Where to look if your health is stuck

It’s not unusual for one’s perspective on their personal health to change at different points in his or her life. For some there is indifference, frustration, and reactivity. For others there is clarity, deep involvement, proactivity, and even identity.

Each person has their own “health documentary.” Typically it’s a blend of factors that include your health history, family’s eating habits, psychological health, environmental factors, financial pressures, value systems, and other lifestyle habits.

I want you to pause and think about how you engage with your own health and possibly your family’s health. Do you think about the future of your health? Is it your responsibility or is it a transaction to be had with a doctor at a perfunctory check up? Are you competent enough to embrace your own inner doctor barring some critical situations?

You may be familiar with the term functional medicine. Functional medicine was born out of necessity. It is a systems-based approach that looks to reverse disease by identifying the drivers and causes. This form of personalized medicine is practiced by M.D.’s, D.C’s, D.O’s, Naturopathic doctors and a host of adjunct practitioners. Allopathic or conventional healthcare accels in acute situations and provides disease management. Where it is lacking is disease prevention and health optimization. If you only treat symptoms, people want pills. Show people the root cause and they will demand a fix.

For the most part you do not catch disease. You build it through life exposure, sometimes referred to as the exposome. The exposome is a collection of environmental factors, such as stress and diet, to which an individual is exposed and which can have an effect on health.

Let’s get back to your health. Imagine that you just landed in your body. Time for an appraisal. Can you move well? How do you feel? What’s your emotional and mental state? Is it a fixer-upper or does it require just some basic maintenance?

Perhaps you want to take a closer look at your physiology and chemistry by running predictive lab work. But before you even seek out a doctor, what is in your immediate control? Your lifestyle choices! Let’s touch on a few.

I. Manage stress wisely

Stress is a ubiquitous part of life that affects us all. Stress can have a profound effect on your gut. There is ample evidence that many chronic metabolic diseases start in the gut. Exposure to prolonged stress alters brain-gut interactions, ultimately leading to the development of a broad array of psychological and GI disorders.

II. Focus on nutrition

Food is one of the most effective tools for bringing balance to your body. When we optimize our diets we see improvements in detoxification, energy and metabolic health. We are a society in a chronically fed state. Too much processed foods derail our metabolism. Eating low-carb and the occasional keto cycle can retrain your metabolism and provide a necessary reboot.

III. Intermittent fasting

Our high school biology teachers failed to mention that fasting is not only a evolutionary skill , but also the best way to activate your body’s own “house cleaning” systems. It’s referred to as autophagy and it promotes healthy cell cycles and deep cellular detoxification. When paired with a proper diet it can help balance blood sugar, prune the microbiome, and build metabolic flexibility. Metabolic flexibility means your body can use protein, fats and carbohydrates efficiently.

VI. Exercise

Physical activity has endless possibilities. Research shows that we get the best results when we mix up our routines and change how we stress our bodies.

Fasted- cardio in the morning can help support healthy blood sugar and utilize body fat for fuel. (2-3 times per week)

Post-meal activity can put circulating blood sugar to work. This is 20-40 minute walks a few times a week after lunch or dinner.

High intensity interval training (HIIT) is a great way to work your metabolic machinery and increase insulin sensitivity (2 hours per week total)

Strength training you can’t go wrong having a higher proportion of muscle to fat mass ratio. Free weights, body weight, resistance bands all work well. (3 X per week 20-30 mins)

This article does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment.

Soft Tissue Work and Healing

Sometimes people’s muscles hurt. Research estimates that massage therapy was a $16 billion dollar industry in 2017. If you have spent any time in a gym or physical therapy office you have probably seen an increase in foam rollers, massage guns like the Hyperice, “The stick”, Thera Cane, fascia blaster, PSO-RITE Psoas Release Tool and Personal Massager and the list goes on. Muscles hurt for a number of reasons such as joint misalignment, tension, stress, overuse, minor injuries, and nerve dysfunction.

Your body is made up of cells. Together those cells make tissues. Tissues make up organs and organs make up entire systems such as the digestive system or musculoskeletal system. Some cells are specifically programmed to help the body heal from trauma. These are known as stem cells. You have probably heard about stem cell injections as they continue gain more attention.

Trauma leads to:

1. Structural damage (disc herniation or muscle sprain/strain)

2. Inhibits normal circulation to that area

3. Triggers inflammation

Stem cells may respond to trauma and come out of an inactive state. They have the ability to move towards sites of injury and differentiate (change in order to carry out a specific function) into cells required for healing. This means they can become bone cells (osteocytes), chondrocytes (connective tissue), muscle cells (myelocytes) and fat cells (adipocytes).

