Friday, May 31, 2013

Is your Chiropractor your Cure?

I've got a friend who wakes up at 5am and swims for 1 hour before work every single day. Which to me sounds absolutely awful... cause I think swimming is one of the hardest exercises to do.  I'm just not a swimmer, if I do a few laps I think I'm gonna die, I mean literally, I may just pass out and sink!  So to me, he's a crazy person, but you know what?  He loves it.  When I ask him why he does it he always responds with "cause it evens me out and I'm just not myself if I miss a day."  Again... crazy person!

So he's an example of a person who has to do something every day or else he doesn't feel good.  But we all have things like this.  For some people it's walking or running, drinking coffee or making a smoothie, meditating or calling best friends.  We've all got things that we have to do in our lives to make us feel good.

Now if we stopped doing these things, we'd be all out of whack.  If my buddy stopped swimming he'd be miserable, and we all know of the woman who if she stopped taking her morning walks to the coffee shop would be a disaster.  My point here is that we all do things to make us feel better and improve our lives but they aren't one time occurrences, they're things we do on a daily or weekly basis, and if we stop doing them we don't feel good.  For some people this thing is seeing their chiropractor.

Some people have to see their chiropractors on a weekly or monthly basis to feel good.  For these people seeing their chiropractors is like swimming, or working out, or drinking coffee or calling best friends.  It's the thing they need to feel normal.  And if they stop seeing their chiropractor they just don't feel well... their pain comes back, headaches come back, stress comes back, whatever it is comes back. For some people, seeing a chiropractor is as much a cure for their pain as working out is a cure for weakness. (I think that's an analogy... or a simile... I can never remember which is which).  Meaning that seeing their chiropractor isn't their cure, it's just the thing they've found that improves their lives.

"For some people, seeing a chiropractor may be as much a cure for pain as working out is a cure for weakness."

And even though we all know this, some people have a really tough time dragging themselves into the chiropractors office on a monthly basis.  If you're old enough to remember the charlie brown cartoons you'll remember how charlie brown would walk when he was upset.  Head down just dragging his body along... just like this arrested development spoof (and I apologize if you don't know what arrested development is and you don't get this reference)  This is how some people arrive in the office!

Now this isn't true for everyone.  The majority of people we see don't have to come back for life and are feeling much much better within 1-3 weeks.  But for a handful of people that's not the case.  Some people just have bad backs and have to see their chiropractor throughout life or else their pain comes back.  I'll share a story with you about what I mean.

A few weeks ago we had a woman come into the office who has mild scoliosis which causes her to be in some sort of pain every single day.  And she had been in pain for over 30 years, tried everything from pain killers and physical therapy to acupuncture and herbal remedies... none of which helped her pain.  So she came to us, as some people do, as a last resort and only because her best friend convinced her to come in.  We examined her, saw the mild scoliosis and the pain it was causing and explained to her that we could help her pain... but we could NOT cure her scoliosis.  She responded by saying "I'll do anything to get out of pain, I can't live like this anymore."  So she began treatment... still not really believing we could help her.

Now a little background here.   With mild scoliosis there is a slight curve to the spine which causes altered mechanics in the spine.  You get too much pressure and too much irritation on one side of the spine.  So the joints of the spine jam together on one side and stop moving correctly which causes a lot of discomfort and achiness for most people who battle scoliosis.  But if the joints of the spine can be loosened then the pressure is released and most people get can get relief.  This is why we see hundreds of people with mild scoliosis... because adjustments are very effective at helping this type of pain.  But of course we don't cure the scoliosis, we just allow some people to live relatively pain free.

So we started treating this woman, and low and behold, after 8 adjustments she was out of pain for the first time in 30 years.  Fantastic you may be saying!  And that's actually what she was saying... how great it was for her to be out of pain.  So we started treating her weekly, then once every two weeks, and then once a month.  A woman who had constant pain every single day now only had to see her chiropractor once a month... how fantastic!  Well not exactly, because as most people do, this woman eventually said this.... "well you've helped me more than I ever thought anyone could, but I really don't want to come every month cause I live on the other side of the city, so what can I do on my own so that I don't have to come in?"

