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.”

How to Safely Stretch Your Hamstrings

Tight hamstrings can cause low back dysfunction and low back dysfunction can cause tight hamstrings. Either way, they need to be stretched daily. The trick is to hold for at least 30 seconds. This video demonstrates the proper technique.

Ice or Heat?

 

I get asked quite frequently whether to use ice or heat on an aching joint. When in doubt, use ice but use it properly. I have outlined protocols for icing below. That is not to say that there are not times when heat is appropriate, but icing is almost always beneficial if done right, whereas heat can cause problems on a new or inflamed injury. 

The rule of thumb is that if the injury is acute or new within the last 6 weeks or if it is an exacerbation of an injury, use ice. Heat is good for loosening up sore muscles and stiff joints. If you need to get things moving, heating for 20 minutes can be very therapeutic. Be careful though. If you heat an inflamed joint, it will feel better while it is on but the heat will increase the inflammation and not only cause more discomfort but also prolong your healing. As a precaution, I typically recommend using heat only if you are going to be moving around (ie. never before or during bedtime). If you are going to use heat before bed, follow it up with ice. That way you won’t wake up feeling like you were hit by a train.

Icing is not as simple as just putting something cold on you for a little while. If done properly, it can be extremely beneficial. If done improperly, it will have little to no benefit. So, here are the rules to using ice properly.

1. Cover the affected area. Not using enough ice will not drive the inflammation away enough to make it worth the pain of icing. A nice big ice pack for big areas like the back, legs, and arms is critical. Conversely, for feet and hands, an ice pack might not be good at all. I usually recommend an ice bucket if the body part fits. ***I will explain those protocols below.

2. Make sure the ice penetrates. Too often, people will put a bath towel between the ice pack and the affected area. Their excuse is usually that it is too cold. They are missing the point. It is supposed to be cold! You should only use a paper towel or thin t-shirt in between.

3. Let it go numb. If the area you are icing doesn’t get numb you really haven’t done it right. When icing you should feel it get cold which should then start to burn. (Be careful not to get an actual ice burn. On rare occasion, if the ice pack is too cold and it is up against sensitive skin it can burn the skin. This shouldn’t happen with most ice packs if you have a paper towel in-between.) After the burning feeling, the area should start to ache until it goes numb. Once it is numb, you are done!

4. Never ice longer than 20 minutes. After 20 minutes the body sends out a signal that the area is developing frostbite and will send more blood to the area. As icing helps to drive blood/inflammation away, sending more blood in is a bad thing. If after 20 minutes the area never got numb, take it off and wait 40 minutes to ice again.

5. Wait 40 minutes before you can ice again. Make sure the affected area is back to regular body temperature before you shock it again with ice.

***Ice Bucket Protocol: Use an ice bucket for ankles/feet and hands/wrists. This is by far the best way to drive out inflammation from these areas.
1. Get a bucket big enough.
2. Put as much ice in it that will cover your affected extremity.
3. Fill it with water to the same level.
4. Cover fingers or toes with a sock.
5. Immerse the extremity.
6. Keep it moving gently to keep the water immediately surrounding from warming up.
7. Ice until numb (usually around 5 minutes).
8. Repeat once the limb is back to body temperature.

Proprio…What? or, Are You Coordinated?

One of the best ways that chiropractic can help everyone from everyday folks to elite athletes is by improving proprioception (pronounced: pro-pre[long “e”]-o-sep-shun).

Proprioception has to do with coordination and position sense. Try this experiment. Close your eyes and touch the tip of your nose with your fingertip. Were you able to do it? The highest number of nerve receptors that sense movement are in the neck, hands, and feet. All joints, however, have their fair share. The better these receptors work, the better the body can respond.

Let me give you an example. If a person sprains his or her ankle, they are more likely to sprain it again and again. This happens because the ligaments are weak but more importantly because with injury the proprioceptors become dull. It doesn’t have to be an injury either. Posture changes proprioceptors, as well.

The danger of having dulled proprioceptors is a much broader topic than you probably want to delve into at this time. Suffice it to say that if your proprioceptors are not working well, you leave yourself very susceptible to injury. Likewise, pain sensation travels on the same nerve fibers so pain increases as proprioception decreases and vice versa.

The trick to getting these proprioceptors to wake up? Get the joint moving. Lack of motion or improper motion scrambles the receptors. Proper stimulation through movement, improves their function. Chiropractic adjustments and activities that challenge us physically both in strength and coordination are the best ways I can think of to accomplish this goal.

Photo by Leio McLaren (@leiomclaren) on Unsplash

Mesothelioma Pain Management through Chiropractic Care

Chiropractic care is typically administered to treat and prevent pain and disorders pertaining to the musculoskeletal system that controls the body’s movement, including the spine. However, it is often sought as a form of alternative medicine and complementary care to coincide with traditional medical treatments.

In order to help manage pain and relieve headaches, tension and stress, many cancer patients have included chiropractic care in their course of treatment. Patients interested in alternative treatment, who strongly believe in the body’s ability to heal itself, may find chiropractic care particularly appealing. Alleviating severe headaches and movement pains during cancer treatment may make the treatment process more comfortable for cancer patients, including those fighting mesothelioma.

Mesothelioma is a type of cancer that is mainly cause by exposure to asbestos, a naturally occurring mineral that was used in a number of military and industrial applications throughout the 20th century. The symptoms typically take 20 to 50 years to become noticeable and by this time the disease is usually in advanced stages. Treatment options are often limited as the cancer is diagnosed late in development.

Two studies published in the Journal of Manipulative and Physiological Therapeutics examined the cases of two patients combating cancer. A 57-year-old man diagnosed with terminal pancreatic cancer experienced significant pain relief and was able to reduce the amount of medication needed following chiropractic care. He also reported an increase in his quality of life during his journey with the cancer following a visit to a chiropractor.

A 54-year-old man diagnosed with lung cancer (a cancer sometimes linked to asbestos exposure) began seeing a chiropractor after experiencing little pain relief one year after he underwent surgery to combat his cancer. The man experienced pain relief immediately after beginning chiropractic care and discontinued use of all pain medications after two visits to his chiropractor. The Journal noted, “These clinical examples offer two specific instances of how chiropractic may improve the quality of a cancer patient’s life.”

Note: Though I am not the author of this blog post, I fully endorse its message and the benefits of chiropractic for patients suffering from mesothelioma. I would also add that in my office we have seen great success helping people who are suffering from a variety of cancers and their subsequent treatment protocols (radiation, chemotherapy, etc.) with both chiropractic and hyperbaric oxygen therapy. –Dr. Thomas

Spinal Stabilzation Exercise Bird Dog (#2/4)

In this video, I explain how to perform the “The Bird Dog.” This is not a difficult exercise but it does require some coordination. It helps facilitate the erector spinae muscle which are the long muscles that run on either side of the vertebrae. I recommend doing this daily 10-20 times after doing the Cat/Cow.

“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.

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?