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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How Do I Know If My Chiropractic Treatments Are Helping?

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One of the most fulfilling yet difficult aspects of my career is helping people navigate their journey to better health. Healing is a process that can take a lot of time. We tend to think of that process as a straight road from disease or injury to health but that is the exception rather than the rule. Often, things feel worse before they feel better and there are always plateaus and valleys. Helping patients to have faith in the process and continue care inspite of bumps in the road is a worthy challenge.

Everyone comes into the office with disfunction. Not all disfunction is symptomatic but it all has potential to become so. Sometimes people come in with symptoms that are just starting to show but during further examination, I discover that those symptoms are just the tip of a very large disfunctional iceberg. I know that when I start chipping away at the disfuntion below the surface it is going to make those symtoms much more obvious. This can be very alarming. In addition, symptoms can change or move locations. People who are more prone to worry, often need a lot of reassurance to stay the course. There are several signs and symptoms that may cause concern but are actually indicative of progress. Most of these happen in early stages of care.

Pain will often increase with increased movement. Adjustments are designed to move joints that have been stuck or moving improperly for some time. Getting them to move again can cause pain. It is not always pleasant but it is a necessary step. As a rule, the pain should be more of an ache or soreness. Furthermore, pain can centralize and therefore increase in intensity. Centralized pain, or pain that is focalizing on the disfunctional joint, is usually more painful than a broad spread out pain. In this phenomenon, the pain is going back to where it belongs which is a very positive step. The closer your symptoms are to the structure that is actually causing the symptoms, the better the body will be at promoting healing in that area.

Symptoms often change especially when nerves are involved. If a nerve is significantly injured, the worst thing is complete numbness with zero sensation. There is actually no pain. When we lessen the irritation, the sensation is one of pins and needles and achiness. This can be followed by soreness. These symptoms will wax and wane for some time before a complete recovery.

Another change that can happen that will cause a patient mental anguish is when a symptom switches sides. We often see this is disc related injuries. This is not necessarily a bad thing either. It tells me that the disc is not completely stuck in one bulging position and can change or, even better, that it has not degenerated to the point of no return. The ability to change means it can heal.

I find it much better to not focus on symptoms but to look at movement patterns, muscle tone, and inflammation. If range of motion is improving and muscles are calming down, then progress is being made, and it is only a matter of consistency and time before symptoms start to go away for long stretches of time. When people ask if they are getting better, or complain that they are not any better, when I know they are, I usually ask them how they feel after an adjustment. More often than not, they feel significantly better but it just does not last as long as they think it should. As we get better, we also tend to forget how bad the pain was. The contrast of any pain when you have experienced little to no pain promotes the idea that one is not improving. Perspective is the key.

If you feel like chiropractic is not helping you, please take a step back and consider the big picture before you cut your care short, thus nullifying all of the hard work you and your doctor have done to help you become functional again.

 

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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.

It’s a Wonderful Life From This Chiropractor’s Perspective

I love the movie, “It’s a Wonderful Life.” I am especially moved by and relate to the main character, George Bailey. George consistently puts the needs of others before his own wants. He is flawed for sure, but when it comes down to it, he does the right thing for others. In the end, we see just how much his generosity and selflessness has affected others and when George is in dire straights, they lift and support him.

I often tell people that I strive to work by the George Bailey Principle where people and community are more important than money and business. I really believe this. I am also thoroughly convinced that when we focus on relationships and helping others, money and business will come.

Why am I sharing this? It kills me that there are people out there who need help but do not seek it because they fear the expense. They suffer because of something as stupid as money. Now, I get that for some it is a priority issue. I try not to know or judge. Honestly, what I care about most is helping people live healthier lives. Because of this, I know that money and success will come. It has come, and will continue. If you need care and finances are a concern, come talk to me and let’s work it out to make it affordable.

The two quotes that impact me the most in the movie are: “Remember, George, no man is a failure who has friends.”  and “A toast to my big brother, George: the richest man in town.” In my practice, I do not need to have the most money; I just want to help the most people. This will make me the richest man in town.

Low Back Pain and Tight Hamstrings

If you are around my age, you might remember having to pass the Presidential Fitness Test in P.E. Part of that test was flexibility demonstrated by sitting on the ground with the legs extended and the knees straight. Then, you would reach forward as far as you could. Not to brag, but I could reach well beyond my feet. I was, in fact, the most flexible boy in my whole middle school. I remained pretty flexible until I was in college when I hurt my low back. Since then, I can barely touch my toes on a good day.

With any injury, the body has protective measures. When you hurt your low back, the hamstrings will shorten to protect against bending forward and causing further damage. Like most of these reactions though, the body doesn’t always know when to stop guarding which can prolong the healing process or lead to more problems down the line. My recommendation is to first start improving the function of the low back through chiropractic adjustments, and then to start regularly stretching the hamstrings.