And there it was... the question that I could not answer... because there's no good answer.  People with scoliosis got dealt a bad hand, if you will.  The mechanics of the spine will always be a bit off, and will need some sort of care.  But since she had gotten so much relief she felt that there must be some way of not coming in for care anymore.  Now remember, she had once said "I'll do anything to get out of pain" and was now saying "I really don't want to come once a month"... what a shocking change!  And also remember, she had tried literally everything before coming to see me, and now was asking me what else she could do on her own to prevent her pain... as if I knew some crazy stretch or exercise that nobody knew of... which of course I didn't.  And this doesn't just happen with scoliosis.  It happens with degenerated discs, sciatica, chronic headaches, fibromyalgia, pain from sitting at a desk all day, pain from traveling for a living, and other pain syndromes associated with the ways people live their lives.

Here's another example.  The guy who sits at his desk for 10 hours a day, getting up only once to grab lunch.  Comes into the office complaining of back pain that has gotten so severe that he can't sleep at night.  He's on heavy doses of pain killers and muscle relaxers which just make him tired all day but don't really help his pain.  He now can't focus at work and he's losing business because of it.  So I examine him and find that his constant sitting is compressing the joints of his spine which is causing his pain.  I told him that I could get him out of pain but NOT permanently because his pain is CAUSED by sitting.  To which he responded "I hurt literally all day and I can't live a normal life without sleeping so do whatever you have to do and I'll come as much as I need to."  So after 2 weeks of treatment he started feeling great.  But he couldn't go more than 2 weeks without getting an adjustment or else his pain comes back.  Doesn't sound too bad right?  From constant pain that caused sleepless nights to having to walk 3 blocks to see his chiropractor for 15 minutes every 2 weeks.  But after a month or so of bi-weekly treatments the question came up again "Doc I feel great when I see you every couple weeks but I'm really busy at work and I just can't get here every 2 weeks so what can I do on my own to not have to come here?"  And again, other than telling him to stop sitting, I didn't have a good answer.  So of course I sarcastically told him he could "stop being you" and we laughed a little... but that joke got us nowhere of course.

And the reason I don't have good answers to questions like the ones I heard from these patients is because the pain many people experience is caused by either something incurable like scoliosis or how people live their lives.  Whether it's sitting, travel, scoliosis, or too much stress.  But these aren't things I can cure.  So when people ask me what else they can do, I really don't have an answer.  And when I do hear this question I always think it's sort of funny, because it's kind of like walking to your hair dresser and saying "Listen, I love how you make my hair look but I live 3 blocks away and I really don't have time to come in here, so what can I do on my own so that I don't have to come see you?"  Sounds funny right?

So what's my point here?  Well my point is that some people have to see chiropractors their whole lives, it's just the way it is.  And it's not because their chiropractor is telling them they're gonna die if they don't come in.  It's just that their chiropractor may have been the only person to ever help their pain and there's no permanent cure for them.  There's no real cure for scoliosis or for sitting all day.  Just like some people have to avoid red meat or else they'll get a heart attack, swim in the morning or else they're miserable, or drink coffee in the morning to get through the day.  Some people just need chiropractors... but is that necessarily a bad thing?  Can you imagine if these people were never introduced to their chiropractor?  And along the same lines can my friend imagine if he never found swimming?  Daily life clearly just wouldn't be the same.

So the next time you drag yourself across town, kicking and screaming, to see your chiropractor, for that long 15 minute appointment, just try to remember how much pain you were in before your first visit.  And just think that even though your chiropractor may not be able to "cure" your chronic pain... they may be able to give you a life without pain.... even though it's a huge "pain" to get to their office :)

Thursday, January 24, 2013

A Pinched Nerve in my neck!

Raise your hand if you've ever had someone kick you in the neck... anyone?  No?  Well my hand is raised.  My nephew slammed his foot into my neck last friday, not in a malicious way but he jumped on me and his foot happened to land on the side of my neck.  It was really a great feeling.  And yes, he's only 3 years old, and yes I should be "more manly" and just tough it out but come on people... it's a foot to your neck!  So it hurt, and I'm basically writing this whole post for sympathy.  And this may or may not be related but that same night... I threw my neck out for the first time in my life!

