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.

 

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.
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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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If You Are In An Auto Accident That is Not Your Fault, It Should Not Cost You Anything.

Statistically speaking, you will probably be in an auto accident at some point in your life. I believe that injuries happen in most accidents, even the small ones and that you are doing yourself a disservice by not healing correctly after. One of the barriers that keep people from getting the care they need is the potential cost. Let me be very clear, if you are in an auto accident and it is not your fault, your care should be covered 100% either by the responsible person’s insurance company, through your insurance company, or by the responsible person. This article explores the most common ways to have healthcare bills paid.

The simplest way to make sure your bills are covered is to hire an experienced personal injury attorney. I understand that there is a stigma with hiring a personal injury attorney and there are definitely some shady characters out there. However, there are some good guys, too, and they can make life so much easier. A good attorney will make it so you do not have to talk to the insurance company again which means no more harassing phone calls or bullying you into believing you are not really hurt or that you are milking the system. Personal Injury attorneys work on a contingency so they get a percentage of the settlement they get for you. Usually, that is 33%. A good attorney, provided it is a decent case, will usually get a larger settlement which means more money for you in the form of pain and suffering. It can take a while for everyone to get paid using this method but most doctors will treat you on a lien backed by the attorney because they know the attorney will pay them when the case settles. I highly recommend this option for most of my patients.

The next easiest, and frankly the one chiropractors like the best, is to bill your insurance company through med-pay. Med-pay is an extra on your policy and not everyone has it. It usually costs an extra few bucks per month and covers up to around $5,000 in healthcare if you are in an accident regardless if it is your fault or not. Chiropractors like it because they pay as you go so they do not have to wait for a lump sum payment. You can still get an attorney if you have med pay if you would like a settlement for yourself. You can also negotiate a settlement for yourself but you need to be careful that the other insurance company knows that the total settlement includes what your insurance company already paid in med-pay.  Your insurance company can go after the other insurance company for what they paid in med-pay and if you close the case with the other insurance company by taking a settlement, your insurance company might come after you for compensation.

You can negotiate a settlement yourself with the other person’s insurance company. This is the riskiest thing to do, especially for the doctor. In this situation, after all the treatment is done, you take all of your bills and any other expenses and submit it to the claims adjuster. You can also ask for more money for pain and suffering. It has been my experience that this is not as easy as it should be. Claims adjusters will often deny a legitimate claim hoping you do not want to spend your time and energy to fight with them. They can bully you into believing that what you are asking for it too much and way above what is normal and try and pit you against your doctors. They can even take the attitude of “what are you going to do about it?” At this point, it is usually too late to get an attorney which means you are left to figure out a way to file a complaint or sue in small claims court. Both are a pain and may cost you. Most chiropractors will not treat you unless you pay upfront which can get expensive. I will treat in this situation on a lien in hopes that the insurance company will play nice and trusting the patient to pay me when it all settles.

Finally, you can take the insurance company or the other driver to small claims court. The limit of small claims court is around $7,500 in most counties depending on the nature of the claim. It will cost you a filing fee, usually around $75 and you will also have to pay someone to serve the defendant which can be expensive. These cases are simple to win but with all of the upfront expenses, the low reward, and the time you will spend, it is by far the least attractive option. Plus, actually getting money from the person you are suing can be very difficult, at least in California.

I am not a lawyer and I am not giving legal advice. If you are in an accident that is not your fault, please do yourself a favor and educate yourself on how the process works. Doing so will allow you to get the care you need which is the most important thing.

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You Can Adjust the Bones in Your Skull?

There are 22 bones in the skull connected by a type of joint called a suture. In the old days, doctors thought these bones fused together in adulthood. Now, we know that they can and do move with some regularity. The suture as a joint is only found in the skull. It doesn’t pop like the synovial joints in our backs and extremities, they just shift a little here and there. Because there is movement, though, it can be adjusted, and because of the proximity to the brain, the results can be very beneficial.

There are several reasons people need the cranial bones adjusted. Most often it is due to a build-up of sinus pressure which changes the shape of the skull. The sinuses are open areas in the middle of cranial bones. They have a mucous lining and are sensitive to atmospheric changes. When full, as a result of a cold or allergies, they tend to hurt from the pressure. When one gets cranial bones adjusted, it regulates the pressure and promotes drainage into lower sinuses and into the lymphatic system.

Another reason to adjust the cranial bones is for TMJ issues that won’t resolve with adjusting the jaw. The “T” in TMJ stands for Temporal, as in the temporal bone. It makes the socket part of the joint where the mandible articulates. If it is shifted, the joint is not going to work right no matter how much you try to increase the movement of the mandible.

I have seen great success adjusting the cranial bones. It seems a little odd but it can make a difference. It can help with sinus issues, headaches, TMJ syndrome,  and a host of weird neurlogical conditions due to mild pressure on the brain.  Let me know if you want me to check it out.

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 your 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 paraesthesia.

The scenario described is the least serious form of paraesthesia. 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 paraesthesia 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. So, if you are getting numb hands, get in and let us help you.

Photo by Matilda Vistbacka on Unsplash