LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

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Fascia: 8 Things You Always Wanted to Know (But Couldn’t Spell It)

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In addition to doing blog posts into the wee hours of the morning, I have a chiropractic office in Mesa, AZ.  I have always hung my hat on the fact that we’re different.

Different from many of my colleagues who rely on just the adjustment.  Different from the physical therapists who use electric stim and exercises.  Different from the primary care docs who blindly give anti-inflammatories.  Different from the pain management clinics who inject steroids into the spine.

For me, I think the journey started was back in school when I took a weekend seminar based on Trigger Point Therapy from Dr. Ray Nimmo.  Later in practice I took Dr. Peter Levy’s Neuromuscular Re-education course.  Then Graston Technique came along to completely change the breadth of what I could treat.  My soft tissue techniques were further refined by FAKTR-PM training with Dr. Greg Doerr and Dr. Tom Hyde.

Shortly after this training, the 1st International Fascial Conference happened at the Harvard Medical School in October of 2007 that has changed the world as we know it as it relates to the treatment of structural problems.  Research brain trusts and clinicians from across the globe came together to share ideas and further our understanding of the vastly important but little understood tissue, the fascia.

A few years ago I begun the foray into Dr. Luigi Stecoo’s work on Fascial Manipulation.  His books have reminded me of how critical an understanding of the fascia is as well as how incredibly complex this tissue system is.

While the learning is lifetime, I have developed a strong appreciation for how much the soft tissues of the human body play a role in what brings patients into our office.  unfortunately, it’s difficult for me to explain to patients what this tissue known as fascia is.  It is incredibly complex and does not have any good analogies to the world around us that I can use to explain.

Luckily, this particular article does a fantastic job of summing it all up from the viewpoint of Dr. A.T. Still (the founder of osteopathy).  I’ve boiled it down to 5 easy bullet points:

  1. Fascia surrounds and connects every muscle and ALL organs in your body, interconnecting everything.  It includes aponeuroses, joint capsules and the muscular envelopes that surround your muscle fibers.
  2. In regards to movement, the fascia is intricately tied in with every muscle in order to move a joint, which involves the contracting muscle, the opposing muscle as well as the bone.  This means that when we look at a problem with a joint, we can not just look at a problem in a muscle or muscle group (such as the quadriceps), but we have to look at almost the entire region to see why the knee may be hurting.
  3. Injured the lateral collateral ligament of the knee?  What if I told you there is no such thing?  That ligaments and tendons were actually the condensing and continuation of the fascia surrounding an area rather than a distinct structure?
  4. The fascia is heavily imbedded with receptors feeding up to and back down from the brain.  This system is what gives us our incredible agility and allows us to find tune every movement or every joint either singly or during whole body movements.
  5. The cells of the fascia are dynamic, able to change chemically because of stresses placed upon it (the basis for treatment with Graston or Fascial Manipulation) as well as electrically, capable of passing along electrical signals as well.
  6. Different layers of fascia allow muscle fibers, muscles and organs to slide along one another with near-frictionless movement.  Injuries and the use of anti-inflammatories can turn a frictionless surface into stuck layers of gunk (my technical term).
  7. The fascia contains and controls the vast majority of interstitial (not inside of the cell) fluid in your body.  After an injury, fluid flow can increase 100 fold due to the fascia.
  8. The fascia is also heavily embedded with nerve and pain fibers.  Because of this, problems in the fascia can lead to movement problems as well as pain.

While this list may be a little technical, just understand that the fascia is critical to you feeling on top of your game.  If you have a problem that is not responding to the “normal” channels, maybe it’s time to try someting different.  Ask your doctor or therapist about the fascia.  If he or she mentions that they just painted the trim on the house this weekend, maybe you’re not in the right place…

 

Healing Yoga is Bad for Chiropractors

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Most patients are in my office because they’re locked up. Muscles, ligaments, tendons and joints just aren’t moving. Anything that stimulates movement is good.

This is why exercise and chiropractic can be so powerful for so many.  Because we take areas on a patient in pain and help them move better.  It really can be put into that simple of terms.  This is why yoga is so dangerous for a chiropractic practice.  Of course, our office still recommends yoga heavily.  After all, our main goal is to destroy our practice by having patients do everything they need to do outside of the office so that they no longer need us.  Unfortunately not likely to happen, it still remains a primary goal for every patient that enters the office.

As I mentioned, so many patients are experiencing pain because they just don’t move.  We live in a sedentary society both at work and at home.  If we exercise, many opt for a linear aerobic exercise like the elliptical, treadmill or stair-climber.  These lock us into a specific movement and really don’t fully allow our bodies to move.  Weight training is not too much different.  We isolate a muscle and work out that muscle to make it grow bigger.  Again–this does not take our bodies through full ranges of motion.