So where do stem cells live? To name a few sites, they reside throughout the body in brain tissue, muscle tissue, fat tissue, and in a baby’s umbilical cord.

There are 4 main approaches to healing a musculoskeletal injury.

1. Eat nutrient dense foods and remove toxins (processed carbs and medications)

2. Adequate rest to avoid further injury followed by gradual exposure to activity aka “corrective care,” and other stress that create positive adaptations (i.e. sauna, fasting, and supplementation)

3. Correct structural misalignments with specific adjustments and rewire poor movement patterns. This will restore balance to the nervous system that plays a key role in healing through control of the neuroimmune system.

4. Help accelerate the body’s ability to heal by working on the soft tissue (muscles, ligaments, fascia)

I’m not going to expand on number 1 & 2 in this article. However, number 3 should be in a chiropractor’s wheelhouse. To correct a misalignment a specific adjustment should be used. Gross manipulation and a cookie cutter approach fall short in my opinion. Let me give you an example of a specific patient. We’ll call him Mike. Mike plays collegiate baseball. In the last few years he’s torn his quadriceps and his opposite leg’s hamstring. He has worked with the team PT, massage therapist and even a practitioner specializing in myofascial release.

Mike continues to play and his schedule is rigorous. The pain is becoming more frequent and increasing in intensity especially with throwing and hitting.

After evaluating Mike it became pretty obvious what was wrong. He presented with muscle asymmetries in his low back, significant pelvic distortion (rotated and un-level), specific areas tender to palpation, and his non-painful side was severely restricted. His painful side was picking up the slack and overworked. Had Mike decided to continue to play, rely solely on physical therapy and soft tissue treatments without specifically correcting the joint issue - my sense is that he would continue to play injured and below his potential.

Instrument assisted soft tissue mobilization (IAST).

Let’s dive a little deeper into number 4. Using the ceramic spoon is known as instrument assisted soft tissue mobilization (IAST). The instrument is run along the skin, subcutaneous tissue, fascia, muscles and ligaments. This is essentially trauma indicated by bruising (e.g. petechiae) that initiates a cellular inflammatory response.

I’d theorize that the “scraping” may be manipulating the local native stem cells populations at the site of treatment. That said, the literature does not support the theory that you are breaking up scar tissue and I agree with the evidence. This reminds me of a quote:

“If you’re not prepared to be wrong you will never come up with anything original.”

The treatment rationale varies as does the type of tool, force, and application used by the practitioner.

Despite the variations in treatment the general premise is to

• decrease pain,

• enhance myofascial mobility aka connective tissue

• stimulate tissue resorption,

• induce regeneration and repair.

New studies are being published to assess the efficacy and how stem cells work in a clinical setting both in the body and in vitro (outside a living organism)

While we don’t always have perfect information scientists have made great strides understanding how the body works.

Are you the CEO of Your Health and how does Chiropractic care fit

Running a results-driven chiropractic office is less about gadgets and more about providing potent corrective care. It’s more about clinical diagnosis and less concerned with e-stim, massage guns, and pulsed compression sleeves for leg recovery. Through my lens we deal with people and their multi-dimensional struggles. 

If you have suffered an injury we can look at it on three levels. The external level, which equates to the pain, soreness, and the physical extension of the issue. The second part is the internal component. How has this injury manifested from an emotional standpoint? Are you scared, frustrated, anxious, or even apathetic? Lastly philosophically speaking what does it mean to you? Are you dumbfounded that this has happened to you? Do you think you deserve to be aligned and healthy? Are you in a position to look after yourself?

Patients often look to their D.C.s as a primary source of healthcare when helping their children with sports-related injuries. Equally pertinent, are the high number of patients that look to chiropractic treatments after all other avenues have proved ineffective. It’s why taking a thorough history on every new patient and performing an in-depth evaluation is a critical component for any clinician working on neuromuscular issues.

Patient’s present across a spectrum from simple injuries to complex polygenic illness.

