Thoughts from the Chiropractor

Take a second to think about your grandmother; the hump on her upper back, slumped over in her chair, unable to look up at the ceiling, shrunk 5 inches in height, dealing with osteoarthritis, bone spurring, degenerative disc disease, shortness of breath, and dwindling hormones.  Now think about your 12 year old daughter constantly looking down at her phone, slouching down in her chair at the dinner table, not standing up straight because she is taller than the other kids.  That daughter is going to turn into your grandmother if she doesn’t fix one very important thing:  Forward head posture.

Forward head posture in the medical world is not just leaning your head forward for a moment, it is when the structure on the inside shifts, resulting in sustained forward leaning of the head.  After hours per day, for years, the curvature of the spine in the neck starts to straighten out, and in more severe cases, starts curving in the opposite direction.  The weight of the head transitions from over the joints in the back of the spine, where it is designed to carry lots of weight, to over the discs in the front of the spine that are not designed to maintain that load.  As a result, the discs start to degenerate, decreasing in height, causing a smaller opening for the nerves to exit from the spine.  Then the discs start to bulge outward, butting up against the adjacent nerves, and causing radiculopathy and loss of function wherever those nerves go.  In extreme cases, this added pressure to the discs can cause enough damage that a hole opens in the side of the disc resulting in the material from the inside pushing out and causing even bigger problems (known as a herniation).  In response to the added weight over the discs, the body recognizes abnormal stress and attempts to fix the problem on its own.  It does this by building extra bone (“bone spurs” or spondylosis) in the areas of additional stress to try to fortify and strengthen the area.  It’s an awesome response but results in irritation to the joints, which we call arthritis. 

Beyond the disc degeneration and arthritis, prolonged forward head posture causes the ligament that runs down the front of the bones of the spine to shorten over time, which limits the body’s ability to regain normal positioning of the head.  Musculature imbalances accompany the new head position which can impede the flow of blood and nerve function to the upper extremities.  The strain to the muscles at the base of the skull can result in chronic headaches and the muscles of the upper back get over worked resulting in “carrying your stress” in that area.   

I know that it sounds extreme that one little thing like forward head posture can lead to the body breaking down, but it’s true.  Obviously there are a lot of other things that we need to do to stay healthy, but something as simple as maintaining proper posture makes one of the biggest differences in spinal health and subsequently, the health of the rest of your body.  Proper work space ergonomics, decreasing time staring down at your phone, and exercising the muscles that maintain proper posture are all things that you can do now to prevent, decrease, and even reverse forward head posture.  So when mom tells you to "sit up straight," at the dinner table, she is probably speaking from experience and you should listen to her!

Getting your spine adjusted is essential to the function of the nervous system and maintaining the structure that our musculature attaches to.  We were given 24 bones that surround and protect that nervous sytem so that we can bend and move.  Our bones move every day with our daily activities, therefore, getting adjusted on a regular schedule should become part of the maintenance of your body.  But what can you do at home to supplement your chiropractic adjustments and help your body function and heal as it should?

I am not going to re-invent the wheel here, the answer is exactly what we have been told for our whole lives; eat right, drink more water, exercise/stretch, and get enough rest.  It sounds simple, but with our busy schedules, it is far too easy to put the basic principles of self-care down the list of priorities.  My goal is to make those things easier for everyone, so here are my simple recommendation.

Eat better-  Better does not mean perfect.  If you are the person that can never eat a carbohydrate again and be happy, then more power to you, but most of us will have an extremely hard time doing that.  Instead, aim to reduce grains (bread, pasta, cereal, etc) and dairy (milk and cheese) which will help to decrease inflammation in the body and will likely have the added benefit of decreasing body weight, easing pressure on your joints.  When grocery shopping, stay on the outer perimeter of the store.  The aisles are primarily processed foods.  Your diet should be mostly meats, vegetables, and fruits.  When you screw up with your diet, make sure that it is the exception, not every other day.

