Fast Food Chiropractic?

More often than I would like, new patients present to our office for a different approach to Chiropractic Care.   What I find is a patient has been seeing another practitioner for some time, but then something happens. The allure and magic of care has vanished, and it is replaced by a doctor/patient approach similar to a fast-food encounter.

Many patients initially seek out Chiropractors for pain relief of neck and lower back pain-then routinely discover the benefits of the Chiropractic adjustment. When patients are suffering and want quick relief, they may at first overlook the speed at which care is rendered, especially if its helping.

Naturally as chiropractic visits start to reduce in frequency, something shifts. The pain relief is still occurring, but its replaced with a feeling of dissatisfaction. This process may take months or years in my experience, and not everyone feels this way. There are thousands of busy chiropractic practices that follow this model with loyal patients who come month after month for the same service-others want more from their providers.

Chiropractors are not primary care providers but spend a lot of time with patients (or they should) helping them out of pain at first- then guiding them towards a more natural approach to health.

The statement that I commonly hear from patients is “I just feel like a number now,” or it’s the same service without change each visit. No discussion of their overall health, or other health concerns that they may have--- just “snap, crackle, and pop.”  Every visit the same as the last, no discussion of what is wrong, or how patients can help themselves outside of a Chiropractic office.

As health care providers, we have a responsibility to do more for the people who trust us with their care- not just run an assembly line to make more money churning people in and out.

I have had healthy disagreements with many of my fellow colleagues, who insist they care for their patients-- they are just more efficient and have systems in place to see more people per day.  I can justify this to a point- as I have staff that aides me also; but people know when personal attention has gone away. 

If you are feeling like a number, rest assured there are Chiropractic providers who don’t practice in this fashion, but finding one is getting harder. I always tell my patients that I work for them, and If they ever feel like this to speak up so that I can discuss their feelings and rectify the matter immediately.   

Do I need orthotics?

I have a poster in my office that advertises orthotics, and the above question is one I get often.  A common reason for knee, hip, and back pain is poor arch support from shoes-but does this mean that orthotics are needed?

Orthotics are typically molded inserts made from a cast of someone’s foot, and then inserted into a sneaker or dress shoe for the purpose of supporting the foot arches. These can be fitted by podiatrists, chiropractors, orthopedic doctors, or physical therapists; and they can be obtained outside of a medical office by purchasing them online or other retail settings.

Here are reasons to consider orthotics:

1. Persistent heel/foot pain in the morning, or after sitting for a while then rising to walk.

2. Flat feet (usually present from birth).

3. Feet that develop corns or callouses.

4. Persistent ankle, knee, hip, or lower back pain.

5. Patients with diabetes or who have bunions.

6. People with balance and stability issues.

7. After knee or hip replacement surgery.

8. Individuals involved in high impact sports-especially (runners, soccer/basketball players)

Proper support of the foot is key to potentially avoiding a multitude of conditions, from arthritis to general wear and tear on the cartilage, ligaments, and tendons of the foot, ankle, knee, and hip joints.  Some studies have indicated that proper foot support could reduce lower extremity injuries and may help manage chronic knee conditions.   

Remember the initial point of contact of the body to the ground is the foot, and if the way stress from the ground is loaded into the lower extremities is compromised, this in many cases causes chronic wear and tear injuries to joints and surrounding soft tissues.

One last thought: When it comes to foot inserts, you get what you pay for. Invest time and energy into having your foot, knees, and spine properly evaluated by a medical professional before you purchase orthotics. A good pair of orthotics will run you $300-600 dollars but will last for years to come-its worth the investment in yourself. Listed below are some links to research concerning this topic. 