"My neck went out", "I pinched a nerve in my neck", "I can't turn my head!"  These are common things we hear in the office and for the vast majority of people we're able to fix the issue within a few visits.  But when it happens to me things aren't as easy!  Cause who's gonna fix me?  You? Who do I call?  Where do I go?  Well when it happened to me, I initially did what everyone else does... I hoped it would just go away.

So I woke up at 3am saturday morning lying almost on my stomach with my head turned to the side, which never happens.  I sleep on my side, never on my stomach, and since this was the first time I've ever slept on my stomach I woke up in some pain.  Plus lets not forget my black belt (not even close) giant (40 pound) 30 year old (3 year old) muscle bound (all bone basically) nephew that kicked me in the neck!  So anyway, I woke up feeling like something was pinched or jammed in my neck.  Every time I tried to turn my head I got a sharp pain deep in my neck.  "So this is what everyone complains about" I said to myself, followed by "this kinda sucks." Hey it was 3am, I couldn't think of anything more eloquent to say to myself!

When I woke up a few hours later I knew that something was wrong and I had to do something.  So of course I started to ice it, well that didn't do anything other than numb my neck up, which was kinda nice, but when that wore off I was still in a good deal of pain.  I knew something was really jammed up.  And at this point I got the idea of writing a blog post about what exactly was "jammed" or "pinched" in my neck, because I understand physiologically what it is, but I don't think most people do.  So here we go.

To understand what gets "jammed" or "pinched" in the neck we have to take a look at spinal anatomy, and I'll try to make it really basic for those of you who hate anatomy.  Whenever 2 bones come together they form a joint, just like where your thigh and shin bones come together you get a joint called your knee joint.  Or where your upper arm and lower arm come together is called your elbow joint.  In the neck we have 7 different bones (vertebrae) stacked on top of one another.  Where each bone contacts the bone above it is called a Facet Joint and there's one on the right side and one on the left side.  This is shown in the picture below where we see 2 of the vertebrae of the neck.  This view would be looking at someone from the side.

In a normal spine these facet joints provide movement.  Just like the knee joint enables the bones of the leg to flex and extend, the facet joints of the spine enable the head to look up, down, left and right.  If we didn't have facet joints we wouldn't be able to move our heads, so they're very important.  As you can see below, the bones actually glide on top of one another at the facet joint, as if you were rubbing your hands together.  This is shown below.

Picture #1
Picture #2

Now to someone who's never looked at vertebra or facet joints before these 2 pictures may look identical, but look closer at the facet joints.  In the second picture you'll notice that the bones aren't quite as lined up as they were in the first picture.  Below you can see this in detail where I've added red lines on the joint surfaces of the 2 bones that make up a facet joint.  You'll see that the bottom picture shows that the top red line has actually moved upwards, enabling someones head to make a "yes" motion.
    Picture #3

    Picture #4

This is how our bodies move, it's how we turn our heads, it's how we twist our torso, and how we bend our lower back.  Every movement depends upon facet joints.  This is one of the main reasons why people see chiropractors.  They make sure that the facet joints are gliding properly.  Each bone should glide on top of the other bone below it, but sometimes these joints can stop moving correctly, they can become "jammed" or "pinched" together, and this is what chiropractors refer to as being "out of alignment." Think about you rubbing your hands together in front of you but pushing them really hard together and then trying to keep rubbing.  It's difficult to do and starts to actually hurt your hands, and the same thing happens in your neck.

Many medical professionals don't quite understand human movement and biomechanics so they like to say that the spine can't really go out of alignment.  So is it truly out of alignment?  Well yeah technically it is, we're talking about 2 vertebrae that come together to form a facet joint and those 2 vertebrae becoming stuck so that when a person tries to move their head the facet joint doesn't move correctly.  That means the 2 bones now aren't gliding in the proper range of motion and by definition that would make this part of the spine "out of alignment."