Drink more water-  The old thinking was that we should drink 8 glasses of water per day, which is good for some people and not for others.  The way I want you to think about it is this; drink half of your body weight in ounces of water per day.  I weigh 200 pounds, which means I should be drinking 100 ounces of water per day.  That is a lot more than the 64 ounces of water that I would be getting from just 8 glasses.  This means you will be spending a little bit more time in the bathroom, especially when you first make the switch to drinking more, but your body will adjust.  Water means water, not sweet tea/coffee/tea/gatorade/juices/diet soda or any of the other excuses for water.

Exercise/stretch-  Keep this simple, we are not looking to become power lifters or marathon runners here.  Spend some time doing cardiovascular exercise (fast walking, jogging, running, biking, rowing, elliptical, swimming) 3 times per week for a minimum of 20 minutes.  If your heart rate is not getting elevated, then it is not achieving the desired outcome.  The goal behind cardio is not strength or weight loss, it is heart and lung health.  Do some form of strengthening (weights, bodyweight, resistance bands) 3 times per week, making sure to hit all of the major muscle groups.  Stretch as often as you can.  Several times per day.  If you stretch one side of your body, make sure to stretch the other side as well (left/right, front/back).  To make it easier, in your own living room, go on YouTube and do one of the million yoga videos that you can find and it likely will do a great job of getting you to stretch while also strengthening your stabilizing muscles.

Get enough rest-  This one is not rocket science, get more sleep.  Aim for 8 hours per night.  Go to bed earlier, there is no good reason to stay up until midnight.  Sleep in whatever position you get the best sleep in.  Sleep on whatever pillow/bed you get the best sleep on.  Your body needs rest to build itself back up.

If you can do better at these 4 things, your body will thank you and you can expect less discomfort and better function.

Questions about pain are a daily thing in chiropractic offices, and honestly, are very difficult to answer.  Pain manifests in everyone differently; numbness, tingling, radiating, sharp, dull, debilitating, headaches, hot, cold, cramping, weakness.  There are A LOT of different ways that we can be uncomfortable.  Some people have higher tolerance to pain than others, but no one, absolutely no one, wants to be in pain.  

Almost all people who walk through the door at chiropractic offices are there because they have something that hurts, so the question always gets asked, “how long is this going to last?”  It is a difficult question to answer, and most of the time, the answer is, “I don’t know.”  No one wants to hear that their doctor doesn’t know how long they will be in pain, but it is the truth.  Everybody is different, and everyone’s healing potential is different.  The 18 year old athlete recovers much faster than the 75 year old obese arthritic grandmother.  Disc bulges respond almost always the same while plantar fasciitis and tennis elbow never recover the way the text books would tell you.  You adjust one person expecting that it will take weeks for them to feel better, and they come in on their next visit raving that they feel like a million bucks.  Then the next person that you expect is going to do great takes triple the time to recover.  Then there are the people that you know will never be fully out of pain because of how much permanent damage they have done to their body through injuries, trauma, and arthritic changes.  These people you are trying to maximize whatever percentage of improvement their bodies are still capable of achieving.

Everyone is different, but the goal is always the same behind your adjustment.  If we can open up the communication from your brain to your body and free up nervous system function, your body is going to start to heal.  The amount of time that it takes to heal is often an unknown, but just like you, I want everyone to get better as fast as possible. 

Doing your part as the patient makes a HUGE difference when it comes to recovery.  Follow your visit frequency that your doctor recommends.  Eat a clean, anti-inflammatory diet (decrease or eliminate grains/breads/pasta, dairy, and highly processed foods).  Exercise 4-5 times per week (yoga, cardiovascular exercise, and weight training that is appropriate for your goals).  Avoid sitting for long periods of time.  Heat or ice to the area of complaint depending on what your doctor recommends.  Get enough rest.  All of these things are important for recovery from acute situations as well as keeping our bodies functioning how they were designed to.