At a time where:

2/3 of American adults are overweight,

7/10 Americans take at least one prescription drug,

45 % of the population have at least 1 chronic disease

35 % of Americans are inactive (no regular physical activity),

44% admit to feelings of increased stress over the last 5 years

4/5 Americans are  undiagnosed pre-diabetic or diabetic (insulin resistant)

The large majority has no idea how to tailor eating to optimize their health

The bodies natural ability to function and  heal is being suppressed. Chiropractic is grounded in this idea of lifestyle based medicine. As a clinician it’s my goal to help boost a patient’s wherewithal to look after themselves. In addition to adjusting the joints we act as guides providing accountability when it comes to exercise, reexamining a patient’s eating habits, or informing them on the efficacy of cryotherapy, use of CBD, or other relevant research

Speaking of research, here are two interesting  summaries on new literature that provide additional insights into the nervous system

SCIATICA

• More than 5 million cases of sciatica are seen annually in the US
• Animal studies have uncovered activation of the immune system linking it to neuro-inflammation beyond the brain
• A combination of diagnostic imaging (MR and PET) in a human study shows increased inflammation in the brain, spinal cord, and nerve roots that correspond with the effected leg.
• One of the first human studies to demonstrate evidence of an inflammatory process happening at the nerve root.
  (Journal reference #1)

LEG EXERCISE

• Groundbreaking research shows that neurological health depends as much on signals sent by the body's large, leg muscles to the brain as it does on signals from the brain to the muscle. The brain is receiving direct input from the muscles throughout the body.
• In animal studies, it was demonstrated that limiting the physical activity, specifically the hind legs, led to a 70% decrease in neural stem cells compared to a control group in mice.
• Cutting back on exercise makes it difficult for the body to produce new nerve cells -- some of the very building blocks that allow us to handle stress and adapt to challenge in our lives.

• Quote from Lead researcher
  "It is no accident that we are meant to be active: to walk, run, crouch to sit, and use our leg muscles to lift things," says Adami. "Neurological health is not a one-way street with the brain telling the muscles 'lift,' 'walk,' and so on." -Dr. Raffaella Adami 

(Journal Reference # 2)

REFERENCES

1. Daniel S. Albrecht, Shihab U. Ahmed, Norman W. Kettner, Ronald J.H. Borra, Julien Cohen-Adad, Hao Deng, Timothy T. Houle, Arissa Opalacz, Sarah A. Roth, Marcos F. Vidal Melo, Lucy Chen, Jianren Mao, Jacob M. Hooker, Marco L. Loggia, Yi Zhang. Neuroinflammation of the spinal cord and nerve roots in chronic radicular pain patients. PAIN, 2018; 159 (5): 968 DOI: 10.1097/j.pain.0000000000001171

2. Raffaella Adami, Jessica Pagano, Michela Colombo, Natalia Platonova, Deborah Recchia, Raffaella Chiaramonte, Roberto Bottinelli, Monica Canepari, Daniele Bottai. Reduction of Movement in Neurological Diseases: Effects on Neural Stem Cells Characteristics. Frontiers in Neuroscience, 2018; 12 DOI: 10.3389/fnins.2018.00336

Long term activation of stress disrupts all of the body's processes

This video is Part 3 of a discussion on stress reduction. If you want additional context please follow us on Instagram @spineandjointoc.

Below I provide a summary that highlights the types of dysfunction one may experience due to overexposure to stress. If you watched the clip, I corrected a slip of the tongue. I replaced sleep deprived with sleep de-fried and I own that folly. Now for the comparison.

Overexposure to Cortisol

Normal Cortisol Release

Medically Reliant

Sleep-Deprived

Immunity Suppression (vulnerable
to disease)

Increase in sympathetic activity


Diminished Self-Regulation

Chronic Inflammation

Brain Atrophy

Physiologic Imbalance

Hormonal Imbalance (i.e. decrease in Thyroid hormone)

Weight gain/obesity

Weakened Bones

Healthy State

Rested and Recovered

Increased Immunity


Increase in Parasympathetic activity

Stress Tolerance

Acute Inflammation

Neurogenesis

Homeostasis

Hormonal/Circadian balance


Normal biostatistics

Strong Bones

An Ounce of Spinecare

An Ounce of Spinecare

From my perspective, I think it's fair to infer that the general population's understanding of chiropractic is steeped in misinformation and ludicrous youtube videos.

However the chance to better educate, improve utilization, and delivery quality care doesn’t always propel chiropractors forward.

Definition by its opposite

Chiropractic is not roller tables, tens machines, kinesio tape and 5 minutes of popping with the doctor. It's not meant exclusively for infants, kids, adults, or geriatrics. While there are treatment protocols - chiropractic is not a one-sized fits all approach. In my opinion it’s not a room with five tables where five different patients receive the same five adjustments. When performed in line with a proper assessment and true to biomechanical concepts the risks associated with chiropractic care are very small.