But if your definition of "out of alignment" is a stack of blocks with some blocks sticking out the side then you won't understand this type of alignment.  We're talking about how the spine is moving, not how the spine looks on a static X-ray picture, it's all about functional movement.  Think about when your car is "out of alignment."  Do you see it?  Or do you feel it?  You feel it right?  The only time you actually see the alignment problem is when the tires wear out or something breaks.  Normally you just feel the car start to shake and veer to the side, but if you look at the car from the outside you don't see anything at all.  But functionally your car is moving incorrectly, it's actually out of alignment.  Same thing goes for the spine, you don't normally see the issue, you feel it, and damage is only seen after months or years of the problem persisting.   But if you're looking at an X-ray and expecting to see the picture below then you're gonna think this "out of alignment" statement is nonsense cause you'll never see this.

We're talking about proper spinal movement being altered and thus effecting alignment. But if you look at an Xray of a human spine you'll never see one of the blocks (vertebra) sticking out to the side. The terminology is what gets many people, and many doctors, confused.  But I digress.

Let's get back to the most important part of this post... my neck!  It was still killing me.  So what actually happened to my neck?  Well what happened was that I slept on my stomach which places the head into extension and that compressed my facet joints and they "pinched" or got "jammed" together.  This causes inflammation and pain.  So every time I tried to turn my head or look up and down my facet joints weren't gliding like they should so it felt like something was jammed or pinched together in my neck.  And that's exactly what was happening.

What happened to my neck is what happens to thousands of people every day, and isn't just caused by sleeping wrong.  It can be caused by a trauma, tight muscles, degeneration in the neck, sitting too long and a plethora of other reasons.  Most people who have neck pain or low back pain have problems in their facet joints.  The pain is easily fixed when the facet joints are returned to normal movement.  When they aren't fixed in a timely manor, or if the facets get jammed very close together, the nerve that comes out right next to the facet joints becomes irritated and then you've got a pinched nerve.  This causes pain typically behind the shoulder blade, on the outside of the shoulder, or down the arm but it all stems from the facet joint irritation in the neck.

Now I know what you're saying as you sit on the edge of your seat... "So what did you do for your neck?"  well first off, thanks for caring!  Second, I toughed the day out because my chiropractor was out of town.  Then I woke up on sunday, even more swollen and more angry at my neck.  So I finally made it out to see my chiropractor and he was able to pinpoint which facet joints were stuck and he adjusted those areas.  I could now move a bit better.  Was my pain gone?  Nope!

Why not?  Well my pain didn't go away instantly because that's not how the body works.  For the previous 2 days my body was swelling from my injury, the muscle tissue had become tight and knotted, and my neck was filled with substance P (a chemical that causes pain).  So did seeing my chiropractor cure  me?  Well not right away, all he did was get my facet joints moving again so that my body could start to heal, whereas before I wasn't able to start the healing process cause things were "stuck" together.  But it takes time for the body to heal itself.  So the remainder of the day I iced and by that night I was starting to feel a whole lot better.  By monday, I was back in the office feeling better and treating patients who were dealing with the same problem I had all weekend.  I followed up on monday night with a second adjustment which seemed to cure the residual "pinch" I was still feeling.  But if I hadn't been able to see my chiropractor I would have  been in pain for many days, if not weeks, from a simple "jammed" facet joint in my neck.

Doctors Note:

1. Facet Joints are where 2 vertebrae come together.  They enable us to turn our heads, and bend our bodies.  Without proper Facet Joint motion we get tight, stiff, and eventually jammed in our spines.

2. Facet joints that aren't moving properly is what chiropractors call "out of alignment" and causes swelling, pain, dysfunction and a feeling of "pinched" or "jammed" in the neck/back or muscles near the neck/back.

3.  The sooner you can get the facet joint moving again the quicker you will heal.  The longer you wait the more it will swell up and the longer it will take to heal.  See your chiropractor the day that you feel the pain.

4.  The adjustment won't cure your pain instantly, it will just enable the body to start to heal.  Once the healing process starts the inflammation will decrease as well as the pain.  It may take 1 adjustment, or it may take 5 or even 10 adjustments, it all depends upon how far "pinched" the spine actually becomes.