If you do not understand what chiropractic really is, it is difficult to know when you should go to a chiropractor.  Do you wait until your back is killing you?  When you can’t get out of bed without excruciating pain in your back?  When you get a diagnosis of degenerative disc disease?  When you are in a car accident, or fall down the stairs?  Although all of these situations are absolutely times that you should go to the chiropractor, you should have gone to the chiropractor before things got this bad. 

Chiropractors love to say, “When is the best time to start chiropractic care?  The day you were born.  When is the next best time to start chiropractic care?  Today!” 

Chiropractic is about optimizing the brains communication with the rest of the body along the nervous system that runs inside the bones of the spine.  Better brain function is something that benefits everyone, all the time.  So despite how cheesy that saying by chiropractors is, it is completely true.  If you are alive, the best time to get your spine checked is as soon as possible so that your brain can start communicating with your body better, and you can start living life to your full potential!

People who have never been adjusted are usually nervous about letting someone work on their spine due to their fear that the adjustment might hurt.  That fear is understandable because they have never been adjusted, and most people have a healthy fear of the unknown. 

Moving the vertebrae of the spine through chiropractic adjustments looks barbaric in videos on YouTube, but in reality is done with light force and high speed.  That means that the push on the bone is not hard at all, it is just done quickly, so as to move the segment that the doctor is touching, instead of everything else around it.   The light force means that for almost everyone, getting adjusted is easy and comfortable. 

All that being said, there are times that patients come in the office in terrible discomfort BEFORE they get adjusted.  For those people, getting adjusted is not always a walk in the park.  As their condition improves, the adjustments should get more comfortable.

Along the lines of comfort with adjusting, patients should expect that they will experience soreness following their first few adjustments.  This soreness is due to the inflammation that is a result of moving vertebrae.  The new position of the bones results in different stresses on the musculature and ligaments, causing inflammation.  That inflammatory response becomes less as the body gets familiar with the new position of the bones and the new mobility that results from proper joint alignment.  A great analogy for this experience of soreness is working out at the gym for the first time.  If you haven’t been working out, the first few times you exercise, you will be sore, but if you continue, that soreness will decrease each workout until it is not a problem anymore.  It is the same with getting adjusted.

In closing, chiropractic adjustments are low force and should be comfortable for most people, and are only uncomfortable for those who are already in a lot of pain.

I have the pleasure of adjusting a lot of people in my office, but by far the most fulfilling and fun to work with are the children.  When I talk about this with people outside of the chiropractic world, it often surprises them that children would need to get adjusted.

First we have to remember that the main reason for adjusting anyone is to open up the pathway from the brain to the body so that the nervous system functions properly.  That is not just limited to people who are hurting, it is important for everyone.

Secondly, children’s bodies are growing rapidly and their brains are learning and building neural pathways much faster than when we are adults.  It makes sense that removing pressure from the nervous system helps their bodies to grow during the most important years of brain development.

Lastly, and maybe most obviously, kids put themselves through a lot of trauma.  I have a one and a half year old daughter who has just recently learned to walk, and that process had her falling down hundreds of times per day.  My four year old son is trying to keep up with his eight year old brother and falls off the monkey bars, trips over his soccer ball, wrestles with his brother, bumps his head against everything, and generally is just a crazy kid.  My eight year old is busy playing soccer, flag football, falling off his scooter or bike, and somehow managing to twist himself into a pretzel while laying on the couch watching television.  If you have been around kids for any amount of time, you know what I'm talking about.  Kids are hard on their bodies!  All of these traumas are part of kids having fun and learning how to use their bodies and are absolutely necessary for their development, but because of all this trauma, they should be getting their spines checked on a regular basis.

After reading this, hopefully you understand why it is even more important for kids to get checked and adjusted than adults.  Go get your kids checked!

First we have to define the difference between getting checked and getting adjusted.  Getting checked is having a chiropractor analyze your spine to see if bones are out of place.  Getting adjusted is the process of the chiropractor moving the bones from a misaligned position to their proper alignment.   