Activities like the martial arts (my personal choice), hiking (second choice), tennis and racquetball require your body to move in unrestricted patterns.  THIS is what we need to stay healthy and pain free.  So where does yoga fit in?

Perfectly.

This particular study demonstrates just how effective yoga can be at controlling pain.  Here are the details:

  1.  Researchers looked at 6 studies
  2. These included back pain, rheumatoid arthritis, headache/migraine were the most common
  3. All studies reported positive effects in favor of the yoga interventions
  4. With respect to pain, the overall improvement was 26%
  5. For pain-related disability, overall improvement was 21%

Not too shabby overall considering the safety of yoga.  In addition, none of these address the potential stress reduction that can occur with yoga as well, which would have benefits far beyond pain and disability.

So, if you are dealing with chronic pain issues, make sure you combine your visits to your chiropractor with regular yoga sessions to get the best benefits.

What type of yoga do you find the best for your body and mind?

PULLED A MUSCLE? WHY POPPING THAT ALEIVE IS A VERY BAD IDEA

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Obviously, this article is going to sound a little self serving since I am, after all, a chiropractor in Mesa with a vested interest in my patients not taking drugs of any kind unless absolutely necessary. My more inquisitive patients all seem to ask a similar question…if the body is so brilliantly designed, where do chronic musculoskeletal complaints come from?

Certainly there are injuries that are severe and result in tissue damage that is much greater in degree and have a high likelihood of producing chronic pain. Think skiing, skateboarding or snowboarding injury. High speed car crashes. Motorcycle accidents. Equestrian wipeouts. Surgery.

But what about the weekend warrior who pulls a hamstring? The 8 hour per day computer user? Or me, as a lifelong martial artist, who has had untold injuries over the decades to pretty much every potential area of my body? Why do these situations lead to chronic pain?

My personal thought (backed by lots of research and years of clinical practice) is that the development of chronicity has much to do with how we handle the immediate period after the injury or onset of symptoms. What do the vast majority of us do (which is, of course, the direction indicated by billions of dollars of advertising) in this immediate period? Rest the area and pop an over the counter pain medication or anti-inflammatory. This is arguably the worst possible combination possible.

Why?

First, let’s address the immobilization aspect. Literally within minutes of immobilization, the soft tissues surrounding the immobilized joint begin to break down. The longer that joint is kept from a full range of motion, the worse the tissue damage. Anyone who’s ever broken a bone and had it casted can attest to how much joint motion is lost once the cast comes off. Recovery time can be even longer than the immobilization time.

With tissue injury, ultimately, the size of the region affected is larger than the original injury size. Consider the swelling associated with an ankle sprain—the area of the ligament injury may actually be very small, but the entire ankle, foot and lower leg swells up to the size of a balloon and becomes discolored. Now the amount of injured tissue is much larger than the original injury and this tissue has to heal. But healing occurs in a haphazard fashion if the area is not used. I give the analogy of a leak in your bathroom faucet. You call in the plumber. He shows up with a crew that’s been drinking at the bar for half the day. They proceed to rip out half the bathroom to fix the leak and rebuild with a level of skill only a three-sheets-to-the-wind Irishman can achieve.

Our body is no different. As we heal after an injury, the new tissue, whether it is bone, muscle, ligaments, fascia or tendons, is laid down in a disorganized manner. Only as that region goes through movement do these healing tissues become stressed and become organized along the lines of force. Immobilization becomes the enemy of proper healing.

Next, let’s address the routine use of over the counter anti-inflammatories, or prescription, for that matter. All anti-inflammatory medications are, by their very nature, designed to interfere with the inflammatory process. Unfortunately, inflammation is the normal process of healing. Disrupt this and you disrupt the ability of our tissues to heal the way they were designed. Contrast this with the use of ice right after an injury. Ice works simply by reducing blood flow to the newly injured area, thus keeping the damage of the drunken plumbing crew from getting too out of hand. Arguably a good idea. But then blocking the crew from repairing the area in specific ways, like maybe taking all their crescent wrenches away from them, is going to result in improper repair.

Hopefully you can begin to understand why the combination of immobilization and anti-inflammatory medications immediately after an injury may be the first step in developing chronic pain. Repeat this cycle the next time you injure the area and the dysfunction begins to mount.

This particular study demonstrates just how bad the outcome can be when non-steroidal anti-inflammatories (NSAIDs) are used after a rotator cuff surgery tendon repair. Researchers looked at the tendon to bone healing that occurred in the presence of NSAIDs and found that every case was affected, from complete failure of healing to weakened tissue. No normal healing tissue was present when compared to the group in which no NSAIDs were used.

