It is a joke to get your attention. Even if Charles Barkley, or any other athlete turned commentator, might use such a faux word to great effect, the true word is persistence. Now that we have that out of the way, let’s talk about why this is the topic of this article.

We live in an instant gratification society. People want to see results immediately and there is very little patience if they do not.  This is true in healthcare, as well. The only problem is that it does not work. Healing is a process that takes time, effort and energy. The more consistent the effort and energy put into healing over time, the better the results.

In addition, there is significantly more value in going through the process. All too often, I am sitting across from a patient explaining the healing process and how it takes time and consistency when I see the glaze fall over their eyes. From there, they either just ignore what I explained or they honestly believe they are the exception. Very few people are the exception, that is why they are the exception!

For chiropractic, the healing process centers mostly around the function of joints. We help train joints how to move correctly which then helps re-train the nervous system which then re-trains the muscle system. Proper movement promotes coordination between the three and establishes a body awareness. This awareness helps maintain balance and function and helps us avoid future injury. Proper function also slows down degeneration. Again, this is a process. On average, people get adjusted three times a week in the beginning. After about a month, they drop to twice a week and then eventually once a week. After about three months, the patient is typically as functional as they are going to be and ready for maintenance care.

Heber J. Grant said, “That which we persist in doing becomes easier. Not that the nature of the task has changed, but our ability to perform it increases.” This is true with joint movement, as well. At the beginning of care, joints are resistant to change. Not only are they harder to move but they also revert back to old movement patterns. It takes several adjustments in close succession to generate enough healing momentum to make a change. If you are persistent in making that change and are consistent in the application, you will reap the reward of an adjustment that lasts longer and keeps your body from falling apart. In other words, it is not that the adjustment has changed but that your body becomes accustomed to the proper movement. Proper movement, and all of the health benefits that come with it is the result of consistency and persistency.

***Photo by Emily Campbell on Unsplash

Read More