Answering how often should I get adjusted is easy; whenever there is a bone out of place, you should get adjusted. 

Answering how often to get checked is a bit more subjective.  When patients walk in my door in acute situations, it may require getting checked multiple times per week.  For the completely healthy individual who is seeking to maintain the health of their spine, I recommend getting checked once per week.  Bones move out of place because we are living our lives, playing sports, sitting with poor posture, driving our cars, sleeping in funny positions in our beds, and playing with our kids.  Because we do these things, our bones move.  We move a lot so we need to check our spines frequently to make sure they are ok.  If nothing is out of place, great, no adjustment.  The only way to know if our spines are out of place is to get them checked.   

To reiterate,

Everyone, from 1 minute old to 100 years old should get their spine checked once per week to make sure that everything is where it should be. 

You should get checked more frequently when injured or stressing your body more than normal.

 If vertebrae are out of place, adjust as needed.

A lot of times as my patients are warming up to get adjusted, they tell me that they did my job for me because their spine just popped, but there is a big difference between popping a joint, and a chiropractic adjustment.

To understand the difference, we first have to start with a little anatomy lesson of the joints of our bodies.  A joint is formed when two bones come together and articulate with each other.  Around the joint we have soft tissue that is called the joint capsule which provides a little bit of stability, but primarily produces fluid that is inside the joint space called synovial fluid which acts as a lubricant for the joint, almost like oil does for your car engine.  Through our daily activity, the synovial fluid produces the gases oxygen, nitrogen, and carbon dioxide that build up in the joint space.

When we flex our joints far enough that the gas can escape from the joint space, it creates a “popping” sound that we call cavitation.  This can happen through any number of normal daily motions like squatting down to pick something up and your knees or ankles may pop, or when you lay in bed and roll over and your spine might pop.  The nice thing about cavitation is that it also triggers your body to release endorphins, which are feel good hormones, so it actually feels good when this happens.  This is the reason that people obsessively pop their knuckles or twist in their chairs to get their spine to pop, it feels good and it is easy to understand why people might think that they just adjusted themselves!

The difference between a pop and an adjustment, is that the purpose of the adjustment is to actually move the bone from a misaligned position to its proper position to take pressure off of the nervous system.  To do that, you need to be able to identify which bones are misaligned, where they need to go, and then have the skill to put it in the proper position.  That is the special skill set that chiropractors go to so many years of school to learn.  It is not possible to adjust your own spine, even if you are a chiropractor, which is why I go to a chiropractor too.  Now most times when we deliver adjustments to the spine, the joint space does flex enough for the gas to escape and make a popping noise, but that is just a byproduct of what we are doing.  I joke and describe it as a fart for your spine.  The purpose behind an adjustment is to move the bone, if it pops that’s great because of the fun sound and the endorphin release making it feel good, but if it doesn’t pop, that is fine too as long as the bone goes where it is supposed to and takes pressure off of the nerves.

I had initially planned on writing today about what to expect for first timers getting adjusted, but my new patient last night was a great example of why it is important to do a good history with clients at their first visit. 

The patient came in with a sore neck that had been going on for at least 3 weeks, causing him to struggle sleeping at night and overall making every day difficult.  A little back story on this man;  he is your stereotypical good ole boy from the South, fairly rough around the edges, and a tough guy.  I describe him this way, not to be mean (he is awesome), but because that is what comes through the door sometimes.  As we started to discuss his condition, I knew that I was going to have to pry in order to get this man to open up about what was really going on with him.  As the layers of the onion started to peel back, it turned out that this man's neck pain was also complete numbness in his left arm to the point of having no feeling in his hand at all (HUGE RED FLAG).  There was also swelling above the shoulder blade that looked like the awful masses that you see Dr. Pimple Popper work on.  I asked this man if he had been to see anyone else about this condition prior to coming in my office to which he said that his GP had sent him to an orthopedist.  The ortho did an MRI of his shoulder followed by a cortisone injection which caused no change.  They then wanted to do an MRI of his neck, but the patient had been in my office years ago with great results, so he elected to come here first. 