Are foot orthotics efficacious for treating painful medial compartment knee osteoarthritis? A review of the literature - Marks - 2004 - International Journal of Clinical Practice - Wiley Online Library

The Effect of Foot Orthoses on Patellofemoral Pain Syndrome in: Journal of the American Podiatric Medical Association Volume 93 Issue 4 (2003) (japmaonline.org)

Effectiveness of Foot Biomechanical Orthoses to Relieve Patients Suffering from Plantar Fasciitis: Is the Reduction of Pain Related to Change in Neural Strategy? (hindawi.com)

Can custom-made biomechanic shoe orthoses prevent problems in the back and lower extremities? A randomized, controlled intervention trial of 146 military conscripts - ScienceDirect

Will I need surgery?

This is the question that patients routinely ask me during the initial consultation at my office. The answer to this question is multifactorial and will be different for each patient.  A comprehensive history and thorough exam usually gives clues as to if surgery is needed or not.

I learned early on in Chiropractic school, and this has been the case after practicing for over 25 years, in general you know after taking the history if care will help an individual. I do not start care with a patient unless I am fairly certain that I can help them via conservative care, and I tell them this upfront to avoid wasting time and money.

The list below is not an exhaustive list, but a good starting point in ascertaining if someone needs surgery for a spinal or extremity complaint:

1. The pain has been there for more than 6-12 months and is steadily worsening.

2. Upper or lower extremity weakness

3. Difficulty walking, poor balance, or instability while standing or moving.

4. Urgency with going to the bathroom along with back or neck pain.

5. Condition has been treated by multiple providers and continues to not respond or worsen.

6. Progressive loss of ability to perform daily tasks with pain or weakness.

7. History of Cancer

8. Signs of instability in a knee, shoulder, or hip i.e., clicking, popping, or sharp pain upon movement

9. Pain worsens with in clinic treatment or home care given to the patient.

10. Documented spinal or extremity fracture.

A caveat to the above list is that patients sometimes present to my office with imaging that shows severe degenerative changes to their joints and discs and have chronic pain. More times than not Chiropractic, Physical therapy, or massage therapy can help patients get out of pain and start functioning better in a non-operative way. Just because the images look horrible, doesn’t mean a person’s body isn’t compensating in some way to allow them to be pain free and function just fine.

Most adults over the age of 40 already have arthritis and discal narrowing of some kind, but degenerative changes and arthritis don’t automatically mean surgery, and any good surgeon will tell you that. Surgery is the last thing most quality surgeons want to do.

Proper Ergonomics For Deskwork

In the last 50 years since the advent of the computer, the human body has endured a significant change in the way it functions. Almost all jobs that are not labor intensive require some sort of data entry in the workplace. Unfortunately, this places the head, neck, and upper back in positions that were not intended.  Additionally, in the last 20 years cell phone use has increased astronomically, and it seems that if people are not on their computers, they are hunched over their phones.

When patients come in, besides a comprehensive examination, I discuss with them their habits on the aforementioned devices. This inevitably leads to posture recommendations that go hand in hand with treatment at our office to help patients reach treatment goals.

Here is a listing of the most common tips I give patients concerning ergonomics.

1. Have your computer monitor at eye level, feet on the floor.

2. Make sure that the area between your shoulder blades keeps in touch with the back of the seat at all times. Avoid leaning, or creeping forward to reach the mouse, or otherwise.

3. If possible, use a headset for phone calls.

4. Get up every 30 minutes to reset posture and reduce pressure on the lower back.

5. Avoid sitting on your feet, or leaned over to one side or another.

6. Practice activating your postural muscles for support by intermittently pulling your belly button to your spine while simultaneously pulling your shoulders together for 3-5 seconds multiple times per hour through the day. Its hard to slouch when your belly button is tucked in.

7. When breathing, make sure your shoulders don’t rise when you breathe in-if so you are using the wrong muscles to breathe. Proper breathing in causes your belly button to protrude out, not your shoulders to go up in your ears.

While using your cellphone or tablet, place it on a pillow to raise it up, versus you putting your head down. This is especially important for teenagers, as poor posture starts early using devices that cause chronic spine tension when the head is down all the time.

These tips will improve posture and reduce stress on the neck/upper back and should lead to less chronic pain.