While this relates to surgical cases in animals, the same process is interfered with in every case of tissue injury that happens in our body when NSAIDs are used. While my opinion that you should run to your chiropractor at the first hint of any type of pain may sound self-serving, the reality is that you may be diverting the development of chronic pain.

THE “WAR ON DRUGS” WAS LOOKING AT THE WRONG DRUGS

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In 1971, President Nixon declared a war on drugs.  Unfortunately for our country, that war was limited to illicit drugs.  For the next several decades, drug overdose deaths were largely attributable to these drugs.  However, beginning just after this century, these statistics began to take a scary turn.

In this recent report from the CDC’s report looking at data in Florida from 2003-2009, the numbers of drug overdose deaths increased 61%.   NONE of this increase was from cocaine or heroin.

 The death rate for prescription drugs increased 84.2%, with the greatest increase from oxycodone (264.6%), followed by alprazolam (233.8%) and methadone (79.2%).

By 2009, the number of deaths involving prescription drugs was four times the number involving illicit drugs.  Four times.  Were exactly is the “war on drugs” when it comes to prescription medications?  Glaringly absent.

Notice that these drugs are primarily used for pain control.  While some cases may be for intractable pain from situations like cancer, pancreatitis or kidney stones, I frequently see patients coming into my office on Oxycodone for a condition that would’ve been gone had they seen a chiropractor first.

So long as mainstream medical providers like PCPs, orthopedic surgeons, neurosurgeons and physiatrists are seen as the first point of entry for musculoskeletal complaints, the risk of getting drugs prescribed and aggressive procedures performed will remain high.  In general, for at least one of the larger insurers in the US, chiropractors provide about a 30% cost savings when they are seen first.

Other studies confirm that imaging, surgery and, most importantly for this study, pain medication use are much lower under chiropractic care.

Read more…

SPINAL ARTHRITIS – DO I NEED SURGERY?

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Pretty much every day I address this question from patients.  They come in after having an X-ray or MRI done after a few weeks of untreated back pain and may even have their orthopedic surgeon appointment set up.  The problem remains that there is very little correlation between what we see on imaging and pain levels of a patient.

As a matter of fact, this is probably one of the bigger educational challenges I have in my practice because society has brainwashed into thinking that all the answers lie in the MRI or X-ray and they are infallible.  I can’t tell you how many times I have had patients come in with knee pain due to “arthritis.”  However, after 2 or 3 visits they are greatly improved.  We obviously did nothing to magically get rid of the arthritis, but the arthritis was not the pain generator for this patient.

This particular article reinforces this same concept for back pain, with a specific focus on those over 60 years of age.  The researchers found a very high level of arthritis of the spine (75.8%), but only a small portion (28.8%) had back pain.  And again, referring back to the knee example above, how many of these patients with back pain would still have symptoms after a solid course of chiropractic care coupled with soft tissue treatment?

The bottom line is that arthritis is something we see on X-rays or on MRI, but it is merely the canvas on which your symptoms may be painted.  Only rarely is surgery in these cases a good idea with a good outcome.  Without a doubt, your best first option for any type of pain is a Mesa chiropractor.  And this is NOT my bias, but rather, strongly supported by claims data from insurance companies and clinical studies.

http://ard.bmj.com/content/68/9/1401.abstract

TAKING A SHORT COURSE OF STEROIDS FOR PAIN?

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Medrol dose packs are commonly used to calm down inflammation and pain in musculoskeletal injuries.  This pack starts with a high dose of steroids that tapers down over the next 6 days.  Doesn’t fix the injury or restore the mechanics of an injury, but it sure curbs the inflammation associated with the injury.  So what could be wrong with that?

For starters, any diabetic can tell you that steroids wreak havoc on blood sugar.  They should–one of the jobs of cortisol in the body is to break down muscle to make glucose.  That may be fine when you skip a single breakfast, but with time you lose muscle mass and head towards diabetes.

But what about healthy patients?  A short course of steroids won’t do any harm, right?

Other than the aforementioned fact that it does nothing to actually heal an injury and will actually weaken the tissues leading to increased concern for future injuries, but, in this particular study, a single week of low dose prednisone in healthy males worsened the way insulin worked in the body by 33%.

This is NOT a good thing given that the effectiveness of the way our bodies use insulin is a (if not THE) critical component to a long, disease free life.  As usual, my bent as a chiropractor here in Mesa is that ANY musculoskeletal problem should be treated without medications first.  Anything less may produce greater harm than benefit.