I created the following video to help you do this stretch properly. Remember that in order to actually lengthen a muscle, you must sustain the stretch for at least 30 seconds. It can take time before you see results. If after several weeks of stretching you are not improving, it most likely means that there is still a significant amount of  dysfunction in your low back that you need to address.

Hamstring Stretch

Do Your Hands Fall Asleep?

Most of us have experienced it. There you are sitting in what seems like a comfortable position, watching tv. All of sudden you notice that you have no feeling in your hand! It has fallen asleep. You move from the all-of-a-sudden awkward position trying to pause the show you are watching but you can’t because you have no feeling. You do the obligatory shaking of the hand trying to get it to wake up. It starts to get some feeling back but really it just feels  like someone is jabbing you with thousands of pins and needles. Then you start to flex and extend you fingers. It finally starts to wake up and you are able to reverse back and watch what you missed. Slowly, the hand goes back to normal. You have just experienced paresthesia.

The scenario described is the least serious form of paresthesia. It is usually temporarily caused from either a direct pressure on a nerve or by cutting off blood supply to the nerve. Once you release the pressure or get the blood moving, feeling starts to return. One still needs to be careful in such a situation. I have a  patient who tried to walk when, unbeknownst to her, she had a foot that had fallen asleep. When she got up to walk, she fell and shattered that numb foot requiring surgery and a litany of issues. So, be careful!

The bigger issue, however, happens when parasthesia comes on insidiously. In these types of situations, there is something deeper that is irritating the nerve. For the hand, this can happen at the carpal tunnel, at the elbow, at the shoulder, under the pectoralis minor muscle, under the scalene muscles, and at the nerve roots in the neck. Irritation can be caused by swelling of soft tissue (ligaments, muscles or tendons), by bulging discs, by stretched nerves due to poor posture, by a deficiency in blood supply due to a host of conditions, and the list goes on. If your hand consistently falls asleep, you need to figure out the cause. It could be a simple remedy or it could be a sign of something serious. The longer a nerve is injured, the longer it takes for it to heal. In addition, you run the risk of injury to the area the nerve supplies.

What Makes a Comfortable Adjustment?

When a chiropractor adjusts a person, the goal is to get joints moving properly. Because we are talking about movement, the force equation comes into play: Force = Mass x Acceleration. So, in order to adjust, a chiropractor needs mass and acceleration. If there is not enough mass, they need enough acceleration and vice versa. In general, the greater the acceleration, the more comfortable the adjustment.

There are a number of reasons a quick adjustment is preferable. Most people guard to some degree when getting adjusted. It is a natural response. Guarding only gets worse when someone tries to increase the force by increasing mass because the body is aware of the force. Along those same lines, an adjustment when someone is guarding doesn’t always move the joints thoroughly enough which leads to an unsatisfied feeling that there is still something not moving correctly. In addition, the  nerve sensors of a joint, known as the proprioceptors, need to be stimulated to get the full benefit of an adjustment. The only way to do that is with a quick movement of the joint.

Everybody is different in how they interpret comfort. Some like a firm touch others gentle. Some like to hear the cracking sound and some do not. Regardless of preference, thorough movement of joints is critical for a proper adjustment. Whether the speed is achieved through skilled hands, an adjusting tool like the Activator, or a drop table, the quicker the movement, the less mass and the less trauma on the body.

Massage and Chiropractic

Massage and Chiropractic care go together like peas and carrots. By the way, who eats peas and carrots together anymore? Anyway, suffice it to say that they are very complimentary. Chiropractic is great at improving joint movement and coordination but can often be encumbered by muscles and fascia that refuse to relax. Along those same lines, massage is fantastic for removing scar tissue and relaxing soft tissue but if  muscles are guarded in order to protect injured joints, the massage will be ineffective, at best.

Generally speaking, getting adjusted before a massage is the best strategy. Getting adjusted helps reset the never impulses in the area which can turn off the protective muscle guarding. This makes for a more comfortable massage as well as a dramatically more effective one. In addition, it allows me, as the doctor,  to give the massage therapist some target areas where massage would really help.

Occasionally, I have a patient that is just too tight and guarded to adjust. In that rare instance, getting massaged before the adjustment is warranted. Then, sometimes it makes no difference whether you get massaged or adjusted first, if you are healthy and maintaining. In conclusion, there is great benefit to massage including but not limited to improved muscle tone, better blood flow, mental relaxation, and the release of toxicity in the soft tissues. When you combine massage with chiropractic care, you can experience synergistic improvement in your health.

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.