To any chiropractors out there, DO NOT WORK ON SOMEONE WITH THESE SYMPTOMS.  Too often do I hear stories of chiropractors who think they can solve every single problem that walks through their doors.  Sometimes I think this is because of pride, more often is because of taking a bad history, but most often I think this is because they are trying to pay their bills and have forgotten that the patient's health needs to always come first.

Anyone who knows anything about symptoms associated with cervical disc herniations can tell you that the big indicator is radiating symptoms down the arms.  Sometimes this can be as minor as weakness with grip strength, or it can be as obvious as this man who lost all sensation in his entire arm/hand.  A disc herniation is when there is a hole in the side of the disc and the material on the inside is leaking out.  This is a huge health concern, especially in a chiropractic office.  If I had chosen to work on this man, there is a 50% chance that his symptoms improve through regaining mobility in his joints and allowing the disc material to centralize and remove pressure from his nerves.  Unfortunately, there is also a 50% chance that through the adjustment more disc material comes out, puts more pressure on his nerves or spinal cord, and results in permanent nerve damage, a more invasive surgery, or in the worst possible case, paralysis.  When it comes to percentages in health care, 50/50 is not good. 

The decision was made to hold off on working on this man until he has had a cervical MRI.  Could I be wrong? Of course.  Could it be something completely different that is causing his symptoms? Of course.  Could it have been completely safe for me to work on him?  Possibly, but without that MRI, I cannot be more than 50% sure, and that is not a risk that anyone should take. 

Had I not asked the right questions, it could have opened the door for a very bad result.  The symptoms are easy to recognize, you just have to ask the right questions in order to protect the patient, and yourself as the doctor. 

The question I want to answer today is, what is chiropractic?  In the past, chiropractic care was viewed mostly unfavorably by the public, and although the perception and understanding of this form of healthcare has come a long way, most people still think that chiropractic is all about neck pain, back pain, and “popping” joints.  I’m always annoyed when people who are unfamiliar with chiropractic believe that way, but the only ones to blame for the public not understanding what we do, is ourselves.  Chiropractors are notorious for mixing a lot of other forms of healthcare into their practices, doing a terrible job of explaining what we really do, or not educating their patients at all.

So here it is, chiropractic care is a form of healthcare centered around the alignment of the vertebrae in your spine.  It is pretty common knowledge that chiropractors work on backs, but what makes chiropractic care special is WHY we work on backs.  The bones of our spine, including our skull, serve the purpose of protecting our nervous system.  The nervous system consists of the brain which is inside of our skull, the brain stem and spinal cord, which are protected by our vertebrae, and the nerves that connect to all the organs of our body.  The nerves exit from the spinal cord between the vertebrae of the spine and carry communication from the brain to the body and from the body back to the brain.  When the bones of our spine are in the proper position, there is room for the nerves to exit, but when those bones move out of their normal position, the bones can actually impede on the nerves, which can alter or even block the transmission from the brain to the body part that the nerve travels to.  The brain controls every single function of the body, including your hormones, immune system, heart, lungs, digestion, sense of feeling, and even your skin healing.  So when the vertebrae of your spine move out of position and start interfering with your nerves, it could mean something as simple as having some numbness in your fingers or toes, but it also could mean something as serious as your heart or lungs not working properly.  The goal behind a chiropractic adjustment is to align the vertebrae of the spine, for the sole purpose of removing nerve interference.  So when I hear people ask me the question, “Can chiropractic help with…,” the simple answer is always yes.  Not because we are treating cancer, ear infections, skin conditions, digestive issues, or even back pain, but because removing interference from the brain to the body allows your body to heal itself, the way that God intended it to.