So what is chiropractic

It is a health platform tasked primarily with holistic spine care, but responsible for integrative or coordinated care (in-house and referring out) that includes physiotherapy, massage, nutrition, mental health and other holistic constructs. At its core chiropractic is about assessing the spine and providing adjustments to decrease pain, increase function and facilitate the body’s capacity to heal.

Chiropractic may be medically necessary for infants exposed to birth trauma. You might be surprised to learn that the force used to adjust babies is comparable to the force one would use to check the ripeness of a tomato. I once had a parent ask me if it’s too soon to treat her son as he was only 16 years old. I was not that surprised because she had no prior experience with chiropractic. Kids, especially those participating in gymnastics, dance, marital arts, and all of the traditional sports (i.e. lacrosse, football, baseball, basketball, etc.) can reap the benefits of identifying an injury prior to pain,  quicker healing and injury prevention (both acute injuries and wear and tear from repetitive stress).

Most people do not think about the mobility of their spine or joints such as the hip or ankle. Spinal degeneration has become so common (due to our lifestyles -there are outlier circumstances) that your orthopedist or radiologist will refer to it as normal aging. In many ways chiropractic care is a way to realign and remove abnormal stress placed on the joints, muscle and neural tissues.

Should everyone see a chiropractor

Chiropractic comes at a cost that is both financial and psychological. The former mainly due to poor insurance reimbursement and the latter because most outcomes require some degree of patient accountability.  The cost leads to a large majority of patients accessing chiropractic care as a means to resolve pain. Pain truly is the great motivator and presents differently for each individual.

Pain can be simple or complex. It can be multifaceted and may involve the following components:

• neurovascular
• psychological
• neurological
• muscular
• mechanical

Here are 3 different scenarios and how chiropractic care could be used to correct the problem and prevent future injury.

Hip pain

A 45 year old female patient complains of intractable hip pain for the last 5 months. She believes that it began after a session of interval training with her personal trainer. The pain is sharp and she notes that now she has some numbness along the lateral portion of her thigh.

The pain makes it difficult to sleep. A thorough exam reveals that she has a rotated sacrum on the same side that she is having hip pain. In this case the patient was adjusted, underwent soft tissue release, and was prescribed a few exercises. The pain resolved after the first visit and has not returned over the course of 4 months. 

Wondering what is a "sacrum"

Sacrum in in Red

Upper back pain

A 37 year-old mother of 2 complains of pain where her neck and shoulder meet. At times the pain radiates up into the neck and down between the shoulder blades. Picking up her 2 year old gives a burning feeling and rotating her head to the left has become painful and more difficult. During our history taking she notes that she sprained her left rotator cuff while in high school (volleyball injury). We found a misalignment in her thoracic spine (T2) and a misaligned scapula on the left side. Both areas were adjusted and the patient had immediate relief (90 %) improvement. Over the course of 2 additional treatments the patient regained full range of motion in her neck and was free of pain. 

Picture of the thoracic vertebrae.

Jaw and shoulder pain

A 14 year old male lacrosse player complains of jaw pain and associated neck and upper trapezius pain. During a game he was kneed in the jaw. He was able to turn his head to the right, but only about 60 % compared to rotation to the left. Evaluation of his neck and upper back  revealed a misalignment of the first cervical vertebra. Once this bone was adjusted the patient regained full ROM and a decrease in pain of 50-75%. Moreover, if this patient had not addressed the misalignment in his neck there is a possibility that the abnormal alignment can lead to a handful of symptoms and changes in postural control down the line.

First cervical vertebra (green) aka "atlas"

Summary

What’s the goal of chiropractic?

Zero in on the primary cause of pain and implement a treatment plan so that it does not return. This is predicated on a proper evaluation of the spine and neuromuscular system. 

Who should see a chiropractor?

All ages infants to geriatrics

Athletes across a wide spectrum

Those with pain or those looking for a holistic wellness approach

If you have a spine it can be evaluated.

Why do I have pain and what should I do?

Start with the least invasive therapy first. If you have muscle and joint pain or headaches find a well-reviewed chiropractor and have them perform an evaluation. That information will help you make an educated decision and understand your options. (Disclaimer: pain related to cardiovascular problems, stroke, cancer, etc ay require emergency medicine or the immediate attention of a medical specialist.)

What sort of commitment should I expect if I undergo care?

By and large true health is becoming increasingly collaborative. You may be asked to return for several visits, undergo additional diagnostic tests and follow a tailored treatment plan. Corrective care exercise may be prescribed and you may be asked to make specific changes in your behavior i.e. postural control, activity levels, nutritional choices, etc.